Nosocomial Transmission of SARS CoV-2 in a Tertiary Care Hospital in Peshawar, Pakistan

Objective The study aimed to determine the frequency of nosocomial transmission of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) in a tertiary care hospital in Peshawar, Pakistan. Methodology This cross sectional, analytical study was carried out in Hayatabad Medical Complex, Peshawar, Pakistan from 1st June 2021 to 31st August 2021. Consecutive patients aged 18 years and above admitted for conditions other than COVID-19 with a negative rapid antigen test for COVID-19 at admission were included. Patients with respiratory symptoms or those who were hospitalized for any reason in the preceding six weeks in any health care facility were excluded. The study protocol was completed by 90.9% of participants. The rapid antigen test was repeated for participants at the time of discharge or symptoms suggestive of COVID-19. Patients with a positive rapid antigen test for COVID-19 either at the time of discharge or symptom onset were considered to have acquired nosocomial SARS-CoV-2 infection. Statistical Package for the Social Sciences version 21 for Windows was used for data analysis. Results The frequency of nosocomial transmission of SARS-CoV-2 was 2.7% (13/482). Patients with nosocomial COVID-19 stayed longer in the hospital than those who tested negative (7.5±4.0 versus 4.8±3.6 days; p=0.006). Age (p=0.796), gender (p=0.453), department of inpatient stay (p=0.943), major surgery (p=0.678), minor surgery (p=0.576), and visit to the radiology department (p=0.707) did not affect nosocomial spread of SARS-CoV-2. Conclusion Nosocomial transmission of COVID-19 was infrequent, accounting for 2.7% of participants in this study

Novel hydroquinone derivatives alleviate algesia, inflammation and pyrexia in the absence of gastric ulcerogenicity

Purpose: To synthesize and characterize novel hydroquinone compounds that exhibit an aspirin-like pharmacological profile devoid of ulcerogenic side effects.Methods: Two novel hydroquinone derivatives, viz, 2,5-bis(piperidinomethyl)hydroquinone and 2,5- bis(pyrrolidinomet hyl)hydroquinone, were synthesized by refluxing hydroquinone, paraformaldehyde and secondary amines (piperidine or pyrrolidine) in ethanol. The structures were authenticated by infrared (IR) spectroscopy, elemental analysis, mass spectrometry (MS) and 1H and 13C nuclear magnetic resonance (NMR) spectroscopic techniques. The synthesized derivatives were evaluated for antinociceptive, anti-inflammatory and antipyretic activities along with gastric-ulcerogenicity using wellknown testing paradigms. Aspirin served as reference standard.Results: The newly synthesized hydroquinone derivatives, significantly attenuated tonic visceral chemically-induced nociception at 10 mg/kg (p < 0.01, p < 0.001), 20 and 40 mg/kg (p < 0.001), inhibited the temporal-inflammatory reaction at 50 mg/kg (2 - 5 h, p < 0.05, p < 0.001), 100 and 150 mg/kg (1 - 5 h, p < 0.05, p < 0.01, p < 0.001) in addition to alleviating the febrile-response at test doses during 0.5 h (p < 0.05, p < 0.01, p < 0.001), 1 and 1.5 h (p < 0.001) of the study period. The synthesized compounds exhibited improved gastric tolerability profile since they were devoid of aspirin-associated biochemical and ulcerative changes. The in silico studies predicted high binding affinity of the hydroquinone derivatives to the active site of the cyclooxygenase 2 (COX-2) enzyme.Conclusion: The synthesized hydroquinone compounds possess analgesic, antipyretic and antiinflammatory properties with low gastric-ulcerogenic potential. This may be credited to preferential inhibition of the COX-2 enzyme and the beneficial basic rather than acidic chemical nature of the compounds. However, further molecular studies are required to substantiate these findings.Keywords: 2,5-Bis(piperidinomethyl)hydroquinone], 2,5- is(pyrrolidinomethyl)hydroquinone, Antiinflammatory, Antinociceptive, Antipyretic, Gastric-ulcerogenicity, Algesi

The prevalence of HBV infection in the cohort of IDPs of war against terrorism in Malakand Division of Northern Pakistan

<p>Abstract</p> <p>Background</p> <p>Hepatitis B is an important public health problem in the Pakistani population and is the major cause of chronic hepatitis, cirrhosis, fibrosis and hepatocellular carcinoma. High prevalence of HBV infections has been observed especially in areas of low economic status. In spite of effective immunization programs, no significant change has been observed in the epidemiology of HBV in the rural areas of Pakistan (~67.5% of the total population) mainly due to lack of interest from government authorities and poor hygienic measures. The current study was aimed at estimating the prevalence and risk factors associated with HBV infection within internally displaced persons (IDPs) due to war against terrorism in the Malakand Division of Northern Pakistan.</p> <p>Methods</p> <p>Blood samples from 950 IDPs suspected with HBV infection (including both males and females) were collected and processed with commercial ELISA kits for HBsAg, Anti HBs, HBeAg, Anti HBe antibodies. The samples positive by ELISA were confirmed for HBV DNA by real-time PCR analysis.</p> <p>Results</p> <p>The overall prevalence of HBV observed was 21.05% of which 78.5% were males and 21.5% were females. Most confirmed HBV patients belong to the Malakand and Dir (lower) district. High-risk of infection was found in the older subjects 29.13% (46-60 years), while a lower incidence (11.97%) was observed in children aged <15 years. Lack of awareness, socioecomic conditions, sexual activities and sharing of razor blades, syringes and tattooing needles were the most common risk factors of HBV infection observed during the cohort of patients.</p> <p>Conclusion</p> <p>The present study, revealed for the first time a high degree of prevalence of HBV infection in rural areas of Northern Pakistan. The noticed prevalence is gender- and age-dependent that might be due to their high exposures to the common risk factors. To avoid the transmission of HBV infection proper awareness about the possible risk factors and extension of immunization to the rural areas are recommended.</p

The Karachi intracranial stenosis study (KISS) Protocol: an urban multicenter case-control investigation reporting the clinical, radiologic and biochemical associations of intracranial stenosis in Pakistan.

Background: Intracranial stenosis is the most common cause of stroke among Asians. It has a poor prognosis with a high rate of recurrence. No effective medical or surgical treatment modality has been developed for the treatment of stroke due to intracranial stenosis. We aim to identify risk factors and biomarkers for intracranial stenosis and to develop techniques such as use of transcranial doppler to help diagnose intracranial stenosis in a cost-effective manner. Methods/Design: The Karachi Intracranial Stenosis Study (KISS) is a prospective, observational, case-control study to describe the clinical features and determine the risk factors of patients with stroke due to intracranial stenosis and compare them to those with stroke due to other etiologies as well as to unaffected individuals. We plan to recruit 200 patients with stroke due to intracranial stenosis and two control groups each of 150 matched individuals. The first set of controls will include patients with ischemic stroke that is due to other atherosclerotic mechanisms specifically lacunar and cardioembolic strokes. The second group will consist of stroke free individuals. Standardized interviews will be conducted to determine demographic, medical, social, and behavioral variables along with baseline medications. Mandatory procedures for inclusion in the study are clinical confirmation of stroke by a healthcare professional within 72 hours of onset, 12 lead electrocardiogram, and neuroimaging. In addition, lipid profile, serum glucose, creatinine and HbA1C will be measured in all participants. Ancillary tests will include carotid ultrasound, transcranial doppler and magnetic resonance or computed tomography angiogram to rule out concurrent carotid disease. Echocardiogram and other additional investigations will be performed at these centers at the discretion of the regional physicians. Discussion: The results of this study will help inform locally relevant clinical guidelines and effective public health and individual interventions

Safety and Cost-Effectiveness of N-butyl-2-Cyanoacrylate without Lipiodol in Endoscopic Management of Gastric Varices

Introduction: Gastric varices are frequently seen in patients with portal hypertension. The mainstay of treatment is variceal injection with a mixture of N-butyl-2-Cyanoacrylate and lipiodol. The use of N-butyl-2-Cyanoacrylate without lipiodol is not extensively studied and it can be a cost-effective approach. The objective of our study was to evaluate whether the use of N-butyl-2-Cyanoacrylate without lipiodol is a safe and effective endoscopic treatment for gastric varices. Material and Methods: This prospective observational study was conducted between June 2016 and May 2017 at the Department of Gastroenterology, Gujranwala Medical College/ DHQ Teaching Hospital, Gujranwala. A total of 100 patients with gastric varices diagnosed on upper GI endoscopy were enrolled in the study. N-butyl-2-Cyanoacrylate without lipiodol was injected into the gastric varices of all the patients. All procedures were performed by experienced gastroenterologists. The patients underwent monthly follow-up endoscopies to determine the outcome and adverse events. Results: Out of 100 patients, 40 patients (40 %) were men and 60 (60%) were women. The mean age was 53 years. The mean volume of N-butyl-2-Cyanoacrylate used per session was 1.5ml ± 0.5 ml (range 1-2ml). Obliteration of Gastric varices was achieved in 92 patients (92%) while in 04 patients (4%) varices did not obliterate over a mean follow-up of 12 months. No treatment-related immediate or late complications were observed in all patients. Four patients (4%) died of delayed rebleeding (after two weeks of intervention). Conclusion: Injection therapy of gastric varices with N-butyl-2-Cyanoacrylate alone without lipiodol is a safe and cost-effective method for gastric varices

ASSOCIATION OF VITAMIN D DEFICIENCY WITH TUBERCULOSIS IN ADULT PATIENTS REPORTING TO A TERTIARY CARE HOSPITAL OF RAWALPINDI

Objectives: To compare the mean vitamin D levels in pulmonary tuberculosis patients and healthy controls and to find out the frequency and association of vitamin D deficiency in patients with tuberculosis. Study Design: Case control study. Place and Duration of Study: Pulmonology department, Military Hospital Rawalpindi from Jan 2013 to Dec 2013. Patients and Methods: Fifty two incident outdoor pulmonary tuberculosis patients were selected with 52 age and gender matched controls. Tuberculosis was diagnosed by the sputum examination through gene Xpert technique from National Institute of Health (NIH), Islamabad. Serum 25-hydroxvitamin D level <50 nmol/l (electrochemiluminescene assay) was taken as vitamin D deficiency. Results: Mean vitamin D was much lower (20.688 ± 14.065 nmol/l) in cases as compared to the controls (57.917 ± 18.197 nmol/l) which was statistically significant (p 0.05). Conclusion: Significant vitamin D deficiency was seen in newly diagnosed TB patients. It was found that vitamin D deficiency is associated with tuberculosis, but its causal role has not been established

Overflow Effect of COVID-19 Pandemic on Stock Market Performance: A Study Based on Growing Economy

Purpose. The purpose of this study is to evaluate the effect that COVID-19 has on the performance of the stock market in emerging economies. The findings as a whole demonstrate that the stock market does not react significantly. We believe that the outcomes of this study provide knowledge that is useful for decision makers in financial markets and policy all around the globe. Methods. Data for 140 companies are obtained from the official websites of the companies listed on the Pakistan Stock Exchange. The Wilcoxon signed-rank test was used to determine whether there was a significant difference before and after the pandemic era. In addition, the ARDL model was chosen because of the variable integration mix (order 0 and 1). Implications. Theoretically, it added to the information that was already available about the implications of the COVID-19 pandemic on the performance of stock markets in emerging economies. In a purely practical way, it will help those in charge of making policies come up with plans to deal with things that cannot be predicted. Results. The findings of the analysis demonstrate that the COVID-19 pandemic has caused a 52.85% reduction in the volatility of Pakistan’s net profit returns. The study shows a statistically insignificant negative association between the COVID-19 pandemic and Pakistan’s stock returns. The empirical results of ARDL models provide the first conclusion of the analysis, indicating that the number of long-term connections was greater than short-term connections. Conclusion. According to the findings of the research, the pandemic caused by COVID-19 has a bigger impact on the financial performance of enterprises (both positively and negatively). Some companies are able to maintain their place in the market even if the bulk of the firms see their performance suffer during a pandemic. Originality. We are the first to use the ARDL model to evaluate the effect of the new COVID-19 pandemic on a stock market in a developing nation