Factors Contributing to Rapid Early Infarct Expansion in Acute Ischemic Stroke Patients With Large Vessel Occlusion.

Background Acute ischemic stroke, particularly in cases involving large vessel occlusion (LVO), poses a significant challenge due to the potential for rapid infarct expansion in the early phase. Such expansion, if not managed promptly, can lead to severe neurological deficits and poor clinical outcomes. Understanding the contributing factors that accelerate early infarct expansion is crucial for optimizing treatment strategies and improving patient prognosis. The main aim of the study is to determine the factors contributing to rapid early infarct expansion in acute ischemic stroke patients with LVO. Methodology The retrospective study was conducted at Liaquat National Hospital in Karachi from August 2023 to December 2023. Data were collected from 685 patients with anterior circulation LVO-related acute stroke with witnessed stroke onset and baseline perfusion imaging. Extracted clinical data included age, gender, medical history (hypertension, diabetes, etc.), and baseline National Institutes of Health Stroke Scale (NIHSS) scores. Results The mean age of the included patients was 67.4 years, with a relatively balanced gender distribution, i.e., 48.5% male (n = 332) and 51.5% female (n = 353). The mean baseline NIHSS score was 14.2, reflecting initial neurological severity. Imaging parameters revealed that 294 (42.6%) patients exhibited infarct expansion, with an average penumbra size of 23.5 mL. Hypoperfusion intensity ratio (HIR) quartiles demonstrated a notable association with progression rates, escalating from 27 (4%) patients in the first quartile to approximately 527 (77%) patients in the fourth quartile, highlighting a significant correlation between HIR and infarct expansion (p < 0.001). Conclusions HIR emerged as a pivotal factor strongly associated with rapid infarct expansion, underscoring its significance in predicting the trajectory of ischemic injury.

In vitro and in vivo antimicrobial potential of lithium complex against multi-drug resistant Acinetobacter baumannii.

IMPORTANCE: Multi-drug resistance (MDR) by virtue of evolving resistance and virulence mechanisms among A. baumannii is a global concern which is responsible for lethal hospital-acquired infections. Therefore, it is crucial to develop new therapeutics against it. Metal complexes are compact structures with diverse mechanisms that the pathogens cannot evade easily which make them a strong drug candidate. In this study, we assessed the in vitro and in vivo efficacy of lithium complex {[Li(phen)2 sal]} against biofilm-forming MDR A. baumannii. The lithium complex displayed strong antimicrobial activity and reduced the pre-formed mature biofilm which is key barrier for antimicrobial action. Moreover, it employs oxidative stress as one of its mode of actions and causes cellular rupturing. Lithium complex was non-toxic and was significantly effective to overcome pneumonia in mice model. These results highlight the untapped potential of metal complexes that can be explored and utilized for combating notorious A. baumannii infections.

Nano-sized warriors: zinc chromium vanadate nanoparticles as a dual solution for eradicating waterborne enterobacteriaceae and fighting cancer.

The revolution of biomedical applications has opened new avenues for nanotechnology. Zinc Chromium vanadate nanoparticles (VCrZnO4 NPs) have emerged as an up-and-coming candidate, with their exceptional physical and chemical properties setting them apart. In this study, a one-pot solvothermal method was employed to synthesize VCrZnO4 NPs, followed by a comprehensive structural and morphological analysis using a variety of techniques, including X-Ray diffraction, scanning electron microscopy, high-resolution transmission electron microscopy, Energy-dispersive X-ray, and X-ray photoelectron spectroscopy. These techniques confirmed the crystallinity of the NPs. The VCrZnO4 NPs were tested for their antibacterial activity against primary contaminants such as Enterobacteriaceae, including Shigella flexneri, Salmonella cholerasis, and Escherichia coli, commonly found in hospital settings, using the broth dilution technique. The results indicated a stronger antibacterial activity of VCrZnO4 NPs against Shigella and Salmonella than E. coli. Electron microscopy showed that the NPs caused severe damage to the bacterial cell wall and membrane, leading to cell death. In addition, the study evaluated the anticancer activities of the metal complexes in vitro using colorectal cancer cells (HCT-116) and cervical cancer cells (HELA), along with non-cancer cells and human embryonic kidney cells (HEK-293). A vanadium complex demonstrated efficient anticancer effects with half-inhibitory concentrations (IC50) of 38.50+3.50 g/mL for HCT-116 cells and 42.25+4.15 g/mL for HELA cells. This study highlights the potential of Zinc Chromium vanadate nanoparticles as promising candidates for antibacterial and anticancer applications. Various advanced characterization techniques were used to analyze the properties of nanomaterials, which may help develop more effective and safer antibacterial and anticancer agents in the future.

Factors influencing road traffic accidents causing maxillofacial injuries in Nalgonda District: prospective survey of 366 cases.

BACKGROUND: Road traffic accidents are the leading etiological factor for maxillofacial trauma in India. The incidence of these accidents is impacted by various cultural, socioeconomic, and behavioral factors the understanding of which is paramount in assessing their importance in influencing the incidence of maxillofacial injuries. METHODS: Data was collected via a questionnaire from 366 patients who reported with maxillofacial injuries due to Road Traffic Accidents to the casualty and maxillofacial OPD at a tertiary center in the Nalgonda District over a five-year period. Data collected included patient details, type of vehicle involved, speed of the vehicle, type of accident, location of the accident, the seating of the patient, presence of alcohol influence, usage of helmet or seatbelt and the injuries sustained by the patient. Statistical analysis was done using Chi squared test. RESULTS: 88.5%of the patients were male and 87.4% of the cases were injured in RTA involving two-wheeler vehicles. (50.3%) of the accidents took place between 6 pm to 12 am. 41.5% of cases reported their speed at the time of the accident as 40- 60 kmph. 42% of accidents were reported as skid accidents. 70.29% of accidents on rural roads occurred at night (between 6 pm and 6 am) as opposed to 29.71% during the day. Only 4.37% of cases reported wearing seatbelts or helmets. 51.17% of the participants who were driving reported or were observed as being under the influence of alcohol. CONCLUSIONS: The poor conditions of the roads, the lack of use of protective measures while driving, and the high incidence of driving under the influence of alcohol were seen to be the most significant contributing factors to road traffic accidents causing maxillofacial injuries in the Nalgonda population.

Photoplethysmography temporal marker-based machine learning classifier for anesthesia drug detection.

Anesthesia drug overdose hazards and lack of gold standards in anesthesia monitoring lead to an urgent need for accurate anesthesia drug detection. To investigate the PPG waveform features affected by anesthesia drugs and develop a machine-learning classifier with high anesthesia drug sensitivity. This study used 64 anesthesia and non-anesthesia patient data (32 cases each), extracted from Queensland and MIMIC-II databases, respectively. The key waveform features (total area, rising time, width 75%, 50%, and 25%) were extracted from 16,310 signal recordings (5-s duration). Discriminant analysis, support vector machine (SVM), and K-nearest neighbor (KNN) were evaluated by splitting the dataset into halve training (11 patients, 8570 segments) and halve testing dataset (11 patients, 7740 segments). Significant differences exist between PPG waveform features of anesthesia and non-anesthesia groups (p < 0.05) except total area feature (p > 0.05). The KNN classifier achieved 91.7% (AUC = 0.95) anesthesia detection accuracy with the highest sensitivity (0.88) and specificity (0.90) as compared to other classifiers. Kohen's kappa also shows almost perfect agreement (0.79) with the KNN classifier. The KNN classifier trained with significant PPG features has the potential to be used as a reliable, non-invasive, and low-cost method for the detection of anesthesia drugs for depth analysis during surgical operations and postoperative monitoring.

To study the effect of acute infrared radiation-induced alterations in human skin at cellular and molecular level using in vivo confocal Raman spectroscopy.

BACKGROUND: Solar radiations are classified in terms of wavelengths, including visible light, infrared, and ultraviolet. Infrared radiation (IR) accounts the largest proportion of solar radiations that cause oxidative stress-induced aging of human skin. This study investigates the biochemical changes in proteins, lipids, and DNA associated with acute exposure to IR radiations. METHOD: In vivo confocal Raman spectroscopy was used to examine the forearms region of 20 healthy participants with phototype II skin, aged between 18 and 30 years, without IR incidence (T0), with IR incidence 30 minutes (T30) at day 1 and 30 minutes at day 2 (T60). One-way ANOVA and two-tailed t test along with post hoc Bonferroni correction were used to detect the existence of significant differences in the timestamps of stratum corneum, stratum basale, and dermis at all IR wavenumbers under test. RESULTS: An increase in the Raman peaks of stratum corneum lipids, decrease in stratum basal DNA peaks, and a shift in the amide I peak of collagen in the skin dermis were observed. One-way ANOVA results showed significant differences among timestamps of stratum corneum, stratum basale, and dermis at all wavenumbers under test (P < .001). Furthermore, paired timestamps also showed significant differences (P < .016) except at two wavenumbers 1293 cm-1 and 852 cm-1 in stratum corneum and basale layer clusters on timestamps (T0 & T30 and T30 & T60, P > .016). This study proved that confocal Raman spectroscopy is an useful technique for early evaluation of IR-induced skin changes.

Designing a Band for Vehicles' Drivers Induced by Ultraviolet and Infrared Radiations.

Background: Solar radiations that reach the Earth can be divided into ultraviolet, visible light, and infrared. Overexposure to these radiations can facilitate adverse skin diseases such as sunburn, skin cancer, and photoaging. People who drive vehicles for an extended period are likely to develop skin cancer in the exposed body area. Method: This research proposes a wearable protective device around the upper arm to measure the transmitted radiation through the front and the side windows. A novel skin type classification algorithm using a color sensor was created to provide an accurate skin type identification. Also, the device was programmed to calculate the time before sunburn occurrence based on the ultraviolet index, sunscreen's sun protection factor, and skin type. Results: The prototype was tested inside a Toyota Camry model 2001 vehicle with an accuracy of 97%. The front window had transmitted more infrared radiation compared to the side window. The highest recorded value was 76.76 mW/cm2. On the other hand, the side window had transmitted more ultraviolet compared to the front window as it lacks the protective polyvinyl butyral layer that the front window has. The highest recorded ultraviolet index was 3.5. Conclusion: These results highlight the importance of wearing the designed solar band and using appropriate UV and IR protection while driving a vehicle to prevent skin diseases from occurring.

Linking Green Human Resource Practices and Environmental Economics Performance: The Role of Green Economic Organizational Culture and Green Psychological Climate.

An eco-friendly environment with green strategies can help to achieve better environmental performance. However, literature on the relationship between green human resource management practices (GHRMP) and sustainable environmental efficiency (SEF) is limited. Moreover, there is limited knowledge about the factors that could mediate the relationship between GHRMP and SEF. Therefore, the present study examines the impact of green human resource management practices mediating through green psychological climate (GPC) and green organizational culture (GOC) for better environmental efficacy. For this purpose, the primary data on variables are collected by using structured assessment tools and analyzed through regression models. Unlike previous studies, this study adopts a mediation model and unfolds not only the role of green human resource practices in psychological climate and green organizational culture but also clarifies the mediating role of GPC and GOC in sustainable environmental efficiency. The findings unfolded that ecological factors such as green psychological climate, green organizational culture, and sustainable environmental efficiency are positively affected by green human resources management. In addition, green organizational culture and green psychological climate positively mediate the relationship between GHRMP and SEF. This study recommends adopting green human resource management strategies and increasing technical innovations to improve sustainability and economic performance.

Approaches and perspectives for online learning during the COVID-19 pandemic and future chaos.

BACKGROUND: Online learning (OLL) methodology has been incorporated in higher education extensively on the mount over the last few decades and with the onset of COVID-19 situation, the virtual method in academia became essential. After observing worldly destructions and death due to coronavirus, the WHO declared a high alert emergency, and since Pakistan started to follow lockdown since March 2020 to prevent high penetration and consequently, the online teaching method was adapted to keep the learning atmosphere alive. The study is aimed to identify the influencing factors and compliance for the implementation of the OLL system in COVID-19 and, in the future, nonpandemic state as well. MATERIALS AND METHODS: The present study is designed to observe the adaptability and hurdles among pharmacy students, and for the purpose of the study, a questionnaire on the Likert scale was developed and asked to respond from pharmacy undergraduate and postgraduate students after taking consensus, which further analyzed through IBM SPSS Statistics Version 26. RESULTS: The outcomes of the study were analyzed with a high level of conformity; however, the gender-based reservations were observed, and moreover, merits of OLL were observed with high jeopardy. CONCLUSION: The adaptation of OLL, though proved as the only troubleshooter in an uncontrollable situation and enabled universities, professors, and students for patience, resilience, and hopefully, will serve as swift safeguard for future challenges of epidemic and pandemic disasters. According to the evolution theory, brain adaptability and plasticity of human organisms grow the capacity to adjust itself with an advanced characteristic.

Leadership Styles and Organizational Citizenship Behavior for the Environment: The Mediating Role of Self-Efficacy and Psychological Ownership.

Change and environmental patterns are having an immense effect upon the world. Businesses, communities, and even individuals are struggling to perform their role within environmental protection. This paper investigates the role of leadership styles on organizational citizenship behavior for the environment (OCBE) directly and through the mediation of self-efficacy and psychological ownership. The survey technique was used to collect the data from Chinese banking, insurance, medicine, and teaching service sector employees for the current study. The reliability and validity of the scale items were tested. This study used AMOS-SEM for data analysis and testing the developed hypotheses. The empirical results confirmed that responsible, inclusive, authentic, and supportive leadership styles positively impact employees' OCBE. The results further confirm that self-efficacy and psychological ownership act as mediators between leadership and OCBE. The current study widens our understanding of leadership styles and their impact on OCBE, along with limitations associated with the study and future guidelines for investigators.

In vivo confocal Raman spectroscopic imaging of the human skin extracellular matrix degradation due to accumulated intrinsic and extrinsic aging.

BACKGROUND: Skin aging is a dynamic process that affects the entire body, marked by molecular and structural changes. Type I collagen is the most abundant structural component and accounts 80% of total collagen in human skin. The amount of proline and hydroxyproline reflect the quantity and quality of the collagen fiber in the extracellular matrix of skin, which is alerted due to accumulated effects of intrinsic and extrinsic aging. Extrinsic aging is driven by ultraviolet radiation-induced reactive oxygen species production that activates the matrix metalloproteinase and disrupts the extracellular matrix of skin dermis, while intrinsic aging is the non-enzymatic process resulting in advanced glycation end products (AGEs). In the presence of pentosidine-AGEs, aging process is accelerated. METHOD: In vivo Raman spectra of human dermis were collected from forearms of 30 volunteers and were divided into three groups: 10 young adult 25 ± 5 years, 10 old adult 65 ± 10 years and 10 diabetic old adult 65 ± 10 years old male participants. Density functional theory was performed to compute the vibration modes of AGEs, pentosidine, and glucosepane. RESULTS: In vivo confocal Raman spectroscopy detects the specific changes in the proline and hydroxyproline conformation, collagen fiber degradation of type I collagen and AGE protein contribution to specific Raman bands in the aged dermis because of Intrinsic and Extrinsic aging. Statistical t test marked significant differences (P < .01) in Raman peaks of proline and hydroxyproline among young adult, old adult, and diabetic old adult participants at wavenumbers 855, 875, 922, and 938 cm-1 . CONCLUSION: In vivo confocal Raman spectroscopy is a useful tool to detect the AGE markers in the old adult and diabetic old adult male participants, which interacts with the ultraviolet radiations and accelerates the aging process resulting in the extracellular matrix degradation.

An approach to design a wristwatch for the protection of the human skin damage induced by ultraviolet and infrared radiations.

BACKGROUND: Ultraviolet radiations (UV) absorbed by the skin can drive photochemical reactions which range from sunburn to skin cancer. The repeated exposure to Infrared radiations (IR) induces the heat into the skin, which causes dehydration and erythema as an immediate effect. This heat activates the metalloproteinase enzyme that reduces the number of procollagen and collagen fibers in the dermal skin, which results premature skin aging. This work aims to design a protective measure in order to avoid these damages. METHOD: The proposed protective measure is a wristwatch with an alert alarm which can sense UV and IR radiations. Whenever UV/IR radiation levels exceed beyond the defined limits, alarm will be activated that warns the user to apply protective measures. These radiations are detected by SI1145 digital UV Index/IR/visible light sensor and assigned, using Arduino, to an appropriate UV index and IR radiation levels. RESULTS: The IR and UV readings were recorded several times and at four different hours through the day. The readings showed its highest value at 10 am and 2 pm, which are considered the highest sun intensity. The other readings were at 6 am and 5 pm and considered the least dangerous hours. CONCLUSION: The data collected from the sensor are used to program the alarm. To combine all components, a PCB and a prototype were designed and printed. The UV/IR wristwatch is applicable to alert the user from the continuous and accumulated harmful effects of the radiations and enable them to seek protective measures.

Gastric adenocarcinoma expressing human epidermal growth factor receptor in South Asian population.

BACKGROUND/AIM: Gastric cancer is the third leading cause of cancer mortality worldwide. Human epidermal growth factor (Her-2/neu) has shown strong therapeutic implication in breast cancer. Although the prevalence of Her-2/neu over-expression in gastric cancer has been reported across the world, it is still unknown from South Asia. The aim of this study is to evaluate Her-2/neu expression in gastric adenocarcinomas and to correlate with various clinicopathological variables. PATIENTS AND METHODS: A total of 95 consecutive patients undergoing endoscopic biopsy or gastrectomy were recruited in this study. Clinicopathological parameters of all patients were recorded and hematoxylin and eosin (H and E) staining was performed. Over-expression of Her-2/neu was investigated by immunohistochemistry using α-Her-2 antibody. To quantify Her-2/neu over-expression, the Hofmann validation scoring system was used and further its association was seen with age, gender, histopathological type, grade, and stage of the tumor. Data were entered and analyzed using SPSS version 21. A P value of <0.05 was considered as significant. RESULTS: Overall, 21 (22.1%) cases were positive for Her-2/neu overexpression from the total of 95 gastric adenocarcinomas. Her-2/neu was significantly expressed in low-grade gastric cancer (grade I = 50%, grade II = 34.5%, grade III = 14.5%; P = 0.030). Although there was insignificant difference between Her-2/neu over expression and other variables, Her-2/neu score 3+ was predominantly seen in females, age >60 years, Laurens intestinal type, and IIIC stage tumors. CONCLUSION: Her-2/neu is over-expressed in a limited group of gastric cancer patients in our population and indicates a significant strong association with low grades of gastric cancer.

Prevalence of Phantom Limb Pain, Stump Pain, and Phantom Limb Sensation among the Amputated Cancer Patients in India: A Prospective, Observational Study.

INTRODUCTION: The phantom limb pain (PLP) and phantom limb sensation (PLS) are very common among amputated cancer patients, and they lead to considerable morbidity. In spite of this, there is a lack of epidemiological data of this phenomenon among the Asian population. This study was done to provide the data from Indian population. METHODS: The prevalence of PLP, stump pain (SP), and PLS was prospectively analyzed from the amputated cancer patients over a period of 2 years in Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi. The risk factors and the impact of phantom phenomenon on patients were also noted. RESULTS: The prevalence of PLP was 41% at 3 and 12 months and 45.3% at 6 months, whereas that of SP and PLS was 14.4% and 71.2% at 3 months, 18.75% and 37.1% at 6 months, 15.8% and 32.4% at 12 months, respectively. There was higher prevalence of PLP and PLS among the patients with history of preamputation pain, smoking with proximal level of amputation, receiving general anesthesia, receiving intravenous (IV) opioid postoperative analgesia, and developing neuroma or infection. CONCLUSION: The prevalence of PLP and PLS was higher among the cancer amputees as compared to SP, and a few risk factors responsible for their higher prevalence were found in our study. The PLP and PLS lead to considerable morbidity in terms of sleep disturbance and depression.

Genetic Polymorphisms of X-ray Repair Cross-Complementing Group 1 and Apurinic/Apyrimidinic Endonuclease-1 in Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous collection of conditions characterized by irreversible expiratory airflow limitation. The disease is interspersed with exacerbations; periods of acute symptomatic, physiological, and functional deterioration. The present study was designed to investigate the role of X-ray cross-complementing group 1 (XRCC1) and apurinic/apyrimidinic endonuclease 1 (APE1) polymorphisms and the risk of COPD. Blood samples from 354 unrelated subject (age range 18-60 years; 156 with COPD, 198 healthy controls) were collected. Genomic DNA was isolated and genotyped for XRCC1 Arg399Gln and APE1 Asp148Glu using a confronting two pair primers polymerase chain reaction. GA genotype of XRCC1 gene was found to be predominant in the COPD group compared to controls with 1.86-fold increased risk for COPD (OR 1.86, 95 % CI 1.20-2.88, p = 0.0013). TG genotype of APE1 was found to be predominant in COPD group compared to controls with the difference being statistically significant (OR 1.68, 95 % CI 1.08-2.61, p = 0.0043). The GA haplotype was found to be predominant in COPD than controls with a 2.19-fold significant increase (OR 2.19, 95 % CI 1.46-3.28, p = 0.003). Polymorphism in XRCC1 and APE1 gene is associated with an increased risk of COPD.

Breast cancer pain management - a review of current & novel therapies.

Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients' lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients.

Patient expectations and experiences of multiple sclerosis interferon ß-1a treatment: a longitudinal, observational study in routine UK clinical practice.

BACKGROUND: Premature discontinuation and poor treatment adherence are problems in chronic conditions, such as multiple sclerosis in which patients must take long-term treatment in order to receive maximum benefit from their medication. The Assessing needs In Multiple Sclerosis (AIMS) study explored factors related to premature treatment discontinuation and patients' experiences of subcutaneous (sc) interferon (IFN) ß-1a treatment in the UK. METHODS: A questionnaire-based survey was integrated into the Bupa Home Healthcare patient-support program, which delivers sc IFN ß-1a to patients in their home. Data were collected via patient questionnaires incorporated into routine clinical care and administered upon registration of a new patient by the coordinator, following initial delivery of treatment, prior to each delivery during therapy and at the end of treatment. Univariate and multivariate analyses were performed to identify factors associated with premature discontinuation. RESULTS: Data were collected from 2,390 patients (1,267 new; 1,123 existing) from 59 UK prescribing centers (November 2006-April 2011). Following the first delivery of sc IFN ß-1a, 94% (1,149/1,225) of patients had received training, and 73% (818/1,120) reported that they had no concerns. In total, 24% of new patients discontinued therapy by the end of the study. In the univariate model, none of the candidate variables tested were significant predictors of treatment discontinuation. The strongest predictors of discontinuation in multivariate analyses were lack of information prior to starting treatment and patients feeling unwell on treatment and geographic region (P<0.05 for each variable). CONCLUSION: This study suggests that patients feeling well on treatment and provision of high-quality information are the main determinants of persistence with sc IFN ß-1a therapy. A package of care that targets these issues should therefore be considered when initiating sc IFN ß-1a therapy.

Prevalence of phantom breast pain and sensation among postmastectomy patients suffering from breast cancer: a prospective study.

BACKGROUND: With the advent of newer treatment modalities, survival rate among breast cancer patients has improved substantially over the last few years. Hence, the concern has also shifted to the impact of treatment, side effects, and the morbidities arising from disease management. Among them is the development of phantom breast pain (PBP) and sensation (PBS) after mastectomy. METHODS: After obtaining ethical committee approval, 80 patients suffering from carcinoma breast undergoing modified radical mastectomy were enrolled into the study. They were assessed preoperatively for presence of breast pain, disease, and surgical concerns and followed up postoperatively at 6 weeks, 6 and 12 months, respectively, for development of PBP and PBS, and other associated effects. RESULTS: The prevalence of PBP and PBS was 5.4%, 9.5% at 6 weeks, 8.2%, 6.8% at 6 months, and 13.6% and 17% at 12 months, respectively. There was high prevalence of depression, sleep disturbance, and anxiolytic intake among the patients with PBP and PBS (P value < 0.05). CONCLUSION: The prevalence of PBP and PBS was very low and of minor clinical significance. There was higher prevalence of depression, sleep disturbances, and anxiolytic intake among the patients with PBP and PBS, but it did not result in any significant impact on the patients daily activities.