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Alcohol's detrimental effects on bone health are well established, yet some literature suggests moderate consumption may offer benefits. With alcohol use on the rise, we investigate the impact of acute and chronic alcohol administration, along with withdrawal, on male Wistar rat femurs. We observed a transient cortical thickness increase with acute alcohol (AA) compared to chronic exposure (CA) but no significant changes in trabecular parameters or mechanical properties. High osteocalcin and osteopontin expression levels were noted in AA, alongside elevated RANKL expression. Conversely, CA showed low TRAP levels. FGF23 expression significantly increased during alcohol withdrawal (AW), while GPX decreased after chronic exposure but rose during withdrawal. Although mechanical strength changes were insignificant, biochemical shifts suggest alcohol exposure promotes bone resorption, reduces antioxidant protection, and potentially hampers active vitamin D and phosphate reabsorption via FGF23 upregulation.

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BACKGROUND: Glioneuronal tumors (GNTs) comprise a rare class of central nervous system (CNS) neoplasms with varying degrees of neuronal and glial differentiation that predominately affect children and young adults. Within the current 2021 World Health Organization (WHO) classification of CNS tumors, GNTs encompass 14 distinct tumor types. Recently, the use of whole-genome DNA methylation profiling has allowed more precise classification of this tumor group. OBSERVATIONS: A 3-year-old male presented with a 3-month history of increasing head circumference, regression of developmental milestones, and speech delay. Magnetic resonance imaging of the brain was notable for a large left hemispheric multiseptated mass with significant mass effect and midline shift that was treated with near-total resection. Histological and molecular assessment demonstrated a glioneuronal tumor harboring an MYO5A::NTRK3 fusion. By DNA methylation profiling, this tumor matched to a provisional methylation class known as "glioneuronal tumor kinase-fused" (GNT kinase-fused). The patient was later started on targeted therapy with larotrectinib. LESSONS: This is the first report of an MYO5A::NTRK3 fusion in a pediatric GNT. GNT kinase-fused is a provisional methylation class not currently included in the WHO classification of CNS tumors. This case highlights the impact of thorough molecular characterization of CNS tumors, especially with the increasing availability of novel gene targeting therapies.

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Atypical teratoid rhabdoid tumors (ATRTs) are rare embryonal tumors comprising 1-2% of all pediatric CNS neoplasms. Spinal ATRTs are even more uncommon, accounting for 2% of all reported ATRT cases. Despite their rarity, ATRTs affect young children disproportionately and are characterized by a high malignant potential due to a heterogeneous cellular composition and inactivating mutations in the SMARCB1 (90%) and SMARCA4 (10%) genes. A 15-month-old female presented with a 2-week history of decreased lower extremity movement and new-onset need for assistance with ambulation. MRI lumbar spine revealed a contrast-enhancing intradural mass at the L3-L4 level with iso-intensity on T1 and T2 sequences. The patient subsequently underwent subtotal tumor resection (∼80%) given concerns for maintaining neurological function. Final pathology was consistent with spinal ATRT, and she later underwent adjuvant chemoradiation therapy per ACNS0333 protocol. She has since remained in remission with age-appropriate developmental milestones over the past 2 years. ATRTs should be considered in the differential diagnosis of intradural spinal lesions, especially in the pediatric patient population. Clinical course, presentation, and diagnosis is often delayed due to the rarity of these tumors, but contrasted craniospinal MRI is key for diagnosis and histopathology with IHC staining showing loss of INI is confirmatory. While gross total resection is the goal, maximal safe tumor resection should be prioritized in order to preserve neurological function. Adjuvant chemoradiation following gross total/subtotal resection has been shown to significantly improve overall survival.

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The incidence of stroke in young individuals has been showing an increasing trend. In such cases, atypical mechanisms of stroke should be considered. Here, we report a case of a 37-year-old healthy female who presented with complaints of right-sided ataxia and clumsiness that started after an amusement park ride where she was swung rapidly. Imaging revealed an infarct in the right cerebellar hemisphere. This case report highlights certain mechanisms that can cause a stroke in this situation, with special emphasis on recognition, timely medical management, public awareness of such risk factors, and the prevention of complications.

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This is a case report of an 83-year-old female who presented to the emergency department within eight hours of symptom onset. A CT angiogram revealed a distal basilar artery occlusion, as well as a perfusion deficit in the right superior cerebellar artery. Her symptoms fluctuated, and she was started on a heparin drip, but later in the evening her symptoms worsened. A mechanical thrombectomy was performed by interventional radiology. The following morning, most of the patient's deficits had resolved, and, when seen in the clinic several weeks later, she continued to be asymptomatic. This case report highlights the importance of timely diagnosis and intervention in the management of distal basilar artery occlusion.

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E'Jiao is a traditional Chinese medicine derived from donkey skin. E'Jiao is reported to suppress elevated bone remodelling in ovariectomised rats but its mechanism of action is not known. To bridge this research gap, the current study aims to investigate the effects of E'Jiao on skeletal mineralisation, osteocyte and WNT signalling inhibitors in ovariectomised rats. Female Sprague-Dawley rats (3 months old) were ovariectomised and supplemented with E'Jiao at 0.26 g/kg, 0.53 g/kg and 1.06 g/kg, or 1% calcium carbonate (w/v) in drinking water. The rats were euthanised after two months of supplementation and their bones were collected for Fourier-transform infrared spectroscopy, histomorphometry and protein analysis. Neither ovariectomy nor treatment affected the skeletal mineral/matrix ratio, osteocyte number, empty lacunar number, and Dickkopf-1 and sclerostin protein levels (p > 0.05). Rats treated with calcium carbonate had a higher Dickkopf-1 level than baseline (p = 0.002) and E'Jiao at 0.53 g/kg (p = 0.002). In conclusion, E'Jiao has no significant effect on skeletal mineralisation, osteocyte and WNT signalling inhibitors in ovariectomised rats. The skeletal effect of E'Jiao might not be mediated through osteocytes.

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The world we live in has been taken quite surprisingly by the outbreak of a novel virus namely SARS-CoV-2. COVID-19 i.e. the disease associated with the virus, has not only shaken the world economy due to enforced lockdown but has also saturated the public health care systems of even most advanced countries due to its exponential spread. The fight against COVID-19 pandemic will continue until majority of world's population get vaccinated or herd immunity is achieved. Many researchers have exploited the Artificial intelligence (AI) knacks based IoT architecture for early detection and monitoring of potential COVID-19 cases to control the transmission of the virus. However, the main cause of the spread is that people infected with COVID-19 do not show any symptoms and are asymptomatic but can still transmit virus to the masses. Researcher have introduced contact tracing applications to automatically detect contacts that can be infected by the index case. However, these fully automated contact tracing apps have not been accepted due to issues like privacy and cross-app compatibility. In the current study, an IoT based COVID-19 detection and monitoring system with semi-automated and improved contact tracing capability namely COVICT has been presented with application of real-time data of symptoms collected from individuals and contact tracing. The deployment of COVICT, the prediction of infected persons can be made more effective and contaminated areas can be identified to mitigate the further propagation of the virus by imposing Smart Lockdown. The proposed IoT based architecture can be quite helpful for regulatory authorities for policy making to fight COVID-19.

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Osteoporosis refers to excessive bone loss as reflected by the deterioration of bone mass and microarchitecture, which compromises bone strength. It is a complex multifactorial endocrine disease. Its pathogenesis relies on the presence of several endogenous and exogenous risk factors, which skew the physiological bone remodelling to a more catabolic process that results in net bone loss. This review aims to provide an overview of osteoporosis from its biology, epidemiology and clinical aspects (detection and pharmacological management). The review will serve as an updated reference for readers to understand the basics of osteoporosis and take action to prevent and manage this disease.

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Introduction The global struggle against the impact of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) on physical and mental health and on economic and social aspects of human life continues even after two and a half years have passed since the emergence of this virus. The development of vaccines was a milestone. By June 2022, billions of people have been vaccinated against the deadly virus. However, like any other vaccine, the various vaccines against coronavirus disease 2019 (COVID-19) also cause a variety of adverse effects. Therefore this study aimed to determine the different acute side effects experienced after receiving the vaccines and correlating them with some socio-demographic and biomedical factors.  Methodology This cross-sectional study has a sample size of 467. Study participants were recruited after fulfilling inclusion and exclusion criteria. After gaining approval from the Ethical Review Board (ERB) of CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan, an online questionnaire was distributed via social media. The survey questionnaire had a series of questions regarding the socio-demographic and biomedical characteristics of the participants, as well as the type of vaccine they got, followed by questions about the development of adverse effects after each dose (first and second). Data were statistically analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). The analysis was carried out in a confidence range of 95%, and a p-value<0.05 was considered statistically significant.  Results Sinopharm (76.0%) was the most frequently received vaccine. Adverse events were reported more after the first dose (79.7%) than in the second (67.2%) (p value 0.001). The reported adverse events after either dose were of mild intensity (p<0.05). None of the individuals reported serious adverse events or hospitalization after getting the shots. Females, younger age groups, and individuals with BMI in the underweight category were more prone to developing symptoms and experiencing difficulty doing routine work after getting the doses. The associations were statistically significant (p<0.05). Blood group (A,B,0,AB), past COVID-19 history, and smoking status were not positively associated with the appearance of symptoms after either dose or with inconvenience doing daily work post-vaccination. Conclusion The vaccines developed against COVID-19 offer benefits that outweigh the few mild adverse effects experienced. None of these symptoms is severe enough to stop an individual from doing routine work or result in morbidity or mortality. Therefore, people should avoid any hesitancy towards getting vaccinated to get past this pandemic.

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A case series is presented of five overweight or obese patients with confirmed coronavirus disease 2019 (COVID-19) in South Miami, Florida, United States. A multitude of coagulation parameters was suggestive of a hypercoagulable state among the hospitalized COVID-19 patients. This article reports various manifestations of hypercoagulable states in overweight and obese patients, such as overt bleeding consistent with disseminated intravascular coagulation, venous thromboembolism, gastrointestinal bleeding as well as retroperitoneal hematoma. All of the required admission to the intensive care unit and subsequently patients died. The characteristics of COVID-19-associated coagulopathy are atypical and warrant a further understanding of the pathophysiology to improve clinical outcomes, specifically in overweight or obese patients.

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INTRODUCTION: South Asia has had a dynamic response to the ongoing COVID-19 pandemic. The overall burden and response have remained comparable across highly-burdened countries within the South Asian Region. METHODOLOGY: Using a population-based observational design, all eight South Asian countries were analyzed using a step-wise approach. Data were obtained from government websites and publicly-available repositories for population dynamics and key variables. RESULTS: South Asian countries have a younger average age of their population. Inequitable distribution of resources centered in urban metropolitan cities within South Asia is present. Certain densely populated regions in these countries have better testing and healthcare facilities that correlate with lower COVID-19 incidence per million populations. Trends of urban-rural disparities are unclear given the lack of clear reporting of the gaps within these regions. COVID-19 vaccination lag has become apparent in South Asian countries, with the expected time to complete the campaign being unfeasible as the COVID-19 pandemic progresses. CONCLUSION: With a redesigning of governance policies on preventing the rise of COVID-19 promptly, the relief on the healthcare system and healthcare workers will allow for adequate time to roll out vaccination campaigns with equitable distribution. Capacity expansion of public health within the Region is required to ensure a robust healthcare response to the ongoing pandemic and future infectious disease outbreaks.

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In this study, a cellulose membrane (CM) was chemically treated with phenolic (PF) resin to improve its performance as a polymeric insulator. The CM was prepared from kenaf pulp, and the PF was synthesized from oil palm empty fruit (EFB) fibre. Four different concentrations of synthesized PF resin (5, 10, 15, and 20 wt.%) were impregnated under wet or dry conditions. Thermal analysis of the phenolic cellulose membrane (PCM) showed that the samples had good chemical interaction and compatibility. The PF uptake in the wet phenolic cellulose membrane (PCMW) was higher than in the dry phenolic cellulose membrane (PCMD). During the PF uptake, the CM underwent solvent exchange and absorption in wet and dry membranes, respectively. This difference also affected the crosslinking of PCM samples via the formation of methylene bridges. Due to the PF treatment, the PCM showed lower water absorption than CM. The PF concentrations also affect the surface roughness and electrical properties of PCM samples. These findings prove that PCM can be used as a renewable and green polymer electrical insulator.

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Despite its severe adverse effects, such as agranulocytosis, clozapine is the primary treatment for treatment-resistant schizophrenia. The established clozapine monitoring system has contributed to reducing agranulocytosis incidence and mortality rates. However, the pandemic coronavirus disease 2019 (COVID-19) has caused changes in the monitoring system. This review aimed to assess the current evidence on the neutrophil changes in the patient on clozapine treatment and infected with COVID-19. Individual cases reported various absolute neutrophil count (ANC) levels, normal, reduced, or elevated. No agranulocytosis case was reported. One case had a borderline moderate-severe ANC level, but the patient was in the 18-week period of clozapine treatment. A cumulative analysis of case the series initially reported inconclusive results. However, a more recent study with a larger sample size reported a significant reduction in the ANC during COVID-19 infection. Nevertheless, this effect is transient as no significant difference was found between the baseline and the post-infection period in ANC levels. In conclusion, COVID-19 is associated with a temporary reduction in ANC levels. The results supported the recommendation to reduce the frequency of clozapine monitoring in the eligible candidates. However, more data are required to confirm the current findings given the limitations, including study design, sample size, and statistical analysis.

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Takayasu's arteritis is a rare chronic granulomatous vasculitis that predominantly affects the aorta and its branches. It is estimated to affect 2.6/million/annum, predominantly women in the second or third decade of their lives. This case report describes the case of a 21-year-old female, who initially only had low-grade fever and acrodynia, which over a few months, progressed to arm and leg claudication, weight loss, nausea, headache, and dizziness. A year later, the patient experienced impalpable radial pulses bilaterally, and her CT angiogram revealed multi-level arterial stenosis. A diagnosis of Takayasu's arteritis was made and the patient was started on steroids and methotrexate. A consult was made with vascular surgery but no intervention was deemed necessary and the patient responded well to the medical treatment given. Though Takayasu's arteritis is a very rare disease, a detailed history, clinical examination, and investigations can help with early diagnosis.

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OBJECTIVE: This prospective, pilot randomized double-blind study aimed to compare the effects of buffered and non-buffered xylocaine solutions on injection pain and anesthesia effectiveness in patients undergoing arteriovenous fistula surgery. MATERIAL AND METHODS: A total of 100 adult patients meeting inclusion criteria undergoing arteriovenous fistula surgery were included in the study. They were split into two groups at random. The control group received 1% xylocaine dissolved in 5 ml distilled water, while the intervention group received sodium bicarbonate mixed with 1% xylocaine solution as a local anesthetic. The patients were asked to rate the pain of first and subsequent injections on a visual analog scale (VAS). Besides, the need for extra analgesia was investigated. The mean and standard deviation of the data was determined. RESULTS: During both the first and subsequent injections, the alkalinized local anesthetic group showed substantially lower VAS scores. In the alkalinized local anesthetic group, anesthesia satisfaction was also more than three times higher. Furthermore, the non-alkalinized group's mean analgesic requirement was higher than the intervention group. CONCLUSION: Our findings support the effectiveness of the alkalinized local anesthetic solution in minimizing injection pain and increasing anesthesia duration and overall patient's surgical experience in terms of anesthesia satisfaction score.

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INTRODUCTION: The objective of our study was to explore the views and perceptions of female patients attending the obstetrics and gynecology (OB/GYN) outpatient department towards the gender of their healthcare provider, to look for any preference that might exist in this regard, and to highlight any discrimination towards male obstetricians/gynecologists. MATERIAL AND METHODS: A cross-sectional study was conducted from November 2020 to March 2021 at Combined Military Hospital, Lahore. A total of 280 female patients were included in the study and interviewed consecutively. A self-designed questionnaire was administered. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY). Chi-square test was used to determine for any statistical significance and p≤0.05 was considered significant. Numerical data were represented as percentages. RESULTS: Over 280 female patients participated in our study, out of which 132 were married and 148 were single. Thirteen of these patients were uneducated, 40 had completed high school and 227 patients had obtained a bachelor's level of education; 120 patients were aged 15-25 years, 95 patients were aged 26-35 years, 30 patients were aged 36-45 years, and 35 patients were aged >46. Women with less education preferred to be seen by a female obstetrician/gynecologist, whereas those with higher education were less biased (p=0.0001). Married patients preferred to be seen by female obstetrician/gynecologists as compared to single patients (p=0.0004). A significant proportion of females were impartial in terms of physician competence but those who did have a preference preferred female obstetrician/gynecologist based on three significant variables: competence, rapport building and empathy, and personal comfort. CONCLUSION: A female gender preference exists in obstetrics and gynecology clinic attendees. This is significant in those who are married and those with no formal education. Overall, a significant proportion of women feel a higher comfort level with female doctors and find it easier to discuss their medical issues and develop rapport.

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A descriptive, cross-sectional study was conducted from July 2018 to September 2018 to assess the level of awareness among healthcare workers regarding rotavirus infection and its vaccination in Rawalpindi and Islamabad. The study site was conducted at tertiary care hospitals of Rawalpindi and Islamabad. Ethical approval was obtained from the Institutional Review Board of Army Medical College, Rawalpindi. Closed and open ended questionnaires were distributed via non-probability convenient sampling. The sample size was 257. Among the study participants, 247 (96.1%) of the participants had good level of awareness regarding rotavirus, whereas 212 (82.5%) had awareness regarding the vaccine. The mean awareness score was 16.16 ± 4.097 out of a maximum score of 22. Both male and female participants had almost equal awareness regarding the rotavirus infection (Males = 96, 93.2%, Females = 151, 98%) and vaccination (Males = 87, 84%, Females = 125, 81.1%). The mean awareness was directly related with the level of education of the participants, i.e. MBBS/FCPS/MCPS = 221(85.9%), MBBS = 209(81.5%), B.Sc. Nursing = 206(80%), and Basic Education = 220(85.7%) knew about the vaccine.

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COVID-19 may manifest as mild, moderate or severe disease with each grade of severity having its own features and post-viral implications. With the rising burden of the pandemic, it is vital to identify not only active disease but any post-recovery complications as well. This study was conducted with the aim of identifying the presence of post-viral symptomatology in patients recovered from mild COVID-19 disease. Presence or absence of 11 post-viral symptoms was recorded and we found that 8 of the 11 studied symptoms were notably more prevalent amongst the female sample population. Our results validate the presence of prolonged symptoms months after recovery from mild COVID-19 disease, particularly in association with the female gender. Hence, proving the post-COVID syndrome is a recognizable diagnosis in the bigger context of the post-viral fatigue syndrome.

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Takayasu's arteritis (TA), commonly referred to as "pulseless" disease, is a large-vessel inflammatory vasculitis most commonly affecting the aorta and its major branches. Due to its irregular nature, it has the propensity to involve any organ system thus leading to a wide spectrum of clinical features. Most patients affected by TA are females in their second or third decades of lives. Our case is of a 33-year-old male who presented with sudden onset of hypertension for which he was prescribed antihypertensives. Over the next few weeks, he had multiple visits to the emergency department for a variety of different symptoms including fever, myalgias, left arm numbness, and persistence of hypertension. His CT aortogram showed multi-vessel narrowing including that of the celiac axis, superior mesenteric, renal, and internal iliac arteries with right atrophic kidney. At this time, a diagnosis of TA was made and he was started on oral corticosteroid and immunosuppressant therapy and continued to be treated as an outpatient. Nearly five years after his initial symptoms, he presented to the Emergency for acute abdomen, severe vomiting, and constipation, at which time an emergency laparotomy was done and peritonitis was found. A CT angiogram of the abdomen done after this procedure showed tight stenosis of the inferior mesenteric artery (IMA) and proximal stenosis of the left renal artery. He is currently planned for left renal artery and IMA stenting. Our case highlights the important characteristics of TA in male patients and how they differ from females. It also focuses on the importance of early initial workup and diagnosis and the need for a multi-disciplinary team when handling any patient with TA.