Simple clinical parameters to diagnose Malaria in Outpatient Department.

Introduction: Malaria is the world's most important parasitic infection which poses major health challenges. Best estimates currently describe the annual global burden of malaria as 300-500 million cases and 1-2 million deaths. Traditionally malaria is diagnosed clinically based upon sign symptoms and clinical examination particularly in remote areas where laboratory facilities are not available. However, no universal criteria exist for clinical diagnosis of malaria and presenting features are highly variable region to region. Therefore, we planned to define the simple parameters based on clinical signs and symptoms that predict malaria without laboratory confirmation of parasitemia. Objective: To determine the sensitivity, specificity and positive predictive values of simple clinical parameters for the diagnosis of malaria without laboratory confirmation of parasitemia. Methodology: This observational study was carried out at pediatric department of Karachi Medical and Dental college and Abassi Shaheed Hospital Karachi during 15 April 2015 to 15 February 2015. Children between 6 months to 5 years, who presented with short duration of fever (less than 7 days) were included in study. The diagnosis of malaria was confirmed on identification of parasite (Plasmodium vivax or Plasmodium falciparum) in blood obtained from finger prick sample for thick and thin film. The patients were divided into two groups (+ve MP cases and -ve MP cases). Focal signs and symptoms, pallor (anemia) and splenomegaly were checked in both groups to assess the sensitivity, specificity and predictive values of these simple clinical parameters and co-related with the presence of malaria parasitemia. Result: Six hundred fifty-seven children were examined. One hundred (15.22%) children out of 657 had malaria confirmed while 84.78% (557 of 657) had illness other than malaria. There were 43 children (43%) with Plasmodium falciparum malaria, 47 children (47%) with Plasmodium vivax malaria and 10 (10%) with mixed infections. Three clinical parameters (No focal features, anemia & splenomegaly) were studied in all febrile patients which were divided into two groups (Malarial parasite +ve and malarial parasite -ve). Conclusion: Few simple clinical findings can lead to reliable clinical diagnosis of malaria with more logical use of antimalarial drugs in children.  Key words: Malaria, Anemia, Splenomegaly

Outcome of Hepatitis-E Virus Infection among Pregnant Women Admitted in a Tertiary Care Hospital

PURPOSE:  To study the effect of post-operative Non-Steroidal Anti-inflammatory (NSAID) eye drops on macular thickness in patients without diabetic retinopathy measured by Optical Coherence Tomography (OCT) STUDY DESIGN: Quasi experimental study PLACE & DURATION OF STUDY:  removed for blind review METHODOLOGY: Diabetic patients without retinopathy who required cataract surgery for visual rehabilitation were included in study. They were than divided into two groups. Group A included patients who received routine steroid+antibiotic post-operative drops while Group B comprised of patients who received nepafenac (0.1%) eye drops eight hourly in addition to routine post-operative eye drops. All patients underwent standard phacoemulsification and intraocular lens implantation followed by use of NSAID eye drops for a month. OCT measurements were done pre-operatively, 7 and 28 days post operatively. RESULTS: Comparison of central macular thickness between groups was significant at (Pre & 7 day post op) and insignificant at (7th day & 28th day post op) and (Pre & 28th day post op) i.e. 0.043, 0.834 and 0.084 respectively. However, difference of mean central macular thickness was significant at all follow-up periods i.e.0.003, 0.006, and 0.000 CONCLUSION: Post-operative NSAID in diabetic patients without retinopathy leads to a significant decrease in macular thickness as compared to controls after cataract surgery. KEY WORDS: Phacoemulsification, Optical Coherence Tomography, Non-steroidal Anti-Inflammatory Agent

Outcome of Hepatitis-E Virus Infection among Pregnant Women Admitted in a Tertiary Care Hospital

PURPOSE:  To study the effect of post-operative Non-Steroidal Anti-inflammatory (NSAID) eye drops on macular thickness in patients without diabetic retinopathy measured by Optical Coherence Tomography (OCT) STUDY DESIGN: Quasi experimental study PLACE & DURATION OF STUDY:  removed for blind review METHODOLOGY: Diabetic patients without retinopathy who required cataract surgery for visual rehabilitation were included in study. They were than divided into two groups. Group A included patients who received routine steroid+antibiotic post-operative drops while Group B comprised of patients who received nepafenac (0.1%) eye drops eight hourly in addition to routine post-operative eye drops. All patients underwent standard phacoemulsification and intraocular lens implantation followed by use of NSAID eye drops for a month. OCT measurements were done pre-operatively, 7 and 28 days post operatively. RESULTS: Comparison of central macular thickness between groups was significant at (Pre & 7 day post op) and insignificant at (7th day & 28th day post op) and (Pre & 28th day post op) i.e. 0.043, 0.834 and 0.084 respectively. However, difference of mean central macular thickness was significant at all follow-up periods i.e.0.003, 0.006, and 0.000 CONCLUSION: Post-operative NSAID in diabetic patients without retinopathy leads to a significant decrease in macular thickness as compared to controls after cataract surgery. KEY WORDS: Phacoemulsification, Optical Coherence Tomography, Non-steroidal Anti-Inflammatory Agent

Phylogenetics of HCV: Recent advances

Hepatitis C virus (HCV), a virus present in human population from indefinite time period, has affected millions of people globally, by causing liver infection which in majority of cases leads to chronicity, cirrhosis, end stage liver disease and hepatocellular carcinoma (HCC). The disease burden is expected to increase in the developing and under developed world in future. The distribution of HCV genotypes is changing, as are the modes of transmission. Evolution of HCV is a highly dynamic process as it exploits all known mechanisms of genetic variation including recombination and mutation, to ensure its survival. It occurs both through multiple processes of adaptive selection that drive sequence change and through drift, in which phenotypically neutral sequence changes accumulate over time without altering the phenotype or behaviour of the virus. However, despite its potential to change rapidly, the longer-term evolution of HCV appears to be remarkably conservative. Phylogenetic and statistical models of viral evolution are useful in reconstructing mutational pathways of drug resistance. The two major divisions of viral heterogeneity include genotypes and quasispecies. The rate of nucleotide changes varies significantly among the different regions of the viral genome. The present HCV classification is incomplete, as new genotypes and variants are being identified till yet. Diversification of HCV occurred over time but with different rates. Host immune pressure is thought to be a main factor driving diversification in HCV quasispecies. Core and hypervariable regions are more diverse while 5' un-translated region (UTR) and 3' UTR are highly conserved across the genotypes.Keywords: HCV, phylogeny, 5' UTR, viral evolution, recombination, quasispeciesAfrican Journal of Biotechnology Vol. 9(36), pp. 5792-5799, 6 September, 201

Recent novel tumor gatekeepers and potential therapeutic approaches (2017)

Tumor remains a challenging task for oncology community. Drug resistance due to chemotherapy remain principal impediments  toward potential therapeutic strategies. Development of novel anti-cancer drugs or new targeted strategies to conquer drug  resistance is a key goal of cancer research. In this respect, novel tumor gatekeepers and innovative targeted strategies can be  helpful in overcoming drug resistance as well as improve currently used targeted therapies. In this review, efforts have been made to present some of the latest knowledge about novel tumor gatekeepers and new therapeutic strategies to improve the efficacy of  chemotherapy and give new hope to cancer patients to fight against cancer.Keywords: Cancer, Potent inhibitors, Gatekeepers, Therapeutic approaches, Oncogenic pathway

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

An embedding technique to determine ττ backgrounds in proton-proton collision data

An embedding technique is presented to estimate standard model tau tau backgrounds from data with minimal simulation input. In the data, the muons are removed from reconstructed mu mu events and replaced with simulated tau leptons with the same kinematic properties. In this way, a set of hybrid events is obtained that does not rely on simulation except for the decay of the tau leptons. The challenges in describing the underlying event or the production of associated jets in the simulation are avoided. The technique described in this paper was developed for CMS. Its validation and the inherent uncertainties are also discussed. The demonstration of the performance of the technique is based on a sample of proton-proton collisions collected by CMS in 2017 at root s = 13 TeV corresponding to an integrated luminosity of 41.5 fb(-1).Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research