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

DISSOLUTION BEHAVIOR OF BIOACTIVE GLASS CERAMICS WITH DIFFERENT CaO/MgO RATIOS

In this work, powders of three different compositions, each having 34 SiO2-14.5 P2O5-1 CaF2-0.5 MgF (% wt) and ratio of CaO/MgO varying from 11.5:1 to 1:11.5 were thoroughly mixed and melted under oxy-acetylene flame in a fire clay crucible that made the glass formation cheaper in time and cost. The melt of each composition was quenched in water to form three different glasses. Every glass was sintered at 950°C to form three glass ceramics named G1, G2 and G3 respectively. To study the dissolution behavior, each sample was immersed in a simulated body fluid (SBF) for 2, 5, 10, 20 and 25 days at room temperature. Thin film XRD analysis revealed that the samples with larger CaO/MgO ratio exhibited better bioactivity. pH of SBF increased efficiently in case of G1 whereas in case of G2 and G3, this increase was slower due to greater amount of MgO. The concentrations of Ca, P, Mg and Si ions were measured by Atomic Absorption Spectroscopy. EDS analysis showed the increase in P and Ca ions and presence of C in G1 after 5 days immersion and after 10 days, in case of G2 indicating the higher formation rate of hydroxycarbonate Apatite layer in G1 as compared to G2 due to greater CaO/MgO ratio whereas in G3 Mg-hydroxycarbonate apatite (Ca(Mg)5(CO3)(PO4)3(OH)) (heneuite) layer was recognized after 20 days showing the least bioactivity due to very large amount of Mg and the least CaO/MgO ratio

Clinicopathological prognostic factors of oral squamous cell carcinoma: An experience of a tertiary care hospital

Locoregional recurrence accounts for majority of the treatment failures in oral cancer patients. Current study aimed to determine the predictors of recurrence and survival in patients with biopsy proven Squamous Cell Carcinoma (SCC) of the oral cavity. This study included 88 patients of squamous cell carcinoma treated at our institution from 2007 till 2013. Primary intervention was surgery in all patients with radiation and chemotherapy in selected patients. Primary end point was locoregional recurrence, distant metastasis and death. Out of 88 patients, 23 (26.1%) patients developed locoregional recurrence and 6 (6.8%) patients developed distant metastasis. Overall survival rate was 77.3%. Follow up ranged from 1 month to 63 months with mean of 17.8±16.2. On multivariate analysis, lymph node involvement and loco-regional recurrence were independent parameters related to decrease overall survival. Lymphovascular invasion, perineural spread, TNM stage and lymph node involvement had significant impact on recurrence

PERFORMANCE EVALUATION OF A MULTICARRIER MIMO SYSTEM BASED ON DFT-PRECODING AND SUBCARRIER MAPPING

The ever-increasing end user demands are instigating the development of innovative methods targeting not only data rate enhancement but additionally better service quality in each subsequent wireless communication standard. This quest to achieve higher data rates has compelled the next generation communication technologies to use multicarrier systems e.g. orthogonal frequency division multiplexing (OFDM), while also relying on the multiple-input multiple-output (MIMO) technology. This paper is focused on implementing a MIMO-OFDM system and on using various techniques to optimize it in terms of the bit-error rate performance. The test case considered is a system implementation constituting the enabling technologies for 4G and beyond communication systems. The bit-error rate optimizations considered are based on preceding the OFDM modulation step by Discrete Fourier Transform (DFT) while also considering various subcarrier mapping schemes. MATLAB-based simulation of a 2 × 2 MIMO-OFDM system exhibits a maximum of 2 to 5 orders of magnitude reduction in bit-error rate due to DFT-precoding and subcarrier mapping respectively at high signal-to-noise ratio values in various environments. A 2-3dBs reduction in peak-to-average power ratio due to DFT-precoding in different environments is also exhibited in the various simulations

Assessment of factors affecting quality of life in oral squamous cell carcinoma patients using university of washington quality of life questionnaire

Introduction Post-treatment Quality of Life (QOL) is considered an important outcome in cancer patients. A number of questionnaire tools have been designed for its assessment. University of Washington Quality of Life (UW QOL) questionnaire version four is a reliable tool for assessment of post-treatment QOL in oral squamous cell carcinoma (OSCC) patients. Our aim was to identify the post-treatment problems faced by OSCC patients and to assess the impact of clinical factors affecting post-treatment QOL by using UW QOL (version four) questionnaire. Methods The study was conducted on 59 patients with OSCC who were treated with curative intent at Patel Hospital, Karachi from August 2015 to September 2015. Patients were asked to fill the UW QOL questionnaire (version four) on their follow-up visit. Results Overall mean composite QOL score was 66.59 ± 16.98. Chewing and saliva (dryness of mouth) had the lowest scores (38.98 ± 37.2 and 56.78 ± 41.4, respectively) among all domains while pain and anxiety had the highest scores (80.93 ± 20.4 and 79.66 ± 29.8, respectively). Patients having tumors of the tongue, late stage (III and IV) tumors, and restricted mouth opening had significantly lower mean composite QOL scores. Patients with tongue tumors revealed significantly lower scores for pain, swallowing, mood, and anxiety. Patients with late-stage tumors showed significantly lower scores for chewing, swallowing, taste, saliva, appearance, anxiety, and recreation. Patients with restricted mouth opening had significantly lower scores for pain, speech, appearance, recreation, and anxiety domains. Conclusion Different clinical features have different impacts on QOL in terms of problems faced by the patients. Features having a significant effect should be identified, and measures focused on most relevant problems should be employed in order to improve the post-treatment QOL

Clinicopathologic features and prognostic grouping of gastrointestinal stromal tumors (GISTs) in Pakistani patients: An institutional perspective

Objectives: Gastrointestinal stromal tumors (GISTs) are rare tumors of gastrointestinal tract, prognosis of which largely depends upon histopathologic characteristics of resection specimens, which were not widely studied in our population. Therefore we aimed to evaluate the histopathologic characteristics of GISTs in our population and their prognostic grouping according to college of American pathologist’s guidelines. Results: Mean age of patients was 53.4 years (18–71 years). 92% of cases were of primary GISTs and stomach was the most common site (57.7%). 75% of cases were of spindle cell morphology and 53.8% belonged to high risk prognostic group. Comparison of stomach and intestinal GISTs showed that intestinal GISTs were found to be of high grade (70%) and of high risk prognostic group (75 and 80%) compared to stomach GISTs (43% were of high risk prognostic group), however this fnding was not statistically signifcant. GISTs are infrequent gastrointestinal tumors but early diagnosis and identifcation of adverse histological features are key to successful treatment. We found a large majority of GISTs to be located in stomach, however intestinal GISTs were found more likely to be associated with adverse prognostic parameters. However more large scale studies are warranted to establish this fnding

Frequency and Pattern of Anterior Crossbite With Primary and Mixed Dentition in School Children

OBJECTIVES To determine the frequency and pattern of anterior crossbite with primary and mixed dentition in School Children. METHODOLOGY A descriptive cross-sectional study was conducted at Sharif Medical and Dental College, Lahore. This study included 296 participants having either deciduous or mixed dentition, no history of orthodontic treatment, aged between 3-11 years, both genders and Pakistani nationals. Participants with a history of trauma, cleft lip/palate, or any craniofacial syndrome and systemic disease were excluded. Participant’s age, gender, skeletal class, and anterior crossbite (ACB) were recorded. The Chi-square/Fisher exact test was run to compare ACB and their pattern among gender, age group, and skeletal class. RESULTS There is a relatively high rate of anterior crossbite in this population, which is about 10%. The females were 169(57.09%) and males were 127(42.91%). The mean age was 6.92 ± 1.68 years. Overall, the ACB was present in 31(10.47%). The most common pattern of ACB was single incisor involvement (n=11, 35.48%) followed by two incisors (n=9, 29.03%), and the least was four incisors (n=5, 16.13%). The difference for ACB was statistically significant among skeletal classes (p<0.001). The frequency of ACB was higher in skeletal class 1 (n=17, 54.84%) and in skeletal class 3 (n=13, 41.94%) than in class 2 (n=1, 3.23%). CONCLUSION The frequency of anterior crossbite is about 10%, which is relatively higher than in other populations. Most anterior cross bites are dental due to one or two incisor involvement, which can be corrected easily at the mixed dentition stage

Antibiotic susceptibility surveillance in the Punjab Province of Pakistan : findings and implications

Background and Objectives: The increase in antimicrobial resistance (AMR) across countries has seriously impacted the effective management of infectious diseases, with subsequent impact on morbidity, mortality and costs. This includes Pakistan. Antimicrobial surveillance activities should be mandatory to continually assess the extent of multidrug-resistant bacteria and the implications for future empiric prescribing. The objective of this retrospective observational study was to monitor the susceptibility pattern of microbes in Pakistan. Materials and Methods: Clinical samples from seven laboratories in Punjab, Pakistan were collected between January 2018 and April 2019, with Punjab being the most populous province in Pakistan. The isolates were identified and their antimicrobial susceptibility was tested using the Kirby-Bauer disc diffusion assay and micro broth dilution methods. The antibiotics assessed were those typically prescribed in Pakistan. Results: In total, 2523 bacterial cultural reports were studied. The most frequently isolated pathogens were Staphylococcus aureus (866, 34.3%), followed by Escherichia coli (814, 32.2%), Pseudomonas aeruginosa (454, 18.0%) and Klebsiella pneumoniae (269, 10.7%). Most pathogens were isolated from pus (1464, 58.0%), followed by urine (718, 28.5%), blood (164, 6.5%) and sputum (81, 3.2%). Conclusions: The findings suggest that current antimicrobial options are severally restricted in Pakistan due to the emergence of multidrug-resistant pathogens. This calls for urgent actions including initiating antimicrobial stewardship programs to enhance prudent prescribing of antibiotics. This includes agreeing on appropriate empiric therapy as part of agreed guidelines, in line with the WHO EML and AWaRe book, whilst awaiting culture reports. This is alongside other measures to reduce inappropriate antimicrobial prescribing and reverse the threat of rising AMR

A Comparative Study of Tumor Regression Efficiency under the Impact of Cytokines Interleukin-21 and Interleukin-2 for Cancer Treatment Cultured with Chemo - Immunotherapy: A Mathematical Modeling Approach

In our study we have developed a new mathematical model in the form of system of ordinary differential equations governing the interactions among the cellular populations NK cells, CD8+T cells, tumor cells and cultured with chemo-immunotherapy under the impact of newly characterized cytokine InterleukinIL-21. We have compared our formulated model under the impact of IL-21 to that with de Pilli&rsquo;s model under the impact of IL-2 with same cellular populations in order to investigate which Interleukin is more efficient to eradicate tumor. Theoretical interpretation shows that our developed model is more efficient than the de Pillis model for better tumor regression. We have also simulated both models for tumor reduction efficiency using MATLAB. Our simulations demonstrate that IL-21 is more efficient for tumor reduction than IL-2. Thus our experimental results agree with theoretical interpretations. In future IL-21 may be combined with IL-2 or any other antitumor agent for better tumor reduction.&nbsp