Clinico-epidemiological Characteristics of Children with Infectious Meningitis at Nishtar Medical Hospital

Objective: This study aims to determine the common Clinico-epidemiological Characteristics of Patients suffering from infectious meningitis presenting at Nishtar medical university hospital Multan, Pakistan. Study design: Descriptive cross-sectional study Place and duration of study: Pediatric department, Nishtar Hospital Multan the duration of the study was February 01, 2016 to January 31, 2017. Method The study comprised of 172 patients. All the children of age 1 month to 12 years with suspected meningitis presenting to Pediatric Department Nishtar Hospital, Multan were included in our study. The patients who were critically ill or immune compromised were not included in the study. The cases in which the parents did not give consent were also excluded. The written informed consent was taken from the parents. All these cases were evaluated by detailed history, thorough physical examination and the necessary investigations. All the demographic data and other variables related to clinico-epidemiological features were measured and recorded using a specifically designed performa. The data were analyzed by using computer program SPSS 21 version. Result Of the 154 patients included in the final analysis, 98 (63.6%) were females and 56 (36.4%) males. The age ranged from 1 month to 12 years with a median of 31 months (6.00 - 72.50). Seventy-five percent of them were below 5 years. On the basis of investigations, bacterial meningitis was diagnosed in 91, viral meningitis in 27, tuberculous meningitis in 21 and cryptococcal meningitis in 15 patients. The most common clinical presentations of meningitis were fever, vomiting, headache, irritability, neck stiffness and altered level of consciousness. While the photophobia and fits were less common. The GCS score was more than 13 in 109 patients (70.8%) while less than eight GCS score was observed in 45 children (29.2%). Most of the complications were observed in the initial 36 hours of admission. The commonly observed complications were an altered level of sensorium, seizure, and shock. The minimum length of hospitalization was one day and the maximum was 36 days with median (IQR) of 12 days (4-15). The mortality was observed in 22 patients (14.3%) of Pediatric Medicine Department. Conclusion Meningitis is a highly morbific and fatal central nervous system infection in children population. It is associated with life-threatening complications and exhibits highly diverse clinical course with a very non-specific sign and symptoms. Younger children of rural areas are highly prone to fall a victim to this lethal disease. By vaccinating the children population against causative agents of meningitis, we can reduce the burden of disease. Keywords: Meningitis.  Children. Clinico-epidemiological features

Clinico-Epidemiological Study of Dengue Fever in Nishtar Medical University Hospital Multan, Pakistan

Introduction: Dengue fever is a common vector borne disease caused by dengue virus. In developing tropical countries, it is considered as one of the major public health problems. Consequently, this disease is highly associated with increased morbidity, mortality and economic burden to poorly resourced health system of less privileged countries. Aim and objectives: The current work is intended to assess the incidence, signs, symptoms, and epidemiological characteristics of cases of Dengue fever presenting in Nishtar Medical University Hospital Multan Pakistan. Study design: Descriptive cross-sectional study Place and duration of study: Department of Infectious Diseases, Nishtar Medical University Hospital Multan Pakistan. The time span of study was from January 01, 2016 to December 31, 2017. Method: The present work was a prospective cross –sectional study conducted in our centre.  A total 876 fever cases, fulfilling WHO criteria for dengue suspicion were included as target population of the study. For each individual case, detailed history and thorough physical examination was performed. In addition to routine baseline investigations, the disease-specific investigations such as rapid immuno chromatographic card test were also performed to confirm the diagnosis. A specifically predesigned proforma was used to collect socio- demographic profile, signs and symptoms of serologically diagnosed cases. The data were analyzed by using computer program SPSS 21. Results: The results of our study exposed that out of 576 suspected cases, 254 patients were serologically positive for Dengue fever. The highest number of cases (110 cases) was reported in the 3rd week of September. Maximum number of dengue cases reported were males belonging to 31-40 years age group from urban area. Fever was the main complaint in all the cases followed by vomiting, headache, and abdominal pain. Conclusion: Dengue is one of the major public health problems in developing countries like India. A large number of cases are reported in the monsoon and post-monsoon period in the month of September and October. Measures can be taken both at personal and government level to reduce morbidity and mortality from dengue. Keywords: Dengue, Epidemiology, Fever, Signs, Symptom

Measuring customer based beverage brand equity : investigating the relationship between perceived quality, brand awareness, brand image, and brand loyalty

This study examined the antecedents of brand equity such as, brand awareness, perceived quality and the mediating role of a brand Image on brand loyalty. Total number of (n = 150) questionnaires were distributed among the consumers living in four cities (Islamabad, Rawalpindi, Sialkot, and Sargodha) of Pakistan. Out of the total questionnaires only (n = 130, 86.6%) completed questionnaires were received. Pearson correlation, linear regression and multiple regression tests were used to test the data and infer the results. Results show a positive relationship between the independent and dependent variables. Additionally, mediation has been found between brand awareness, perceived quality and brand loyalty due to brand image. It means that brand awareness and perceived quality develop the brand image which ultimately yields brand loyalty. Thus loyalty programs of beverage companies should focus on brand awareness and consumers’ perception of quality. Overall, these results show that the influence on brand loyalty varies across various variables of the study. The results contribute significantly to the brand equity topic.Copyright for this article is retained by the author(s), with first publication rights granted to the journal. This is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).fi=vertaisarvioitu|en=peerReviewed

Five insights from the global burden of disease study 2019

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers. © 2020 Elsevier Ltd. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Muhammad Aziz Rahman” is provided in this record*

Evaluation of the anti-pyretic potential of Orthosiphon stamineus Benth standardized extract.

The anti-pyretic activity of a standardized methanol/water (50/50) extract of Orthosiphon stamineus Benth. (SEOS) was investigated for its effect on normal body temperature and yeast-induced pyrexia in Sprague Dawley (SD) rats. The SEOS showed no effect on normal body temperature. Doses of 500 and 1000 mg/kg body weight of SEOS significantly reduced the yeast-induced elevation in body temperature. This effect persisted up to 4 h following the administration of the extract. The anti-pyretic effect of SEOS was comparable with that of paracetamol (acetaminophen in U.S) (150 mg/kg p.o.), a standard anti-pyretic agent. HPLC study revealed that rosmarinic acid, sinensetin, eupatorin and tetramethoxyflavone were present in SEOS in the amounts of 7.58 %, 0.2 %, 0.34 % and 0.24 % respectively. The LD 50 of the extract in rats was higher than 5000 mg/kg body weight. Therefore, the present study ascertained that SEOS possesses a significant anti-pyretic activity

Payment Issues in Industrialized Building System (IBS) Projects in Malaysia: Towards a Better Approach

Industrialised Building System (IBS) was first implemented in Malaysia during the year 1960s and since then it has shed light on the many advantages this system has to offer such as having a systematic and efficient deliverable of fabricated factory-made products, reduced construction period, improved safety on site and many more. Nevertheless, despite the benefits, the level of uptake till today is still way lower than expectation and one of the main contributors to this dilemma is the payment issues that surround projects that uses IBS system. Due to the different nature of work between IBS and conventional in-situ construction, there is a need for proper handling of payment mechanisms so as to not cause burden to any party which would contribute to poor IBS adoption rate. This paper therefore explores the risks associated with IBS uptake, the payment issues surrounding its projects in Malaysia, the way forward and to propose other payment method that suits Malaysia. Besides performing extensive literature reviews, expert opinion was also obtained by interviewing four (4) Malaysian construction industry practitioners from different supply chains of an IBS project with each of them possessing a minimum of 25 years of working experience. Their vast experience was important in getting an insight on the real-world scenario of the subject matter. In the end, it was found that IBS adoption in Malaysia is generally still at far from convincing and poor payment mechanism was a major contributor to this scenario thus, to improve the situation, initiatives should come not only from the government bodies but also from financial institutions; and attention should be placed from both technical and procurement aspects if any improvement on IBS uptake are to be expected

Lessons from humanitarian clusters to strengthen health system responses to mass displacement in low and middle-income countries: A scoping review.

The humanitarian cluster approach was established in 2005 but clarity on how lessons from humanitarian clusters can inform and strengthen health system responses to mass displacement in low and middle-income countries (LMIC) is lacking. We conducted a scoping review to examine the extent and nature of existing research and identify relevant lessons. We used Arksey and O'Malley's scoping framework with Levac's 2010 revisions and Khalil's 2016 refinements, focussing on identifying lessons from discrete humanitarian clusters that could strengthen health system responses to mass population displacement. We summarised thematically by cluster. Of 186 sources included, 56% were peer-reviewed research articles. Most related to health (37%), protection (18%), or nutrition (13%) clusters. Key lessons for health system responses included the necessity of empowering women; ensuring communities are engaged in decision-making processes (e.g. planning and construction of camps and housing) to strengthen trust and bonds between and within communities; and involving potential end-users in technological innovations development (e.g. geographical information systems) to ensure relevance and applicability. Our review provided evidence that non-health clusters can contribute to improving health outcomes using focussed interventions for implementation by government or humanitarian partners to inform LMIC health system responses to mass displacement

Orthosiphon stamineus leaf extract protects against ethanol-induced gastropathy in rats

Orthosiphon stamineus Benth., which is used as a gastroprotective herbal remedy in Malaysia, was assessed for its anti-ulcerogenic activity against ethanol-induced ulcers in rats. Fifty percent methanol was used to extract the oven-dried O. stamineus leaves. The extract was then lyophilized with a rotary evaporator and freeze-dried. Oral administration of O. stamineus methanolic extract (OSME) (125, 250, 500, and 1,000mg/kg) was found to significantly decrease the ulcer index (P<.01, P<.001, P<.001, and P<.001, respectively). Histological study of a section of the rat stomach also showed a marked improvement in the gastric mucosal damage in groups receiving OSME. In order to further investigate the gastroprotective mechanism of OSME, mucus secretion and lipid peroxidation level were estimated in vitro and ex vivo. OSME exhibited dose-dependent stimulation of mucus secretion (r=0.718, P<.001) and inhibition of lipid peroxidation in rat gastric mucosal homogenates (both in vitro [r=0.819, P<.05] and ex vivo [r=0.981, P<.05]). It was concluded that the gastroprotective mechanism of OSME was partly due to its ability to inhibit lipid peroxidation and stimulate gastric mucus secretion

Outcome of patients with visceral leishmaniasis in Diyala province

Background: Visceral leishmaniasis is the second largest parasitic killer in the world after malaria. Objective: The outcome of patient with visceral leishmaniasis in hospital samples depending on spot test for diagnosis. Patients and Methods: This study was conducted in Al-Batool Teaching Hospital in Baqubah- Diyala province, during the period from January 2015 to December 2015. Thirty five collecting cases were suspected to have visceral leishmaniasis. History was taken regarding residence, gender, age, animal contact, blood group type. Clinical examination and investigation were done using complete blood count, abdominal ultrasound and spot test. Results: In this study, thirty-five children were diagnosed as visceral leishmaniasis. It is found more among males (60%) than females (40%), more common in spring and winter, than in summer and autumn; which was (48.5%, 31%, 14% and 0.05%) respectively. High percentage recorded among patient with type (A) and (B) blood group, and less in (AB) and (O) (57%,22%,5%,14%) respectively also infection in rural area (71%) more than in urban (29%). Regarding the site of infection, organomegaly was (57%), splenomegaly (14%), hepatomegaly (17%), hepatosplenomegaly (26%) no-organomegaly(43%). All patients were anemic (43%), mild anemia (10 mg% and less) and (57%) severe anemia (7mg% and less). The percentage of duration of fever was 17%2 weeks. Conclusion: Visceral leishmaniasis is a common in patients live in rural areas that have contact with animals (Dog, fox and jackals)

HPLC and anti-inflammatory studies of the flavonoid rich chloroform extract fraction of Orthosiphon stamineus leaves.

The aim of the present study was to verify the anti-inflammatory activity of Orthosiphon stamineus leaf extracts and to identify the active compound(s) contributing to its anti-inflammatory activity using a developed HPLC method. Active chloroform extract of O. stamineus was fractionated into three fractions using a dry flash column chromatography method. These three fractions were investigated for anti-peritoneal capillary permeability, in vitro nitric oxide scavenging activity, anti-inflammatory and nitric oxide (NO) inhibition using carrageenan-induced hind paw edema method. The flavonoid rich chloroform extract fraction (CF2) [containing sinensetin (2.86% w/w), eupatorin (5.05% w/w) and 3'-hydroxy-5,6,7,4'-tetramethoxyflavone (1.101% w/w)], significantly reduced rat hind paw edema, NO and decreased dye leakage to peritoneal cavity at p < 0.05. IC50 of in vitro NO scavenging of CF2 was 0.3 mg/mL. These results suggest that the anti-inflammatory properties of these CF2 may possibly be due to the presence of flavonoid compounds capable of affecting the NO pathway