Objective: To analyse the frequency and management outcome of Neutropenia in women with breast cancer receiving Anthracycline chemotherapy. Study Design: Comparative Cross-sectional study. Place and Duration of Study: Oncology Department, Combined Military Hospital, Rawalpindi Pakistan, from Feb to Nov 2021. Methodology: This study was conducted on 200 patients who have breast cancer who were put on an Anthracycline-based chemotherapy regimen. They underwent three or four cycles of chemotherapy as per the treatment plan. A complete blood picture was carried out on all patients after the cycle, and Neutropenia was graded according to the National Cancer Institute's Common Toxicity Criteria. Grade III and IV neutropenia patients were administered Granulocyte colony-stimulating factor and the response was observed. Results: A total of 200 patients with breast cancer receiving Anthracycline-based chemotherapy were included. The mean age of the patients was 54.775±9.649 years. Seven hundred sixty-two cycles were recorded on these patients during the study period. Of these 762 cycles, 245(32.1%) episodes of Neutropenia were recorded. 60(24.4%) had either Grade III or IV neutropenia. Out of those having Grade III or IV neutropenia, 50(83.3%) had improvement after administration of G-CSF, while 10(16.7%) did not show any improvement. The advancing age of patients had a statistically significant relationship (p-value-0.001) with poor response to G-CSF treatment in our study participants. Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking Anthracycline-based chemotherapy showed the presence of Neutropenia. G-CSF emerged as an effective treatment for high-grade Neutropenia in these patients.

Abstract Background Assessment of histological disease activity in patients with ulcerative colitis (UC) is becoming more important. Therefore, the DCA score was developed for use in clinical practice. Distribution (D), chronicity (C) and activity (A) are each scored on a three-point scale with distribution being dependent on the percentage of biopsy area affected by inflammatory changes. A major problem for implementation of any score is interobserver heterogeneity. To overcome this hurdle, we developed a deep learning algorithm to automatically compute the DCA score. Methods A retrospective cohort was created consisting of 117 adult patients with ulcerative colitis from which biopsies were taken during a colonoscopy performed in the setting of routine clinical evaluation (training set of 537 slides). From 75 cohort patients, an additional set of biopsies was available (test set of 299 slides). An expert gastrointestinal pathologist performed the DCA score. The model was trained on H&E-stained whole slide images scanned at 40x (0.243-μm pixel) resolution. Training was performed in a weakly supervised multiple-instance learning setup, using slide-level labels without region of interest annotations. The features from the convolutional neural network-based model trained at 2.5x, 5x, and 10x magnification were incorporated using a random forest classifier for final prediction. Model accuracy was evaluated using the test set. Results The algorithm differentiates between normal and inflamed with an accuracy of 90.9% (Table 1). Model performance from features aggregated across all magnification levels (i.e., 2.5x, 5x, and 10x) was superior to features from individual levels. This can be explained with the help of GradCam heatmaps (Figure 1), where we show that features learned at different magnification levels correspond to different aspects of histological changes in UC. The multiple instance approach did not appear to detect crypt abscesses, which may have resulted in a relatively poor performance in differentiating A1 from A2. The model accuracy for the 9-class DCA was 64.8%. Conclusion The algorithm first appears to assess architectural distortions at lower magnification and then the presence of cellular elements like neutrophils at higher magnification. This closely mirrors the approach of pathologists. The present model automates the scoring process and by supporting the daily diagnostic practice highlights the potential of deep learning technologies in assessment of histological disease activity in UC.

Objective: To assess the frequency and factors related to the presence of 17p deletion among patients diagnosed with chronic lymphocytic leukaemia at the Oncology Department of Combined Military Hospital Rawalpindi Study Design: Cross-sectional study. Setting And Duration Of Study: Oncology Department, Combined Military Hospital, Rawalpindi Pakistan, Feb 2020 to Mar 2021. Methodology: Patients with Chronic lymphocytic leukaemia were recruited for the study. The fluorescence in situ hybridization method was used to look for the presence of 17p deletion, using 10% cells as a cut-off value. Demographics, treatment status, and β2-microglobulin levels were correlated with 17p deletion in our study population. Results: A total of 102 patients diagnosed with Chronic Lymphocytic leukaemia were included in the analysis. The mean age of the patients was 55.82±7.176 years.74(72.5%) were male, while 28(27.5%) patients diagnosed with this condition were female. 17p deletion was present in 16(15.7%) patients, while 86(84.3%) patients were not detected with 17p deletion. Elevatedβ2-microglobulin levels were strongly related to 17p deletion in our target population (p-value-0.005). Conclusion: 17p deletion was a fairly common finding among patients of chronic lymphocytic leukaemia presenting to our department. Patients with elevated β2-microglobulin levels were more at risk of having this genetic mutation than those with normal β2-microglobulin levels.

Objective: To determine the response rate and tolerability of Bortezomib, Cyclophosphamide and Dexamethasone (VCD) induction therapy in multiple myeloma patients. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Oncology, Combined Military Hospital, Rawalpindi Pakistan, from Mar to Sep 2020. Methodology: Patients of either gender aged >20-65 years, newly diagnosed cases of multiple myeloma, Durie-Salmon stage II/III, were included. Patients were given Bortezomib, Cyclophosphamide and Dexamethasone induction therapy for a 21-day cycle. Response rate and tolerability were measured. Results: A total of 147 patients were included in the study. There were 75(51%) male and 72(49%) female.The overall response rate was seen in 93(63.3%) patients, complete response was seen in 30(20.4%), and partial response was seen in 63(42.9%) patients. The overall response rate was significantly associated with age, myeloma type, and Karnofsky's performance status (p-value<0.001). Conclusion: The novel sequential 3-drug combination of Bortezomib, Cyclophosphamide and Dexamethasone is safe and well tolerated for multiple myeloma patients. The results of the current study increase evidence of a moderately high response rate with Bortezomib, Cyclophosphamide and Dexamethasone induction therapy.

A new species of Nepeta L. (Lamiaceae) from the Margalla Hills, in Pakistan, is described and illustrated. It belongs to Nepeta sect. Cataria sensu Bentham and is characterised by tuberous roots up to 3 cm in diameter, the presence of long multicellular flattened eglandular hairs, a spike-like inflorescence, an oblique calyx throat, unequal calyx teeth, and a 9 mm long white corolla. It is closely related to Nepeta cataria L., from which it differs in the root, indumentum, calyx and inflorescence characters. A distribution map of the new species is presented, as is an updated key to Nepeta sect. Cataria.

Antibiotic resistance among bacterial infections has become a leading problem in the medical industry. Herein, we have synthesized the silver nanoparticles (AgNPs) from fresh leaves of Moringa oleifera extract. The synthesis was optimized by varying the concentration of AgNO3, plant extract, and contact time. The as-prepared nanoparticles (NPs) were examined by various advanced analytical tools including UV-Vis, FTIR, XRD, SEM-EDS, TEM, DSC and TGA to confirm the morphology, particle distribution, and thermal effect. The antimicrobial potential of AgNPs was determined against selected pathogenic strains including Klebsiella pneumoniae (ATCC (R) 13883TM), Escherichia coli (ATCC (R) 25922TM), Acinetobacter baumannii (ATCC (R) 19606TM), and Pseudomonas aeruginosa (ATCC (R) 27853TM). The ager-well assay showed inhibitory zones in the range of 7-15 mm with MIC value of 250 mu g/ml which suggests that strains are sensitive in growth inhibitory conditions. The present work affirms that AgNPs mediated through leaves of Moringa oleifera exhibits a higher antibacterial potential as compared with previous reported studies, and can be used in biomedical science for disinfection applications.

In this paper, we study the phase transition and thermodynamics of Reissner–Nordstrom black hole. We compute the thermodynamics quantities such as Hawking temperature, Bekenstein entropy and heat capacity by using mathematical and graphical analysis. We obtain the corrected entropy to examine the effect of logarithmic corrections on the different thermodynamic quantities like pressure, Gibbs free energy, Helmholtz free energy, internal energy, enthalpy. Moreover, we investigate the stability of the system with the help of heat capacity and well known Hessian matrix technique. It is noted that the considered system is thermodynamically stable under these correction terms.

This paper investigates thermodynamics, quasi-normal modes, thermal fluctuations and phase transitions of Reissner-Nordström black hole with the effects of non-linear electrodynamics.We first compute the expressions for Hawking temperature, entropy and heat capacity of this black hole and then obtain a relation between Davies's point and quasi-normal modes with non-linear electrodynamics.We also observe the effects of logarithmic corrections on uncorrected thermodynamic quantities such as entropy, Hawking temperature, Helmholtz free energy, internal energy, Gibbs free energy, enthalpy and heat capacity.It is found that presence of non-linear electrodynamic parameter induces more instability in black holes of large radii.Finally, we analyze the phase transitions of Hawking temperature as well as heat capacity in terms of entropy for different values of charge (q), horizon radius (r + ) and coupling parameter (α).We obtain that Hawking temperature changes its phase from positive to negative for increasing values of q and r + while it shows opposite trend for higher values of α.The heat capacity changes its phase from negative to positive for large values of charge, horizon radius and coupling parameter.

Biofouling is the growth of plants, bacteria, and aquatic animals on manmade surfaces submerged in seawater. Recently, biofouling has caused a negative impact on the marine sector such as hull weight increases, low speed, and excessive fuel consumption, etc. Layer-by-layer (LBL) self-assembly of alternate charged polyelectrolytes on film with various numbers of layers provides an efficient method for putting antibacterial and anti-adhesive compounds on films. This antifouling coating LBL approach is a novel solution, which is based on the alternate deposition of oppositely charged polyelectrolytes. In this study, we assembled different number of layers on film comprised of chitosan (CHT) and acid siloxane resin (ASR) as a cationic and an anionic solution for LBL assembly using the dipping method. Then, the as-prepared polyelectrolyte multilayer (PEM) films were investigated by various techniques. FTIR analysis of CHT, ASR and assembled (CHT/ASR) 2 film was carried out to confirm the functional groups responsible for their successful synthesis. SEM analysis was observed for each film in order to see the surface morphology, which showed a successful assembly of PEM films. AFM was used to see the topography of each as-prepared film; it was also observed that AFM results have agreement with SEM observations. The contact angle (CA) measurement depicted that the CA for PEM films increased with the increasing number of layers. The chemical bonding nature and composition of the PEM films were determined using XPS analysis. Marine diatom settlement and growth inhibition test was observed against Nitzschia closterium (NC) on each film for antifouling performance. It was observed that more algae cells were attached to the film surface of the (CHT/ASR) 2 , (CHT/ASR) 4 , (CHT/ASR) 6 layer as compared with the (CHT/ASR) 8 and (CHT/ASR) 10 layers in NC diatom suspension. On the seventh day, the (CHT/ASR) 10 layer film showed 0.0619 cell/10 5 number/mL of diatom cell attachment in the suspension, which is only 11% of the blank. This study provides new insights into the LBL approach for the development of CHT/ASR PEM films with desirable antifouling and environmentally friendly properties.

Objective: To look for adverse event profiles in advance of hepatocellular carcinoma treated with Sorafenib presenting to CMH Rawalpindi and study associated socio-demographic factors Study Design: Comparative cross-sectional study Place and Duration of Study: Oncology Department, Combined Military Hospital, Rawalpindi Pakistan, from Dec 2020 to Nov 2021. Methodology: Three hundred patients with diagnosed hepatocellular carcinoma in advanced stage taking Sorafenib chemotherapy for more than three months and less than one year were included in the study. Each patient was assessed for relevant adverse effects in the follow-up outpatient visits by a consultant oncologist. Results: Out of 300 cancer patients using Sorafenib for more than three months and less than one year, 212(70.7%) patients had at least one or more adverse effects, while 88(29.3%) did not experience any adverse effects. Diarrhoea 120(40%) was the most common adverse effect, followed by rash/desquamation 110(36.7%). Advancing age was statistically significantly associated (p-value-0.001) with adverse effects among the target population. Conclusion: A significant number of patients suffering from hepatocellular carcinoma using Sorafenib had mild to moderate adverse effects. Physicians should keep an eye on patients with advancing age for adverse effects of this medication.

Solid dosage form is estimated to be around 90% of all dosage form. Tablets and capsules are the most common solid dosage forms. The widespread use of tablets and capsule is due to their convenience of administration and ease of manufacturing. This chapter presents basics of tablets and capsules and the formulation and manufacturing technology. Moreover, the chapter also reviews the different techniques for coating of tablets. The chapter also discusses in detail the formulation and manufacturing of hard and soft gelatin capsules.

Objective: To analyze the presence of osteoporosis and osteopenia in post-menopausal breast cancer patients receiving hormonal therapy. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021. Methodology: This study was conducted on 200 post-menopausal female breast cancer patients who had been taking Aromatase inhibitors for more than six months. All the study participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to measure bone mineral density. As a result, they were classified as having osteoporosis or osteopenia based on bone mineral density. In addition, age, duration of therapy, tumour stage and molecular subtypes of breast cancer were correlated with the presence of osteopenia/osteoporosis in the study participants. Results: A total of 200 post-menopausal patients with breast cancer using hormonal therapy for more than six months were included in the final analysis. The mean age of the patients was 56.331 ± 6.744 years. In addition, 55 (22.5%) patients had normal bone mineral density, 92 (46%) had osteopenia, while 53 (26.5%) had osteoporosis on a dual-energy X-ray absorp- tiometry (DEXA) scan. Molecular subtypes of the tumour, the advancing age of patients and the long duration of hormonal therapy were statistically significantly associated with the presence of osteopenia/osteoporosis (p-value <0.05) in our study participants. Conclusion: Considerable number of post-menopausal patients with advanced breast cancer taking hormonal therapy showed the presence of osteopenia and osteoporosis. Molecular subtyping, the advanced age of patients and the long duration of hormonal therapy significantly predicted.........

Enterococcus faecium is a ubiquitous opportunistic pathogen that is exhibiting increasing levels of antimicrobial resistance (AMR). Many of the genes that confer resistance and pathogenic functions are localized on mobile genetic elements (MGEs), which facilitate their transfer between lineages. Here, features including resistance determinants, virulence factors and MGEs were profiled in a set of 1273 E. faecium genomes from two disparate geographic locations (in the UK and Canada) from a range of agricultural, clinical and associated habitats. Neither lineages of E. faecium , type A and B, nor MGEs are constrained by geographic proximity, but our results show evidence of a strong association of many profiled genes and MGEs with habitat. Many features were associated with a group of clinical and municipal wastewater genomes that are likely forming a new human-associated ecotype within type A. The evolutionary dynamics of E. faecium make it a highly versatile emerging pathogen, and its ability to acquire, transmit and lose features presents a high risk for the emergence of new pathogenic variants and novel resistance combinations. This study provides a workflow for MGE-centric surveillance of AMR in Enterococcus that can be adapted to other pathogens.

In this paper, we study thermal fluctuations, quasi-normal modes and phase transitions of two black holes, i.e., regular Bardeen and Bardeen black hole surrounded by perfect fluid dark matter. We investigate the effects of thermal fluctuations on uncorrected thermodynamic quantities such as entropy, Hawking temperature, Helmholtz free energy, Gibbs free energy and thermal stability. It is found that large black holes are stable under the effect of thermal fluctuations. We then obtain a relation between Davies point and quasi-normal modes of a black hole with perfect fluid dark matter. Finally, we study the influence of magnetic charge, correction parameter and perfect fluid dark matter parameter (α) on Hawking temperature as well as heat capacity. It is found that phase transitions occur in Hawking temperature from positive to negative by increasing charge but it shows opposite behavior for higher values of α. The heat capacity changes its phase from positive to negative for large values of both magnetic charge as well as α.

OBJECTIVES The objective of this study was to isolate bacteria from human nails of public of Peshawar and perform antibiogram analysis of isolated bacterial species. METHODOLOGY For this study, a total of 25 samples were collected from nails of students of Abasyn University, Peshawar. These samples were cultured on Nutrient agar, Eosin Methyl Blue dye agar and Mannitol Salt agar and were identified by Catalase, Oxidase, Triple Sugar Iron, Citrate, and Indole tests. RESULTS It was found that 60% of collected hand samples were contaminated with 47% Staphylococcus aureus (S. aureus) and 53% Escherichia coli (E. coli). Antibiogram analysis showed that the most potent antibiotic for E. coli and S. aureus was Ciprofloxacin (22mm and 26mm respectively) while less effective antibiotic was Cefixime having zone of inhibitions 13mm for E. coli and 10mm for S. aureus. CONCLUSION The results concluded that mostly the human nails are contaminated due to environmental factors and thus, require good hygienic practices to prevent different transmission of different infection.

Antibiotic resistance is concerned with public health and a serious threat in modern world. Pathogenic strains are rapidly developing resistance against antibiotics and limiting the treatment options. Nanostructured zinc oxide (ZnO) shows significant results when doped with silver (Ag), therefore used as an antibacterial agent. In this work, we synthesized pure and varying concentration of Ag-doped ZnO nanoplates through a one-step hydrothermal route. The structural, morphological, and optical properties of prepared nanostructures were comparatively studied. Furthermore, we have performed the ager-well assay, minimum inhibitory concentration study, and minimum bactericidal concentration study of synthesized nanoplates against five different bacterial strains including A. baumannii, P. aeruginosa, E. coli, K. pneumoniae, and S. aureus. The antimicrobial screening shows that Ag-doped ZnO nanoplates are more effective against all pathogenic strains as compared to pure ZnO, and therefore can be used in biomedical science.

Objective: To analyze the factors associated with adverse effects in elderly women receiving chemotherapy for breast cancer. Study Design: Comparative Cross-sectional Study. Place and Duration of Study: Oncology Department, Combined Military Hospital (CMH), Rawalpindi Pakistan, from Dec2020 to Nov 2021. Methodology: This study was conducted on 145 female patients (>65 years) with breast cancer who were taking chemotherapy of any type and had undergone one cycle. All the study participants underwent detailed clinical evaluation by a consultant oncologist to assess the presence of various adverse effects of chemotherapy. In addition, the association of Anthracycline use,>3 months of treatment, low haemoglobin at baseline and abnormal liver functions at baseline were studied with adverse effects in the study participants. Results: The final analysis included one hundred forty-five elderly female patients with breast cancer receiving chemotherapy.The mean age of the patients was 69.731±8.794 years. 89(61.4%) patients had no adverse effects, while 56(38.6%) had one or more adverse effects during chemotherapy. Anaemia 26(17.9%) was the commonest adverse effect, followed by fatigue 18(12.4%) and abnormal liver function tests 18(12.4%). It was revealed that the use of Anthracycline-based chemotherapy and long duration of chemotherapy were statistically significantly associated with adverse effects (p-value<0.05) in our study participants. Conclusion: Considerable number of elderly patients with breast cancer undergoing chemotherapy showed the presence of adverse effects. In addition, patients using Anthracycline-based chemotherapy and taking chemotherapy for more than three months were more at risk of developing adverse effects.

In this paper, we explore thermodynamics, thermal stability, effects of logarithmic corrections on thermodynamic quantities and phase transitions of spherically symmetric regular black hole with the de Sitter core. We first calculate the expressions for Hawking temperature as well as heat capacity and investigate its thermal stability. We also discuss the effects of logarithmic corrections on thermodynamical quantities such as pressure, Gibbs–Helmholtz free energy, internal energy and enthalpy of the system. Finally, we analyze the behavior of Hawking temperature as well as specific heat capacity of the regular black hole versus entropy for different values of the de Sitter parameter [Formula: see text]. It is found that Hawking temperature changes its phase from positive to negative and heat capacity changes its phase from negative to positive for large values of [Formula: see text].