Risk Factors and Outcome of Neonatal Thrombocytopenia

Introduction: About 30% of neonates develop thrombocytopenia during hospital admission. Inevitable and irreversible complications can be prevented by determining the risk factors of neonatal thrombocytopenia. The present study was undertaken to determine the risk factors and outcome of neonatal thrombocytopenia in neonates admitted to Neonatal Intensive Care Unit Benazir Bhutto Hospital Rawalpindi. Materials and Methods: A prospective study was conducted to evaluate the risk factors for neonatal thrombocytopenia (NT) in 160 neonates. Neonatal and maternal risk factors were recorded and neonates were categorized into three groups based on the severity of thrombocytopenia. Results: A higher percentage of the neonates 89 (55.6%) were male. The majority (61.9%) had moderate neonatal thrombocytopenia while 21.9% had severe neonatal thrombocytopenia. A highly significant difference was observed for the distribution of gestational age, platelet count, birth weight, and age at admission (for all p-value ≥0.0001) among different groups. Multivariate logistic regression revealed a significant independent association of prematurity, birth asphyxia, and low birth weight with neonatal thrombocytopenia. Conclusion: Prematurity, low birth weight, and birth asphyxia were the significant causes of Neonatal thrombocytopenia. The mortality rate increased significantly with the severity of thrombocytopenia

Why do patients with limb ischaemia present late to a vascular surgeon? A prospective cohort study from the developing world

OBJECTIVE: To look into the factors responsible for delay in presentation of Iimb ischemia patients to a vascular surgeon. METHODS: The prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, from October 01, 2016, to August 10, 2018. Patients coming with delayed presentation of both acute and chronic limb ischemia were included. All the patients were assessed by qualified vascular surgeons. SPSS 23 was used for data analysis. RESULTS: Of the 55 patients, 33(60%) had acute and 22(40%) had chronic limb ischaemia. Mean age of acute cases was 44±23.72 years and it was 60±12.49 years for chronic cases. Overall, the commonest reason behind delay was non-referral by primary physician which was the case with 11(33.3%) patients in the acute group, and 13(59%) in the chronic group. The limb loss in the acute group was 20(60%) and 8(36%) in the chronic group.. CONCLUSION: Delayed presentation of patients with limb ischaemia is mainly due to non-referral. A robust campaign needs to be launched to reduce the rate of limb loss

Situational analysis of antimicrobial stewardship program (ASP) among public and private sector tertiary care hospitals in Karachi, Pakistan: A qualitative case study

Abstract Objective: To assess the current status of implementation of the Antimicrobial Stewardship Program (ASP) across Tertiary Care Hospitals in Karachi, Pakistan. Design: Exploratory qualitative case study. Setting: Public and private tertiary care hospitals in Karachi, Pakistan Participants and Methods: The study data were collected from 3 public and 4 private tertiary care hospitals. Twenty-eight in-depth interviews were conducted from the Chief Executive Officer, Chief Medical Officer, Medical Superintendent, and departmental heads of internal medicine, general surgery, and pediatric, respectively. Purposive sampling was done to include higher and middle managers, whereas the infectious diseases consultant, infectious diseases/clinical pharmacist, and clinical microbiologist were interviewed through snowball sampling methodology. Analysis was done using NVivo. Data were source-triangulated within and among the study setting and study participants. Results: We found that more than two-thirds (n = 5, 71%) of tertiary care hospitals in Karachi do not have a structured ASP which includes major public sector hospitals (n = 3, 43%) and half of the private sector hospitals (n = 4, 29%). The study results led to four broad themes, (1) ASP structure, (2) ASP interventions, (3) hospital medical record-keeping system, and (4) structured way for analyzing and reporting mechanism of data related to the ASP. At H1 and H2, there was a consistency in ASP structure and interventions, whereas paucity seen among remaining tertiary care hospitals. Conclusion: There is an alarming need for ASP in the public and private sector hospitals in Karachi. This study can inform future stakeholders regarding ASP and strategies for structural change at hospitals

Response of Some Biochemical Components in Phosphine Susceptible and Resistant Populations of 4th Instar Larvae of Trogoderma Granarium (Coleoptera: Dermestidae)

Stored grain pests are controlled by a number different pesticides and fumigants. This study, investigated the effect of phosphine on khapra beetle (Trogoderma granarium) which is a notorious pest in stored grain godowns in Pakistan and a significant trade pest around the world. For this purpose, the LC50 of phosphine against 4th instar larvae of two different strains of T. granarium (collected from different cities of Punjab, Khaniwal (Khw) and Chishtian (Chi) were determined. The LC50 values shown by these strains were 3.8 and 7.0 ppm respectively. On the basis of LC50 the Chishtian strain was considered as resistant to phosphine, whereas Khaniwal strain was regarded as a susceptible strain. The effect of sub lethal doses (LC10, LC20, and LC30) on the larval stages of two T. granarium strains were evaluated. The toxic effect of phosphine was observed on glucose, glycogen, total lipid, FAA, protein and trehalose of the strains after 24 hours of exposure. The treatment showed significant increase in glucose content in Khaniwal (susceptible) and decrease in resistant strains throughout the treatment. Lipid content showed a highly significant increase for all doses of phosphine in both strains. Glycogen, Trehalose, protein and FAA contents depicted highly significantly increases in the resistant strain at LC10, LC20, and LC30

Antioxidant, antimicrobial studies and characterisation of essential oil, fixed oil of Clematis graveolens by GC-MS

The GC-MS, antimicrobial and antioxidant activity of Clematis graveolens was assessed to explore its medicinal importance. Medicinal importance of its genus plants encourages us to undertake the comprehensive investigation of the essential oil and fixed oil of the leaves and stem. GC-MS analysis of essential and fixed oils showed the presence of many compounds in the leaves and stem parts of the plant like 2,2 dimethoxy butane (15.16%) flouroethane (45.14%) undecane (5.16), 1,2-benzenedicarboxylic acid (18.35), 3,8,12-tri-O-acetoxy-7-desoxyingol-7-one (12.74), propanoic acid, 2-(3-acetoxy-4,4,14-trimethylandrost-8-en-17-yl)- (9.14) and vitamine E acetate (4.38). The antimicrobial activity of the essential and fixed oil was resolute by disc diffusion and MIC (Minimum inhibitory concentration) assay and plant showed potent activity. Furthermore the antioxidant potential of essential and fixed oil was assessed by the DPPH, Reducing power and by percentage inhibition in linoleic acid system

Exposure to low concentrations of heavy metals alone and in combination induces histopathological and genotoxic effects in fish (Labeo rohita)

Background: The terrestrial and agro-aquatic ecosystems are continuously at the pity of human's negative impacts. Extensive and indiscriminate application of agrochemicals like heavy metals, industrial wastes, germicides, drug residues and different feed additives has become serious threats to public health. The current experimental trial was executed to investigate genotoxic potential of different heavy metals in fresh water fish (Labeo rohita).Methods: A total of 120 active, healthy, free from  disease and internal parasites fish having three months of age were procured from local fish breeding center and were kept in glass aquarium having 100 liter water. After two weeks of acclimatization, fish were arbitrarily distributed and placed in different eight groups (A-H). Prior to start of experiment, acute toxicity of various heavy metals alone such as lead, cadmium, chromium and in combination (Pb +Cr), (Cr+Cd), (Cd+Pb) and (Pb+Cr+Cd) mixture were determined in-term of 96-h LC50 and lethal doses for Labeo rohita. After assessment of acute toxicity, all the fish were exposed to three sub-lethal concentrations (5, 7 and 9%) of heavy metals alone and in combinations for a period of 30 days in triplicate experiments.Results: Different clinical ailments like, increased surface breathing, loss of coordination, rapid opercular movement, erratic swimming, air gulping, jerking movement and tremors were noted in fish. Histopathological observations of gills of various fish exhibited severe microscopic alterations. Results on micronucleus assay exhibited increased frequency of formation of micronuclei in red blood cells, while comet assays showed significantly increased DNA damage in peripheral erythrocytes in-term of arbitrary units of comets, average percentile rate of damaged cell and genomic damage index.Conclusion: From the results of our experimental study, it can be concluded that fresh water fish are useful and reliable bio-indicators of heavy metal toxicity. Micronucleus and comet assays showed that heavy metals alone and in combination induced DNA damage in fish.Keywords: Labeo rohita; Heavy metals; Histopathology; Erythrocytes; DNA damag

Factors associated with hypertension in Pakistan: A systematic review and meta-analysis

Background: High blood pressure is an important public health concern and the leading risk factor for global mortality and morbidity. To assess the implications of this condition, we aimed to review the existing literature and study the factors that are significantly associated with hypertension in the Pakistani population.Methods: We conducted several electronic searches in PubMed, ISI Web of Science, PsycINFO, EMBASE, Scopus, Elsevier, and manually searched the citations of published articles on hypertension from May 2019 to August 2019. We included all studies that examined factors associated with hypertension regardless of the study design. To assess the quality of the research, we used the Newcastle-Ottawa Quality Assessment Scale. We also conducted meta-analyses using the DerSimonian & Laird random-effects model to collate results from at least three studies.Results: We included 30 cross-sectional and 7 case-control studies (99,391 participants country-wide) in this review and found 13 (35.1%) to be high-quality studies. We identified 5 socio-demographic, 3 lifestyle, 3 health-related, and 4 psychological variables that were significantly associated with hypertension. Adults aged between 30–60 years who were married, living in urban areas with high incomes, used tobacco, had a family history of hypertension, and had comorbidities (overweight, obesity, diabetes, anxiety, stress, and anger management issues) were positively associated with hypertension. On the other hand, individuals having high education levels, normal physical activity, and unrestricted salt in their diet were negatively associated with hypertension.Conclusion: We found several socio-demographic, lifestyle, health-related, and psychological factors that were significantly (positively and negatively) associated with hypertension. Our findings may help physicians and public health workers to identify high-risk groups and recommend appropriate prevention strategies. Further research is warranted to investigate these factors rigorously and collate global evidence on the same

Determination of expression profile of p53 gene in different grades of breast cancer tissues by real time PCR

Background: Pakistan has a high incidence of breast cancer in Asia, where annually 16,232 deaths are reported. There are many exogenous and endogenous risk factors that affect the tumor suppressor genes and oncogenes. The p53 gene is a tumor suppressor gene and it has a role to protect the whole genome from external and internal stresses, which causes damages to the genome. Objective: The aim of the current study was to investigate the p53 gene expression by using the real-time PCR technique in different grades of breast cancer as compared to the normal tissue. Methods: Fresh Modified Radical Mastectomy (MRM) samples (grade1-grade3) were collected from different hospitals of the Lahore. The project was approved by an ethical review committee of Jinnah Hospital, Lahore. And before sampling an informed consent was obtained from patients and clinicians. RNA from fresh biopsies was extracted by Qiagen extraction kit and cDNA was formed. Real time PCR performed by using SYBR green master mix (ABI) and the data was evaluated by using Livak method. Statistical analysis was done by using Microsoft Excel. Results: There was an abnormal gene expression of p53 in all grades of the breast tumors. Non-significant (p>0.05) difference of down and up regulation of p53 in different grades of breast tumor was found. However, as a whole up-regulation was more than down-regulation with significant difference (p<0.0011). Conclusion: The abnormal expression of p53 shows that there are some genetic and epigenetic factors which are the primal cause of an abnormal gene expression. It is recommended that perform next generation sequencing (NGS) of the gene to find out the mutations causing the abnormal behavior of p53 gene