Comparison of hemodynamic changes in ketamine versus fentanyl as co-induction agent with propofol in elective surgical procedures

Objectives: To assess the hemodynamic changes caused by the co-induction of ketamine or fentanyl with propofol. Methodology: This prospective randomized trial included 220 patients that underwent elective surgical procedures under general anesthesia with endotracheal intubation. Random allocation of patients was done into two equal groups and drugs were administered using the double-blinded technique. Group A received propofol and fentanyl while group B received propofol and ketamine given as intravenous bolus doses. Measurement of systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) was done before induction and 10 minutes after induction before the surgical stimulus. Independent samples t-test and paired t-test were employed for analysis of the collected data. Results: Both groups had normal hemodynamic parameters before induction; however, there was a significant difference in hemodynamic indices of both groups after 10 minutes of induction (p<0.001). Group A showed a significant decrease in SBP, DBP, and MAP after 10 minutes of induction (p<0.001). The patients in group B showed a significant increase in mean HR from baseline to 10 minutes (p<0.001). Group B demonstrated no change in the systolic, diastolic, and mean arterial pressures; however, group A elucidated a significant decrease in these hemodynamic parameters. Conclusion: The combination of ketamine and propofol provides better hemodynamic stability than fentanyl and propofol. More studies are required to evaluate these changes in patients with cardiovascular comorbidities

Sonographic Correlation of Fetal Foot Length as a Reliable Parameter for Estimation of Gestational Age in 2ND and 3RD Trimester

Objective: To sonographic correlation fetal foot length as a reliable parameter for estimation of gestational age in 2nd and 3rd trimester. Study Design: An analytical cross-sectional prospective study was performed. Settings: The study was performed in Meer Children and family clinic, Tajpora Lahore. Period: An analytical cross-sectional study was conducted from 15 October, 2021 to 15 January, 2021. Material & Methods: The present study is conducted in the in the Meer Children and Family Clinic Tajpura Lahore .In pregnant women attending the OPD during 2nd and 3rd trimester for routine checkups. The present study done in 60 normal pregnant women who were sure about their last menstrual period, have regular menstrual cycle, not experienced any vaginal bleeding. Ultrasonographic fetal foot length measurements was done without previous knowledge of gestational age and then the gestational age confirmed by biparietal diameter, abdominal circumference and head circumference . Results: The present study is conducted in 63 pragnent women between 15 to 35 weeks  of gestational age attending the OPD for 2nd and 3rd trimester routine checkups the  in the Meer Children and Family Clinic Tajpura Lahore . Sonographically we calculated foot length from 15 to 35 weeks of gestation. In our study to Early  age at which fetal foot length could be seen and measured sonographically was found to be 15 weeks of  gestation age. In 27 weeks of gestational age and mean foot length 83.67 with std. deviation 5.718 and std. Error Mean -720 and the mean value of foot length by gestational age is 93.33 with std. deviation and std. error mean 338.740 and 42.677 respectivly.  Along with foot length bipraietal diameter(BPD),Abdominal circumference(AC),head circumference(HC) also measured for comparison. Conclusion: In the normal growing fetus the fetal foot length increases with increasing gestational age. Fetal foot length is a good parameter for gestational age especially in cases of femur achondroplasia, dolichocephaly or brachycephaly and in cases who are not sure about their L.M.P. Fetal foot length is  used as an investigational implement  to measured  of gestational age in the late second and third trimesters of pregnancy. Fetal foot length was especially useful when other parameters did not correctly estimate gestational age, e.g., in cases of short-limb dwarfism hydrocephalus or anencephaly. Keywords: Gestational age, Fetal foot length, Ultrasonographically age estimation DOI: 10.7176/JHMN/93-04 Publication date:September 30th 202

Gendered effects of COVID-19 school closures: Pakistan case study

This brief summarizes a case study conducted to assess the gendered impacts of COVID-19 school closures on adolescent girls and boys in three districts in the province of Punjab in Pakistan. Data as well as discussions and interviews with adolescents, teachers, and parents shed light on difficulties in accessing and adjusting to remote learning, learning loss, deterioration of behaviors and health, and other effects. Based on these findings and further reflections by stakeholders on the successes and gaps of mitigation measures, the case study proposes recommendations for improved teacher training, digital access, alternative learning options, and a gendered focus in interventions

Diagnostic Accuracy of Ultrasound for the Evaluation of Ureteric Calculi Taking Non-enhanced Computed Tomography as a Gold Standard

Objective: To find the diagnostic accuracy of ultrasound for the evaluation of ureteric calculi taking non enhanced Computed Tomography as gold standard. Study Design: An analytical cross-sectional prospective study was performed. Settings: The study was performed in National Hospital and Medical Center, Lahore. Period: An analytical cross-sectional study was conducted from 15 October, 2020 to 15 January, 2021. Material & Methods: In our study, all those patients with suspected ureteric calculi presenting to radiology department were included. Patients on dialysis, those with polycystic disease and ureteric stricture, as well as patients who declined to give consent and those who were uncooperative, were all excluded. Ultrasound was performed on both sides of the patient's kidney, concentrating on the ureters. Then were sent to a 64 slice CT scanner for a non-enhanced CT scan. Results: Total 121 Patients were reviewed in this research. Females were 82 (67.8%) while male was 39 (32.2%). On Ultrasound 61(50.4%) were positive for ureteric calculi while 60 (49.6%) were negative for stone in the ureter. On CT scan 110 (90.9%) patients were positive for ureteric calculi while 11 (9.1%) were negative for stone in ureter (p= 0.05). The trans-abdominal ultrasound with sensitivity 58.62%, Specificity 56.76%, Positive predictive value 51.52% and Negative predictive value of 63.64% and accuracy of 57.68%. Conclusion: The sensitivity of ultrasound is comparable to Computed Tomography findings, hence, it can be used as an option in cases where CT scans are not available or is contraindicated, such as in pregnant women. Moreover, Ultrasound modality is cheap, with no radiation dose and is readily available in our setups, making it suitable for initial diagnosis as well as for follow-up scans. Keywords: Non-enhanced Computed Tomography, Ultrasound, Ureteric Calculi, radiation, Computed Tomography. DOI: 10.7176/JHMN/90-04 Publication date:June 30th 2021

FREQUENCY OF BONE FRACTURES DETECTED BY PLAIN RADIOGRAPHY AND KEEPING CT AS GOLD STANDARD

Background: The main cause of bone fracture is traffic accidents are (72.2%), falls (11.6%), blunt injuries are (7.7%) and others (5.8%)). About 84 patients were included in our studies. Out of which 21 (25.0%) were females and 63(75.0%) were males. Objective: The objective of this study is to evaluate the frequency of bone fractures detected by plain radiography and keeping CT as gold standard. Methodology: In our cross-sectional study all the patients with fracture undergoing CT and X-Ray were included. Patients with bone surgery were excluded as well as patients who declined to give consent and those who were uncooperative were all excluded. X-ray performed for all the fractures and the complex one sent to CT. The consent form was obtained by patients in this study. We reviewed our data of patients who underwent CT and X-ray. CT (Toshiba 64) was performed from the exact area of fracture and images reconstructed at 3mm and for reporting 5mm for filming. X-ray performed according to the appropriate range of kVp and mAs. All findings of CT were considered by the advice of consultant radiologist. Data was represented with means of standard deviation of frequency and percentage where appropriate. Chi square testing was used to compare CT and X-ray qualitative data. Data was entered into IBM SPSS Statistics 24.0. P-value <0.05 considered the significant. Results: In our study 84 patients were included. Out of which 21 (25.0%) were females and 63 (75.0%) were males and the standard deviation was 0.436. There causes of fracture were 18(21.4%) injury, 8(9.5%) were compression fractures, 54(64.3%) RTA, 2(2.4%) pathologic fractures and 1(1.2%) was sports injury fracture and the standard deviation was .997. Conclusion: Our study concluded that the bone fractures are more common in males than females. The most common cause of bone fractures is RTA (Road Traffic Accidents). Study also concludes that most common type of bone fracture is Transverse bone fracture. CT was more efficient in detecting bone fractures than plain radiography because more fractures were detected on CT than plain radiography. Keywords: Non-enhanced CT, X- ray, Bone fracture, Road Traffic Accidents DOI: 10.7176/JHMN/93-09 Publication date:September 30th 202

Integrated omics and machine learning-assisted profiling of cysteine-rich-receptor-like kinases from three peanut spp. revealed their role in multiple stresses

Arachis hypogaea (peanut) is a leading oil and protein-providing crop with a major food source in many countries. It is mostly grown in tropical regions and is largely affected by abiotic and biotic stresses. Cysteine-rich receptor-like kinases (CRKs) is a family of transmembrane proteins that play important roles in regulating stress-signaling and defense mechanisms, enabling plants to tolerate stress conditions. However, almost no information is available regarding this gene family in Arachis hypogaea and its progenitors. This study conducts a pangenome-wide investigation of A. hypogaea and its two progenitors, A. duranensis and A. ipaensis CRK genes (AhCRKs, AdCRKs, and AiCRKs). The gene structure, conserved motif patterns, phylogenetic history, chromosomal distribution, and duplication were studied in detail, showing the intraspecies structural conservation and evolutionary patterns. Promoter cis-elements, protein–protein interactions, GO enrichment, and miRNA targets were also predicted, showing their potential functional conservation. Their expression in salt and drought stresses was also comprehensively studied. The CRKs identified were divided into three groups, phylogenetically. The expansion of this gene family in peanuts was caused by both types of duplication: tandem and segmental. Furthermore, positive as well as negative selection pressure directed the duplication process. The peanut CRK genes were also enriched in hormones, light, development, and stress-related elements. MicroRNA (miRNA) also targeted the AhCRK genes, which suggests the regulatory association of miRNAs in the expression of these genes. Transcriptome datasets showed that AhCRKs have varying expression levels under different abiotic stress conditions. Furthermore, the multi-stress responsiveness of the AhCRK genes was evaluated using a machine learning-based method, Random Forest (RF) classifier. The 3D structures of AhCRKs were also predicted. Our study can be utilized in developing a detailed understanding of the stress regulatory mechanisms of the CRK gene family in peanuts and its further studies to improve the genetic makeup of peanuts to thrive better under stress conditions

Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review

Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers-including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals-for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest that tailored, culturally sensitive, and evidence-informed strategies, unambiguous public health messaging, and health system strengthening are needed to address access and acceptance barriers to vaccination in migrants and create opportunities and pathways for offering catch-up vaccinations to migrants

Global, regional, and national burden of chronic kidney disease, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI

Global, regional, and national burden of neurological disorders, 1990–2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background: Neurological disorders are increasingly recognised as major causes of death and disability worldwide. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 is to provide the most comprehensive and up-to-date estimates of the global, regional, and national burden from neurological disorders. Methods: We estimated prevalence, incidence, deaths, and disability-adjusted life-years (DALYs; the sum of years of life lost [YLLs] and years lived with disability [YLDs]) by age and sex for 15 neurological disorder categories (tetanus, meningitis, encephalitis, stroke, brain and other CNS cancers, traumatic brain injury, spinal cord injury, Alzheimer's disease and other dementias, Parkinson's disease, multiple sclerosis, motor neuron diseases, idiopathic epilepsy, migraine, tension-type headache, and a residual category for other less common neurological disorders) in 195 countries from 1990 to 2016. DisMod-MR 2.1, a Bayesian meta-regression tool, was the main method of estimation of prevalence and incidence, and the Cause of Death Ensemble model (CODEm) was used for mortality estimation. We quantified the contribution of 84 risks and combinations of risk to the disease estimates for the 15 neurological disorder categories using the GBD comparative risk assessment approach. Findings: Globally, in 2016, neurological disorders were the leading cause of DALYs (276 million [95% UI 247–308]) and second leading cause of deaths (9·0 million [8·8–9·4]). The absolute number of deaths and DALYs from all neurological disorders combined increased (deaths by 39% [34–44] and DALYs by 15% [9–21]) whereas their age-standardised rates decreased (deaths by 28% [26–30] and DALYs by 27% [24–31]) between 1990 and 2016. The only neurological disorders that had a decrease in rates and absolute numbers of deaths and DALYs were tetanus, meningitis, and encephalitis. The four largest contributors of neurological DALYs were stroke (42·2% [38·6–46·1]), migraine (16·3% [11·7–20·8]), Alzheimer's and other dementias (10·4% [9·0–12·1]), and meningitis (7·9% [6·6–10·4]). For the combined neurological disorders, age-standardised DALY rates were significantly higher in males than in females (male-to-female ratio 1·12 [1·05–1·20]), but migraine, multiple sclerosis, and tension-type headache were more common and caused more burden in females, with male-to-female ratios of less than 0·7. The 84 risks quantified in GBD explain less than 10% of neurological disorder DALY burdens, except stroke, for which 88·8% (86·5–90·9) of DALYs are attributable to risk factors, and to a lesser extent Alzheimer's disease and other dementias (22·3% [11·8–35·1] of DALYs are risk attributable) and idiopathic epilepsy (14·1% [10·8–17·5] of DALYs are risk attributable). Interpretation: Globally, the burden of neurological disorders, as measured by the absolute number of DALYs, continues to increase. As populations are growing and ageing, and the prevalence of major disabling neurological disorders steeply increases with age, governments will face increasing demand for treatment, rehabilitation, and support services for neurological disorders. The scarcity of established modifiable risks for most of the neurological burden demonstrates that new knowledge is required to develop effective prevention and treatment strategies. Funding: Bill & Melinda Gates Foundation