STUDY TO KNOW INCIDENCE OF DRUG INDUCED HEPATITIS IN PATIENTS USING ANTI- TUBERCULOSIS DRUGS AND REVEALING ITS RISK FACTORS

Objective: To identify risk factors for anti-tuberculous drugs influence hepatitis (ATDH) among tuberculosis patients. Study Design: A retrospective study. Place and Duration: In the Jinnah Hospital, Lahore in Gastroenterology and Pulmonology department for three years period from January 2016 to December 2018 after the approval from the ethical committee of Jinnah Hospital, Lahore Methodology: The medical records of tuberculosis 3056 cases were reported for three years was collected and data analyzed for ATDH done. TB inclusion criteria identified based on the National Tuberculosis Program (NTP) has been documented. ATDH and Non-ATDH data were analyzed in the SPSS version 17 and full fisheries and chi-square tests. Results: 198 cases were diagnosed as ATDH which include 66 (33.01%) women and 134 (66.99%) males, 43.2 years was the mean age, SD 9.5 treatment and ATDH as follow up period were selected for the study. ATDH in patients was found to be significant statistically (p = 0.0001, OR: 13.92) (OR: 7.6, p = 0.0002) and (OR: 11.3, p = 0.0001) was the difference between intravenous injection ATDH and HIV infection. Conclusion: ATDH had the highest prevalence among patients suffering from HCV infection, HIV and IVDU infection. Key words: Tuberculosis, drug-induced hepatitis, national tuberculosis program

THE ROLE OF INTRAOPERATIVE FROZEN SECTION OF SENTINEL LYMPH NODES IN UPFRONT BREAST CONSERVATION CANCER SURGERY

Objective: Sentinel lymph node biopsy is the standard of care in clinically negative axilla in breast cancer patients for which frozen section (FS) is routinely performed intraoperatively. The objective of this study was to justify the use of FS in terms of number of tests performed and their impact on decision-making and cost saving. Materials and Methods: We retrospectively reviewed our prospectively maintained data from January 2014 to January 2018 for intraoperative FS in upfront breast conservation surgery patients. Results: A total of 357 patients were studied. All were female. Median age was 50 years (24–84). Mean tumour size was 29.11 mm. Numbers of sentinel lymph nodes identified were 1 in 50 (14.2%) patients, 2 in 121 (33.89%) patients and ≥3 in 186 (52%) patients. Number of positive sentinel lymph nodes was 0 in 264 (73.9%) patients, 1 in 62 (17.4%) patients, 2 in 20 (5.6%) patients and ≥3 in 11 (3.08%) patients. Axillary lymph node dissection (ALND) was offered to 30 (8.4%) patients as per the American College of Surgeons Oncology Group Z0011. The results for ALND showed that only 8 (2.3%) out of 30 patients had positive nodes identified in the additional axillary nodes dissected. Sensitivity of FS was 97% and specificity was 98.86%. False-negative rate was 3.22%. Conclusion: Intraoperative FS can be safely omitted in early breast cancer patients undergoing upfront breast conservation cancer surgery due to high sensitivity and specificity leading to low false-negative rates. ALND can be performed as a second operation as warranted only in a minority of patients. Key words: American College of Surgeons Oncology Group Z0011 trial, axillary lymph node dissection, intraoperative frozen section, sentinel lymph node biops

Comparing sensitivity and specificity of pacemaker ID application and cardiac rhythm management device-finder application in identifying cardiac implantable electronic device manufacturer using chest radiograph - An observational study

Background: Smartphone-based applications to identify cardiac implantable electronic devices (CIED) are extremely useful in circumstances, where urgent device interrogation is needed, and a device identification card is not available. Few studies have provided insights regarding the utility of these applications. We have studied two widely available applications i.e., Pacemaker ID app (PMIDa) or Cardiac Rhythm Management Device-Finder (CRMD-f) to identify device manufacturers in CIEDs.Methods: 547 patients who underwent CIED implantation from the year 2016-2020 in our institute were enrolled. There were 438 Medtronic and 109 St. Jude\u27s devices. All chest radiographs were de-identified and resized into 225*225 pixels focusing on the CIED. PMIDa and CRMD-f applications were used to identify the CIED. Accuracy, sensitivity, specificity, negative predictive value, and positive predictive value for both applications were calculated and compared.Results: Overall, CRMD-f application has higher specificity (93.58 vs. 82.5%) but lower sensitivity (53.6 vs. 55%) than PMIDa. The accuracy of both applications was comparable (61.6% vs. 60.5%). Accuracy varied with CIED model and type tested, and radiograph projection used. Accuracy is greatest with Cardiac-Resynchronization-Therapy (CRT) devices for both applications, followed by a single lead pacemaker.Conclusion: CRMD-f has higher accuracy and specificity for CIED manufacturer identification. Both PMIDa and CRMD-f are specific tools to identify CIED but have low sensitivity

Inclusive, supportive and dignified maternity care (SDMC)-Development and feasibility assessment of an intervention package for public health systems: A study protocol.

INTRODUCTION: Mistreatment, discrimination, and poor psycho-social support during childbirth at health facilities are common in lower- and middle-income countries. Despite a policy directive from the World Health Organisation (WHO), no operational model exists that effectively demonstrates incorporation of these guidelines in routine facility-based maternity services. This early-phase implementation research aims to develop, implement, and test the feasibility of a service-delivery strategy to promote the culture of supportive and dignified maternity care (SDMC) at public health facilities. METHODS: Guided by human-centred design approach, the implementation of this study will be divided into two phases: development of intervention, and implementing and testing feasibility. The service-delivery intervention will be co-created along with relevant stakeholders and informed by contextual evidence that is generated through formative research. It will include capacity-building of maternity teams, and the improvement of governance and accountability mechanisms within public health facilities. The technical content will be primarily based on WHO's intrapartum care guidelines and mental health Gap Action Programme (mhGAP) materials. A mixed-method, pre-post design will be used for feasibility assessment. The intervention will be implemented at six secondary-level healthcare facilities in two districts of southern Sindh, Pakistan. Data from multiple sources will be collected before, during and after the implementation of the intervention. We will assess the coverage of the intervention, challenges faced, and changes in maternity teams' understanding and attitude towards SDMC. Additionally, women's maternity experiences and psycho-social well-being-will inform the success of the intervention. EXPECTED OUTCOMES: Evidence from this implementation research will enhance understanding of health systems challenges and opportunities around SDMC. A key output from this research will be the SDMC service-delivery package, comprising a comprehensive training package (on inclusive, supportive and dignified maternity care) and a field tested strategy to ensure implementation of recommended practices in routine, facility-based maternity care. Adaptation, Implementation and evaluation of SDMC package in diverse setting will be way forward. The study has been registered with clinicaltrials.gov (Registration number: NCT05146518)

Review of the governance of public sector hospitals in Pakistan: Lessons for the future

Governance of public sector hospitals has been a major challenge in Pakistan. A framework has been adapted to assess governance at the macro- and micro levels of decision making. At the macro-level, the experience of hospital autonomy to improve efficiency and quality of care has been inconclusive in the absence of proper rules and regulations. Following devolution in health, the provincial governments have instituted regulatory regimes for improved governance and have experimented with PPPs to improve management of district hospitals. At the micro-level, the focus has been on institutional aspects of hospital management. Most public hospitals face challenges related to human resource, financial and supply chain management; lack of information technology, poor quality of care, and lack of disaster preparedness and management capability. This paper offers three strategic priorities for policymakers to consider – first, demonstrate consistency and commitment in implementing policies related to hospital governance; second, launch a countrywide capacity development program for hospital managers; and third, establish e-governance to enhance accountability, transparency and performance of hospitals

Loperamide-induced cardiotoxicity: A case overlooked?

A young man presented to the emergency department with seizures and recurrent episodes of polymorphic ventricular tachycardia (PMVT)/torsades de pointes (TdP) requiring cardioversion and administration of intravenous magnesium. A battery of tests performed to identify a cause for his arrhythmias and seizures were all normal. A revisit of history with family revealed he had consumed over 100 tablets/day of loperamide for the past 1 year. A prolonged QT interval on his ECG raised concerns for long QT syndrome (LQTS) (congenital or acquired). Our patient was suspected to have loperamide-induced cardiotoxicity. TdP is a specific PMVT that occurs with a prolonged QT interval and is usually drug-induced. Less frequently, congenital LQTS may be implicated. With supportive care, including mechanical ventilation, vasopressors and temporary transvenous overdrive pacing, our patient recovered completely. We describe the importance of a systematic and time-sensitive approach to diagnosing critical illness. Loperamide overdose may cause QT prolongation, life-threatening arrhythmias/cardiogenic shock, or cardiac arrest. Seizures/epilepsy may also be a manifestation in young patients. There is a substantial need to revisit the safety of over-the-counter medications and increasing awareness of manifestations of drug overdose

Decision-Making Tools for Informed Decisions by Health Policymakers and Managers

International audienc

Making health systems work in low and middle income countries: Textbook for public health practitioners

The importance of health systems has been reinforced by the commitment of Low- and Middle-Income Countries (L&MICs) to pursue the targets of Universal Health Coverage, Health Security, and to achieve Health-related Sustainable Development Goals. The COVID-19 pandemic has further exposed the fragility of health systems in countries of all income groups. Authored by international experts across five continents, this book demonstrates how health systems can be strengthened in L&MICs by unravelling their complexities and by offering a comprehensive overview of fundamental concepts, performance assessment approaches and improvement strategies to address health system challenges in L&MICs. Centred on evidence and advocacy this unique resource on health systems in L&MICs will benefit a wide range of audiences including, readers engaged in public health practice, educational programs and research initiatives; faculties of public health and population sciences; policymakers, managers and health professionals working for governments, civil society organizations and development agencies in health

Computer Malware Classification, Factors, and Detection Techniques: A Systematic Literature Review (SLR)

A Systematic Literature Review (SLR) was conducted using tailored searches based on our study topic. We completed all SLR processes, including periodic reviews as SLR. Researchers may find out about the justification, the review procedure, and the research question by using search keywords. This paper describes the trial approach to elaborate the search keywords, resources, restrictions, and validations that were, and explores search strategies made. The reviews are carried out by assessing the publication's quality, devising a data extraction approach, and synthesizing the results. All four research questions were used to analyze the papers concerning the findings.  Finally, reports on the categorization of computer malware were analyzed for their detection methods, factors, and how they infiltrate computer systems have been published. SLR identifies the element, characteristics, and detection techniques that are explained in this research paper. Computer malware infects the computer system. This comprehensive literature review's is mainly based on recommendations by earlier studies