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Background: The use of Polysulfone (PSf) as membrane material for dialysis therapy is becoming more common. However, the PSf membrane can cause the adsorption of blood proteins followed by the adhesion of platelets, destruction of red blood cells, and thrombus formation. One of the biggest challenges in creating membranes for hemodialysis (HD) applications is ensuring biocompatibility. Therefore, to maintain the biocompatibility of PSf membranes, further modifications are necessary. Methods: In this study, the performance and biocompatibility of PSf membranes were improved by the impregnation of TiO2‐hydroxyapatite composite as an additive. The TiO2‐hydroxyapatite composite was first synthesized via sintering at 1200°C, and then a dope solution composed of pristine PSf polymer solution in N‐Methyl‐2‐pyrrolidone solvent (NMP) and different wt% ratios of the synthesized composite were prepared, and resultant membranes were fabricated using a film applicator via a phase inversion scheme using water as a non‐solvent exchange medium. The synthesized composite was characterized using SEM, EDX, and XRD techniques. Results: The FTIR analysis confirmed the weak interaction of PSf polymer with the hydroxyapatite moiety of the composite. The interaction of the synthesized composite within the membrane matrix was evaluated via leaching ratio results. The hydrophilicity, pore profile, and pure water permeation flux rates were also determined. The results of the biocompatibility study showed that membranes based on TiO2‐hydroxyapatite composite had reduced adsorption of BSA protein by 34.41% as well as less than 5% hemolysis ratio. Additionally, the study displayed thrombus formation ranging from 2.08% to 8.69%, respectively. The dialysis results indicated that compared with the original PSf membrane, the TiO2‐hydroxyapatite composite showed high clearance rates for urea (73.81%) and creatinine (72.13%) solutes, respectively. Conclusion: Therefore, blending TiO2‐hydroxyapatite composite in the PSf membrane significantly improved the biocompatibility and removal ability of uremic solutes. [ABSTRACT FROM AUTHOR]

This article from the Qatar Medical Journal discusses a rare case of acute fibrinous and organizing pneumonia (AFOP) induced by the drug everolimus. The patient, a 54-year-old woman with a history of breast cancer, developed AFOP while taking everolimus. The condition improved after discontinuing the drug and receiving steroid treatment. The article highlights the need for further understanding of the association between everolimus and AFOP, and discusses treatment options for managing the condition. [Extracted from the article]

Primary spontaneous tension pneumothorax (STP) is a rare and life‐threatening condition. We report a case of COVID‐19‐pneumonia patient who developed STP as a complication. He had a prolonged hospital stay and was ultimately discharged asymptomatic. A systematic literature search was performed to review studies (N=12) reporting STP in the setting of COVID‐19. [ABSTRACT FROM AUTHOR]

This article, published in the Qatar Medical Journal, discusses a case of tuberculous pleural effusion (TPE) with profuse mesothelial cell counts. TPE is typically characterized by a predominance of lymphocytes and a scarcity of mesothelial cells, but in this case, the pleural fluid contained a higher percentage of mesothelial cells. The article presents the case of a 33-year-old male who presented with symptoms of TPE and underwent various tests and procedures to confirm the diagnosis. The presence of elevated mesothelial cells in TPE, although rare, should not exclude the consideration of tuberculosis pathology in patients. [Extracted from the article]

This article is a response to a study conducted in Southern Punjab, Pakistan, which aimed to assess the frequency and risk factors associated with GERD (gastroesophageal reflux disease) in an unstudied population. The authors commend the study for its use of a cross-sectional design and the GerdQ questionnaire for screening GERD symptoms. However, they express concerns about the conclusion regarding the correlation between GERD and soft drinks, as it contradicts other well-reputed studies. They also highlight limitations in the study's sample size, reliance on self-reported data, and the need for further research on the correlation between carbonated beverages and GERD. The authors emphasize the importance of addressing these concerns to enhance understanding of GERD risk factors. [Extracted from the article]

Free-floating right-heart thrombus (FFRHT) in the context of a pulmonary embolism (PE) is a rare but serious encounter with no guidelines addressing its management. We performed a systematic review and meta-analysis addressing prevalence, clinical behavior, and outcomes of FFRHT associated with PE. Among the included 397 patients with FFRHT and PE, dyspnea was the main presenting symptom (73.3%). Obstructive shock was documented in 48.9% of cases. Treatment with thrombolytic therapy, surgical thrombectomy, and percutaneous thrombectomy was documented in 43.8%, 32.7%, and 6.5% of patients, respectively. The overall mortality rate was 20.4%. Syncope (p : 0.027), chest pain (p : 0.006), and obstructive shock (p : 0.037) were significantly associated with mortality. Use of thrombolytic therapy was significantly associated with survival (p : 0.008). A multivariate logistic regression model to determine mortality predictors revealed that syncope (OR: 1.97, 95% CI: 1.06–3.65, p : 0.03), and obstructive shock (OR: 2.23, 95% CI: 1.20–4.14, p : 0.01) were associated with increased death odds. Treatment with thrombolytic therapy (OR: 0.22, 95% CI: 0.086–0.57, p : 0.002) or surgical thrombectomy (OR: 0.35, 95% CI: 0.137–0.9, p : 0.03) were associated with reduced death odds. Meta-analysis of observational studies revealed a pooled prevalence of FFRHT among all PE cases of 8.1%, and overall mortality of 23%. Although uncommon, the presence of FFRHT in the context of PE is associated with high obstructive shock and mortality rates. Favorable survival odds are observed with thrombolytic therapy and surgical thrombectomy. Data are derived from case reports and observational studies. Clinical trials elucidating these findings are needed. [ABSTRACT FROM AUTHOR]

The first outbreak of COVID-19 was reported in December 2019 in Wuhan, China and it was declared as a global pandemic on March 11, 2020. To cope with the high infectivity and increasing number of deaths associated with this disease, the healthcare resources of nearly all countries were directed to put measures in place to manage this disease. As a result, many other services including lung cancer care have been adversely affected as treatments have been delayed. The widespread lockdowns and advice to stay at home especially with common symptoms of cough has resulted in late presentations and possible upstaging of lung cancer. Owing to this similarity of symptoms and pressures faced by respiratory community to manage COVID-19 pandemic, the lung cancer patients will encounter delays in their management leading to untoward effects on their survival and quality of lives. According to an estimate, the impact of COVID-19 could lead to an additional 1372 deaths due to lung cancer in the United Kingdom alone. There has also been reluctance among the oncology community to treat patients with systemic anticancer agents due to fear of patients catching COVID-19 infection. There should be a balance between the risks and benefits of providing cancer services during this pandemic and every step should be taken to minimize delays faced by patients with lung cancer. [ABSTRACT FROM AUTHOR]

Patient: Male, 57-year-old Final Diagnosis: COVID-19 pneumonia • reinfection Symptoms: Cough • fever Medication: -- Clinical Procedure: -- Specialty: Infectious Diseases Objective: Unusual clinical course Background: Coronavirus disease 2019 (COVID-19) has radically changed the world, and promising vaccine trials are currently underway. The immune responses in asymptomatic and symptomatic individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still under investigation, and data are evolving. While it is known that humoral and cell-mediated immune responses against SARS-CoV-2 are elicited, it is uncertain whether these responses protect against reinfection or that they provide definitive evidence of viral clearance. Very few cases have been reported in the literature regarding reinfection with SARS-CoV-2. Case Report: We present a case of a middle-aged man with asymptomatic SARS-CoV-2 infection who later developed mild symptomatic COVID-19 after a period of 3 months. The source of reinfection was likely from the community, which had a soaring burden of infection with the highest number of COVID-19 cases per million in the world at that time. The patient had 2 negative COVID-19 polymerase chain reaction (PCR) tests 2 weeks after the initial infection. During the second infection, a nasopharyngeal reverse-transcription PCR test and tests for the presence of COVID-19 immunoglobulin (Ig)M and IgG antibodies were all positive. Conclusions: Reinfection with SARS-CoV-2 is a strong possibility. This case raises concerns that asymptomatic infections may not provide long-term protective immunity to all patients, which could make them susceptible to reinfection. Possible explanations for reinfection include an interval decrease in protective antibodies titers after SARS-CoV-2 infection that may be more prevalent in patients who had an asymptomatic infection. Other possibilities include viral reactivation after a prolonged carriage of the virus or delayed immune response. [ABSTRACT FROM AUTHOR]

Objective: To compare the mean time duration of patient's first request for analgesic for pain relief after open cholecystectomy with preoperative use of pregabalin or gabapentin. Study Design: Randomized controlled trial. Place and Duration of Study: Department of anesthesia, Combined Military Hospital (CMH) Peshawar during a period of six months, from May 2014 to Nov 2014. Material and Methods: This study included a total of 126 patients with clinical and ultrasound diagnosis of acute cholecystitis. Patients were distributed randomly into two groups equally (63 patients in each group). Group A was given 300mg pregabalin and group B was given 900mg gabapentin one hour before surgery by mouth. Results: Mean age was 46.68 ± 8.074 years for group A and 46.33 ± 8.046 years for group B. In group A, there were 49.2% males and 50.8% females while in group B, there were 42.9% males and 57.1% females. Weight of patients was 68.54 ± 6.283 kg in group A and 69.75 ± 5.778 kg in group B respectively. Mean time duration score was 37.48 ± 7.175 minutes and 18.27 ± 3.366 minutes in group A and B, respectively (p<0.001). Conclusion: Preoperative use of pregabalin provides significantly prolonged postoperative analgesia compared to gabapentin after open cholecystectomy. [ABSTRACT FROM AUTHOR]

Objective: To observe the efficacy of blind obturator nerve block by Labat technique for prevention of obturator jerk during transurethral resection of bladder tumor performed under spinal anesthesia. Study Design: Descriptive Study. Material and Methods: This was a single center based study conducted at tertiary care military hospital for a period of thirty months. Fifty five patients were recruited in the study, after identifying the location of bladder growth in the lateral wall on ultrasound USG and confirming its exact site on cystoscopic examination. Those eliciting obturator jerk during transurethral resection of bladder tumor (TURBT) were included and ONB was performed using 2% lidocaine via blind technique of Labat. TURBT was restarted and presence of obturator jerk was recorded if evoked (primary outcome). Results: Median age was 67.3 ± 8 years with majority (72.7%) in the age group between 61 to 80 years. Male female ratio was 7:1. Fifty (90%) patients presented with solitary growth. Mean operating time was 28.8 ± 12 minutes. ONB was successful in 52 (94.54%) of the cases while failure in 3 (5.45%) resulted in conversion to general anesthesia for the completion of TURBT. Conclusion: Blind obturator nerve block (ONB) by using Labat technique for obturator nerve block has proven to be simple, reliable and easily replicable in any set up and it does not require any time consuming steps or sophisticated equipment. [ABSTRACT FROM AUTHOR]

Objective: To compare laparoscopic and conventional open appendectomy in terms of operative time, hospital stay and frequency of surgical site infection (SSI). Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Quetta from 6th Jun 2010 to 1st Sep 2011 and Combined Military Hospital, Multan, Pakistan from 2nd Sep 2011 to 5th Jun 2012 over a period of 2 years. Patients and Methods: A total of 417 patients underwent appendectomy during this period. 137 patients underwent laparoscopic appendectomy (group A) while 280 patients had open appendectomy (group B). The sample includes all patients who were operated upon, between the time-span of June 2010 to September 2011. A chi square-test was performed to compare the data for statistical significance. Results: Mean operative time for group A was 79.21 ± 23.42 minutes whereas in group B, the mean operative time was 41.49 ± 20.86 minutes. Group A patients had a shorter hospital, l stay (3.6 ± 1 day) but in group B, it was (5.2 ± 3 days). Seven patients (5.1%) developed surgical site infection (SSI) in group A and 34 patients (12.14%) developed postoperative SSI in group B (p < 0.05). Conclusion: Laparoscopic appendectomy is superior to open appendectomy because of shorter hospital stay and lesser post-operative SSI, but requires longer operative time. [ABSTRACT FROM AUTHOR]

Objectives: Leishmaniasis is quite commonly encountered in Balochistan. Of all the known treatment modalities, only a few are available at our hospital. We carried out this study in search of an effective and easily available agent. Methodology:This quasi-experimental study was carried out at Combined Military Hospital Sibi in Balochistan from May to Nov 2010. The gross appearance of non healing ulcers and demonstration of parasite in Giemsa stained smears were used to confirm the diagnosis. Thirty nine patients were enrolled and divided into two groups by non- probability convenience sampling. Eighteen patients (having 30 ulcers) received meglumine antimoniate and 21 patients (having 32 ulcers) received 0.2% ciprofloxacin intralesionally every fifth day till re-epithelialization started, up to a maximum of five doses. Side effects of therapy were checked at every visit. Patients were followed up at one week and subsequently one month after completion of treatment to assess complete clinical healing and regression in size of the scar. Results:Two ulcers in meglumine antimoniate and five ulcers in ciprofloxacin group did not heal (response rate 93.33% vs. 84.38%, p: 0.273). Those treated with meglumine antimoniate required a lesser number of doses (mean 3.83 and 4.27; p: 0.039). Reduction in scar size was equal in both groups (58.46% and 57.21%; p: 0.087). Conclusions: Intralesional ciprofloxacin is an effective, cheap and safe treatment for cutaneous leishmaniasis. [ABSTRACT FROM AUTHOR]

Competing Interests: There is no conflict of interest in regards to this abstract.

Competing Interests: There is no conflict of interest in regards to this abstract.

Coronavirus disease 19 (COVID-19) has affected over 180 countries, resulting in global mass death. It has been reported that patients with underlying disease are more likely to contract the disease and become critically ill. The impact of chronic kidney disease (CKD) on the severity of COVID-19 has been underlined in the literature. In this analysis, we have provided evidence of an association between CKD and COVID-19. We followed the PRISMA protocol and conducted a literature search using Google Scholar, EMBASE, PubMed, and Clinical trail.gov. The initial search yielded 2102 articles. We included 20 cohorts based on inclusion criteria reporting an association between CKD and COVID-19 after excluding irrelevant articles, including review articles and duplicates. We conducted pooled prevalence of CKD and meta-analysis to estimate the odds ratio (OR), 95% confidence interval (CI) using Cochrane RevMan (version 5.4, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration), and R programming language version 4.16-2 (University of Auckland, New Zealand). Our study involved 4350 patients from different countries, and 212 (4.9%) patients had CKD. Among 20 cohorts, 57.27% were male with a median age of 55.5 years. Eight hundred sixty-six patients developed severe COVID-19, and out of which, 39 (4.5%) were CKD patients. CKD patients had a significantly increased risk of severe disease as compared to non-CKD patients with a pooled OR of 2.15 (95% CI 1.16-4.01) (I 2 =41;  p =0.02). Out of 443 COIVD-19 patients who died, 85 patients had CKD, with a prevalence of 19.18%. CKD patients had an increased risk of death as compared to non-CKD patients with a pooled OR of 5.58 (95% CI 3.27-9.54) (I 2 =0; p <0.00001). CKD is manifested as a common underlying disease in COVID-19 patients who had a worse prognosis, including mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Menon et al.)

Infection with Bartonella henselae ,a gram-negative coccobacillus, most frequently presents as cat-scratch disease (CSD) and often accompanies a recent history of cat bite or scratch. As compared to adults, teenagers and children or immunocompromised patients are predominantly affected by CSD. In immunocompetent individuals, CSD is typically a self-limiting clinical syndrome with complete resolution of febrile illness in two to four weeks with or without antimicrobial therapy. While most cases present with fever of unknown origin (FUO), previous reports have also documented atypical clinical presentation or systemic symptoms in few cases, including reports of hepatosplenic involvement. We present a case of visceral bartonellosis in an immunocompetent 15-year-old female, who presented with a six-week history of fever and abdominal pain with hepatosplenomegaly. She recovered completely after prolonged antibiotic treatment for six weeks with doxycycline and amikacin. We emphasize that in the workup of FUO, it may be pertinent to include bartonellosis as a differential especially in cases exhibiting hepatosplenomegaly on examination along with hepatosplenic lesions on imaging., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Sharma et al.)