Hepatitis G Virus associated aplastic anemia: A recent case from Pakistan

<p>Abstract</p> <p>Background</p> <p>Aplastic anemia (AA) is a serious and rare disorder characterized by a hypocellular bone marrow. Hepatitis associated aplastic anemia (HAAA) is a variant of aplastic anemia in which aplastic anemia follows an acute attack of hepatitis. Several reports have noted an association between HGV and hepatitis-associated aplastic anemia besides other hepatitis causing viruses.</p> <p>Case presentation</p> <p>A female girl of age 11 year with a history of loose motion for one month, vomiting for last 15 days and poor oral intake for last few days is reported here. The physical examination presents fever, pallor whereas bleeding, hepatomegaly, Splenomegaly and bruising were absent, abdominal ultrasonography confirmed the absence of hepatomegaly, Splenomegaly and lymphodenopathy. The laboratory investigation parameters were: haemoglobin 6.2 g/L, total leucocytes count 1.51, neutrophils 0.47%, absolute reticulocyte count 0.5%, Monocytes 0.16%, red cell count 3.2 mil/uL, Picked cell volume (PCV) 30.13%, Mean Corpuscular Volume (MCV) 78 fL, Mean Corpuscular Hemoglobin (MCH) 26.3 pg. The liver enzymes were alanine aminotransferease (ALT) 98 IU/L, aspartate aminotransferase (AST) 114 IU/L. Serologic and molecular tests for hepatitis A, B, C, D, E, TTV, B19 were negative, whereas HGV RNA PCR test was found positive for hepatitis G virus. The bone marrow aspirate and trephine biopsy examination revealed hypo- cellularity, erythropoiesis, myelopoiesis and megakaryopoiesis.</p> <p>Conclusion</p> <p>HAAA is an uncommon but severe condition, which may occur following idiopathic cases of acute hepatitis. Our finding suggests the involvement of HGV in the development of aplastic anemia. In patients presenting with pancytopenia after an episode of acute hepatitis, the definitive diagnosis should be considered and confirmed by RT-PCR and if possible by bone marrow biopsy.</p

Draft genome sequence of a Salmonella enterica serovar Typhi strain resistant to fourth-generation cephalosporin and fluoroquinolone antibiotics

ABSTRACT Typhoid is endemic in developing countries. We report here the first draft genome sequence of a Salmonella enterica serovar Typhi clinical isolate from Pakistan exhibiting resistance to cefepime (a fourth-generation cephalosporin) and fluoroquinolone antibiotics, two of the last-generation therapies against this pathogen. The genome is ~4.8 Mb, with two putative plasmids. </jats:p

Mobile Application Usability Evaluation : A Study Based on Demography

Peer reviewedPublisher PD

Comparison of casting versus elastic nail for the treatment of pediatric tibial diaphyseal fractures

Objective: To assess outcomes of Titanium elastic nail (regarding radiologic union, a discrepancy of limb length, malalignment, pain and complications) in treating pediatric tibial fractures in comparison with the traditional Casting method.Methodology: This randomized controlled trial study was conducted in Department of Orthopaedics, Shaikh Zayed Hospital, Lahore through emergency /Outdoor patient department from May 2018 to Feb 2019. The total number of patients were categorized into two groups, 14 each group. In Group A, patients underwent treatment by elastic nails and patients in group B, underwent treatment with cast method. Post op X-Rays (serial) were done and Leg length inequality, Malalignment, pain and radiological union were assessed radiologically. Follow up of the patients was done in the outpatient department of Orthopaedic department after 1,3 and 6 months. The comparison for this among both groups was done by using Chi-square test. P value ≤ 0.05 was considered significant.Results: The mechanism of injury was statistically same in both groups, p-value &gt; 0.05. In group-A, 7(50.0%) cases had Transverse, 4(28.6%) had Oblique and 3(21.4%) cases had comminuted fracture while in group-B there were 5(35.7%) cases who had Transverse, 2(14.3%) had Spiral, 4(28.6%) cases had Oblique and 3(21.4%) cases had Comminuted fracture, p-value &gt; 0.05. In both groups, the leg length inequality, frequency of malalignment, pain severity and complications were statistically same, p-value was &gt; 0.05.Conclusion: Similar outcomes of Titanium elastic intramedullary nailing as compared to cast application in terms of bone union, alignment and infection rates

COMPARATIVE STUDY OF THE FLEXURAL STRENGTH OF MAXILLARY DENTURE BASES MADE IN CONVENTIONAL AND HIGH IMPACT HEAT CURE ACRYLIC RESIN

OBJECTIVE: To compare the flexural strength of maxillary denture bases made in high impact and conventional heat cure acrylic resin. METHODS: This experimental laboratory-based study was conducted in Peshawar Dental College, Materials Research and Centralized Resource Laboratories University of Peshawar, Pakistan. Total 120 edentulous maxillary casts, sixty each of conventional acrylic (30 in subgroup-IA for shallow palate and 30 in subgroup-IB for deep palate and high impact acrylic (30 in subgroup II-A for shallow palate and 30 in subgroup II-B for deep palate) were made. These were then tested for flexural strength using universal testing machine. The load was applied at the rate of 5.0 mm/min. Independent samples t-test was applied for statistical analysis. RESULTS: Mean values of deflection at fracture, fracture load and flexure strength were 0.309±0.059 cm, 87.729±22.497 Kg and 13.645± 4.453 kg/cm² respectively. Mean Flexure Strength (kg/cm2) was 8.30±1.27, 16.54±1.77, 10.88±1.01 and 18.85±1 in subgroups I-A, I-B, II-A and II-B respectively (<0.001). Mean deflection at fracture (cm) was 0.24±0.04, 0.29±0.03, 0.35±0.03 & 0.368±0.03 in subgroups I-A, I-B, II-A and II-B respectively (<0.001).Mean Fracture Load (Kg) was 69.97±3.12, 114.9±6.75, 63.28±7.05 & 102.8±5.5 in in subgroups I-A, I-B, II-A and II-B respectively (<0.001). CONCLUSION: High impact acrylic resin was found to have significantly higher flexure strength as compared to conventional acrylic resi

Acetone-Gasoline Blend as an Alternative Fuel in SI Engines: A Novel Comparison of Performance, Emission, and Lube Oil Degradation

The disproportionate use of petroleum products and stringent exhaust emissions has emphasized the need for alternative green fuels. Although several studies have been conducted to ascertain the performance of acetone-gasoline blends in spark-ignition (SI) engines, limited work has been done to determine the influence of fuel on lubricant oil deterioration. The current study fills the gap through lubricant oil testing by running the engine for 120 h on pure gasoline (G) and gasoline with 10% by volume acetone (A10). Compared to gasoline, A10 produced better results in 11.74 and 12.05% higher brake power (BP) and brake thermal efficiency (BTE), respectively, at a 6.72% lower brake-specific fuel consumption (BSFC). The blended fuel A10 produced 56.54, 33.67, and 50% lower CO, CO2, and HC emissions. However, gasoline remained competitive due to lower oil deterioration than A10. The flash-point and kinematic viscosity, compared to fresh oil, decreased by 19.63 and 27.43% for G and 15.73 and 20.57% for A10, respectively. Similarly, G and A10 showed a decrease in total base number (TBN) by 17.98 and 31.46%, respectively. However, A10 is more detrimental to lubricating oil due to a 12, 5, 15, and 30% increase in metallic particles like aluminum, chromium, copper, and iron, respectively, compared to fresh oil. Performance additives like calcium and phosphorous in lubricant oil for A10 decreased by 10.04 and 4.04% in comparison to gasoline, respectively. The concentration of zinc was found to be 18.78% higher in A10 when compared with gasoline. A higher proportion of water molecules and metal particles were found in lubricant oil for A10

Breaking the Bonds of Poverty: Effectiveness of Microcredit in Improving the Wellbeing of Brick Kilns’ Laborers in Pakistan

This study examines the effectiveness of microcredit to enhance family income, eradicate peshgi and improve the wellbeing of brick kiln laborers. A survey was carried out to determine the effectiveness of microcredit among laborers working at brick kilns located in Lahore and Kasur districts. Linear regression analysis was run at 418 cases to track patterns in the data. The results of study indicated that microcredit significantly increased the family income, eradicated peshgi and improved the wellbeing of borrowers. Furthermore, segregated data indicated that female, married, aged, illiterate, beneficiaries having 6 and above children, beneficiaries having 9 and above family members, family income more than 20001, family expenditures more than 20001, beneficiaries who consulted their families and repeaters experienced higher benefits of microcredit scheme. The researchers recommend increasing the microcredit access to the poor people living in urban slums and rural areas, where the facility of formal lending institutions is lower and people are forced to take peshgi (advance) for meeting their basic need

Hepatitis Associated Aplastic Anemia: A review

Hepatitis-associated aplastic anemia (HAAA) is an uncommon but distinct variant of aplastic anemia in which pancytopenia appears two to three months after an acute attack of hepatitis. HAAA occurs most frequently in young male children and is lethal if leave untreated. The etiology of this syndrome is proposed to be attributed to various hepatitis and non hepatitis viruses. Several hepatitis viruses such as HAV, HBV, HCV, HDV, HEV and HGV have been associated with this set of symptoms. Viruses other than the hepatitis viruses such as parvovirus B19, Cytomegalovirus, Epstein bar virus, Transfusion Transmitted virus (TTV) and non-A-E hepatitis virus (unknown viruses) has also been documented to develop the syndrome. Considerable evidences including the clinical features, severe imbalance of the T cell immune system and effective response to immunosuppressive therapy strongly present HAAA as an immune mediated mechanism. However, no association of HAAA has been found with blood transfusions, drugs and toxins. Besides hepatitis and non hepatitis viruses and immunopathogenesis phenomenon as causative agents of the disorder, telomerase mutation, a genetic factor has also been predisposed for the development of aplastic anemia. Diagnosis includes clinical manifestations, blood profiling, viral serological markers testing, immune functioning and bone marrow hypocellularity examination. Patients presenting the features of HAAA have been mostly treated with bone marrow or hematopoietic cell transplantation from HLA matched donor, and if not available then by immunosuppressive therapy. New therapeutic approaches involve the administration of steroids especially the glucocorticoids to augment the immunosuppressive therapy response. Pancytopenia following an episode of acute hepatitis response better to hematopoietic cell transplantation than immunosuppressive therapy