Poly(ADP-ribose) mediates bioenergetic defects and redox imbalance in neurons following oxygen and glucose deprivation.

PARP-1 over-activation results in cell death via excessive PAR generation in different cell types, including neurons following brain ischemia. Glycolysis, mitochondrial function, and redox balance are key cellular processes altered in brain ischemia. Studies show that PAR generated after PARP-1 over-activation can bind hexokinase-1 (HK-1) and result in glycolytic defects and subsequent mitochondrial dysfunction. HK-1 is the neuronal hexokinase and catalyzes the first reaction of glycolysis, converting glucose to glucose-6-phosphate (G6P), a common substrate for glycolysis, and the pentose phosphate pathway (PPP). PPP is critical in maintaining NADPH and GSH levels via G6P dehydrogenase activity. Therefore, defects in HK-1 will not only decrease cellular bioenergetics but will also cause redox imbalance due to the depletion of GSH. In brain ischemia, whether PAR-mediated inhibition of HK-1 results in bioenergetics defects and redox imbalance is not known. We used oxygen-glucose deprivation (OGD) in mouse cortical neurons to mimic brain ischemia in neuronal cultures and observed that PARP-1 activation via PAR formation alters glycolysis, mitochondrial function, and redox homeostasis in neurons. We used pharmacological inhibition of PARP-1 and adenoviral-mediated overexpression of wild-type HK-1 (wtHK-1) and PAR-binding mutant HK-1 (pbmHK-1). Our data show that PAR inhibition or overexpression of HK-1 significantly improves glycolysis, mitochondrial function, redox homeostasis, and cell survival in mouse cortical neurons exposed to OGD. These results suggest that PAR binding and inhibition of HK-1 during OGD drive bioenergetic defects in neurons due to inhibition of glycolysis and impairment of mitochondrial function.

Comparative genomics and evolutionary analysis of dengue virus strains circulating in Pakistan.

Dengue fever virus (DENV) poses a significant public health risk in tropical and subtropical regions across the world. Although the dengue fever virus (DENV) exhibits significant genetic diversity and has the potential to evolve, there is a lack of comprehensive research on the comparative genomics and evolutionary dynamics of the virus in Pakistan. Phylogenetic analysis demonstrated the circulation of all four dengue virus serotypes (DENV-1, - 2, - 3, and - 4) with prevalent genotypes III and V within DENV-1, cosmopolitan genotype within DENV-2, genotype III within DENV-3, and genotype I within DENV-4 during 2006-2014. Based on the complete envelope region, genome-wide residue signature and genetic diversity indicate that there is a high level of genetic diversity among DENV-1 strains, while DENV-3 strains exhibit the least genetic diversity. Comparative analysis of all four DENV serotypes revealed that certain codons in DENV-2 and -4 were subject to strong purifying selection, while a few codon sites in the envelope region showed evidence of positive selection. These findings provided valuable insights into the comparative genomics and evolutionary pattern of DENV strains reported from Pakistan. Whether those characteristics conferred a fitness advantage to DENV-1 genotypes within a specific geography and time interval warrants further investigations. The findings of the current study will contribute to tracking disease dynamics, understanding virus transmission and evolution, and formulating effective disease control strategies.

To evaluate the complication and patency rate of superficial femoral vein transposition in tertiary care center.

INTRODUCTION: When all access options in the upper extremity have been exhausted, an autologous access can be created in lower extremity. The purpose of this study is to report our experience with superficial femoral vein transposition (SFVT) results in terms of postoperative complication and patency rate. MATERIALS AND METHODS: In the time period from January 1, 2019 to April 30, 2021, thirty-five cases of SFVT performed at our large tertiary care center Sindh Institute of Urology and Transplantation (SIUT). All patients had exhausted upper arm veins or had central vein obstructions. Medical records of all patients were traced, patients were interviewed using a standard proforma and evaluated the current AVF function in the OPD clinic or by telephone calls. Data including demographics and postoperative complications were collected. RESULTS: Thirty-nine cases of SFVT performed at our institute. Three were immediately lost to follow up so they were excluded from the study. Mean patient age was 30 ± 13.4 years. Most of our patients were females (57%) and 15 males (43%) with an average age of 29.05 years. The most common underlying renal diseasewas unknown in 16 (45%).Thirty-five patients included in the analysis; out of which primary failure observed in 4 patients, three patients were expired before fistula maturation and 3 were expired before 6 months. The remaining 25 fistulas patency rates were estimated. No any patient died due to fistulas related complication; patients died due to their primary disease. CONCLUSION: Our study shows that with appropriate patient selection, SFVT have low infection rates and patency that is comparable with other access types.

Effect of different concentrations of resveratrol on nuclear maturation and in-vitro development competence of oocytes of Nili Ravi buffalo.

Buffaloes are considered animals of the future with the ability to survive under unfavorable conditions. However, the lack of access to superior germplasm poses a significant challenge to increasing buffalo production. Resveratrol has been shown to improve oocyte quality and developmental competence in various animals during in vitro embryo development. However, limited information is available on the use of resveratrol to improve the in vitro maturation and development competence of Nili Ravi buffalo oocytes. Therefore, the current study aimed to investigate the influence of different concentrations of resveratrol on the maturation, fertilization, and development of buffalo oocytes under in vitro conditions. Oocytes were collected from ovaries and subjected to in vitro maturation (IVM) using varying concentrations of resveratrol (0 µM, 0.5 µM, 1 µM, 1.5 µM, and 2 µM), and the maturation process was assessed using a fluorescent staining technique. Results indicated no significant differences in oocyte maturation, morula rate, and blastocyst rate among the various resveratrol concentrations. However, the cleavage rate notably increased with 1 µM and 1.5 µM concentrations of resveratrol (p < 0.05). In conclusion, the study suggests that adding 1 µM of resveratrol into the maturation media may enhance the cleavage and blastocyst hatching of oocytes of Nili Ravi buffaloes. These findings hold promise for advancing buffalo genetics, reproductive performance, and overall productivity, offering potential benefits to the dairy industry, especially in Asian countries.

Risk of multiple lower and upper urinary tract problems among male older adults with type-2 diabetes: a population-based study.

AIM: This study explores the risk of diabetes-associated lower and upper urinary tract diseases among male older adults aged 45 and above in India. METHODS: Longitudinal Ageing Study in India (LASI), 2017-2018 data was used in this study. The prevalence of various urinary tract problems and diabetes among male older adults was estimated by background characteristics using bivariate cross-tabulation. In addition, multivariate logistic regression was applied to examine the likelihood of urological disorders associated with diabetes. RESULT: The prevalence of incontinence was highest among male older adults with diabetes, followed by kidney stones, benign prostatic hyperplasia, and chronic renal failure. Multivariate logistic regression estimation showed that men diagnosed with diabetes were 80% more likely to experience chronic renal failure, 78% more likely to suffer from incontinence, and 37% more likely to suffer from kidney stones than those without diabetes when controlling for various socio-demographic, behavioral, and co-morbidity status of the older adults. CONCLUSIONS: The study findings suggest that diabetes is associated with multiple urinary complications among male older adults in India and needs more careful investigation of the phenomenon. Independent risk factors such as changes in lifestyle with regular monitoring and diagnosis may help to prevent the progression of diabetes and reduce the risk of diabetes-associated lower and upper urinary tract diseases among male older adults.

Eco-friendly alkali lignin-assisted water-based graphene oxide ink and its application as a resistive temperature sensor.

Inkjet-printable ink formulated with graphene oxide (GO) offers several advantages, including aqueous dispersion, low cost, and environmentally friendly production. However, water-based GO ink encounters challenges such as high surface tension, low wetting properties, and reduced ink stability over prolonged storage time. Alkali lignin, a natural surfactant, is promising in improving GO ink's stability, wettability, and printing characteristics. The concentration of surfactant additives is a key factor in fine-tuning GO ink's stability and printing properties. The current study aims to explore the detailed effects of alkali lignin concentration and optimize the overall properties of graphene oxide (GO) ink for drop-on-demand thermal inkjet printing. A meander-shaped temperature sensor electrode was printed using the optimized GO ink to demonstrate its practical applicability for commercial purposes. The sensing properties are evaluated using a simple experimental setup across a range of temperatures. The findings demonstrate a significant increase in zeta potential by 25% and maximum absorption by 84.3%, indicating enhanced stability during prolonged storage with an optimized alkali lignin concentration compared to the pure GO dispersions. The temperature sensor exhibits a remarkable thermal coefficient of resistance of 1.21 within the temperature range of 25 °C-52 °C, indicative of excellent sensitivity, response, and recovery time. These results highlight the potential of alkali lignin as a natural surfactant for improving the performance and applicability of inkjet-printable GO inks in various technological applications.

Association of a high-fat diet with I-FABP as a biomarker of intestinal barrier dysfunction driven by metabolic changes in Wistar rats.

BACKGROUND: The epithelial lining of the gut expresses intestinal fatty-acid binding proteins (I-FABPs), which increase in circulation and in plasma concentration during intestinal damage. From the perspective of obesity, the consumption of a diet rich in fat causes a disruption in the integrity of the gut barrier and an increase in its permeability. HYPOTHESIS: There is an association between the expression of I-FABP in the gut and various metabolic changes induced by a high-fat (HF) diet. METHODS: Wistar albino rats (n = 90) were divided into three groups (n = 30 per group), viz. One control and two HF diet groups (15 and 30%, respectively) were maintained for 6 weeks. Blood samples were thus collected to evaluate the lipid profile, blood glucose level and other biochemical tests. Tissue sampling was conducted to perform fat staining and immunohistochemistry. RESULTS: HF diet-fed rats developed adiposity, insulin resistance, leptin resistance, dyslipidemia, and increased expression of I-FABP in the small intestine compared to the control group. Increased I-FABP expression in the ileal region of the intestine is correlated significantly with higher fat contents in the diet, indicating that higher I-FABP expression occurs due to increased demand of enterocytes to transport lipids, leading to metabolic alterations. CONCLUSION: In summary, there is an association between the expression of I-FABP and HF diet-induced metabolic alterations, indicating that I-FABP can be used as a biomarker for intestinal barrier dysfunction.

Chromate Removal by Enterobacter cloacae Strain UT25 from Tannery Effluent and Its Potential Role in Cr (VI) Remediation.

An indigenous chromate-resistant bacterial strain isolated from tannery effluent was identified based on morphological, biochemical, and 16S rRNA gene sequencing, as Enterobacter cloacae UT25. It was found to resist heavy metal ions such as Cr (VI), Pb (II), Cu (II), Co (II), Ni (II), Hg (II), and Zn (II) and antibiotics. The strain was able to remove 89 and 86% chromate, after 24 h of incubation in a Luria-Bertani (LB) medium at an initial Cr (VI) concentration of 1000 and 1500 µg/ml, respectively. Minimum inhibitory concentration (MIC) was observed for chromate to be 80,000 and 1850 µg/ml, after 48 h of incubation in LB and acetate minimal media (AMM), respectively. Scanning Electron Microscopy (SEM) and Transmission Electron Microscopy (TEM) analysis showed discrete cells with intact and smooth cell walls and homogenous cytoplasm in the absence of metal stress, whereas chromate stress caused cell lysis and reduction in size, which was a characteristic response to Cr (VI) toxicity. Energy Dispersive X-Ray Spectroscopy (EDX) confirmed the adsorption of oxyanions to the cell wall which was one of the Cr (VI) removal mechanisms by the bacterium. Atomic Force Microscopy (AFM) micrographs of chromate-untreated and treated cells revealed Root Mean Square roughness (Rq) values of 16.25 and 11.26 nm, respectively, indicating less roughness in the presence of stress. The partial gene sequence of class 1 integrons (intI1) of strain UT25 showed 94% homology with intI1 gene of strain Enterobacter hormaechei strain ECC59 plasmid pECC59-1. The present analysis highlighted the potential of E. cloacae UT25 as a promissory bacterium that could be applied in removing chromate from polluted environments.

COVID-19 spread control policies based early dynamics forecasting using deep learning algorithm.

Many severe epidemics and pandemics have hit human civilizations throughout history. The recent Sever Actuate Respiratory disease SARS-CoV-2 known as COVID-19 became a global disease and is still growing around the globe. It has severely affected the world's economy and ways of life. It necessitates predicting the spread in advance and considering various control policies to avoid the country's complete closure. In this paper, we propose deep learning-based stacked Bi-directional long short-term memory (Stacked Bi-LSTM) network that forecasts COVID-19 more accurately for the country of South Korea. The paper's main objectives are to present a lightweight, accurate, and optimized model to predict the spread considering restriction policies such as school closure, workspace closing, and the canceling of public events. Based on the fourteen parameters (including control policies), we predict and forecast the future value of the number of positive, dead, recovered, and quarantined cases. In this paper, we use the dataset of South Korea comprised of several control policies implemented for minimizing the spread of COVID-19. We compare the performance of the stacked Bi-LSTM with the traditional time-series models and LSTM model using the performance metrics mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean square error (RMSE). Moreover, we study the impact of control policies on forecasting accuracy. We further study the impact of changing the Bi-LSTM default activation functions Tanh with ReLU on forecasting accuracy. The research provides insight to policymakers to optimize the pooling of resources more optimally on the correct date and time prior to the event and to control the spread by employing various strategies in the meantime.

Intrusion Detection System CAN-Bus In-Vehicle Networks Based on the Statistical Characteristics of Attacks.

For in-vehicle network communication, the controller area network (CAN) broadcasts to all connected nodes without address validation. Therefore, it is highly vulnerable to all sorts of attack scenarios. This research proposes a novel intrusion detection system (IDS) for CAN to identify in-vehicle network anomalies. The statistical characteristics of attacks provide valuable information about the inherent intrusion patterns and behaviors. We employed two real-world attack scenarios from publicly available datasets to record a real-time response against intrusions with increased precision for in-vehicle network environments. Our proposed IDS can exploit malicious patterns by calculating thresholds and using the statistical properties of attacks, making attack detection more efficient. The optimized threshold value is calculated using brute-force optimization for various window sizes to minimize the total error. The reference values of normality require a few legitimate data frames for effective intrusion detection. The experimental findings validate that our suggested method can efficiently detect fuzzy, merge, and denial-of-service (DoS) attacks with low false-positive rates. It is also demonstrated that the total error decreases with an increasing attack rate for varying window sizes. The results indicate that our proposed IDS minimizes the misclassification rate and is hence better suited for in-vehicle networks.

Diabetic Foot Ulcers: Contemporary Assessment And Management.

Diabetic foot ulcer disease is the combination of vasculopathy, neuropathy and infection. It is important to identify the main aetiology and to treat it for optimal ulcer healing so that limb amputation may be prevented. A literature review spanning five years (2018-2021) was performed to assess the current understanding of these aetiologies and management options for their treatment. Peripheral artery disease is prevalent in patients with diabetes. Before performing any amputations, whether minor or major, vascular supply in these patients needs to be evaluated and, if needed, improved. Diabetic neuropathy is a long-term complication of uncontrolled diabetes. Patients' education is very important with respect to selfcare and prevention of foot complications arising out of minor trauma in diabetic population. Better foot care and regular use of off-loading shoe wear can prevent neuropathic diabetic foot ulcers. Infection in diabetic patients is mostly polymicrobial and it can present as superficial or deep infections. Early diagnosis, use of broad-spectrum antibiotics, and aggressive debridement, when needed, is advocated to prevent foot amputation. Contemporary treatment armamentarium provides many options for treating diabetic foot ulcers. Nevertheless, one must exhaust all preventive strategies to avoid ulcers in the first place. Once an ulcer has developed, it should be managed aggressively with appropriate soft tissue and, if required, with bony procedures. The current narrative review was planned to explore the current understanding about the main aetiologies of diabetic foot ulcers and about the available treatment options.

Decadal change in the association between the status of young mother's Body Mass Index and anaemia with child low birth weight in India.

BACKGROUND: The study aims to investigate the changes in the socio-economic and demographic status of young mothers of age 15-24 years and to examine the association between mothers' nutrition, i.e., Body Mass Index (BMI) and anaemia with child low birth weight for almost two decades during 1998-2016 in India. METHODS: National Family Health Survey (NFHS) round II and IV were used. The sample of this study included 3405 currently married young mothers from NFHS II and 44,742 from NFHS IV who gave birth at least one child in the last three years preceding the surveys. Logistic regression and Blinder-Oaxaca decomposition analysis have been used in this study to examine the corresponding association between the concerned variables. RESULTS: The analysis showed that the prevalence of low birth weight (LBW) babies has decreased from 26.1 to 22.8 for the 15 to 19 age group and from 20.4 to 18.7 for the 20 to 24 age group over time. Young mothers with low BMI or severe anaemia have shown higher odds of having LBW babies. For instance, the odds of having a LBW child was 1.44 (p-value = 0.000; 95% CI: 1.05, 1.65) for mothers with low BMI and 1.55 (p-value = 0.000; 95% CI: 1.27, 1.90) with severe anaemia. Over the decade, the association of LBW babies with mothers' nutrition has decreased. The odds of LBW with mothers with low BMI decreased from 1.63 (p-value = 0.004; 95% CI: 1.21, 2.21) to 1.41 (p-value = 0.000; 95% CI: 1.27, 1.55). Similarly, mothers with severe anaemia, the odds of LBW child decreased from 2.6 (p-value = 0.000; 95% CI: 1.75, 3.8) in 1998 to 1.3 (p-value = 0.024; 95% CI: 1.02, 1.65) in 2016. CONCLUSIONS: The maternal and child health improvement in India has been moderate over the decade. Still, a significant proportion of the women are suffering from poor health and young mothers are at more risk to deliver LBW babies. It is highly recommended to integrate maternal and child health programmes with the ongoing health policies to improve the situation while taking additional care of the young pregnant mother and their nutritional health.

An emerging potential of metabolomics in multiple sclerosis: a comprehensive overview.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the nervous system that primarily affects young adults. Although the exact etiology of the disease remains obscure, it is clear that alterations in the metabolome contribute to this process. As such, defining a reliable and disease-specific metabolome has tremendous potential as a diagnostic and therapeutic strategy for MS. Here, we provide an overview of studies aimed at identifying the role of metabolomics in MS. These offer new insights into disease pathophysiology and the contributions of metabolic pathways to this process, identify unique markers indicative of treatment responses, and demonstrate the therapeutic effects of drug-like metabolites in cellular and animal models of MS. By and large, the commonly perturbed pathways in MS and its preclinical model include lipid metabolism involving alpha-linoleic acid pathway, nucleotide metabolism, amino acid metabolism, tricarboxylic acid cycle, D-ornithine and D-arginine pathways with collective role in signaling and energy supply. The metabolomics studies suggest that metabolic profiling of MS patient samples may uncover biomarkers that will advance our understanding of disease pathogenesis and progression, reduce delays and mistakes in diagnosis, monitor the course of disease, and detect better drug targets, all of which will improve early therapeutic interventions and improve evaluation of response to these treatments.

Attention based parameter estimation and states forecasting of COVID-19 pandemic using modified SIQRD Model.

In this work, we propose a new mathematical modeling of the spread of COVID-19 infection in an arbitrary population, by modifying the SIQRD model as m-SIQRD model, while taking into consideration the eight governmental interventions such as cancellation of events, closure of public places etc., as well as the influence of the asymptomatic cases on the states of the model. We introduce robustness and improved accuracy in predictions of these models by utilizing a novel deep learning scheme. This scheme comprises of attention based architecture, alongside with Generative Adversarial Network (GAN) based data augmentation, for robust estimation of time varying parameters of m-SIQRD model. In this regard, we also utilized a novel feature extraction methodology by employing noise removal operation by Spline interpolation and Savitzky-Golay filter, followed by Principal Component Analysis (PCA). These parameters are later directed towards two main tasks: forecasting of states to the next 15 days, and estimation of best policy encodings to control the infected and deceased number within the framework of data driven synergetic control theory. We validated the superiority of the forecasting performance of the proposed scheme over countries of South Korea and Germany and compared this performance with 7 benchmark forecasting models. We also showed the potential of this scheme to determine best policy encodings in South Korea for 15 day forecast horizon.

Dose-response and temporal ergogenic effects of ginseng supplementation in athletes and active participants: A systematic review and meta-analysis.

This review sought to assess the dose-response, i.e., low (<300 mg/day) and high (>300 mg/day), and temporal effects of ginseng, i.e., immediate, short-term (up to 4 weeks) and long-term (>4 weeks) in comparison to placebo on physical performance [visual analogue scale (VAS) level, vertical jump(VJ), rating of perceived exertion (RPE), peak power output (PPO)] and physiological measures [VO2 max, creatine kinase(CK), heart rate(HR)], in athletes and active participants. Search in four databases with English language constraints yielded 492 studies. Fourteen studies were shortlisted through PEDro scale by methodological quality evaluation. Ginseng exhibited significant short-term effect at high dosage for VJ improvement (SMD: -8.17, 95% CI: -16.28 to -0.06, p= 0.05). Ginseng had no effect on VAS (SMD: -0.65, 95% CI: -1.35 to 0.06, p= 0.07), RPE (SMD: -1.11, 95% CI: -2.57 to 0.35, p= 0.14), PPO (SMD: -0.70, 95% CI: -1.78 to 0.38, p= 0.20), HR (SMD: -0.54, 95% CI: -2.05 to 0.96, p= 0.48), CK (SMD: 0.33, 95% CI: -0.18 to 0.84, p= 0.21) and VO2 max (SMD: 0.08, 95% CI: -0.69 to 0.85, p= 0.08).The ginseng supplementation was found to have significant short-term effect at high dose only for VJ in athletic and active participants. Methodologically strong research is warranted to further consolidate these findings.

Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital Are Maintained 4 Years after Initiation.

Blood product usage is an important outcome for patients undergoing cardiac surgery. In 2015, our center made a concerted effort with multiple departments to focus on reducing transfusion rates in surgical patients requiring cardiopulmonary bypass (CPB). Specific changes included an upgrade of the oxygenator in mid-2015 and, in early 2016, implementation of a hemostasis management system (HMS) that used heparin dose-response titration assays for heparin and protamine management. A retrospective chart review demonstrated significant decreases in the quarterly average of patients receiving packed red blood cells (PRBCs) from a baseline of 26.7% to 22.7% following the oxygenator upgrade (p = .021) and from 22.7% to 8.8% following implementation of the HMS (p = .0017). Platelet usage decreased from an average of 50.5% during the baseline and oxygenator upgrade periods to 22.2% following implementation of the HMS (p < .0001). Usage of fresh frozen plasma (FFP) decreased from an average of 28.2% of cases during the baseline and oxygenator upgrade periods to 10.4% during 2016, and cryoprecipitate usage decreased from 38.5% to 15.4%. Heparin usage averaged 56,903 units before implementation of the HMS, decreasing to an average of 43,796 units following HMS implementation (p < .0001). During the same time periods, protamine usage averaged 340.3 mg and 183.2 mg, respectively. Because improvements achieved during quality initiatives may revert back to their pre-intervention state once the assessment period is over, we performed a second retrospective analysis to determine whether the improvements achieved were maintained during the 48 months following the initial study. During 2017-2020, quarterly average usage of blood products was as follows: PRBCs, 11.9%; platelets, 14.7%; FFP, 6.2%; and cryoprecipitate, 11.5%. Quarterly, average use of heparin and protamine were 31,556 ± 2,757 units and 189 ± 113 mg, respectively. These findings indicate that the improvements achieved were not limited to the duration of the initial quality initiative.

REIP: A Reconfigurable Environmental Intelligence Platform and Software Framework for Fast Sensor Network Prototyping.

Sensor networks have dynamically expanded our ability to monitor and study the world. Their presence and need keep increasing, and new hardware configurations expand the range of physical stimuli that can be accurately recorded. Sensors are also no longer simply recording the data, they process it and transform into something useful before uploading to the cloud. However, building sensor networks is costly and very time consuming. It is difficult to build upon other people's work and there are only a few open-source solutions for integrating different devices and sensing modalities. We introduce REIP, a Reconfigurable Environmental Intelligence Platform for fast sensor network prototyping. REIP's first and most central tool, implemented in this work, is an open-source software framework, an SDK, with a flexible modular API for data collection and analysis using multiple sensing modalities. REIP is developed with the aim of being user-friendly, device-agnostic, and easily extensible, allowing for fast prototyping of heterogeneous sensor networks. Furthermore, our software framework is implemented in Python to reduce the entrance barrier for future contributions. We demonstrate the potential and versatility of REIP in real world applications, along with performance studies and benchmark REIP SDK against similar systems.

The blame game- experiences of female residents in obstetrics & gynecology regarding lapses in patient safety.

Objectives: Primary objective was to explore experiences of female residents of Obstetrics and Gynecology (OB/GYN) regarding lapses in patient safety (PS) while secondary objective was to explore factors hampering or favouring improvement of PS in OB/GYN. Methods: In this qualitative narrative study carried out in OB/GYN department of Combined Military Hospital (CMH) Lahore for six months from 1st April to 30th September 2021, six fourth-year residents were asked to write narratives of their personal experiences of medical error (witnessed or committed) in detail and reflect on those experiences, which were then transcribed. Code labels and themes were assigned manually. Interpretation of these themes was done after thematic content analysis. Results: Six, fourth-year female residents with a mean age of 28.6±1.8 participated in the study. Two main themes with sub-themes were identified: 1) Challenges in patient safety (Personal challenges, Workplace challenges, Barriers to PS), 2) Lessons learnt from experiences (Self-improvement and; Promotion of patient safety culture). Heavy workload with long working hours, lack of communication and teamwork, lack of experience and inadequate supervision were major factors involved in PS lapses experienced by residents. Conclusion: Incidents of Patient Safety (PS) lapses had a strong impact on the emotional and professional life of residents. Formal PS training with improvement of working conditions may help promote PS culture.

IL-33 ameliorates liver injury and inflammation in Poly I:C and Concanavalin-A induced acute hepatitis.

The IL-33/ST2 axis is known to be involved in liver pathologies and IL-33 is over-expressed in mouse hepatitis models. We aimed to investigate the proposed protective effect of IL-33 in murine fulminant hepatitis induced by a Toll like receptor 3 (TLR3) viral mimetic, Poly I:C or by Concanavalin-A (ConA). The Balb/C mice were administered intravenously with ConA (15 mg/kg) or Poly I:C (30 µg/mouse) to induce acute hepatitis along with vehicle control. The recombinant mouse IL-33 (rIL-33) was injected (0.2 µg/mouse) to mice 2 h prior to ConA or Poly I:C injection to check its hepato-protective effects. The gross lesions, level of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), histopathology (H&E staining) and levels of IFNγ and TNFα were measured by ELISA. The gross pathological liver injury induced by Poly I:C or ConA was reduced by rIL-33 administration in mice. The levels of AST and ALT were significantly (P ≤ 0.05) higher in mice challenged with Poly I:C or ConA in comparison to control mice. The rIL-33 pre-treated mice in both Poly I:C and ConA challenge groups showed significantly (P ≤ 0.05) lower levels of AST and ALT, and decreased liver injury (parenchymal and per-vascular necrotic areas) in histological liver sections. The soluble levels of TNFα and IFNγ were significantly (P ≤ 0.05) raised in Poly I:C or ConA challenged mice than control mice. The levels of TNFα and IFNγ were significantly reduced (P ≤ 0.05) in rIL-33 pre-treated mice. In conclusion, the exogenous IL-33 administration mitigated liver injury and inflammation (decreased levels of IFNγ and TNFα) in Poly I:C and ConA-induced acute hepatitis in mice.

Assessment of lower urinary tract symptoms among calcium channel blocker-users and its impact on quality of life.

OBJECTIVE: To investigate the prevalence and severity of lower urinary tract symptoms among calcium channel blocker users, and the impact on patients' quality of life. METHODS: The cross-sectional study was conducted at one hospital and 2 community pharmacies in Lahore, Pakistan, from November 2017 to July 2018, and comprised patients using calcium channel blockers. Data was collected using standardised scales to assess lower urinary tract symptoms and quality of life. Data was analysed using SPSS 22. RESULTS: Of the 410 subjects, 315 (76.8%) were males. The overall median age was 50.84 years, IQR 19 with 126 (30.7%) aged 41-50 years. Of the total, 108 (26.3%) patients were on calcium channel blockers alone, while the rest were taking it in combination with other drugs. Prevalence of lower urinary tract symptoms was 307 (74.9%); mild 103 (25.1%), moderate 201 (49.1%) and severe 106 (25.9%). The symptoms were significantly associated with reduced quality of life (p<0.05). CONCLUSION: Majority calcium channel blockers users had clinically significant lower urinary tract symptoms which significantly reduced patients' quality of life.