Determination of reference ranges of plasma glycosaminoglycans in a tertiary care centre

Objective: To determine reference ranges of plasma glycosaminoglycans (GAGs) in a population presenting at a tertiary care centre of Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi from January 2020 to December 2020.Methodology: An observational cross-sectional study which involved one hundred and twenty (120) disease-free healthy population was selected by non-probability consecutive sampling at a 90% confidence interval with a 5% margin of error. Plasma glycosaminoglycans were assayed by manual ELISA technique. The study population was stratified according to gender. Normality of data was assessed by Kolmogorov-Smirnov test. Dixon range test was employed to find outliers. After removing the outliers, mean ±, SD was calculated for plasma GAG levels (mg/L). Sex-specific reference values were determined Results: In our study, the total male population was 62 (51.7%), while the female was 58 (48.3%) in the disease-free population (n=120). The overall GAG levels were calculated as 24.12±7.9 mg/l in blood samples against the reference range of 11.48-36.76 mg/l. In males, GAG levels were found as 24.67±6.65 against a reference range of 11.67-37.7 mg/l, while in females, it was 22.22±5.36 against the reference interval of 11.71-32.73 mg/l.Conclusion: The reference range for plasma GAG was found 11.48-36.76 mg/l in our study population. GAG levels differ significantly among males and females with reference ranges of 11.67-37.7 mg/l and 11.71-32.73 mg/l, respectively

Evaluation of liver function test abnormalities in patients having COVID-19 according to severity of disease

Background: COVID-19 infection affects all major organs of body in addition to lungs. Damage done to liver varies from being hepatocellular, obstructive or mix pattern. The aim of the study was to evaluate abnormalities of LFTs, in COVID-19 patients according to disease severity in our population.Methods: A cross sectional study, conducted at GTTH and Surgimed Hospital Lahore, on 100 patients who presented with COVID-19 in between October 2020 and September 2021. According to Symptoms, patients were marked as having mild, moderate or severe disease. Bilirubin, Albumin, ALP, ALT, AST, GGT, LDH and prothrombin time were checked at admission and subsequently. Data was analyzed using SPSS v23.  Laboratory values were computed in each severity category and SD values, odds ratio, 95% confidence intervals were studied in logistic regression models. P value<0.05 were considered statistically significant.Results: Among studied patients, 66% were male, 34% were female, mean age of 44.68±9.36 and range of 29-68 years. 29% were with mild disease, 40% with moderate disease, and 21% with severe disease level. 80% cases with rural background had moderate/severe disease levels while only 14.3% cases with severe levels were from urban areas. Only direct bilirubin showed a statistical significance with p value<0.05 in all severity groups. Other LFT’s didn’t show any significance between different severity groups.Conclusions: Among Liver function markers only bilirubin was related to COVID-19 disease and proportional to severity of disease.

DIAGNOSTIC ACCURACY OF PLAIN MAGNETIC RESONANCE IMAGING OF CRUCIATE LIGAMENTS AND MENISCAL INJURIES KEEPING ARTHROSCOPY AS GOLD STANDARD

OBJECTIVE: To find out the accuracy of plain Magnetic Resonance imaging (MRI) in comparison with arthroscopy in diagnosing cruciate ligaments and meniscal injuries. METHODS:  This prospective study was conducted from June 2019 to June 2020 at Khyber teaching hospital Peshawar, Pakistan. All patients, aging 14-55 years, with history of trauma to knee and suspected meniscal and ligament injuries were included. Patients with positive findings on clinical examination and MRI were sent for arthroscopy. Findings on MRI and arthroscopy were compared for diagnostic accuracy. RESULTS:    Out of 100 patients, 87 were males. Fifty-nine patients had anterior cruciate ligament injuries (ACLI), one patient had posterior cruciate ligament injuries (PCLI), 49 patients had medial meniscus injuries (MMI) and 8 had lateral meniscal injuries (LMI) respectively. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI was 93.4%, 71.4%, 82.35% & 88.23% respectively for ACLI and 100%, 96%, 20% and 100% respectively for PCLI. Similarly, sensitivity, specificity, PPV and NPV of MRI was 81.6%, 45.3%, 57.97% & 72.72% respectively for MMI and 37.5%, 91.5%, 27.27% and 94.5% respectively for LMI. There was no statistically significant difference for gender (p=0.43) and side of knee (p=0.22) between MRI vs arthroscopy. CONCLUSION: MRI has high sensitivity and NPV for ACLI & PCLI, low sensitivity for LMI, low specificity for MMI and low PPV for PCLI, MMI and LMI. In cases of clinical suspicion of meniscal or ligamental injury, clinicians should not rely on MRI findings alone but should follow it up with diagnostic arthroscopy

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p &lt; 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p &lt; 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Assessment of Food Security and Its Implication on Urban Poor People in District Peshawar

Purpose: This study was carried out to address the issue of food security and the factors affecting it in the semi-urban area of district Peshawar, Khyber Pakhtunkhwa, Pakistan. More specifically the study reviewed the food security situation among urban poor households using their food expenditures patterns and further investigated its various dynamics. Methodology: Data were collected with the help of interviewing techniques from randomly sampled 100 households in the Peshawar suburb. Household food security was assessed using the food security index adopted from Omonona (2007). Using the Omonona index, the threshold which differentiated the food secure from the food-insecure households in the study area was Rs. 1500 per month (i.e., 2/3 of mean food expenditure). Findings: The result legitimized using the Omonona food security index as a smart indicator in determining food security status at the household level. Implications: To help the urban poor in improving the situation of food security efforts are needed to enhance awareness of food security by promoting education regarding livelihood strategies, self-sustainability programs, and the importance of a proper diet.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp

Impact of malocclusion of oral health related quality of life among 13-18 years visiting dental hospital

Malocclusion is one of the most significant factors affecting oral health, and it is significant not only for financial and physical comfort but also for quality of life (QoL) by impairing appearance, interpersonal connections, function, self-confidence, socializing, and psychological well-being. Objectives: This study was piloted to evaluate OHRQoL in children between the ages of 13 and 18 who were seeking orthodontic treatment at Abbottabad International Medical and Dental College, Abbottabad and to determine the relationship between the need for orthodontic management, gender, age and OHRQoL. Methodology: A descriptive cross-sectional study using a questionnaire was done among 900 young individuals, ages 13 to 18, who visited the department of orthodontics. The OASIS survey was completed by the participants. All patients aged 13 to 18 who reported for treatment at the orthodontic department between January 2023 till June 2023 were included while those having a history of jaw trauma, those who are undergoing orthodontic therapy, and those who have undergone orthodontic treatment were omitted from the study.

A Family of Transformerless Quadratic Boost High Gain DC-DC Converters

This paper presents three new and improved non-isolated topologies of quadratic boost converters (QBC). Reduced voltage stress across switching devices and high voltage gain with single switch operation are the main advantages of the proposed topologies. These topologies utilize voltage multiplier cells (VMC) made of switched capacitors and switched inductors to increase the converter’s voltage gain. The analysis in continuous conduction mode is discussed in detail. The proposed converter’s voltage gain is higher than the conventional quadratic boost converter, and other recently introduced boost converters. The proposed topologies utilize only a single switch and have continuous input current and low voltage stress across switch, capacitors, and diodes, which leads to the selection of low voltage rating components. The converter’s non-ideal voltage gain is also determined by considering the parasitic capacitance and ON state resistances of switch and diodes. The efficiency analysis incorporating switching and conduction losses of the switching and passive elements is done using PLECS software (Plexim, Zurich, Switzerland). The hardware prototype of the proposed converters is developed and tested for verification