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Huzaifa Ahmad Cheema,1 Rustam Shariq Mujtaba,2 Amna Siddiqui,3 Laiba Imran Vohra,4 Abia Shahid,1 Jaffer Shah,5 Abdulqadir J Nashwan,6 Natasha Howard7– 9 1Division of Infectious Diseases, Department of Medicine, King Edward Medical University, Lahore, Pakistan; 2Department of Pharmacy, National University of Singapore, Singapore, Singapore; 3Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan; 4Department of Medicine, Ziauddin University, Karachi, Pakistan; 5New York State Department of Health, Albany, NY, USA; 6Hamad Medical Corporation, Doha, Qatar; 7Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore; 8Free Aleppo University, Aleppo, Syria; 9Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKCorrespondence: Abdulqadir J Nashwan, Department of Nursing, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar, Email anashwan@hamad.qaAbstract: Dengue outbreaks have been documented in Singapore since 1901, occurring almost annually in the 1960s and disproportionately affecting the paediatric population. In January 2020, virological surveillance detected a shift from DENV-2, which was the previous dominant strain, to DENV-3. As of 20 September 2022, 27,283 cases have been reported in 2022. Singapore is currently also responding to the COVID-19 pandemic, overcoming another wave of infections with 281,977 cases recorded in the past two months as of 19 September 2022. While Singapore has adopted several policies and interventions to combat dengue, primarily through environmental control but also innovations such as the Wolbachia mosquito programme, there is a need for further efforts to deal with the dual threat of dengue and COVID-19. Drawing lessons from Singapore’s experience, countries facing such dual epidemics should enact clear policy responses, including establishing a multisectoral dengue action committee and action plan prior to potential outbreaks. Key indicators should be agreed upon and tracked at all healthcare levels as part of dengue surveillance and incorporated into the national health information system. Digitizing dengue monitoring systems and implementing telemedicine solutions are innovative measures that would facilitate the response to dengue in the context of restrictions during the COVID-19 pandemic that hinder the detection and response to new cases. There is a need for greater international collaboration in reducing or eradicating dengue in endemic countries. Further research is also required on how best to establish integrated early warning systems and extend our knowledge of the effects of COVID-19 on dengue transmission in affected countries.Keywords: DENV-3, SARS-CoV-2, infectious disease control, Singapore

Background/aim: Probiotics are live microbial supplements that improve the microbial balance in the host animal when administered in adequate amounts. They play an important role in relieving symptoms of many diseases associated with gastrointestinal tract, for example, in necrotizing enterocolitis (NEC), antibiotic-associated diarrhea, relapsing Clostridium difficile colitis, Helicobacter pylori infections, and inflammatory bowel disease (IBD). In this narrative review, the authors aim to evaluate the role of different probiotic formulations in treating gastrointestinal diseases in pediatric population aged 18 years or younger and highlight the main considerations for selecting probiotic formulations for use in this population., Methodology: The authors searched PubMed and Clinicaltrials.gov from inception to 24th July 2022, without any restrictions. Using an iterative process, the authors subsequently added papers through hand-searching citations contained within retrieved articles and relevant systematic reviews and meta-analyses., Results: The effectiveness of single-organism and composite probiotics in treating gastrointestinal disorders in pediatric patients aged 18 or under were analyzed and compared in this study. A total of 39 studies were reviewed and categorized based on positive and negative outcomes, and compared with a placebo, resulting in 25 studies for single-organism and 14 studies for composite probiotics. Gastrointestinal disorders studied included NEC, acute gastroenteritis (AGE), Acute Diarrhea, Ulcerative Colitis (UC), and others. The results show that probiotics are effective in treating various gastrointestinal disorders in children under 18, with single-organism probiotics demonstrating significant positive outcomes in most studies, and composite probiotics showing positive outcomes in all studies analyzed, with a low incidence of negative outcomes for both types., Conclusion: This study concludes that single-organism and composite probiotics are effective complementary therapies for treating gastrointestinal disorders in the pediatric population. Hence, healthcare professionals should consider using probiotics in standard treatment regimens, and educating guardians can enhance the benefits of probiotic therapy. Further research is recommended to identify the optimal strains and dosages for specific conditions and demographics. The integration of probiotics in clinical practice and ongoing research can contribute to reducing the incidence and severity of gastrointestinal disorders in pediatric patients., Competing Interests: The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Acute disseminated encephalomyelitis (ADEM) is a rare neurological disorder characterized by inflammation in the brain and spinal cord. This systematic review aims to investigate the potential association between ADEM and influenza vaccination by analyzing relevant case reports. ADEM is traditionally thought to be a monophasic condition, predominantly affecting children, often following viral illnesses or immunizations. Recent attention has focused on a possible link between ADEM and influenza vaccination, prompting the need for a thorough investigation., Methods: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews 2) guidelines. Electronic searches were conducted on PubMed, Cochrane Library, and clinicaltrials.gov databases, spanning up to August 2023. Inclusion criteria encompassed full-text articles in English, observational studies, case reports, and case series providing comprehensive details for confirming clinical diagnoses of ADEM following influenza vaccination. Data were extracted, including demographic information, vaccination details, clinical symptoms, diagnostic evaluations, treatment modalities, and outcomes. Quality assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal tool., Results: A total of 23 cases of ADEM following influenza vaccination were identified from 19 included articles. The mean age of affected individuals was 40.2 years (±25.7) with 60.8% being male. Common presenting symptoms included muscle weakness (52.1%), urinary abnormalities (30.4%), altered consciousness (26%), and sensory disturbances (26%). Neurological examination revealed findings such as extensor plantar reflex (positive Babinski sign) in 26%, hyperreflexia in 30.4%, and generalized hyporeflexia in 13% of the cases. Diagnostic evaluations involved MRI, showing multiple hyperintense lesions in cerebral hemispheres (43.4%), subcortex (60.8%), and spinal cord (39.1%). Cerebrospinal fluid analysis indicated elevated white blood cell count in 69.5% of cases, with lymphocytic pleocytosis in 52.1%. Oligoclonal bands were reported positively in 8.6% of cases. Treatment approaches varied, with intravenous methylprednisolone being the most common (39.1%). Out of the 23 cases, two (8.6%) patients had a fatal outcome, while the rest showed clinical improvement with complete or partial resolution of symptoms. Persisting symptoms included numbness in the lower extremities (8.6%) and impaired ability to walk after 10 months (4.3%)., Conclusion: While the association between ADEM and influenza vaccination is rare, healthcare professionals should remain vigilant and consider patients' vaccination history, particularly following an influenza immunization. This systematic review highlights the clinical manifestations, diagnostic tools, treatment approaches, and outcomes of ADEM cases post-influenza vaccination. Further research is essential to understand this association and improve clinical decision-making, ensuring the safety and efficacy of immunization programs., Competing Interests: There are no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: The association between fluoroquinolone use and the risk of aortic aneurysm as well as the risk of aortic dissections remains uncertain, primarily due to conflicting findings from observational studies. We sought to conduct a double-systematic review and meta-analysis of all observational studies to assess the existence and extent of both these associations. The aim of our study is to assess the role of Fluoroquinolone on aortic aneurysm and aortic dissection in comparison to other antibiotics., Evidence Acquisition: MEDLINE and Cochrane CENTRAL were systematically searched up till June 2021 for observational studies studying the correlation between fluoroquinolone usage and aortic aneurysms and dissections. Random-effects pooling was used to calculate adjusted hazard ratios (HRs) with 95% confidence intervals (CI). To assess publication bias, propensity score matching was conducted, and heterogeneity was evaluated by using I 2 statistics., Evidence Synthesis: Of 688 potentially relevant articles, 635 titles were screened. Ten studies were included in the systematic review, and 4 observational studies with 53,651,283 participants were eligible to be included in the meta-analysis. Pooled estimates showed that fluoroquinolone use was associated with a higher risk of aortic aneurysm when compared to other Antibiotics (HR 1.84, 95% CI 1.10-2.48; P<0.00001). However, fluoroquinolones had no significant effect on the risk of developing aortic dissection (HR 1.09, 95% CI 0.96-1.25; P=0.19)., Conclusions: The present analysis suggests that fluoroquinolone usage is more strongly linked to aortic aneurysm than other antibiotics. However, there was no statistically significant link between fluoroquinolone and aortic dissection. As a result, clinicians should exercise caution when administering fluoroquinolone to patients who have a history of or are at risk of aortic disease.

Digital health is a field that aims to improve patient care through the use of technology, such as telemedicine, mobile health, electronic health records, and artificial intelligence. The aim of this review is to examine the challenges and potential solutions for the implementation and evaluation of digital health technologies. Digital tools are used across the world in different settings. In Australia, the Digital Health Translation and Implementation Program (DHTI) emphasizes the importance of involving stakeholders and addressing infrastructure and training issues for healthcare workers. The WHO's Global Task Force on Digital Health for TB aims to address tuberculosis through digital health innovations. Digital tools are also used in mental health care, but their effectiveness must be evaluated during development. Oncology supportive care uses digital tools for cancer patient intervention and surveillance, but evaluating their effectiveness can be challenging. In the COVID and post-COVID era, digital health solutions must be evaluated based on their technological maturity and size of deployment, as well as the quality of data they provide. To safely and effectively use digital healthcare technology, it is essential to prioritize evaluation using complex systems and evidence-based medical frameworks. To address the challenges of digital health implementation, it is important to prioritize ethical research addressing issues of user consent and addressing socioeconomic disparities in access and effectiveness. It is also important to consider the impact of digital health on health outcomes and the cost-effectiveness of service delivery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Mumtaz, Riaz, Wajid, Saqib, Zeeshan, Khan, Chauhan, Sohail and Vohra.)

Hepatitis is often called a 'silent killer' as most patients remain asymptomatic and hence remain unaware of their illness. They are either diagnosed incidentally or get symptomatic when their illness advances years after getting the infection. In Pakistan, transmission has increased due to ignorance of sterilization techniques, sharing personal items, and unsafe healthcare practices and the burden of liver cancers and transplants has risen three-fold during the past 20 years. Chronic hepatitis often goes undetected, leading to a rise in liver cancers and transplants. Pakistan bears the second-largest burden of hepatitis C globally, with a nationwide prevalence of 4.8%. From 2015 to 2019, there was a 5% increase in hepatitis C-related deaths and an 8% increase in hepatitis B-related deaths. During the last 4 years, out of the 110 million population, only 281 578 individuals were screened for hepatitis B and C, and 1 634 614 individuals were registered at various hepatitis clinics. However, only 278 308 patients were treated. Despite a national vaccination strategy, coverage falls short, and regular screening is neglected. The burden of hepatitis-related morbidity is a considerable challenge for the Pakistani government and healthcare system, being a low-income country with limited health resources and limited access to treatment. Increased awareness, education, and emphasizing preventive measures, such as hepatitis B vaccination, is crucial. Careful supervision of healthcare workers and the promotion of safe practices are essential. Pakistan can learn and implement the Egypt model to combat hepatitis effectively. This article aims to discuss barriers and challenges and provides possible recommendations., Competing Interests: The author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Competing Interests: None declared.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Predictive scoring systems are tools that assess the magnitude of a patient's illness and forecast disease prognosis, usually in the form of mortality, in the ICU. We aimed to determine the mortality rate among patients admitted to ICU using the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system correlating with lengths of stay in the ICU., Methodology: A cohort study using team approach to care was conducted from July 2021 through July 2022 at KRL Hospital. Five hundred fifty-two patients aged 18-40 years, admitted for medical or surgical reasons (other than cardiac) who stayed in the ICU for more than 24 h were included. The APACHE II score was determined using 12 physiological variables at the end of the first 24 h of ICU admission. Data were analyzed using IBM Corp. released in 2015 (IBM SPSS Statistics for Windows, Version 23.0, Armonk, New York)., Results: The average age of study participants was 36.34±2.77, ranging from 18 to 40 years. Three hundred fifteen participants were males and 237 were females. Patients were categorized into four separate groups as per their respective APACHE II scores. Patients with an APACHE II score of 31-40 were assigned to group 1. Patients with an APACHE II score of 21-30 were assigned to group 2. Patients with an APACHE II score of 11-20 were assigned to group 3. Lastly, patients with an APACHE II score of 3-10 were assigned to group 4. All patients in group 1 and group 2 died and none survived. Groups 1 and 2 contained a sum of 228 patients. A total of 123 patients were assigned to group 3, out of which 88 patients (71.54%) survived and 35 patients (28.45%) died. From these observations, it is evident that a higher APACHE II score is correlated with increased mortality., Conclusion: APACHE II scoring serves as an early warning indication of death and prompts clinicians to upgrade their treatment protocol. This makes it a useful tool for the clinical prediction of ICU mortality., Competing Interests: No conflicts of interest were declared.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article, (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

While the Coronavirus pandemic continues to spread havoc across the world, countries like Pakistan are faced with another challenge: the steady rise of vector borne diseases alongside a spike in COVID-19 cases. Moreover, signs and clinical manifestations of multiple arbovirus infections mimic those experienced in COVID-19, causing further complications in management and diagnosis. Without urgent adequate management and testing equipment, the recent surge of COVID-19 along with the steady rise in Vector Borne Diseases (VBDs) could collapse the exhausted Pakistani healthcare system. This article explores the impact of COVID-19 on the management, diagnosis, and treatment of the common arbovirus infections of Pakistan, including dengue (DENV), malaria, chikungunya (CHIKV), and other foreign infections that are on a hazardous rise., Competing Interests: None., (© 2022 The Authors.)

As of 3rd June 2022, 445 cases of monophasic Salmonella Typhimurium sequence type 34 infection had been reported globally. The outbreak was caused by two novel strains of monophasic S. Typhimurium with unusual multi-drug resistance. The majority of these cases involved children aged 10 or younger, and they had a hospitalization rate higher than most previous outbreaks of monophasic S. Typhimurium, but no fatalities were recorded. The infection was traced to certain Belgian chocolate products after extensive microbiological and epidemiological research. Public health officials took immediate action to recall all the contaminated products, and the risk of exposure was reduced. The common symptoms are bloody diarrhea, acute onset of fever, abdominal pain, and vomiting. This article aims to thoroughly review the recent outbreak of monophasic Salmonella Typhimurium ST-34, including its epidemiology and comparison with ongoing outbreaks. We also highlighted past chocolate-related salmonella outbreaks and current control and prevention guidelines and recommendations., Competing Interests: No Conflict of interest., (© 2022 The Authors.)

Pakistan is dealing with the fifth wave brought on by the new type, Omicron (or B.1.1.529) with 1,547,795 confirmed cases with 30,452 deaths of COVID-19, as reported by World Health Organization (WHO) from 2020 to 2022. Vaccination is the best tool to curb this pandemic and fight against the new variants as it reduces the likelihood that the disease will be severe. A two-dose regimen of the BNT162b2 vaccine provides 95% protection to people aged 16 years and above, against the novel coronavirus. However, like in other developing countries, the vaccination campaign in Pakistan is hampered due to vaccine hesitation. This might not be the last mutation the world shall face. As with any other virus, the corona-virus is also expected to mutate frequently in the future, making annual booster shots the only way to stay significantly immunized against this deadly virus. Communication and counseling are needed to build their trust while taking care of social inequalities in the population. The authorities must intensify their efforts and should address this very important issue., (© 2022 The Authors.)

Competing Interests: None declared.

Afghan children have suffered for decades because of chronic socioeconomic health crises. The current state of Afghanistan has deprived the basic human needs of children. The lack of freedom leaves their voices unheard, causing detrimental effects on their mental health. Mental illnesses such as post-traumatic stress disorder, anxiety, and depression are prevalent in Afghanistan, causing severe negative outcomes among children. Promotion of mental health services, psychological training, awareness campaigns, acceptance of Afghan refugees, and initiatives to support re-connecting with loved ones, are among the many recommended measures needed to manage this alarming situation. This requires an immediate action plan from government and public health officials to mitigate this impending catastrophe., (© The Author(s) 2022.)