Effect of Implementation of COVID-19 Guidelines on the Lives of Haemophilia Patients Registered with the Haemophilia Treatment Centre, Rawalpindi

Introduction: The development of isolation strategies to prevent spread of COVID -19 could affect the lives of Haemophilia patients beyond the risk of infection. In order to prevent this, the Haemophilia Treatment Centre, Rawalpindi, adopted additional combat strategies including the use of telephonic and video consultations, dispensing medicine at home and single day treatments.Objective: To assess the impact of COVID -19 pandemic and associated lockdown and changes in Standard Operating Procedures (SOPs) on the working of Haemophilia Treatment Centre, Rawalpindi and on the lives of its registered patients.Methods: An observational study was carried out at the Haemophilia Treatment Centre, Rawalpindi, between September, 2019 and August, 2020. Written records of frequency of virtual/physical visits to the Centre, treatment compliance, bleeding episodes, musculoskeletal health, psychosocial health, pain, disability and inhibitor status were obtained from six months pre pandemic and followed prospectively six months into the pandemic.Results: The Haemophilia Treatment remained open and functional throughout the study period. All staff members followed specially developed Haemophilia Treatment Centre guidelines vigilantly. Since telemedicine was encouraged , a rise in telephonic consultations was observed and therefore, no difference in overall visits was observed among the Pre- and Intra- Pandemic eras. The option of at-home dispensing of medicine via courier was available, and therefore, all patients remained treatment compliant. Among patients on Low Dose Prophylaxis (LDP) regimen, no difference in musculoskeletal health, bleeding episodes, inhibitor status, psychosocial health and nutritional status was observed among the two time periods. None of the staff members or patients were affected by the Covid-19.Conclusion: Our study shows that timely anticipation of potential impact of a pandemic and prompt development of modified mechanisms can indeed make the working of a Health Care Centre successful and prevent side effects on the lives of its patients

Maternal and fetal complications of antiphospholipid syndrome: a case report with long-term follow-up

We report a case of a 26- year old woman having antiphospholipid syndrome in pregnancy with long-term follow up. She presented with recurrent miscarriages, venous thrombosis, avascular necrosis of femoral head, mid-cerebral artery infarction and skin ulcers. Antiphospholipid syndrome is a recognized disorder of pregnancy. Diagnosis requires a high index of suspicion when evaluating women with recurrent pregnancy losses and vascular thrombosis. A low dose aspirin combined with heparin can reduce morbidity and improves the pregnancy outcome

Clinico- haematological spectrum of females with inherited Bleeding Disorders

Background: Inherited bleeding disorders in females are under-diagnosed, eventually leading to multiple problems. This situation is further worsened by the inadequate information , non – availability of diagnostic facilities and low awareness on the clinical side Methods: In this non – interventional descriptive study , females with inherited bleeding disorders were assessed. Clinical presentations, demographic data and management received was recorded. Complete blood counts, prothrombin time, activated partial thromboplastin time, thrombin time and platelet function studies were performed, where required.. Results: In all the patients with inherited bleeding disorders , females constituted 16.85%. von Willebrand disease was the commonest (50.84%) out of all inherited bleeding disorders in females. In rest of the females autosomal recessive coagulation defects and platelet function defects constituted 25.42% and 23.72%, respectively. Majority of the females (83.04%) were below 17 years of age. Menorrhagia (46.87%) was the commonest clinical episode. Spontaneous bleed was seen in 95% episodes. Majority of the episodes (94.14%) were soft tissue bleeding episodes and joint bleeds were minimal (5.68%). Tranexamic acid was the most commonly used therapeutic agent . Surgical intervention was employed in 18 episodes. Conclusion: Females with inherited bleeding disorders have severely impaired quality of life , fail to get proper management and go through unwanted surgeries ( D&C; Hysterectomies)

EFFECT OF CROSS FIT EXERCISES ON WEIGHT LOSS OF MALES IN LAHORE

The purpose of this research was to explore the effect of Cross Fit, a latest fitness techniques being used all over the world to get a good physique and health, in reducing weight of male persons ranging from 18 to 25 years. A sample of 8 male students ranging age from 18 to 25 years to measure the change in variables like Body weight, %age Fat ratio, %age of Total Body Water contents, %age of Lean Muscle Mass after applying Cross Fit training program in pre and post analysis. After designing and applying a 28 days Cross Fit plan and diet plans for each individual according to their Basal Metabolic Rate (BMR) and Total Daily Energy Expenditure (TDEE), it was found that there is a positive significant change in these variables mentioned above which showed that Cross Fit training program d

EFFECT OF CROSS FIT EXERCISES ON WEIGHT LOSS OF MALES IN LAHORE

The purpose of this research was to explore the effect of Cross Fit, a latest fitness techniques being used all over the world to get a good physique and health, in reducing weight of male persons ranging from 18 to 25 years. A sample of 8 male students ranging age from 18 to 25 years to measure the change in variables like Body weight, %age Fat ratio, %age of Total Body Water contents, %age of Lean Muscle Mass after applying Cross Fit training program in pre and post analysis. After designing and applying a 28 days Cross Fit plan and diet plans for each individual according to their Basal Metabolic Rate (BMR) and Total Daily Energy Expenditure (TDEE), it was found that there is a positive significant change in these variables mentioned above which showed that Cross Fit training program d

RELATIONSHIP BETWEEN SOCIAL CONTROL AND SPORTS

The main objective of the study is to evaluate the effects and relationship between social control and sports. Social control is extremely basic for each general public. Without social control, society and in addition individual can't exist. Hence, the need of social control is exceptionally basic. Social control is important for the presence and association of a general public. Players learn violent strategies from sports, this give them a better cure for deviant behaviors. players learns how to obey the laws in sports this enables to develop discipline in society and help to promote cultural values and also it help to develop better instruction among people. Sports are a useful to create accountability environment in society. Results of this research work showed that the sports have positive effect on social control

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

Prenatal Diagnosis of β Thalassaemia Tazeen Anwar*,

Background: To study the effectiveness of choronic villous sampling, followed by molecular analysis, for prenatal diagnosis of β thalassaemiaMethods: In this descriptive study 116 high risk mothers with 12-16 weeks of pregnancy, underwent choronic villous sampling (CVS) for studying β thalassaemia mutations in fetuses. CVS sampling was done with a trans-abdominal route, under local anaesthesia and ultrasound guidance. The choronic villi extracted were investigated upon using genomic amplification of β globin gene by amplification refectory mutation system (ARMS). The couples were informed about the consequences and were advised to act accordinglyResults: Chorionic villous sampling was advised to 161 and was done in 116 (72.04%) and 41 (25.46%) refused to proceed. Age of mothers ranged from 18 to 35 years. Nine (7.75%) were primrigravida. Consanguineous marriage were found in 85.34% couples. Majority (86.2%) previously had a child affected with β –thalassaemia major. On polymerase chain reaction , out of 116, 30.17% fetuses were diagnosed as beta thalassaemia major, having mutation of both alleles of β globin gene. One case (0.86%) had unidentified mutation. Frame shift 8-9 was the commonest mutation (42.85%), followed by IVS 1-5 (25.71%). cap+1 mutation was seen in 2.85%. Majority (94.3%) of the couples with β thalassaemia decided to abort. Spontaneous abortion, after the procedure, was found in one case .Conclusion: Ultrasound guided trans-abdominal CVS, with molecular assessment , is an effective procedure for prenatal diagnosis of β thalassaemi