The sustainable use of diverse plants accustomed by different ethnic groups in Sibi District, Balochistan, Pakistan.

The present study was conducted to analyze the utilization of medicinal plants (traditional as well as cultivated) and there recipes accustomed by different ethnic groups of Sibi District (SD), Balochistan, Pakistan. The study was carried out between 2018 and 2021 by using semi-structured and open-ended questionnaire.. The randomly selected methods applied for this study were mainly based on household surveys walk through and interview with indigenous communityage 40 to 80, a total of 75 plants, belonging to 63 genera and distributed among 33 plant families were recorded. The dominant Plant families were the Fabaceae (12%) of all studied taxa, followed by the Amaranthaceae (7%), Asteraceae (6%), Cucurbitaceae, Solanaceae, Poaceae (4% each), Rhamnaceae and Zygophyllaceae (3%). Thirty traditional Food Recipes (TFR) and Traditional Medicinal Recipes (TMR) were novel being first time reported from SD., which are utilized by the local communities in their daily routine. These ethnic TFR and TMR have a tremendous role in preservation and sustainable use of traditional food habits and culture. It was also documented that along with cultivated, the wild edible and medicinal plant preparations play a significant role in in the economic potential and primary health care system of the local communities. The study recommends the specific measures, such as small industries, improved export means, tourism and educational activities, to protect the traditional knowledge and biocultural heritage of the region before its erosion.

Input density tunes Kenyon cell sensory responses in the Drosophila mushroom body.

The ability to discriminate sensory stimuli with overlapping features is thought to arise in brain structures called expansion layers, where neurons carrying information about sensory features make combinatorial connections onto a much larger set of cells. For 50 years, expansion coding has been a prime topic of theoretical neuroscience, which seeks to explain how quantitative parameters of the expansion circuit influence sensory sensitivity, discrimination, and generalization. Here, we investigate the developmental events that produce the quantitative parameters of the arthropod expansion layer, called the mushroom body. Using Drosophila melanogaster as a model, we employ genetic and chemical tools to engineer changes to circuit development. These allow us to produce living animals with hypothesis-driven variations on natural expansion layer wiring parameters. We then test the functional and behavioral consequences. By altering the number of expansion layer neurons (Kenyon cells) and their dendritic complexity, we find that input density, but not cell number, tunes neuronal odor selectivity. Simple odor discrimination behavior is maintained when the Kenyon cell number is reduced and augmented by Kenyon cell number expansion. Animals with increased input density to each Kenyon cell show increased overlap in Kenyon cell odor responses and become worse at odor discrimination tasks.

Hacking brain development to test models of sensory coding.

Animals can discriminate myriad sensory stimuli but can also generalize from learned experience. You can probably distinguish the favorite teas of your colleagues while still recognizing that all tea pales in comparison to coffee. Tradeoffs between detection, discrimination, and generalization are inherent at every layer of sensory processing. During development, specific quantitative parameters are wired into perceptual circuits and set the playing field on which plasticity mechanisms play out. A primary goal of systems neuroscience is to understand how material properties of a circuit define the logical operations-computations--that it makes, and what good these computations are for survival. A cardinal method in biology-and the mechanism of evolution--is to change a unit or variable within a system and ask how this affects organismal function. Here, we make use of our knowledge of developmental wiring mechanisms to modify hard-wired circuit parameters in the Drosophila melanogaster mushroom body and assess the functional and behavioral consequences. By altering the number of expansion layer neurons (Kenyon cells) and their dendritic complexity, we find that input number, but not cell number, tunes odor selectivity. Simple odor discrimination performance is maintained when Kenyon cell number is reduced and augmented by Kenyon cell expansion.

Rosai Dorfman Disease With Extensive Bony Involvement- A Diagnostic Dilemma.

Previously classified as Non Langerhan cell histiocytosis by the Working Group of Histiocytic Society in 1987 Rosai Dorfman Destombes disease was first described by Destombes in 1965 and later in 1969 by Rosai and Dorfman as a rare histiocytic disorder with sinus histiocytosis and massive lymphadenopathy. They exist in both nodal and extranodal forms. Immunohistochemistry is an essential part of diagnosis to differentiate between Langerhans cell histiocytosis and another malignant histiocytosis. Some overlap has also been reported with IgG4-related diseases. We hereby reflect upon a patient who presented to our facility with pyrexia of unknown origin, the challenges faced to reach a diagnosis and the management offered.

Pregnancy and Motherhood Challenges during Postgraduate Training in Pakistan.

In Pakistan, women have outnumbered men in medicine and many women now choose to start a family earlier in their careers. A 24-question survey was electronically distributed over social media. Female postgraduate trainees and consultants who had experienced pregnancy and motherhood during their training were included. Questions were asked about their experiences of pregnancy, news breaking, attitudes of colleagues and supervisors, maternity leaves, and lactational issues. A total of 320 responses were received; Internal Medicine (19.1%), Gynaecology and Obstetrics (15.0%), Surgery 46 (14.4%), and Pediatrics (11.9%) were major specialities. One hundred and nineteen (37.2%) respondents feared they would be considered 'uncommitted" if the news of their pregnancy broke. Breastfeeding was important to 77.5% mothers, but only 40% of the mothers could breastfeed, and 86.2% reported that lactation facilities were inadequate. 50% mothers thought to strongly reconsider their speciality. Postgraduate training programs in Pakistan should be tailored to address the needs of trainee mothers. Key Words: Motherhood, Postgraduate training, Lactation, Pregnancy.

Nodular Lymphocyte Predominant Hodgkin Lymphoma With Aberrant Immunophenotype or Variant Histopathology: Insights From Case Series of Three Patients.

BACKGROUND: Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) with variant histopathology or aberrant immunophenotype is exceedingly rare and there is paucity of data with regards to its clinical characteristics and course. CASE REPORT: Herein, we present three cases of NLPHL with aberrant immunophenotype or variant histopathological picture, which displayed distinct clinical and imaging findings. These case reports involved a patient with CD30 and CD20 positivity without Reed-Sternberg cells present, a NLPHL patient with aggressive, persistent disease activity with progressive transformation to germinal centres, and a patient with combined morphology of NLPHL and classical Hodgkin's lymphoma. CONCLUSION: Aberrant immunophenotype/variant NLPHL might represent a distinct form of NLPHL, sharing characteristics with classical Hodgkin, non-Hodgkin lymphomas or benign, progressive transformation of germinal centre lymphadenopathy.

Management of Allogeneic Stem Cell Transplantation for High-Risk AML following SARS-CoV-2 Associated Pancytopenia with Marked Bone Marrow Biopsy Alterations.

The present study describes a patient aged 70 with very high-risk AML who successfully received a nonmyeloablative matched unrelated donor allograft shortly following SARS-CoV-2 infection, which manifested with mild cough, interstitial abnormalities on chest CT, and pancytopenia with profound bone marrow biopsy histological alterations. In parallel, our study provides bone marrow biopsy data in a series of contemporary patients with serious haematological diseases who had a bone marrow biopsy performed within two weeks of PCR confirmation of SARS-CoV-2 infection. This study is notable because there are no published data describing the bone marrow biopsy changes observed in patients with haematological malignancies and SARS-CoV-2 infection. Finally, it is suggested that nonmyeloablative hematopoietic stem cell transplantation for very high-risk haematological malignancies can be successfully performed following recovery from SARS-CoV-2 infection.

Untangling the wires: development of sparse, distributed connectivity in the mushroom body calyx.

Appropriate perception and representation of sensory stimuli pose an everyday challenge to the brain. In order to represent the wide and unpredictable array of environmental stimuli, principle neurons of associative learning regions receive sparse, combinatorial sensory inputs. Despite the broad role of such networks in sensory neural circuits, the developmental mechanisms underlying their emergence are not well understood. As mammalian sensory coding regions are numerically complex and lack the accessibility of simpler invertebrate systems, we chose to focus this review on the numerically simpler, yet functionally similar, Drosophila mushroom body calyx. We bring together current knowledge about the cellular and molecular mechanisms orchestrating calyx development, in addition to drawing insights from literature regarding construction of sparse wiring in the mammalian cerebellum. From this, we formulate hypotheses to guide our future understanding of the development of this critical perceptual center.

Nephron sparing surgery for renal tumors-comparison of off-clamp partial nephrectomy with hilar clamping.

BACKGROUND AND OBJECTIVE: Open partial nephrectomy (PN) is still considered gold standard procedure for T1 localized renal tumors. Conventional technique involves clamping of the renal artery with or without vein however, renal ischemia produces a certain level of damage to the kidneys. This study aims to investigate potential effect of off-clamp vs. hilar clamping PN on renal function. METHODS: This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution. A total of 90 partial nephrectomies were performed of which 65 cases were eligible for analysis. Non clamping technique was used in 43 while clamp was applied in 22 patients. Variables studied were patients' demographics, clinical variables, the laterality, tumors size and location, R.E.N.A.L nephrometry score, blood loss, tumor histology and surgical margins. Patients' renal function (serum creatinine and eGFR) were determined pre-operatively, at 3 and 12 months follow up. Data was analyzed on SPSS v. 22. RESULTS: Both the groups were comparable with regards to pre-operative renal function. Mean radiological size of tumor was 4.71±1.31 and 3.81±1.0 (0.003) in two groups respectively. Mean R.E.N.A.L nephrometry score was 6.1±1.5 in off-clamp group compared to 7.05 ± 1.7 in clamp group (p=0.04). No statistically significant difference was found in operative duration, blood loss, positive surgical margins and intra/ peri-operative complications. At three months and one year, renal function was better preserved in non-clamp group compared to clamp group (p=0.001 and 0.007 respectively). CONCLUSION: Off clamp open partial nephrectomy is safe and feasible option leading to less decline in renal function.

Presynaptic developmental plasticity allows robust sparse wiring of the Drosophila mushroom body.

In order to represent complex stimuli, principle neurons of associative learning regions receive combinatorial sensory inputs. Density of combinatorial innervation is theorized to determine the number of distinct stimuli that can be represented and distinguished from one another, with sparse innervation thought to optimize the complexity of representations in networks of limited size. How the convergence of combinatorial inputs to principle neurons of associative brain regions is established during development is unknown. Here, we explore the developmental patterning of sparse olfactory inputs to Kenyon cells of the Drosophila melanogaster mushroom body. By manipulating the ratio between pre- and post-synaptic cells, we find that postsynaptic Kenyon cells set convergence ratio: Kenyon cells produce fixed distributions of dendritic claws while presynaptic processes are plastic. Moreover, we show that sparse odor responses are preserved in mushroom bodies with reduced cellular repertoires, suggesting that developmental specification of convergence ratio allows functional robustness.

Despite having a limited number of senses, animals can perceive a huge range of sensations. One possible explanation is that the brain combines several stimuli to make each specific sensation. The olfactory learning system in the fruit fly Drosophila melanogaster is in a part of the brain called the mushroom body. It allows fruit flies to associate a specific smell with a reward (e.g. food) or a punishment (e.g. poison) and behave accordingly. Two groups of neurons process stimuli from sensory receptors in the mushroom body: olfactory projection neurons carry information from the receptors and pass it on to neurons called Kenyon cells. The system relies on Kenyon cells receiving the combined input of multiple olfactory projection neurons, and therefore information from multiple receptors. The number of inputs each Kenyon cell receives is thought to determine the number of sensations that can be told apart, and thus, the number of signals that can be used for learning. While many mechanisms dictating the complexity of a neuron's shape have been described, the logic behind how two populations of neurons become connected to combine several inputs into a single sensation has not been addressed. A better understanding of how these connections are established during development can help explain how the brain processes information, and the D. melanogaster mushroom body is a good system to address these questions. Elkahlah, Rogow et al. manipulated the number of olfactory projection neurons and Kenyon cells in the mushroom body of fruit flies during development. They found that despite there being a varying number of cells, the number of connections into a post-synaptic cell remained the same. This indicates that the logic behind the combinations of inputs required for a sensation depends on the Kenyon cell, while olfactory projection neurons can adapt during their development to suit these input demands. Thus, if there are fewer Kenyon cells, the olfactory projection neurons will each provide connections to fewer cells to compensate, and if there are fewer olfactory projection neurons, each of them will input into more Kenyon cells. To show that the developing mushroom body could indeed adapt to different numbers of olfactory projection neurons and Kenyon cells, the modified flies were tested for olfactory perception: their responses to odor were largely normal. These results underline the robustness of neuronal circuits. During development, the mushroom body can compensate for missing or extra neurons by modifying the numbers of connections between two groups of neurons, thus allowing the olfactory system to work normally. This robustness may also predispose the system to evolutionary change, since it allows the system to continue working as it changes. These findings are relevant to any area of the brain where neurons rely on combined input from many sources.

Routine laboratory surveillance of antimicrobial resistance in community-acquired urinary tract infections adequately informs prescribing policy in England.

OBJECTIVES: To assess whether resistance estimates obtained from sentinel surveillance for antimicrobial resistance (AMR) in community-acquired urinary tract infections (UTIs) differ from routinely collected laboratory community UTI data. METHODS: All patients aged ≥18 years presenting to four sentinel general practices with a suspected UTI, from 13 November 2017 to 12 February 2018, were asked to provide urine specimens for culture and susceptibility. Specimens were processed at the local diagnostic laboratory. Antibiotic susceptibility testing was conducted using automated methods. We calculated the proportion of Escherichia coli isolates that were non-susceptible (according to contemporaneous EUCAST guidelines) to trimethoprim, nitrofurantoin, cefalexin, ciprofloxacin and amoxicillin/clavulanic acid, overall and by age group and sex, and compared this with routine estimates. RESULTS: Sentinel practices submitted 740 eligible specimens. The specimen submission rate had increased by 28 specimens per 1000 population per year (95% CI 21-35). Uropathogens were isolated from 23% (169/740) of specimens; 67% were E. coli (113/169). Non-susceptibility of E. coli to trimethoprim was 28.2% (95% CI 20.2-37.7) on sentinel surveillance (33.4%; 95% CI 29.5-37.6 on routine data) and to nitrofurantoin was 0.9% (95% CI 0-5.7) (1.5%; 95% CI 0.7-3.0 on routine data). CONCLUSIONS: Routine laboratory data resulted in a small overestimation in resistance (although the difference was not statistically significant) and our findings suggest that it provides an adequate estimate of non-susceptibility to key antimicrobials in community-acquired UTIs in England. This study does not support the need for ongoing local sentinel surveillance.

ATLANTIS - Attractor Landscape Analysis Toolbox for Cell Fate Discovery and Reprogramming.

Boolean modelling of biological networks is a well-established technique for abstracting dynamical biomolecular regulation in cells. Specifically, decoding linkages between salient regulatory network states and corresponding cell fate outcomes can help uncover pathological foundations of diseases such as cancer. Attractor landscape analysis is one such methodology which converts complex network behavior into a landscape of network states wherein each state is represented by propensity of its occurrence. Towards undertaking attractor landscape analysis of Boolean networks, we propose an Attractor Landscape Analysis Toolbox (ATLANTIS) for cell fate discovery, from biomolecular networks, and reprogramming upon network perturbation. ATLANTIS can be employed to perform both deterministic and probabilistic analyses. It has been validated by successfully reconstructing attractor landscapes from several published case studies followed by reprogramming of cell fates upon therapeutic treatment of network. Additionally, the biomolecular network of HCT-116 colorectal cancer cell line has been screened for therapeutic evaluation of drug-targets. Our results show agreement between therapeutic efficacies reported by ATLANTIS and the published literature. These case studies sufficiently highlight the in silico cell fate prediction and therapeutic screening potential of the toolbox. Lastly, ATLANTIS can also help guide single or combinatorial therapy responses towards reprogramming biomolecular networks to recover cell fates.

Quality of interdisciplinary postsimulation debriefing: 360° evaluation.

Introduction: Debriefing is widely perceived to be the most important component of simulation-based training. This study aimed to explore the value of 360° evaluation of debriefing by examining expert debriefing evaluators, debriefers and learners' perceptions of the quality of interdisciplinary debriefings. Method: This was a cross-sectional observational study. 41 teams, consisting of 278 learners, underwent simulation-based team training. Immediately following the postsimulation debriefing session, debriefers and learners rated the quality of debriefing using the validated Objective Structured Assessment of Debriefing (OSAD) framework. All debriefing sessions were video-recorded and subsequently rated by evaluators trained to proficiency in assessing debriefing quality. Results: Expert debriefing evaluators and debriefers' perceptions of debriefing quality differed significantly; debriefers perceived the quality of debriefing they provided more favourably than expert debriefing evaluators (40.98% of OSAD ratings provided by debriefers were ≥+1 point greater than expert debriefing evaluators' ratings). Further, learner perceptions of the quality of debriefing differed from both expert evaluators and debriefers' perceptions: weak agreement between learner and expert evaluators' perceptions was found on 2 of 8 OSAD elements (learner engagement and reflection); similarly weak agreement between learner and debriefer perceptions was found on just 1 OSAD element (application). Conclusions: Debriefers and learners' perceptions of debriefing quality differ significantly. Both groups tend to perceive the quality of debriefing far more favourably than external evaluators. An overconfident debriefer may fail to identify elements of debriefing that require improvement. Feedback provided by learners to debriefers may be of limited value in facilitating improvements. We recommend periodic external evaluation of debriefing quality.

Paediatric External Ventricular Drains: Experience from a tertiary care hospital of a Developing Country.

The aim of the study was to describe indications and complications of external ventricular drain (EVD) placement in children aged between 1 month and 16 years. This retrospective chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised all children who underwent EVD placement from January 2007 to December 2014. Of the 177 patients identified, 117(66%) were males 60(34%) were girls. The overall mean age was 5.4±5.2 years. The median Glasgow Coma Scale score on presentation and discharge was 13 (interquartile range [IQR]: 7) and 15 (IQR: 4), respectively. Major diagnosis included intracranial tumour 60(34%), bacterial meningitis 34(19%), tuberculous meningitis 33(18.6%), and haemorrhage 23(13%). Clinical indications for EVD insertion were acute hydrocephalus secondary to infection 64(36.2%), tumour 54(30.5%), and haemorrhage 23(13%) ventriculoperitoneal shunt malfunction or infection 25(14.1%) and traumatic brain injury 11(6.2%). Complications were observed in 47(26%) patients including infections 25(14.1%), malfunction 11(6.2%), haemorrhage 6(3.4%), misplacement 3(1.7%) and obstruction 2(1.1%). Staphylococcus was the main organism isolated. Moreover, 25(14%) patients expired. Acute hydrocephalus was the major indication and EVD infection was the major complication.

The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review.

OBJECTIVE: To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. DESIGN: A systematic review. DATA SOURCES: Embase, Ovid Medline and PsycINFO databases. STUDY SELECTION: Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. DATA EXTRACTION: The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions. RESULTS: We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation. CONCLUSIONS: There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread.