Functional outcome of anorectal malformations and associated anomalies in era of krickenbeck classification

Abstract OBJECTIVE: To describe the management and functional outcome of anorectal malformations and associated anomalies according to Krickenbeck classification. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2002 to December 2012. METHODOLOGY: Anorectal anomalies were classified according to Krickenbeck classification. Data was collected and proforma used regarding the primary disease associated anomalies, its management and functional outcome, according to Krickenbeck classification. Cases included were: all those children with imperforate anus managed during the study period. Qualitative variables like gender and functional outcome were reported as frequencies and percentages. Quantitative variables like age were reported as medians with interquartile ranges. RESULTS: There were 84 children in study group. Most common associated anomaly was cardiac (38%), followed by urological anomaly (33%). All children were treated by Posterior Sagittal Anorectoplasty (PSARP). Fistula was present in 64 out of 84 (76%) cases. The most common fistula was rectourethral (33%), followed by recto vestibular (31%). According to Krickenbeck classification, continence was achieved in 62% children; however 27% children were constipated, followed by 12% children having fecal soiling. CONCLUSION: Functional outcome of anorectal malformation depends upon severity of disease. A thorough evaluation of all infants with ARM should be done with particular focus on cardiovascular (38%) and genitourinary abnormalities (33%)

Perceived Stress and Emotional Exhaustion among Undergraduate Medical Students of Gujranwala Medical College, Pakistan

Objective: To determine a student's performance. A survey of undergraduate medical students was done to determine the factors linked to increased stress and emotional tiredness among medical students at Gujranwala Medical College (GMC) Pakistan. Material and Methods:  Data was collected using a structured questionnaire collected from undergraduate medical students. Information related to stress, nervousness, being upset, daily life restlessness, being irritated, being focused, satisfaction with the lecturing, financial strains, family-related stress, living problems, and career, was collected from the respondents via proforma with permission. Results:  40.4% of students felt they had often faced stress during their last month with 37.1% facing unexpected events. Often students (34.4%) found restlessness during their last month with 39.1% of subjects feeling irritated by things happening around them. Some 35.8% of subjects had given thoughts to the future, 26.5% felt worthless and 33.1% forgot simple things or tasks. 39.1% felt they had difficulty focusing on the tasks given to them. Financial strain was always there in 3.3% and was rarely felt in 33.8% of subjects.  Family-related problems were always there in 7.3% of subjects. 33.1% always felt dissatisfied with the quality of food in the mess. 29.8% of subjects felt they were unable to fulfill their parents’ expectations while 22.5% felt they face stress about their career. Conclusion:  40% of students are experiencing various forms of stress and emotional exhaustion. 33 percent of students always felt tension due to messed-up food, and 26.5 percent felt they always felt alone to deal with their problems.

Diversified Impact of COVID-19 Pandemic on the Overall Health and Well-Being of Children: A Survey Based Case Study

BACKGROUND: COVID-19 pandemic led to the closure of non-essential services including educational institutions and recreational facilities all around the world. The pandemic has affected children at different levels including their mental well- being. AIM: The objective of this study was to assess the overall impact of the pandemic on the well-being of children in terms of their demographic details, physical activity pattern, sanitary practices, mental health and nutritional practices. 300 children aged between 4-18 years were surveyed through an online survey developed as a Google form. MATERIAL AND METHODS: Parents or guardians were asked to fill the questionnaire. The questionnaire was approved by Medical doctors for the sake of accuracy and authenticity. RESULTS: The annual household income of majority of the respondents was between 1-5 lakhs, and they belonged to urban and nuclear households. Although modern amenities were available for the children at home, yet majority of them did not have a separate room and a personal smart phone. 89.4% (n=268) children used internet for 1-5 hours every day. 82.4% (=247) of them were also enrolled in other online courses as well. Lesser time was devoted on physical activity during the pandemic. Negative psychological symptoms like lack in concentration and anxiety, etc. were reported. CONCLUSION: The paper addresses the changes impacting children’s lives at different levels related to their health and well-being. The results must be corroborated with studies reported in literature and may be used for formulating strategies to make children adapt the situation without any negative impact on their personality

Association of Ki-67 expression in radical cystectomy specimens of infiltrating urothelial carcinoma with histopathological parameters

Urothelial carcinoma is the most common neoplasm of urinary bladder. Antigen Ki-67 is a nuclear protein that is necessary for cellular proliferation. The aim of this study was to determine the association of expression of Ki-67 with histopathological parameters in radical cystectomy specimens of histologically diagnosed cases of infiltrating urothelial carcinoma. This is a cross-sectional study conducted among 36 cases of infiltrating urothelial carcinoma collected from Department of Pathology, Bangabandhu Sheikh Mujib Medical University. Histopathological parameters i.e. morphologic variants, stage (pT), lympho-vascular invasion, perineural invasion and lymph node metastasis were assessed. Ki-67 immunohistochemistry were performed. Mean ±SD age of the patients was 58.9±13.8 years. Among the morphological variants, 64% cases were microscopically arranged in papillary pattern. Eighteen (50%) patients underwent surgical intervention at stage pT2. Lympho-vascular invasion, perineural invasion and lymph node metastasis were identified in 12 (33.3%), 9 (25%) and 13 (48.1%) of the cases, respectively. Among the morphological parameters, Ki-67 shows association with pathological stages and lymph node metastasis. The use of Ki-67 immunomarker along with grading and staging may provide significant prognostic information in urothelial carcinoma of the urinary bladder. BSMMU J 2022; 15(3): 186-19

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

A Qualitative Analysis on Customer Dissatisfaction with Cellular Calling in Mobile Network Operators in Hyderabad, Pakistan

The telecommunication industry was rapidly growing sector in the aftermath of deregulation and privatization in Pakistan and still today growth is not subsiding. Deregulation in telecommunication sector in Pakistan initiated fierce competition among the cellular network providers to create and retain subscribers. To keep the customer base flourishing is a significant task for the service providing companies in order to keep revenue figures moving upward. This study focuses on the customer satisfaction and dissatisfaction with the services offered by the two cellular companies i.e. Jazz and Zong in Pakistan. Excellent marketing activities have been launched by these network operators to enhance customer base and retain subscribers. But the telecom companies have to face the customer churn. One of the main causes of churn is the customer dissatisfaction. The study focuses on the customer dissatisfaction factors such as call quality of mobile networks that can influence customer attrition rate for both companies in the region of Hyderabad, Pakistan. Attributes of network call quality like call drop or disconnect, delay or noisiness, echo and no-audio calls were analysed. Based on convenience sampling collectively 200 samples were collected data and analysed in SPSS 20. The Analysis revealed that customer dissatisfaction has significant relationship with the disconnection, echo, no audio and noise during call. Hence it is concluded that disconnection and no audio call were the top two determinants which results in dissatisfying customers followed by echo occurrence while on-going calls and Noise was found to be the least important factor among all

Comparison of multiclass classification techniques using dry bean dataset

Background: The application of classsification methods through multivariate and machine learning techniques has enormous significance in agricultural sector. It is vital to classify various types of seeds as well as identify the quality of seeds which has a great impact on the production of crops. There is a wide range of genetic variations in dry beans all over the world. Many studies have been conducted previously on various dataset to indentify the sorts of dry beans, however most of them focused on machine learning techniques with binary classification. Objective: The aim of this study is to investigate a reliable classifier which has the lowest noise implications and establish an algorithm for dry bean classification effectively. This paper focuses on outlier removals, oversampling with Adaptive Synthetic (ADASYN) algorithm and finding the best classifier to guarantee the highest possible accuracy. Methods: The raw dataset for this study was accessed from UCI Machine Learning Repository. The dataset contained grains having 16 features, 12 dimensions, and 4 distinct shapes. For the purpose of eliminating missing values from the dataset, interquartile range (IQR) with python programming was utilized. Eight most popular classifiers were used in this study which are Logistic Regression (LR), Naïve Bayes (NB), k-Nearest Neighbor (KNN), Decision Tree (DT), Random Forest (RF), Extreme Gradient Boosting (XGB), Support Vector Machine (SVM), and Multilayer Perception (MLP) with balanced and imbalanced classes. The authors utilized frequency tables, bar diagrams, boxplots, analysis of variance for descriptive analysis as well as data preprocessing. Results: The XGB classifier preferably outperformed than other classifiers with balanced and imbalanced distribution of dry beans within each class. It has acquired accuracy (ACC) 93.0% and 95.4% in imbalanced and balanced classes respectively. In case of balanced dataset, after application of ADASYN algorithm both KNN and RF techniques also performed well regarding the Classification Accuracy (ACC), Sensitivity (SE), Specificity (SP) and Cohen's kappa coefficient (Kappa) etc. The most important attributes for classifying the dry beans were found ShapeFactor2, Minor Axis Length, and ShapeFactor1 along with EquivDiameter, Roundness and ConvexArea. Conclusions: For classification of dry seeds, the XGB classifier had performed well when the dataset contained both balanced and imbalanced distribution in classes. Also, it is the primary approach of identifying the classes of seeds/beans with balanced or not. If the classes of the target variable are balanced well, then the KNN and RF algorithms may be applied along with XGB technique for more accurate classification

Neutrophil extracellular traps in colorectal cancer progression and metastasis

Neutrophils form sticky web-like structures known as neutrophil extracellular traps (NETs) as part of innate immune response. NETs are decondensed extracellular chromatin filaments comprising nuclear and cytoplasmic proteins. NETs have been implicated in many gastrointestinal diseases including colorectal cancer (CRC). However, the regulatory mechanisms of NET formation and potential pharmacological inhibitors in the context of CRC have not been thoroughly discussed. In this review, we intend to highlight roles of NETs in CRC progression and metastasis as well as the potential of targeting NETs during colon cancer therapy

Association of biochemical markers with COVID-19 severity in Pakistan

Objective: To evaluate demographics, biochemical markers and clinical features of patients suffering from coronavirus disease-2019. Method: The cross-sectional study was conducted retrospectively at the Capital Hospital, Islamabad, and the Fauji Foundation Hospital, Rawalpindi, Pakistan, from October 08, 2021 to March 01, 2022 and comprised patients of either gender with coronavirus disease-2019 diagnosed on the basis of reverse transcriptase polymerase chain reaction. Patients’ demographic, clinical and laboratory findings were obtained using patient charge sheets. Coronavirus disease-2019 was categorised as non-severe, severe and critical, according to the World Health Organisation criteria. Data was analysed using SPSS 26. Results: Of the 431 patients, 91(21.1%) were men and 340(78.9%) were women. The overall mean age was 60.75±14.45 years. Of the total, 148(34.3%) had non-severe, 190(44.1%) severe and 93(21.6%) had critical condition at the time of admission. Hypertension 307(71.2%) and diabetes mellitus 249(57.8%) were the most common comorbidities, while fever 353(81.9%), shortness of breath 339(78.7%) and cough 302(70.1%) were the most common symptoms reported. Higher age was significantly associated with coronavirus disease-2019 severity (p<0.001). Among comorbidities, chronic kidney disease (p<0.001) and cancer (p=0.046), and, among signs and symptoms, shortness of breath (p=0.002) and chest pain (p=0.021), were significantly associated with coronavirus disease-2019 severity. Serum total bilirubin, alanine aminotransferase, urea and creatinine levels had significant association with disease severity (p<0.001). Total leukocyte count, neutrophil-to-lymphocyte ratio, prothrombin time, and plasma D-Dimer levels had significant association with disease severity (p<0.001). Serum ferritin, lactate dehydrogenase and interleukin-6 levels were also significantly associated with disease severity (p<0.05). Conclusion: Assessment of biochemical markers was an excellent way to monitor disease progression in coronavirus disease-2019 patients. Key Words: COVID-19, Diabetes, Severity, Hypertension, Clinical features