The frequency of vibrio cholera 01 EL TOR (Inaba And Ogawa) and its Resistance Pattern in Karachi.

Introduction: Cholera is an acute infectious disease of small intestine, caused by the bacterium Vibrio cholerae. More than 200 serogroups of V. cholerae have been identified. In Iran, Inaba strains were 75% resistant against trimethoprim-sulfamethoxazole in 2011, while during 2012-13 it was 100%. Ogawa strains showed 96% resistance against trimethoprim-sulfamethoxazole in 2011, whereas 100% resistant in 2012, while no resistance was seen in 2013 against the same antibiotic.   Objective: To determine the frequency of vibrio cholera 01 EL TOR (Inaba And Ogawa) and its resistance pattern in Karachi. Methodology: Samples were collected from patients with acute diarrhea with rice-water stool from Medical Unit, JPMC and NICH, Karachi between October 2015 to August 2016. These samples were then transported to Microbiology Department, Basic Medical Sciences Institute, JPMC, Karachi and processed according to standard protocol. Results: No growth was noticed in 147 (66.81%) samples while a total of 28 (12.7%) were V. cholerae species, and 45 (20.45%) were other organisms. The distribution of V. cholerae serotypes, out of 28 V. cholerae species, 13 (46.4%) were of Inaba serotypes, 09 (32.1%) were of Ogawa serotypes while 06 (21.4%) were of Non-01 serotypes. Conclusion: The susceptibility results of tetracycline and trimethoprim-sulfamethoxazole are not very favorable. Involvement of multidrug resistant V. cholerae O1 serotypes in the community is a very serious public health concern. Such patients were observed to be very difficult to treat in the community. &nbsp

Perioperative hemodynamic effects of dexmedetomidine as an adjuvant to 0.2% ropivacaine in ultrasonography guided interscalene brachial plexus block for elective shoulder arthroscopic surgeries under general anaesthesia: a prospective observational study

Background: Although an increasing number of anesthesiologists are using peripheral nerve catheters for postoperative analgesia, single shot blocks are still more common. Ropivacaine has become the most commonly used long-acting local anesthetic, and the duration of analgesia has been estimated to be 8 to 14 hours.Methods: The study was conducted from February 2020 to October 2021 after obtaining approval from the institutional ethics committee. The study was a prospective observational study.Results: Hemodynamic changes in patients who received dexmedetomidine in combination with Ropivacaine had a favorable reduction in both heart rate and blood pressure without causing any major side effect. Comparison of postoperative MAP (mmHg) in two groups at various intervals of time was observed and found to be statistically significant (p value of <0.05). Comparison of postoperative heart rate (beats/min) among two groups at various intervals of time was statistically significant (p value of <0.05).Conclusions: We can conclude that preoperative inter-scalene block given reduces the analgesic requirement intraoperatively as well postoperatively. And the hemodynamic changes in patients who received dexmedetomidine in combination with ropivacaine had a favorable reduction in both heart rate and blood pressure without causing any major side effect.

Efficacy of combined phenotypic methods for methicillin-resistant Staphylococcus aureus detection and antibiotic susceptibility

Background: The main aim of our study is to demonstrate comparative evaluation of oxacillin disc diffusion (ODD), oxacillin screen agar (OSA), CHROM agar (CA) with cefoxitin disc diffusion (CDD) method for the detection of methicillin-resistant Staphylococcus aureus obtained from various clinical samples.Methods: This prospective study was conducted to detect Methicillin resistance among staphylococcus aureus by four phenotypic methods isolated from various clinical samples received in the Department of microbiology MMIMSR, Mullana.Results: The data was statistically analyzed, compiled in form of tables, graphs, percentage and test of significance will also be done wherever necessary (using Microsoft Excel, 2008 version) CDD+ODD+OSA+CA proved to be 100% followed by ODD+OSA+CA and CDD+OSA+CA 82.07% and CDD+ODD+OSA 80.1%.Conclusions: Combined phenotypic methods are better in evaluating and studying MRSA infections in hospitals as compared to tests done in isolation for proper diagnosis and timely treatment of infections

Clinical features, pathological outcomes and management of internal rectal prolapse-combined retro-prospective observational study

Background: Internal rectal prolapse probably represents the first stage of a progressive anomaly that eventually leads to full thickness external prolapse. Non-surgical treatment modalities like dietary advice and feedback therapy should be used before doing any surgical intervention in such cases. This study focuses on clinical features, pathological outcomes and treatment modalities of internal rectal prolapse.Methods: The study is a combined prospective (from Aug. 2018 to Aug. 2020) and retrospective (from Aug. 2015 to Aug. 2018) conducted at Sher-I-Kashmir institute of medical sciences, Soura, SrinagarResults: A total of 79 patients were studied out of which 39 were retrospective and 40 were prospective. Internal rectal prolapse is usually missed by surgeons as a cause of obstructed defecation syndrome. So, it was worthwhile to study this entity in our patients.Conclusions: Before choosing any treatment strategy for internal rectal prolapse, conservative trial with dietary modification and feedback therapy should be attempted

Post spinal anaesthesia shivering- incidence and associated risk factors in patients undergoing lower limb and abdominal surgeries

Background: This study was conducted to evaluate the incidence of shivering and likely associated risk factors following spinal anaesthesia in patients undergoing lower abdominal and lower limb surgeries.Methods: The present study was conducted in MMIMSR, Department of anaesthesia from December 2016 to September 2018. It was an observational study which was conducted over a period of 2 years. Patients who were scheduled to undergo elective lower abdominal and lower limb surgeries under spinal anaesthesia were included in study.Results: The present study depicts a high incidence of post spinal shivering, which was 42.8%. Majority of the patients belonged to the young age group between 20-30 years. The mean time of onset of shivering, was around 25 mins. Duration of shivering was observed between 15-75 minutess with a mean of 43.75 and SD±19.39.Conclusions: Shivering is one of the distressing complications of spinal block, which may be deleterious to the patients with poor cardio-respiratory reserve

High Risk Human Papilloma Virus Genotype Distribution in Cervical Intraepithelial and Invasive Carcinoma

Background: High-risk (HR) Human Papillomavirus (HPV) is an established cause of cervical cancer. HPV genotype detection is significant in preventing cervical cancers through targeted vaccination. Our study aimed to identify HRHPV16/18 and non 16/18 in cervical intraepithelial neoplasia (CIN) and squamous cell carcinoma (SCC). Methods: A retrospective study was performed at Pathology Department, BMSI, JPMC, Karachi. About 96 cases of CIN and SCC were included. Analysis of HPV genotypes was performed by DNA extraction, PCR amplification and flow-through hybridization technique. The probes used had a cluster of 13 HRHPV into a group of 3 as HPV HR 1, 2 and 3. Chi square/ Fischer Exact test were applied to observe the association of morphological types of the lesion and expression of HPV genotypes. Results: HPV DNA positivity was 44% in our series. HPV HR 1 was observed in majority of cases (61.9%), followed by HPV 16 in 23.8%, HPV HR 3 in 9.5%, and HPV HR 2 in 4.7% cases respectively. The unique finding was absence of HPV 18 in the series. High grade lesions and invasive cancers showed positivity for HPV HR 1 and HPV 16, while low grade lesions were positive for HPV HR 1, 2 and 3 respectively. Conclusion: HPV HR1 are major causative agents for low and high grade intraepithelial and invasive SCC, followed by HPV 16. Absence of HPV 18 was the novel finding. Our results differ from studies within and outside the region, suggestive of diversified genetic makeup and impact of detection techniques on results

Extracorporeal Shockwave Lithotripsy versus Ureteroscopy: A First Line Distal Ureteric Stone Treatment

Background: Despite the emergence of many novel minimally invasive techniques including percutaneous nephrolithotomy, ureteroscopy, extracorporeal shock wave lithotripsy, many urologists still prefer open surgery for the management of ureteric stones. The present study compared the efficacy of extracorporeal shockwave lithotripsy (ESWL) with ureteroscopy (URS) for the treatment of distal ureteral calculi. Methods: A single-blinded, randomized controlled trial, which was conducted between January 2018 to June 2019 at the Sindh Institute of Urology and Transplantation, Karachi, Pakistan. All patients diagnosed with unilateral, solitary, and distal ureteral stones were randomized in two groups. The patients in Group A underwent with ESWL and group B underwent ureteroscopy. The outcome of procedures was assessed after 3 months. Data was analyzed via Statistical Package for the Social Sciences (SPSS version 25). Chi-squared test was applied to compare the clinical efficacy of both techniques. A p<0.05 was considered as statistically significant. Results: Out of 106 patients, majority were females n=61(58%). Overall, the mean age of population was 41.9 ± 10.4 years, and the mean stone size was 13.1 ± 4.3 mm. Both the groups were almost comparable with respect to age and size of stones. There was a significant difference in outcome of both the procedures, as the residual stones were more in ESWL and URS i.e., 64.0% vs. 33.9% (p=0.019). Conclusion: In hospitals, both of the techniques are suitable for treatment purpose. However, the present results suggest that URS is a more effective procedure than ESWL (p=0.019) for treating ureteral stones and should be utilized as the first-line treatment for distal ureteral calculi. Keywords: Lithotripsy; Ureteroscopy; Ureteral Calculi

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Background: A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97\ub71 (95% UI 95\ub78-98\ub71) in Iceland, followed by 96\ub76 (94\ub79-97\ub79) in Norway and 96\ub71 (94\ub75-97\ub73) in the Netherlands, to values as low as 18\ub76 (13\ub71-24\ub74) in the Central African Republic, 19\ub70 (14\ub73-23\ub77) in Somalia, and 23\ub74 (20\ub72-26\ub78) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91\ub75 (89\ub71-93\ub76) in Beijing to 48\ub70 (43\ub74-53\ub72) in Tibet (a 43\ub75-point difference), while India saw a 30\ub78-point disparity, from 64\ub78 (59\ub76-68\ub78) in Goa to 34\ub70 (30\ub73-38\ub71) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4\ub78-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20\ub79-point to 17\ub70-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17\ub72-point to 20\ub74-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global Burden of Disease Study 2016

Copyright © 2018 The Author(s). Published by Elsevier Ltd. Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita. Findings In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries. Interpretation GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle- SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view - and subsequent provision - of quality health care for all populations

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill &amp; Melinda Gates Foundation