Since the isolation of adenovirus (AdV) in 1953, AdVs have been used as vectors for various therapeutic purposes, such as gene therapy in cancers and other malignancies, vaccine development and delivery of CRISPR-Cas9 machinery. Over the years, several AdV vector modifications have been introduced, including fiber switching, incorporation of ligands in the viral capsid and hexon modification of the fiber, to improve the efficiency of AdV as a vector. CRISPR-Cas9 has recently been used for these modifications and is also used in other adeno-associated viruses. These modifications further allow the production of AdV libraries that display random peptides for the production of cancer-targeting AdV vectors. This review focuses on the common methods of AdV construction, changes in AdV tropism for the improvement of therapeutic efficiency and the role of AdV vectors in gene therapy, vaccine development and CRISPR-Cas9 delivery.

Background and Objective: A delayed presentation of benign breast diseases may lead to a therapeutic challenge when they enlarge enormously or become multiple. Aim of this study was to evaluate the factors leading to delayed presentation of benign breast lumps. Methods: This cross-sectional study was conducted at Madinah Teaching Hospital and Allied Hospital, Faisalabad from January 2019 to October 2021. One hundred and forty five female patients were selected by non-probability purposive sampling. Patients with large size (>5cm) or multiple benign breast lumps were included. An interview was conducted using structured questionnaire translated in Urdu. Factors leading to delayed presentation and social impact scale for stigma were evaluated. Results: Patients had a mean age of 26.52 ± 6.90 years. The average delay of seeking medical care was 8.48 ± 8.41 months. Factors leading to delayed presentation were; lack of knowledge n=112 (77.2%) and parda (religious issues) n=112 (77.2%), followed by poverty n=109 (75.2%), and fear of cancer n=90 (62.1%). All the sub-scales of stigma, i.e., social rejection, financial insecurity, internalized shame and social isolation were high in late presenters, though, only financial insecurity was significantly high in late presenters (p=0.03). Conclusion: Lack of awareness, socioeconomic factors and disease related stigma were the main factors related to delayed presentation in young females with benign breast diseases. Addressing these factors may improve timely diagnosis and management of delayed and challenging cases. doi: https://doi.org/10.12669/pjms.39.1.6647 How to cite this: Saleem S, Tariq S, Tariq S, Irfan S, Javed F. Factors leading to delayed and challenging presentation of benign breast lumps in young females. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6647 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives: The objective of the current study was to find prevalence of relevant ESBL and carbapenemase producing genes in nosocomial E. coli and K. pneumoniae isolates and to check phenotypic susceptibility of all ESBL positive isolates to carbapenems. Methods: Forty ESBL producing clinical isolates of Escherichia coli (n=33) and Klebsiella pneumoniae (n=7) were examined for the presence of β-lactamase genes (CTX-M, CTX-M-1, 2, 3, 4 and TEM). Carbapenem resistance was checked phenotypically and by presence of blaNDM-1 gene. Results: Nine (27%) were positive for CTX-M genes, and 10 (30%) for TEM among E. coli isolates. Importantly, six isolates showed co-existence of CTX-M and TEM genes. In K. pneumoniae, two (28%) isolates were positive for CTX-M and one (14%) for TEM genes. Eight (24%) E. coli and one (14%) K. pneumoniae isolates were positive for CTX-M-1. Respective figures for CTX-M-4 were three (10%) and one (14%). CTX-M-2 and CTX-M-3 groups were not represented. Twenty (50%) isolates were resistant to both imipenem and meropenem out of which only four isolates expressed blaNDM-1 gene. Conclusions: The significant presence of both ESBL and carbapenemase producers and co-existence of ESBL and carbapenemases in the same isolates is worrisome. Abbreviations: ESBL: Extended spectrum β-lactamase. MBL: Metallo-betlactamase. PCR: Polymerase chain reaction. doi: https://doi.org/10.12669/pjms.37.1.3192 How to cite this:Irfan S, Azhar A, Bashir A, Ahmed S, Haque A. High frequency of simultaneous presence of ESBL and carbapenemase producers among nosocomial coliform isolates in Faisalabad, Pakistan. Pak J Med Sci. 2021;37(1):34-39.  doi: https://doi.org/10.12669/pjms.37.1.3192 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT… Thyroid is a highly vascular gland and hemostasis is a key limiting factor in morbidity and mortality in thyroid surgery. Hemostasis has always been a challenge and various techniques have been used. Vessel sealers like Ligasure are now gaining popularity. Objectives: The objective of this study is to compare thyroidectomy by Ligasure with conventional technique in terms of mean operative time and post-operative blood loss. Study Design: It is a Randomized Control Trial. Setting: Surgical Department of Allied Hospital Faisalabad. Period: Six months (March 2017 to August 2017). Material & Methods: After approval of study from ethical review committee and informed consent, the patients were subjected to complete history and clinical examination in addition to baseline investigations. Total 135 patients of multinodular goiter (MNG) and euthyroid were divided in two groups by simple random sampling. All surgeries were performed under general anesthesia with orotracheal intubation and procedure offered to each patient was subtotal thyroidectomy. Both techniques were compared by measuring the time from opening of pretracheal fascia till its closure in minutes by stop watch and mean was calculated. Post operative blood loss was measured in graduated drain placed in thyroid bed for 24 hours. Results: Mean operative time was recorded as 62.11+4.07 minutes in Ligasure technique group and 73.05+4.01 minutes in conventional technique group. Mean blood loss was recorded as 57.28+3.42 ml in Ligasure technique group and 70.85+4.12 ml in conventional technique group. Conclusion: We concluded that mean operative time and post operative blood loss is significantly lower in cases undergoing thyroidectomy with Ligasure as compared to conventional technique. Article Citation: Akram M, Randhawa SR, Durr-i-Chaman, Zafar S, Yaqoob M, Irfan S, Sajid M. Comparison of outcome of Sutureless Thyroidectomy by Ligasure small jaw verses conventional technique.