Unusual case of non-resolving necrotizing pneumonia: a last resort measure for cure.

Abstract To our knowledge, this is an unusual case of a community-acquired pneumonia (CAP) with sepsis secondary to Streptococcus pneumoniae that required lung resection for a non-resolving consolidation. A 74 year old previously healthy woman, presented with acute fever, chills and pleuritic chest pain in Emergency Department (ED). A diagnosis of CAP was established with a Pneumonia Severity Index CURB-65 score of 5/5. In the ER, she was promptly and appropriately managed with antibiotics and aggressive supportive therapy. She remained on ten days of intravenous antibiotics. However, 48 hours post antibiotic course, she returned to ER with fever and signs of sepsis. Despite timely and appropriate management, the consolidated lobe remained the focus of sepsis for over four weeks. The patient recovered after the offending lobe was resected. Histopathology of the lung tissue revealed acute and chronic inflammation. However, no malignancy, bacterial infection or broncho-pleural fistula was found. Eighteen months post-surgery, the patient remains well

Development and validation of sunlight exposure measurement questionnaire (SEM-Q) for use in adult population residing in Pakistan

Background: Vitamin D deficiency has been identified as a major public health problem worldwide. Sunlight is the main source of vitamin D and its measurement using dosimeters is expensive and difficult for use in population-based studies. Hence, the aim of this study was to develop and validate questionnaires to assess sunlight exposure in healthy individuals residing in Karachi, Pakistan. Methods: Two questionnaires with seven important items for sunlight exposure assessment were developed. Fifty four healthy adults were enrolled based on their reported sunlight exposure (high = 17, moderate = 18, low = 19) from Aga Khan University, Karachi. Over four days, study participants were asked to wear a dosimeter between sunrise and sunset and report time spent and activities undertaken in the sun for questionnaire validation. Algorithm for item weightage was created as an average score based on ultraviolet B percentage received. Blood samples were obtained for serum vitamin D. Results: The mean time (minutes) spent in sun over 4 days (±SD) was 69.5 (±32) for low, 83.5 (±29.7) for moderate and 329 (±115) for high exposure group. The correlation between average time (minutes) spent in sun over 4 days and mean change in absorbance of UV dosimeters for 4 days was 0.60 (p \u3c 0.01). Correlation between average score and vitamin D levels was found to be 0.36 (p = 0.01) for short term questionnaire score, 0.43 (p = 0.01) for long term questionnaire score in summers and 0.48 (p = 0.01) in winters. Conclusions: The sunlight exposure measurement questionnaires were valid tools for use in large epidemiological studies to quantify sunlight exposure

Impact of Maternal Education about Complementary Feeding on Their Infants\u2019 Nutritional Outcomes in Low- and Middle-income Households: A Community-based Randomized Interventional Study in Karachi, Pakistan

This cluster-randomized interventional trial at peri-urban settings of Karachi was conducted to evaluate the impact of maternal educational messages regarding appropriate complementary feeding (CF) on the nutritional status of their infants after 30 weeks of educational interventions delivered by trained community health workers. Mothers in the intervention group received three education modules about breastfeeding (BF) and appropriate CF at a baseline visit and two subsequent visits 10 weeks apart. The control group received advice about BF according to national guidelines. Infants\u2019 growth [weight, length, and mid-upper arm-circumference (MUAC), stunting, wasting, and underweight] were measured at four time points. At the end of the study, infants in the intervention group had a higher mean weight of 350 g (p=0.001); length of 0.66 cm (p=0.001), and MUAC of 0.46 cm (p=0.002) compared to the controls; proportionate reduction of stunting and underweight were 10% (84% vs 74%; ORadj 8.36 (5.6-12.42) and 5% (25% vs 20%; ORadj 0.75 (0.4-1.79) in the intervention compared to the control group. For relatively food-secure populations, educational interventions about appropriate CF to mothers had a direct positive impact on linear growth of their infants

Care and feeding practices and their association with stunting among young children residing in Karachi\u27s squatter settlements

The nutrition, growth and development of infants and young children depends not only on sufficient food, but also adequate health services and appropriate care behaviors. A household\u27s capacity to provide care to a child is dependent on the availability of resources within the household and the wider community. These resources are not only economic but also include maternal skills and behaviors that can be learnt. The nutritional status of children is a good indicator of overall well being in a society and reflects food security as well as existing health care and environmental conditions. In Pakistan, it is estimated that nearly 40-50% of children under the age of five are stunted, or low height-for-age. Inadequate feeding and repeated illness are the immediate causes of stunting which are exacerbated as a result of household food insecurity, unhygienic environment and the consequent inability of families to adequately take care of their young. The objective of this study was to explore various child-care and feeding practices prevalent among children between the ages of six and eighteen months residing in Karachi\u27s squatter settlements and to identify feeding and care factors associated with stunting among them. A community-based cross sectional survey was conducted in eight squatter settlements of Karachi between October and December 2000. A total of 399 mothers of eligible children were interviewed using a structured questionnaire. Anthropometric measurements were also taken of the mother and child. Stunting was classified as height/length-for-age Z-score less than -2 standard deviations and evaluated against the currently recommended international growth reference, i.e. the US National Center for Health Statistics reference population (NCHS). The final results of our study indicated that being a female child (aOR=2.8, 95% CI: 1.6, 4.7) as well as household food insecurity in the past 12 months (aOR=2.8, 95% CI: 1.6, 4.9) were strongly associated with young children being stunted. Among socio demographic and parental characteristics, no formal schooling of the mother (aOR=2.7; 95% CI: 1.3, 5.6); and peri-urban residence (aOR=2.0; 95% CI: 1.1, 3.8) were also significantly associated with a child being stunted. Stunted children also appeared to be from large households (aOR=1 .1; 95% CI: 0.9, 3.0). These results suggest that in this population, linear growth among young children influenced by household food insecurity compounded by large household size, lack maternal education as well as a gender preference in favor of the male child. It is recommended that an investment into basic services such as primary education especially of girls are essential to break the cycle of malnutrition, along with a clear set of guidelines for the community regarding cheap, easily available and appropriate home foods to feed their child. However, in poor households where food insecurity exists, knowledge on care and feeding practices may not be sufficient and other types of interventions such as food stamps must precede or accompany educational efforts if an impact on child health and nutrition is to be expected

Reducing Cost of Rabies Post Exposure Prophylaxis: Experience of a Tertiary Care Hospital in Pakistan.

Rabies is a uniformly fatal disease, but preventable by timely and correct use of post exposure prophylaxis (PEP). Unfortunately, many health care facilities in Pakistan do not carry modern life-saving vaccines and rabies immunoglobulin (RIG), assuming them to be prohibitively expensive and unsafe. Consequently, Emergency Department (ED) health care professionals remain untrained in its application and refer patients out to other hospitals. The conventional Essen regimen requires five vials of cell culture vaccine (CCV) per patient, whereas Thai Red Cross intradermal (TRC-id) regimen requires only one vial per patient, and gives equal seroconversion as compared with Essen regimen.This study documents the cost savings in using the Thai Red Cross intradermal regimen with cell culture vaccine instead of the customary 5-dose Essen intramuscular regimen for eligible bite victims. All patients presenting to the Indus Hospital ED between July 2013 to June 2014 with animal bites received WHO recommended PEP. WHO Category 2 bites received intradermal vaccine alone, while Category 3 victims received vaccine plus wound infiltration with Equine RIG. Patients were counseled, and subsequent doses of the vaccine administered on days 3, 7 and 28. Throughput of cases, consumption utilization of vaccine and ERIG and the cost per patient were recorded.Government hospitals in Pakistan are generally underfinanced and cannot afford treatment of the enormous burden of dog bite victims. Hence, patients are either not treated at all, or asked to purchase their own vaccine, which most cannot afford, resulting in neglect and high incidence of rabies deaths. TRC-id regimen reduced the cost of vaccine to 1/5th of Essen regimen and is strongly recommended for institutions with large throughput. Training ED staff would save lives through a safe, effective and affordable technique

Reported Male Circumcision Practices in a Muslim-Majority Setting

Introduction. Male circumcision is a recommended practice in Muslim tradition. It is important to ensure that this procedure is performed as safely as possible in these communities. Methods. Five hundred adult men and women with at least one male child less than 18 years were interviewed in Karachi, Pakistan, regarding details of their child’s circumcision. The survey focused on actual and perceived delays in circumcision and perceptions about appropriate age and reasons and benefits and complications of the procedure. Circumcisions done after two months of age were defined as delayed. Results. Religious requirement was the primary reason for circumcision in 92.6% of children. However, 89.6% of respondents were of the opinion that circumcision had medical benefits as well. Half of the children (54.1%) had delayed circumcision (range 2.5 months to 13 years), even though 81.2% of parents were of the opinion that circumcisions should be done within 60 days of birth. Facility-delivered babies had less delay in circumcisions (49.1%) as compared to home-delivered babies (60.5%). Conclusion. Understanding the perceptions and practices around male circumcision can help guide national strategies for designing and implementing safe circumcision programs in Muslim-majority settings, with the potential to benefit an annual birth cohort of 20–25 million boys worldwide

Consumption and cost of biologicals for Rabies PEP July 2013 to June 2014 at TIH.

<p>Consumption and cost of biologicals for Rabies PEP July 2013 to June 2014 at TIH.</p

Profile of bite victim throughput seen at The Indus Hospital Rabies Prevention Center (July 2013-June 2014).

<p>Profile of bite victim throughput seen at The Indus Hospital Rabies Prevention Center (July 2013-June 2014).</p

Cost savings of vaccine by using TRC–id regimen for 2300 patients.

<p>Cost savings of vaccine by using TRC–id regimen for 2300 patients.</p

Bite cases throughput at Rabies Prevention Center (2009–2014).

<p>Bite cases throughput at Rabies Prevention Center (2009–2014).</p