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.

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.

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.

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.

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.

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.

Synthesis of nickel nanoparticles using Citrullus colocynthis stem extract for remediation of Reactive Yellow 160 dye.

In current years, pollution caused by synthetic dyes has become one of the most serious environmental issues. By rapidly developing industrial units, effluents having synthetic dyes are directly or indirectly being discharged into the environment. Bio-sorption is cost-effective way for the eradication of toxic dyes present in textile effluent. The present study involves the synthesis of nickel nanoparticles using Citrullus colocynthis stem extract. The characterization of synthesized nickel nanoparticles (Ni-NPs) was done by SEM. The synthesized Ni-NPs were used to degrade the Reactive Yellow 160 dye following the optimization of different experimental parameters. The maximum decolorization (91.4%) was obtained at 0.02% dye conc., 9 mg/L conc. of Ni-NPs, pH 7 at 40 °C. TOC and COD were used to assess the efficiency of this experiment. Percent reduction in COD and TOC was found to be 84.35% and 83.24% respectively. The degradation pathway of dye under study confirmed the formation of non-toxic end-products.

Studies on effects of umbelliferon derivatives against periodontal bacteria; antibiofilm, inhibition of quorum sensing and molecular docking analysis.

OBJECTIVE: Umbelliferon derivatives are exclusively found in plants of Ferula spp. that are commonly used in curing various health concerns related to oral cavity. Diabetic patient are especially effected with periodontitis and allied complications. METHOD: We investigated various compounds isolated from Ferula narthex exudate against clinical strains obtained from diabetic patients with periodontitis. Further antibiofilm, antiquorum sensing and molecular docking studies and ADMET analysis were performed. RESULTS: The docking target included 2Q0J, 2UV0, 3QP5 and 3QP1. HYDE affinity assessment was performed for the first 30 top ranking docked conformations within these active sites. The binding free energy ΔG, FlexX docking score and the most favorable poses for all the compounds were determined. During in vitro analysis, feselol presented high inhibition of Pseudomonas aeruginosa (MIC 0.01 mg/mL, MBC 0.02 mg/mL). Similarly, Feselol presented significant inhibition against clinical strain S. epidermidis (MIC 0.087 mg/mL, MBC 0.174 mg/mL) and S. aureus (MIC 0.087 mg/mL, MBC 0.087 mg/mL) preceded by 10'-R-acetyl-karatavacinol against S. epidermidis (MIC 0.56 mg/mL, MBC 0.56 mg/mL) and S. aureus (MIC 0.28 mg/mL, MBC 0.28 mg/mL). During antibiofilm inhibition assay, 10' R-acetyl-karatavacinol showed significant inhibition (54% at a final concentration 0.45 mg/mL), whereas slight antiquorum sensing activity was recorded. CONCLUSIONS: The umbelliferon derivatives have significant inhibition of clinical isolates and moderate antibiofilm potential.

Health-related Quality of Life of Nurses Working in Tertiary Care Hospital of Karachi.

OBJECTIVE: The aim of this study was to assess nurses' health-related quality of life. METHODS: This cross-sectional analytical study was accomplished among 154 nurses. Data were collected from two tertiary care hospitals of Karachi. Consent was taken prior to data collection from every participant. Questionnaire Short Form Health Survey-26 (SF-26) and Patients Health Questionnaire-9(PHQ-9) were used as a study tool. Data were analyzed through SPSS version 21. RESULTS: ANOVA and T-test confirmed that energy/fatigue domain differed significantly with level of education, duty shift and monthly income with p-values 0.025, 0.001 and 0.006 respectively. It was observed that mean scores of physical functioning, role limitation due to physical health and pain domains differ significantly between depressive and non-depressive participants, with p-values 0.045, 0.01 and 0.005 respectively. CONCLUSIONS: Health related quality of life differs in comparison of physical health domain with depressive and non-depressive nurses. Only energy/fatigue domain was significantly associated with level of education, duty shift and monthly income of nurses.

Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan.

OBJECTIVE: Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity. SETTING: This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan. PARTICIPANTS: In total, 187 of 700 patients who underwent oesophago-gastro-duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument. RESULTS: Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20). CONCLUSION: Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

Recent Trend in Specialty Choices of Medical Students and House Officers from Public Sector Medical Universities, Karachi.

OBJECTIVE: To determine career choices of medical students of public-sector medical universities and factors affecting their career choices. METHODS: The cross-sectional study was conducted at Dow University of Health Sciences and Jinnah Sindh Medical University, Karachi, from May 2015 to May 2016, and comprised 4th and 5th year medical students and house officers. A self-administrated structured questionnaire was used to collect data which was entered and analysed using SPSS 20. RESULTS: Of the 445 Subjects, 314(70.6%) were females. There were 206(46.3%) 4th year students, 194(43.6%) were from the 5th year and 45(10%) were house officers. Top 15 medical specialties were ranked according to the respondents' top three choices. Internal medicine 67(15.1%), cardiology 47(10.6%), paediatrics 46(10.3%) and general surgery 40(9.0%) were the four highest ranked specialties. Overall, 377(84.7%) subjects said prestige in working in that field was the reason of their respective choices. CONCLUSIONS: Medical students chose a wider range of specialties and stated varying factors affecting their choices.