Burden of ileal perforations among surgical patients admitted in tertiary care hospitals of three Asian countries: Surveillance of enteric fever in Asia project (SEAP), september 2016-september 2019

Background: Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan.Methods: Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data were retrieved from medical records. Tissue samples were collected for histopathology and blood cultures where available.Results: Of the 249 enrolled cases, 2 from Bangladesh, 5 from Nepal and 242 from Pakistan. In Pakistan, most of the cases were in the 0-15 (117/242; 48%) and 16-30 (89/242; 37%) age groups. In all countries, males were most affected: Pakistan 74.9% (180/242), Nepal 80% (4/5), and Bangladesh 100% (2/2). Blood culture was done on 76 cases; 8 (11%) were positive for S. Typhi, and all were extensively drug resistant (XDR) S. Typhi. Tissue cultures was done on 86 patients; 3 (3%) were positive for S. Typhi, and all were XDR S. Typhi, out of 86 samples tested for histopathology 4 (5%) revealed ileal perforation with necrosis. Culture or histopathology confirmed total 15 (11%) enteric fever cases with ileal perforation are similar to the clinically diagnosed cases. There were 16/242 (7%) deaths from Pakistan. Cases of ileal perforation who survived were more likely to have sought care before visiting the sentinel hospital (P = .009), visited any hospital for treatment (P = .013) compared to those who survived.Conclusions: Although surveillance differed substantially by country, one reason for the higher number of ileal perforation cases in Pakistan could be the circulation of XDR strain of S. Typhi in Karachi

Process optimization for enhanced production of cellulases form locally isolated fungal strain by submerged fermentation

Cellulase has myriad applications in various sectors like pharmaceuticals, textile, detergents, animal feed and bioethanol production, etc. The current study focuses on the isolation, screening and optimization of fungal strain through one factor at a time technique for enhanced cellulase production.  In current study sixteen different fungal cultures were isolated and the culture which quantitatively exhibits higher titers of cellulase activity was identified both morphologically and molecularly by 18S rDNA and designated as Aspergillus niger ABT11. Different parameters like fermentation medium, volume, temperature, pH and nutritional components were optimized. The highest CMCase and FPase activities  was achieved in 100ml of M5 medium in the presence of 1% lactose and sodium nitrate at 30 oC, pH5 after 72 hours. The result revealed A. niger can be a potential candidate for scale up studies

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Dysgerminoma with Pregnancy and Viable Baby: A Case Report

Dysgerminomas are the most common of primitive germ cell tumors of the ovary, accounting for 1-5% of all ovarian malignancies. The reproductive age group females are most commonly affected, thereby causing problems in conception and if pregnancy occurs, it leads to feto-maternal compromise. It is extremely rare to have a successful natural pregnancy, with viable child birth with a coexisting dysgerminoma, without any assisted reproductive interventions. We hereby report a case of successful spontaneous natural pregnancy in a primi gravida, associated with dysgerminoma, with no feto-maternal compromise

Distribution and determinants of sedentary lifestyle among health care professionals

Background: This study aimed to assess the knowledge, attitudes of health care providers towards physical activity and healthy eating by measuring leisure-time physical activity and food intake patterns.Methods: A cross sectional study was conducted on 211 participants using Modifiable Activity Questionnaire and Food Frequency questionnaires at the Jinnah Medical and Dental College (JMDC) and Aga Khan University Medical College (AKUMC). The targeted population was students from year 1 to 5 of MBBS, faculty & staff of medical college. Body composition analysis and questions assessing personal perception of healthy diet and lifestyle were performed.Results: Out of the 211 participants in this study, 55.18% spent time sitting at job for 6 or more hours, 33.2% spent at least 2-3 hours on screen time. Only 42.7% individuals exercised for less than 15 minutes in a week. The most consumed food groups in the participants were bread/roti (46.9%) followed by and hot beverages (51.7%). Seventy-one percent regarded their dietary habits as moderately healthy and reported that lack of leisure time (65.9%) and work/family commitment (38.4%) were the major restraints for being physically active.Conclusion: Health professionals followed sedentary lifestyle and unhealthy dietary patterns. The major limitation identified was being lack of time and willingness

Pott’s Puffy Tumor Elicited by Klebsiella Pneumoniae: An Uncommon Clinical Entity

A lesser-known clinical non-neoplastic entity was first described in 1775, known as Pott’s puffy tumor (PPT). PPT is characterized by frontal bone osteomyelitis with an associated subperiosteal abscess. The diagnosis is usually confirmed with a computed tomography scan of the paranasal sinuses. Early treatment is the law as there is imminent substantial morbidity if left untreated. Herein, we presented a case of a 27-year-old male with a Pott’s puffy tumor due to Klebsiella Pneumoniae that was effectively treated with surgery and antibiotics for a total of 3 weeks. Even rare it is a terrifying complication, making it fundamental importance to make an early diagnosis and a correct surgical combined with medical management

An infrequent case of adult nasopharynx rhabdomyosarcoma with bony involvement: a case report

Rhabdomyosarcoma is a rare and highly aggressive malignancy arising from the striated skeletal muscle fibre. It is commonly a childhood tumour and rarely seen in adults. The most predominant part commonly involved is head and neck. We are reporting a rare case of a 54 year old adult male with Rhabdomyosarcoma of nasopharynx with a non specific presentation of weight loss for past four months, fever, a perianal abscess and backache since 10 days. Continu

Demographic variation and risk factors regarding breast cancer among female in Southern Punjab, Pakistan

Objective: Breast cancer is a second major cause of female death worldwide. This study aimed to explore epidemiology, clinical profiles and contribution of reproductive and non-reproductive risk factors in breast cancer development among females from South Punjab, Pakistan. Methods: Data was collected through hospitals between October 2017 and March 2018 and study got approval by Bioethical Committee of Quaid-i-Azam University in September, 2017. A total of 163 cases and 163 age-matched controls were recruited through non-probability consecutive sampling method. All histologically confirmed patients irrespective of age, family history, clinical presentation and histopathological type were included in the study as cases. Patients, who were not willing to participate were excluded from the study. Details regarding socio-demographic characteristics, family history of cancer, reproductive health and lifestyle factors were recorded using a structured questionnaire. Conditional logistic regression was performed to calculate odds ratios at 95% confidence intervals for breast cancer by menstrual and reproductive factors after adjustment of potential confounders. Conditional logistic regression was also applied for various demographic and medical risk factors/exposures. Results: We found positive family history and hypertension significantly linked to an increased breast cancer risk (adjusted O.R >1.5, 95% CI, P<0.05) whereas, intense physical activity, increased anthropometric measurements and breastfeeding per child in months were inversely associated with breast cancer risk (adjusted O.R <1.0, 95% CI, P<0.05) in our study cohort. Conclusion: Our study reaffirms contribution of established risk factors for breast cancer, highlights protective factors and necessitates awareness/screening programs to reduce breast cancer burden in upcoming generations. Continuous..

Dysgerminoma with Pregnancy and Viable Baby: A Case Report

Abstract Dysgerminomas are the most common of primitive germ cell tumors of the ovary, accounting for 1-5% of all ovarian malignancies. The reproductive age group females are most commonly affected, thereby causing problems in conception and if pregnancy occurs, it leads to feto-maternal compromise. It is extremely rare to have a successful natural pregnancy, with viable child birth with a coexisting dysgerminoma, without any assisted reproductive interventions. We hereby report a case of successful spontaneous natural pregnancy in a primi gravida, associated with dysgerminoma, with no feto-maternal compromise

The quality of patient care in oncology departments in Karachi, Pakistan: Patients\u27 perceptions

Purpose: This study aims to assess the quality of care among adult oncology patients in tertiary care hospitals in Karachi by using an international standard of quality of care and to identify domains where improvement is needed.Design/methodology/approach: This is a cross-sectional study carried out at two tertiary care hospitals of Karachi, Pakistan, belonging to private and public sector, respectively, between February and April 2018. Face-to-face interviews were conducted using a modified questionnaire having five-point Likert scale questions regarding satisfaction of patients with doctors, nursing staff, information provided and the hospital standards. SPSS 20 was used for statistical analysis, and the results were expressed using mean, frequencies, percentages and p-values.Findings: The authors approached 415 patients, out of which 389 patients agreed to participate in the study. For both hospitals, the lowest mean scores were for sections pertaining to satisfaction with psychosocial support and information provided. The mean satisfaction score of patients from the private hospital were found to be significantly higher as compared to patients from the public hospital for all domains of patient care (p-value \u3c 0.01 using t-test for two independent samples). The data showed an increasing trend of satisfied responses as the household income increased.Research limitations/implications: A comparative study should be conducted with the aim of pinpointing the differences in areas in which there is a significant difference in positive satisfaction levels between private and public sectors. Similar research could also be expanded adding other variables that affect quality of care such as doctor\u27s approach to their patients, time given during each consultation and patient\u27s understanding of doctor\u27s knowledge. Further studies can be done to bridge the gaps between what a doctor views as standard care and what the patient knows will help them receive a more holistic approach to care.Practical implications: Assessing the quality of care helps determine gaps in care and allocating health resources accordingly. In clinical practice, emphasis needs to be given on increased duration and improved quality of patient counselling to improve the low satisfaction levels of patients regarding the psychosocial support. Addressing patients\u27 concerns should be made part of clinical teaching from an undergraduate level. As far as patient access to doctors of the specific speciality is concerned, hospital managements should adopt systems to ensure continuum of care and come up with mechanisms to bridge the discrepancy between a patient\u27s needs and doctor availability.Social implications: After being identified as a major deficiency, training doctors in the sensitivities of the population and demographics, especially with respect to socio-economic statuses, can aid in enhancing patient satisfaction to the treatment. Implementation of patient-centred care leads to greater satisfaction with care, which, in turn, increases a patient\u27s self efficacy in managing important aspects of their care and improves health care-related quality of life.Originality/value: Cancer patients have long-term exposure to the hospital environment. A patient\u27s satisfaction with the quality of care is an important determinant in patient compliance to the treatment protocol and required hospital visits. There is a dearth of research on the outpatient quality of care in the oncology departments in Karachi. This study provides an overview of the quality of care available to cancer patients in Karachi both in public and private sectors. The results of our study identify the gaps in the quality of care being provided to the patients in a developing country like Pakistan, which can be used to improve the quality of care, leading to better patient outcomes