Heterotopic pregnancy: A case Report.

Heterotopic pregnancy (HP) is a rare phenomenon. It is defined as simultaneous presence of intrauterine and extrauterine pregnancy. A case of HP is discussed. A young patient presented initially with two months amenorrhea and lower abdominal pain. Initial ultrasound showed only 6 weeks intrauterine pregnancy. But, due to increasing severity of pain ultrasound was repeated showing heterotopic pregnancy, which was later confirmed by histopathology. Keywords: Tubal pregnancy, Ectopic pregnancy, Heterotopic pregnancy .   &nbsp

Activity Of Piperacillin/Tazobactam And Cefoperazone/Sulbactam Against Pathogenic Isolates Of Enterobacteriaceae

Background: Enterobacteriaceae are a large family of gram negative bacteria including many genera. The emergence and spread of resistance in Enterobacteriaceae is increasing due to the production of extended spectrum beta lactamase (ESBL) enzymes. Combinations of Beta-lactam/Beta-lactamase inhibitors such as Piperacillin/Tazobactam and Cefoperazone/Sulbactam have good activity against these isolates. The purpose of this study is to determine the antimicrobial susceptibility pattern of Piperacillin/Tazobactam and Cefoperazone/Sulbactam against isolates of Enterobacteriaceae from a tertiary care hospital laboratory of Pakistan. This study validates better options for empirical antimicrobial treatment for this group of difficult to treat pathogens. Methods: A total of 2111 clinical samples were received for culture and sensitivity from both in and outpatients. Samples were inoculated on Chocolate agar, Sheep blood agar and MacConkey’s agar and were incubated for 24 to 48 hours according to standard technique. All isolates belonging to the family Enterobacteriaceae identified by conventional biochemical tests were included in the study. Antimicrobial sensitivities of Enterobacteriaceae were tested and interpreted by Kirby-Bauer disc diffusion method according to Clinical Laboratory Standard Institution criteria. Results: Out of 2111 clinical samples, 214 isolates of Enterobacteriaceae were identified. Escherichia coli was recognized as the predominant pathogen (130/214; 60.75%). Frequency of extended spectrum beta lactamases producing Enterobacteriaceaewas100/214(47%) in 214 samples. Antimicrobial sensitivity was 80% (172/214) to Piperacillin/Tazobactam and 83% (178/214) to Cefoperazone/Sulbactam against the total 214 isolates of Enterobacteriaceae. Conclusion: Piperacillin/Tazobactam and Cefoperazone/Sulbactam are potential and better empirical treatment options for treating isolates of Enterobacteriaceae. This will help in reducing selection pressure on last resort antimicrobials and hence curtail antimicrobial resistance. Key Words: Antimicrobial susceptibility. Piperacillin/Tazobactam. Cefoperazone/Sulbactam. Enterobacteriaceae. Beta lactamases

Promoting transdisciplinary collaboration in academia: uniting for climate-resilient health

In a world where some regions are directly experiencing the effects of the climate change, while others are more vulnerable; this article dives into the deep and frequently catastrophic impact of the climate change on vulnerable countries. This review emphasizes the need for transdisciplinary academic collaboration, including social scientists, healthcare professionals, engineers, policy experts, and climate scientists, and underscores academia’s potential role in advancing climate-resilient health systems in these areas. The study promotes inclusive research that prioritizes at-risk groups, involves communities, and supports culturally sensible methodologies. Beyond their traditional tasks, academia has an obligation for action, learning, innovation, and change. To address the complex health concerns brought on by the planetary crisis, collaboration across academic fields and in tandem with communities, governments, and international organizations is crucial. Ongoing collaboration between academia, governments, and stakeholders is crucial to developing healthcare systems and technologies that are climate resilient. The complex role of academia involves developing pioneering solutions in healthcare for a sustainable future, advocating for policies based on evidence, and educating the next generation of professionals

Biocompatibility and Physiological Thiolytic Degradability of Radically Made Thioester-Functional Copolymers: Opportunities for Drug Release

Being nondegradable, vinyl polymers have limited biomedical applicability. Unfortunately, backbone esters incorporated through conventional radical ring-opening methods do not undergo appreciable abiotic hydrolysis under physiologically relevant conditions. Here, PEG acrylate and di(ethylene glycol) acrylamide-based copolymers containing backbone thioesters were prepared through the radical ring-opening copolymerization of the thionolactone dibenzo[c,e]oxepin-5(7H)-thione. The thioesters degraded fully in the presence of 10 mM cysteine at pH 7.4, with the mechanism presumed to involve an irreversible S–N switch. Degradations with N-acetylcysteine and glutathione were reversible through the thiol–thioester exchange polycondensation of R–SC(═O)–polymer–SH fragments with full degradation relying on an increased thiolate/thioester ratio. Treatment with 10 mM glutathione at pH 7.2 (mimicking intracellular conditions) triggered an insoluble–soluble switch of a temperature-responsive copolymer at 37 °C and the release of encapsulated Nile Red (as a drug model) from core-degradable diblock copolymer micelles. Copolymers and their cysteinolytic degradation products were found to be noncytotoxic, making thioester backbone-functional polymers promising for drug delivery applications

Prevalence of Black Quarter in Association with Patho-Morphological Alterations in Affected Tissues at Different Zones of Punjab-Pakistan

Background: Blackleg or Black Quarter (BQ) is a serious bacterial disease caused by Clostridium chauvoei. It causes edematous and gaseous changes in skeletal muscles of animals. The study was designed to find prevalence of BQ in 6 districts of Punjab, Pakistan from June 2018 to June 2019.Methods: Animals were randomly monitored, and selected in each union council regardless of age, sex and species, but lameness and hyperthermia were the selection parameters. A proforma was used to record the experimental readings of each animal. A total of 1500 swab samples from bovines (cattle and buffaloes) were processed through conventional PCR and culture sensitivity tests to examine the comparative diagnostic efficacy and suitability of the test.Results: Sensitivity and specificity of culture tests were 87.6% and 34.19% respectively, whereas PCR demonstrated 81% and 47.3% results for the said aspects, respectively. Alpha toxin gene (Ccta) was amplified at 52.2oC yielding an amplicon size of 1400 base pairs. Area wise and season wise prevalence of each animal was also determined. The prevalence of BQ in cattle was significantly higher (P 0.05) in Lahore (0%) and Nankana Sahib (8%) which belonged to the canal irrigated zones.Conclusion: There was higher prevalence of BQ in different areas of Punjab, Pakistan that show the higher risk of disease transmission. A systematic surveillance system is essential to regularly monitor the disease incidence and prevalence in these areas of Pakistan.Keywords: Black Quarter; Prevalence; Pathological; Ruminants;  Zone

ASSESSING STAFF REQUIREMENTS AND WORKLOAD PRESSURE AMONG DOCTORS WORKING IN OBSTETRICS & GYNECOLOGY DEPARTMENT OF A PUBLIC SECTOR HOSPITAL IN PAKISTAN USING THE WORLD HEALTH ORGANIZATION’S WORKLOAD INDICATORS OF STAFFING NEEDS

OBJECTIVE: To assess the doctors’ requirement/workload pressure in Department of Obstetrics and Gynecology (DObGyn) of a public sector hospital for effective planning and management of human resources. METHODS: World Health Organization's Workload Indicators of Staffing Needs (WISN) tool was used in assessing the staffing requirements for doctors working in the DObGyn of a public sector hospital Khyber Pakhtunkhwa, Pakistan. Information on working conditions and staffing was acquired by reviewing relevant documents and interviewing key informants. We obtained workload statistics from the hospital from January 1 to December 31, 2015. We assisted a senior technical expert working group in identifying workload components and activity standards, as well as validating both. RESULTS: The average working time needed by the doctors to perform ‘health service activities' was 1952 hours, for which 32 doctors are needed, while there are 36 doctors in the department. ‘Support activities’ accounted for about a fifth of the doctors' annual working hours (-category allowance standards=18.54%), for which 7 doctors were additionally needed. The ‘additional activities' required 3566 hours for which 2 additional doctors were needed. To perform all the three activities, there was a total need of 41 doctors. The workload pressure was also found to be high (WISN ratio: 0.87) on doctors. CONCLUSION: The health services, support and additional activities take up about significant part of the doctors’ time annually. This may require recruitment of a low-cost skill-mix of healthcare personnel to cope with the current workload and/or a health system thinking perspective to reduce the workload indirectly

Strategic priorities for hematopoietic stem cell transplantation in the EMRO region

The World Health Organization-designated Eastern Mediterranean region (EMRO) consists of 22 countries in North Africa and Western Asia with a collective population of over 679 million. The area comprises some of the wealthiest countries per capita income and some of the poorest. The population structure is also unique and contrasts with western countries, with a much younger population. The region sits in the heart of the thalassemia belt. Many countries have a significant prevalence of sickle cell disease, and cancer is on the rise in the region. Therefore, the strategic priorities for the growth and development of hematopoietic stem cell transplantation (HSCT) differ from country to country based on resources, healthcare challenges, and prevalent infrastructure. Thirty-one reporting teams to the Eastern Mediterranean Blood and Marrow Transplantation Group have active HSCT programs in 12 countries; allogeneic transplants outnumber autologous transplants, and the proportion of allotransplants for non-malignant conditions is higher in the EMRO region than in Western Europe and North America. The vast majority (99%) of allotransplants are from matched related donors. Matched unrelated donors and other alternate donor transplants are underutilized. The chance of finding a matched related donor for allografts is higher, with a significant chance of finding matched donors among non-sibling related donors. Reasons for relatively lower rates of transplants compared with other countries are multifactorial. Capacity building, development of newer centers, innovative funding, and better utilization of information technology are required to make transplantation as an accessible modality to more patients. Cost-effectiveness and cost-containment, regulation, and ensuring quality will all be priorities in planning HSCT development in the region

Comparison of Conventional Cyclophosphamide versus Fludarabine-Based Conditioning in High-Risk Aplastic Anemia Patients Undergoing Matched-Related Donor Transplantation

Allogeneic stem cell transplant for high-risk aplastic anemia (AA) yields inferior results using conventional cyclophosphamide (CY)-based conditioning. The use of fludarabine (Flu)-based regimens has resulted in improved outcomes in high-risk patients. Limited data are available comparing these two conditioning regimens in such patients. We retrospectively analyzed 192 high-risk patients undergoing matched-related donor transplantation from July 2001 to December 2018. The median age was 19.5 (2–52) years. Patients were divided into 2 groups, Cy200 anti-thymocyte globulin (ATG)20 (Gp1 n = 79) or Flu120–150 Cy120–160 ATG20 (Gp2 n = 113). The risk of graft failure was significantly higher in Gp1, and the majority occurred in patients with >2 risk factors (p = 0.02). The incidence of grade II-IV acute graft versus host disease (GVHD) and chronic GVHD was not significantly different between the two groups. The overall survival (OS) of the study cohort was 81.3 %, disease-free survival (DFS) 76.6 % and GVHD-free relapse-free survival (GRFS) was 64.1%. DFS and GRFS were significantly higher in Gp2 as compared to Gp1: DFS 84.1% versus 68.4 % (p = 0.02), GRFS 77.9% versus 54.4% (p = 0.01), respectively. We conclude that Flu-based conditioning is associated with superior OS, DFS and GRFS as compared to the conventional Cy-based regimen in high-risk AA

Pseudoaneurysm of left proximal common carotid artery following penetrating trauma

A 33-year male with history of penetrating trauma to left upper chest in 2006, presented through Medical unit to Radiology Department with complain of hemoptysis. Chest X-ray showed a soft tissue lesion in left upper lobe with a linear metallic foreign body. Contrast enhanced CT scan of chest and later CTA was performed which showed a saccular aneurysm arising from mediastinal part of left common aortic artery surrounded by thrombosis with a cylindrical linear metallic foreign body. He was planned for endovascular repair with stenting which he could not afford due to financial constraints. He is currently on conservative follow up. Vascular lesions can be serious complications resulting from blunt or penetrating trauma, when presenting with hemoptysis due to pseudaoneurysms formation even after so many years of trauma