An Assessment of Personal Hygiene Practices Among Young Adults: A Cross-Sectional, Descriptive Study.

Background Personal Hygiene behavior and practices play a major role in health promotion and disease prevention. Socio-demographic, behavioral, and psychological factors sway a person's overall adaptation of good practices. Disease burden leading to loss of productivity and its influence on the economy cannot be overstated. As medical professionals come in contact with a large number of people, they carry the potential to be super-spreaders in disease outbreaks. Thus, it is of utmost importance that medics and paramedics maintain hygiene to the highest standards. Method This cross-sectional study comprised 323 young adult participants from Muslim Town, Faisalabad. A structured questionnaire containing close-ended questions was used for data collection regarding personal hygiene behavior and practices. Dependency between various qualitative categorical variables and hygiene practices was analyzed using Chi-squared tests. Results It was found that although the majority of the participants followed good hygiene for most of the practices; laziness, lack of relevant education, improper time management, and unreliable water supply posed a significant barrier to good practices. Females had demonstrably better practices compared to males. Urbanity did not have a significant correlation with the results.  Conclusion We conclude that a rigorous program of awareness and education regarding this subject is the need of the hour to facilitate an improvement in predictive and preventive health care and reduce morbidity and mortality. Steps should be taken to ease the barriers that are obstructing optimal hygienic practices.

A novel homozygous frameshift variant in DNAH8 causes multiple morphological abnormalities of the sperm flagella in a consanguineous Pakistani family / 亚洲男科学杂志(英文版)

Multiple morphological abnormalities of the sperm flagella (MMAF) is a severe form of asthenozoospermia categorized by immotile spermatozoa with abnormal flagella in ejaculate. Whole-exome sequencing (WES) is used to detect pathogenic variants in patients with MMAF. In this study, a novel homozygous frameshift variant (c.6158_6159insT) in dynein axonemal heavy chain 8 (DNAH8) from two infertile brothers with MMAF in a consanguineous Pakistani family was identified by WES. Reverse transcription-polymerase chain reaction (RT-PCR) confirmed DNAH8 mRNA decay in these patients with the DNAH8 mutation. Hematoxylin-eosin staining and transmission electron microscopy revealed highly divergent morphology and ultrastructure of sperm flagella in these patients. Furthermore, an immunofluorescence assay showed the absence of DNAH8 and a reduction in its associated protein DNAH17 in the patients' spermatozoa. Collectively, our study expands the phenotypic spectrum of patients with DNAH8-related MMAF worldwide.

Functional Outcome Of Bristow-Latarjet Procedure In Post-Traumatic Recurrent Anterior Shoulder Instability.

BACKGROUND: Due to its lack of bony support, the shoulder joint has the broadest range of motion out of all the joints in the body. Instead, one of the joints that dislocate most frequently is the shoulder joint. Multiple pathologic abnormalities, including the traumatic separation of the anterior-inferior capsule-labral complex from the glenoid rim, are caused by repeated anterior glenohumeral dislocation. The objective of the study is to ascertain the Bristow-LATARJET procedure's efficacy in situations of recurrent post-traumatic anterior shoulder instability. METHODS: From 31 January 2020 to 31 July 2020, a descriptive case series was undertaken in the orthopaedic surgery department of the Lahore General Hospital. For this study, 71 patients who met the inclusion and exclusion criteria were recruited, and all interventions were conducted while the patients were lying in a beach chair while under general anaesthesia. The Delto-pectoral incision surgical technique was applied. For 12 weeks, all patients underwent clinical follow-up, and the results were documented. RESULTS: There were 50(70.4%) males and 21(29.6%) females in this study & the mean age of the patients were 34.64±10.73. There were 37(52.1%) patients among them the outcome of treatment (Rowe Scale at 12th week) was excellent, among 21(29.6%) it was good, among 8(11.3%) it was fair and among 5 (7.0%) it was poor. There was a significant association between the outcome of treatment (Rowe scale at 12th week) and age groups (p-value: 0.000). CONCLUSIONS: The Bristow-LATARJET procedure is deemed to be a very productive, safe, and problem-free procedure for curing post-traumatic reoccurring traumatic anterior shoulder instability.

Increased levels of inflammatory molecules in blood of Long COVID patients point to thrombotic endotheliitis

The prevailing hypotheses for the persistent symptoms of Long COVID have been narrowed down to immune dysregulation and autoantibodies, widespread organ damage, viral persistence, and fibrinaloid microclots (entrapping numerous inflammatory molecules) together with platelet hyperactivation. Here we demonstrate significantly increased concentrations of Von Willebrand Factor, platelet factor 4,serum amyloid A, -2antiplasmin E-selectin, and platelet endothelial cell adhesion molecule-1, in the soluble part of the blood. It was noteworthy that the mean level of -2-antiplasmin exceeded the upper limit of the laboratory reference range in Long COVID patients, and the other 5 were significantly elevated in Long COVID patients as compared to the controls. This is alarming if we take into consideration that a significant amount of the total burden of these inflammatory molecules has previously been shown to be entrapped inside fibrinolysis-resistant microclots (thus decreasing the apparent level of the soluble molecules). We also determined that by individually adding E-selectin and PECAM-1 to healthy blood, these molecules may indeed be involved in protein-protein interactions with plasma proteins (contributing to microclot formation) and platelet hyperactivation. This investigation was performed as a laboratory model investigation and the final exposure concentration of these molecules was chosen to mimic concentrations found in Long COVID. We conclude that presence of microclotting, together with relatively high levels of six inflammatory molecules known to be key drivers of endothelial and clotting pathology, points to thrombotic endotheliitis as a key pathological process in Long COVID. This has implications for the choice of appropriate therapeutic options in Long COVID. SENTENCE SUMMARYThe presence of fibrinaloid microclots and multiple inflammatory molecules in the soluble part of blood points to thrombotic endotheliitis as a key pathological process in Long COVID.

Long Covid active case finding: a co-produced community-based pilot within the STIMULATE-ICP study (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways)

Background and aimLong Covid is a significant public health concern with potentially negative implications for health inequalities. We know that those who are already socially disadvantaged in society are more exposed to COVID-19, experience the worst health outcomes and are more likely to suffer economically. We also know that these groups are more likely to experience stigma and discrimination and have negative healthcare experiences even before the pandemic. However, little is known about disadvantaged groups experiences of Long Covid and preliminary evidence suggests they may be under-represented in those who access formal care. We will conduct a pilot study in a defined geographical area (Camden, London, UK) to test the feasibility of a community-based approach of identifying Long Covid cases that have not been formally clinically diagnosed and have not been referred to Long Covid Specialist services. We will explore the barriers to accessing recognition, care and support, as well as experiences of stigma and perceived discrimination. MethodsThis protocol and study materials were co-produced with a Community Advisory Board (CAB) made up primarily of people living with Long Covid. Working with voluntary organisations, promotional material are co-developed and will be distributed in the local community with engagement from key community organisations and leaders to highlight Long Covid symptoms and invite those experiencing them to participate in the study if they are not formally diagnosed and accessing care. Awareness of Long Covid and symptoms, experiences of trying to access care, as well as stigma and discrimination will be explored through qualitative interviews with participants. Upon completion of the interviews, participants will be offered referral to the local social prescribing team to receive support that is personalised to them potentially including, but not restricted to, liaising with their primary care provider and the regional Long Covid clinic run by University College London Hospitals (UCLH). Ethics and disseminationEthical approval has been obtained from the Faculty of Medicine Ethics Committee and Research Integrity and Governance, University of Southampton. (reference number 72400). Findings will be reported in a report and submitted for peer-reviewed publication. Definitive methods of dissemination will be decided by the CAB. Summaries of the findings will also be shared on the STIMULATE-ICP website, locally in the study area and through social media. We will specifically target policy makers and those responsible for shaping and commissioning Long Covid healthcare services and social support such as NHSE England Long Covid Group.

Comparison of sleep quality among COVID-19 patients and non-COVID-19 population in Pakistan: A cross sectional study during the COVID-19 pandemic.

Background: Adverse effects on the health and well-being changes may also express as a decreased sleep quality in COVID-19 patients. This study aimed to assess sleep quality among confirmed COVID-19 patients and the non-COVID-19 Pakistani population. Methods: An online cross-sectional survey was conducted between April and September 2020 in Punjab province, Pakistan. Information about demographic characteristics, COVID-19 diseased status, prior knowledge about COVID-19, and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) was collected. Results: A total of 597 participants were included in this study, 296 (49.6%) COVID-19 patients and 301(50.4%) non-COVID-19 population. The PQSI was used to measure seven distinct sleep components; subjective quality, latency, duration, efficiency, disturbances, medication, and daytime dysfunction. Where mean ± standard deviation (SD) were 0.96 ± 0.743, 1.47 ± 1.032, 0.97 ± 1.006, 0.61 ± 0.995, 1.13 ± 0.649, 0.23 ± 0.651, 1.02 ± 0.861 respectively in total population (N = 597). Sleep latency, sleep duration, and sleep efficiency did not show a significant difference in the T-Test. While sleep quality, sleep disturbances, sleep medication, and daytime dysfunction showed a significant difference between both populations. Conclusion: In conclusion, we highlighted the poor sleep quality in COVID-19 patients as compared to the non-COVID-19 population.

Contamination by hazardous elements in low-priced children's plastic toys bought on the local markets of Karachi, Pakistan.

Children's plastic toys may contain toxic metals to which infants and young children can be orally exposed and may pose acute or chronic adverse health effects. This research aims to evaluate the total metal concentrations (TMCs) of Pb, Cd, Cr, Ni, Zn, Cu, and Mn in children's plastic toys bought in the local markets of Karachi, Pakistan, and compare TMCs to different toy safety regulatory limits. A total of 44 children's plastic toys sourced in the Karachi local markets were analyzed by an atomic absorption spectrophotometer for contamination of hazardous elements. Toy samples were divided into two groups: plastic toys (DCT) and plastic toys with paints or coatings (DPCT). For plastic toys, 83% (19) of samples had TMCs that exceeded European Union (EU) toy safety regulation limits for Pb, and 65% (15) of samples that exceeded for Cd. For plastic toys with paints or coating, 43% (9) of samples had TMCs that exceeded EU migration limits for Pb and 24% (5) for Cd. More than 20 samples exceeded the United States Consumer Product Safety Commission (US CPSC), Canadian, and Bureau of Indian Standards (BIS) toy safety regulation limits. In toy samples (n = 44), very high TMCs of Pb (64%), Cd (45%), Cr (5%), and Ni (2%) were observed. Zn, Cu, and Mn TMCs existed but were below the regulation limits. The contamination levels of Pb, Cd, Cr, and Ni and smaller extent of Zn, Cu, and Mn still pose health issues in children and may cause serious problems in their health.

The risk of cutaneous mucormycosis associated with COVID-19: A perspective from Pakistan.

As a developing country, Pakistan reports a high burden of fungal diseases, of which cutaneous mucormycosis remains a prominent infection, presenting as a highly invasive disease with significant mortality. Apart from a high population of at-risk individuals, multiple factors have precipitated an increment in mucormycosis cases in the country following the COVID-19 pandemic. These include increased use of corticosteroids, immunosuppression following the viral infection, prolonged stays in the intensive care unit and sub-optimal laboratory testing available in the country. This article aims to assess the potential implications of a mucormycosis epidemic on a healthcare system already strained under the COVID-19 pandemic, and provides subsequent recommendations to weather the dual challenge of two deadly pathogens.

Novel biallelic loss-of-function mutations in / 亚洲男科学杂志(英文版)

Multiple morphological abnormalities of the sperm flagella (MMAF) is a specific type of asthenoteratozoospermia, presenting with multiple morphological anomalies in spermatozoa, such as absent, bent, coiled, short, or irregular caliber flagella. Previous genetic studies revealed pathogenic mutations in genes encoding cilia and flagella-associated proteins (CFAPs; e.g., CFAP43, CFAP44, CFAP65, CFAP69, CFAP70, and CFAP251) responsible for the MMAF phenotype in infertile men from different ethnic groups. However, none of them have been identified in infertile Pakistani males with MMAF. In the current study, two Pakistani families with MMAF patients were recruited. Whole-exome sequencing (WES) of patients and their parents was performed. WES analysis reflected novel biallelic loss-of-function mutations in CFAP43 in both families (Family 1: ENST00000357060.3, p.Arg300Lysfs*22 and p.Thr526Serfs*43 in a compound heterozygous state; Family 2: ENST00000357060.3, p.Thr526Serfs*43 in a homozygous state). Sanger sequencing further confirmed that these mutations were segregated recessively in the families with the MMAF phenotype. Semiquantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) was carried out to detect the effect of the mutation on mRNA of the affected gene. Previous research demonstrated that biallelic loss-of-function mutations in CFAP43 accounted for the majority of all CFAP43-mutant MMAF patients. To the best of our knowledge, this is the first study to report CFAP43 biallelic loss-of-function mutations in a Pakistani population with the MMAF phenotype. This study will help researchers and clinicians to understand the genetic etiology of MMAF better.

The Epidemiology of COVID-19 and applying Non Pharmaceutical interventions by using the Susceptible, Infectious Recovered epidemiological Model in Pakistan.

IntroductionThe COVID-19 is caused by the virus known as sever acute respiratory syndrome corona virus 2 (SARS-CoV-2) having the common symptoms such as Flue, fever, dry cough and shortness of breath. The first case was reported in WUHAN city china in December 2019 and it spread to the whole world, WHO declared as world pandemic on 11th march 2020. SIR Epidemiological ModelThe first case in Pakistan was confirmed on 26th Feb 2020 as by the 8th April 2020 the total no of confirmed cases 4187 with 58 deaths and 467 recoveries throughout the country. The upcoming situation of the COVID-19 in Pakistan is forecasted by using SIR epidemiological, which is one of the mathematical derivative models with great accuracy rate prediction used for infectious disease. This model was introduced in the early 20th century. ResultsPakistan is will be having a heavy burden of patients 80000 plus infected patients 45000 recoveries 10000 hospitalized 3000 ICU and 800 plus deaths in the next 20 days. A complete lock down, social distancing and imposing curfew to keep every person at home can save Pakistan from a very huge number 1000000 infected patients with huge number of causalities with next 2 months.

Antifungal activity of silver nanoparticles from Aspergillus niger.

In recent years, silver nanoparticles have gained attention because of their high surface area to volume ratio that makes them more advantageous than their bulky counterparts. Apart of chemical and physical methods of silver nanoparticles (AgNPs) production, green synthesis is being exploited by the researchers. Aspergillus niger are among some fungi being used in fabrication of silver nanoparticles and their antifungal activities are being studied. We have experimented using A. niger Gin for extracellular silver nanoparticle synthesis. Characterization of AgNPs was done by UV-Visible spectroscopy and SEM-EDS.

Metal-based biologically active compounds: Synthesis, spectral and antioxidant studies of transition metal complexes with hydrazone derivatives.

New series of Co+2, Ni+2, Cu+2 and Zn+2 complexes have been synthesized using a bio-active hydrazone compound 4-hydroxybenzaldehyde-N-(5-chloro-2-oxo-1,2-dihydro-3H-indol-3-ylidene), abbreviated as [HL]. Complexes were characterized using elemental analysis, FT-IR, UV-visible spectroscopy conductivity and magnetic susceptibility measurements. Results showed that the bi-dentate [HL] coordinated in a square planner manner with Cu+2 while for the rest of the M+2 ions, it coordinated in a octahedral fashion. Free ligand and its metal complexes were also studied for their antioxidant potential by employing two methods i.e. DPPH radical scavenging and reducing power assay. It was observed that the metal complexes were considerably more potent free radical scavenger and had better reducing abilities compared to the free ligand, furthermore, for both in vitro assays, metal complexes turned out to be better DPPH scavengers and had better reducing abilities than the standards used during biological assays.

Spectroscopic and cytotoxic studies of losartan complexes.

Use of drug-metal complexes for the treatment of several human diseases has resulted in significant progress in the field of medicinal inorganic chemistry. The current study describes the synthesis and characterization of Cu (II) and Ni (II) complexes of Losartan, an antihypertensive drug. These complexes were evaluated for their cytotoxic activity against four human cancer cell lines; SNB-19, HCT-15, COLO-205 and KB-3-1. Spectroscopic characterization revealed that during complex formation, the metal was bound through the nitrogen atoms of the tetrazole moiety of the losartan molecule. The molecular formulas of copper ([Cu (LS) 2 Cl2].6H2O) and nickel ([Ni (LS) 2Cl2]. H2O) complexes were found to be in agreement with the analytical data obtained through elemental analysis. For both the complexes, metal to ligand ratios of 1:2 were calculated. As revealed by FTIR, UV-Visible, and 1H-NMR studies, both the complexes displayed octahedral geometries. Scanning electron microscopy (SEM) revealed marked changes in the morphology of the complexes, compared to the pure drug. From XRD studies, characteristic crystalline peaks of pure losartan were observed whereas no prominent peaks were observed for its complexes. Complexes were found to be inactive in the cytotoxic activity test performed using SNB-19, HCT-15, COLO-205 and KB-3-1 cell lines.

The burden of HIV-associated neurocognitive disorder (HAND) in the Asia-Pacific region and recommendations for screening.

BACKGROUND: HIV-associated neurocognitive disorder incurs a significant burden on HIV patients in Asia-Pacific countries; however, the incidence is difficult to estimate due to a lack of local epidemiological data. The impact of neurocognitive impairment in HIV patients is often underestimated due to a lack of education and awareness, and there are consequently gaps in the provision of screening and diagnosis to enable earlier intervention to limit neurocognitive impairment. METHOD: This review seeks to redress the imbalance by promoting awareness and education among physicians concerning the neurovirulence of HIV and thereby increase screening efforts to improve diagnosis rates and clinical outcomes for underserved patients in this region. The Asia, Australia, and Middle East (AAME) HAND Advisory Board convened expert regional representatives to review current practice and recommend appropriate measures related to the implementation of standardised screening programmes and treatment recommendations to curb the developing HAND epidemic in the region. In particular, we recommend basic neuropsychological testing protocols that could be efficiently introduced into clinical practice for routine screening. RESULT: We also propose simple guidelines for the management of HAND. We believe that HAND is a significant and under-reported diagnosis in HIV patients that warrants both greater recognition and further clinical investigation of the underlying pathophysiology and the impact of HIV disease progression, with HAND being associated with worse medication adherence and therefore possibly increased risk of ARV treatment failure. DISCUSSION: Widespread screening will lead to greater recognition of HAND and earlier intervention, which may lead to improved management strategies in the future.

Knee dislocations and popliteal artery injury: A single centre experience from Karachi.

OBJECTIVE: To determine the association of popliteal artery injury with simple knee dislocations or knee fracture dislocations, and to evaluate the role of clinical assessment and colour Doppler ultrasound examination in diagnosing these injuries. METHODS: The prospective case series study was done at the Liaquat National Hospital, Karachi, and comprised patients with simple knee dislocations or knee fracture dislocations presenting between February 2013 and April 2014. All patients underwent clinical assessment including distal pulse examination and signs of vascular trauma. Following reduction of dislocation, repeat clinical examination and assessment of limb with colour Doppler ultrasound was carried out. RESULTS: Out of 9 patients in the study, 6(66.7%)had simple dislocations, while 3(33.3%) sustained fracture dislocations of the knee. Two (22%) patients sustained injury to the popliteal artery which was effectively managed via surgical treatment. Clinical examination of the affected extremities effortlessly revealed the 2(22%) vascular trauma cases. Doppler ultrasound was carried out in 8(89%) cases and it successfully excluded 7(78%) cases for vascular trauma and identified 1(11%) injury with reduced flow. This case underwent computed angiography scan and later surgery revealed popliteal artery trauma. Doppler ultrasound was not carried out in 1(11%) case which was a spontaneously relocated knee with hard signs of vascular injury. CONCLUSIONS: Popliteal artery injury can be a limb-threatening complication following trauma to the knee. Carefully performed clinical examination and colour Doppler ultrasound are effective tools for identification of such cases.