Anti-Biofilm Forming Activity of Natural Products Extract Punica Granatum L. and Magnifera Indica L

OBJECTIVES o evaluate the biofilm activity of Escherichia coli and the anti-biofilm forming activity of Pomegranate peels Punica granatum L. and Mango leafs Mangifera Indica L. extracts against Escherichia coli and their combined synergistic effect using 96 well microtiter plate. METHODOLOGY The study design was a cross-sectional study. The sample size was 150. The samples were collected from patients at PNS Shifa Hospital Karachi. The age group of the individuals included was from 15 to 50 years. The specimens received in the lab were inoculated on CLED agar, Blood agar, and MacConkey’s agar culture plates. Escherichia coli was identified by colony morphology, gram staining, TSI, and further biochemical test analysis. After identification, the samples were processed for biofilm activity on 96 well microtiter plate method and using serial dilution method to assess the anti-biofilm activity of natural product extracts. Patient's age, gender, and hospital number of patients were recorded on specially designed proforma with ERC approval no 83/2021.  RESULTSAmong 150 patients, 64% were males, and 36% were females. Overall mean age was (33.79±9.94) and (34.02±10.59) years. 90% of samples showed biofilm formation. We found a significant relationship between culture and examination (p-value 0.000), while no significant association was found between gender (p-value 0.69), age (p-value 0.44) and biofilm formation (p-value 0.57). Anti-biofilm forming activity of pomegranate peel extract against Escherichia coli was (24.46±19.09) with mean and standard deviation. Anti-biofilm forming activity of Mango leaf extract against Escherichia coli was (14.90±9.56). Significant synergistic relation was observed in both extracts, Punica granatum L. and Mango leaf extract Mangifera Indica L. used in combination. CONCLUSION It was concluded that a novel combination of natural product extracts had shown higher effectiveness against the rapid emergence of biofilm-forming pathogens

Hybrid organisational form as a response to institutional complexity: The case of local municipally owned corporations in Lahore

This paper explores hybrid organisational forms that have emerged in response to institutional complexity. For this purpose, the paper studies organisational practices to explore hybrid characteristics in municipally owned corporations (MOCs) and differentiate between distinct manifestations of hybridity. Using a case study research design, three MOCs are selected as units of analysis, and 30 semi-structured interviews are conducted to explain why and how organisations emerge as hybrid organisations through the adoption of multiple institutional prescriptions that compete with their existing logic. The findings of the study reveal a practical approach to managing complexity where organisations tend to form different hybrids rather than simply accepting or rejecting institutional pressures. The study offers insights into the outcomes within organisational milieus as they navigate and assimilate these competing pressures, underscoring that the resultant ramifications may not invariably align with initial expectations

The Woes of Economic Burden of Traumatic Brain Injury (TBI) Cases Borne by Public Sector Hospital of Pakistan

Objectives: To highlight the role of public sector hospitals in sharing the major burden of severely head injured patients in a resource constrained economically striving countryMaterials and Methods: The study was conducted in the Neurosurgery department of Jinnah Hospital, Lahore, Pakistan. 70 patients with moderate to severe TBI cases above one year of age were included. The data was analyzed for the cost estimation for the period of six months, for the following heads: 1) hospital cost per day, 2) ICU setup cost per day, and 3) salaries of hospital staff per day.Results: There were 53 cases of moderate injury and 17 cases of severe injury. Mean hospital stay was 14 days, minimum number of stay was 2 days and the maximum number of stay was 124 days in six months. Overall, in six months, per day cost of hospital bills head was Rs. 42,333/$263/€ 238. For the ICU setup head, the total cost was Rs. 17,9923/$1130/€ 1016 per day. The salary head’s total cost was Rs. 2573/16.06/€ 14.44. The grand total of all heads, (bills, ICU setup & salaries) was Rs. 22,482,29/1409/€ 1270.Conclusion: We evaluated the cost effectiveness of the Neurocritical care unit of a public sector hospital who provides the best possible health care facilities at a cheaper rate as compared to developed countries. We are highlighting the economic burden borne by the developing country’s government

Evaluation of bi-lateral co-infections and antibiotic resistance rates among COVID-19 patients

In addition to the pathogenesis of SARS-CoV-2, bacterial co-infection plays an essential role in the incidence and progression of SARS-CoV-2 infections by increasing the severity of infection, as well as increasing disease symptoms, death rate and antimicrobial resistance (AMR). The current study was conducted in a tertiary-care hospital in Lahore, Pakistan, among hospitalized COVID-19 patients to see the prevalence of bacterial co-infections and the AMR rates among different isolated bacteria. Clinical samples for the laboratory diagnosis were collected from 1165 hospitalized COVID-19 patients, of which 423 were found to be positive for various bacterial infections. Most of the isolated bacteria were Gram-negative rods (n = 366), followed by Gram-positive cocci (n = 57). A significant association (p 50% of COVID-19 patients were fever, fatigue, dyspnea and chest pain with a significant association (p < 0.05) in bacterial co-infected patients. The current study results showed a comparatively high prevalence of AMR, which may become a severe health-related issue in the future. Therefore, strict compliance of antibiotic usage and employment of antibiotic stewardship programs at every public or private institutional level are recommended

Understanding perceptions and factors involved in do not resuscitate (DNR) decision making in the emergency department of a low-resource country: A mixed-methods study protocol

Introduction: Do not resuscitate (DNR) decision making is an integral component of emergency medicine practice. There is a paucity of data, protocols and guidelines regarding the perceptions and barriers that are involved in the interactions among healthcare professionals, patients and their caregivers regarding DNR decision making. The aim of this study is, therefore, to explore the perceptions and factors influencing DNR decision making in the emergency department and to evaluate the use of a context-based protocol for DNR decision making.Methods and analysis: This will be a sequential mixed method study beginning with qualitative research involving in-depth interviews (IDIs) with patient family members and focus group discussion with healthcare professionals. The consensual qualitative approach will be used to perform a thematic analysis to the point of saturation. The expected outcome will be to identify key themes that suggest perceptions and factors involved in DNR decision making. After piloting, the derived protocol will then be used with a different group of individuals (150 healthcare professionals) who meet the eligibility criteria in a quantitative cross-sectional study with universal sampling. Data will be analysed using NVIVO in the qualitative phase and SPSS V.19 in the quantitative phase. The study findings will support the development of a standardised protocol for DNR decision making for healthcare professionals in the emergency department.Ethics and dissemination: The proposal was reviewed by the ethics review committee (ERC) of the institution (ERC # 2020-1551-7193). The project is an institution SEED grant recipient PF139/0719. The results will be disseminated among participants, patient communities and healthcare professionals in the institution through seminars, presentations, brochures and emails. The findings will be published in a highly accessed peer-reviewed medical journal and will be presented at international conferences

Association of vascular endothelial growth factor a gene (VEGFA) polymorphisms, rs699947 and rs1570360, with diabetic retinopathy and altered VEGF secretion in the Pakistani patients with type 2 diabetes mellitus: a case-control study

Objective: To investigate the association of vascular endothelial growth factor A gene polymorphisms 2578C/A (rs699947) and 1154G/A (rs1570360) with type 2 diabetes mellitus, diabetic retinopathy and serum vascular endothelial growth factor levels in Pakistani patients. Method: The case-control study was conducted from Jan 2017 to Dec 2018 after approval from the ethics review board of Riphah International University, Islamabad, Pakistan, and comprised type 2 diabetes mellitus patients of either gender with diabetic retinopathy in group A, and without diabetic retinopathy in group B. Non-diabetic healthy individuals were enrolled in control group C. Genotyping was done by amplification refractory mutation system-polymerase chain reaction and serum vascular endothelial growth factor levels were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22. Results: Of the 450 subjects, 150(33.3%) were in each of the 3 groups. The mean age in group A was 58.16±9.42, in group B 56.25±8.5 years and in group C it was 55.90±10.90. The proportion of Punjabi ethnicity was significantly high in group B compared to other groups (p<0.05). There was no significant association of rs699947 and rs1570360 genotypic and allelic frequencies in group B compared to group A. Further, rs699947 AA genotype was significantly associated with proliferative diabetic retinopathy compared to group A (p<0.05). Minor allele A showed significant association in groups A and B compared to group C (p<0.05). Significantly raised serum vascular endothelial growth factor levels were found in group B compared to group A (p<0.05), and were associated with rs699947 and rs1570360 heterozygosity in group A (p<0.05). Also, rs699947 genotype showed significant association with groups A and B in Punjabi and Pathan ethnicities (p<0.05) and with Kashmiri ethnicity in group B (p<0.05). Conclusion: There was a strong association of vascular endothelial growth factor 2578C/A (rs699947) gene polymorphism with proliferative diabetic retinopathy in type 2 diabetic Pakistani patients, suggesting its role in the pathogenesis of this condition. Key Words: Diabetic retinopathy, Polymorphisms, Type 2 diabetes mellitus, Vascular endothelial growth factor A gene

Seed-Based System for Cost-Effective Production of Vaccine Against Chronic Respiratory Disease in Chickens.

The production of vaccines in plant cells, termed plant-made pharmaceuticals or molecular farming, is a promising technology for scalable production. Compared to mammalian cell lines, like Chinese Hamster Ovary (CHO)&nbsp;or bacterial cells, plants can be grown with less cost on a large scale to make vaccines antigens and therapeutics affordable and accessible worldwide. An innovative application of this alternative system is the production of vaccines in edible tissues that can be consumed orally to deliver protein antigen without any further processing. In this project, we report stable expression of amino acid sequences corresponding to the TM-1 gene of Mycoplasma gallisepticum as a candidate vaccine antigen against Chronic Respiratory Disease (CRD) in&nbsp;chickens using wheat seed's tissues&nbsp;as a production host. Molecular and immunoblotting analysis confirmed the ubiquitous expression of a recombinant 41.8-kDa protein with an expression level of 1.03&nbsp;mg/g dry weight in the endosperm tissues. When orally delivered, the plant-made vaccine was effective in terms of developing antibody response in animal model i.e., chicken without any detectable weight loss. Two doses of orally delivered plant-made TM-1 vaccine candidate elicited the immune response and protective effect against MG virus challenge at the level comparable to commercially available inactivated vaccine against CRD. Our study demonstrates that plant-made vaccines are not only safe but also scalable and cost-effective with prolonged stability at room temperature