Mumps myocarditis: a forgotten disease?

Mumps is an acute viral illness that follows a self-limiting course but up to 10% of cases have a complicated course with the involvement of other organ systems. Myocarditis is reported as a complication but the incidence has greatly fallen ever since the development of the mumps vaccine. A child presented to our department with parotid swelling and fever. Persistent tachycardia with irregular pulse led to further cardiac work up which showed decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With ionotropic agents and supportive care, there was complete normalization of ejection fraction and serum cardiac enzyme levels. He was discharged within a week of admission. This case highlights the importance of suspecting myocarditis in the setting of mumps, a diagnosis that precludes early suspicion in mumps patients suffering from cardiac symptoms not explained by other potential aetiologies. Early suspicion and timely supportive care are essential to ensure favourable outcomes

Pre-operative Anxiety Compounding Intra-operative Hypotension in Parturient women undergoing Cesarean Deliveries under Spinal Anesthesia

OBJECTIVE: To assess the relation of intra-operative hypotension with severity of pre-operative anxiety in patients undergoing caesarean section under spinal anesthesia. STUDY DESIGN: Prospective observational study. PLACE AND DURATION OF STUDY:  This study was carried out from June 2017 to May 2018 at anesthesia department of Combined Military Hospital Lahore. METHODOLOGY: One hundred and twenty patients belonging to America Society of Anesthesiology class I and II, undergoing caesarean section under spinal anesthesia were selected.  Verbal Analogue Scale for anxiety (VASA) and Straight Trait Anxiety Inventory (STAIs) questionnaire were used to measure pre-operative anxiety. Patients were divided into three groups as mild (VASA<3or STAIs<44), moderate (VASA 4-7 or STAIs 44-55) and severe (VASA 7-10 or STAIs>55) anxiety. Baseline mean arterial pressure was measured. Patients were placed in supine position immediately after induction of spinal anesthesia at L3-L4 or L4-L5 level with 12mg bupivacaine. Blood pressure was measured every two minutes until the delivery of baby. Hypotension was labeled when mean arterial pressure dropped by 20% below the baseline. The effect of level of anxiety on drop in MAP was assessed. RESULTS: Seventeen (14.17%) patients had mild pre-operative anxiety; out of which four (23.53%) developed hypotension. Seventy three (60.83%) patients had moderate anxiety; out of which twenty seven (36.99%) developed hypotension. Thirty (25%) patients had severe anxiety; out of which twenty two (73.33 %) developed hypotension. P-value (0.001) was quite significant. CONCLUSION:  It was concluded in our study that severity of pre-operative anxiety has significant effect on intra-operative spinal hypotension

Contextual challenges in the implementation of the alliance for maternal and newborn health improvement, prospective cohort study, an experience from rural Pakistan

Introduction: Improving maternal and newborn survival needs robust data on patterns of morbidity and mortality from well-characterized cohorts. It is equally important for researchers to document and understand the contextual challenges of data collection and how they are addressed. Methods: This was a prospective cohort study implemented from December 2012 to August 2014 in Matiari, Pakistan. A total of 11,315 pregnancies were enrolled. Participants were approached at home for sequential data collection through the standard pretested structured questionnaires. Some indicators were sourced through health facility records. Information on field challenges gathered through field diaries and minutes of meetings with field staff. Results: Inaccurate reporting of last menstrual period (LMP) dates caused difficulties in the planning and completion of antenatal data collection visits at scheduled gestational weeks. We documented ultrasound reports wherever available, relied on quickening technique, and implemented a seasonal event calendar to help mothers’ recall their LMP. Health system coordinators of public sector and private healthcare providers were individually approached for maximum data collection. But an unregulated private health system with poor record maintenance and health care providers’ reluctance for cooperation posed a greater challenge in data collection. Conclusions: Within a broader understanding of the health systems and socio-cultural environment, temporal and spatial feasibility of data collection should be considered thoroughly at the early stages of study designing, planning, resource allocation, and implementation. Pre-defined regular and need-based meetings with each tier of data collection teams and study managers help to reinvigorate field execution plans and optimize both quantity and quality of study data

How does a democratic government with limited intervention affect environmental quality? Fresh evidence with international panel data

This paper examines the effect of democratic countries which encourage economic freedom on the environment, measured by Carbon Dioxide (2) emission. For the empirical analysis, an annual panel data sample consisting of 179 countries from 1990 to 2018 is collected. Applying the Ordinary Least Squares and Two-Step Generalized Method of Moments estimation techniques, we find that the environmental quality is enhanced with a higher degree of democracy and economic freedom. The results firmly hold for high and middle-income countries when the sample is decomposed across income levels

Knowledge, attitudes and practices of parents regarding antibiotic use in children

Background: Emerging resistance to antimicrobial chemotherapy is becoming a challenge for medicine in recent times. Un-prescribed use of antibiotics is a major contributor to development of this problem. In Pakistan access to antibiotics remains unchecked and hence results in it are over use. The aim of this study was to assess knowledge of parents regarding use of antibiotics, its associated problems, their source of information and their expectations from Paediatricians for prescription of anti-biotics.Methods: This is a questionnaire based cross sectional study conducted in Hayatabad town, District Peshawar. Parents who were consenting, had children aged between 0-16 years, and were not related to medical profession were included in study. Total number of participants interviewed was 400. Analysis was done using prevalence ratios.Results: Most of the participants were mothers. Majority of respondents were literate with education up till level of Graduation. 64% mentioned that they enjoyed a good access to healthcare. Most common source for use of antibiotics was Physician. 35% mentioned that antibiotics must be administered in any case of fever, 47% thought antibiotics to increase recovery time and 51% knew that antibiotics have their own side effect. The most common reason to administer un-prescribed antibiotics was same antibiotic being prescribed by a physician earlier followed by family member or pharmacist recommending use of antibiotic. Lack of resources was denied as a reason for self-administration of antibiotics by majority of parents.CONCLUSION: There is a need of intervention to increase awareness regarding judicious use of antibiotics and to check un-prescribed dispensing of antibiotics

Deriving requirements for integrated and standardised cadastre profile from the legacy Board of Revenue and the contemporary land administration systems

Modernising the paper-based manual Land Administration System (LAS) benefits society at large. This study examines the integration and standardisation requirements of LASs in Islamabad, Pakistan, using the Land Administration Domain Model (LADM). The exploratory case study approach assesses land tenure, value, use and development aspects. The existing LASs satisfy LADM requirements for a unified LAS. Systematic transformations are required to upgrade revenue sketch maps and drawings into accurate geospatial data in 2D and above and below-ground infrastructure into 3D. Developing a LADM edition I & II country profile is recommended for land tenure security, socioeconomic development and sustainable urban growth

Exploring copyrolysis characteristics and thermokinetics of peach stone and bituminous coal blends

Copyrolysis, being an active area of research due to its synergistic impact in utilizing diverse fuel resources, including waste materials, like, peach stone (PS), has been the focal point for this study. PS, produced in vast quantities annually and typically intended for landscaping or insulation purposes, is being studied in combination with low‐grade bituminous coal for energy utilization focusing on thermokinetics and synergistic aspects. Coal‐peach stone (C‐PS) blends were formulated at different ratios and subjected to comprehensive characterization techniques, including ultimate analysis (CHN‐S), gross calorific value (GCV), Fourier transform infrared spectroscopy, and thermogravimetric analyzer (TGA). The ultimate analysis revealed an enhancement in carbon and hydrogen content from 45.38% to 68.08% and from 3.89% to 6.96%, respectively. Additionally, a reduction in sulfur and nitrogen content from 0.54% to 0.11% and from 1.16% to 0.42%, respectively, was observed with an increase in the ratio of PS in the C‐PS blends. The GCV of C‐PS blends ranged from 20.75 to 26.01 MJ kg−1. The pyrolysis conditions simulated in TGA are pivotal for evaluating thermokinetics and synergistic effects. The 60C:40PS blend shows a positive synergy index (SI) value of 0.0203% concerning total mass loss (MLT) indicating a favorable condition for bio‐oil generation. Coats–Redfern model‐fitting method reveals that the activation energy (Ea) of C‐PS blends increases in Section II with the addition of PS, and conversely, it decreases in Section III. The Ea for 100PS and 100C was 106.76 and 45.85 kJ mol−1 through (D3) and (F1), respectively, which was improved through the optimal blend 60C:40PS with an Ea of 94.56 and 27.58 kJ mol−1 through (D3) and (F2), respectively. The values obtained from linear regression prove that the kinetic models are effective while the thermodynamic analysis indicates that the pyrolytic behavior of C‐PS blends is characterized as endothermic, nonspontaneous, and capable of achieving thermodynamic equilibrium more rapidly

Impact of 10-valent pneumococcal conjugate vaccine (PCV10) on nasopharyngeal carriage in children 2 years of age: Data from a four-year time series cross-sectional study from Pakistan

The dataset described in this paper was collected for a time-series cross-sectional study exploring the impact of 10-valent Pneumococcal Conjugate Vaccine (PCV10) on nasopharyngeal (NP) carriage in children under 2 years of age from a rural population in Sindh, Pakistan. The study was carried out in two union councils of Matiari - Khyber and Shah Alam Shah Jee Wasi (Latitude 25.680298 / Longitude 68.502711). Data was collected on socio-demographics, clinical characteristics and vaccination status using android phone-based application. NP samples were collected using standard World Health Organisation (WHO) techniques, culture and serotyping was done using sequential Multiplex PCR described by Centre for Disease Control, USA. We looked at the carriage rate of vaccine type (VT) and non-vaccine type (NVT) serotypes over time in vaccinated and unvaccinated children. We additionally looked at the predictors for pneumococcal carriage. The uploaded dataset, available on Mendeley data repository (Nisar, Muhammad Imran (2021), Impact of PCV10 on nasopharyngeal carriage in children in Pakistan , Mendeley Data, V1, doi:10.17632/t79h6g97gr.1), has 3140 observations in CSV format. Additional files uploaded include a data dictionary and the set of questionnaires. The dataset and accompanying files can be used by other interested researchers to replicate our analysis, carry similar analysis under varying set of assumptions or perform additional exploratory or metanalysis