Molecular Detection of pulmonary Tuberculosis using the Gene X pert MTB/RIF assay in Kurdistan of Iraq

Tuberculosis has been potentially diagnosed by an innovative Gene Xpert Mycobacterium tuberculosis refampcin tool substantially impacted the quick detection of RIF resistance in clinical samples, Multi drug-resistant tuberculosis signify the remarkable resistance to the conventional (isoniazid, rifampicin against tuberculosis. The gene x pert MTB/RIF has been clinically and microscopically utilized for the detection of the multivariate pulmonary specimens of early pulmonary tuberculosis cases. Robust screening study had been implemented at Erbil community in the chest and respiratory diseases centre in the period June 2017- June 2018. Two hundred fifty Sputum samples were obtained from TB suspects. All samples were tested on Gene X pert for MTB/RIF detection after acid fast bacilli microscopy.75(30%) sputum samples were AFB smear positive and 175 (70%) were negative. In MTB/RIF assay 85 (34%) were MTB positive and 165 (66%) were negative. The MTB/RIF assay also detected 7 RIF-resistant specimen and 78 RIF-susceptible specimens, and the results were confirmed by drug susceptibility testing. Sensitivity and specificity of Gene x pert were 100% and 94.29% respectively, compared with the conventional method. Hence from the overall conclusion, we can acknowledge that the MTB/RIF assay has simplified and solve the dramatic challenge of multiple TB cases and cut short with positive impact the dilemma of empirical TB treatment drugs

Molecular surveillance of drug resistance: Plasmodium falciparum artemisinin resistance single nucleotide polymorphisms in Kelch protein propeller (K13) domain from Southern Pakistan

Background: K13 propeller (k13) polymorphism are useful molecular markers for tracking the emergence and spread of artemisinin resistance in Plasmodium falciparum. Polymorphisms are reported from Cambodia with rapid invasion of the population and almost near fixation in south East Asia. The study describes single nucleotide polymorphisms in Kelch protein propeller domain of P. falciparum associated with artemisinin resistance from Southern Pakistan.Methods: Two hundred and forty-nine samples were collected from patients with microscopy confirmed P. falciparum malaria attending Aga Khan University Hospital during September 2015-April 2018. DNA was isolated using the whole blood protocol for the QIAmp DNA Blood Kit. The k13 propeller gene (k13) was amplified using nested PCR. Double-strand sequencing of PCR products was performed using Sanger sequencing methodology. Sequences were analysed with MEGA 6 and Bio edit software to identify specific SNP combinations.Results: All isolates analysed for k13 propeller allele were observed as wild-type in samples collected post implementation of ACT in Pakistan. C580Y, A675V, Y493H and R539T variants associated with reduced susceptibility to artemisinin-based combination therapy (ACT) were not found. Low frequency of M476I and C469Y polymorphisms was found, which is significantly associated with artemisinin resistance.Conclusion: Low frequencies of both nonsynonymous and synonymous polymorphisms were observed in P. falciparum isolates circulating in Southern Pakistan. The absence of known molecular markers of artemisinin resistance in this region is favourable for anti-malarial efficacy of ACT. Surveillance of anti-malarial drug resistance to detect its emergence and spread need to be strengthened in Pakistan

Rhesus and kell phenotyping of voluntary blood donors: foundation of a donor data bank

OBJECTIVE: To assess the Rhesus (Rh) and Kell (K) phenotype of voluntary blood donors and lay foundation of a data bank of voluntary blood donors. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Blood Bank, The Aga Khan University Hospital, Karachi, in the year 2014. METHODOLOGY: Voluntary blood donors were inducted after taking written informed consent. Three -5cc of EDTA anticoagulated blood sample was taken to phenotype red cells for C, c, E, e, and Kell antigens using antisera. [DiaMedSwitzerland]. RESULTS: Hundred blood donors were included in the study. ABO blood groups of the donors were: O [37%], B [31%], A [21%] and AB [11%]. Ninety-seven percent were Rh D positive while 3% were Rh D negative; \u27e\u27 antigen had the highest frequency [99%], while \u27E\u27 antigen was the least frequent [19%]. The most common probable Rh phenotype was R1R1 ((DCe/DCe) in 44 [44%]. In the Kell system, all the donors [100%] had phenotype of K-k+. CONCLUSION: The most common blood group was O +ve. The pattern of Rhesus antigen expression and phenotype found in this study was concordant to that reported previously from Asia. However, there was a much lower frequency of K antigen

Attitude of Medical Students Towards Psychiatry in a Tertiary Care Hospital

Background: Dearth of psychiatrist specialists is evident worldwide. Awareness of undergraduate students towards mental illness has an important role in affecting the quality of care the patient receives and in choosing  psychiatry as a career . Decision to specialize in psychiatry based on many factors, however attitude of undergraduates towards career choice play most important role in this aspect. Objective: This study aims to explore attitude and towards psychiatry among medical undergraduates in tertiary care hospital and factors influencing this decision. Methodology: It was Descriptive cross sectional study done at Nishtar medical University, tertiary care hospital of Multan Pakistan from July to December 2019. The total 384 students from first to final year were enrolled by non probability convenient sampling technique. Participation was voluntary and ensured that response would be kept anonymous. ATP-30 (Attitude towards Psychiatry)   a 30 item self- administered questionnaire was used to measure the attitude of medical students. Data collected on a pre defined questionnaire was analyzed using SPSS version 23. Results pertaining to rates were reported as frequencies and percentages. Result: 47.4% of study respondents were male and 52.6 % were female. 52.3% of our study respondents strongly agree that psychiatry was respected branch of medicine and 56.7% strongly agree that psychiatry should be an important part of medical curriculum. 19.4% of study respondents consider it in the list of the carrier choice while majority didn’t think that it should be in their career list options. Conclusion: Majority of students shows positive attitude. Mostly found it as respected and essential field of medicine. However insufficient knowledge and awareness can also be observed in responses pertaining to available treatment and advancement in the field. There is a need to revise the curriculum and clinical rotation schedule to raise interest of students  regarding  mental health issues of their community and ease their decision in choosing it as a career. Keywords: Attitude, Undergraduate medical students, Psychiatry, Multan, Pakistan DOI: 10.7176/JMPB/63-06 Publication date: January 31st 202

Congenital factor VII deficiency in children at tertiary health care facility in Pakistan

This study presents the demographics, clinical spectrum, and outcome of patients with congenital factor VII (FVII) deficiency at a tertiary care center over a period of 12 years. Of the 49 patients, 27 (55%) patients were males. Consanguinity was found in 92% of the patients. The median age of symptom onset was 2.4 (interquartile range [IQR]: 1.1-6.5) years with a median age of 5.8 (IQR: 3.1-10) years at diagnosis. Life-threatening complications like intracranial bleeding (ICB) and intra-abdominal bleeding (IAB) were observed in 8 (16.4%) patients. We found that 11 (55%) of the 20 patients with FVII coagulant activity (FVIIc) 5% were affected by severe symptoms. Age (P = .042; odds ratio 6.46). Overall, 4 (8.2%) died as a consequence of ICB (3 patients) and IAB (1 patient)

Synthesis, Characterization of some New 1, 3, 4-Oxadiazole derivatives based on 4- amino benzoic acid

In this research various of 2,5-disubstituted 1,3,4-oxadiazole (Schiff base, oxo-thiazolidine , and other compounds) were synthesized from 2,5-di(4,4?- amino-1,3,4-oxadiazole ) which use quently synthesized from mixture of 4-amino benzoic acid and hydrazine in the presence of polyphosphorus acid. The synthesized compounds were characterized by using some Spectral data (UV, FT-IR, and 1H-NMR)

Frequency of G6PD mediterranean in individuals with and without malaria in southern Pakistan

Background: Pakistan has an estimated annual burden of 1.5 million malaria cases. The current situation calls for an efective malaria control and eradication programme in this country. Currently, primaquine is an attractive option for eliminating reservoirs of Plasmodium vivax hypnozoites and killing gametocytes of Plasmodium falciparum. However, this drug causes haemolysis in individuals who are glucose-6-phosphate (G6PD) defcient. It is important to map G6PD defciency and malaria distribution in Pakistan to design an efective malaria eradication regimen. Frequency of G6PD defciency (G6PDd) in malaria patients has not been reported from Pakistan in any meaningful way. The purpose of this study was to evaluate the frequency of G6PD c.563C\u3eT (G6PD Mediterranean) in male individuals with and without falciparum malaria.Methods: Two hundred and ten archived DNA samples from males (110 from falciparum malaria patients and 100 from healthy individuals) were utilized in this study. Healthy blood donors were selected based on stringent predefned criteria. Patients were confrmed for malaria parasites on microscopy and or immune chromatographic assay detecting P. falciparum histidine-rich protein 2. Parasitaemia was also computed. DNA samples were tested for G6PD c.563C\u3eT mutation through PCR–RFLP according to the previously defned protocol and its allelic frequency was computed.Results: G6PD c.563C\u3eT was observed in four of 110 patients with falciparum malaria and in two of 100 healthy donors. Mean (± SD) haemoglobin, median (IQR) platelet and median (IQR) parasite count in G6PD-defcient malariapatients were 8.9 ± 0.9 g/dL, 124 × 109/L (IQR 32, 171) and 57,920/μL of blood (IQR 12,920, 540,000) respectively.Conclusions: Cumulative allelic frequency for G6PD 563c.C\u3eT was 0.0285 detected in 6 of 210 X-chromosomes in Southern Pakistan. Frequency for this G6PD allele was 0.0364 in malaria-patients and 0.0200 in healthy individuals. Large studies including females are needed to elucidate the true burden of G6PDd in malaria-endemic areas. The information will enable local health policy makers to design efective strategies for eliminating malaria form this region

Renal involvement in systemic lupus erythematosus in Pakistan

Objective: To find the prevalence of lupus nephritis, delineate its clinical, immunological and therapeutic characteristics and compare them with the data worldwide.PATIENTS AND Methods: Between 1985 and 2001, 198 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association (ARA) admitted to the hospital were studied by means of a retrospective review of their records.Results: Renal involvement was found in 89 (45%) patients. Biopsy showed lupus nephritis in 42 patients; there were 9 male and 33 females. Mean age at initial presentation was 27 years and mean duration of follow-up was 2 .3 years. The histological types (WHO Classification) were mainly class. 4 (n = 27), class 3 (n = 7) and class 5 (n = 6). Immunoflourescence showed a predominantly granular pattern of IgG, IgA and C3. Renal manifestations included renal failure (50%), microscopic hematuria (67%), active urine sediment (22%), and proteinuria (74%). Proteinuria was nephrotic range in 45% patients. Treatment was with combinations of prednisolone and cyclophosphamide (n = 13), prednisolone and azathioprine (n = 27). 19 patients received high dose methyl prednisolone (1 gm/day for 3 days). There was no difference in mortality rate between prednisolone and cyclophosphamide and prednisolone and azathioprine treatment groups. The overall mortality rate was 17% (n = 7). Mortality was higher in WHO class 4 and 5 as compared to class 2 and 3 (p \u3c 0.001).CONCLUSION: The prevalence of lupus nephritis in our population is an intermediate between Caucasians and other Asians. Certain clinical characteristics in our patients with lupus nephritis are different as compared to various other studies. Because of limited resources for treatment in developing countries, we believe that patients with lupus nephritis should be treated with improved ancillary medical therapies and more effective immunosuppressive regimens

Does Financial Development and Corruption reduce the level of Income Inequality? Evidence from Malaysia

Income inequality is an enduring issue and an important one to address, especially in the new era of digital transformation, as it is a crucial element in promoting persistent income inequality. The theory is that while financial development promotes economic growth, the mixed explanations of previous studies show that this does not always help low-income people in emerging economies. Moreover, the effects of globalization may reinforce motives and increase opportunities for international corrupt practices. It is, therefore, crucial to explore how corruption can be motivated by ineffective rules governing cross-border crimes and how technology can open up new avenues for corrupt behavior, for example by making it easier to find victims, accomplices and money. Profound socio-economic changes can also provide incentives and opportunities for corruption. This study examines how corruption and financial development affect the wealth gap in a developing country like Malaysia over the period 1995 to 2021. The empirical results show that financial development has a positive impact on income inequality. Moreover, the result also shows that corruption control is an insignificant determinant of per capita income in Malaysia. Even though the growth of the financial sector has led to a variety of outcomes, it has only helped to reduce income inequality. Income inequality is negatively and significantly affected by the interaction between financial development and anti-corruption. It is therefore important to promote financial development, prevent corruption and increase government transparency as these factors can promote sustainable economic development and resilience

Do clinical manifestations of Systemic Lupus Erythematosus in Pakistan correlate with rest of Asia?

Objective: Systemic Lupus Erythematosus (SLE) is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data.Methods: Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University Hospital between 1986 and 2001 were studied by means of a retrospective review of their records. The results were compared with various studies in different regions of Asia.Results: Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is generally consistent with Asian data. There was less cutaneous manifestations, arthritis, serositis, haematological and renal involvement compared to various regions in Asia. The neurological manifestations of SLE, however, place Pakistani patients in the middle of a spectrum between South Asians and other Asian races.CONCLUSION: This study has shown that the clinical characteristics of SLE patients in our country may be different to those of other Asian races. Although our population is similar to South Asians, but clinical manifestations of our SLE patients are considerably different, suggesting some unknown etiology. Further studies are required to confirm the above results and to find statistically sounder associations