Efficacy and safety of peri-partum Esketamine for prevention of post-partum depression in women undergoing caesarian section: A meta-analysis and systematic review of randomized controlled trials.

Postpartum depression (PPD) is a psychiatric condition affecting women post-childbirth. Medication combined with psychotherapy, is the current protocol for its treatment. A meta-analysis was conducted using RevMan 5.4 to explore the efficacy and safety of peri-partum administration of esketamine for preventing PPD. After searching several databases to retrieve the relevant RCTs, seven were included in this analysis, with dichotomous data presented as risk ratio and continuous data as mean difference. The study found a lower incidence of PPD in the esketamine group compared to the control group (RR= 0.37), with significant difference in EPDS scores between the two groups (MD= -1.23) in the first week postpartum. The esketamine group reported a lower prevalence of PPD 4-6 weeks postpartum (RR= 0.48), and no significant difference in EPDS scores after 4 weeks postpartum (MD = -0.10). The esketamine group had a significantly higher incidence of hallucination (RR= 13.85). Other adverse effects, such as dizziness (RR= 4.09), nausea (RR= 0.88), vomiting (RR=0.74), headache (RR=1.52), nightmares (RR=1.22), pruritus (RR=0.29), and drowsiness (RR=1.57) did not show significant differences between the two groups. The study found that esketamine, with manageable side effects, reduces the prevalence of post-partum depression (PPD) after one week as well as after four to six weeks. However, the findings are limited by the limited number of available RCTs, and future research should determine the ideal dosage, the most effective method of administration and the long-term safety profile of esketamine so that it may be considered as an adjunct therapy or a potential sole treatment option.

Work-related musculoskeletal disorders among information technology professionals in Riyadh, Saudi Arabia.

BACKGROUND: This study was done to see the prevalence of work-related musculoskeletal disorders among information technology (IT) professionals in Saudi Arabia, the risk factors associated with them, their consequences, and to propose some preventive measures. MATERIAL AND METHODS: A self-administered online questionnaire that included questions on the demographic data, job nature, medical history, work-related pain after joining information technology profession and distribution and severity of pain was sent to 250 information technology professionals working in Saudi Arabia. RESULTS: Out of 250, 202 (81%) IT professionals participated in the study. At least 62 (32%) reported that they have developed some type of musculoskeletal pain after joining their profession and 38 (61%) respondents further reported that it was so severe that they had to seek some sort of treatment for their pain. On the Visual Analog Scale ranging 0-10, 14 (23%) respondents reported that their worst ever pain was >7. Despite lower representation 67% of the females reported to develop work-related pain. CONCLUSIONS: Development of work-related musculoskeletal pain among information technology professionals has been shown to affect their activities of daily living. It may even force them to change their work setting or reduce working hours. Information technology sector has rapidly grown in Saudi Arabia in the recent times and there is no data on the incidence or prevalence of such disorders among them. Role of ergonomics and counseling should be emphasized during their training that help them work effectively and efficiently. A similar large-scale study should be conducted to see the effect of lifestyle related to COVID-19 on the lives of working population especially IT professionals. Med Pr. 2022;73(5):397-406.

Vaccinomics-Aided Development of a Next-Generation Chimeric Vaccine against an Emerging Threat: Mycoplasma genitalium.

Mycoplasma genitalium, besides urethritis, causes a number of other sexually transmitted diseases, posing a significant health threat to both men and women, particularly in developing countries. In light of the rapid appearance of multidrug-resistant strains, M. genitalium is regarded as an emerging threat and has been placed on the CDC's "watch list". Hence, a protective vaccine is essential for combating this pathogen. In this study, we utilized reverse vaccinology to develop a chimeric vaccine against M. genitalium by identifying vaccine targets from the reference proteome (Strain G-37) of this pathogen. A multiepitope vaccine was developed using proteins that are non-toxic, non-allergic, and non-homologous to human proteins. Several bioinformatic tools identified linear and non-linear B-cell epitopes, as well as MHC epitopes belonging to classes I and II, from the putative vaccine target proteins. The epitopes that showed promiscuity among the various servers were shortlisted and subsequently selected for further investigation based on an immunoinformatic analysis. Using GPGPG, AAY, and KK linkers, the shortlisted epitope sequences were assembled to create a chimeric construct. A GPI anchor protein immunomodulating adjuvant was adjoined to the vaccine construct's N-terminus through the EAAK linker so as to improve the overall immunogenicity. For further investigations of the designed construct, various bioinformatic tools were employed to study the physicochemical properties, immune profile, solubility, and allergenicity profile. A tertiary chimeric design was computationally modeled using I-TASSER and Robetta and was subsequently refined through GalaxyRefine. ProSA-Web was exploited to corroborate the quality of the construct by detecting errors and the Ramachandran plot was used to identify possible quality issues. Simulation studies of the molecular dynamics demonstrated the robustness and flexibility of the designed construct. Following the successful docking of the designed model to the immune receptors, the construct was computationally cloned into Escherichia coli plasmids to affirm the efficient expression of the designed construct in a biological system.

Outbreak investigation and identification of risk factors associated with the occurrence of foot and mouth disease in Punjab, Pakistan.

Foot-and-mouth disease (FMD) is a highly contagious viral disease of domesticated and wild ruminants and pigs that causes enormous economic losses through morbidity, mortality, and trade restrictions. Although the disease is endemic in Pakistan, seasonal outbreaks occur every year throughout the country. This study aimed to investigate FMD outbreaks and to identify the risk factors associated with FMD outbreaks between January and April 2019 in the Punjab province. We performed outbreak investigations (n = 64) for FMD in nine districts of the Punjab province through Divisional Disease Diagnostic Laboratories, Livestock and Dairy Development Department Punjab. Subsequently, we conducted a case-control study including 128 livestock farms (case to control ratio = 1). The data on various plausibly associated factors were collected using a structured questionnaire from each farm. The FMD outbreaks started during the month of January, culminated in February (n = 36, 56.25%) and stopped during the month of April 2019. The most common serotype was O (45.83%), followed by Asia1 (29.17%) and A (13.89%); however, some case farms had mixed infection with serotypes A and O (9.72%) and serotypes O and Asia1 (1.39%). Multivariable analysis revealed that the history of introducing a new animal with unknown FMD vaccination status in the herd (OR =11.51, 95% CI = 3.28 - 40.47), not practicing regular vaccination against FMD (OR = 20.81, 95% CI = 4.59 - 94.35), history of the visit of an animal broker (OR = 9.06, 95% CI = 2.31 - 35.61), distance of the farm to a nearby livestock farm (OR = 6.13, 95% CI = 1.39 - 27.01) and large herd size (OR = 20.79, 95% CI = 2.45 - 176.27) were significantly associated with the occurrence of FMD outbreaks in Punjab province during 2019. In conclusion, improving biosecurity measures, avoiding the introduction of animals without FMD vaccination history and regular vaccination against FMD can significantly reduce the occurrence of the disease on livestock farms in Pakistan.

Overactive bladder: A multicenter study in Pakistan.

OBJECTIVE: To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender. METHODS: The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23. RESULTS: Of the 1291 respondents, 632(49%) were males with a mean age of 37.8±14.4 years, and 659(51%) were females with a mean age of 38.3±13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001). CONCLUSIONS: The prevalence of overactive bladder was found to be low when assessed with strict application.

Doppler-Assessed Ureteric Jet Frequency: A Valuable Predictor of Ureteric Obstruction.

OBJECTIVES: To compare ureterovesical jet frequency in non-obstructed versus obstructed ureter secondary to ureteric stone using ultrasonography in patients presenting with ureteral stones. STUDY DESIGN:  Cross-sectional prospective study. Place of study and duration: Urology Department, The Kidney Centre Post Graduate Training Institute from May 16 to November 15, 2019. METHODS: This study included 97 patients having presented in the emergency department with acute renal colic and were diagnosed as having ureteral stones on a non-contrast-enhanced computed tomography (NCCT). The ureteric jet frequency was measured by Doppler ultrasonography by our radiologist with the Hitachi Aloka F-37 ultrasound machine after they underwent CT. Patients were asked to drink 750-1000 ml of liquids 15-20 minutes before their ultrasonographic examination of both kidneys, ureters, and urinary bladder. The kidney size (length and width) and presence/absence of hydronephrosis were evaluated by grayscale ultrasound. Then, with the help of color Doppler ultrasonography, the frequency of the ureteric jet was recorded. RESULTS: The patient's mean age was 46.66 ± 3.21 years ranging from 37 to 56 years. There were 58 (59.8%) male and 39 (40.2%) female cases. The mean cumulative stone size was 9.77 ± 2.65 mm. According to stone location, 44 (45.4%) cases had upper ureteric, 24 (24.7%) cases had mid ureteric, and 29 (29.9%) cases had lower ureteric stone. The mean obstructive side jet frequency was 0.70/min ± 0.49, and the non-obstructive side jet frequency was 2.89/min ± 1.29 (P < 0.05). CONCLUSIONS: The mean obstructive side jet frequency was 0.70 ± 0.49/min, which, if we compare to the non-obstructed normal ureter, is significantly less. Hence, color Doppler ultrasonography can be helpful to patients who were previously diagnosed with ureteral stones on NCCT to see if their stone has passed. This can be a very cost-effective modality especially in resource-poor countries where repeat CT can be very expensive. The results from this study can also be used in a specific population (i.e., pregnancy) where the use of imaging modalities that involve ionizing radiation is prohibited.

Autonomous Assessment of Delamination Using Scarce Raw Structural Vibration and Transfer Learning.

Deep learning has helped achieve breakthroughs in a variety of applications; however, the lack of data from faulty states hinders the development of effective and robust diagnostic strategies using deep learning models. This work introduces a transfer learning framework for the autonomous detection, isolation, and quantification of delamination in laminated composites based on scarce low-frequency structural vibration data. Limited response data from an electromechanically coupled simulation model and from experimental testing of laminated composite coupons were encoded into high-resolution time-frequency images using SynchroExtracting Transforms (SETs). The simulated and experimental data were processed through different layers of pretrained deep learning models based on AlexNet, GoogleNet, SqueezeNet, ResNet-18, and VGG-16 to extract low- and high-level autonomous features. The support vector machine (SVM) machine learning algorithm was employed to assess how the identified autonomous features were able to assist in the detection, isolation, and quantification of delamination in laminated composites. The results obtained using these autonomous features were also compared with those obtained using handcrafted statistical features. The obtained results are encouraging and provide a new direction that will allow us to progress in the autonomous damage assessment of laminated composites despite being limited to using raw scarce structural vibration data.

Seroprevalence and Associated Risk Factors of Bovine Brucellosis in District Gujranwala, Punjab, Pakistan.

Bovine brucellosis is a contagious zoonotic disease that causes economic losses through abortion and infertility. A cross-sectional study was designed to determine the seroprevalence and associated risk factors of bovine brucellosis in district Gujranwala of Punjab, Pakistan. A total of 220 bovine sera (112 from buffaloes, 108 from cattle) from 46 unvaccinated herds were collected. Parallel testing by the Rose Bengal Plate Test (RBPT) and Indirect Enzyme-linked Immunosorbent Assay (I-ELISA) showed a 58.7% (27/46) herd-level and 22.7% (50/220) animal-level seroprevalence. Seroprevalence was higher (p < 0.001, OR = 7.62) in adult animals (37.2%) compared to younger animals (4.9%). A herd size of >10 animals (p = 0.021, OR = 7.83), less housing space (p = 0.037, OR = 6.39) and history of abortion at the farm (p = 0.023, OR = 5.6) were found as risk factors associated with the seropositivity of brucellosis. There was a substantial agreement between the RBPT and I-ELISA results (Cohen's kappa coefficient (κ) = 64.16, percent agreement = 89.5%). In conclusion, a relatively higher seroprevalence was found compared to the previous reports from the country. Standardization and validation of the advanced diagnostic tests would be needed. Biosecurity, personal protection, quarantine measures and routine screening of animals at the farm level and disease awareness programs and consumption of pasteurized milk in the human population will be helpful in preventing the transmission/zoonosis of the disease.

Comparative evaluation of upper versus lower calyceal approach in percutaneous nephrolithotomy (PCNL) for managing renal calculi.

OBJECTIVE: To compare upper versus lower calyceal approaches in percutaneous nephrolithotomy for managing renal calculi. METHODS: The retrospective study was conducted in the Department of Urology, The Kidney Centre Post-Graduate Training Institute, Karachi, and comprised data of patients who underwent percutaneous nephrolithotomy from January 2014 to January 2015. Patients were divided into upper pole puncture group A and lower pole puncture group B. Data was analysed using SPSS 17. RESULTS: Of the 198 patients, 147(74.2%) were males and 51(25.8%) were females. The overall mean age was 40.64±14.02 years. Of the total, 69(34.84%) were in group A and 129(65.15%) were in group B. Inter-group difference was significant in pre- and post-operative haemoglobin (p<0.05). Post-operative outcomes showed that blood transfusion, stone clearance and complication like tube thoracostomy had significant association with both the groups (p<0.05). Complete clearance was seen in 152(76.8%) patients; 40(74.1%) in group A and 102(81.6%) in group B. CONCLUSIONS: The success rate was found to be better in lower calyceal puncture group than upper calyceal puncture group for the management of renal calculi.

Intelligent Steam Power Plant Boiler Waterwall Tube Leakage Detection via Machine Learning-Based Optimal Sensor Selection.

Boiler waterwall tube leakage is the most probable cause of failure in steam power plants (SPPs). The development of an intelligent tube leak detection system can increase the efficiency and reliability of modern power plants. The idea of e-maintenance based on multivariate algorithms was recently introduced for intelligent fault detection and diagnosis in SPPs. However, these multivariate algorithms are highly dependent on the number of input process variables (sensors). Therefore, this work proposes a machine learning-based model integrated with an optimal sensor selection scheme to analyze boiler waterwall tube leakage. Finally, a real SPP test case is employed to validate the proposed model's effectiveness. The results indicate that the proposed model can successfully detect waterwall tube leakage with improved accuracy vs. other comparable models.

Evolutionary Algorithm Based Capacity Maximization of 5G/B5G Hybrid Pre-Coding Systems.

Hybrid pre-coding strategies are considered as a potential solution for combating path loss experienced by Massive MIMO systems operating at millimeter wave frequencies. The partially connected structure is preferred over the fully connected structure due to smaller computational complexity. In order to improve the spectral efficiency of a partially connected hybrid pre-coding architecture, which is one of the requirements of future 5G/B5G systems, this work proposes the application of evolutionary algorithms for joint computation of RF and the digital pre-coder. The evolutionary algorithm based scheme jointly evaluates the RF and digital pre-coder for a partially connected hybrid structure by taking into account the current RF chain for computations and therefore it is not based on interference cancellation from all other RF chains as in the case of successive interference cancellation (SIC). The evolutionary algorithm, i.e., Artificial Bee Colony (BEE) based pre-coding scheme outperforms other popular evolutionary algorithms as well as the SIC based pre-coding scheme in terms of spectral efficiency. In addition, the proposed algorithm is not overly sensitive to variations in channel conditions.

A review on numerical modeling for magnetic nanoparticle hyperthermia: Progress and challenges.

Recent progress in nanotechnology has advanced the development of magnetic nanoparticle (MNP) hyperthermia as a potential therapeutic platform for treating diseases. Due to the challenges in reliably predicting the spatiotemporal distribution of temperature in the living tissue during the therapy of MNP hyperthermia, critical for ensuring the safety as well as efficacy of the therapy, the development of effective and reliable numerical models is warranted. This article provides a comprehensive review on the various mathematical methods for determining specific loss power (SLP), a parameter used to quantify the heat generation capability of MNPs, as well as bio-heat models for predicting heat transfer phenomena and temperature distribution in living tissue upon the application of MNP hyperthermia. This article also discusses potential applications of the bio-heat models of MNP hyperthermia for therapeutic purposes, particularly for cancer treatment, along with their limitations that could be overcome.

Late-Onset Nonthrombotic Left Common Iliac Vein Compression Secondary to Degenerative Lumbar Disc: A Case Report of May-Thurner Variant.

May-Thurner syndrome (MTS) refers to venous outflow obstruction caused by extrinsic compression of the left common iliac vein (LCIV) by the overlying pulsatile right common iliac artery against lumbar vertebrae. The classic clinical presentation is acute unilateral left leg painful swelling due to deep venous thrombosis in a young woman in the second or third decade of life. We present a case of a 66-year-old woman who presented with late-onset left leg swelling caused by nonthrombotic venous hypertension due to degenerative lumbar disc bulge leading to LCIV compression against the left common iliac artery which was confirmed by computed tomography and intravascular ultrasound. Our case highlights the importance of high index of suspicion for MTS in elderly patients with unilateral leg swelling and the importance of multimodality imaging for understanding the mechanism and appropriate treatment of MTS.

Stenosis Caused by Suture-Mediated Vascular Closure Device in an Angiographic Normal Common Femoral Artery: Its Mechanism and Management.

Vascular closing devices (VCDs) are widely used to replace manual compression at the femoral puncture site and to reduce the discomfort of patients undergoing percutaneous coronary procedure by shortening bed rest. Among the vascular complications related to these devices, the femoral artery stenosis or occlusion is rarely reported, and its standard management is not well established. We report a case of symptomatic femoral artery stenosis caused by suture-mediated VCD and managed using rotational atherectomy device and balloon angioplasty. In addition, we propose the possible mechanisms for this complication.

Novel approach to coronary artery perforation repair.

Coronary artery perforation (CAP) during percutaneous coronary intervention is a rare but serious complication. Treatment options of CAP include prolonged balloon inflation, covered stent, and coil embolization. Although most cases of CAP can be treated with prolonged balloon inflation, some cases, especially Ellis grade III CAP require covered stents or coiling. Covered stents may require a large bore guide catheter and have a high rate of restenosis, which can be a limiting factor in patients with severe peripheral arterial disease. Coil embolization is generally used in distal CAP because coiling in the proximal vessels results in a large territory of infarction. We present a case of an Ellis grade III CAP during rotational atherectomy successfully treated with a novel coiling technique whereby the thrombogenic coil extends through the perforation outside of the vessel, and the intraarterial portion of the coil is excluded from the lumen by drug-eluting stent placement over the proximal portion of the coil.

Outcome of 980 nm diode laser vaporization for benign prostatic hyperplasia: A prospective study.

Purpose: To evaluate the initial experience and outcome of photo-selective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) in Pakistan with the use of a 980 nm diode laser. Materials and Methods: A prospective study was performed from November 2016 to December 2017. A total of 100 patients diagnosed with bladder outlet obstruction secondary to BPH who planned for PVP were enrolled in the study. PVP was carried out with a diode laser at 980 nm (Biolitec Diode 180W laser) in a continuous wave with a 600 nm (twister) fiber. Baseline characteristics and perioperative data were compared. Postoperative outcomes were evaluated by International Prostate Symptom Score (IPSS), post void residual (PVR) and maximum urinary flow rate (Qmax) at 3 and 6 months after surgery. Results: The mean age was 65.82±10.42, mean prostate size was 67.35±16.42, operative time was 55.85±18.01 and total energy was 198.68±49.12 kJ. At 3 months and 6 months, significant improvements were noted (p<0.001) in IPSS 7.04±1.69 (-18.92), Qmax 19.22±4.75 mL/s (+13.09) and and PVR 18.89±5.39 mL (-112.80). Most frequent problems were burning micturition (35%) and terminal dysuria (29%). No significant difference in postoperative hemoglobin was seen in patients who were on anti-platelet drugs. Conclusions: PVP with a diode laser is a safe and effective procedure for the treatment of BPH and is also safe in patients who are on anti-platelet agents.

Postoperative Pain Score of Bupivacaine versus Placebo in Patients Undergoing Percutaneous Nephrolithotomy.

OBJECTIVE: To compare postoperative mean pain score of bupivacaine versus placebo in patients undergoing percutaneous nephrolithotomy. STUDY DESIGN: An experimental study. PLACE AND DURATION OF STUDY: Department of Urology, The Kidney Centre, Postgraduate Training Institute (PGTI), Karachi, from November 2014 to December 2015. METHODOLOGY: A total of 94 patients who underwent standard percutaneous nephrolithotomy, clinically diagnosed renal stone by CT scan, KUB, X-ray or ultrasound were included in the study. Patients were randomly divided into two groups. Forty-seven patients in group A were treated with 20ml/50mg of 0.25% bupivacaine; and 47 patients in group B were treated with normal saline. Postoperatively, visual analog score was used to assess the pain at 6, 12 and 24 hours. Data was analysed using SPSS version 20.0 and student t-test was applied for comparison between the groups. RESULTS: The average age of the patients was 37.23 ±11.31 years. Mean pain score in 24 hours was low in group A as compared to group B (5.22 ±0.76 vs. 7.85 ±0.78; p<0.001). CONCLUSION: Bupivacaine infiltration into the nephrostomy tract is a highly effective and safe in postoperative pain management for patients undergoing standard PCNL.

Predictive Factors for Intraoperative Blood Loss during Percutaneous Nephrolithotomy.

OBJECTIVE: To evaluate the factors that may increase bleeding during Percutaneous nephrolithotomy (PCNL) and correlate them with outcome. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: The Kidney Centre postgraduate Training Institute, Karachi, Pakistan, from July to December 2016. METHODOLOGY: Consecutive patients who underwent PCNL from July to December 2016 were prospectively enrolled. Drop in hemoglobin was divided into three groups: mild <1 gm/dl, moderate 1-2 gm/dl and major >2 gm/dl. Factors such as age, gender, comorbidities, body mass index (BMI), operative time, creatinine levels, renal cortical thickness, stone size, its characteristics and location, puncture type and site, and need for blood transfusion were assessed by Chi-square/ Fisher exact test and Kruskal Wallis test. Predictive factors were assessed by multinomial logistic-regression analyses. RESULTS: Total 305 patients were enrolled in the study. Median age was 37 (27.5-49.1) years with predominantly males (n=217, 71.8%). Median BMI was 27.3 (24.6-31.4) Kg/m2 and mean stone size was 2.7 (2.1-3.4) cm. Two hundred and ninety-seven (97.7%) stones were radio-opaque. Operative time was 95 (60-127) minutes. There were 50.8% patients who had moderate drop in hemoglobin (1-2 gm/dl). Stone size, BMI and operative time were strongly associated with significant drop in hemoglobin. Complete stone clearance was achieved in 256 (84%) patients. Thirty (9.8%) patients needed blood transfusion. None of the patients required angioembolisation. CONCLUSION: BMI, stone size, and operative time were strongly associated with intraoperative blood loss during PCNL.

Awareness of risk factors and fallacies associated with urinary bladder cancer in our population: A prospective survey.

OBJECTIVE: To determine the awareness of risk factors for bladder cancer and false beliefs associated with this disease. METHODS: This cross-sectional study was conducted at the Kidney Centre, Karachi, from January to February 2015, and comprised subjects who presented to the various in-house clinics. The subjects were interviewed using a questionnaire comprising demographic parameters, level of education and awareness of smoking hazards, knowledge and false beliefs associated with bladder cancer. A pilot study was performed prior to the main study and the questionnaire was redesigned accordingly. SPSS 20 was used for data analysis. RESULTS: Of the 1,000 respondents, 593(59.3%) were males and 407(40.7%) were females. Moreover, 229(22.9%) respondents were aware of the association between smoking and bladder cancer compared to 858(85.8%) who knew that there is an association between smoking and lung cancer. Besides, 479(47.9%) respondents said that smoking caused tuberculosis. Patients with a higher level of education were statistically more likely to be aware of the association between smoking and bladder cancer, i.e. 91(9.1%) uneducated, 208(20.8%) primary, 182(18.2%) secondary, 222(22.2%) intermediate and 352(35.2%) graduates (p=0.0001). Most common fallacy associated with bladder cancer was low intake of water 504(50.4%), followed by multiple sexual partners 362(36.2%). CONCLUSIONS: Most patients were unaware of the relationship between bladder cancer and tobacco smoking.