The advent of RNA-based therapeutics for metabolic syndrome and associated conditions: a comprehensive review of the literature.

Metabolic syndrome (MetS) is a prevalent and intricate health condition affecting a significant global population, characterized by a cluster of metabolic and hormonal disorders disrupting lipid and glucose metabolism pathways. Clinical manifestations encompass obesity, dyslipidemia, insulin resistance, and hypertension, contributing to heightened risks of diabetes and cardiovascular diseases. Existing medications often fall short in addressing the syndrome's multifaceted nature, leading to suboptimal treatment outcomes and potential long-term health risks. This scenario underscores the pressing need for innovative therapeutic approaches in MetS management. RNA-based treatments, employing small interfering RNAs (siRNAs), microRNAs (miRNAs), and antisense oligonucleotides (ASOs), emerge as promising strategies to target underlying biological abnormalities. However, a summary of research available on the role of RNA-based therapeutics in MetS and related co-morbidities is limited. Murine models and human studies have been separately interrogated to determine whether there have been recent advancements in RNA-based therapeutics to offer a comprehensive understanding of treatment available for MetS. In a narrative fashion, we searched for relevant articles pertaining to MetS co-morbidities such as cardiovascular disease, fatty liver disease, dementia, colorectal cancer, and endocrine abnormalities. We emphasize the urgency of exploring novel therapeutic avenues to address the intricate pathophysiology of MetS and underscore the potential of RNA-based treatments, coupled with advanced delivery systems, as a transformative approach for achieving more comprehensive and efficacious outcomes in MetS patients.

Enhancing Radiation Safety Culture: Investigating the Mediating Role of Awareness Among Orthopedic Doctors and Operation Theatre Assistants.

INTRODUCTION: The increasing use of minimally invasive orthopedic procedures has led to a greater reliance on fluoroscopy, resulting in elevated radiation exposure for surgeons. This study aimed to evaluate the knowledge, awareness, and daily practices of orthopedic surgeons regarding radiation safety in an academic hospital. Understanding radiation safety is crucial to minimize patient exposure and prevent adverse effects on surgeons. METHODS: This cross-sectional study was conducted at the Department of Orthopedics of different tertiary care hospitals in Rawalpindi, Pakistan. Data were collected prospectively for two years, and a total of 505 participants, including residents, consultants, and operation theatre assistants, completed a questionnaire. The questionnaire was validated by experts and covered information on fluoroscopy usage, frequency of surgeries, awareness of radiation safety, and protective measures. Ethical approval was obtained, and data were analyzed using SPSS version 26.0. RESULTS: The majority of participants were male (74.1%), and the sample included various ranks of orthopedic surgeons. Only 56.2% of participants were aware of the usage of fluoroscopy, and 40.2% had read some research on the topic. While 44.6% used lead aprons for radiation protection, the usage of other protective measures and dosimeters was limited. The mediation analysis showed an insignificant indirect association between the rank of orthopedic surgeons, number of surgeries performed, and fluoroscopy usage as a mediator. Awareness and reading research on fluoroscopy were significantly associated with radiation protection. CONCLUSION: The knowledge, awareness, and daily practices of orthopedic surgeons regarding radiation safety in fluoroscopy use need improvement. The findings emphasize the importance of implementing training programs, providing radiation protection devices, and ensuring compliance with safety guidelines.

The relationship between knowledge, attitude, and practice of plasma donation with age and gender as moderators: a cross-sectional survey.

Convalescent plasma therapy has gained worldwide notoriety since its inception as a form of soul treatment for terminally ill patients. This study investigates the link between knowledge, attitude, and practice of plasma donation while simultaneously probing the moderative role of age and gender in this context. Method: A cross-sectional study was undertaken in Rawalpindi, Pakistan, on COVID-19-recovered patients (coronavirus disease 2019). In all, 383 persons were chosen using simple random sampling. A prestructured questionnaire was first validated and then used as a tool for data collection. jMetrik version 4.1.1 and SPSS version 26 were used to enter and analyze the data. Reliability analysis, hierarchal regression, and logistic regression analysis were applied. Results: A total of 85.1% and 58.2% of 383 individuals had a favorable attitude and sufficient knowledge toward plasma donation, respectively. Plasma donation was observed in 109 (28.5%) of the individuals. Plasma donation practice was shown to be strongly related to plasma donation attitude [adjusted odds ratio (AOR)=4.48; P<0.05] and knowledge (AOR=3.78; P<0.001). Females who had more plasma donation knowledge and attitude tend to donate more compared to males. However, no interactional effect of gender×knowledge and attitude, and age×knowledge and attitude was found with plasma donation practice. Conclusion: Plasma donation was uncommon, even though the majority of individuals had a good mindset and were well-informed. Fear of getting a health problem was linked to the decreased practice.

The Effect of Dexamethasone on Postoperative Pain Management in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial.

Objective The objective of this study was to evaluate the effectiveness of dexamethasone in treating postoperative pain in patients undergoing total knee arthroplasty (TKA). Methodology This randomized controlled trial (RCT) was completed over the course of two years (September 7, 2015, to September 6, 2017). In the course of their treatment for osteoarthritis of the knee, all of the patients who had primary unilateral total knee replacement (TKR) participated in the research. Under spinal anesthesia, each patient had medial para-patellar approach medial orthopedic surgery. Patients were assigned to group A or group B based on a random selection. Each of the groups consisted of 79 individuals. Group A was given dexamethasone through intravenous administration at a dose of 0.1 mg/kg before the operation. During the subsequent period of 24 hours, no more treatment was administered (control group). On a predesigned questionnaire, postoperative pain was measured using the visual analog scale (VAS) for pain. Functional results, duration of hospital stay, and complications were all recorded on the questionnaire (VAS). Analysis of data was carried out using the Statistical Package for the Social Sciences (SPSS) version 23 (IBM SPSS Statistics, Armonk, NY, USA). Results There were 158 patients in total in the study, out of which 98 were females and 60 were males in the group. The patients' average body mass index (BMI) was 26.94 ± 3.14 kg/m2. Patients in group A had lower postoperative analgesic and antiemetic needs and higher VAS scores and spent less time in the hospital than patients in group B. There were no postoperative problems in either group. Conclusion In patients undergoing TKA, the use of dexamethasone during and after surgery decreases pain, the need for analgesics, and the duration of hospital stay.

Total Body Irradiation Versus Chemotherapy Conditioning in Pediatric Acute Lymphoblastic Leukemia Patients Undergoing Hematopoietic Stem Cell Transplant: A Systematic Review and Meta-Analysis.

Allogeneic hematopoietic stem cell transplant (HSCT) is indicated in pediatric patients with acute lymphoblastic leukemia (ALL) who have relapsed or are at a very high risk of relapse during first complete remission. Two types of myeloablative conditioning are employed before allogeneic HSCT: total body irradiation (TBI)-based regimens and chemotherapy (CHT) alone. This study compares the efficacy and safety of TBI-based regimens and CHT-based conditioning in pediatric, adolescent, and young adult patients with ALL (0-24 years old). TBI-based and CHT-conditioning regimens were evaluated in 4262 and 1367 patients, respectively, from 15 studies. Compared to CHT alone, TBI-based regimens were associated with better overall survival (OS), relative risk (RR) 1.21, better event-free survival (RR 1.34), and a reduced risk of relapse (RR 0.69). Both approaches had comparable risk of acute graft-versus-host disease (GVHD), grades 3 to 4 acute GVHD, chronic GVHD, and nonrelapse mortality (NRM). In the subgroup analysis for patients in first complete remission, TBI-based regimens and CHT alone had comparable OS and NRM. Our results demonstrate the superiority of TBI-based regimens compared to CHT alone in pediatric patients with ALL.

Placenta percreta invading left broad ligament in a woman with twin pregnancy: A case report.

Introduction: and importance: Placenta percreta is an abnormal of placentation disorder that causes firm and deep attachment of placenta into myometrium due to absent decidua basalis and leads to significant morbidity and mortality due to severe hemorrhage. Presentation of case: A 28-year, old women gravida 2 para 1 + 0 with previous one Lower segment caesarean section (LSCS), presented to emergency department of HFH with complaint of per vaginal bleeding. It was a twin pregnancy and was a rare case of complex placenta percreta with invasion into left broad ligament and urinary bladder in a woman having twin pregnancy. Placental invasion into bladder was diagnosed pre-operatively on USG scan, however; the broad ligament involvement was diagnosed intraoperatively. Patient underwent hysterectomy and internal iliac artery ligation to control hemorrhage soon after delivery of twins with T2 being IUD and patient shifted to ventilatory support but unfortunately due to massive hemorrhage and hemodynamic instability patient did not survive. Discussion: Placenta percreta is a subtype of placenta accreta spectrum disorder that is associated with significant morbidity and mortality depending upon nature and extent of placental invasion. Preoperative diagnosis and management can be of significant value in preventing obstetrics related morbidity. A multidisciplinary approach is required in management of such cases and due to involvement of surrounding structures including urinary bladder. Conclusion: Placenta percreta is a rare disorder of placentation that poses significant life-threatening risk of bleeding and maternal mortality and multidisciplinary approach can be of benefit in such cases.

Student's perception of E-learning during COVID-19 pandemic and its positive and negative learning outcomes among medical students: A country-wise study conducted in Pakistan and Iran.

Background: Since the emergence of coronavirus diseases 2019 (COVID-19) not only have social and the economical dimension of life been disturbed but it has also shattered educational activities as well. Due to fear of disease spread educational institutes are forced to implement online educational systems to teach their pupils. This study aims to explore the student's perceptions related to E-learning and their positive and negative outcome among medical students in Pakistan and Iran. Method: ology: This cross-sectional questionnaire-based study was conducted at Rawalpindi Medical University, Rawalpindi, Pakistan, and Islamic Azad University of Medical Sciences Tehran, Iran. This study involved 402 medical students of Rawalpindi Medical University, Rawalpindi, Pakistan (n = 202), and Islamic Azad University of Medical Sciences Tehran, Iran (n = 200) who were actively involved in the online mode of education. A self-administered validated questionnaire was used for data collection. Descriptive statistics and chi-square analysis was used and analysis was done through SPSS V.23. A P-value of 0.05 was taken as significant. Results: A total of 402 students were enrolled, 202 from Pakistan and 200 from Iran. About 68.2% of the students were acquainted with moderate levels of IT skills. About 75.8% of the students were not showing any previous experience with E-learning. The most common advantage of E-learning was the ability to stay at home. The technical problem was the most common disadvantage in our study. Finally, face-to-face learning in terms of increasing knowledge, skill, and social competence was considered the best mode of learning both by Pakistani and Irani students. Country-wise effectiveness of face-to-face learning in terms of increasing knowledge is statistically significant (p-value = 0.019). Acceptance of E-learning is statistically associated with the country of learning (p-value = 0.020). E-learning was rated as enjoyable by 51.5% of the students. Conclusion: E-learning has its associated advantages and disadvantages as perceived by medical students but still face-to-face learning is considered the most effective form of learning as responded by medical students.

Poliomyelitis in Pakistan: Challenges to polio eradication and future prospects.

Poliomyelitis is a viral disease that causes acute paralysis, muscle weakness and autonomic dysfunction. It primarily affects children under the age of five. It is mainly transmitted via the feco-oral route, through contaminated water. As of the year 2022, Pakistan remains one of the two countries where polio is still endemic, the other being Afghanistan. Numerous myths and misconceptions regarding the polio vaccine, lack of awareness and proper governance, terrorism and difficult access to remote areas due to poor infrastructure are just some of the reasons why polio remains endemic in Pakistan to this day. Therefore, the government should take measures to ensure the safety and wellbeing of health care workers, as well as spread awareness regarding the importance of polio vaccines, while addressing the myths and misconception regarding said vaccines.

Monkeypox: Potentially another pandemic or a mere hoax?

Monkeypox is a vesicular, pustular illness caused by an orthopox virus. It has remained endemic to the Central and West African regions for the past four decades, with only a few outbreaks outside these regions. It is mainly transmitted by direct skin to skin with an infected individual who has developed pustules. Recently there have been major outbreaks in about fourteen countries of the world, and over nine hundred people have been infected. This short summary gives a review about the epidemiology, history, virulence, symptoms and prevention of Monkeypox, while addressing a major question that the general public has right now: "Will Monkeypox turn into the next global pandemic?".

Efficacy and safety of regimens used for the treatment of multicentric Castleman disease: A systematic review.

OBJECTIVES: Treatment options for multicentric Castleman disease (MCD) remain limited. The only FDA-approved drug is siltuximab for idiopathic MCD (iMCD), but the response rate with siltuximab is less than 50%. We performed a systematic review to examine the efficacy and safety of various regimens used for the treatment of MCD. METHODS: A database search on PubMed, Embase, Cochrane, Web of Science, and Clinicaltrials.gov using the terms "Castleman disease," "treatment outcome," and "patient safety" was done. RESULTS AND CONCLUSIONS: Results from a randomized controlled trial and an extension study highlighted the efficacy and long-term safety of siltuximab for iMCD; other trials showed tocilizumab to be a suitable alternative. A recent trial reported high response rates with thalidomide in iMCD patients. Promising results were reported for bortezomib in relapsed/ refractory MCD. For human herpesvirus-8 (HHV8)-associated MCD, rituximab along with doxorubicin therapy followed by maintenance with zidovudine and valganciclovir is the most effective therapy. A single-arm trial has highlighted the potential role of tocilizumab in HHV8-MCD. Data for these regimens are limited and mostly comprise nonrandomized trials. Further research on emerging agents could have a major impact on the treatment of this rare disease.

Impact of COVID-19 on palliative care of cancer patients: Perspectives from Pakistan.

The COVID-19 pandemic has adversely affected the survival rate and palliative care of cancer patients all over the globe. In Pakistan, there are only a few institutions and organizations which provide specialized facilities for palliative care. During the pandemic, these specialized facilities were further limited. As only less than one percent of people had access to palliative care across Pakistan in the pandemic, the situation can be improved by establishing more such departments, providing telemedicine, increasing social media campaigns, and highlighting the importance of palliative care among cancer patients.

Psychosocial Impact of Electrical Burn in Children: A Follow-Up Study Conducted at a Tertiary Care Hospital.

Introduction Electrical burn injuries are very common in the pediatric population and are usually accidental and sometimes occupational. The objective of our study was to evaluate the epidemiology of electrical burn injuries and prospectively evaluate the long-term psychosocial impact of electrical burn injuries in children. Materials and methods A qualitative interview study was conducted prospectively among sixty patients presented to Holy Family Hospital, Rawalpindi, Pakistan. Demographic details, mode of presentation, detail of injury, total body surface area, initial condition, and surgical interventions were noted during their stay at the hospital. Their physical and psychological outcomes were evaluated by administering the Strength and Difficulties Questionnaire (SDQ) and Body Dysmorphic Disorder Questionnaire (BDDQ) via telephonic interviews after six weeks of discharge from the hospital. The study was conducted over a span of 1 year from January 2021 to January 2022. Results There were 60 patients who presented to the department of pediatric surgery during the span of the study. The mean age was 9.9 years ± 3.133 years (SD) and 80% of the patients were above 8 years of age with a male-to-female percentage of 86.67% to 13.33%, respectively. Forty-two (70%) patients incurred high-voltage electrical burns while 18 (30%) suffered low-voltage electrical burns. Mortality was 13.33% (n=8). Out of 52 patients who survived, 35 (67.30%) were labeled as having Body Dysmorphic Disorder upon administration of BDDQ through a six-week follow-up. The majority of the patients had abnormal or borderline results in different scales of SDQ. Conclusion The long-term psychological stress and the varied spectrum of psychiatric disorders in electrical burn patients are profound. The prevention of burn injuries can be effectively achieved by educating parents about safety measures and improving health infrastructure. Implementation of a dedicated national program for psychological support of burn patients should be made accessible to all patients.