Serum anti mullerian hormone and renalase levels in predicting the risk of preeclampsia

Objective: The aim of the study was to explore the association of serum AMH and Renalase with the risk of preeclampsia thereby assessing them as screening tools, reducing the risk of gravid consequences of preeclampsia.Materials and Methods: This cross-sectional study recruited n = 95 pregnant women between 14 and 32 gestational weeks. They were categorized as a) women with gestational hypertension (n = 45); b) women with pre-eclampsia (n = 20) and c) normotensive pregnant women (n = 30) according to the ACOG criteria. Anthropometrics data and blood and urine samples were collected. AMH and Renalase levels were measured by ELISA assay.Results: The mean age of study cohort was 27.3 ± 6.2 year and weight was 65.1 ± 14.1 kg. Blood pressures were significantly higher in pre-eclamptic patients versus both the gestational hypertensive females and controls (p \u3c 0.05). AMH was found to be significantly higher in controls but no difference was observed between gestational hypertensive and pre-eclamptic patients. No difference was seen for serum Renalase among the three groups (p \u3e 0.05). AMH showed a negative weak correlation with diastolic blood pressure (r = -0.272; p = 0.008) that remained significant even after adjustment (r = -0.236; p = 0.023) whereas Renalase did not show any difference (r = -0.051; p \u3e 0.05). Females with low levels of AMH were 1.07 times at risk of developing hypertension even after adjustment for age and BMI (p \u3c 0.05).Conclusion: Low AMH levels may lead to hypertension in pregnancy suggesting a role in detecting vascular diseases as well as its effect on ovarian aging. However, further research is required to establish a causal relationship

Frequency of Human Immune Deficiency Virus (HIV) Infections at Tertiary Care Hospital of Karachi from 2017-2019

Background: Human immunodeficiency virus (HIV) is the world’s most serious health problem. Pakistan is included among high prevalent countries and two outbreaks of HIV have been reported one in 2018, in Sargodha (Kot Momin) and the other largest so far in 2019 in Larkana, first time infecting children as well. Therefore, a study was designed to find out the frequency as well as risk factors involved in the transmission of HIV. Methods: This was a retrospective cross-sectional study (n=28,679), conducted in the Microbiology laboratory of Dow Diagnostic Reference and Research Laboratory (DDRRL), Karachi, Pakistan from 1st January 2017 to 31st December 2019. Serum samples were screened for the presence of HIV antigen and antibody by using HIV combo ARCHITECT i2000 SR, chemiluminescent immunoassay (CMIA). The Chi-square was used to analyze the data and a p-value of <0.05 was considered statistically significant. Results: The total HIV-positive samples were 198 (0.69%). The mean age was 30.39 ± 10.1 with a predominance of males 158 (79.8%) followed by females 39(19.7%) and trans-genders 1(0.5%). The most prevalent ethnic background was Sindhi 40(20.2%) followed by Urdu speaking 32(16.2%). The major risk factors were sexual contact (25%) and surgical procedure (13%). The research found the highest incidence reported in Malir District (17.12%) followed by East (13.63%) and West (11.6%) of Karachi. The most significant association (p<0.001) of HIV was found with age. Conclusion: The male population from the Malir district of Sindhi ethnicity had a high frequency of HIV. Moreover, sexual contact and surgical procedures were found major risk factors for HIV. Keywords: Human Immunodeficiency Virus (HIV); Risk Factors; Sexually Transmitted Diseases; Epidemic

Design, Electrical, and Optical Modelling of Bulk Heterojunction Polymer Solar Cell

The energy scenario today is focused on the development and usage of solar cells, especially in the paradigm of clean energy. To readily create electron and hole pairs, solar cells utilize either photoactive or photosensitive components. A bulk heterojunction (BHJ) is a nanolayer consisting of donor and acceptor components with a large interpenetrated acceptor and donor contact area. In this context, a mix of P3HT and PCBM offers novelty for its use as an acceptor as well as a donor. In the work presented here, we address the mechanism of modelling and characterization of a BHJ-based polymer solar cell. Here, a new design of BHJ polymer solar cells have been designed, modelled, using Silvaco TCAD in the Organic Solar module, and matched with an already assembled device having similar features. Using this model, we have been able to estimate key parameters for the modelled devices, such as the short-circuit current density, open-circuit voltage, and fill factor with less than 0.25 error index compared to the fabricated counterpart, paving the way for fabless polymer solar cell design and optimization

Paediatric choroid plexus carcinoma: a retrospective case series from Karachi

The objective of this study is to report clinical, radiological, and histopathological characteristics of three paediatric patients diagnosed as Choroid plexus carcinoma seen at our hospital, between 2015 and 2020. Three patients were diagnosed with choroid plexus carcinomas between 2015 and 2018. The mean age at diagnosis was 1.3 years (range 8 months to 1.5 years). All the three patients had subtotal resection and received adjuvant chemotherapy. One patient also received adjuvant radiotherapy. Despite these treatment measures, residual disease was noted in all three patients and two patients were subsequently treated on palliative care grounds. The average duration of follow-up after the first surgery for all three patients was approximately 33 months. Attaining satisfactory outcome in patients with CPC is challenging. Our case series reflects the difficulty in achieving gross total resection and ensuring that the disease does not recur

Paediatric choroid plexus carcinoma : A retrospective case series from Karachi

The objective of this study is to report clinical, radiological, and histopathological characteristics of three paediatric patients diagnosed as Choroid plexus carcinoma seen at our hospital, between 2015 and 2020. Three patients were diagnosed with choroid plexus carcinomas between 2015 and 2018. The mean age at diagnosis was 1.3 years (range 8 months to 1.5 years). All the three patients had subtotal resection and received adjuvant chemotherapy. One patient also received adjuvant radiotherapy. Despite these treatment measures, residual disease was noted in all three patients and two patients were subsequently treated on palliative care grounds. The average duration of follow-up after the first surgery for all three patients was approximately 33 months. Attaining satisfactory outcome in patients with CPC is challenging. Our case series reflects the difficulty in achieving gross total resection and ensuring that the disease does not recur

Surgical management during the COVID-19 era at a private tertiary care hospital of Karachi, Pakistan: A cross-sectional study

Background: The coronavirus disease 2019 (COVID-19), declared a pandemic in March 2020, has affected the entire healthcare system, including the surgical practice. Guidelines for the management of surgical patients during this COVID-19 era need to be established to provide timely yet safe surgical care. In this study, we aimed to evaluate the outcomes of the COVID-19 testing algorithm established for surgery patients presenting to a tertiary care hospital in Karachi, Pakistan, and to compare the outcomes among patients who underwent elective versus emergency surgery.Methodology: This is a cross-sectional study conducted at a tertiary care hospital in Pakistan to apply and assess the outcomes of the COVID-19 testing algorithm established for patients presenting for surgery. We included all patients who underwent any surgery from May to October 2020. The total sample size was 6,846. The data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY, USA). The categorical variables were assessed using the chi-square or Fisher’s exact test. A p-value of \u3c0.05 was considered significant.Results: A total of 6,846 surgeries were performed from May 1 to October 31, 2020. In total, 74% of the surgeries were elective procedures. We observed that a significantly higher proportion of emergency surgery patients tested positive for COVID-19 (4.2%) compared to elective surgery patients (25/5,063, 0.5%). A higher proportion of surgeries were performed in September (1,437, 21%) and October (1,445, 21%) while the lowest number of surgeries were performed in May (625, 9.1%). From week one to week five, a higher proportion of emergency surgeries were performed (32%) compared to elective surgeries (25%). Only 1.9% of the patients who were undergoing surgery were COVID-19 positive, with the highest number of COVID-19 cases presenting in June. Overall, 74 (4.2%) of the COVID-19-positive patients underwent emergency surgeries.Conclusions: The timely establishment of well-defined guidelines for surgical management during the pandemic allowed us to provide timely and effective surgical care to patients with the priority of minimizing the spread of COVID-19 and preventing unnecessary deferral of surgeries

Private vs public care for intracranial tumours: Findings from Pakistan

Objective: To observe the patient characteristics and centres providing neuro-oncological care in public and private health hospitals in Pakistan. Methods: The Pakistan Association of Neuro-oncology carried out a retrospective, cross-sectional study in 2019 on patients admitted to 32 hospitals in Pakistan, with dedicated neurosurgical facilities. Patients with a histopathological diagnosis of an intracranial tumour were included. Results: Public health care facilities catered for 84% patients with ages between 20 and 60 years and children having intracranial tumours. Private centres were utilised by 66.7% patients from the upper socioeconomic sector. More patients were lost to follow-up in the public sector (n = 784) versus in the private sector (n = 356). Mortality was also higher in the public sector hospitals, (13.9%) as compared to 9.6% in the private sector. Conclusion: Public and private sector health services for neuro-oncological care in Pakistan still have a long way to go to cover the gaps for unmet needs. Strengthening health systems for brain tumour care is imperative to increase both the access to care and the quality of care to fulfil this need. Keywords: Retrospective study, Health systems, Brain neoplasms, Health care, Epidemiology, Chemoradiotherapy.

Time to surgery after radiological diagnosis of brain tumours in Pakistan: A nationwide cross-sectional study

Objective: To investigate waiting times for brain tumour surgery in Pakistan from a nationwide sample and highlight specific affected patient populations. Methods: A nationwide study was conducted as part of the Pakistan Brain Tumour Epidemiology Study; data from 32 high-volume neurosurgical centres were collected. The national sample included 2,750 patients. Time to surgery was calculated by the difference in dates recorded for radiological diagnosis and the date of the first surgery. This was further stratified according to demographic factors, histopathological diagnosis, type of surgical procedure performed and survival outcomes. Results: The data of 1,474 patients for time to surgery was available. Patients travelling to public hospitals had significantly longer mean wait times (94.07 (CI: 85.29, 102.84)  vs 75.14 (CI: 54.72, 95.56) days, p<0.001). Significant differences were seen between patients of various age groups, as adolescents (116.63 (CI: 65.27, 167.98) days) and young adults (103.34 (CI: 85.96, 120.72) days) had higher waiting times compared to middle-aged (72.44 (CI: 61.26, 83.61) days) and older (48.58 (CI: 31.17, 65.98) days) adults. No difference was seen between the genders. A significantly longer time to surgery was observed for middle- and lower-socioeconomic class patients. Those undergoing gross total resection of the tumour had significantly (p<0.001) longer waiting times for surgery when compared to STR (sub-total resection), biopsy, and CSF-diversion procedures, for all tumour types.  Patients diagnosed with meningioma had the most prolonged waiting periods (106 (CI: 76, 95) days). Gliomas had a mean waiting period of 88 (CI: 73, 103) days across the country. Low-grade gliomas had significantly (p=0.031) longer mean waiting times (99.73 (CI: 61.91, 127.36) days) in comparison to high-grade gliomas (70.13 (CI: 43.39, 89.69 ) days). A significant difference was seen between waiting times for patients who survived surgical procedures for a brain tumour on the most recent follow-up and those who had expired (91.87 (CI: 79, 107.74)  vs 77.41 (CI: 59.90, 94.91)  days, p<0.001). Conclusion: Prolonged delays to surgery are a significant barrier within low-and-middle-income countries, leading to adverse outcomes for patients. Patients undergoing brain tumour surgery at public hospitals from lower or middle SES and electing for gross resections were more likely to have longer delays. Keywords: Treatment delay, Neuro-oncology, Time to surgery, Neurosurgery

Conducting the Pakistan brain tumour epidemiology study - report on the methodology

Objective: To combat the lack of brain tumour registries, the Pakistan Brain Tumour Epidemiology Study (PBTES) was conducted without any funding from an external source. Methods: A retrospective analysis of patient data, including patients of all age groups diagnosed with all histopathological types of brain tumours from all over Pakistan, was performed. For this, Pakistan Brain Tumour Consortium (PBTC) was established, including 32 neurosurgical centres from around the country. Data was collected online through a proforma that included variables such as patient demographics, clinical characteristics, operative details, postoperative complications, survival indices, and current functional status. The data collection and analysis team included principal investigators, core leads, regional leads, regional associates, and student facilitators. Despite logistical concerns and lack of resources, the PBTES was conducted successfully, and a formal brain tumour surveillance database was formed without any external funding, which remains unheard of. Conclusion: The methods applied in this study are reproducible and can be employed not just to develop more robust brain tumour and other cancer registries but also to study the epidemiology of communicable and non-communicable diseases in resource-limited settings, both locally and globally.  Keywords: brain neoplasms, retrospective study, epidemiology, noncommunicable diseases. Continue..