In vivo effects of a selected thiourea derivative 1-(2-chlorobenzoyl)-3-(2,3-dichlorophenyl) against nociception, inflammation and gastric ulcerogenicity: Biochemical, histopathological and in silico approaches.

The current study was designed to investigate the potential of a synthetic therapeutic agent for better management of pain and inflammation, exhibiting minimal to non-existent ulcerogenic effects. The effect of 1-(2-chlorobenzoyl)-3-(2,3-dichlorophenyl) thiourea was assessed through model systems of nociception and anti-inflammatory activities in mice. In addition, the ulcerogenic potential was evaluated in rats using the NSAID-induced pyloric ligation model, followed by histopathological and biochemical analysis. The test was conducted on eight groups of albino rats, comprising of group I (normal saline), groups II and III (aspirin® at doses of 100 mg/kg and 150 mg/kg, respectively), groups IV and V (indomethacin at doses of 100 mg/kg and 150 mg/kg, respectively), and groups VI, VII, and VIII (lead-compound at 15 mg/kg, 30 mg/kg and 45 mg/kg doses, respectively). Furthermore, molecular docking analyses were performed to predict potential molecular target site interactions. The results showed that the lead-compound, administered at doses of 15, 30, and 45 mg/kg, yielded significant reductions in chemically and thermally induced nociceptive pain, aligning with the levels observed for aspirin® and tramadol. The compound also effectively suppressed inflammatory response in the carrageenan-induced paw edema model. As for the ulcerogenic effects, the compound groups displayed no considerable alterations compared to the aspirin® and indomethacin groups, which displayed substantial increases in ulcer scores, total acidity, free acidity, and gastric juice volume, and a decrease in gastric juice pH. In conclusion, these findings suggest that our test compound exhibits potent antinociceptive, anti-inflammatory properties and is devoid of ulcerogenic effects.

Multidisciplinary management of high-grade pediatric liver injuries.

OBJECTIVE: To present our experience of multidisciplinary management of high-grade pediatric liver injuries. INTRODUCTION: Pediatric high-grade liver injuries pose significant challenge to management due to associated morbidity and mortality. Emergency surgical intervention to control hemorrhage and biliary leak in these patients is usually suboptimal. Conservative management in selected high-grade liver injuries is now becoming standard of care. Management of hemobilia due to pseudoaneurysm formation and traumatic bile leaks requires multidisciplinary management. METHODS: A retrospective review was undertaken for patients presenting with blunt liver injuries at two tertiary care centers in Karachi, Pakistan, from March 2021 to December 2022. Twenty-eight patients were identified, and four patients fulfilled the criteria for grade 4 and above blunt liver injury during this period. RESULTS: One case with grade 4 liver injury developed hemobilia on 7th day of injury. He required two settings of angioembolization but had recurrent leak from pseudoaneurysm. He ultimately needed right hepatic artery ligation. Second patient presented with massive biliary peritonitis 2 days following injury. He was managed initially with tube laparostomy followed by ERCP and stent placement. The third patient developed large hemoperitoneum managed conservatively. One case with grade 5 injury expired during emergency surgery. CONCLUSION: Conservative management of advanced liver injuries can result in significant morbidity and mortality due to high risk of complications. Trauma surgeons need to have multidisciplinary team for management of these patients to gain optimal outcome.

Determination of Normal Anal Position Using the Anal Position Index in Pakistani Neonates.

INTRODUCTION: Anterior displacement of the anus (ADA) is recognized as a common congenital abnormality of the anorectal region and is often associated with constipation. It is diagnosed through a physical examination by measuring the Anal Position Index (API) at birth. METHODS: A cross-sectional study was conducted utilizing non-probability consecutive sampling of all patients presenting with ADA at our institute over a six-month period. The study focused on key variables, including the measurement of scroto-anal and scroto-coccygeal distances in boys and fourchette-anal and fourchette-coccygeal distances in girls. Data collection was carried out using a structured proforma, ensuring prospective data collection from neonates meeting the selection criteria (neonates born at our center and identified by the neonatology team as having a normal anal opening, regardless of their gestational period or birthweight). RESULTS: Our study comprised a cohort of 204 neonates. The Anal Position Index was determined to be 0.36 ± 0.07 for male newborns and 0.24 ± 0.06 for female newborns. Notably, a statistically significant correlation was observed between the API and factors such as gestational age, birth weight, and advancing paternal age. CONCLUSION: The assessment of the API proves highly valuable in identifying indicators of ADA in neonates, facilitating early disease detection, and guiding the prompt management of subsequent functional symptoms, such as constipation, during later stages of life.

Near-total penile amputation secondary to hair Torniquet syndrome - Case of a staged repair with a satisfactory outcome.

Penile Hair Tourniquet Syndrome, a subtype of Penile Tourniquet Syndrome, is a rare condition and a pediatric surgical emergency seen in infants whereby a constricting hair coil strangulates the penis most often at the coronal sulcus, leading to edema, ischemia and necrosis, If untreated, it can potentially lead to development of a urethrocutaneous fistula or even urethral transection and penile amputation. Therefore, a well-timed intervention can prevent complications and lifelong unhappiness. Herein, we present a case of an 11-month-old boy who presented with near total amputation of the glans and underwent two-staged repair with a satisfactory outcome.

Is there an ideal method of reconstruction for proximal humerus osteosarcoma? A review of different reconstruction techniques.

Osteosarcoma is the commonest primary bone malignancy occurring in patients aged <20, and humerus is the third most common site affected by it. In the past, ablative surgery with poor functional outcomes was the only option, but due to advances in chemotherapy, medical imaging and surgical techniques, patient survivorship and the rate of limb salvage surgery has increased significantly. Over the decades many treatment options have been proposed for the reconstruction of the defect following extirpation of the tumour in the proximal humerus, with every procedure having its merits and demerits. However, there is no agreement on the preferred treatment even in similar age groups, and the best way to reconstruct the proximal humerus remains debatable because the restoration of the function of the shoulder girdle remains primarily dependant on the extent of muscle-loss during tumour resection, available surgical expertise and financial constraints in different health systems. The current narrative review was planned to discuss the various reconstruction techniques with their advantages and disadvantages, and a present general review of the relevant literature.

Comparison Of Accelerated Vs Standard Ponseti Technique Among Children's Having Congenital Talipes Equinovarus.

Background: The resurgence and long duration of treatment of the Ponseti method in recent years has been punctuated by less than favourable long-term outcomes for surgically treated feet. Objectives of the study were to compare the two treatment techniques accelerated vs standard Ponseti technique among children's having Congenital Talipes Equinovarus. Methods: This was two years randomized control trial study carried out among total 104 idiopathic congenital talipes equinovarus patients in Orthopaedics and Spine Unit, Hayatabad Medical Complex, Peshawar. A convenient sampling technique was used in this study. Informed written consent was taken from each respondent. Patients in group A was subjected to accelerated ponseti technique and patients in group B was subjected to standard ponseti technique. At one month after treatment, all the patients were re assessed on the basis of pirani score. Data was collected and analyzed using SPSS version 21. Results: This study included a total 104 clinically diagnosed Congenital Talipes Equinovarus patients with mean age 5.5±2.1 months and 52 in each treatment group. Out of total 104 patients 68 (65.4%) were male and 36 (34.6%) were female. They're found significant difference in the mean ponseti scores of these two-group p=0.042 provided comparatively low mean pirani score in accelerated ponseti group. All female child in accelerated ponsati group was responded to the treatment with 100% effectiveness rate. The difference of effectiveness of treatment was significant p=0.015 for children age range 4-8 months divided in two treatment group with good effectiveness 80.8% in accelerated ponseti group. Conclusion: Accelerated ponseti technique is more effective than standard ponseti technique for Congenital Talipes Equinovarus.

Do ridesharing transportation services alleviate traffic crashes? A time series analysis.

OBJECTIVES: On-demand ridesharing services are suggested to provide several benefits, such as improving accessibility and mobility, reducing drive-alone trips and greenhouse gas emissions. However, the impacts of these services on traffic crashes are not completely clear. This paper investigates the availability of Via- an on-demand ridesharing service in Arlington, TX, to identify the effects of this service on traffic crashes. We hypothesize that the launch of Via would result in more shared rides, fewer drive-alone trips and fewer traffic crashes. METHODS: We implement an Interrupted Time Series Analysis (ITSA) approach to study the impact of Via service availability on traffic crashes using weekly counts of all traffic crashes, the number of injuries, and serious injuries that occurred in Arlington from 2014 to 2021. RESULTS: The results show a statistically significant reduction in the weekly number of total crashes and total injuries but do not show any significant impact on the number of serious injuries. Shared Autonomous Vehicles have the potential to reduce traffic crashes caused by driver's fault. CONCLUSIONS: This study reveals the potential impacts ridesharing services can have on traffic crashes and injuries in a mid-sized city. The results of this study can help decision and policymakers to understand the full potential of ridesharing services that can contribute to making relevant decisions toward creating sustainable and safer transportation systems in cities.

A review on the contamination of SARS-CoV-2 in water bodies: Transmission route, virus recovery and recent biosensor detection techniques.

The discovery of SARS-CoV-2 virus in the water bodies has been reported, and the risk of virus transmission to human via the water route due to poor wastewater management cannot be disregarded. The main source of the virus in water bodies is the sewage network systems which connects to the surface water. Wastewater-based epidemiology has been applied as an early surveillance tool to sense SARS-CoV-2 virus in the sewage network. This review discussed possible transmission routes of the SARS-CoV-2 virus and the challenges of the existing method in detecting the virus in wastewater. One significant challenge for the detection of the virus is that the high virus loading is diluted by the sheer volume of the wastewater. Hence, virus preconcentration from water samples prior to the application of virus assay is essential to accurately detect traceable virus loading. The preparation time, materials and conditions, virus type, recovery percentage, and various virus recovery techniques are comprehensively discussed in this review. The practicability of molecular methods such as Polymer-Chain-Reaction (PCR) for the detection of SARS-CoV-2 in wastewater will be revealed. The conventional virus detection techniques have several shortcomings and the potential of biosensors as an alternative is also considered. Biosensing techniques have also been proposed as an alternative to PCR and have reported detection limits of 10 pg/µl. This review serves to guide the reader on the future designs and development of highly sensitive, robust and, cost effective SARS-CoV-2 lab-on-a-chip biosensors for use in complex wastewater.

Fe-N-C single-atom nanozymes based sensor array for dual signal selective determination of antioxidants.

Machine learning algorithms as a powerful tool can efficiently utilize and process large quantities of data generated by high-throughput experiments in various fields. In this work, we used a general ionic salt-assisted synthesis method to prepare oxidase-like Fe-N-C SANs. The possible reason for the excellent enzyme-mimicking activity and affinity of Fe-N-C SANs was further verified by density functional theory calculations. Due to the remarkable oxidase-mimicking activity, the prepared Fe-N-C SANs were used to detect ascorbic acid (AA) with a detection limit of 0.5 µM. Based on the machine learning algorithms, we successfully distinguished six antioxidants (ascorbic acid, glutathione, L-cysteine, dithiothreitol, uric acid, and dopamine) with the same concentration by either one kind of Fe-N-C SANs or three kinds of different Fe-N-C SANs. The usefulness of the Fe-N-C SANs sensor arrays was further validated by the hierarchal cluster analysis, where they also can be correctly identified. More importantly, a SANs-based digital-image colorimetric sensor array has also been successfully constructed and thereby achieved visual and informative colorimetric analysis for practical samples out of the lab. This work not only provides a design synthesis method to prepare SANs but also combines machine learning algorithms with SANs sensors to identify analytes with similar properties, which can further expand to the detection of proteins and cells related to diseases in the future.

Advanced Nanoscale Surface Characterization of CuO Nanoflowers for Significant Enhancement of Catalytic Properties.

In this work, advanced nanoscale surface characterization of CuO Nanoflowers synthesized by controlled hydrothermal approach for significant enhancement of catalytic properties has been investigated. The CuO nanoflower samples were characterized by field-emission scanning electron microscopy (FE-SEM), X-ray powder diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, high-resolution transmission electron microscopy (HR-TEM), selected-area electron diffraction (SAED), high-angular annular dark field scanning transmission electron microscopy (HAADF-STEM) with elemental mapping, energy dispersive spectroscopy (STEM-EDS) and UV-Vis spectroscopy techniques. The nanoscale analysis of the surface study of monodispersed individual CuO nanoflower confirmed the fine crystalline shaped morphology composed of ultrathin leaves, monoclinic structure and purified phase. The result of HR-TEM shows that the length of one ultrathin leaf of copper oxide nanoflower is about ~650-700 nm, base is about ~300.77 ± 30 nm and the average thickness of the tip of individual ultrathin leaf of copper oxide nanoflower is about ~10 ± 2 nm. Enhanced absorption of visible light ~850 nm and larger value of band gap energy (1.68 eV) have further supported that the as-grown material (CuO nanoflowers) is an active and well-designed surface morphology at the nanoscale level. Furthermore, significant enhancement of catalytic properties of copper oxide nanoflowers in the presence of H2O2 for the degradation of methylene blue (MB) with efficiency ~96.7% after 170 min was obtained. The results showed that the superb catalytic performance of well-fabricated CuO nanoflowers can open a new way for substantial applications of dye removal from wastewater and environment fields.

Synthesis of an un-modified gum arabic and acrylic acid based physically cross-linked hydrogels with high mechanical, self-sustainable and self-healable performance.

A novel and simple strategy was designed for the synthesis of an unmodified gum arabic (GA) and acrylic acid (AA) based polymer hydrogels using Fe3+ as a physical cross-linking agent. The hydrogels showed a high mechanical strength, self-sustainability and self-healing ability, which depends on the content of GA and Fe3+ in the composition. The fracture stress increased from 0.23 to 0.841 MPa and a decrease in self-healing from 53 to 34% was observed by increasing the GA amount from 12 to 50% respectively. The self-healing performance of the hydrogels enhanced with the existence of the Fe3+ amount on the interface. Therefore, the 3% addition of Fe3+, increased the self-healing ability of up to 70%. Furthermore, the hydrogels also showed an excellent fatigue resistance up to 20 cycles without any rapture and can beard a load of 2.5 kg for a very long time. After 4 min of resting time, the percent recovery in dissipated energy reaching a high value of 95%, indicating the excellent fatigue resistance performance of the hydrogels. The hydrogels contain 3-5% of water at normal conditions and confirm its environmental stability. This work provides a new direction for the synthesis of unmodified GA based physically cross-linked polymer hydrogels systems and can be applied in bioengineering and robotic science in the future.

Surface Study of CuO Nanopetals by Advanced Nanocharacterization Techniques with Enhanced Optical and Catalytic Properties.

In the present work, a facile one-step hydrothermal synthesis of well-defined stabilized CuO nanopetals and its surface study by advanced nanocharacterization techniques for enhanced optical and catalytic properties has been investigated. Characterization by Transmission electron microscopy (TEM) analysis confirmed existence of high crystalline CuO nanopetals with average length and diameter of 1611.96 nm and 650.50 nm, respectively. The nanopetals are monodispersed with a large surface area, controlled morphology, and demonstrate the nanocrystalline nature with a monoclinic structure. The phase purity of the as-synthesized sample was confirmed by Raman spectroscopy and X-ray diffraction (XRD) patterns. A significantly wide absorption up to 800 nm and increased band gap were observed in CuO nanopetals. The valance band (VB) and conduction band (CB) positions at CuO surface are measured to be of +0.7 and -1.03 eV, respectively, using X-ray photoelectron spectroscopy (XPS), which would be very promising for efficient catalytic properties. Furthermore, the obtained CuO nanopetals in the presence of hydrogen peroxide ( H 2 O 2 ) achieved excellent catalytic activities for degradation of methylene blue (MB) under dark, with degradation rate > 99% after 90 min, which is significantly higher than reported in the literature. The enhanced catalytic activity was referred to the controlled morphology of monodispersed CuO nanopetals, co-operative role of H 2 O 2 and energy band structure. This work contributes to a new approach for extensive application opportunities in environmental improvement.

Infantile haemangioendothelioma of the parotid gland: Case report and review of literature.

Haemangioendotheliomas (HAE), although rare but are the most common parotid gland tumours in children. We report a 4-month-old girl who presented with a progressively enlarging right sided facial swelling overlying the angle of the mandible. An Ultrasound of the lesion and a computed tomography (CT) scan of the head and neck was carried out which revealed a large lesion within the right parotid gland. CT scan further demonstrated a direct communication with the right external carotid artery and external jugular vein. Considering the clinical course and radiological findings, there was sufficient evidence to avoid any invasive testing. Due to the self-limiting nature of the disease, patient was managed expectantly.

Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan.

A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the postoperative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chisquare and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and postsurgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). The study found that pre-surgery wound status could be an indicator for risk of SSI in a post-operative scenario.

Congenital prepubic sinus-An aborted dorsal urethral duplication or a cloacal remnant?

BACKGROUND: Congenital Prepubic Sinus (CPS) is an uncommon urogenital anomaly characterized by a blind tract between the skin over the pubis to anterior of the urinary bladder, Urethra or umbilicus. We report four such cases to emphasize varied clinical presentation and embryological conundrum. METHODS: Following Ethical Review Committee (ERC) approval, medical records of pediatric patients (<16 years) presenting with CPS (identified through operating room records and Hospital Information Management System (HIMS) between 1994 and 2018 were reviewed for demographics, clinical presentation, investigations including histopathology, management and outcome. RESULTS: Four cases of CPS, 3 females and 1 male, age range 9 months to 13 years were managed over 25-years. Clinical presentation includes a discharging sinus and recurrent episodes of cellulitis and abscess formation in pubic area and labia majora. Urological investigations were mostly normal. Insertion of lacrimal probe or plastic sheath of intravenous cannula through the sinus opening was useful to determine the course of sinus and aid its excision. Histology of excised sinus highlights the possible embryological origin. CONCLUSIONS: CPS is a rare anomaly with varied clinical presentation. It seems CPS is an aborted urethral duplication (Stephen Type 3) or a Cloacal remnant. Complete excision of the tract in the reported cases was curative. TYPE OF STUDY: Case series. LEVEL OF EVIDENCE: IV.

Recent trends in molecular epidemiology of Hepatitis C virus in Mardan, KPK Pakistan.

To determine the genotypic distribution of HCV, frequency of risk factors involved in its transmission, and correlation of genotype with viral load in Mardan population which is the second largest city of Khyber Pakhtunkhwa (KPK), Pakistan. Blood samples of 1140 were collected from different regions of Mardan and major proportion of recruited patients were internally displaced people (IDPs), refugees, and slum dwellers. Complete patient's history was analyzed to assess the possible risks involved in HCV transmission. Viral genotype was determined by PCR (polymerase chain reaction) whereas, HCV RNA was measured by qRT-PCR. Data was analyzed using SPSS statistical software. Our results indicate 3a as the most abundant subtype in Mardan population followed by 3b, 2a, 2b, 4a, untypeable, mixed, 1a, and 1b. In contrast to previous findings, genotype 1 was the least prevalent genotype and the overall prevalence of HCV in Mardan population was significantly higher in females (n = 687, 60.2%) than males (n = 453, 39.7%). Significant difference between-genotypes and gender was observed in genotype 1 (p < .034) and genotype 3 (p < .004). The mean age was 44 (SD ±â€¯9.51). The most frequently found mixed genotype was 3a + 1b and mixed genotype was more prevalent in males. The proportion of middle-aged people (41-49 years) was higher whereas, older and younger people were least infected with HCV. This is the first study that showed substantial correlation of genotype 3 with low and intermediate viral load in Mardan population. Moreover, high and extremely high viral load was associated with other genotypes. Our findings showed that most of the patients who experienced high and extremely high viremia in their blood were males and belonged to Takhat Bhai and Mardaan regions. There were significant difference in the prevalence of HCV genotype 3a (p = .001) and genotype 3b (p = .005) in different regions of Mardan. Pre-treatment viral load is significantly high (p 0.001) in tehsil Mardan patients infected with HCV genotype 3 as compared to other genotypes. Unsafe medical practices such as medical and dental surgeries, intravenous drug use, and blood transfusions were the main risk factors for HCV transmission in Mardan, KPK Pakistan. This study gives clear insights into the epidemiological status of HCV in Mardan population. Genotype 3 is correlated with low and intermediate viral load whereas high viral loads were revealed among patients infected with genotypes other than genotype 3. In the absence of better data and robust epidemiological information, this detailed analysis of HCV genotypes with special reference to risk factors, pretreatment viral load, gender, and age will provide the baseline data for development of optimal HCV eradication and preventive strategies.

Histopathological changes induced in liver, kidney, heart and pancreas of rabbits by prolonged oral cyanide exposure.

The aim of the present study was to determine the deleterious effects of prolonged oral cyanide insult on various organs and tissues in rabbits. For this purpose, 12 locally bred adult male rabbits were allocated into two groups of 6 viz. control and experimental. Rabbits in control group were offered feed only while the rabbits in experimental group received feed plus potassium cyanide (KCN) at 3 mg/kg body weight orally for a period of 40 days. None of the rabbit in both the groups demonstrated any of the gross changes in any organ on postmortem examination. Liver was normal in size, shape, texture and color. Kidneys were also normal in size and color. Histopathological examination revealed severe hepatocyte vacuolation and degeneration in liver of rabbits in experimental group. There was also excessive congestion in liver and bile duct of rabbits in experimental group. Kidneys of rabbits in experimental group demonstrated severe glomerular and tubular necrosis and congestion. In the tubular epithelial cells, pyknotic nuclei were also present. On the other hand, heart and pancreas of rabbits in both control and experimental group did not show any histopathological change in microscopic structures. In conclusion, prolonged oral cyanide administration could have harmful effects on liver and kidney functions.

Sensitivity and specificity of CT scan in small bowel obstruction among children.

OBJECTIVE: To determine the sensitivity and specificity of computed tomography scan for diagnosing small bowel obstruction among children. METHODS: The retrospective diagnostic test accuracy study was carried out at the Aga Khan University Hospital, Karachi, and comprised data of all patients aged 2-16 years who presented with clinical features of small bowel obstruction and underwent computed tomography scan of abdomen from January 2001 to December 2015Data was analyzed using SPSS19. RESULTS: Of the 98 subjects, 65(66.0%) were males and 33(34.0%) were females. Overall mean age of the patients was 7.67±4.33 years and mean duration of symptoms was 2.84±1.17 days. Sensitivity, specificity, positive and negative predictive values as well as accuracy of computed tomography scan was 97.4%, 81.8%, 94.9%, 90.0% and 93.9% respectively. CONCLUSIONS: CT scan was found to have a high sensitivity, fairly good specificity and accuracy in revealing small bowel obstruction. However, the scan is known to have its limitations in sub-acute intestinal obstruction and primary peritonitis.

Assessing the efficacy of aqueous garlic extract, sodium nitrite and sodium thiosulfate against prolonged oral cyanide exposure in rabbits.

This study was aimed to compare the efficacy of aqueous garlic extract, sodium nitrite (SNT), sodium thiosulfate (STS) and hydroxocobalamin against oral cyanide exposure in rabbits. For this purpose, forty two adult male rabbits were divided randomly into 7 groups of 6 animals (A-G) each. Rabbits in group A were offered feed only and served as negative control, while the rabbits in group B received feed plus potassium cyanide (KCN) at 3mg/kg orally and were kept as positive control. Animals in group C received feed, KCN and intraperitoneal injection (IP) of aqueous garlic extract at 500mg/kg. Rabbits in group D were given feed, KCN and IP injection of STS at 600mg/kg. Members in group E received feed, KCN and IP injection of both aqueous garlic extract at 500mg/kg and SNT at 20mg/kg. Animals in group F were given feed, KCN and IP injection of both STS at 600mg/kg and SNT at 20mg/kg, while the rabbits in group G received feed, KCN and IP injection of hydroxocobalamin at 300mg/kg. The treatments were given to respective groups for 40 days. The efficacy of the antidotes was measured on the basis of changes in biochemical profile of rabbits in each group. In this study, hydroxocobalamin was found to be significantly more effective cyanide (CNI) antidote than garlic, STS, SNT plus garlic extract, or SNT and STS, either alone or in combination. A combination of SNT and garlic extract was the second most effective CNI antidote. The efficacy of garlic alone was significantly higher than STS alone or in combination with SNT. The efficacy of combined SNT and STS was superior to STS alone in treating rabbits with CNI toxicity. In conclusion, aqueous garlic extract alone or in combination with STS can effectively be used against cyanide toxicity.