A rare case of constrictive pericarditis as initial manifestation of paediatric anaplastic large cell lymphoma requiring urgent pericardiectomy

Constrictive pericarditis (CP) is a rare end stage inflammatory disorder affecting both parietal and visceral pericardium leading to a right heart failure. Malignancy is the least common cause of CP. Anaplastic large cell lymphoma (ALCL) accounts for 10-15% of all Non-Hodgkin lymphomas in children. Very few case reports have reported ALCL that is involving the heart and only two have been published involving pericardium but all were managed medically. We present an interesting case of an 11 year old child who presented with an effusive CP that required urgent Pericardiectomy for managing right heart failure. His histopathology was positive for ALK + ALCL

Knowledge, attitude and practices of self-medication including antibiotics among health care professionals during the COVID-19 pandemic in Pakistan; findings and implications

Since the emergence of COVID-19, several different medicines including antimicrobials have been administered to patients to treat COVID-19. This is despite limited evidence of the effectiveness of many of these, fueled by misinformation. These utilization patterns have resulted in concerns with patients’ safety and a rise in antimicrobial resistance (AMR). Health care workers (HCWs) were required to serve in high-risk areas throughout the pandemic. Consequently, they may be inclined towards self-medication. However, they have a responsibility to ensure any medicines recommended or prescribed for the management of patients with COVID-19 are evidence based. This though is not always the case. A descriptive cross-sectional study was conducted among HCWs in six districts of the Punjab to assess their knowledge, attitude and practices of self-medication during the ongoing pandemic. This included HCWs working a a range of public sector hospitals in Punjab Province. A total of 1173 HCWs were included in the final analysis. The majority of HCWs possessed good knowledge regarding self-medication and good attitudes. However, 60% were practicing self-medication amid the COVID-19 pandemic. The most frequent medicines consumed by the HCWs under self-medication were antipyretics (100%), antibiotics (80.4%) and vitamins (59.9%). Azithromycin was the most commonly purchase antibiotic (35.1%). In conclusion, HCWs possess good knowledge of, and attitude, regarding medicines they pur-chased. However, there are concerns that high rates of purchasing antibiotics, especially ‘Watch’ antibiotics, for self-medication may enhance AMR. This needs addressing

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

Erdheim Chester disease–An unusual presentation of a rare histiocytic disease in a 3-year old boy

Erdheim Chester disease (ECD) is a rare, multisystem non-Langerhans histiocytosis seen in adults characterized by a clinical triad of bone pains, bilateral painless exophthalmos and diabetes insipidus. Only 10 pediatric ECD cases are reported. We report here the youngest child in the literature, diagnosed at three years of age. He presented with osteolytic lesions in the skull, diabetes insipidus and bilateral proptosis. He was initially misdiagnosed and treated as Langerhan cell histiocytosis(LCH). In ECD, the typical radiological findings are symmetrical osteosclerosis of long bones. Osteolytic lesions are rare and if present are usually seen in the limbs. This is the first pediatric case with osteolytic lesions solely in the skull. A repeat biopsy confirmed ECD with the presence of foamy histiocytes in fibrous background positive for CD68 andCD163 and negative for CD1a and S100, typical histopathological features of ECD. The BRAFgene mutation was also detected. The patient responded well to interferon alpha therapy, which is now considered the first line treatment in ECD

Erdheim Chester diseaseâAn unusual presentation of a rare histiocytic disease in a 3-year old boy

Erdheim Chester disease (ECD) is a rare, multisystem non-Langerhans histiocytosis seen in adults characterized by a clinical triad of bone pains, bilateral painless exophthalmos and diabetes insipidus. Only 10 pediatric ECD cases are reported. We report here the youngest child in the literature, diagnosed at three years of age. He presented with osteolytic lesions in the skull, diabetes insipidus and bilateral proptosis. He was initially misdiagnosed and treated as Langerhan cell histiocytosis(LCH). In ECD, the typical radiological findings are symmetrical osteosclerosis of long bones. Osteolytic lesions are rare and if present are usually seen in the limbs. This is the first pediatric case with osteolytic lesions solely in the skull. A repeat biopsy confirmed ECD with the presence of foamy histiocytes in fibrous background positive for CD68 andCD163 and negative for CD1a and S100, typical histopathological features of ECD. The BRAFgene mutation was also detected. The patient responded well to interferon alpha therapy, which is now considered the first line treatment in ECD

Pattern of anemia and associated parameters in HIV positive patients taking highly active retroviral therapy (HAART)

Objective: This study was designed to determine the pattern of anaemia among HIV positive patients taking HAART. Study Design: Cross-sectional study. Place and Duration: Diagnostic and research Laboratory Liaquat university of Medical and health sciences Jamshoro, Hyderabad. January 2022-December 2022. Methods: Total 250 HIV patients (aged 18 years and above) of both genders taking HAART for at least the past six months. After taking written informed consent, data was recorded with the help of a structured questionnaire that contained questions regarding basic bio-data and medical history, along with the interpretation of general physical and systemic examination. A blood complete picture was done to evaluate baseline haematological parameters. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: The mean age of the patients was 32.09 (±SD12.165). Most of the individuals, i.e., 160 (64%), were males, and the number of females was 90 (36%). The mean viral load was 2674.60. Anaemia was present in 210 (84%) patients and 40 (16%)non-anemic with standard parameters. Among anaemic patients, 130 52% had mild disease, moderate anaemia was found in 105 (42%), and only a few (n=15) 6% had severe anaemia.&nbsp

A Comprehensive Experimental Study and Numerical Analysis of Coefficient of Friction of Nanocomposite Coatings

This paper presents a comprehensive study of nanocomposite coating friction behaviour in oscillating-reciprocating simulated condition with interfacing steel ball. A study on Nickel/Graphene (Ni/GPL) and pure Nickel (Ni) coatings has been conducted. Pre-test SEM, EDS and AFM analyses were performed to study the particle size, particle distribution, grain size and surface morphology of coatings. Furthermore, four types of tests were performed to compare the COF of pure Ni and Ni/GPL coatings subject to various test conditions. The post-tests revealed that Ni exhibited higher coefficient of friction (COF) compared to Ni/GPL which was evidenced by microscopic characterisation of wear tracks, wear on counter carbon steel ball and “U-shaped” wear depth profiles of wear tracks. The “U-shaped” profiles were utilised to calculate the energy distribution (Archard factor density) along the interface. A novel 2-D predictive numerical model integrating the wear concepts with the microstructural and lubrication concepts is developed to investigate the influences of intrinsic microstructural properties of nanocomposite coatings for instance porosity and surface stresses on COF. Predictions from newly developed model and the experimental results are in close agreement. In conclusion Ni/GPL showed better COF than Ni because of high strengthening properties in the presence of graphene. Although significant body of experimental research is available in terms of understanding frictional performance of various nanocomposite coatings, there is a need for the development of novel yet reliable predictive models to analyse the coefficient of friction (COF) of nanocomposite coatings within the context of design and industrial applications. The significance of this research is apparent from numerous applications which need precise modelling methods for predicting coatings failures owing to high COF and wear. The research will convey substantial impact to high-end manufacturing, renewable , automotive and aerospace industries in addressing several frictional failures

Prevalence of Luminal A, Luminal B, HER2 enriched and triple negative breast carcinoma in population of Sindh: A tertiary care hospital experience

The incidence of breast cancer has increased significantly in Asian countries in comparison to Western countries, and it is now one of the leading causes of cancer-related death among women worldwide. Each year, 1.5 million women (25% of all cancer women) are diagnosed with BC around the world, and this number is expected to rise to 2.2 million by 2025. In particular, breast cancer shows biologic heterogeneity in terms of risk factors, natural histories, responses to therapy, and prognostic features that vary considerably between ethnic and geographical groups. Many studies have focused on the distinctions between tumor subtypes because of the importance they play in guiding therapeutic decision making in breast cancer. These factors include histological grade, tumor type and size, and the presence of lymph node metastasis. As a proxy for profiling gene expression, immunohistochemical examination of breast cancer tissue with various biomarkers is employed. This method is cheap, widely accessible, reliable, and technically not demanding. The purpose of this research was to analyze the relationship between molecular subtypes of breast cancer and certain pathological characteristics