Toxic Epidermal Necrolysis

Toxic epidermal necrolysis (TEN) is the most severe form of drug-induced skin reaction and includes denudation of >30% of total body surface area. The mechanism of disease is not completely understood, but immunologic mechanisms, cytotoxic reactions, and delayed hypersensitivity seem to be involved. Drug-induced toxic epidermal necrolysis (TENS), also known as Lyell’s syndrome, remains one of the most dramatic dermatological emergencies characterized by extensive destruction of epidermis and mucosal epithelia that often can be caused by drugs. TEN affects between 0.4 and 1.5 cases per million people every year with a mortality rate between 15% to 40%, with a large portion of patients dying from infections or multi-organ failure.1-4 The pathogenesis of drug-induced TEN is unknown, although several theories have been developed. Recent discoveries have shown that keratinocytes in TEN undergo apoptosis, not simply necrosis.5,6 Further research has elucidated that this apoptosis can be induced by interactions between cell surface death receptor Fas and its ligand, FasL or CD95L. The management of these patients is primarily supportive, although the use of corticosteroids and intravenous immunoglobulin (IVIG) therapy has been widely used with controversy. We report a case of risperidone induced toxic epidermal necrolysis with excellent response to corticosteroid

Knowledge of primary paediatric care providers regarding attention deficit hyperactivity disorder and learning disorder: a study from Pakistan

Introduction: Attention deficit hyperactivity disorder (ADHD) and learning disorder (LD) remain prevalent globally and are also speculated to have a high occurrence in Pakistan. An early diagnosis and intervention in these disabilities is imperative for achieving good clinical and functional outcomes. This can be ensured by an effective screening at the level of primary paediatric care in the developing countries. We aimed to explore the ability of general practitioners (GPs) and paediatricians in Pakistan to screen for ADHD and LD based on their awareness regarding the risk factors and symptomatology of ADHD and LD. Methods: A total of 96 paediatricians and 98 GPs practising in Karachi, Pakistan were included in the study. Data was collected employing a self-administered questionnaire. Results: Only 13.7 percent of the GPs and 21.6 percent of the paediatricians were shown to have knowledge sufficient to effectively screen for / diagnose ADHD. Alarmingly, not a single GP was adequately familiar with the established risk factors and clinical symptoms of LD. The level of knowledge was not influenced by age, gender, and clinical practice attributes of the physicians. Doctors who regularly read medical journals and attend medical education seminars showed slightly better trends. Conclusion : We hypothesise that this demonstrated lack of knowledge at the level of primary care in Pakistan prevents an early screening of ADHD and LD. A multipronged strategy targeted at the provision of objective screening tools for primary paediatric care providers, regular continuing medical education seminars and an emphasis on paediatric mental health in undergraduate and postgraduate curricula may ensure an early detection of ADHD and LD in Pakistan

Prevalence of Postpartum Depression and its Risk Factors among Pakistani Females:

Background: A severe form of clinical depression is related to pregnancy and childbirth. As a new mom, a lot of challenges are encountered in getting used to life with a newborn including lack of sleep. Hormonal changes and fatigue may lead towards psychological maladjustment towards motherhood. Low socioeconomic status, family system, mode of delivery, ill health of infant may be the reasons behind postpartum depression. Objective: To study the prevalence of postpartum depression among females. Method: This Cross sectional study was conducted after ethical approval on a sample of 200 females of reproductive age (20-45years). Participants were selected through convenient random sampling on the basis of predefined eligibility criteria. Data were collected from primary and secondary healthcare facilities of district Sialkot using Edinburg postnatal depression screening tool. Results: The mean age±Std Dev of the participants was 28.09±5.346 years ranging from 20 to 45. Mean±SD of total score EPDS was found 3.53±5.72 with 87.50% participants with score below 13. Out of 200, 25(12.50%) females were candidates for postpartum depression. Conclusion: Postpartum depression screening helps recognition of the disorder. Postpartum depression among females of the target population is not negligible

Comparison of Tzanakis and Alvarado scoring system in diagnosis of acute appendicitis, with Histopathology as gold standard

Objective: To determine the diagnostic accuracy of Tzanakis and Alvarado score for the diagnosis of acute appendicitis taking histopathology as the gold standard. Materials and Methods: It was a Cross-sectional validation study The study was carried out at the emergency department of RMC allied hospital Rawalpindi. The study was completed in eighteen months from 1st May 2016 till 30th Nov 2017. After approval from the ethical committee total of 420 patients fulfilling inclusion criteria from the emergency department of District head Quarter hospital, Rawalpindi was taken. Informed consent was taken from patients or their attendants, and their demographic information like name, age, sex, and address was obtained. Alvarado score and Tzanakis score were calculated (as per operational definition) at the time of admission of the patients. After surgery, the specimen appendix was sent for histopathology in the hospital lab.  The diagnosis of the acute appendix was based on a positive histological report which was verified by a pathologist. All the data was entered by a researcher who will collect the data by himself. Results: The mean age of patients in this study was 20.15±7.13 years with 218 (51.9%) males and 202 (48.1%) females. The mean Alvardo score was recorded as 7.22±1.58 with the mean Tzanakis score being 9.64±3.13. The histopathology for diagnosing appendicitis showed positive for 367 (87.4%) patients and negative for 53 (12.6%) patients. The sensitivity of Alvarado score for diagnosing appendicitis, keeping histopathology as the gold standard was 86.92%, specificity was 92.45%, Positive Predictive Value was 98.76%, and Negative Predictive Value was 50.52% and overall diagnostic accuracy was 87.62%. The sensitivity of the Tzanakis score for diagnosing appendicitis, keeping histopathology as the gold standard was 88.83%, specificity was 88.6%, Positive Predictive Value was 98.19%, Negative Predictive Value was 53.41% and overall diagnostic accuracy was 88.81%. Conclusion: The sensitivity of the Tzanakis score was high when compared to the Alvarado score. And specificity was high in the Alvarado score when compared to the Tzanakis score. Moreover, the overall diagnostic accuracy of the Tzanakis score was high when compared to the Alvarado score. SoTzanakis score can be utilized to predict appendix and in the future, we can avoid negative appendectomies

Comparison of Tzanakis and Alvarado scoring system in diagnosis of acute appendicitis, with Histopathology as gold standard

Objective: To determine the diagnostic accuracy of Tzanakis and Alvarado score for the diagnosis of acute appendicitis taking histopathology as the gold standard. Materials and Methods: It was a Cross-sectional validation study The study was carried out at the emergency department of RMC allied hospital Rawalpindi. The study was completed in eighteen months from 1st May 2016 till 30th Nov 2017. After approval from the ethical committee total of 420 patients fulfilling inclusion criteria from the emergency department of District head Quarter hospital, Rawalpindi was taken. Informed consent was taken from patients or their attendants, and their demographic information like name, age, sex, and address was obtained. Alvarado score and Tzanakis score were calculated (as per operational definition) at the time of admission of the patients. After surgery, the specimen appendix was sent for histopathology in the hospital lab.  The diagnosis of the acute appendix was based on a positive histological report which was verified by a pathologist. All the data was entered by a researcher who will collect the data by himself. Results: The mean age of patients in this study was 20.15±7.13 years with 218 (51.9%) males and 202 (48.1%) females. The mean Alvardo score was recorded as 7.22±1.58 with the mean Tzanakis score being 9.64±3.13. The histopathology for diagnosing appendicitis showed positive for 367 (87.4%) patients and negative for 53 (12.6%) patients. The sensitivity of Alvarado score for diagnosing appendicitis, keeping histopathology as the gold standard was 86.92%, specificity was 92.45%, Positive Predictive Value was 98.76%, and Negative Predictive Value was 50.52% and overall diagnostic accuracy was 87.62%. The sensitivity of the Tzanakis score for diagnosing appendicitis, keeping histopathology as the gold standard was 88.83%, specificity was 88.6%, Positive Predictive Value was 98.19%, Negative Predictive Value was 53.41% and overall diagnostic accuracy was 88.81%. Conclusion: The sensitivity of the Tzanakis score was high when compared to the Alvarado score. And specificity was high in the Alvarado score when compared to the Tzanakis score. Moreover, the overall diagnostic accuracy of the Tzanakis score was high when compared to the Alvarado score. SoTzanakis score can be utilized to predict appendix and in the future, we can avoid negative appendectomies

Detection of bacterial blight resistant gene xa5 using linked marker approaches

Rice is the primary source of food for 57% of the world’s population. Genetic resistance is important to control many kinds of pathogenic diseases. Bacterial blight caused by Xanthomonas oryzae pv oryzae(Xoo) decreases rice production by 20 – 30% and up to about 90% loss of grain weight. xa5 is an important recessive bacterial blight resistant gene, which is effective and important in Asian rice breeding program. It was also used in combination by incorporation with various recessive anddominant BB resistant genes. The purpose of our study was to identify the bacterial blight resistant genes xa5 in Pakistani rice germplasm including Basmati varieties. The seeds were collected from different research institute and then sowed in the National Institute for Biotechnology and Genetic Engineering (NIBGE) in pots. DNAs were extracted and surveyed for polymorphism by using DNA marker linked to xa5 gene. During this polymorphic survey, out of 88 germplasm lines, 45 lines showed the presence of xa5 gene like MB 2, MB 33 MB 57 and MB 66. All these lines showed the amplification of 240 bp corresponding to resistant source IRBB-5 line, while 43 germplasm lines showed no such fragment and elucidated same bands as susceptible source IR-24 having fragment of about 230 base pair. The 10 Pakistani Basmati varieties were also surveyed for xa5 gene. It was observed that none of our cultivated basmati varieties exhibited the presence of xa5 gene. The purpose of screening of xa5 gene in Pakistani rice germplasm is to utilize the local source of xa5 gene for elite molecular breeding program being carried out at NIBGE in future including pyramiding of different disease resistant gene in Basmati varieties

Condition Survey for Evaluation of Pavement Condition Index of a Highway

Pavements are major means of highway infrastructure. Maintenance and rehabilitation of these pavements for the required serviceability is a routine problem faced by highway engineers and organizations. Improvement in road management system results in reduction of time and cost, the pavement condition survey plays a big role in the pavement management. The initial phase in setting up a pavement management system (PMS) is road network identification. A vital element of a PMS is the capacity to assess the present condition of a pavement network and anticipation of future condition. The pavement condition index (PCI) is a numerical index generally utilized for the assessment of the operational condition & structural reliability of pavements. Estimation of the PCI is dependent on the results of a visual inspection in which the type, severity, and quantity of distresses are distinguished. In this research, a pavement distress condition rating strategy was utilized to accomplish the goals of this study. The main targets of this research were to categorize the common types of distress that exist on “Lakhi Larkana National Highway (N-105)”, and to estimate the pavement condition index. Using these data, Average PCI for the highway section was calculated. PCI to assess the pavement performance, 10 out of 19 defects were recognized in the pavement, as stated by the PCI method. Results indicated that the common pavement distress types were depressions, polished aggregate, rutting, potholes, block cracking, and alligator cracking