Clinico-epidemiological Characteristics of Children with Infectious Meningitis at Nishtar Medical Hospital

Objective: This study aims to determine the common Clinico-epidemiological Characteristics of Patients suffering from infectious meningitis presenting at Nishtar medical university hospital Multan, Pakistan. Study design: Descriptive cross-sectional study Place and duration of study: Pediatric department, Nishtar Hospital Multan the duration of the study was February 01, 2016 to January 31, 2017. Method The study comprised of 172 patients. All the children of age 1 month to 12 years with suspected meningitis presenting to Pediatric Department Nishtar Hospital, Multan were included in our study. The patients who were critically ill or immune compromised were not included in the study. The cases in which the parents did not give consent were also excluded. The written informed consent was taken from the parents. All these cases were evaluated by detailed history, thorough physical examination and the necessary investigations. All the demographic data and other variables related to clinico-epidemiological features were measured and recorded using a specifically designed performa. The data were analyzed by using computer program SPSS 21 version. Result Of the 154 patients included in the final analysis, 98 (63.6%) were females and 56 (36.4%) males. The age ranged from 1 month to 12 years with a median of 31 months (6.00 - 72.50). Seventy-five percent of them were below 5 years. On the basis of investigations, bacterial meningitis was diagnosed in 91, viral meningitis in 27, tuberculous meningitis in 21 and cryptococcal meningitis in 15 patients. The most common clinical presentations of meningitis were fever, vomiting, headache, irritability, neck stiffness and altered level of consciousness. While the photophobia and fits were less common. The GCS score was more than 13 in 109 patients (70.8%) while less than eight GCS score was observed in 45 children (29.2%). Most of the complications were observed in the initial 36 hours of admission. The commonly observed complications were an altered level of sensorium, seizure, and shock. The minimum length of hospitalization was one day and the maximum was 36 days with median (IQR) of 12 days (4-15). The mortality was observed in 22 patients (14.3%) of Pediatric Medicine Department. Conclusion Meningitis is a highly morbific and fatal central nervous system infection in children population. It is associated with life-threatening complications and exhibits highly diverse clinical course with a very non-specific sign and symptoms. Younger children of rural areas are highly prone to fall a victim to this lethal disease. By vaccinating the children population against causative agents of meningitis, we can reduce the burden of disease. Keywords: Meningitis.  Children. Clinico-epidemiological features

Gender Difference in Relationship of Apnoea/Hypopnoea Index with Body Mass Index and Age in the Omani Population

Objectives: Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a disorder characterised by repetitive upper airway collapse during sleep in association with daytime sleepiness. It has an estimated prevalence of 2% and 4% among middle-aged women and men respectively. The aim of the study was to look at the association of body mass index (BMI), age and gender and prevalence of OSAHS in the Omani population. Methods:Polysomnography reports and hospital medical records of all patients who took part in the Sleep Study at the Sleep Laboratory of the Clinical Physiology Department, Sultan Qaboos University Hospital, between January 1995 and December 2006, were retrospectively reviewed. Data from both sources was gathered and analysed. Results: A total of 1,042 sleep studies were conducted with 608 valid studies for analysis. The study showed that the apnoea/hypopnoea index (AHI) >15 was more prevalent in men compared to women (47.9% versus 33.5%, P = 0.001). There was significant correlation of AHI with BMI (P <0.0001) among men compared to women (P = 0.1); however, age was significantly correlated with AHI among women (P <0.0001), but not with men (P = 0.1). Conclusion: The results indicate that there is a gender difference in the prevalence of OSAHS and obesity is a major risk factor for OSAHS among Omani men whereas age is found to be a risk factor for OSAHS among women.

Leadership framework intensifies innovation culture in an organization

The exit of third revolution, paving the way for population of the world treads into the beginning of fourth industry revolution. Indeed the organizations in 22nd century will catalyst as medium for culture of innovation. Innovation has become a necessity in boosting the nation’s economic prowess. Necessarily a culture of innovation routinely touted as the key to achieve it in today’s era. This is a culture that is holding the majority of organizations around the world to sustain total growth. Hence the leaders of an organization from every industry and sector will face with multi challenges to optimize leadership capability. Therefore many scholars assume that both leadership and organization culture play important roles in fostering innovation. However there are not many options for researchers to explore comprehensive framework, which provide linkage of leadership appropriately with intensifies the innovation culture in an organization. Responding of this phenomenon, understanding leadership in relation of augmenting the innovation pivotal in creating sustainable organizations spheres. The mutual leadership and innovation has greatly unraveled abundantly by researchers through their work since decade ago to finetune the continuation. Backed by the strength of these fabric, this research paper promulgated the leadership of which was related to the culture of innovation in an organization, closely connected of leadership purview. The establishment of the framework constituted by qualitative analysis of quality literature reviews and selected case study of most innovative organization. Framework developed with right balance of integrated and directive linkage the innovation culture with wide angles of leadership for concerted effort of intensifying innovation culture. Furthermore this framework expected to be an avenue for researchers for any related structured research in fusion of leadership and innovation in the future

Primary Dural Repair in Minimally Invasive Spine Surgery

We describe an effective surgical technique in primary repair of the spinal dura during minimally invasive spine surgery (MISS). Objective. Minimally invasive spine surgery includes the treatment of intradural lesions, and proper closure of the dura is necessary. However, primary dural closure can be difficult due to the restricted space of MIS retractors and the availability of appropriate surgical instrumentation. Methods. We describe the use of a needle already used in the pediatric neurosurgical arena that can facilitate easier and safer closure of spinal dura through MISS retractors in two illustrative intradural cases. Results and Discussion. The primary dural closure technique is described and patient demographics are included. The instruments specifically used for the intradural closure through MIS retractor systems include (1) 4-0 Surgilon braided nylon (Covidien, Dublin, Ireland) with a CV-20 taper 1/2 circle, 10 mm diameter needle; (2) Scanlan (Saint Paul, MN, USA) dura closure set. Conclusion. Successful primary dural repair can be performed on primary and incidental durotomies during minimally invasive spinal surgery. We describe the novel use of a 10 mm diameter needle to help surgeons safely and efficiently close the dura with more ease than previously described

A Students’ Perspective on University Education and Well-Being One-Year into the COVID-19 Pandemic

We report university student perspectives on COVID-19 impact on education, general health and well-being, one year into the pandemic.   A ‘low risk’ questionnaire with modified General Health (GHQ-28) and Anxiety Disorder (GAD-7) instruments was shared with students via an email link over a 4-week period.   725 students responded from five countries. Half of the students reported significant general health difficulties and more than ten per cent experienced a severe state of generalised anxiety disorder. The virtual learning techniques adopted during the pandemic were welcomed by students but many were frustrated by the poor quality teaching material, poor scheduling of virtual sessions with inadequate spacing and assessments not being truly representative of what was taught. Digital poverty due to inadequacies in hardware, software compatibility and connectivity were major hindrances to virtual learning.   Universities should urgently modify the virtual training methods and enhance mental health and wellbeing support before disaster strikes

Translating and Testing the Validation of the Arabic Peer Mental Health Stigmatization Scale

Objective: Attitudes toward mental difficulties are influenced by culture, and different cultural backgrounds have different effects on people's behavior. This study aimed to prepare the Arabic version of the Peer Mental Health Stigmatization Scale (PMHSS) and validate it among Omani adolescents. Method: The study was conducted from October 2020 to the end of February 2021. The 24-items PMHSS was translated into Arabic and tested in a sample of 369 adolescents from different governmental schools in Oman. Both exploratory factor analysis (a principal component analysis (PCA) technique with Varimax rotation) and confirmatory factor analysis were performed to examine the construct validity of the PMHSS. Results: Confirmatory factor analysis was performed to examine the construct validity of the PMHSS. Cronbach’s α was 0.86 for the total scale and 0.84 and 0.81 for awareness and agreement, respectively. Therefore, the goodness-of fit-indicators support the two-correlated factor 16-item model to measure stigma (χ2 / df = 2.64 (p > 0.001), GFI = 0.92, AGFI = 0.89, CFI = 0.90, IFI = 0.90, RMSEA = 0.067). Conclusion: The Arabic version of the Peer Mental Health Stigmatization Scale (PMHSS) could assess adolescents’ stigmatizing attitudes toward various types of mental health problems within the Arabic context, and it can be utilized by researchers in Arab countries to screen for stigmatizing attitudes and to suggest suitable, effective, and outcome-focused interventions based on its results

Critical care bed capacity in Asian countries and regions

Objective: To assess the number of adult critical care beds in Asian countries and regions in relation to population size. Design: Cross-sectional observational study. Setting: Twenty-three Asian countries and regions, covering 92.1% of the continent’s population. Participants: Ten low-income and lower-middle–income economies, five upper-middle–income economies, and eight high-income economies according to the World Bank classification. Interventions: Data closest to 2017 on critical care beds, including ICU and intermediate care unit beds, were obtained through multiple means, including government sources, national critical care societies, colleges, or registries, personal contacts, and extrapolation of data. Measurements and Main Results: Cumulatively, there were 3.6 critical care beds per 100,000 population. The median number of critical care beds per 100,000 population per country and region was significantly lower in low- and lower-middle–income economies (2.3; interquartile range, 1.4–2.7) than in upper-middle–income economies (4.6; interquartile range, 3.5–15.9) and high-income economies (12.3; interquartile range, 8.1–20.8) (p = 0.001), with a large variation even across countries and regions of the same World Bank income classification. This number was independently predicted by the World Bank income classification on multivariable analysis, and significantly correlated with the number of acute hospital beds per 100,000 population (r2 = 0.19; p = 0.047), the universal health coverage service coverage index (r2 = 0.35; p = 0.003), and the Human Development Index (r2 = 0.40; p = 0.001) on univariable analysis. Conclusions: Critical care bed capacity varies widely across Asia and is significantly lower in low- and lower-middle–income than in upper-middle–income and high-income countries and regions

Patients' satisfaction and opinions of their experiences during admission in a tertiary care hospital in Pakistan – a cross sectional study

<p>Abstract</p> <p>Background</p> <p>It is often felt that developing countries need to improve their quality of healthcare provision. This study hopes to generate data that can help managers and doctors to improve the standard of care they provide in line with the wishes of the patients.</p> <p>Methods</p> <p>It was a cross sectional study carried out at a major tertiary care hospital of Karachi. Patients between the ages of 18 and 80 years admitted to the hospital for at least one day were included. Patients in the maternity, psychiatry and chemotherapy wards and those in the ICU/CCU were excluded. A pretested, peer reviewed translation of a validated patient satisfaction scale developed by the Picker Institute of Europe was administered.</p> <p>Results</p> <p>A total of 173 patients (response rate: 78.6 %) filled the questionnaire. Patient satisfaction was at levels comparable to European surveys for most aspects of hospital care. However, nearly half the patients (48%) felt they had to wait too long to get a bed in the hospital after presenting to the ER. 68.6% of the patients said that they were never asked for views on the quality of care provided. 20% of the patients did not find anyone in the staff to talk to about their worries and fears while 27.6% felt that they were given emotional support to only some extent. Up to one third of the patients said they were not provided enough information regarding their operative procedures beforehand.</p> <p>Conclusion</p> <p>Although several components of patient care equal the quality levels of the west, many sections require considerable improvement in order to improve health care provision. The healthcare team needs to get more involved with the patients, providing them greater support and keeping them informed and involved with their medical treatment. Efforts should be made to get regular feedback from the patients.</p

The state of ambient air quality in Pakistan—a review

Background and purpose: Pakistan, during the last decade, has seen an extensive escalation in population growth, urbanization, and industrialization, together with a great increase in motorization and energy use. As a result, a substantial rise has taken place in the types and number of emission sources of various air pollutants. However, due to the lack of air quality management capabilities, the country is suffering from deterioration of air quality. Evidence from various governmental organizations and international bodies has indicated that air pollution is a significant risk to the environment, quality of life, and health of the population. The Government has taken positive steps toward air quality management in the form of the Pakistan Clean Air Program and has recently established a small number of continuous monitoring stations. However, ambient air quality standards have not yet been established. This paper reviews the data being available on the criteria air pollutants: particulate matter (PM), sulfur dioxide, ozone, carbon monoxide, nitrogen dioxide, and lead. Methods: Air pollution studies in Pakistan published in both scientific journals and by the Government have been reviewed and the reported concentrations of PM, SO2, O3, CO, NO2, and Pb collated. A comparison of the levels of these air pollutants with the World Health Organization air quality guidelines was carried out. Results: Particulate matter was the most serious air pollutant in the country. NO2 has emerged as the second high-risk pollutant. The reported levels of PM, SO2, CO, NO2, and Pb were many times higher than the World Health Organization air quality guidelines. Only O3 concentrations were below the guidelines. Conclusions: The current state of air quality calls for immediate action to tackle the poor air quality. The establishment of ambient air quality standards, an extension of the continuous monitoring sites, and the development of emission control strategies are essential. © Springer-Verlag 2009

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin