2D Janus ZrSSe/SnSSe Heterostructure: A Promising Candidate for Photocatalytic Water Splitting.

The distinctive physical characteristics and wide range of potential applications in optoelectronic and photovoltaic devices have ignited significant interest in two-dimensional materials. Intensive research attention has been focused on Janus transition metal dichalcogenides due to their unique properties resulting from symmetry disruption and their potential in photocatalysis applications. Motivated by the current fascination with Janus TMD heterostructures, we conducted first-principles calculations to examine the stability, electronic, and optical properties of monolayers consisting of ZrSSe, SnSSe, and the ZrSSe/SnSSe heterostructure. The results indicate that the Janus ZrSSe/SnSSe heterostructure exhibits a structural and mechanical stability. Using the HSE06 functional, the ZrSSe/SnSSe heterostructure shows an indirect band gap of 1.20 eV, and band edge analysis reveals a type-II band alignment. The potential for photo/electrocatalysis in the ZrSSe/SnSSe heterostructure for water splitting or generating reactive oxygen species (ROS) has been explored, and it was found that the oxygen evolution reaction (OER) can spontaneously activate in acidic (pH = 0) media under light irradiation, with a potential of U = 1.82 eV. Additionally, the ZrSSe/SnSSe heterostructure exhibits strong light absorption across a wide range, from visible light to the ultraviolet region, at various levels. These findings open up possibilities for the application of ZrSSe/SnSSe-based materials in optoelectronic devices.

Health-related quality of life among people with diabetes: A cross-sectional study in Hail region, Saudi Arabia ​.

BACKGROUND: Diabetes Mellitus is a serious and expanding health problem, together with the issues of health- related quality of life (HRQoL). This further puts pressure on the government to allocate more funds for public healthcare. OBJECTIVES: This study was devised to evaluate the health-related quality of life of people living with diabetes in Hail region of Saudi Arabia. METHODS: This cross-sectional research was carried out at eight locations in the Hail region of Saudi Arabia between 21st March-20th May 2022 using the adapted version of the Euro QoL-5 dimension (EQ-5D-3L) questionnaire. A multistage random sample approach was used to choose the diabetes clinics, and data collectors approached the participants in the waiting areas to collect the information. The data were analyzed using logistic regression analysis, Mann-Whitney test, and Kruskal-Wallis tests in IBM SPSS statistics 21.0. RESULTS: The mean HRQoL score was 0.71±0.21 with a visual analog score of 68.4±16.2. Despite having much higher levels of quality of life in terms of self-care (85.8%), regular activity (73.8%) and anxiety (71.8%), nearly one half of the people reported moderate pain or discomfort, and more than one third reported having moderate mobility issues. In general, the quality of life for women was poorer than for men. Individuals with diabetes who were unmarried, young, educated, financially secure, and taking only oral medication had much improved HRQoL. The Euro QoL of people with diabetes patients were significantly influenced by gender, marital status, age, education, employment and treatment modality (p-values < 0.05), whereas only treatment modality had a significant impact on the patients' visual analogue measures (p-values < 0.05). CONCLUSIONS: The HRQoL of people with diabetes in Hail region was moderate in general, with pain and mobility issues being particularly prevalent. Gender, marital status, age, education, employment and type of medication therapy are significant predictors of HRQoL of patients with diabetes. Hence, planning and programs to enhance the HRQoL of people with diabetes, especially women is recommended.

Knowledge of Medical Students Towards the Re-emergence of Human Monkeypox Virus.

INTRODUCTION: Declaration of human monkeypox(HMPX) virus as Public Health Emergency of International Concern (PHEIC) by World Health Organisation (WHO) has raised concerns among the public andlack of knowledge is a prominent challenge in curbing this outbreak. Therefore, assessment ofknowledge level on this outbreak among the medical students is also necessary due to the fact that they are the future healthcare practitioners who will be directly involved in the disease management as well as a major source of knowledge dissemination to the public. AIM: The main objective of this study is to assess the knowledge level of medical students at Universiti Sultan Zainal Abidin (UniSZA) regarding the emergence of HMPX. Additionally, the study aims to investigate potential associations between socio-demographic characteristics and knowledge levels, while also identifying factors that predict a high level of knowledge in this context.. METHODS: A descriptive cross-sectional study was conducted among UniSZA undergraduatemedical students from Year 1 to Year 5. A validated questionnaire comprising six socio-demographic variables and 27 knowledge items was shared online. Descriptive statistics, non-parametric tests and multivariate logistic regression were performed using SPSS software. RESULTS: A total of 138 medical students out of 300 participated in this study. Overall, the average knowledge score was 73.95% ±4.43, which indicates that the medical students have moderate knowledge level. Nearly half of them had good knowledge level (n= 68; 49.3%), 43 of them had moderate knowledge level (31.2%), and 27 of them had poor knowledge level (19.6%). There was a significant association between knowledge level and two factors: receiving information on HMPX during their education and seniority (P-value < 0.01 and P-value < 0.05, respectively). Besides, received information on HMPX during their education was a significant predicting factor of good knowledge level (P-value = 0.002). CONCLUSION: The knowledge level among the medical students was relatively inadequate.

Prevalence And Risk Factors Of Sarcopenia In Patients With Cirrhosis: An Observational Study.

Objective: To identify the prevalence and predictors of sarcopenia in cirrhotic patients. METHODS: This observational, cross-sectional study was conducted at the National Institute of Liver and Gastrointestinal Diseases, Karachi, from January 30 to July 31, 2021, and comprised cirrhotic patients of either gender between aged 18-60 years. Clinical and laboratory data was recorded for each patient. Body weight was adjusted for ascites. Sarcopenia was determined based on the Asian Working Group for Sarcopenia-2019 guideline via hand grip strength and chair standing. Independent predictors for sarcopenia were identified. Data was analysed using SPSS 26. RESULTS: Out of 434 cirrhotic patients assessed, 386(89%) were enrolled. Of them, 237(61.4%) were males, 149(38.6%) were females, 327(84.7%) were aged >45 years and 201(52.1%) had moderate professional activity. Sarcopenia was detected in 314(81.3%) patients; 185(59%) males and 129(41%) females. Age, chair exercise and hand grip scores as well as haemoglobin, albumin and potassium levels were significantly associated with sarcopenia (p<0.05). Conclusion: Sarcopenia was found to be very common in patients with cirrhosis. Increasing age, concomitant comorbidities, and presence of liver decompensation increased the risk of sarcopenia.

Impact of Duration of Catheterization on the Success Rate of Trial Without Catheter in Acute Urinary Retention Due to Benign Prostatic Enlargement.

BACKGROUND: The most common cause of acute urinary retention in men over 50 is benign prostate enlargement (BPE). Following the urethral catheterization, a trial without a catheter (TWOC) under the cover of alpha-blockers is given. The timing of TWOC varies from Day 3 to Day 7 of the retention episode. There is a need to study the improvement in the success rate of TWOC with the increasing number of days of catheterization. OBJECTIVE: To measure the success rate of TWOC in acute urinary retention due to benign prostatic enlargement with increasing days of catheterization. METHOD: The study was conducted in Social Security Teaching Hospital Lahore. Patients who presented with acute urinary retention due to benign prostatic enlargement were catheterized and given alpha-blockers. The patients were divided into two groups, one group having TWOC after three days and the other having TWOC after seven days. The success rate of TWOC was calculated and compared in the two groups. All patients included in the study had the first episode of acute retention with a moderately enlarged prostate and no element of second pathology or neurological deficit. RESULTS: A total of 48 patients were included in the study, divided into two groups of 24 patients each. In the first group who underwent TWOC after seven days of catheterization, 15 out of 24 patients had successful TWOC with a success rate of 62.5%. In the second group of 24 patients, who had TWOC after three days of catheterization, only 11 patients had successful TWOC with a success rate of 45.8%. CONCLUSION: There was a marked improvement in the success rate of TWOC with increasing days of catheterization after an acute retention episode, secondary to BPE.

Physics of self-assembly and morpho-topological changes of Klebsiella pneumoniae in desiccating sessile droplets.

HYPOTHESIS: The bacteria suspended in pure water self-assemble into unique patterns depending on bacteria-bacteria, bacteria-substrate and bacteria-liquid interactions. The physical forces acting on bacteria vary based on their respective spatial location inside the droplet cause an assorted magnitude of physical stress. The shear and dehydration induced stress on pathogens(bacteria) in drying bio-fluid droplets alters the viability and infectivity. EXPERIMENTS: We have investigated the flow and desiccation-driven self-assembly of Klebsiella pneumoniae in the naturally evaporating sessile droplets. Klebsiella pneumoniae exhibits extensive changes in its morphology and forms unique patterns as the droplet dries, revealing hitherto unexplored rich physics governing its survival and infection strategies. Self-assembly of bacteria at the droplet contact line is characterized by order-to-disorder packing transitions with high packing densities and excessive deformations (analysed using scanning electron microscopy and atomic force microscopy). In contrast, thin-film instability-led hole formation at the center of the droplet engenders spatial packing of bacteria analogous to honeycomb weathering. FINDINGS: Self-assembly favors the bacteria at the rim of the droplet, leading to enhanced viability and pathogenesis on the famously known "coffee ring" of the droplet compared to the bacteria present at the center of the droplet residue. Mechanistic insights gained via our study can have far-reaching implications for bacterial infection through droplets, e.g., through open wounds.

Comparison Of An Experimental Root Canal Irrigant (Sapindus Mukorossi) And Ethylenediaminetetraacetic Acid On Microhardness Of Human Dentin.

BACKGROUND: The treatment of infected root canals is one of the most essential areas in dentistry. The endodontic therapy comprises of a sequence of steps that includes the purging of disease and infectious tissues from the root canal system. The objective of the study is to compare the effect of an experimental herbal root canal irrigant (Sapindus mukorossi) and Ethylenediaminetetraacetic acid, on the micro hardness of human dentin. METHODS: Ninety single rooted teeth were collected displayed intact external morphology the selected teeth were than divided randomly into 3 groups (n=30); 1 control and 2 experimental groups: Group A consisted of specimen treated with Ethanolic extract of Sapindus mukorossi. Group B consisted of specimen treated with 17% Ethylenediaminetetraacetic acid and Group C (control group) consisted of specimen of roots were sectioned immersed in distilled water. After the removal of crowns, the roots were sectioned embedded in the polymer resin leaving the root dentine exposed, the micro hardness was determined. Then, the samples from each group were treated with respective irrigant solution for 15 minutes and then observation regarding the micro hardness were noted again by using Vickers micro hardness tester. Analysis of data were obtained by application of Wilcoxon signed rank test. RESULTS: The study revealed that there was no significant difference noted in dentin microhardness of group "A" sample after dipping in experimental irrigant solution (Sapindus mukorossi). However, the study found significant difference in context of decrease in dentin microhardness after dipping a sample in a group "B" irrigant solution (17% Ethylenediaminetetraacetic acid). CONCLUSIONS: In order to preserve the strength of dentin that will ultimately be beneficial for increase in survival of teeth in function, probably the herbal extract of Sapindus mukorossi would be better candidate for future endeavour and presented as an economic and effective alternative amongst root canal irrigants.

Incidence Of Tibial Diaphyseal Fractures Among Patients Presenting With Motorcycle Accidents.

Background: To determine the frequency of tibial diaphyseal fractures among patients presenting with motorcycle accidents. It was a cross-Sectional Study, conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi between May to December, 2020. Methods: All patients irrespective of gender, between ages 18-60 years who suffered from a motorcycle injury with a single bone involvement were eligible for the study. All patients who refused to take part in the study, had head injury, or had multiple fractures were excluded from the study. The data included patient's age, sex, associated bones involved and types of injury. The fractures were classified according to whether it was open or closed. Results: A total of 174 patients were included in the study with a mean±SD age of 43.7±12.4. Tibial diaphyseal fracture was found to be in 111 (63.8%) patients as shown. Duration of fracture, gender, side of fracture, type of fracture was done with respect to Tibial diaphyseal fracture among patients. Insignificant difference was noted in age group (p=0.346), duration of fracture (p=0.087), gender (p=0.672), and type of fracture (p=0.063) whereas significant difference was found in side of fracture (p=0.0001). Conclusion: We highlighted the importance of tibial diaphyseal fractures in middle aged men who use motorcycles as a means of transport in Karachi, Sindh which is a frequent finding among these patients. Efforts should be made at both the community and government levels to increase awareness regarding traffic rules and consequences of reckless driving.

Factors Associated with Self-Medication during the COVID-19 Pandemic: A Cross-Sectional Study in Pakistan.

Self-medication (SM) is characterized by the procurement and use of medicines by bypassing primary healthcare services and without consulting a physician, usually to manage acute symptoms of self-diagnosed illnesses. Due to the limited availability of primary healthcare services and the anxiety associated with the COVID-19 pandemic, the compulsion to SM by the public has increased considerably. The study aimed to assess the characteristics, practices, and associated factors of SM by the public during the COVID-19 pandemic in Sargodha, Pakistan. χ2-tests and univariable analyses were conducted to explore the identification of characteristics and the potential contributing factors for SM during COVID-19, while multivariable logistic regression models were run to study the effect of variables that maintained a significant association. The study was performed during July−September 2021, with n = 460 questionnaires returned overall (response rate: 99.5%). The majority of respondents were males (58.7%, n = 270) who live in the periphery of the town (63.9%, n = 294), and most of the respondents belonged to the age group of 18−28 years (73.3%, n = 339). A large number, 46.1% (n = 212), of the participants were tested for COVID-19 during the pandemic, and among them, 34.3% (n = 158) practiced SM during the pandemic; the most common source of obtaining medicines was requesting them directly from a pharmacy (25.0%; n = 127). The chances of practicing SM for medical health professionals were 1.482 (p-value = 0.046) times greater than for non-medical health personnel. The likelihood of practicing SM in participants whose COVID-19 test was positive was 7.688 (p-value < 0.001) times more than who did not test for COVID-19. Allopathic medicines, acetaminophen (23.6%), azithromycin (14,9%), and cough syrups (13%), and over the counter (OTC) pharmaceuticals, vitamin oral supplements, such as Vitamin C (39.1%), folic acid (23.5%), and calcium (22.6%), were the most commonly consumed medicines and supplements, respectively; being a healthcare professional or having a COVID-test prior showed a significant association with the usage of Vitamin C (p < 0.05 in all cases). Respondents who mentioned unavailability of the physician and difficulty in travelling/reaching healthcare professionals were found 2.062-times (p-value = 0.004) and 1.862-times (p-value = 0.021) more likely to practice SM, respectively; SM due to fear of COVID was more common in individuals who had received COVID-tests prior (p = 0.004). Practices of SM were observed at alarming levels among our participants. Consciousness and understanding about the possible adverse effects of SM must be established and validated on a continuous level; in addition, on a commercial level, collaboration from pharmacists not to sell products (especially prescription-only medicines) without a certified prescription must be developed and implemented.

Machine Learning-Based Fragility Assessment of Reinforced Concrete Buildings.

In the past, large earthquakes caused the collapse of infrastructure and killed thousands of people in Pakistan, a seismically active region. Therefore, the seismic assessment of infrastructure is a dire need that can be done using the fragility analysis. This study focuses on the fragility analysis of school buildings in Muzaffarabad district, seismic zone-4 of Pakistan. Fragility curves were developed using incremental dynamic analysis (IDA); however, the numerical analysis is computationally time-consuming and expensive. Therefore, soft computing techniques such as Artificial Neural Network (ANN) and Gene Expression Programming (GEP) were employed as alternative methods to establish the fragility curves for the prediction of seismic performance. The optimized ANN model [5-25-1] was used. The feedforward backpropagation network was considered in this study. To achieve a reliable model, 70% of the data was selected for training and 15% for validation and 15% of data was used for testing the model. Similarly, the GEP model was also employed to predict the fragility curves. The results of both ANN and GEP were compared based on the coefficient of determination, R 2. The ANN model accurately predicts the global drift values with R 2 equal to 0.938 compared to the GEP model having R 2 equal to 0.87.

Tuning the Electronic and Optical Properties of the ZrS2/PtS2 van der Waals Heterostructure by an External Electric Field and Vertical Strain.

Two-dimensional (2D) material-based heterostructures gain increasing interest due to their extraordinary properties and excellent potential for the optoelectronic devices. This study deals with modulation of electronic and optical properties of the ZrS2/PtS2 van der Waals heterostructure under vertical strain and an external electric field based on first principles calculation. Different stacking of ZrS2 and PtS2 layers are considered for the heterostructure formation and the most stable structure with lowest binding energy is selected for further calculations. The stable ZrS2/PtS2 heterostructure shows an indirect band gap of 0.74 eV, which is smaller than that of both ZrS2 and PtS2 monolayers. With the applied external electric field, the band gap value of the ZrS2/PtS2 heterostructure increases with the negative electric field and decreases with the positive electric field. It is observed that the indirect-to-direct band gap transition occurs when the highest negative value of the electric field is applied. In the case of vertical strain applied to the heterostructure, with an increase in compressive strain, the band gap decreases and vice versa for tensile strain. Optical absorption spectra show significant absorption in the visible light region to the ultraviolet light region. This study shows that the electronic and optical properties of ZrS2/PtS2 heterostructures can be modulated by using vertical strains and an external electric field.

The 7-Hydroxyflavone attenuates chemotherapy-induced neuropathic pain by targeting inflammatory pathway.

Vincristine and paclitaxel are widely used chemotherapeutic drugs for the treatment of brain tumors, breast cancer, leukemia, lymphomas, and malignant solid tumors. Though, these drugs are associated with some severe adverse effects including peripheral neuropathic pain. The anti-nociceptive and anti-inflammatory properties of the 7-Hydroxyflavone (7HF) were evaluated in the mice using thermally- and chemically-induced nociception, naloxone antagonistic test, and carrageenan-induced paw edema models. Initially, the in-vitro cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX) inhibitory assays were carried out. Peripheral neuropathic pain was induced in the Sprague Dawley (SD) rats by administration of paclitaxel (4 mg/kg) and vincristine (200 µg/kg) on days 1, 3, 5, 7, and 9, respectively. The protective effect of 7HF was assessed against the chemotherapy-induced peripheral neuropathy in the rats. Moreover, the expression of the inflammatory mediators in the spinal cord was investigated through RT-PCR. In addition, a computational study was performed to find the potential therapeutic targets and the binding mechanism of 7HF. The 7HF caused concentration-dependent inhibition of COX-2 and 5-LOX, it attenuated the nociceptive pain, carrageenan-induced paw edema, and the development of mechanical and cold allodynia, and hyperalgesia dose-dependently without causing motor coordination deficit. Likewise, the 7HF decreased the vincristine-induced increased expression of different inflammatory mediators including COX-2, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1ß (IL-1ß), and nuclear factor-kappa B (NF-κB). The computational study showed the effective interactions of 7HF with the binding sites of NF-κB, COX-2, and 5-LOX, exert its inhibitory activities. These findings reveal that the 7HF has anti-nociceptive, anti-inflammatory, and anti-neuropathic potentials.

Multiscale vapor-mediateddendritic pattern formation and bacterial aggregation in complex respiratory biofluid droplets.

HYPOTHESIS: Deposits of biofluid droplets on surfaces (such as respiratory droplets formed during an expiratory) are composed of water-based salt-protein solution that may also contain an infection (bacterial/viral). The final patterns of the deposit formed and bacterial aggregation on the deposits are dictated by the fluid composition and flow dynamics within the droplet. EXPERIMENTS: This work reports the spatio-temporal, topological regulation of deposits of respiratory fluid droplets and control of bacterial aggregation by tweaking flow inside droplets using non-contact vapor-mediated interactions. Desiccated respiratory droplets form deposits with haphazard multiscale dendritic, cruciform-shaped precipitates when evaporated on a glass substrate. However, we showcase that short and long-range vapor-mediated interaction between the droplets can be used as a tool to control these deposits at nano-micro-millimeter scales. We morphologically control hierarchial dendrite size, orientation and subsequently suppress cruciform-shaped crystals by placing a droplet of ethanol in the vicinity of the biofluid droplet. Active living matter in respiratory fluids like bacteria is preferentially segregated and agglomerated without its viability and pathogenesis attenuation. FINDINGS: The nucleation sites can be controlled via preferential transfer of solutes in the droplets; thus, achieving control over crystal occurrence, growth dynamics, and the final topology of the deposit. For the first time, we have experimentally presented a proof-of-concept to control the aggregation of live active matter like bacteria without any direct contact. The methodology can have ramifications in biomedical applications like disease detection and bacterial segregation.

Fluid dynamics of droplet generation from corneal tear film during non-contact tonometry in the context of pathogen transmission.

Noninvasive ocular diagnostics demonstrate a propensity for droplet generation and present a potential pathway of distribution for pathogens such as the severe acute respiratory syndrome coronavirus 2. High-speed images of the eye subjected to air puff tonometry (glaucoma detection) reveal three-dimensional, spatiotemporal interaction between the puff and tear film. The interaction finally leads to the rupture and breakup of the tear film culminating into sub-millimeter sized droplet projectiles traveling at speeds of 0.2 m/s. The calculated droplet spread radius ( ∼ 0.5 m) confirms the likelihood of the procedure to generate droplets that may disperse in air as well as splash on instruments, raising the potential of infection. We provide a detailed physical exposition of the entire procedure using high fidelity experiments and theoretical modeling. We conclude that air puff induced corneal deformation and subsequent capillary waves lead to flow instabilities (Rayleigh-Taylor, Rayleigh-Plateau) that lead to tear film ejection, expansion, stretching, and subsequent droplet formation.

Turmeric in the management of oral submucous fibrosis: A systematic review and meta-analysis.

Turmeric exhibits a big promise as a therapeutic agent in the management of oral submucous fibrosis (OSMF). The primary aim of our study is to synthesize the evidence of the use of turmeric/curcumin in the management of OSMF. The secondary goal of this study is to assess the limitations of previous studies to identify gaps in evidence for future research and give an evidence-based recommendation regarding the usage of turmeric/curcumin for OSMF patients and outline the direction of research. A comprehensive search of PubMed, Web of Science, Scopus, Cochrane Library database, Google Scholar, clinical trial registries, and hand searching was conducted from inception until December 2018. This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (guidelines). In this review, 11 articles were selected for qualitative analysis and 3 out of 11 were selected for meta-analysis. Of these 11 studies, involving 428 patients, 7 were randomized control trials (RCTs), 1 was a nonrandomized trial, and 3 were observational studies. Turmeric was found to be effective in reducing signs and symptoms of OSMF in all 11 studies. All the studies included in this review have reported improvement in mouth opening after treatment with turmeric formulations. This could also be concluded from the meta-analysis of three RCTs. Similar improvement in tongue protrusion, burning sensation, and cheek flexibility has been reported. The lack of reliable evidence for the effectiveness of turmeric for the management of OSMF is illustrated by the paucity and poor methodological quality of studies retrieved for this review. We recommend that RCTs are needed using larger sample size with longer duration follow-up with special attention to the recurrence of signs and symptoms.

Hyperimmune anti-COVID-19 IVIG (C-IVIG) treatment in severe and critical COVID-19 patients: A phase I/II randomized control trial.

BACKGROUND: Hyperimmune anti-COVID-19 Intravenous Immunoglobulin (C-IVIG) is an unexplored therapy amidst the rapidly evolving spectrum of medical therapies for COVID-19 and is expected to counter the three most life-threatening consequences of COVID-19 including lung injury by the virus, cytokine storm and sepsis. METHODS: A single center, phase I/II, randomized controlled, single-blinded trial was conducted at Dow University of Health Sciences, Karachi, Pakistan. Participants were COVID-19 infected individuals, classified as either severely or critically ill with Acute Respiratory Distress Syndrome (ARDS). Participants were randomized through parallel-group design with sequential assignment in a 4:1 allocation to either intervention group with four C-IVIG dosage arms (0.15, 0.20, 0.25, 0.30 g/kg), or control group receiving standard of care only (n = 10). Primary outcomes were 28-day mortality, patient's clinical status on ordinal scale and Horowitz index (HI), and were analysed in all randomized participants that completed the follow-up period (intention-to-treat population). The trial was registered at clinicaltrials.gov (NCT04521309). FINDINGS: Fifty participants were enrolled in the study from June 19, 2020 to February 3, 2021 with a mean age of 56.54±13.2 years of which 22 patients (44%) had severe and 28 patients (56%) had critical COVID-19. Mortality occurred in ten of 40 participants (25%) in intervention group compared to six of ten (60%) in control group, with relative risk reduction in intervention arm I (RR, 0.333; 95% CI, 0.087-1.272), arm II (RR, 0.5; 95% CI, 0.171-1.463), arm III (RR, 0.167; 95% CI, 0.024-1.145), and arm IV (RR, 0.667; 95% CI, 0.268-1.660). In intervention group, median HI significantly improved to 359 mmHg [interquartile range (IQR) 127-400, P = 0.009)] by outcome day, while the clinical status of intervention group also improved as compared to control group, with around 15 patients (37.5%) being discharged by 7th day with complete recovery. Additionally, resolution of chest X-rays and restoration of biomarkers to normal levels were also seen in intervention groups. No drug-related adverse events were reported during the study. INTERPRETATION: Administration of C-IVIG in severe and critical COVID-19 patients was safe, increased the chance of survival and reduced the risk of disease progression. FUNDING: Higher Education Commission (HEC), Pakistan (Ref no. 20-RRG-134/RGM/R&D/HEC/2020).

Precipitation dynamics of surrogate respiratory sessile droplets leading to possible fomites.

HYPOTHESIS: The droplets ejected from an infected host during expiratory events can get deposited as fomites on everyday use surfaces. Recognizing that these fomites can be a secondary route for disease transmission, exploring the deposition pattern of such sessile respiratory droplets on daily-use substrates thus becomes crucial. EXPERIMENTS: The used surrogate respiratory fluid is composed of a water-based salt-protein solution, and its precipitation dynamics is studied on four different substrates (glass, ceramic, steel, and PET). For tracking the final deposition of viruses in these droplets, 100 nm virus emulating particles (VEP) are used and their distribution in dried-out patterns is identified using fluorescence and SEM imaging techniques. FINDINGS: The final precipitation pattern and VEP deposition strongly depend on the interfacial transport processes, edge evaporation, and crystallization dynamics. A constant contact radius mode of evaporation with a mixture of capillary and Marangoni flows results in spatio-temporally varying edge deposits. Dendritic and cruciform-shaped crystals are majorly seen in all substrates except on steel, where regular cubical crystals are formed. The VEP deposition is higher near the three-phase contact line and crystal surfaces. The results showed the role of interfacial processes in determining the initiation of fomite-type infection pathways in the context of COVID-19.

Effect of nurse led education on anxiety level among coronary artery bypass grafting pre-operative patients.

OBJECTIVE: The objective of this study was to identify the effect of nurse-led pre-operative education in minimizing the level of anxiety among patients waiting for Coronary Artery Bypass Grafting. METHODS: This experimental study was accomplished at National Institute of Cardiovascular Diseases. Out of 136, there were 80 patients identified with the presence of anxiety using AKUADS 4 to 6 weeks before CABG. Data were collected by the primary researcher from July 2016 to December 2016. Patients with anxiety were divided into experimental and non-experimental groups. After pre-operative education to the experimental group, patients from both groups were re-assessed for anxiety level one week before CABG. RESULTS: Data were assessed through non-parametric Wilcoxon sign ranked and Mann Whitney tests. It was found that anxiety reduced significantly in post-assessment among experimental group participants. No significant difference was found for pre-anxiety assessment between experimental and non-experimental groups. It was noted that post assessment anxiety differed significantly between experimental and non-experimental groups. CONCLUSION: Pre-operative education was found effective to decrease level of anxiety among patients waiting for CABG. There was no significant difference between pre and post assessment among patients from non-experimental group.

Burnout among nurses working at Dow and Civil Hospitals in Karachi: A cross-sectional study.

OBJECTIVE: To identify the frequency of burnout and its associated factors among nurses. METHODS: The analytical cross-sectional study was conducted in Karachi from February 1 to March 31, 2018, and comprised nurses from Dow University Hospital and Dr. Ruth Pfau Civil Hospital who had minimum one-year working experience in a tertiary care setting. Maslach Burnout Inventory was used to measure burnout among the nurses. Data was analysed using SPSS 21. RESULTS: Of the 227 nurses, 155(68.3%) were males, 115(50.7%) had 3-5 years of professional experience, and 145(63.9%) had moderate burnout. There was significant association of burnout with duration of professional experience (p=0.004), job nature (p=0.044) and equipment facility in the assigned units (p=0.22). CONCLUSIONS: Moderate level of burnout was found among two-third of the nurses working in tertiary care hospitals in Karachi.

Propensity and quantification of aerosol and droplet creation during phacoemulsification with high-speed shadowgraphy amid COVID-19 pandemic.

PURPOSE: To study propensity of aerosol and droplet generation during phacoemulsification using high-speed shadowgraphy and quantify its spread amid COVID-19 pandemic. SETTING: Aerosol and droplet quantification laboratory. DESIGN: Laboratory study. METHODS: In an experimental set-up, phacoemulsification was performed on enucleated goat eyes and cadaveric human corneoscleral rims mounted on an artificial anterior chamber. Standard settings for sculpt and quadrant removal mode were used on Visalis 100 (Carl Zeiss Meditec AG). Microincision and standard phacoemulsification were performed using titanium straight tips (2.2 mm and 2.8 mm in diameter). The main wound incisions were titrated equal to and larger than the sleeve size. High-speed shadowgraphy technique was used to detect the possible generation of any droplets and aerosols. The visualization and quantification of size of the aerosols and droplets along with calculation of their spread were the main outcome measures. RESULTS: In longitudinal phacoemulsification using a peristaltic pump device with a straight tip, no aerosol generation was seen in a closed chamber. In larger wounds, there was a slow leak at the main wound. The atomization of balanced salt solution was observed only when the phacoemulsification tip was completely exposed next to the ocular surface. Under this condition, the nominal size of the droplet was approximately 50 µm, and the maximum calculated spread was 1.3 m. CONCLUSIONS: There was no visible aerosol generation during microincision or standard phacoemulsification. Phacoemulsification is safe to perform in the COVID-19 era by taking adequate precautions against other modes of transmission.