Reduction in Packaging Wastes Through Identification of Lean Wastes to Deliver Efficient Waste Controlling Techniques for a Pharmaceutical Industry

The purpose of this paper is to propose a method of reducing material and time waste during packaging in the pharmaceutical industry. This is done by means of identifying the four major lean wastes i.e., motion, inadequate processing, waiting, and defects. These wastes are identified and reduced by means of using lean tools and proposing other cost-effective solutions that would increase process efficiency. Material waste is dealt with through selecting optimal requirements under the constraint limits of ergonomics, engineering, and machine space availability. Along with reduction in change over time, a strategy ensuring improvement in the primary packaging area was developed. The validity of this research has been brought about by means of a case study of a multinational pharmaceutical company. The proposed system proves to be highly beneficial in ensuring wastage and time reduction in changeovers. This strategy provides improved results without any new costs introduced and the production targets were met faster. There is also a special consideration given to the ergonomic aspect of the production processes

Inventory Management System for a General Items Warehouse of the Textile Industry

This research is based on Inventory Management System for a General Items Warehouse of the Textile Industry. The overall inventory is managed by applying classification tools such as ABC, FSN & HML that categorize inventory based on consumption value, issuance rate and unit price respectively. Also, it helps to appropriately position the items on the desired rack and position. The optimized layout is designed that reduces the retrieval time, uplift the storage capacity, and have cross aisles that reduce the retrieval time of any item from the warehouse. The system for proper traceability & tracking of the items is also studied that is based on the 1D Barcode. This whole study improves the overall operation of the Supply Chain

Fosfomycin: A Substitute in Therapeutic Options for Extended Spectrum Beta-lactamase Producing Uropathogens

Background: The emergence of antibiotic resistance among pathogens causing urinary tract infections (UTI) has made treatment options limited. The use of fosfomycin along with other drug combination can significantly address this problem. Our study aimed to identify the rate of resistance among uropathogens and their susceptibility patterns to fosfomycin along with other antibacterial agents. Methods: The retrospective study was conducted at Jinnah Sindh Medical University in collaboration with Dr. Tahir Laboratory, Karachi. A total of 146 urine samples were included which were processed for antibacterial susceptibility testing by Kirby-Bauer disk diffusion method and rate of resistance for antibacterial agents especially fosfomycin were recorded. The statistical analysis was performed by using Chi squared tests and p>0.05 was considered statistically significant. Results: The study reported lowest rate of resistance for fosfomycin among Escherichia coli 3(5.3%), Klebsiella pneumoniae 7(14%) and Pseudomonas aeruginosa 9(22.5%) in comparison with ampicillin, which showed resistance in 43(76.8%), 41(82%) and 39(97.5%) cases of E. coli, K. pneumoniae and P. aeruginosa respectively. The subgroup carbapenem resistant Enterobacteriaceae (CRE) and extended spectrum β-lactamases (ESBLs) producers were seen noticeably high in P. aeruginosa. Overall, the female to male ratio was 1.4:1 (87/59), showing female preponderance (p=0.02). A majority of patients belonged to adult age group (61.6%) followed by senior adults (23.2%, p=0.05). Conclusion: High levels of resistance to commonly used antibiotics were observed. The increasing rate of resistance among Enterobacteriaceae to cephalosporin and ampicillin is an alarming situation. In this context, fosfomycin is an interesting alternative option in treatment of complicated and uncomplicated urinary tract infections. Keywords: Antibiotic Resistance; Enterobacteriaceae; Extended Spectrum Beta Lactamase; Fosfomycin; Urinary Tract Infection

ENDOSCOPIC BIOPSY PROVEN CO-INFECTION OF HELICOBACTER PYLORI AND GIARDIA LAMBLIA IN ADULT POPULATION OF KARACHI CITY

Background: Worldwide, the prevalence of pathogenic bacterium Helicobacter pylori (H.pylori) and the protozoan parasite Giardia lamblia (G. lamblia) is well known. It is more common in densely populated area with poor sanitation in developing countries as compared to developed countries. Although the prevalence of these organisms is widely studied in our population but our study is a unique kind in its way where we have determined co-infection of H.pylori and G. lamblia in gastric and duodenal biopsies respectively. To know the prevalence of H. pylori, G. lamblia and their co-infection in endoscopic biopsy specimen received at Dr. Tahir laboratory, Hamdard Medical University, Karachi. Methods: This prospective study was conducted in the department of Histopathology at Dr. Tahir Laboratory, Hamdard Medical University, Karachi during January 2016 - December 2017. All the consecutive cases of gastric and duodenal biopsies from the same patient received during 2 years were reviewed. The data obtained were subjected to descriptive statistical analysis using SPSS version 22. Results: A total of 187 gastric and duodenal biopsies (males = 99/52.9%, females = 88/47.0%) (age range = 22 to 71 years) were received through 2 years of duration. Out of 187 cases, H.pylori was found in 120 (64.1%) gastric biopsies, torphozoites of G.lamblia were seen in 42 (22.4%) duodenal biopsies, co-infection of H.pylori and G.lamblia was positive in 15 (8.0%)cases whereas no infection was observed by these organisms in 10 (5.3%) cases. Conclusion: This study concludes a high prevalence of H. pylori & G. lamblia in our population. Moreover, the study also noted co-infection of these organisms in the study area

MORPHOLOGICAL SPECTRUM OF NON MELANOMA SKIN CANCER EXPERIENCE AT A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN

Background: Jinnah post graduate medical center is a major tertiary care hospital in Karachi. People of varying skin color from different ethnic groups in this cosmopolitan city present to this hospital. The current study was designed to determine the histopathological spectrum of non melanoma skin cancer including basal cell carcinoma and squamous cell carcinoma in skin biopsy cases reported at pathology department, basic medical sciences institute, JPMC. Methods: This retrospective cross sectional study included 142 cases of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) diagnosed over5-year duration at department of pathology, Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. World Health Organization histologic classification of keratinocytic skin tumors was followed for subtyping of BCC and SCC. Results: Out of the total of 142 NMSC cases, 86 (60%) were (BCC) and 56 (40%) were (SCC). Majority among SCC i.e. 33 (58.9%) were well differentiated carcinoma. The most common single morphology in BCC was the nodular variant constituting 56 (65.1%) cases. Mixed composition of BCC constituted 25 (29%) cases. A combination of two histological patterns was observed in 22 (25.5%) cases while 3 (3.5%) cases showed more than two morphologies. Conclusion: Well differentiated squamous cell carcinoma was the most common variant of cutaneous SCC. Nodular variant was the most frequently observed subtype amongst BCC. A significant number of BCC cases revealed mixed histopathological patterns, a novel finding of the study. Our data include people from different ethnicities with variable skin color and thus provides useful reference for future studies

Suppurative Infections in Hospitalized Patients – An Ongoing MRSA Threat

Background: Penicillin resistance among Staphylococcus aureus commonly encountered in the hospital admitted patients. Detection of antibiotic sensitivity in hospital acquired methicillin resistant Staphylococcus aureus infections is important as it has great influence on empiric antibiotic prescription, successful control of infection, prevention of spread of disease and successful patient management. This study aimed to detect the frequency of HA-MRSA from pus samples in a hospital setup with assessment of their antibiotic susceptibility patterns. Method: A cross-sectional study was conducted in the Microbiology department of Basic Medical Science Institute, JPMC, Karachi from January 2015 until December 2015. Pus samples from surgical site wounds, skin lesions, abscesses from surgical and medical wards and ICUs were collected. According to the standards given by CLSI 2014, MRSA testing of the samples was done and susceptibility testing for antibiotics was performed. Inducible clindamycin resistance was detected by D-Test. E Test determined the MIC (minimum inhibitory concentration) for vancomycin. The data was analyzed by SPSS version 16. Result: Out of the 149 MRSA identified from the pus samples, 106 (71.14%) samples were HA-MRSA. The number of male patients was more than the female patients (67.66%). Out of the 106 HA-MRSA, 91(85.8%) were sensitive to TMP/SMX, 98(92.5%) to rifampicin, 12(11.6%) to gentamicin, 85(80.2%) to tetracycline, 11(10.4%) to erythromycin, 37(34.9%) to clindamycin, 20(18.9%) to ciprofloxacin, 106 (100%) to both vancomycin and linezolid. Conclusion: HA-MRSA showed sensitivity to TMP/SMX and vancomycin making them effective drugs to use in combination in superficial infections. The drug linezolid also showed 100% sensitivity

Compositional analysis of dark colored particulates homogeneously emitted with combustion gases (dark plumes) from brick making kilns situated in the area of Khyber Pakhtunkhwa, Pakistan

In Pakistan raw coal and a little quantity of waste plastics are burnt to sustain high temperature inside brick making kilns. The gaseous emissions of the kilns contain a considerable amount of darkish colored particulates. It is currently believed that the plastic burning produces these particulates. Advanced characterization instruments, such as a scanning electron microscope, energy dispersive spectroscopy, X-ray fluorescence, X-ray diffractometer, surface area analyzer using nitrogen gas adsorption isotherms, and thermogravimetric analyzer, were used to find out the chemistry and physics of the particulates. At a magnification of 30,000x, the SEM picture shows masses that are roughly roundish in shape and their size is in between 0.1 to 0.5 microns. The elements detected in these particles are carbon, oxygen, and sulfur (EDS analysis), or in other words, these elements are a typical composition of raw coal. This elemental analysis suggest that fine coal particles come out with usual combustion gases and these emitted particulates are not plastic combustion product. To strengthen this finding, the sample when calcined discarded a significant amount of sulphur oxides species, as determined in the XRF study by noticing a considerable decrease of sulphur content in the calcined particles, suggesting that the particles are actually a coal. The N2 isotherm graph reveals that the light weight flying coal particles has a very low surface area. Additionally, the XRD and TGA studies supports the conclusion that these dark colored particulate emissions are primarily fine coal particles (cenosphere)

Frequency and Trends of Prostatic Diseases in a Subset of Karachi Population: A Retrospective Study

Background: Prostatic diseases are a leading cause of frequent urinary complaints in elderly males. The most common diseases include prostatitis, benign prostatic hyperplasia, and prostate cancer. This study aimed to determine the frequency of the prostatic diseases, their trend over the years, and the association of age and diagnosis. Methods: A retrospective descriptive study was conducted in Basic Medical Sciences Institute (BMSI) at Jinnah Postgraduate Medical Centre, Karachi. Data was collected from the histopathological files and all the cases diagnosed from 2014 to 2018 were included. Statistical analysis was done using SPSS with 95% confidence interval and p-value of ≤ 0.05 was considered significant. The Chi-square test was applied to find the association with age and year of diagnosis.  Results: Total 163 prostate cases were documented from 2014 to 2018, out of which 98 (60.1%) were of benign prostatic hyperplasia, which was most commonly diagnosed in men aged, 61-70. Prostatic adenocarcinomas having Gleason scores 8-10 were frequent and commonly seen in men aged 51-60 years. An increasing trend (p-value=0.053) was observed in the diagnosis of these prostatic diseases within these five years. Conclusion: Benign prostatic hyperplasia is the most frequently (p-value=0.140) diagnosed prostatic disease in men, followed by adenocarcinoma and prostatitis. Advanced stage prostatic adenocarcinoma was diagnosed more frequently 17(10.4%) and at an earlier age. There is an increase in the number (p-value=0.053) of cases of prostatic diseases diagnosed each year. National-level studies and health policies are needed to facilitate early diagnosis and treatment. Keywords: Prostate; Prevalence; Benign Prostatic Hyperplasia; Prostatic Cancer; Gleason Score; Prostatitis

Multiomics Characterization of Preterm Birth in Low- and Middle-Income Countries.

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies. Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB. Design, Setting, and Participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in low- and middle-income countries (LMICs; ie, Matlab, Bangladesh; Lusaka, Zambia; Sylhet, Bangladesh; Karachi, Pakistan; and Pemba, Tanzania). These cohorts were established to study maternal and fetal outcomes and were supported by the Alliance for Maternal and Newborn Health Improvement and the Global Alliance to Prevent Prematurity and Stillbirth biorepositories. Data were analyzed from December 2018 to July 2019. Exposures: Blood and urine specimens that were collected early during pregnancy (median sampling time of 13.6 weeks of gestation, according to ultrasonography) were processed, stored, and shipped to the laboratories under uniform protocols. Plasma samples were assayed for targeted measurement of proteins and untargeted cell-free ribonucleic acid profiling; urine samples were assayed for metabolites. Main Outcomes and Measures: The PTB phenotype was defined as the delivery of a live infant before completing 37 weeks of gestation. Results: Of the 81 pregnant women included in this study, 39 had PTBs (48.1%) and 42 had term pregnancies (51.9%) (mean [SD] age of 24.8 [5.3] years). Univariate analysis demonstrated functional biological differences across the 5 cohorts. A cohort-adjusted machine learning algorithm was applied to each biological data set, and then a higher-level machine learning modeling combined the results into a final integrative model. The integrated model was more accurate, with an area under the receiver operating characteristic curve (AUROC) of 0.83 (95% CI, 0.72-0.91) compared with the models derived for each independent biological modality (transcriptomics AUROC, 0.73 [95% CI, 0.61-0.83]; metabolomics AUROC, 0.59 [95% CI, 0.47-0.72]; and proteomics AUROC, 0.75 [95% CI, 0.64-0.85]). Primary features associated with PTB included an inflammatory module as well as a metabolomic module measured in urine associated with the glutamine and glutamate metabolism and valine, leucine, and isoleucine biosynthesis pathways. Conclusions and Relevance: This study found that, in LMICs and high PTB settings, major biological adaptations during term pregnancy follow a generalizable model and the predictive accuracy for PTB was augmented by combining various omics data sets, suggesting that PTB is a condition that manifests within multiple biological systems. These data sets, with machine learning partnerships, may be a key step in developing valuable predictive tests and intervention candidates for preventing PTB