Plant PAXX has an XLF-like function and stimulates DNA end joining by the Ku-DNA ligase IV/XRCC4 complex.

Non-homologous end joining (NHEJ) plays a major role in repairing DNA double-strand breaks and is key to genome stability and editing. The minimal core NHEJ proteins, namely Ku70, Ku80, DNA ligase IV and XRCC4, are conserved, but other factors vary in different eukaryote groups. In plants, the only known NHEJ proteins are the core factors, while the molecular mechanism of plant NHEJ remains unclear. Here, we report a previously unidentified plant ortholog of PAXX, the crystal structure of which showed a similar fold to human 'PAXX'. However, plant PAXX has similar molecular functions to human XLF, by directly interacting with Ku70/80 and XRCC4. This suggests that plant PAXX combines the roles of mammalian PAXX and XLF and that these functions merged into a single protein during evolution. This is consistent with a redundant function of PAXX and XLF in mammals.

VP24 matrix proteins of eight filoviruses downregulate innate immune response by inhibiting the interferon-induced pathway.

Filoviruses encode viral protein 24 (VP24) which effectively inhibit the innate immune responses in infected cells. Here we systematically analysed the effects of nine mammalian filovirus VP24 proteins on interferon (IFN)-induced immune response. We transiently expressed Ebola, Bombali, Bundibugyo, Reston, Sudan and Taï Forest ebolavirus (EBOV, BOMV, BDBV, RESTV, SUDV, TAFV, respectively), Lloviu virus (LLOV), Mengla dianlovirus (MLAV) and Marburgvirus (MARV) VP24 proteins and analysed their ability to inhibit IFN-α-induced activation of myxovirus resistance protein 1 (MxA) and interferon-induced transmembrane protein 3 (IFITM3) promoters. In addition, we analysed the expression of endogenous MxA protein in filovirus VP24-expressing cells. Eight filovirus VP24 proteins, including the VP24s of the recently discovered MLAV, BOMV and LLOV, inhibited IFN-induced MxA and IFITM3 promoter activation. MARV VP24 was the only protein with no inhibitory effect on the activation of either promoter. Endogenous MxA protein expression was impaired in cells transiently expressing VP24s with the exception of MARV VP24. We mutated nuclear localization signal (NLS) of two highly pathogenic filoviruses (EBOV and SUDV) and two putatively non-pathogenic filoviruses (BOMV and RESTV), and showed that the inhibitory effect on IFN-induced expression of MxA was dependent on functional cluster 3 of VP24 nuclear localization signal. Our findings suggest that filovirus VP24 proteins are both genetically and functionally conserved, and that VP24 proteins of most filovirus species are capable of inhibiting IFN-induced antiviral gene expression thereby efficiently downregulating the host innate immune responses.

Synchronous pleomorphic adenoma in parotid gland and parapharyngeal space: a case report and literature review.

Synchronous pleomorphic adenoma in the parotid gland and parapharyngeal space are rare. We report a case of simultaneous pleomorphic adenoma in parotid gland and parapharyngeal space in a 65-year-old male presenting to the ENT outpatient department at Northwest General Hospital, Peshawar. The patient presented with a left parotid lump, intra oral examination of which revealed the left palatine tonsil to have been pushed medially. CT of the neck showed a completely separate lump in the left parapharyngeal space, and FNAC of the parotid lump was suggestive of mucoepidermoid carcinoma. The superficial parotid lump was excised first, and the parapharyngeal growth was accessed intraorally and excised. Histopathology revealed both the growths to be pleomorphic adenomas. It is important to raise awareness of synchronous salivary gland tumours, which are a rare occurrence, to highlight its optimal investigation to ensure complete surgical excision, and appropriate management.

A Combination of N and S Antigens With IgA and IgG Measurement Strengthens the Accuracy of SARS-CoV-2 Serodiagnostics.

BACKGROUND: Primary diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is based on detection of virus RNA in nasopharyngeal swab samples. In addition, analysis of humoral immunity against SARS-CoV-2 has an important role in viral diagnostics and seroprevalence estimates. METHODS: We developed and optimized an enzyme immunoassays (EIA) using SARS-CoV-2 nucleoprotein (N), S1 and receptor binding domain (RBD) of the viral spike protein, and N proteins from SARS, Middle East respiratory syndrome (MERS), and 4 low-pathogenic human CoVs. Neutralizing antibody activity was compared with SARS-CoV-2 IgG, IgA, and IgM EIA results. RESULTS: The sensitivity of EIA for detecting immune response in COVID-19 patients (n = 101) was 77% in the acute phase and 100% in the convalescent phase of SARS-CoV-2 infection when N and RBD were used as antigens in IgG and IgA specific EIAs. SARS-CoV-2 infection significantly increased humoral immune responses against the 229E and NL63 N proteins. S1 and RBD-based EIA results had a strong correlation with microneutralization test results. CONCLUSIONS: The data indicate a combination of SARS-CoV-2 S1 or RBD and N proteins and analysis of IgG and IgA immunoglobulin classes in sera provide an excellent basis for specific and sensitive serological diagnostics of COVID-19.

Ameliorative effect of Spatoglossum asperum and its solvent fractions against acetaminophen-induced liver dysfunction in rats.

Acetaminophen (APAP) is a widely consumed drug for pain management and treatment of pyrexia. However, beyond its recommended dose, it becomes harmful for health and may induce acute liver dysfunction. Current work is designed to ameliorate the APAP induced liver toxicity which was induced in rats by giving intra-peritoneal injection of APAP (800mg/kg) dissolved in 40% polyethylene glycol at day 1 and day 14. APAP dosed/intoxicated rats orally administered either with ethanol extract of Spatoglossum asperum (200mg/kg) and its fractions including n-hexane, chloroform and methanol soluble in a dose of 150mg/kg each daily for 14 days in their respective groups. APAP dosed rats showed remarkable elevation in hepatic biomarkers viz., alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenases, total bilirubin, pro-inflammatory cytokines interleukine-6 and apoptotic protein (caspase-3). In addition, hepatic oxidative stress (lipid per oxidation and indirect nitric oxide) and antioxidant biomarkers (glutathione peroxidase, catalase and reduced glutathione) were also altered. Whereas APAP dosed rats treated with ethanol extract of S. asperum and its fractions showed amelioration in concentration of hepatic enzymes, pro-inflammatory cytokines, apoptotic protein and reduction in hepatic oxidative stress by decreasing the lipid peroxidation, indirect nitric oxide and uplifting the activities of antioxidant enzymes and protein.

The improvement on the skin surface by a new type of dermocosmetic loaded plant extract: A split face skin topographic study.

Various extrinsic and intrinsic origins slant skins and pledge evident vicissitudes of the skin surface. We explored the effects of dermocosmetic loaded medical Cannabis seed extract and evaluate the improvement on the skin surface in Asian and male volunteers in a split face topographic study. Dermocosmetic and base (without extract) fabricated were directed to apply by volunteers (Asian male) on their right and left cheek, respectively, in the split face skin topographic study up to three months. Efficacy of dermocosmetic versus base was assessed by non- invasive diagnostic technique focusing on skin texture parameters (energy, contrast and variance) and surface evaluation of the living skin (SELS), SEr (skin roughness), SEsc (skin scaliness), SEsm (skin smoothness), SEw (skin wrinkles). Unlike base, dermocosmetic showed significant effects on skin texture parameters (energy, variance and contrast) and SELS (SEr, SEsc, SEsm and SEw) parameters in Asian male volunteers when ANOVA applied. The level of significance was 5%. Dermocosmetic ultimately improved on skin surface and advocacies for anti-aging effects on skin appearance.

Vicissitudes in polyphenolic extract-based high internal phase creams (HIPCs)- effect of storage temperature dependent characteristics.

The purpose of this investigation was to evaluate the vicissitudes in polyphenolic extract- based high internal phase creams (HIPCs) and effect of storage temperature dependent characteristics. Rheological parameters, that is, power law and IPC analysis with its physical characteristics were exploredat different storage temperatures (8°, 25°, 40° and 40° with 75% relative humidity- RH) with different time intervals up to 2 months of newly formulated poly-phenolic extract- based high internal phase cream and its comparison with base. Polyphenolic- based HIPCs showed non-Newtonian-pseudo plastic tendencies in vicissitudes with time and storage temperatures. Data analysis with Power Law and IPC paste was found to fit to all the rheograms. Flow index, shear sensitivity factor, consistency Index and 10 RPM of freshly prepared HIPCs with and without encapsulated polyphenolic extract were found to be 0.5,0.53, 386.4 cP, and 432.9 cP, respectively.The viscosities were fallen with rise in shear stress.There was no change in color, electrical conductivity, liquefaction and phase separation after centrifugation in any sample of polyphenolic extract-based HIPCs and its base. Polyphenolic- based extract HIPCs behaved non-Newtonian- pseudo plastic tendencies and showed stability up to 2 months and can be directed absolutely to shield skin against ultraviolet radiation (UV) intervened oxidative mutilation.

Stability Studies and Characterization of Glutathione-Loaded Nanoemulsion.

Glutathione reduced (GSH) is the mother of all the antioxidants and has an antimelanogenic effect. It is extremely vulnerable to oxidation in the solution form which limits its use. The GSH in nano-oil droplets present a potential solution to this problem. The aim of this study was to formulate glutathione-loaded nanoemulsion and assess its stability studies over a 90-day testing period. To formulate GSH-loaded nanoemulsion pseudo-ternary phase diagram, it was built with various concentrations of water, liquid paraffin oil, and surfactant mixture (Tween 80 and Span 80). The oily phase was prepared by dissolving the GSH (450 mg) in liquid paraffin oil through stirring. High-energy homogenization was used to prepare the nanoemulsion. From preformulation stability studies of the 28-day testing period, nanoemulsion (NE-19) with oil and surfactant mixture ratio (1:1) of hydrophilic lipophilic balance (HLB) value 10 was selected. The samples of NE-19 and its respective base (B-19) were kept at four different storage conditions for a period of 90 days and evaluated for physical characteristics, droplet size and distribution analysis, zeta potential analysis, electrical conductivity, mobility, polydispersity, pH, phase separation, and flow analysis at different time intervals. Glutathione in nano-oil droplets with nonionic surfactants produced oil-in-water nanoemulsions that were thermodynamically stable over the 90-day testing period at different storage conditions. NE-19 was formulated having non-Newtonian flow and pseudo-plastic behavior. pH was found in the range of 5-6. Polydispersity was less than 0.3. The droplet size of fresh nanoemulsion was 96.05 nm, whereas the zeta potential was -37.1. Mobility and electrical conductivity were -2.726 µm cm/Vs and 0.0141 mS/cm, respectively. Glutathione-loaded nanoemulsions have excellent stability, promising the solution in nano-oil droplets and are suggested for in-vivo release studies for oxidative skin related diseases.

An approach to enhanced stability: Formulation and characterization of Solanum lycopersicum derived lycopene based topical emulgel.

Focus of the study was to design a novel and cost effective extraction technique for the lycopene from Lycopersicum esculentum L. fruit and to develop and characterize a stable emulgel formulation containing lycopene as an active ingredient as well as to design an analytical method to determine lycopene concentration in emulgel. Emulgel formulation was prepared and evaluated for its stability at different storage conditions, 8 °C, 25 °C, 40 °C, 40 °C + 75% relative humidity (RH) and 50 °C, for 6 months. Results were statistically analyzed using two way ANOVA, Post-Hoc test and paired sample t-test at 5% significance level. Designed extraction technique presented comparable yield, 154.83 mg/Kg of tomato fruit, with all recoveries in the range of 145-156 mg/Kg of tomato. "P-values" calculated for different levels of stability parameters were <0.05, except at 50 °C and time points of 60th day and later. Analytical method designed was having linear range of lycopene 1-10 µg/mL with limit of detection 0.11 µg/mL and limit of quantification 0.34 µg/mL. All inter-day and intra-day recoveries were in the range of 94-105% while in all measurements RSD % was ≤5.36. It can be concluded that the extraction technique was cost effective with comparable results and analytical method was simple, robust, specific and sensitive enough to be used for lycopene concentration determination in emulgel formulation. Furthermore, designed formulation was stable even at high temperature of 40 °C and RH 75%.

Comparison of two interactive tutorial methods: results from a medical college in Karachi.

OBJECTIVE: To compare perception of students on usefulness of interactive tutorials and clinically-oriented problem-solving tutorials. METHODS: The cross-sectional study was carried out from January 2012 to November 2013 at Bahria University Medical and Dental College, Karachi. The perception of medical students on usefulness of interactive tutorials and clinically-oriented problem-solving tutorials was acquired through a questionnaire distributed to medical students having completed the first two years of studies. The responses on various aspects of learning of physiology were acquired on a scale of poor, good or excellent. The learning abilities and acquired skills were compared in terms of not at all, to some extent, and to great extent. Data was analysed using SPSS 15. RESULTS: Of the hundred students initially enrolled, complete response was obtained from 83(83%). Of them, 47(57%) were females. There was significant difference in understanding of structure and function by clinically-oriented problem-solving tutorials (p=0.04). The students preferred clinically-oriented problem-solving tutorials as far as understating of difficult concepts was concerned (p<0.01). Presentation skills were improved by interactive tutorials (p=0.02) whereas clinical reasoning skills acquired by clinically-oriented problem-solving tutorials was found to be significantly better (p<0.05). Both tutorials helped in the learning of content of Physiology. CONCLUSIONS: Clinical reasoning skills were acquired more by clinically-oriented problem-solving tutorials that helped in better understanding of structure and functions.

PHYSICAL AND CHEMICAL STABILITY ANALYSIS OF COSMETIC MULTI- PLE EMULSIONS LOADED WITH ASCORBYL PALMITATE AND SODIUM ASCORBYL PHOSPHATE SALTS.

Stability of hydrophilic and lipophilic vitamin C derivatives for quenching synergistic antioxidant activities and to treat oxidative related diseases is a major issue. This study was aimed to encapsulate hydrophilic and lipophilic vitamin C derivatives (ascorbyl palmitate and sodium ascorbyl phosphate) as functional ingredients in a newly formulated multiple emulsion of the W//W type to attain the synergistic antioxidant effects and the resultant system's long term physical and chemical stability. Several multiple emulsions using the same concentration of emulsifiers but different concentrations of ascorbyl palmitate and sodium ascorbyl phosphate were developed. Three finally selected multiple emulsions (ME1, ME2 and ME3) were evaluated for physical stability in terms of rheology, microscopy, conductivity, pH, and organoleptic characteristics under different storage conditions for 3 months. Chemical stability was determined by HPLC on Sykam GmbH HPLC system (Germany), equipped with a variable UV detector. Results showed that at accelerated storage conditions all the three multiple emulsions had shear thinning behavior of varying shear stress with no influence of location of functional ingredients in a carrier system. Conductivity values increased and pH values remained within the skin pH range for 3 months. Microscopic analysis showed an increase in globule size with the passage of time, especially at higher temperatures while decreased at low temperatures. Centrifugation test did not cause phase separation till the 45th day, but little effects after 2 months. Chemical stability analysis by HPLC at the end of 3 months showed that ascorbyl palmitate and sodium ascorbyl phosphate were almost stable in all multiple emulsions with no influence of their location in a carrier system. Multiple emulsions were found a stable carrier for hydrophilic and lipophilic vitamin C derivatives to enhance their desired effects. Considering that many topical formulations contain simple vitamin C it is suggested that present study may contribute to the development of more stable formulations with a combination of vitamin C derivatives to enhance their cosmetic benefits.

A way forward for teaching and learning of Physiology: Students' perception of the effectiveness of teaching methodologies.

OBJECTIVE: To compare the perception of medical students on the usefulness of the interactive lectures, case-based lectures, and structured interactive sessions (SIS) in teaching and learning of Physiology. METHODS: A cross-sectional study was carried out from January to December 2012 at Bahria University Medical & Dental College, Karachi, which had qualitative and quantitative aspects, assessed by self- reported questionnaire and focused group discussion (FGD). The questionnaire was distributed to 100 medical students after completion of first year of teaching of MBBS Physiology. The data was analyzed using SPSS version 15. Differences were considered significant at p-values <0.05 after application of Friedman test. Responses of FGD were analyzed. RESULTS: All the teaching methodologies helped in understanding of precise learning objectives. The comprehension of structure and functions with understanding of difficult concepts was made best possible by SIS (p=0.04, p<0.01). SIS enabled adult learning, self-directed learning, peer learning and critical reasoning more than the other teaching strategies (p< 0.01). CONCLUSION: SIS involved students who used reasoning skills and power of discussion in a group to comprehend difficult concepts for better understanding of Physiology as compared to interactive and case-based lectures.

The role of Wnt signaling pathway in carcinogenesis and implications for anticancer therapeutics.

The Wnt proteins are a family of 19 secreted glycoproteins that occupy crucial roles in the regulation of processes such as cell survival, proliferation, migration and polarity, cell fate specification, body axis patterning and self-renewal in stem cells. The canonical pathway has been implicated in a variety of cancers. As such, it is only fair to conclude that therapies targeting the Wnt pathway may play an essential role in the future of anticancer therapeutics, both alone or in conjunction with traditional therapies.

Antihepatotoxic effect of golden berry (Physalis peruviana Linn.) in carbon tetrachloride (CCl4) intoxicated rats.

Liver is the main site in the body for intense metabolism and excretion. A number of chemicals and drugs which are used routinely cause liver damage. The present study investigates the antihepatotoxic effect of Physalis peruviana whole ripe fruit, water and ethanol extracts of fruit in normal as well as in carbon tetrachloride (CCl(4)) intoxicated rats. The CCl(4) treated rats showed marked elevation in liver enzymes: alanine transaminse, aspratate transaminase, alkaline phosphatase, lactate dehydrogenase and other biochemical parameters: bilirubin, creatinine and urea, thus indicating liver injury. Whereas animal treated/fed with various preparations of Physalis peruviana showed significant lowering effect (p<0.05) in the elevated levels of serum markers like ALAT, ASAT, ALP, LDH, creatinine, urea and bilirubin indicating the protection against hepatic cell damage. The water extract of Physalis peruviana showed highest activity in both rat models while ripe fruit and ethanol extract showed moderate activity compared to standard drug.

Light-Sheet Microscopy Enables Three-Dimensional Fluorescence Imaging and Live Imaging of Satellite Cells on Skeletal Muscle Fibers.

The ex vivo myofiber culture system has proven to be a useful methodology to explore the biology and behavior of satellite cells within their niche environment. However, a limitation of this system is that myofibers and their associated satellite cells are commonly examined using conventional fluorescence microscopy, which renders a three-dimensional system into two-dimensional imaging, leading to the loss of precious information or misleading interpretation of observations. Here, we report on the use of light-sheet fluorescence microscopy to generate three-dimensional and live imaging of satellite cells on myofibers. Light-sheet microscopy offers high imaging speed and good spatial resolution with minimal photo-bleaching, allowing live imaging and three-dimensional acquisition of skeletal muscle fiber specimen. The potentials of this technology are wide, ranging from the visualization of satellite cell behavior such as cell division and cell migration to imaging the sub-cellular localization of proteins or organelles.

Trends in Traumatic Brain Injuries During the COVID-19 Pandemic: A Single-Center Review of Patient Charts From Pakistan.

Introduction A traumatic brain injury (TBI) is one of the leading causes of injury-related deaths, making it a public health concern of extreme importance. In a developing country such as Pakistan, TBIs are significantly underreported, with the treatment frequently being delayed and inadequate, especially in rural healthcare setups all across the country. This concern is further magnified by insufficient epidemiological data on TBIs available in Pakistan. The coronavirus disease 2019 (COVID-19) pandemic brought consequential changes to the healthcare system with the priority shifting toward COVID-19 patients, resulting in considerable changes to the workflow and management of TBIs. The primary objective of this study is to offer valuable insights into the epidemiology of TBIs in Pakistan and its relationship with the impact of the COVID-19 pandemic.  Methods A retrospective study was conducted at a tertiary care center in a metropolitan city in Pakistan. Patient charts were reviewed from January to August 2020, and data was extracted including demographics, clinical presentation, management, and outcomes for cases of TBI. Results The total number of patients is 2126, male 78% and female 21.4%. The mean age of the patients was 28.85. The state of admissions at the hospital is at 99.7% for EME admissions and 0.282% for OPD admissions. Participants presented with loss of consciousness (70.7%), nosebleeds, (53.2%), vomiting (69.0%), and seizures (11.5%). The majority (51.1%) were related to road traffic accidents, followed by falls (20.7%), and assaults (4%). While 1202 (58.5%) of these were managed conservatively, others underwent surgical treatment in the form of craniotomy (28.0%), Burr holes (3.20%), and fracture elevation and repair (10.5%). A decrease in the number of reported TBI cases was observed with lockdown implementation in Pakistan. Conclusion The transportation sector in Pakistan was severely affected by the COVID-19 pandemic, leading to a decline in road traffic injuries and TBIs. Stringent mobility constraints and changes in societal and cultural norms have contributed to this reduction.

Efficacy of searching in biomedical databases beyond MEDLINE in identifying randomised controlled trials on hyperbaric oxygen treatment.

Introduction: Literature searches are routinely used by researchers for conducting systematic reviews as well as by healthcare providers, and sometimes patients, to quickly guide their clinical decisions. Using more than one database is generally recommended but may not always be necessary for some fields. This study aimed to determine the added value of searching additional databases beyond MEDLINE when conducting a literature search of hyperbaric oxygen treatment (HBOT) randomised controlled trials (RCTs). Methods: This study consisted of two phases: a scoping review of all RCTs in the field of HBOT, followed by a a statistical analysis of sensitivity, precision, 'number needed to read' (NNR) and 'number unique' included by individual biomedical databases. MEDLINE, Embase, Cochrane Central Register of Control Trials (CENTRAL), and Cumulated Index to Nursing and Allied Health Literature (CINAHL) were searched without date or language restrictions up to December 31, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. RCTs were included if they involved human subjects and HBOT was offered either on its own or in combination with other treatments. Results: Out of 5,840 different citations identified, 367 were included for analysis. CENTRAL was the most sensitive (87.2%) and had the most unique references (7.1%). MEDLINE had the highest precision (23.8%) and optimal NNR (four). Among included references, 14.2% were unique to a single database. Conclusions: Systematic reviews of RCTs in HBOT should always utilise multiple databases, which at minimum include MEDLINE, Embase, CENTRAL and CINAHL.

Validating an Ultrasonographical Assessment Tool for Predicting Difficult Laparoscopic Cholecystectomy in a Tertiary Care Hospital.

BACKGROUND: Laparoscopic cholecystectomy (LC) is the preferred treatment option in non-complicated symptomatic cholelithiasis. In some cases, the surgery might be complicated by different factors resulting in difficult LC. Ultrasound remains the first-line modality for diagnosing symptomatic cholelithiasis; however, its role in predicting difficult LC remains unclear. The aim of this study was to validate an ultrasonographic scoring system in predicting difficult LC. METHODS: We prospectively enrolled patients undergoing LC in a tertiary care unit over six months. All adult (≥18 years) patients undergoing LC for symptomatic cholelithiasis were included. Patients were excluded if they refused to consent, and those who underwent cholecystectomy for indications other than cholelithiasis. Patients were stratified into two groups based on intra-operative difficulty (easy LC and difficult LC) and were compared. Our primary outcome was radiologic difficulty among these groups. Univariate analysis and kappa statistics were performed. RESULTS: We identified 68 patients with an overall mean (SD) age of 42.2 (12.3) years, a mean (SD) weight of 74.1 (10.9) kg, and 73.5% were female. Of the study cohort, 52 patients had easy LC and 16 patients experienced difficult LC. Amongst the total, 14.7% suffered from diabetes mellitus, 29.4% had hypertension, 7.4% had a known ischemic heart disease, and 63% had a body mass index (BMI) ≥30 kg/m2 with no statistically significant difference between the two groups. On the Chi-square test, there was no statistical difference between the two groups in terms of ultrasonographic difficulty (p>0.05). However, we found a Kappa value of -0.127 (p=0.275) corresponding to a strong disagreement between the intraoperative and ultrasonographic difficulty. CONCLUSION: Despite its role in diagnosing cholelithiasis, an ultrasonographic assessment did not have a role in predicting difficult LC according to the present study. Further studies are required to develop a scoring system for predicting difficult LC based on clinical, laboratory, and ultrasonographic assessment.

Scale and Safety: Analyzing the Association Between Intraoperative Difficulty and Achieving the Critical View of Safety in Laparoscopic Cholecystectomy.

BACKGROUND:  Laparoscopic cholecystectomy (LC) is the preferred method for gallstone removal, but bile duct injuries remain a concern. Achieving the critical view of safety (CVS) is pivotal in preventing such injuries. The aim of this study was to compare the rates of difficult LC in those with CVS achieved compared to those with CVS not achieved. METHODS: We performed a single-center prospective study on all patients with ultrasound-confirmed symptomatic gallstones. Patients were excluded if they refused to consent or if they underwent LC for indications other than gallstone disease. Patients were stratified into two groups as CVS not achieved and CVS achieved groups and compared for outcomes. Our primary outcome was the rate of intraoperative difficulty on the modified Nassar scale (MNS). Statistical analysis was performed using SPSS version 25.0 (IBM Corp., Armonk, NY). RESULTS: We included 70 patients who underwent LC for gallstones (CVS not achieved = 24 and CVS achieved = 46). The mean (SD) age was 42.2 (12.3) years, and 73.5% were females. The mean (SD) weight in our study cohort was 74.1 (10.9) kg, and there was no difference between the two groups in terms of the baseline demographic characteristics, disease characteristics, and comorbid conditions (p > 0.05). On univariate analyses, achieving CVS was associated with lower rates of higher-grade operative difficulty on the MNS and lower rates of length of stay of more than one day. CONCLUSION: Achieving CVS is associated with easy LC based on significantly lower Nassar scores. These findings highlight the role of the MNS in the successful identification of the operative difficulty of LC and its correlation with achieving CVS.

Questionnaire-Based Study of 392 Women in Abbottabad, Pakistan, to Evaluate the Types of Cosmetic Products Purchased Between December 2018 and March 2019 and Their Associated Adverse Events.

BACKGROUND Cosmetics are applied topically to enhance appearance and are commonly used by women of all ages. Cosmetics contain many chemical agents, but the incidence of adverse reactions is low, possibly due to underreporting. This questionnaire-based study included 392 women to evaluate information on the types of cosmetics purchased between December 2018 and March 2019, their use by the women surveyed, and their associated adverse events. MATERIAL AND METHODS A cross-sectional study was conducted among 392 women in Abbottabad, Pakistan, using a pre-structured and validated questionnaire to evaluate information on the types of cosmetics, their use, and their associated adverse events. Part 1 of the study collected information about demographics. Part 2 contained a total of 11 items, and collected the frequency of use of cosmetic on skin and hair care products. Part 3 consisted of 4 items and collected information about problems encountered due to the use of cosmetics. RESULTS In the winter season, 47.7% (n=187) of women preferred chemical-based cosmetic products, while 30.9% (n=121) preferred Ayurvedic products. Among commonly used cosmetic products, 26.9% (n=106) of women used foundations. The most frequently used skin care product was face wash 39.5% (n=155). The most prevalent adverse events related to cosmetics were pimples (19.9%, n=78), redness (17.6%, n=69), and eye discomfort (15.8%, n=62). Furthermore, 51.3% (n=201) strongly agreed that cosmetics aid in getting a whiter complexion. CONCLUSIONS The survey concluded that most women preferred cosmetics with a chemical base, which are associated with rashes, redness, and acne. It is important to encourage cosmetovigilance and awareness campaigns among cosmetic product sellers and users.