ST Elevation in a Patient With COVID-19 Infection-Associated Fever: A Case of Brugada Pattern.

Coronavirus disease 2019 (COVID-19) is a global pandemic presenting with various cardiovascular manifestations. Although Brugada pattern ST-segment elevation (STE) is well described in patients admitted with febrile illness, the implication of recognizing this abnormality in patients with COVID-19 is critical in providing appropriate care for the patient and also reducing the exposure of healthcare professionals to the risk of infection. We report a patient with COVID-19 infection presenting with STE due to fever-related unmasking of Brugada pattern, who was managed conservatively

Effect of different concentrations of soil and foliar applied zinc, boron and iron fertilizers on seedling growth, chlorophyll content and productivity of chickpea seedlings under semi-arid environment

The effectiveness of zinc (Zn), boron (B), and iron (Fe) is reduced in semi-arid regions, which can lead to a deficiency of these nutrients and inhibit chickpea productivity. In this work, three field experiments were executed over two years where soil and foliar applications of Zn, B, and Fe were carried out, including controls (Zn0, B0, and F0), soil application at 4.125 kg/ha (Zn-1, B1, and F1) and 8.25 kg/ha (Zn-2, B2, and F2), and foliar spay at 0.3% at flowering initiating (Zn-3, B3, and F3) and one week after flowering initiation (Zn-4, B4, and F4, respectively). The results indicate that the deficiency of these nutrients inhibited chickpea growth and yield, leading to a reduction in the pigment contents. Nonetheless, soil and foliar application of Zn, B, and Fe significantly improved growth, chlorophyll contents, and yield, showing a dose-dependent effect. The best results were recorded for Zn-3, B2, and F2 treatments which significantly (P<0.05) increased shoot length (20.96-85.19%), root length (42.85-93.65%), shoot fresh (23-76%) and root fresh weight (45-90.32%), compared with the control treatment. Chlorophyll parameters, including chlorophyll a and b contents, showed similar trends. Zn-3, B2, and F2 treatments significantly increased biological and grain yields, which were associated with higher values of the number of pods per plant and the number of seeds per pod. In a nutshell, we suggest that Zn foliar application at 0.3% at flowering initiation and soil application of B and Fe at 25 kg/ha are beneficial for improving the growth, pigment content, and overall productivity of chickpea

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Patient Satisfaction and Utilization of Ambulance Services in Prehospital Services at a Tertiary Care Hospital:A Cross-Sectional Study in Peshawar, Khyber Pakhtunkhwa, Pakistan

OBJECTIVE: Patients reporting to emergency departments frequently use different ambulance services; therefore, the measurement of patient satisfaction is relevant to encouraging those services to meet patient expectations. The aim of this study was to determine the patients' satisfaction and utilization of different ambulance services at a tertiary health care hospital in Peshawar relating to prehospital services. METHODS: This cross-sectional study was conducted at Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from July 2019 to January 2020 using a consecutive sampling technique with a total sample size of 378. The patients reporting to the emergency department using any ambulance service were included in this study. Different types of ambulance services were used as an outcome variable. Proportions were compared for the categoric variables using the chi-square test, whereas the 1-way analysis of variance test was used to determine the mean response time and age. Results were considered significant at a P value ≤ .050. All analyses were completed using SPSS version 20 (IBM Corp, Armonk, NY). RESULTS: Of the total 378 study participants, approximately 166 (43.9%) used Rescue 1122 services, 99 (26.2%) used private ambulance services, and 44 (11.6%) used public ambulance services. Road traffic accidents were the most common complaint by 98 (25.9%, P < .003) participants. The mean response time for Rescue 1122 was 13.2 ± 18 minutes followed by the Chippa Foundation (private) at 17.8 ± 20 minutes (P < .005). Males (n = 254) were the predominant users of all services. Participants from the urban region (n = 112) used Rescue 1122, whereas the public ambulance service was used only by 31 patients (P < .005). Among all the ambulance services, 19 (61.3%) participants were not satisfied with the Chippa service regarding vehicle cleanliness, whereas participants were highly satisfied with Rescue 1122. CONCLUSION: Overall, the patients were more satisfied with the services provided by the Rescue 1122 ambulances compared with all other ambulance services

Association Of BCR-ABL Alternative Splice Variants with Disease Progression, Treatment Response and Survival in Chronic Myeloid Leukemia Patients Treated with Firstline imatinib Monotherapy

Background: Alternative RNA splicing has diverse biological effects in heath as well as disease. It also contributes to cancer onset and progression. Chronic Myeloid Leukemia (CML) results due to BCR-ABL fusion oncogene that is created due to chromosomal translocation t [9; 22] [q34; q11]). BCR-ABL is target of tyrosine kinase inhibitors (TKIs). BCR-ABL through alternative splicing can generate b2a2, b3a2 and some other rare splicing variants. BCR-ABL variants may vary in their response to TKI treatment and disease progression potential, which is a major factor contributing to dismal treatment outcome in CML. Objective: The objective of this study is to investigate correlation of BCR-ABL splice variants with TKI treatment outcome and survival in three phases of CML that has rarely been studied previously.Methods: BCR-ABL splice variants were studied using reverse transcriptase PCR (RT-PCR). in 70 CML patients from three phases of CML who were receiving imatinib (TKI) treatment.Results: Frequencies of different BCR/ABL splice variants like b3a2, b2a2 and b3a2+b2a2 were 49 (70%), 15 (21.4%) and 6 (8.6%), respectively. Splice variant b2a2 were more common (53.3%) in chronic phase CML (CP-CML) while b3a2 had higher frequency in advanced phases of CML (44.9%). CML patients with b2a2 transcript had better complete cytogenetic response and major molecular response to TKI treatment overall (100% vs. 24.5%) as well as in CP-CML (100% vs. 85.7%) and superior survival when compared to patients with b3a2 splice variant. All patients who died had male gender, less than 33 years age, b3a2 transcript, advanced phases of CML and imatinib resistance.Conclusions: Splice variant b3a2 was associated with CML progression, poorer survival and inferior treatment outcome as compared to b2a2. Further investigations on BCR-ABL splice variants and their roles in CML pathogenesis can provide deeper insights into CML biology and new targets for BCR-ABL positive leukemia treatment.          Keywords: CML; BCR-ABL splice variants; Progression; Survival; Treatment outcome 

Habb-e-Azaraqi, A Potent Unani Pharmacopoeial preparation used in Neurological disorder: A review

Unani medicine relies on drugs of natural origin for the treatment of various medical conditions. It is practised throughout Asia and particularly in India. The rich natural drug asset of Unani medicine includes both single and compound drugs. Habb-e-Azaraqi is a polyherbal Unani formulation used clinically since decades for the management of various neurological disorders like facial palsy, paralysis, gout and arthritis. The explicit nature of Habb-e-Azaraqi rationalizes its use in nervine disorders. The main ingredient of Habb-e-Azaraqi is Azaraqi mudabbar (detoxified Strychnos nux-vomica L.) which is known for its diverse medicinal uses. This review highlights the traditional uses of Habb-e-Azaraqi, phytochemistry and pharmacological properties of its ingredient. Keyword: Habb-e-Azaraqi; Facial palsy; Paralysis; Strychnos nux-vomica; Unani medicin

Habb-e-Azaraqi, A Potent Unani Pharmacopoeial preparation used in Neurological disorder: A review

Unani medicine relies on drugs of natural origin for the treatment of various medical conditions. It is practised throughout Asia and particularly in India. The rich natural drug asset of Unani medicine includes both single and compound drugs. Habb-e-Azaraqi is a polyherbal Unani formulation used clinically since decades for the management of various neurological disorders like facial palsy, paralysis, gout and arthritis. The explicit nature of Habb-e-Azaraqi rationalizes its use in nervine disorders. The main ingredient of Habb-e-Azaraqi is Azaraqi mudabbar (detoxified Strychnos nux-vomica L.) which is known for its diverse medicinal uses. This review highlights the traditional uses of Habb-e-Azaraqi, phytochemistry and pharmacological properties of its ingredient.&#x0D; Keyword: Habb-e-Azaraqi; Facial palsy; Paralysis; Strychnos nux-vomica; Unani medicine</jats:p

Impact of Serum Vitamin D Levels on the Preterm Rupture of the Membrane in Pregnant Women. A Cross-sectional Study

Aim: To assess the association between premature rupture of membrane and maternal blood vitamin D levels.&#x0D; Study Design: A cross-sectional study.&#x0D; Place and Duration: Abbasi Shaheed Hospital, Karachi Medical and Dental College from April 2020 to April 2021.&#x0D; Methodology: Over the duration of one year, a total of 100 patients with vitamin D levels, as well as obstetrical abnormalities and risk factors, were monitored. In 88 pregnant women, vitamin D deficiency was observed. Pregnant women who have a thyroid disorder, such as thyroiditis or Grave's disease, or who had calcium or parathyroid disease in the past, or who need cardiac medication therapy,&amp; diuretic particularly calcium channel blockers were excluded from the study.&#x0D; Results: Vitamin D deficiency was found in 88 pregnant women out of 100. It was more prevalent among housewives (86.36 percent) and multiparous women (68.0 percent). Pregnancy complications were present in 33.0 percent of cases such as preeclampsia, gestational hypertension, and diabetes, and PROM was less prevalent in the deficient group.&#x0D; Conclusion: Our data indicate that pregnant females are at a greater risk of Vitamin D deficiency, and associated pregnancy complications. The correlation between maternal vitamin D levels &amp; preterm rupture of the membrane was not statistically significant.</jats:p