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 lifethreatening 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 (intentionto-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, 0.087À1.272), arm II (RR, 0.5; 95% CI, 0.171À1.463), arm III (RR, 0.167; 95% CI, 0.024À1.145), and arm IV (RR, 0.667; 95% CI, 0.268À1.660). In intervention group, median HI significantly improved to 359 mmHg [interquartile range (IQR) 127À400, 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).

Purpose In the present scenario, the demand for additive manufacturing (AM) has increased. Taking into account environmental problems and sustainability, manufacturers are now also considering the environmental and sustainability criteria in their decision-making process. The sustainability concept is known as the triple-bottom line, namely, economic, social and environmental perspectives. Sustainable concept selection in the manufacturing organisation can be considered as the selection of sustainable material, product design, process, method and technology. This study aims to select an appropriate AM process by considering sustainability from various available techniques. Design/methodology/approach Appropriate sustainable performance indicators for the AM were identified based on literature as well as in discussion with experts and decision-makers. The model addresses all the major dimensions of sustainable concepts of AM such as material/product quality, machine performance, market stability, total cost and ecological values. A hybrid multi-criteria decision-making approach, i.e. stepwise weight assessment ratio analysis and complex proportional assessment methods, have been used to select the best AM technique. While selecting criteria affecting AM machines and processes, criteria based on the sustainable concept are considered. Findings Among the four selected AM processes, i.e. fused diffusion modelling (FDM), laminated object manufacturing (LOM), stereolithography apparatus (SLA) and selective laser sintering (SLS), the best alternative was found to be FDM. Research limitations/implications The present study highlights some limitations in the selection of AM process and methodology used in this research. This study considers only four AM processes, i.e. FDM, LOM, SLA and SLS. Future work may include considering other AM processes and criteria that affect the sustainability of AM. Practical implications The present work will help researchers and production managers to decide the best AM alternatives to fabricate desired parts. Hence, AM can help in maximum energy utilisation, optimal consumption of resources, minimum material wastage and reduction of CO2 emission. Originality/value The study considers some important criteria, including energy consumption, eco-friendly and wastage-free production, that help sustainable AM. This study can result in a good economic efficiency of AM industries and, therefore, positively impact customers using green products.

Stroke is characterized by the sudden loss of blood circulation to an areaof the brain, resulting in a corresponding loss of neurologic function. It is also called ascereberovascular accident (CVA) or stroke syndrome. Objectives: To determine frequencyof hypertension, diabetes mellitus and smoking in patients with ischemic stroke. Patientsand methods: This cross sectional study of six months was carried out in the department ofmedicine, Liaquat University of Medical and Health Sciences. Patients aged 20-70 years of agewith ischemic stroke on CT were enrolled in the study after taking consent from caretaker ofpatients. Detailed history focusing on hypertension, diabetes and smoking and their durationwas taken. Blood pressure was recorded and fundoscopy was done to find out diabetic orhypertensive retinopathy. Thorough neurological examination was done and blood sugar(fasting and random) was evaluated. Data was entered and analyzed using SPSS version 16.Results: A total of 100 patients were included in the study during study period. 64% of patientswere in ≥ 50 years of age group with mean age of 52±11 years. A total of 66 (66%) were male;with male to female ratio was 2:1. Hypertension was present in 61% of cases, Diabetes wasfound in 32% cases and 40 patients were cigarette smokers. Conclusions: It was concludedthat high blood pressure, diabetes mellitus and smoking are associated with ischemic stroke.

Objective: To determine the frequency of raised C-reactive protein (CRP) inpatients with metabolic syndrome. Patients and methods: This cross sectional descriptivestudy of six months study was conducted at Liaquat University Hospital Hyderabad. All thepatients of 20 to 60 years of age, of either gender presented with symptoms of metabolicsyndrome for more than 01 year duration were admitted and evaluated for C-reactive protein.The data was analyzed in SPSS 16 and the frequency and percentage was calculated. Results:Total one hundred patients (59 females and 41 males) with metabolic syndrome were evaluatedfor C-reactive protein. The mean waist circumference for males and female patients with raisedCRP was 48.93±2.33 and 48.42±3.41 while the mean ±SD of serum triglycerides level for maleand female with raised CRP was 192.41±3.21 and 196.31±3.43 respectively. The mean ±SD ofserum HDL-C level for male and female with raised CRP was 28.32±1.22 and 25.31±1.42. Themean ±SD of systolic and diastolic pressure for males and female patients with raised CRP was150±3.42 and 100.51±4.42. The mean ±SD of serum fasting blood sugar for male and femalepatients with raised CRP was 131.52±3.33 and 143.42±7.42 respectively. The mean ±SD ofCRP for male and female patients with raised CRP was 4.42±1.21 and 5.8±2.52. In relationto gender distribution, the majority of subjects from 40-49 years of age group with femalepredominance (p = 0.01) while the CRP was raised in 67% patients in relation to age (p=0.05)and gender (p=0.04) respectively. Out of 67 subjects with raised CRP 44 were females and 23were males.Conclusions: The CRP was raised in patients with metabolic syndrome.

Objectives: To identify the frequency of risk factors in hemorrhagic stroke at Liaquat university of medical and health sciences. Patient and methods: This Descriptive case series study of six months was carried out in the department of medicine, Liaquat University of Medical and Health Sciences. Patients aged 20-70 years of age with hemorrhagic stroke on CT were enrolled in the study after taking consent from caretaker of patients. Detailed history focusing on hypertension, diabetes and smoking and their duration was taken. Blood pressure was recorded and fundoscopy was done to find out diabetic or hypertensive retinopathy. Thorough neurological examination and fasting / random blood glucose level was evaluated while the data was done was analyzed using SPSS version 16. Results: A total of 100 patients were included in the study during study period. 61% of patients were in > 50 years of age group with mean age of 53.4±11 years. A total of 66 (66%) were male; with male to female ratio was 2:1. Hypertension was present in 63% of cases, Diabetes was found in 24% cases and 44 patients were cigarette smokers. Conclusions: It was concluded that high blood pressure, diabetes mellitus and smoking are associated with hemorrhagic stroke.