Structure-Property Correlations in Aqueous Binary Na+/K+-CH3COO- Highly Concentrated Electrolytes.

Highly concentrated aqueous binary solutions of acetate salts are promising systems for different electrochemical applications, for example, energy storage devices. The very high solubility of CH3COOK allows us to obtain water-in-salt electrolyte concentrations, thus reducing ion activity and extending the cathodic stability of an aqueous electrolyte. At the same time, the presence of Li+ or Na+ makes these solutions compatible with intercalation materials for the development of rechargeable alkaline-ion batteries. Although there is a growing interest in these systems, a fundamental understanding of their physicochemical properties is still lacking. Here, we report and discuss the physicochemical and electrochemical properties of a series of solutions based on 20 mol kg-1 CH3COOK with different concentrations of CH3COONa. The most concentrated solution, 20 mol kg-1 CH3COOK + 7 mol kg-1 CH3COONa, gives the best compromise between transport properties and electrochemical stability, displaying a conductivity of 21.2 mS cm-1 at 25 °C and a stability window of up to 3 V in "ideal" conditions, i.e., using a small surface area and highly electrocatalytic electrode in a flooded cell. Careful Raman spectroscopy analyses help to address the interaction network, the phase evolution with temperature, and the crystallization kinetics.

Charismatic Trends in COVID-19 Patients in Pakistan: A Case Series.

Severe acute respiratory coronavirus-2 syndrome (SARS-CoV-2), the novel coronavirus causing the coronavirus disease (COVID-19), spread across the world, resulting in a global crisis. This pandemic has caused consequences that are beyond the boundaries of a single discipline of life, but it is healthcare that is under the most stress. As we received COVID-19 cases in our hospital (a private tertiary care facility in Sialkot, Pakistan), we geared up to accommodate these cases, since the government sector was already overburdened. The purpose of this study is to report the trends observed in 80 COVID-19 patients admitted at our facility from May 16 to July 14, 2020.

End of treatment response in chronic hepatitis C patients treated with interferon alpha and ribavirin.

We conducted a study at Combined Military Hospital (CMH), Sialkot, from August 2010 to February 2011 with the objective to determine the frequency of early and end of treatment virological response in patients with chronic hepatitis C infection treated with IFN-a / ribavirin therapy. HCV RNA PCR positive adult patients of either gender were included in the study. A total of 123 patients (56 males and 67 females) were given alpha-interferon ribavirin for 24 weeks. At 12 weeks posttreatment, 82 patients out of 123 (EVR 66.6%) had negative HCV RNA PCR while 85 patients out of 123 were HCV PCR negative at 24 weeks (ETR 69.1%). Conventional alpha-interferon ribavirin therapy should be discontinued in patients who are non responders at 12 weeks of treatment and be offered pegylated interferon to save time, money and minimize the side effects.

Ghost spell or hematohidrosis.

Hematohidrosis is a rare condition of excreting blood in sweat, tears or any other part of the body, with varied underlying etiologies and variable success to different available treatment modalities. We are reporting one such case of an adult female who could secrete blood from eyes and ears simultaneously either due to crying as a result of emotional outburst or even sometimes voluntarily. Considering her origin from tribal culture, she was often thought to be victim of some evil spell. The lady had taken various spiritual treatments from Pirs and various forms of medical treatments from homeopaths, quacks and medical doctors, but of no relief. She was treated for 2 months with non-selective beta blocker (propanolol 10 mg thrice daily) along with psychotherapy. She did improve symptomatically but did not get complete cure. Eventually she was lost to follow-up as is common in female patients of tribal background. To our knowledge, this is the first such reported case from Pakistan.

Does mild hepatitis on liver biopsy warrant immediate combination anti viral therapy in chronic hepatitis C patients?

BACKGROUND: Not all patients with histologically mild chronic Hepatitis C progress to cirrhosis. Many patients being treated on the basis of raised ALT and positive PCR alone may not be actually requiring it. METHODS: All adult patients suffering from chronic Hepatitis C, qualifying for combination interferon ribavirin therapy, under went liver biopsies. Tissue samples were sent to Armed Forces Institute of Pathology (AFIP) Rawalpindi for histopathology. Reporting was done according to modified Ishaq score. RESULTS: Total number of patients was 147. Out of these, 75 (51%) were female and 72 (49%) were male. Mean age of females and males were 35.1 +/- 8.12 and 36.31 +/- 8.56 year respectively. Out of these, 19 (12.9%) were stage zero, 61 (41.5%) at stage 1, and 31 (21.1%) at stage 2 of modified fibrotic Ishaq score. In all, 111 (75.5%) of the patients were < or = 2 of modified Ishaq fibrotic score in either sex or 80 (54.4%) < or = 1 of modified Ishaq fibrotic stage. The necroinflammatory score has been divided into minimal (0-3), mild (4-8), moderate (9-13), and severe (14-18). About the same number of our patients (74%) had minimal to mild inflammation. CONCLUSION: Since the majority of the patients have fibrotic score less than 3, so it will be cost effective to individualise their treatment on liver histpathology. Patients with low fibrotic score and minimal to mild inflammation may not be treated, but only monitored with serial ALT and liver biopsy every 4-5 years. Treatment may be started if there is increase in fibrosis on surveillance biopsy. However, there is a need to conduct prospective studies in similar group of patients to evaluate the natural course of disease in untreated patients.

Interferon-ribavirin treatment in chronic hepatitis C--the less talked about aspects.

BACKGROUND: Combination therapy with interferon and ribavirin has become the standard of care in the treatment of Chronic Hepatitis C (CHC) infected patients. Treatment response, however, is not 100% and is accompanied with side effects faced by the patient as well as observed in haematologic indices. Studies are focusing on daily or high-dose induction therapy with interferon, the titration of interferon dosing to initial viral load, higher doses of interferon throughout treatment, and adjustment of interferon dosing to the viral responses. The safety and efficacy of these approaches have not been sufficiently established. Objectives were to see the response of 2 different dosage regimens, effects and side effects and to assess the efficacy and side effects of 2 treatment regimens of Interferon and Ribavirin in CHC. METHODS: A total of 32 patients with CHC at Department of Gastroenterology and Hepatology, Shaikh Zayed Postgraduate Medical Institute Lahore from June 2001 to February 2003 were included in the study and were divided into two groups for treatment. Group A (14 patients) received 5 MU of injection Interferon alpha 2 b S/C daily for 2 weeks followed by 3 MU thrice weekly for the next 22 weeks. Group B (18 patients) received injection interferon alpha 2 b 3 MU S/C thrice weekly for 24 weeks. Ribavirin therapy was started at 1200 mg daily in 3 divided doses and later modified according to side effects. Patients were evaluated at 2, 4, 8, 12, 16, 20 and 24 weeks during the therapy and then 24 weeks after the completion of treatment. RESULTS: Out of 32 adult patients included in the study, 18 were males and 14 females. Haemoglobin was more than 12 gm/dl in females and more than 13 gm/dl in males, WBC count was more than 3.0 x 10(9)/L and Platelet count was more than 100 x 10(9)/L. Twenty patients completed 6 months combination treatment, 16 reported with their end of treatment HCV RNA PCR results, 8 from each group. Twelve patients were lost to follow up. End of treatment response (ETR) in group A was 88% and 62.5% in group B. Sustained virological response in group-A was 5/8 (62.5%) and 4/5 (50%) in group-B. The frequency and severity of flu like symptoms like fever, body aches, skin rash, hair loss, cough and psychiatric symptoms were more in group A than in group B. There was no significant difference in the 2 groups for haematologic side effects. CONCLUSIONS: Treatment with 5 MU interferon daily for initial two weeks followed by 3 MU thrice weekly for 22 weeks is more effective than 3 MU thrice weekly for 24 weeks but with more side effects.

Endoscopic ultrasound guided biopsy of a mediastinal mass.

Endoscopic ultrasound (EUS) now has an established role in the diagnosis, staging and management of cancers of the oesophagus, stomach, pancreato-biliary system, and rectum. Recently, a role for EUS in the staging of lung cancers has been proposed. Linear EUS allows fine needle aspiration (FNA), core biopsies and therapeutic manoeuvres such as coeliac plexus block to be performed. We present here the first reported EUS-guided biopsy from Pakistan. A patient with probable bronchogenic carcinoma was referred for assessment of operability. A thoracic CT scan showed subcarinal and aorto-pulmonary recess lymphadenopathy. An EUS-guided FNA was performed, confirming metastatic non-small cell lung cancer and rendering the patient inoperable.