Knowledge of primary paediatric care providers regarding attention deficit hyperactivity disorder and learning disorder: a study from Pakistan

Introduction: Attention deficit hyperactivity disorder (ADHD) and learning disorder (LD) remain prevalent globally and are also speculated to have a high occurrence in Pakistan. An early diagnosis and intervention in these disabilities is imperative for achieving good clinical and functional outcomes. This can be ensured by an effective screening at the level of primary paediatric care in the developing countries. We aimed to explore the ability of general practitioners (GPs) and paediatricians in Pakistan to screen for ADHD and LD based on their awareness regarding the risk factors and symptomatology of ADHD and LD. Methods: A total of 96 paediatricians and 98 GPs practising in Karachi, Pakistan were included in the study. Data was collected employing a self-administered questionnaire. Results: Only 13.7 percent of the GPs and 21.6 percent of the paediatricians were shown to have knowledge sufficient to effectively screen for / diagnose ADHD. Alarmingly, not a single GP was adequately familiar with the established risk factors and clinical symptoms of LD. The level of knowledge was not influenced by age, gender, and clinical practice attributes of the physicians. Doctors who regularly read medical journals and attend medical education seminars showed slightly better trends. Conclusion : We hypothesise that this demonstrated lack of knowledge at the level of primary care in Pakistan prevents an early screening of ADHD and LD. A multipronged strategy targeted at the provision of objective screening tools for primary paediatric care providers, regular continuing medical education seminars and an emphasis on paediatric mental health in undergraduate and postgraduate curricula may ensure an early detection of ADHD and LD in Pakistan

Laparoscopic Loop Ileostomy Reversal: Reducing Morbidity While Improving Functional Outcomes

The main advantage of a laparoscopic loop ileostomy reversal was found to be visualization of adhesions for lysis and mobilization of the stoma and small bowel

Detection of bacterial blight resistant gene xa5 using linked marker approaches

Rice is the primary source of food for 57% of the world’s population. Genetic resistance is important to control many kinds of pathogenic diseases. Bacterial blight caused by Xanthomonas oryzae pv oryzae(Xoo) decreases rice production by 20 – 30% and up to about 90% loss of grain weight. xa5 is an important recessive bacterial blight resistant gene, which is effective and important in Asian rice breeding program. It was also used in combination by incorporation with various recessive anddominant BB resistant genes. The purpose of our study was to identify the bacterial blight resistant genes xa5 in Pakistani rice germplasm including Basmati varieties. The seeds were collected from different research institute and then sowed in the National Institute for Biotechnology and Genetic Engineering (NIBGE) in pots. DNAs were extracted and surveyed for polymorphism by using DNA marker linked to xa5 gene. During this polymorphic survey, out of 88 germplasm lines, 45 lines showed the presence of xa5 gene like MB 2, MB 33 MB 57 and MB 66. All these lines showed the amplification of 240 bp corresponding to resistant source IRBB-5 line, while 43 germplasm lines showed no such fragment and elucidated same bands as susceptible source IR-24 having fragment of about 230 base pair. The 10 Pakistani Basmati varieties were also surveyed for xa5 gene. It was observed that none of our cultivated basmati varieties exhibited the presence of xa5 gene. The purpose of screening of xa5 gene in Pakistani rice germplasm is to utilize the local source of xa5 gene for elite molecular breeding program being carried out at NIBGE in future including pyramiding of different disease resistant gene in Basmati varieties

Induction of apoptosis and role of paclitaxel-loaded hyaluronic acid-crosslinked nanoparticles in the regulation of AKT and RhoA

Cancer is a complex multifactorial disease and leading causes of death worldwide. Despite the development of many anticancer drugs, there is a reduced survival rate due to severe side effects. The nontargeted approach of convention drugs is one of the leading players in context to toxicity. Hyaluronan is a versatile bio-polymer and ligand of the receptor (CD44) on cancer cells. The MCF-7 and HT-29 cancer cell lines treated with hyaluronic acid-paclitaxel (HA-PTX) showed the distinguishing morphological features of apoptosis. Flow cytometric analysis showed that HA-PTX induces apoptosis as a significant mode of cell death. The activation level of tumor suppressor protein (p53) increased after PTX treatment in MCF-7, but no changes observed in HT-29 might be due to hereditary mutations. The lack of suppression in AKT and Rho A protein suggest the use of possible inhibitors in future studies which might could play a role in increasing the sensitivity of drug towards mutated cells line and reducing the possibilities for cancer cell survival, migration, and metastasis

School Absenteeism As an Adjunct Surveillance Indicator: Experience during the Second Wave of the 2009 H1N1 Pandemic in Quebec, Canada

A school absenteeism surveillance system was implemented in the province of Quebec, Canada during the second wave of the 2009 H1N1 pandemic. This paper compares this surveillance approach with other available indicators.All (3432) elementary and high schools from Quebec were included. Each school was required to report through a web-based system any day where the proportion of students absent for influenza-like illness (ILI) exceeded 10% of current school enrolment.Between October 18 and December 12 2009, 35.6% of all schools met the 10% absenteeism threshold. This proportion was greater in elementary compared to high schools (40% vs 19%) and in smaller compared to larger schools (44% vs 22%). The maximum absenteeism rate was reached the first day of reporting or within the next two days in 55% and 31% of schools respectively. The first reports and subsequent peak in school absenteeism provincially preceded the peak in paediatric hospitalization by two and one weeks, respectively. Trends in school surveillance otherwise mirrored other indicators.During a pandemic, school outbreak surveillance based on a 10% threshold appears insufficient to trigger timely intervention within a given affected school. However, school surveillance appears well-correlated and slightly anticipatory compared to other population indicators. As such, school absenteeism warrants further evaluation as an adjunct surveillance indicator whose overall utility will depend upon specified objectives, and other existing capacity for monitoring and response

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Estimates of intraclass correlation coefficient and design effect for surveys and cluster randomized trials on injection use in Pakistan and developing countries

Background:  To assess injection practices and to test interventions aimed at reducing unsafe injections in developing countries, cluster surveys and cluster randomized trials are needed. The design of cluster-based studies requires estimates of intraclass correlation coefficients that have to be obtained from previous studies. This study presents such estimates. Methods:  Data were derived from a cross-sectional study of injection use and health seeking in Pakistan that used 34 clusters to select 1150 study subjects aged ≥3 months. We analysed variance to separate its components. Results:  Most of intraclass correlation coefficients were in the range of 0.01–0.05. For proportion of injections received during last 3 months, mean number of injections received and health seeking during the past 3 months the intraclass correlation coefficients were 0.02, 0.04 and 0.02, respectively. Conclusion:  These estimates can be useful in designing cluster surveys and cluster randomized trials for injection safety in Pakistan and other developing countries