“Does Pakistan still have polio cases?”: Exploring discussions on polio and polio vaccine in online news comments in Pakistan

IntroductionPolio, which is caused by poliovirus, is a contagious, potentially crippling, and deadly disease. Pakistan is one of the countries in which polio is still endemic in the 21st century. In 2019, 146 polio cases were reported across the country with some resulting in deaths. Following the spread of rumors insinuating that children were falling sick after receiving an anti-polio vaccine, a mob attacked and set fire to a small hospital in the Peshawar district in April 2019. The present study investigates readers’ discussions that emerged from Dawn’s online readers’ comments on polio-related news stories in Pakistan.MethodsUsing thematic analysis, we analyzed (N = 2216) comments made by readers in the polio-related news stories published on Dawn.com from January 1, 2012, to March 1, 2020.ResultsSeven major themes emerged from the analysis of the comments: 1) reasons for and challenges resulting in the failure to eradicate polio; 2) proposed solutions and policy changes to eradicate polio; 3) misinformation; 4) criticism, frustration, and shame; 5) comparison of Pakistan to other countries; 6) the internet as a public sphere; 7) suffering, empathy, and appreciation. Overall, our findings suggested that commenters are knowledgeable about polio vaccines and consider polio a serious threat to public health in Pakistan.ConclusionOur study not only validated previous study findings such as reasons, challenges, and issues related to polio vaccination, but also found new challenges in online news sites concerning misinformation on polio and polio vaccination in Pakistan.     

Effect of the Source-to-Substrate Distance on Structural,Optoelectronic, and Thermoelectric Properties of Zinc Sulfide Thin Films

Zinc sulfide (ZnS) thin films with variable structural, optical, electrical, and thermoelectric properties were obtained by changing the source-to-substrate (SSD) distance in the physical-vapor-thermal-coating (PVTC) system. The films crystallized into a zinc-blende cubic structure with (111) preferred orientation. The films had a wide 3.54 eV optical band gap. High-quality homogenous thin films were obtained at 60 mm SSD. The sheet resistance and resistivity of the films decreased from 10¹¹ to 10¹⁰ Ω/Sq. and from 10⁶ to 10⁵ Ω-cm, when SSD was increased from 20 mm to 60 mm, respectively. The phase and band gap were also verified by first principles that were in agreement with the experimental results. Thermoelectric characteristics were studied by using the semi-classical Boltzmann transport theory. The high quality, wide band gap, and reduced electrical resistance make ZnS a suitable candidate for the window layer in solar cells.     

Comparative Efficacies and Tolerabilities of Intravenous Azithromycin Plus Ceftriaxone and Intravenous Levofloxacin with Step-Down Oral Therapy for Hospitalized Patients with Moderate to Severe Community-Acquired Pneumonia

Objective: To compare the efficacy and tolerability of ceftriaxone plus azithromycin with those of levofloxacin in the treatment of hospitalized patients with moderate to severe community-acquired pneumonia (CAP). Design: Randomized, open-label multicenter trial with 1 : 1 treatment allocation in an inpatient setting. Patients: 212 male or female inpatients with a clinical diagnosis of CAP were included in the study. In each treatment group >50% of patients had a pneumonia severity index of IV or V. Interventions: Open-label treatment with either intravenous (IV) ceftriaxone 1g and IV azithromycin 500mg daily or IV levofloxacin 500mg daily. Patients who improved clinically were switched to oral follow-on therapy with either azithromycin 500 mg/day or levofloxacin 500 mg/day. At the clinician’s discretion, oral cefuroxime axetil was added to the treatment regimen of patients who received oral azithromycin if a macrolide resistant pneumococcal isolate was documented. Results: Overall, both study treatments were well tolerated. Favorable clinical outcomes in clinically evaluable patients were demonstrated in 91.5% of patients treated with ceftriaxone plus azithromycin and 89.3% (95% CI ?7.1%, 11.4%) of patients treated with levofloxacin at the end of therapy visit and in 89.2% and 85.1% (95% CI ?6.7%, 14.8%) patients, respectively, at the end of study visit. Bacteriological eradication rates for both treatments were equivalent with the exception of Streptococcus pneumoniae; 44% of isolates were eradicated with levofloxacin compared with 100% of isolates with ceftriaxone plus azithromycin. Conclusions: As acknowledged by international CAP treatment guidelines, the combination of a third-generation cephalosporin and a macrolide is at least as efficacious as monotherapy with a fluoroquinolone with enhanced anti-pneumococcal activity, for hospitalized patients with moderate to severe CAP. Combined medication with a macrolide and third-generation cephalosporin may be preferred over fluoroquinolones as first-line therapy of hospitalized patients with CAP to minimize the development of multiresistant nosocomial Gram-negative bacilli.     

A novel splice site mutation in ERLIN2 causes hereditary spastic paraplegia in a Saudi family

Hereditary Spastic Paraplegias (HSP) encompass a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by insidiously progressive weakness and spasticity of the lower extremities. We describe a consanguineous Saudi family segregating a complicated form of HSP in an autosomal recessive pattern. The two affected siblings had early onset, cognitive, speech and motor involvement with spasticity of the lower extremities. Their upper extremities were mildly hypertonic. An intronic splice acceptor site mutation in ERLIN2 was found to be responsible for causing this disorder found in this family. ERLIN2 is a mediator of endoplasmic reticulum degradation pathway (ERAD) which helps to remove the aberrant proteins. Our results, in concurrence with previous studies suggest that alteration in ERLIN2 is one of the causes of complicated HSP, thereby increasing the spectrum of known mutations in SPG18.     

Impaired microsomal oxidation of the atypical antipsychotic agent clozapine in hepatic steatosis

Hepatic lipid infiltration (steatosis) is a complication of the metabolic syndrome and can progress to nonalcoholic steatohepatitis and severe liver injury. Microsomal cytochrome P450 (P450) drug oxidases are down-regulated in experimental steatosis. In this study we evaluated the separate and combined effects of lipid accumulation and P450 down-regulation on the microsomal oxidation of the antipsychotic agent clozapine (CLZ), the use of which is associated with an increased incidence of the metabolic syndrome. Several important drug oxidizing P450s were down-regulated, and the formation of N-desmethyl-CLZ (norCLZ) and CLZ N-oxide was decreased in microsomal fractions from orotic acid-induced early steatotic rat liver. Inclusion of lipids extracted from steatotic, but not control, liver decreased the free concentration of CLZ in microsomes and suppressed norCLZ formation; CLZ N-oxidation was unchanged. Triglycerides increased in steatotic liver to 15-fold of control, whereas increases in the monounsaturated oleic acid to 10-fold of control and total polyunsaturated and saturated fatty acids to 4- and 5-fold of control also occurred. Addition of triglycerides containing esterified omega-6 and omega-3 fatty acids inhibited the microsomal formation of norCLZ but not that of CLZ N-oxide; triglycerides esterified with unsaturated and monounsaturated fatty acids were inactive. Thus, drug oxidation may be suppressed in steatosis by P450 down-regulation and the accumulation of polyunsaturated fatty esters. In contrast, the activity of the flavin-containing monooxygenase that mediates CLZ N-oxidation was unimpaired. Lipid deposition in livers of patients with the metabolic syndrome may necessitate dosage adjustments for toxic drugs, including CLZ.     

The first morphologically controlled synthesis of a nanocomposite of graphene oxide with cobalt tin oxide nanoparticles

In the present research, the degradation and decolorization of Reactive Black 5 synthetic dye at 30 ppm concentration under sun irradiation in the presence of a newly synthesized graphene based cobalt tin oxide nanocomposite were investigated. These nanoparticles were synthesized by a simple hydrothermal approach using precursor chloride salt i.e., stannous chloride and cobalt chloride and then adsorbed on the surface of RGO by a solvothermal process by changing the condition. The newly synthesized product was subjected to various instrumentation to study the morphology and other properties. X-ray powder diffraction analysis (XRD) explained the structural composition and various parameters of the product, which were further verified by Vesta software. The surface morphology of the product was analyzed by scanning electron microscopy (SEM) and it was observed that the size of each cube was approximately 5–10 μm from every face of the cube. Transmission electron microscopy (TEM) explained that the nanoparticles were within the range of 100–250 nm. These synthesized nanocubes were used in one more application, which was the investigation of the fuel efficiency in the presence of different concentrations of newly synthesized nanocomposites as a catalyst. The efficiency of kerosene oil was investigated by studying different parameters: the flash point, fire point, specific gravity, cloud point, pour point, and calorific value at increasing dosages of catalyst (0, 30, 60 and 90 ppm). It was observed that the values of these parameters changed significantly by changing the concentration of the catalyst dosage. The effect of the nanoparticles on the degradation of the RB 5 azo dye showed the highest removal percentage at the largest value of catalyst dosage, which was 0.70 mg ml⁻¹ with the highest value of 3 ml of hydrogen peroxide.

Tin cobalt hydroxide nanoparticles were synthesized by a simple hydrothermal technique. A graphene based cobalt tin oxide nanocomposite was synthesized by a solvothermal method.     

Neuromuscular paralysis as a pharmacodynamic probe to assess organ function during liver transplantation

Potential for assessing liver function during liver transplantation surgery by monitoring muscle paralysis from nondepolarizing neuromuscular blockers that are hepatically cleared is critically assessed. Rocuronium is strongly favored as a promising pharmacodynamic probe for predicting allograft liver function because it is predominantly eliminated via the liver and its putative metabolites are not active. Prolongation of recovery from rocuronium paralysis is closely correlated with allograft liver function postoperatively. Vecuronium, pancuronium, and perhaps pipecuronium may also prove to be useful probes, but the two former blockers have active metabolites. Further prospective studies are necessary with more precise measurement of neuromuscular function to confirm the predictive value of this method. Alterations in neuromuscular blocker plasma concentrations that are correlated with changes in liver function and either the dose required or the intensity or duration of paralysis needs to be demonstrated for this technique to be clinically useful.     

Studies of d-tubocurarine pharmacokinetics in humans and dogs

The pharmacokinetics of d-tubocurarine was studied in man during single and multiple administrations of d-tubocurarine, and in dogs during single administrations. The simplest model consistent with out data was a two-compartment open model. The mean half-lives for the two phases in the human studies were 8.9 and 123.8 minuts. For the greyhounds these mean values were 2.8 and 77.4 minutes. The animals did not demonstrate a difference between the arterial and mixed venous concentrations of d-tubocurarine.     

A comparison of nesiritide vs. epoprostenol in a patient with precapillary pulmonary hypertension due to scleroderma complicated by postcapillary pulmonary hypertension

To the best of our knowledge, acute decompensated left-sided heart failure with preserved left ventricular ejection fraction in a patient with scleroderma has not been previously reported. We describe a patient with severe pulmonary hypertension due to limited scleroderma in whom nesiritide led to marked reductions in pulmonary arterial and capillary wedge pressure as well as resolution of symptoms and pulmonary edema. Subsequent epoprostenol use was associated with an increase in pulmonary capillary wedge pressure and a recurrence of pulmonary edema. Thus, nesiritide may be the preferred agent in scleroderma patients with severe pulmonary hypertension and preserved left ventricular systolic function since epoprostenol may lead to adverse hemodynamic effects.