BURDEN OF THROMBOCYTOPENIA IN CRITICALLY ILL PATIENTS AT A TERTIARY CARE HOSPITAL

Background; Neonatal thrombocytopenia is one of the commonest hematological abnormality encountered in neonatal intensive care unit. Though thrombocytopenia is prevalent it is often overlooked assuming it will resolve spontaneously. However, if it is not detected and managed properly can result in devastating complications. Objective; To determine the frequency of thrombocytopenia in sick neonates admitted in neonatal intensive care unit (NICU). Material and Methods; A total 282 newborns admitted to NICU of department of Pediatrics, Nishtar Hospital, Multan were included in this cross-sectional were enrolled, their blood samples were taken for estimation of platelet count to diagnose thrombocytopenia and all the data was analyzed by SPSS. Results; Of these 282 study cases, 198 (70.2 %) were male patients while 84 (29.8 %) were female patients. Mean age of our study cases was 5.18 ± 3.69 days. Of these 282 study cases, 85 (30.1 %) belonged to rural areas and 197 (69.9 %) belonged to urban areas. Of these 282 study cases, 187 (66.3%) mothers were illiterate while 95 (33.3%) were literate. Preterm birth was noted in 116 (41.1 %) of our study cases. Of these 282 study cases, 188 (66.7%) were born through vaginal deliveries while 94 (33.3%) by cesarean section. Mean duration of disease was 2.34 ± 1.10 days and 241 (85.5%) had disease duration up to 3 days. Mean platelet count of our study cases was 156575.24 ± 50250.53 mm3 and thrombocytopenia was present in 104 (36.9%).  Conclusion; High frequency of thrombocytopenia was observed in sick neonates in our study. Thrombocytopenia was significantly associated with age, residential status, maternal literacy, preterm births, mode of delivery and disease duration. All the clinicians treating such patients should regularly monitor platelet count of all the patients admitted to NICU for early diagnosis and timely management to save them further complications. This will not only decrease disease morbidity but will also reduce mortalities in these patients. Keywords; Thrombocytopenia, sick neonates, Frequency. DOI: 10.7176/JMPB/52-1

IN-HOSPITAL MORTALITY ASSOCIATED WITH ACUTE KIDNEY INJURY AMONG NEWBORNS AT A TERTIARY CARE HOSPITAL

Objective; To determine association of in-hospital outcome of AKI with etiology in newborns at a tertiary care hospital. Methods; This descriptive cross-sectional study was conducted at Department of Pediatric Medicine, Nishtar Hospital, Multan by using non-probability purposive sampling technique from June 2016 to December 2017. A total of 101 newborns diagnosed with acute kidney injury were registered. Etiological factors were assessed and these patients were followed till discharge to monitor in-hospital outcomes. Results; Of these 101 newborns, 75 (74.3%) were boys while 26 (25.7%) were girls. Mean age of these newborns was 7.59 ± 6.13 days (range; 1 day to 28 days). Mean age of the boys was 5.73 ± 7.20 days while that of girls was 6.77 ± 6.16 days. (p=0.515). Mean weight of these neonates was 2545.05 ± 600.42 grams (range; 1000 grams to 4000 grams). Mean serum potassium level was 4.94 ± 0.92 mgEq/L ranging from 3.1 mgEq/L to 7.0 mgEq/L. Mean urea level was 73.35 ± 27.65 mg/dl ranging from 18 mg/dl to 206 mg/dl. Mean serum sodium level was 145.72 ± 12.64 mgEq/L ranging from 126 to 166 mEq/L. Eighty one (80.2%) were term babies while 20 (19.8%) were pre-term babies. Of these 101 study cases, 29 (28.7%) delivered vaginally while 72 (71.3%) through cesarean section. Delayed crying was noted in 48 (47.5%), dehydration 13 (12.9%), sepsis in 36 (35.6 %) and renal malformation in only 4 %. Neonatal mortality in these patients was 15 (14.9%) while 86 (85.1%) were discharged from hospital after recovery. Conclusion; Acute kidney disease in newborns is associated with significant disease morbidity and mortality with asphyxia and sepsis are the main etiological factors responsible. It is predominantly more common in boys compared with girls. Mortality rate was high in our study and it was significantly associated with female gender. Mortality was also associated with elevated serum sodium and urea level. Keywords; Acute Kidney Injury, Sepsis, Etiology

Survey of Hypocalcaemia Frequency in District Lahore, Pakistan

Calcium is important for regulation of various physiological functions like bones, teeth, different types of muscular movements, blood pressure, body growth and maintenance. But continuous calcium deficiency may cause hypocalcaemia in which major cause is insufficient intake of calcium along with other pathological states, financial constraints and lack of general public awareness about the significance and physiological role of calcium. Statistical analysis on the basis of current survey indicates that females remain malnourished and suffer from hypocalcaemia more than males. That’s why; there is urgent need of organized efforts for general public awareness from government and private platforms. Moreover, future researchers should introduce better diagnosis techniques and economical dietary sources and treatments to reduce frequency of hypocalcaemia

Early Versus Interval Cholecystectomy in Mild Acute Biliary Pancreatitis. A Retrospective Study in Tertiary Care Hospital

Objective: The objective is to determine the adequacy of early cholecystectomy (EC) versus interval cholecystectomy (IC) in terms of recurrence, duration of hospital admission, and perioperative complications after mild acute biliary pancreatitis (MABP). Methodology: After endorsement from the ethical committee, clinical data and files of all the admitted patients having MABP in the general surgery department of Holy Family Hospital, Rawalpindi, was collected retrospectively from August 2017 to July 2020. The patients’ demographic profile, clinical findings, diagnostic investigations, timing of cholecystectomy, operating surgeons, operative time, biliary complications, intraoperative bleeding, conversion rate, duration of admission, and recurrence were reviewed. Patients presented with abdominal pain, vomiting, jaundice, or fever. The diagnosis was confirmed on the basis of a CT scan of the abdomen showing an inflamed pancreas and stones in the gallbladder. Outcomes were compared and reviewed between the two groups. Results: In this research proposal, 263 patients admitted were analyzed. EC was performed were discharged after conservative management and followed up after 12 weeks for interval laparoscopic cholecystectomy (IC). It was observed in patients of IC (EC 2 [1.2%] vs IC 7[7%]; p value <0.01) while duration of hospitalization was prolonged as compared to patients of EC (EC 5.53+0.58days vs IC 5.82+0.78days; p value <0.001). lar in both EC and IC. Conclusion: EC performed after MABP is associated with shorter duration of hospitalization and reduced recurrence with similar rate of perioperative complications

Comparative analysis of hyoscine in wild-type and in vitro grown Datura innoxia by high performance liquid chromatography

Purpose: To compare the hyoscine contents of Datura innoxia plant grown in the wild and that grown in vitro.Methods: For callus induction from leaf explants, 15 combinations of 2,4-dichlorophenoxy acetic acid, gibberellic acid, benzyl amino purine and kinetin were used. For regeneration of shoots, 8 combinations of BAP, kinetin and indole butyric acid (IBA) were tested. Different concentrations of IBA were used for rooting. The hyoscine contents of the wild and in vitro samples was initially identified by TLC and subsequently quantified by high performance liquid chromatography using hyoscine N-butyl bromide as standard.Results: For callus induction, 2,4-D at 2 mg/L produced maximum calli (96 %). Maximum shoots regeneration was obtained with 2 mg/L BAP and 1 mg/L kinetin. IBA at 0.5 mg/L induced good rooting. Substantial amount of hyoscine was detected in the extracts of in vitro grown plants through TLC and HPLC. Wild root, stem and leaves exhibited higher amounts (approx. 2 μg/mL) of hyoscine than the parts of in vitro grown plants. Green callus grown in vitro contained a maximum concentration of hyoscine (1.01 μg/mL) followed by leaf (0.82 μg/mL) and brown callus (0.432 μg/mL).Conclusion: The callus cultures of D. innoxia are capable of yielding good amounts of hyoscine, and therefore can be exploited to increase hyoscine production using chemical/hormone treatments on a large scale. Thus, this study provides a sustainable and efficient way for the sustainable production of a natural hyoscine product via in vitro-grown D. innoxia cultures.Keywords: Datura innoxia, Hyoscine, Callus, Hyoscine, Explant, Gibberellic acid, Benzyl amino purine, Kineti

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

Novel Coronavirus disease 2019 (COVID-19): new challenges and new responsibilities in developing countries

Novel coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2 virus, which belongs to the genus Coronaviridae with its high mutation rate. From the current perspective, we discuss the current status of COVID-19, new challenges, and potential interventions to control the pandemic in developing counties such as Pakistan

Gap between theoretical and practical knowledge of basic medical procedures in medical students of D.U.H.S.

Objective: To evaluate and compare the level of knowledge and practical experience of fourth and final year students, of three basic medical procedures namely IV cannulation, urinary catheterization and nasogastric intubation. Methods: This was a cross-sectional survey of 400 fourth and final year M.B.B.S students, recruited by purposive sampling from Dow Medical College, Sindh Medical College and Dow International Medical College. A self-administered questionnaire was used and students were asked to retrospectively reflect on their clinical knowledge and skills of three basic medical procedures namely intra-venous cannulation, nasogastric tube intubation and urinary catheterization. Data was analyzed on SPSS v16.0 using simple descriptive statistics and chi-square test applied to calculate association of different variables with year of study with statistical significance set at 0.5

Functional outcomes of poor ergonomic posture in university workers

Background and Objectives: Work-related musculoskeletal disorders are increasing due to poor posture adaptation. Increasing the use of technologies in the office settings is one of the main reasons behind muscle and soft tissue strains. The objective of the study was to determine the pattern of posture-related musculoskeletal pain in office workers.Methods: This observational study was conducted from 15th May, to 25th June, 2021. Data were collected by convenient sampling. The Nordic Musculoskeletal questionnaire on body postural habits was filled by 150 office workers from different universities of Lahore. Statistical Package for the Social Sciences software version 25 was used for statistical analysis.Results: There were 79 (52.7%) male and 71 (43.7%) female participants, with a mean age of 35.7 &plusmn; 5.14 years. Majority (51.3%) of the subjects reported sitting tilted forward, while a few used backrests and footrests for support. Prolonged crossed legs and twisted spine posture were also adopted by many subjects. Neck, lower back, and shoulder were the most affected regions, with increased musculoskeletal pain reported over the last 12 months. Due to recurrent pain in the neck, shoulder, and upper back, difficulty in carrying out routine jobs, housework, and hobbies was reported by 38.7%, 34.7%, and 30% of the subjects, respectively.Conclusion: Failure to adopt a good ergonomic approach leads to frequent musculoskeletal pain and difficulty in carrying out routine office and household work.</p

Fungal Immunology: Mechanisms of Host Innate Immune Recognition and Evasion by Pathogenic Fungi

For a fungal pathogen to successfully infect, colonize and spread inside a susceptible host, it must have overcome the host immune responses. The early recognition of the fungal pathogen-associated molecular patterns (PAMPS) by the host’s pattern recognition receptors (PRRs) results in the establishment of anti-fungal immunity. Although, our immune system has evolved several processes to combat these pathogens both at the innate and adaptive immune levels. These organisms have developed various escape strategies to evade the recognition by the host\u27s innate immune components and thus interfering with host immune mechanisms. In this chapter, we will summarize the major PRRs involved in sensing fungal PAMPS and most importantly the fungal tactics to escape the host\u27s innate immune surveillance and protective mechanisms