Atmospheric wet deposition of trace elements in Bangladesh: A new insight into spatiotemporal variability and source apportionment.

The interaction between water vapor and natural/anthropogenic airborne particles deposits a massive amount of trace elements in the ecosystem. As the principal source region of the Indian monsoon originated from the Bay of Bengal, atmospheric trace elements in Bangladesh have impacted atmospheric wet deposition along the pathway, even reaching the headwaters in the Asian water tower. However, no study reports the atmospheric wet deposition of trace elements at the spatiotemporal scale. Thus, this study investigated the concentration, sources, and deposition of eighteen trace elements (Al, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Rb, Sr, Mo, Cd, Sn, Sb, Ba, and Pb) from 232 precipitation samples at four sites in Bangladesh. Results showed that the VWM concentrations of the eighteen measured trace elements ranged from 0.03 to 535.6 µg L-1. Zn, Fe, and Al were the principal elements of the atmosphere at four sites with mean values of 207.9 ± 227.8, 18.2 ± 9.3, and 16.3 ± 6.8 µg L-1, respectively. Besides, the eighteen trace elements showed significant variation in spatial scale with distinct seasonality. Enrichment factors of Zn, Sb, and Cd indicated serious anthropogenic influences. The major sources of trace elements were fossil fuel combustion, brick kilns, crustal dust, fugitive Pb, metal smelters, and battery recycling. Both the concentration and precipitation amount played a pivotal role in the deposition. Most of the air masses during the monsoon season came from marine sources passing over southern India and Sri Lanka. Meanwhile, the air masses during the non-monsoon season were from West Asia and the northwestern Indian subcontinent. The air masses are transported over a long range and deposit massive amounts of particulate matter in the Third Pole Himalayan region. This first-hand work on spatiotemporal variation provides a reference dataset for future targeting of the scientific community and policymakers for the development of strategies and action plans.

Risk factors associated with esophageal cancers, diagnosed at tertiary level in Afghanistan: a descriptive cross-sectional study.

BACKGROUND: Worldwide, esophageal cancer (EC) is a common cancer in term of incidence and mortality and is the 4th common cancer in Afghanistan. Current study aimed to evaluate the profile of risk factors for EC among patients diagnosed at tertiary level in Afghanistan. METHODOLOGY: A descriptive cross-sectional study was carried out between January 2019 up to February 2021 including all esophageal cancers diagnosed at pathology department of French Medical Institute for Mothers and Children, Afghanistan. RESULT: 240 diagnosed cases were analyzed, in which 59.40% of squamous cell carcinoma and 41.07% Adenocarcinoma. Both histopathological type of were predominantly diagnosed in males. The majority of the patients were residents of rural areas. More than 80% of the patients were illiterate with only less than 2% completing higher education. Majority of the patients were laborers and farmers while less than 10% were employed. According to income assessment, more than 80% were from low-income household, the rest from middle-income and none from high-income family. Oral snuff consumption was noted in 33.9% of squamous cell carcinoma patients and 40% adenocarcinoma patients whereas, family history of esophageal cancer was observed in 37.8% and 36.7% in both types of carcinomas, respectively. More than 60% of both types of carcinomas patients were hot tea drinkers. CONCLUSION: Current study demonstrated that most patients diagnosed with esophageal cancers were male, uneducated, belongs to low-income groups, lives in rural areas. These findings suggest distribution of esophageal cancer in specific socioeconomic groups, clearly demonstrating the need further analytical study.

Management of the bone loss by metaphyseal sleeves in primary and revision knee arthroplasty: clinical experience and outcome after forty three cases.

AIM OF THE STUDY: Management of metaphyseal bone loss in complex primary and revision TKA is a challenge for surgeons. Out of various types of bony defects, large metaphyseal bone loss (AORI types IIB and III) requires special augments in the form of cones or sleeves. The aim of this study is to assess the reliability of metaphyseal sleeves, in dealing with massive bone defects to provide stability for immediate weight bearing and also to check short to mid-term survivorship of metaphyseal sleeves in Asian population by assessing various parameters and complications. METHODS: This is a retrospective study that includes 36 patients (43 knees), operated from 2011 to 2019. Patients with AORI type IIB (large metaphyseal bone defect) and AORI type III (metaphyseal defect with compromised collateral ligaments) were included. We included both the primary and revision knee arthroplasties in our study. Our interest in this study was to look for incidence of intra-operative iatrogenic fracture on the one hand, and post-operative complications in the form of peri-prosthetic joint infection and aseptic loosening on the other hand. Knee Society Score (KSS) was used to assess improvement in patient's clinical outcome. SPSS version 23 was used to process data. RESULTS: The average age of patients in our study was 59.4 (SD 9.78) years. Male to female ratio was 21:15. The average follow-up was 5.42 (SD 2.24) years with the longest follow up of nine years. Metaphyseal sleeves were used in 12 primary TKA and 31 revision TKA. During surgery, iatrogenic fracture of tibial condyle was encountered in three patients (6.9%), all were managed without any intervention and union was achieved in all cases. There was not a single case with aseptic loosening as per radiological criteria in our study. Peri-prosthetic joint infection (PJI) was encountered in a single case (2.3%). Pre-op Knee Society Score (KSS) was 36.21 (SD 7.43) where as it improved to 92.00 (SD 5.66), six months after surgery. Also the range of flexion was increased from 76.83o (SD 14.07o) to 122.91o (SD 4.84o). CONCLUSION: In our study, metaphyseal sleeves showed excellent short to mid-term survivorship in AORI types IIB and III boneloss in Asian population. These results are comparable to various studies conducted on North American and European population. Metaphyseal sleeve is a reliable tool in the armamentarium of the arthroplasty surgeon. It is user friendly implant and provides immediate stability to allow full weight-bearing mobilization.

Frequency Of Metabolic Syndrome In Asthmatic Patients Of Hazara Division.

BACKGROUND: Bronchial asthma is a common disease and most asthmatics are obese. Both asthma and obesity are showing parallel trends in their increasing prevalence. Obesity is also the main component of metabolic syndrome and several studies have shown metabolic syndrome to be associated with bronchial asthma. The present study was, therefore, designed to determine the frequency of metabolic syndrome among patients with chronic asthma in our setup. METHODS: This cross-sectional study was conducted in Department of Medicine, Ayub Teaching Hospital, Abbottabad from May to November, 2014. One hundred and fifty-four asthmatic patients were enrolled in this study. Samples for blood glucose, triglycerides and HDL Cholesterol were taken after an overnight fast. Sitting blood pressure was measured with mercury sphygmomanometer after 10 minutes of rest. Waist circumference was measured at the level of the midpoint between the high point of the iliac crest and the last rib. RESULTS: Out of 154 patients, 80 were males and 74 were females. Metabolic syndrome was diagnosed in 46 (29.87%) patients. When metabolic syndrome was stratified according to age, sex and duration of asthma, the results were found to be insignificant (p-0.89, 0.30 and 0.85). CONCLUSIONS: This study showed that metabolic syndrome was present in almost one third of study population.

Appetite Regulation In Relation To Energy Provision.

BACKGROUND: Appetite control is a very complex process which influences the short term feeding behaviour and a long term adaptive process that responds to the energy input. Appetite control and food intake is influenced by a combination of behavioural, psychological and neuro-endocrine influences. METHODS: For identification of articles search engines of the databases EMBASE, OVID, Pub med and MEDLINE were used for papers published from 2002 to 2015 in English language. RESULTS: The higher endogenous peptide YY (PYY) and cholecystokinin (CCK) and lower ghrelin levels are not always associated with subjective feelings of fullness or hunger and a decreased energy intake which highlights the fact that appetite control and food intake is a very intricate process. CONCLUSIONS: When food is ingested, numerous physiological, hormonal, social and psychological processes are triggered in an intricate manner. Therefore, it can be said that ghrelin, PYY and CCK are just few pieces, which contributes to the process of appetite control and energy intake.

Frequency of diabetes mellitus in patients with acute coronary syndrome.

BACKGROUND: Diabetes mellitus is a major risk factor for atherosclerosis which eventually causes cardiovascular disease specially affecting coronary arteries. Patients with diabetes have a risk for coronary events similar to that of patients without diabetes who have already had an event, and conversely many patients with established coronary artery disease suffer from diabetes or its pre- states. The objective of study was to determine the frequency of diabetes mellitus in patients presenting with acute coronary syndrome in our setup. METHODS: This cross sectional study was conducted in the Department of Cardiology and Medical unit-B of Ayub Medical College, Abbottabad from October 22, 2009 to April 22, 2010. All patients of either gender presenting with acute coronary syndrome above 25 years of age were included in the study by consecutive non- probability sampling. RESULTS: Two hundred and fifty patients were included in study. Of these 161 (64.4%) were males and 89 (34.6%) were females. The mean age of the study participants was 57.75 years. Frequency of diabetes mellitus was 3 1.6% and most (62%) of the known diabetics with ACS were having poor glycaemic control. The coronary event which was seen in the majority (74%) of patients was ST segment elevation myocardial infarction. CONCLUSION: The frequency of diabetes mellitus in this study was significant as one out of every third patient with acute coronary syndrome was diabetic.

Primary synovial sarcoma in anal canal: Report of a very rare case.

Extensive studies are required to understand the behavior as well as prognosis of SS in the colorectal region. IHC staining is essential for the accurate diagnosis when a lesion is encountered at an unusual site.

Comparing the Efficacy of Ondansetron, Domperidone, and Metoclopramide in Treating Vomiting in Pediatric Patients With Acute Gastroenteritis: A Network Meta-Analysis.

This network meta-analysis compared the efficacy of ondansetron, domperidone, and metoclopramide in managing vomiting in pediatric acute gastroenteritis. A comprehensive literature search was conducted across multiple databases, including PubMed, Cochrane Library, Web of Science, and Embase, from their inception to July 25, 2024. Additionally, Google Scholar was searched to identify further relevant studies. In total, 19 randomized controlled trials (RCTs) were included. The primary outcome was cessation of vomiting. The results indicated that ondansetron was significantly more effective than placebo in achieving cessation of vomiting. While domperidone and metoclopramide also showed improved efficacy compared to placebo, these differences were not statistically significant. Ondansetron emerged as the most effective intervention, followed by domperidone and metoclopramide. These findings have significant clinical implications, suggesting that ondansetron should be the preferred antiemetic for pediatric acute gastroenteritis. Its use may reduce the need for intravenous rehydration and hospitalization, potentially improving patient outcomes and reducing healthcare costs. However, the study has limitations, including a lack of data on secondary outcomes and safety profiles of the interventions. Future prospective, multicenter studies are needed to assess both the efficacy and safety of these antiemetics comprehensively in pediatric acute gastroenteritis.

Sessile Pelvic Osteochondroma: A Rare Case That Required Abdominal Wall Reconstruction After Excision.

Osteochondroma are the most common benign tumours of the bone presenting in the young age group. Commonly found at the metaphysis of the long bones and mostly pedunculated; atypical locations and sessile appearances have also been described in literature. Due to the risk of conversion to malignant chondrosarcoma, the recommended treatment of these lesions is complete excision. We encountered a similar sessile growth in the pelvic region of a 21-year-old male with complaints of pain and swelling. After thorough investigation, excisional biopsy was performed and abdominal wall repair was reinforced with a polypropylene mesh. Careful evaluation, adequate investigations and meticulous surgical treatment can avoid potential problems in managing these tumours.

A Review of the Occurrence of Rheumatoid Arthritis and Potential Treatments through Medicinal Plants from an Indian Perspective.

Arthritis is a medical condition that affects the joints and causes inflammation, pain, and stiffness. There are different types of arthritis, and it can affect people of all ages, even infants and the elderly. Recent studies have found that individuals with diabetes, heart disease, and obesity are more likely to experience arthritis symptoms. According to the World Health Organization, over 21% of people worldwide suffer from musculoskeletal problems. Roughly 42.19 million individuals in India, constituting around 0.31% of the populace, have been documented as having Rheumatic Artheritis (RA). Compared to other common diseases like diabetes, cancer, and AIDS, arthritis is more prevalent in the general population. Unfortunately, there is no specific cure for arthritis, and treatment plans usually involve non-pharmacological methods, surgeries, and medications that target specific symptoms. Plant-based remedies have also been shown to be effective in managing inflammation and related complications. In addition to therapies, maintaining a healthy diet, exercise, and weight management are essential for managing arthritis. This review discusses the causes, prevalence, diagnostic methods, current and prospective future treatments, and potential medicinal plants that may act as anti-inflammatory or anti-rheumatic agents. However, more research is necessary to identify the underlying mechanisms and active molecules that could improve arthritis treatment.

Modelling modifiable factors associated with the probability of human rabies deaths among self-reported victims of dog bites in Abuja, Nigeria.

Canine-mediated rabies kills tens of thousands of people annually in lesser-developed communities of Asia, Africa, and the Americas, primarily through bites from infected dogs. Multiple rabies outbreaks have been associated with human deaths in Nigeria. However, the lack of quality data on human rabies hinders advocacy and resource allocation for effective prevention and control. We obtained 20 years of dog bite surveillance data across 19 major hospitals in Abuja, incorporating modifiable and environmental covariates. To overcome the challenge of missing information, we used a Bayesian approach with expert-solicited prior information to jointly model missing covariate data and the additive effects of the covariates on the predicted probability of human death after rabies virus exposure. Only 1155 cases of dog bites were recorded throughout the study period, out of which 4.2% (N = 49) died of rabies. The odds for risk of human death were predicted to decrease among individuals who were bitten by owned dogs compared to those bitten by free-roaming dogs. Similarly, there was a predicted decrease in the probability of human death among victims bitten by vaccinated dogs compared to those bitten by unvaccinated dogs. The odds for the risk of human death after bitten individuals received rabies prophylaxis were predicted to decrease compared to no prophylaxis. We demonstrate the practical application of a regularised Bayesian approach to model sparse dog bite surveillance data to uncover risk factors for human rabies, with broader applications in other endemic rabies settings with similar profiles. The low reporting observed in this study underscores the need for community engagement and investment in surveillance to increase data availability. Better data on bite cases will help to estimate the burden of rabies in Nigeria and would be important to plan effective prevention and control of this disease.

Recurrent spinal hydatidosis causing Gibbus deformity: Report of a rare case.

Hydatid disease is caused by the larvae of the parasite Echinococcus granulosus and, less commonly, Echinococcus multilocularis in the endemic regions. A hydatid cyst of Echinococcus granulosus commonly develops in the liver and lungs of the affected individual and rarely occurs in the brain, bones, and heart. The spinal hydatidosis comprises 50% of the cases affecting the bones, which usually leads to severe morbidities. We present a case of a 52-year-old Afghan woman presented to the hospital with Gibbus deformity, complaining of lower back pain and flaccid paraplegia for one year. Findings of Magnetic Resonance Imaging of the lumbosacral spine were suggestive of a hydatid cyst involving the vertebrae with extension to the paravertebral soft tissue, leading to acute kyphosis, severe canal stenosis, and cord compression. Treatment included complete cyst removal. The diagnosis was confirmed by gross and microscopic evaluation of the cyst contents. The patient was discharged after significant pain relief and deformity correction. Vertebral hydatidosis is notorious for its recurrence despite vigorous surgical and medical treatment. The hydatid cyst grows rapidly and can cause irreversible damage to the spinal cord in neglected cases. Currently, the best treatment approach is complete surgical removal of the cyst, irrigation with a scolicidal agent, and postoperative follow-up with a long-term course of albendazole. Spinal hydatidosis is a rare, severe disease with significant morbidity. Despite significant scientific advances in understanding of disease pathogenesis, the parasite's predilection for the spine and the influence of host-specific factors on anatomical manifestations remain a mystery.

Primary hydatid cyst of the urinary bladder with associated eosinophilic cystitis: Report of a unique case.

Hydatid cyst of Echinococcus granulosus usually develops in liver and lungs of the affected individual and is considered a common health problem in endemic regions. Although, the cyst can be found in less common locations, such as brain, heart, and bones, the urinary bladder is extremely rare that may mimic malignancy radiologically and creates a diagnostic dilemma for clinicians and radiologists. Here we present a unique case of hydatid cyst in the urinary bladder with associated eosinophilic cystitis.

Congenital mature cystic teratoma of the parotid gland in an infant: Report of a unique case.

INTRODUCTION AND IMPORTANCE: Teratoma is a germ cell tumor originating from pluripotent germ cells and embryonal cells that commonly occurs in the gonads with only 15 % of it arising in extragonadal sites. In infants and children, teratomas of the head and neck are uncommon that comprise 0.47 %-6 % of all teratomas, and their occurrence in parotid gland is extremely rare. It is considered a diagnostic pitfall preoperatively, and their definite diagnosis can only be made upon surgery followed by histopathological examination. CASE PRESENTATION: We present a unique case of parotid gland teratoma in a 9-month-old girl who was brought to the hospital by her parents with right side parotid region swelling since birth. The ultrasonographic findings were suggestive of cystic hygroma. Upon surgery, the mass was completely excised with a part of parotid gland. The diagnosis of mature teratoma was made based on the histopathologic examination. No tumor recurrence was noted during the 4-month postoperative follow-up. CLINICAL DISCUSSION: Teratoma of the parotid gland is an extremely rare entity that may mimic diverse benign and malignant tumors of the salivary gland. Patients often present to the health care facility with a parotid gland swelling leading to defacement. Complete surgical resection of the tumor is considered the best treatment approach with careful preservation of facial nerve. CONCLUSION: Due to the scarcity of information available regarding the behavior and clinical management of parotid gland teratoma in the literature, a good follow-up of patient is required to exclude potential recurrency and neurological deficit.

A huge pseudomyxoma pleurii mimicking hydatid cyst: A case report.

INTRODUCTION: Pseudomyxoma pleurii is a rare disease that is defined by the pleural extension of pseudomyxoma peritonei, usually secondary to a mucinous neoplasm of the appendix or ovary. It is characterized by diffuse mucinous deposits on the pleural surface. CASE PRESENTATION: A 31-year-old woman presented to the hospital with dyspnea, an increased respiratory rate, and decreased oxygen saturation. Following an appendectomy for a perforated mucinous appendiceal tumor eight years ago, the patient underwent multiple surgeries for the resection of mass deposits in the peritoneal cavity. At presentation, her chest computed tomography with contrast revealed cystic mass deposits on the right-side pleura with a massive multi-locular pleural effusion mimicking hydatid cyst. Upon histopathologic examination, multiple small cystic structures lined by tall columnar epithelium with basally placed bland nuclei floating in the mucin pools were noted. CLINICAL DISCUSSION: Pseudomyxoma peritonei often leads to abdominal distention, intestinal blockage, anorexia, cachexia, and eventually death. It rarely spreads outside the abdomen, and its extension to the pleura is extremely unusual, with only a small number of cases documented in the literature to date. Radiologically, pseudomyxoma pleurii may resemble hydatid cyst of the lung and pleura. CONCLUSION: Pseudomyxoma pleurii is a rare entity with a poor prognosis that usually arises secondary to Pseudomyxoma peritonei. The risk of morbidity and mortality is reduced by early diagnosis and treatment. The present case places emphasis on the inclusion of pseudomyxoma pleurii in the differential diagnosis of pleural lesions in patients with the history of appendiceal or ovarian mucinous tumors.

Implementation and expansion of laboratory capacity for molecular diagnostics in response to COVID-19 and preparedness for other emerging infectious diseases in the Islamic Emirate of Afghanistan.

Background: Afghanistan experienced various outbreaks before and during the Covid-19 pandemic, including dengue, Crimean Congo hemorrhagic fever (CCHF), measles, and acute watery diarrhea (AWD). Diagnostic and surveillance support was limited, with only the Central Public Health Laboratory equipped to handle outbreak responses. This article highlights initiatives taken to improve diagnostic capabilities for COVID-19 and other outbreaks of public health concern encountered during the pandemic. Background: The World Health Organization (WHO) Afghanistan Country Office collaborated with the WHO Eastern Mediterranean Regional Office (EMRO), Central Public Health Laboratory (CPHL), and National Influenza Center (NIC) to enhance COVID-19 diagnostic capacity at national and subnational facilities. To alleviate pressure on CPHL, a state-of-the-art laboratory was established at the National Infectious Disease Hospital (NIDH) in Kabul in 2021-2022, while WHO EMRO facilitated the regionalization of testing to subnational facilities for dengue, CCHF, and AWD in 2022-2023. Results: COVID-19 testing capacity expanded nationwide to 34 Biosafety Level II labs, improving diagnosis time. Daily testing rose from 1000 in 2020 to 9200 in 2023, with 848,799 cumulative tests. NIDH identified 229 CCHF cases and 45 cases nationally. Dengue and CCHF testing, decentralized to Nangarhar and Kandahar labs, identified 338 dengue and 18 CCHF cases. AWD testing shifted to NIDH and five subnational facilities (Kandahar, Paktia, Balkh, Herat, and Nangarhar labs), while measles testing also decentralized to nine subnational facilities. Conclusion: Afghanistan implemented a remarkable, multisectoral response to priority pathogens. The nation now possesses diagnostic expertise at national and subnational levels, supported by genomic surveillance. Future efforts should concentrate on expanding and sustaining this capacity to enhance public health responses.

Monodisperse magnetic lecithin-PFP submicron bubbles as dual imaging contrast agents for ultrasound (US) and MRI.

Multimodal imaging is a recent idea of combining two or more imaging methods synergistically to overcome the weakness of individual imaging modalities and utilizing complementary benefits. Ultrasound (US) and magnetic resonance imaging (MRI) are widely used imaging techniques in healthcare and to fully utilize the potential of fusion imaging, dual-modal contrast agents are necessary to improve disease diagnosis by enhancing contrast resolution and reducing health risks associated with the dual dosage of contrast agents. In this study, magnetic microbubbles were synthesized by incorporating oleic acid stabilized superparamagnetic iron oxide nanoparticles (OA-SPIONs) into lecithin microbubbles, encapsulating the perfluoropentane (PFP) core. The magnetic microbubbles were characterized by FTIR, SEM, MFM, zeta potential, in vitro MRI, and ultrasound. Upon in vitro MRI, magnetic microbubbles showed a negative contrast effect by producing darker T2 weighted images. Magnetic microbubbles showed concentration-dependent response with a decrease in signal intensity with an increase in the concentration of OA-IONP in microbubbles. However, a decrease in acoustic enhancement was also observed with an increase in OA-IONP concentration, therefore concentration was optimized to achieve the best effect on both modalities. The magnetic lecithin microbubble with 10 mg SPIONs provided the best contrast on both US and MR imaging. The hemocompatibility testing resulted in hemolysis less than 7% with plasma recalcification time and thrombin time of 240 s and 6 s corresponding to excellent hemocompatibility. Thus the magnetic microbubbles with a phase convertible PFP core encapsulated by a lecithin shell loaded with OA-SPIONs can serve as a potential bimodal contrast agent for both US and MRI imaging.

Efficacy Of Diode Laser In The Management Of Glaucoma Following Intravitreal Silicone Oil Injection In Complicated Retinal Detachment.

BACKGROUND: Intravitreal silicone oil injection has been used to manage complicated retinal detachment. This study aims to analyse the efficacy of diode laser (TSCPC) in the management of secondary glaucoma following intravitreal silicone oil injection in complex retinal detachment surgery. METHODS: The medical records of 58 eyes of 58 patients retrospectively were reviewed. Patients who underwent TSCPC for the management of secondary glaucoma following intravitreal silicone oil injection in complex retinal detachment were included. Procedure performed under local anaesthesia. The laser power was set at 1500-2200 mW for 2 sec. At each follow-up visit, patients went under charting of their IOP measurements with anterior segment and fundus examination. Post procedural follow up visits were carried out as; at 1 week, 1st, 3rdand 6thmonths. The efficacy was measured as reduction in IOP up to ≤20 mmHg without further needs for medications at 6 months. RESULTS: The IOP was reduced up to 19.26±10.15 mmHg. Comparisons of IOP at each interval with pre-treatment showed significant difference with p<0.0001. The efficacy of procedure was achieved in 77.6% patients. Age, gender and pre-operative IOP showed significant association with p<0.05. CONCLUSIONS: Diode laser TSCPC was effective and safe in reducing IOP. The IOP decreases gradually over six month follow up. The procedure is simple and cost-effective yet reasonably afforded by patients in low resources population. In spite of the retained intravitreal silicon oil patients with failed medical treatment for uncontrolled IOP can be treated with TSCPS.

Correlation between reproductive hormones levels and semen quality in patients with diabetes.

Diabetes mellitus (DM) is rarely sought among infertile patients due to a lack of studies and inconsistency regarding its impact on semen quality. This cross-sectional study aimed to determine the influence of T2DM on the pituitary gland hormones (FSH and LH) in males. A total of 60 participants participated in this study, of which 35 were diagnosed with diabetes mellitus, and 25 were without diabetes. Fasting blood sugar, HbA1c, LH, FSH, TT, E2, and prolactin were tested. Diabetic men had lower serum LH, FSH, and TT levels than non-diabetics and higher prolactin and E2 levels. According to the semen examination, including sperm count, PH, motility, and morphology, diabetic patients had considerably lower sperm counts, motility, and morphology than non-diabetic patients. In conclusion, the decrease in the concentration of reproductive hormones in diabetic patients leads to sexual weakness, resulting in abnormal seminal fluid parameters, which are below the normal levels than in apparently healthy persons.

Clinical Response of Nuberol Forte® for Pain Management With Musculoskeletal Conditions in Routine Pakistani Practice (NFORTE-EFFECT).

Background Musculoskeletal pain is the most common complaint presented to the health practitioner. It is well-known that untreated or under-treated pain can have a significant negative impact on an individual's quality of life (QoL). Objectives The current study aimed to assess the clinical response of Nuberol Forte® (paracetamol 650 mg + orphenadrine 50 mg) to musculoskeletal pain in routine Pakistani practice and its impact on improving the patient's QoL. Methods A prospective, observational multicenter study (NFORT-EFFECT: Safety & Efficacy of Nuberol Forte in Pain Management). Three hundred ninety-nine patients with known prescreened musculoskeletal pain were recruited from 10 major healthcare facilities across six (6) major cities of Pakistan, as per the inclusion/exclusion criteria. After the baseline visit (Visit 1), the patients were followed up one to two weeks (Visit 2) after the treatment as per the physician's discretion. Data were collected using the Case Report Form (CRF) designed for the study, and adverse events (AEs) were also monitored to assess drug safety. Pain intensity was assessed through a visual analog scale (VAS), and QoL was assessed using the Muscle and Joint Measure (MJM) scale. Results Out of 399 enrolled patients, 49.4% were males and 50.6% were females with a mean age of 47.24 ± 14.20 years. Most patients were presented with knee osteoarthritis (OA), i.e., 148 (38%), followed by backache 70 (18.2%). A significant reduction in the mean pain score was observed after treatment with the combination of paracetamol and orphenadrine (p<0.05). Furthermore, an overall improvement in the patient's QoL was also observed. During the study, only 10 patients reported mild adverse events (AEs), namely, dryness of the mouth, dizziness, gastric irritation, tachycardia, restlessness, etc. Conclusion The combination of paracetamol and orphenadrine (Nuberol Forte) exhibited effective pain management among patients with musculoskeletal conditions and improved their QoL.