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Objectives: To evaluate the post-operative complications and short-term outcomes of modified Duhamel retrorectal pull-through procedure for Hirschsprung’s disease. Design: Prospective descriptive study Place and Duration of Study: Department of Paediatric Surgery Sahiwal Teaching Hospital Sahiwal from 1stJanuary 2018 to 31st December 2020. Methodology: Thirty seven histologically confirmed cases of Hirschsprung’sdisease having previous decompressing colostomy/stoma age between 1 to 12 years of agewere included. Children under one year of age, with sever comorbidities like Down syndrome and cardiac abnormalities, and those who require re-do pull through procedure were excluded. Modified Duhamel retrorectal pull-through procedure was performed in all cases. The demographic information included age, sex, proximal level of aganglinosis, complications of definite procedure, length of hospitalization andmortality. Other information recorded included long term complications like obstructive symptoms, enterocolitis, incontinence and soiling at follow up. Krickenbeck classification was used to evaluate faecal incontinence and constipation. Kelly’s clinical score was used to assess the anal sphincter. Bowel habits were assessed only in children above three years of age. Results: Twenty six (70.27%) were males and 11 (29.72%) females with male to female ratio 2.3:1 and mean age at operation was 2.89±1-9 years. Twenty nine (78.37%) children were ≤3 years of age and 8 (21.62%) were >3 years. Mean weight was 12.91 kgs, operation time was 126.81 time, fasting time was 6.67 days and hospital stay was 11.91 days. Length of aganglionic segment was short segment 27 (72.97%), long segment 9 (24.32%) and total colonic 1 (2.7%). Hirschsprung associated enterocolitis 7 (18.91%) and wound infection 6(16.21%) were most common reported complications. Constipation in 5(13.51) and soiling with retentive constipation was present in 3 (8.10%) patients. Out of total 31 patients who reached toilet training age, 28 (90.32%) developed satisfactory voluntary bowel habits. Conclusion: Modified Duhamel pull-through procedure was found to be safe, applicable and with lower associated complications and satisfactory short term functional outcomes in our settings. Key words: Hirschsprung’s disease, Modified Duhamel pull-through procedure, Complications, Outcomes

Objective: The aim of this study is to compare the outcome of endoscopic endonasal verus transcranial approach for cerebrospinal fluid leak repair. Study Design: Comparative study Place and Duration: Conducted at department of Neurosurgery, Mardan Medical Complex/ Bacha Khan Medical College, Mardan during the period from 1st January 2020 to 31st December 2021. Methods: Total eighty patients of both genders were presented in this study. Patients were aged between 20-65 years. Patients’ detailed demographics age, sex and body mass were recorded after taking written consent. Patients had CSF leaks and the history of CSF leak was presented. Patients were equally divided into two groups, I and II. Group I received endonasal technique and group II received transcranial approach. All the patients underwent MRI and CT scan. Complete follow up among both groups were taken in the duration of 8 months for the assessment of efficacy. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 33.08±14.90 years with mean BMI28.4±3.12 kg/m2 and in group II mean age was 31.66±4.84 years with mean BMI 27.45±1108 kg/m2. Total 50 (62.5%) patients were males (25 in each group) and 30 (37.5%) patients were females (15 in each group). In group I recurrence rate was found in 3 (7.5%) cases and in group II recurrence rate was 6 (15%). 3 (7.5%) patients in group II developed infection but no infection rate was found in the endoscopic endonasal group. Satisfaction among patients in the endonasal group was greater than that of the transcranial group. Overall efficacy rate among both groups was 71 (88.8%). Conclusion: We concluded in this study that for repair of cerebrospinal fluid leak endoscopic endonasal approach was effective and safe method as compared to transcranial approach. Minimum rate of recurrence and high rate of recovery was fund in endonasal approach. Keywords: CSF, Endoscopic endonasal, Transcranial approach, Complications, Recurrence

contusions managed conservatively. Material and Methods: A prospective observational study was carried out in, Punjab Institute of Neurosciences, Lahore. A total of 97 patients, from 15-65 years, who were diagnosed with cerebral contusions and being managed conservatively were enrolled from July 2019 to December 2019. They were followed-up for 12 – 18 months. Results: A total of 23% patients developed early post-traumatic seizures (PTS) and 11% of patients developed late post-traumatic seizures with mild to moderate brain injury.6% of patients with early PTS used antiepileptic drugs (AED) for at least three months during follow up and 7% with late PTS used AED. 8% of patients developed late PTS without any early PTS. The results of our study show that among 23% early PTS and 11% late PTS only 3 % actually required to use AED for at least 6months. To prevent this, 3% of the population 44% were using AED supplementary. Conclusion: In our study, the incidence of early and late PTS is comparable to the other studies. The non-judicious use of the anti-epileptic drug is common in our country which leads to an increase in the risk of drug resistance and cost-intensive for poor patients in developing countries as prophylactic and excessive use of anti-epileptics does not affect the PTE.

Objective: To determine the outcome of endoscopic pilonidal sinus treatment (EPSIT): Is a new minimally invasive treatment in pilonidal sinus. Study Design: This is a observational study. Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2020 to Feb 2021. Materials and Methods: Patients aged between 20-40 years, both gender having sinus in the cleft of the buttocks on clinical examination with associated symptoms like pain when sitting or standing, reddened, sore skin around the area, pus or blood draining from sinus, hair protruding from the lesion and formation of more than one sinus tract, or holes in the skin were included in this study. Patients with abscess and recurrent pilonidal sinus were excluded. Outcome measurements were postoperative pain, return to normal daily activities and complication rates including infection, recurrence. Results: 44 patients with Pilonidal Sinus were included in this study. 15 to 40 years with mean age ± SD (range) was 26.56±4.1 years. 40(90.90%) were male where as 4(9.09%) were females. Mostly patients have single external openings in 37(84.09%) patients with midline opening location in 26(59.09%) patients. The mean operative time±SD (range) was 21.09±3.62 minutes (15 to 45 min). According to the visual analog scale (VAS) score for postoperative pain assessment after 48 hours of surgery, 36 patients (81.81%) reported a VAS between 1 to 3, and 8(18.18%) reported a score between 4 to 6. Postoperative wound infection was seen in one case 2.27% while recurrence was observed in two cases 4.54%. The overall healing rate was 93.18%. The mean time to return to normal daily activities was 6.1±11 (range, 2–15) days. Conclusion: To conclude that the EPSiT is safe, effective, simple, repeatable and very welcomed by the patients if explained correctly. We can say that EPSiT can be labeled as a day surgery, with fast post-operative recovery and early return to work.

There is a very narrow margin in selenium deficiency and toxicity although it is an important element for humans, animals, and plants. Effects of selenium (Se) on the growth and physiomorphological parameters in maize were studied grown in soil spiked with sodium selenate (Na2SeO4) in 5 different concentrations (i.e., 0. 2.5, 5.0, 10.0, and 20.0 mg kg−1). The growth of plants was affected by high Se concentration. However, maximum increases in plant height and root length were observed at low Se (2.5 mg kg−1) which were 17.89 and 23.17%, respectively. At higher Se concentrations (20 mg kg−1), a considerable reduction was observed in dry matter, root length, antioxidant enzymes, and other physiological parameters. The dry matter of plants was also analyzed for nutrient (Fe and Zn) concentrations. Results indicated that Se stress inhibits plant growth. Gas exchange parameters were also found to be decreased under stress conditions, but at a lower Se level (2.5 mg kg−1), improvement in transpiration rate (63.46%), photosynthetic rate (47.47%), and stomatal conductance (54.55%) was observed. The reduction in growth attributes may be due to the high accumulation of Se in roots and the disturbance in gas exchange parameters. However, the principal component analysis revealed that higher Se levels were more hazardous for maize growth and physiological responses as compared to low Se levels.

Segmentation of a brain tumor from magnetic resonance multimodal images is a challenging task in the field of medical imaging. The vast diversity in potential target regions, appearance and multifa...

Background & Objective: Persistent pulmonary hypertension of the newborn (PPHN) is described as severe respiratory failure along with hypoxaemia. PPHN is known to be linked with high morbidity and mortality around the world. This study was planned to determine the postnatal causes and assess the severity of persistent pulmonary hypertension of newborn in babies presenting to the Children’s Hospital, Multan. Methods: This observational study was conducted at the Department of Paediatric Cardiology, The Children Hospital &Institute of Child Health, Multan, Pakistan from July to December 2019. A total of 122 confirmed cases of PPHN admitted having gestational age above 34 weeks were enrolled. Demographic data of the newborns was recorded along with maternal medical history, pregnancy status and postnatal causes of PPHN. Severity of PPHN was also recorded. Results: Out of a total of 122 cases of PPHN, 81 (66.3%) were male. Majority, 78 (64.0%) had gestational age above 37 weeks. Mode of delivery as cesarean section was noted in 70 (57.4%). Meconium aspiration syndrome 52 (42.6%), birth asphyxia 48 (39.3%), respiratory distress syndrome 23 (18.8%) and sepsis 33 (27.0%) were found to be the commonest causes of PPHN. Severe PPHN was found to be the most frequent, noted among 63 (51.6%) while Moderate PPHN was observed in 40 (32.8%) and Mild PPHN in 19 (15.6%). Morality was noted among 26 (21.3%) of cases. Conclusion: Meconium aspiration syndrome, birth asphyxia and respiratory distress syndrome were the commonest postnatal causes of PPHN. Severe PPHN was found to be the most frequent form of PPHN. doi: https://doi.org/10.12669/pjms.37.5.2218 How to cite this:Arshad MS, Adnan M, Anwar-ul-Haq HM, Zulqarnain A. Postnatal causes and severity of persistent pulmonary Hypertension of Newborn. Pak J Med Sci. 2021;37(5):1387-1391. doi: https://doi.org/10.12669/pjms.37.5.2218 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background There is limited data on the efficacy of direct oral anticoagulants (DOACs) for the treatment of left ventricular thrombus. Currently, vitamin K antagonists (VKAs) remain the preferred oral anticoagulant for left ventricular thrombus. In this retrospective study, we assessed the safety and efficacy of DOACs in comparison to VKAs in patients with a new diagnosis of left ventricular thrombus. Methods We retrospectively identified all patients admitted to the 5 Catholic Health Initiative Omaha hospitals with a diagnosis of left ventricular thrombus between January 2012 and March 2019 and were discharged on oral anticoagulants. Patients were stratified into 2 groups: VKAs or DOACs and followed for up to 1 year. We compared the outcomes of ischemic stroke, bleeding, and echocardiographic resolution of left ventricular thrombus between the 2 groups. Results A total of 99 patients were included in this study (mean age: 61 years, 29% females). Of these, 80 (81%) were discharged on VKAs and 19 (19%) on DOACs. Stroke within 1 year of diagnosis occurred in 2 patients in the VKA group and none in the DOAC group (P = 0.49). Bleeding events were observed in 5 patients (4 in the VKA group and 1 in the DOAC group; P = 0.96). Ninety patients had follow-up echocardiogram; resolution of left ventricular thrombus was similar between the 2 groups (VKAs vs DOACs: 81% vs 80%; P = 0.9). Conclusion In patients with left ventricular thrombus, DOACs and VKAs had similar rates of stroke and bleeding. These findings need confirmation in randomized clinical trials.

Aims/Introduction Abnormalities in Ca2+ signaling have a key role in hemodynamic dysfunction in diabetic heart. The purpose of this study was to explore the effects of streptozotocin (STZ)‐induced diabetes on Ca2+ signaling in epicardial (EPI) and endocardial (ENDO) cells of the left ventricle after 5–6 months of STZ injection. Materials and Methods Whole‐cell patch clamp was used to measure the L‐type Ca2+ channel (LTCC) and Na+/Ca2+ exchanger currents. Fluorescence photometry techniques were used to measure intracellular free Ca2+ concentration. Results Although the LTCC current was not significantly altered, the amplitude of Ca2+ transients increased significantly in EPI‐STZ and ENDO‐STZ compared with controls. Time to peak LTCC current, time to peak Ca2+ transient, time to half decay of LTCC current and time to half decay of Ca2+ transients were not significantly changed in EPI‐STZ and ENDO‐STZ myocytes compared with controls. The Na+/Ca2+ exchanger current was significantly smaller in EPI‐STZ and in ENDO‐STZ compared with controls. Conclusions STZ‐induced diabetes resulted in an increase in amplitude of Ca2+ transients in EPI and ENDO myocytes that was independent of the LTCC current. Such an effect can be attributed, at least in part, to the dysfunction of the Na+/Ca2+ exchanger. Additional studies are warranted to improve our understanding of the regional impact of diabetes on Ca2+ signaling, which will facilitate the discovery of new targeted treatments for diabetic cardiomyopathy., This is the first report to investigate the effects of streptozotocin‐induced diabetes on L‐type Ca2+ current simultaneously measured with Ca2+ transients in epicardial and endocardial left ventricular myocytes isolated from rats 5–6 months after the induction of diabetes. Streptozotocin‐induced diabetes causes a progressive increase in the amplitude of endocardial and epicardial myocyte Ca2+ transients that is independent of the L‐type Ca2+ current. The effect of streptozotocin‐induced diabetes on Ca2+ handling might be attributed, at least in part, to the dysfunction of the Na+/Ca2+ exchanger.

Objectives: The objective was to study breast feeding practices in children with sepsis admitted in intensive care unit of Children Hospital, Lahore. Study Design: Descriptive cross-sectional study. Setting: Medical Intensive Care Unit of The Children Hospital and Institute of Child Health Lahore. Period: From June 2018 to December 2018. Material & Methods: Considering 95% confidence level, 7.5% margin of error and the expected percentage of bottle feeding children i.e. 27% (least among both) feeding types in children with sepsis admitted in ICU, a sample size of 140 children was taken. All the patients from 6 month to 2 years of age and either gender admitted in medical ICU with sepsis were included in the study through non-probability consecutive sampling. After taking an informed written consent from caregiver, a preformed and pre-tested questionnaire was used for data collection. Diagnosis of sepsis as based upon the criteria for SIRS. Exclusively breastfed children for first 6 months of life were classified as ‘breastfed’. Data was analyzed using SPSS version 22 and Chi-square test. P value < 0.05 was taken as significant. Results: Total 140 children were included in the study with the mean age of 14.64 ± 5.26 months. In this study, 47 (33.57%) children were found breast fed while 93 (66.43%) children were not breast fed as per history. Conclusion: The study concluded that breast feeding practice is uncommon in children admitted in intensive care unit with sepsis and breastfeeding was found to be significantly associated with maternal education and gender of the child.

Objectives: Neonatal sepsis is a known and significant contributor to newborn morbidity and mortality. We conducted this study to find out the efficiency of hematological scoring system (HSS) in predicting neonatal sepsis. Study Design: Prospective study. Setting: Neonatology Unit of Civil Hospital, Bahawalpur. Period: 1st July 2018 to 31st December 2018. Materials & Methods: A total of 100 neonates having high probability of sepsis were admitted and evaluated in NICU, Institution’s pathological lab was the center for all the workups. Sensitivity, specificity, positive predictive values (PPVs) along with negative predictive values (NPVs) were calculated for different study parameters. P value < 0.05 was considered as significant. Results: Amongst a total of 100 neonates, 62 (62.0%) were males and 38 (38.0%) females. There were 32 (32.0%) preterm while 68 (68.0%) term neonates. Culture positive cases were found to be 33 (33.0%) whereas CRP was noted reactive in 62 (62.0%) cases. Neonatal age as preterm, culture positive neonates (p < 0.001) as well as CRP as reactive were found to be significantly associated with HSS > 5. Immature to total neutrophil ratio (I:T) as well as Immature to mature neutrophil ratio (I:M) had the highest sensitivity and specificity. Conclusion: HSS is a simple to use and efficient method that can be used to early diagnose and treat cases of neonatal sepsis. HSS has a high sensitivity as well specificity as high scores of HSS highlight sepsis.

Background: VCO is an oil made from fresh coconuts and processed naturally or do not require heating and do not add other chemicals. The fatty acids contained in the VCO has the added benefit of making your skin soft. VCO is effectively applied as a moisturizer to the skin so that it can improve skin hydration and promotes healing of the skin. Decubitus is damage to the skin caused by friction or pressure on the skin located bony section.Purpose: This literature review aimed to determine the effectiveness of the VCO in reducing the risk of decubitus sores.Method: This research method Quantitative descriptive approach Systematic Review through some journals that are relevant to this article. This research article search by using keywords 1 "prevention of decubitus sores" keyword 2 "VCO" search database sources used in this study is Portal Garuda, ISJD and Google Scholar were published from 2015 to 2019 year.Results: The results of this study identified include the use of VCO prevent decubitus sores, that VCO is effective in prevention of decubitus sores in patients with stroke or bedrest.The use of VCO as decubitus sores preventive therapy has many benefits. Substances that are contained in the VCO can provide benefits or nutrients to keep the skin moist.Conclusion: Nurses as nursing care providers are expected to use the VCO to prevent decubitus sores in patients with stroke or bedrest as an intervention in a hospital or as therapy can do at home community.

P104 Table 1Mortality rate after presentation of COVID-19 by: tumour type, time from cancer diagnosis, cancer stage, progression of disease, and systemic anti-cancer treatment (SACT). Number mortality number mortality% odds ratio Cancer type Solid organ 75 28 37.3 1.32 Lung 18 11 61.1 4.66** Haematological 29 11 37.9 1.47 Time from diagnosis 12 months 67 25 37.3 1.25 STAGE AT DIAGNOSIS 4 46 23 50.0 2.82*** 3 26 13 50.0 2.17 2 14 5 35.7 1.22 1 31 8 25.8 0.77 0 5 1 20.0 0.46 disease progression (

Introduction Spinal intramedullary dermoid is very rare, accounting for, Highlights • Intramedullary dermoid cyst is very rare, accounting for

Objective: The aim of this study is to calculate hemoglobin (Hb) levels and find the prevalence of anemia in gynecological cancer patients undergoing cancer treatments including chemotherapy and radiotherapy attending Princess Noorah Oncology Center in King Abdul Aziz Medical City in Jeddah. Method: A cross-sectional chart review study was conducted in gynecological cancer patients receiving chemotherapy/radiotherapy to find the prevalence of anemia in the period between 2016 and 2018. All data were collected from the electronic medical records using a data collection sheet. Results: A total of 107 female patients who had gynecologic cancers and received chemotherapy/radiotherapy were included. Ninety percent (90.7%) of them developed anemia during the treatment course. Conclusion: The prevalence of anemia in patients with gynecological cancers during their active treatment was high. This is attributed to the chemotherapy and radiotherapy they were receiving that affected their Hb levels. Better monitoring and, in severe cases, blood transfusion could be beneficial.

The growing number of diabetes coupled with the harsh side effects of some synthetic drugs has led to the increasing search for alternative medicine which are relatively cheap with minimum side effects. Objective: To investigate the anti-diabetic effect of ethanolic extract of Carica papaya and Psidium guajava extracts separately and in combination, and the effect of treatment on hepato-renal performance. Methods: Papaya and guava leaves were macerated in 98% ethanol for extraction. Results: The result showed that ethanolic leaf extract of P. guajava and C. papaya significantly (P< 0.05) reduced blood glucose level, Total Cholesterol (TC), triglycerides (TG), low density lipoprotein (LDL) and significant increase in high density lipoprotein (HDL) as compared to diabetic control group. Serum activities of liver enzymes such as aspartate aminotransferase (AST), alkaline phosphatase (ALP) and alanine aminotransferase (ALT) was slightly elevated that indicate hepatotoxic nature of plant extracts. The level of gamma-glutamyl transferase (GGT), bilirubin and HbA1C level were restored to normal range. A slight reduction in body weight (P>0.05) of treated groups was observed. Serum urea and creatinine concentration was restored to normal level in treated rats with regeneration of kidney function. Conclusions: The study concluded that individual and combined plant extract show anti-hyperglycemic effect but the combined remedy at this dose show hepatotoxicity.

Aim To identify the types of glaucoma and associated comorbidities among patients attending the ophthalmology clinic at King Abdulaziz Medical City (KAMC) in Jeddah. Methods A cross-sectional study that included all glaucoma patients at KAMC in Jeddah between June 1st, 2016 and November 30th, 2020. Data were collected through retrospective chart review from the electronic medical record system (BestCare) and utilized a structured data collection sheet. Results A total of 283 patients met the inclusion criteria. The most common type was primary open-angle glaucoma (POAG; 53%) followed by secondary glaucomas (SG; 26.5%) then childhood glaucoma and primary angle-closure glaucoma (CG, PACG; 7.4%). The majority of secondary glaucoma cases were due to neovascular glaucoma (NVG; 44.9%), followed by phacomorphic glaucoma (17.9%) and phacolytic glaucoma (10.3%). Hypertension (60.8%) and diabetes (58.3%) were the most prevalent systematic comorbidities, and cataract (49.1%) was the most prevalent ocular comorbidity. Conclusion POAG was the most common glaucoma type, followed by SG, CG, and PACG. Among secondary glaucoma types, neovascular glaucoma was found to be the most common subtype. Hypertension was the most prevalent comorbid condition.

Takotsubo cardiomyopathy (TTC) is a reversible form of myocardial injury characterized by transient systolic and diastolic dysfunction secondary to regional left ventricle (LV) wall motion abnormalities. We present a case of a rare variant of TTC, termed reverse TTC (rTTC), involving basal hypokinesis with apical hyperkinesis accounting for less than 5% of identified cases of TTC. Our patient is a 49-year-old Hispanic female who presented for evaluation of dyspnea. She was diagnosed with acute asthma exacerbation. The patient admitted to more frequent use of her albuterol rescue inhaler. Over the course of her hospitalization the patient had elevation of Troponin I and underwent an echocardiogram and coronary angiogram, which revealed the diagnosis of rTTC in the setting of inhaled beta agonist overuse for acute asthma exacerbation. Our case highlights the importance of adequately managing asthma to prevent exacerbation and overuse of inhaled sympathomimetic agents in an effort to decrease the incidence of TTC in the asthmatic population.

Visceral artery aneurysms, which could be either true or pseudo, are abnormal focal dilations of vessels supplying the abdominal organs. True aneurysms, by definition, suggest dilation of the vessel in response to increased blood flow, ultimately causing a blood-filled sac to form. Pseudoaneurysm, however, is the pooling of blood in surrounding tissues secondary to trauma or rupture. A 43-year-old woman G9 P9, known hypertensive was admitted electively for investigation of melena, hematemesis, hematochezia for one week along with weight loss and epigastric pain. Laboratory studies showed mild anemia with a hemoglobin level of 9.6 g/dL, hematocrit 29.5%, mean corpuscular hemoglobin (MCH) 26.7, upon which she was transfused two pints of blood and commenced at Injectable Vitamin K, injectable transamine, and infusion omeprazole. Two days later her levels improved to HB 12.4 g/dL, hematocrit 37.5%, MCH 26.7 pg, RBC 4.64 × 10*12/L. while being on treatment, a computed tomography (CT) mesenteric angiography was also conducted that showed multiple splanchnic pseudoaneurysms involving celiac axis trifurcation, gastroduodenal artery, superior/inferior pancreaticoduodenal artery, and jejunoileal branch of the superior mesenteric artery, and a large partially thrombosed pseudoaneurysm arising from superior pancreaticoduodenal branch causing significant mass effect on the second part of duodenum. On the basis of such findings, it was advised to perform coiling and embolization of the corresponding arteries. Multiple other small aneurysms with secondary arteriovenous malformations (AVM) were also seen. The whole circuit of flow retrograde and antegrade along with the aneurysm sac was blocked with multiple coils of variable sizes. An angiogram was repeated that revealed a good outcome. Pseudoaneurysms of the visceral arteries are very rare and affect mainly the splenic artery. The rarest of which is gastroduodenal artery (1.5%), pancreaticoduodenal artery (2%), and coeliac truck (4%). Therefore, this can be an incidental finding. The diagnosis is usually made with an angiography combined with clinical presentation. Variable treatment options are available depending on the patient’s fitness and hemodynamic stability. The endovascular approach, however, is mostly used in such cases.

RATIONALE: An age-related mortality risk has been discovered during the COVID-19 pandemic;the elderly being at greater risk. This could be explained by age-related impairment of immunity. Social factors such as congregate housing could also play a role[1]. Similarly, cancer patients have been identified as being high-risk for mortality. Thromboembolic events arising as a result of a cytokine storm has been theorised as a potential cause of death as illustrated in figure 1[2]. Previous studies have highlighted male sex as being another high-risk group for morbidity and mortality[2] . We aim to investigate the effects of age, gender and active cancer on the mortality rate and the length of in-patient stay in patients with COVID-19. Methods: A retrospective study of all in-patients aged ≥ 18 years with a confirmed diagnosis of COVID-19 during the first wave of the pandemic. Statistical analysis was performed using the chi squared and Mann-Whitney U test. Results: 445 COVID-19 positive patients were included in the study, of which 69 had active cancer, 329 were aged 65 years. The study contained 261 males and 263 females. Mortality in patients with active cancer was higher (70%) compared to those without active cancer (48%) (P=0.001). There was no significant difference in the number of patients who had an inpatient stay of >7 days between both groups. We also found that there was a higher mortality rate in patients aged > 65 years (61%) compared to those aged 65 years staying >7 days in-hospital (63%) compared to those aged 7 days between male and female patients. However, interestingly males had a greater intubation rate (14%) compared to females (6%) (P=0.025). Conclusion: Our study demonstrated increasing age and active cancer status to be linked to greater risk of mortality. Furthermore, males showed a more severe disease course as compared to females. This data should be considered when highlighting at risk groups and prioritising them for treatment and isolation. Figure 1-A potential mechanism of death in COVID-19 patients References: 1. Kang SJ et al Age-related Morbidity and Mortality among patients with COVID-19. Infect Chemother 2020;52(2):154-164 2. Curigliano G et al Cancer Patients and Risk of Mortality for COVID-19. Cancel Cell 2020;38(2):161-163.

Background: Antibiotic resistance is a threatening issue to human wellbeing and an obstacle in the treatment process of many life-threating illnesses. This study aims to assess the knowledge and attitudes toward antibiotic usage among the general population in Jeddah, Saudi Arabia. Methods: A self-administered cross-sectional survey of 460 participants was distributed among the general population in Jeddah in the form of a validated questionnaire. Sample size was calculated to be 460 adults of either gender. Descriptive and inferential statistical analyses were performed using the Statistical Package for Social Sciences. Results: the age of more than half of participants (55.6%) was 18–30 years old, followed by the age group 31–40 years old (26.6%), with the smallest age group &gt, 60 years old (1.9%). More than two thirds of participants were male (69.5%), while 131 were female, accounting for 30.5%. Almost one third of participants had poor knowledge about antibiotics (30.5%), 51.0% had used antibiotics without any prescriptions, 54.6% of participants thought antibiotics could be used to treat viral infections, and 55.1% thought it was acceptable to stop taking antibiotics if symptoms start to improve. In addition, 49% believed that taking antibiotics would help them get better more rapidly when suffering from the common cold. Some personal characteristics were significantly associated with the public’s knowledge (e.g., age, education, and monthly income) and their attitudes (e.g., monthly income). Conclusion: Findings revealed a low level of knowledge on the use of antibiotics among the general public in Jeddah. This study signifies the need for improvement in the public’s knowledge and enhancement of their attitudes toward proper utilization of antibiotics.

Asymmetric hypertrophy (ASH) of interventricular septum or subaortic septal bulge is associated with an increased angulation of aorta to the left ventricular outflow axis and development of dynamic left ventricular outflow tract (LVOT) obstruction following aortic valve replacement [(1)][1]. In

Chronic pancreatitis is a fairly common condition with pain being the major symptom and longitudinal pancreaticojejunostomy (LPJ) is performed for symptomatic relief. The aim of the study is to assess the outcome of LPJ for chronic calcific pancreatitis and to evaluate the factors influencing relief of symptoms. A prospective observational study enrolling 28 patients was conducted in the department of surgery of Shaheed Suhrawardy Medical College Hospital from January 2018 to December 2018. This study involved identification of various risk factors related to chronic pancreatitis, pancreaticojejunostomy, early post-operative outcome and postoperative assessment of pain relief at 1 and 6 months from surgery. Pain was assessed using Visual analogue scale (VAS). In chronic pancreatitis, there is a significant relief of pain in post-LPJ; the degree of relief was less in the alcoholics than non-alcoholics (p=0.09) and in smokers. There was also reduction in analgesic requirement and frequency of acute attacks of pain. In chronic pancreatitis, there is a significant relief of pain in post-LPJ, although the degree of relief is less in the alcoholics and smokers. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 13-16

The incidence of dengue in Malaysia has shown an increasing trend since the year 2000. Vector control is the primary approach for dengue control in Malaysia. There is an urgent need for new or modified approaches such as the residual spraying on the outer walls that can potentially last long enough to control the Aedes population, particularly in the outbreak-prone areas. In this field study, we conducted outdoor residual spraying (ORS) using a newly formulated polymer-enhanced suspension concentrate (SC-PE) of deltamethrin. The objectives of this study were to evaluate the efficacy of ORS using deltamethrin SC-PE and its effect on wild Aedes populations and to assess its residual bio-efficacy on painted cement walls against the pyrethroid-susceptible strains of laboratory-reared Aedes mosquitoes. Three rounds of spraying in a four-month cycle were conducted between 2014 and 2015 in four residential areas (low-rise and high-rise housing types) in Hulu Langat, Selangor. The bio-efficacy of the insecticide was evaluated by assessing its impact on vector population using ovitrap surveillance. Standard WHO wall deposit bioassay was adapted to determine bio-efficacy of deltamethrin, i.e. post 30 min knockdown and post 24 h mortality after exposure. During the treatment period, we observed significant reductions in the population of Ae. albopictus in the sprayed low-rise housing in both semi-indoor and outdoor environments, while in the high-rise housing, there was also a significant decline in Ae. aegypti population in the semi-indoor environment. The evaluation of the residual bio-efficacy of deltamethrin SC-PE against laboratory-reared Aedes mosquitoes showed that the insecticide lasted longer in the high-rise housing compared to the low-rise housing with >80% mortality achieved continuously for 16 weeks. We provide initial evidence on residual efficacy of deltamethrin SC-PE in reducing Aedes population size in the low-rise and high-rise housing. Our results showed that ORS is a promising tool in the dengue vector control and like IRS in malaria control; it is a powerful and effective method if conducted correctly. However, large scale and well-designed studies with entomological and epidemiological endpoints are still warranted before its routine use in dengue control.

Background: In a remote district city of Bangladesh, inguinal hernias were repaired by Maloney (Darning) method.Efficacy of Darning repair was compared in this study.Aims and Objectives: The aim of this study was to determine the feasibility of doing Maloney ( Darn ) repair for adult inguinal hernias by specialist surgeons at remote districts . Age of the patients in ourstudy were above 20 years.Study Design: A descriptive retrospective study.Materials and Methods:In our study we included 2000 patient of inguinal hernia surgery repairs from May 2012 through June 2017. In the patients of the study group we repaired inguinal hernia by Maloney ( Darning) technique. Number of patients were 2000 ( male 1990 [99.5%] female 10 [.5%] with a mean age of 45.7 years. There were 1002(50.1%) hernias on the right side, 890(44.5%) were on the left side and 108(5.4%) were bilateral. Among the hernias 1419 ( 70.9%) were indirect, 575 (28.7%) were direct and 4 (0.2%) were of both direct and indirect (Pantoolon type), 2 (0.1%) were of femoral hernia. All were of primary hernias, recurrent hernias and hernias in patients with apparently weak musculature were repaired by Lychtenistein method with prolein mesh and were not included in this stpudy. 60 (3%) patients had feature of incarceration and 20 (1%) patients presented with obstruction. Among the obstructed hernias 8 (.4%) had strangulation and in 2 (.1%) resection and anastomosis were required for gangrenous ileum. In rest of the cases of strangulation circulation returned after incising the constricting ring and hot mob compression. We used IV antibiotic for 24 hours stated with induction of anaesthesia followed by oral for next 6 days. We used Injection Ceftrixone followed by Cefixime and in some patients Flucloxacillin.Statistics Analysis Used: Simple frequencies, proportion and cross tabulation.Results: Average duration of surgery was 70 minutes. There was no perioperative mortality. 90 (4.5%) patients developed mild subcutaneous wound infection, haematoma occurred in 160 ( 8% ) patients and seroma found in 300 ( 15% ) patients. All haematoma and seroma subsided gradually. Only 1 patient needed secondary closure for infected wound gap. The average duration of hospitalization was 3 days. All patients in study group are still in contact with me. Three patients (0.15%) had recurrences. All the recurrent cases reported within 6 months of their operations. Among the three age of 2 patients was above 60 and one patient of age above 70 had Maloney hernia repair for obstructed hernia.Conclusion:In remote places where prolene mesh is not available or is costly we can repair inguinal hernia by Maloney operation with very simple antibiotics with good results in comparison with other methods.J Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 6-10

Glaucoma is a severe eye disease that is known to deteriorate optic never fibers, causing cup size to increase, which could result in permanent loss of vision. Glaucoma is the second leading cause of blindness after cataract, but glaucoma being more dangerous as it is not curable. Early diagnoses and treatment of glaucoma can help to slow the progression of glaucoma and its damages. For the detection of glaucoma, the Cup to Disc ratio (CDR) provides significant information. The CDR depends heavily on the accurate segmentation of cup and disc regions. In this paper, we have proposed a modified M-Net with bidirectional convolution long short-term memory (LSTM), based on joint cup and disc segmentation. The proposed network combines features of encoder and decoder, with bidirectional LSTM. Our proposed model segments cup and disc regions based on which the abnormalities in cup to disc ratio can be observed. The proposed model is tested on REFUGE2 data, where our model achieves a dice score of 0.92 for optic disc and an accuracy of 98.99% in segmenting cup and disc regions.

The prevalence of overnutrition among primary school aged children, which ranges from the risk of obesityglobally including Indonesia, is currently increasing. This study aimed to assess the difference in behaviorchange in physical activity and habit of soft drinks consumptions before and after the intervention withthe dissemination method of resources and information. The research was conducted at primary schools inMakassar City. This research used a Quasy Experiment approach with a pretest and post-test examinationthrough control group design. The study was conducted for 3 months by providing health information relatedto overnutrition and obesity while monthlyvisit or monitoring of children was carried out using a 24 hourfood recall. The sampling technique was carried out by means of proportional random sampling. Data wereanalyzed by univariate, bivariate, and multivariate analysis. The results showed that there was an effect ofdissemination of resources and information on physical activity (p = 0.000) and soft drink consumptionhabits (p = 0.000) before and after the intervention. The conclusion is that the application of the method ofdissemination of resources and information is effective in changing the behavior of preventing overnutritionin primary school children. It is expected that efforts in schools such as the method of dissemination ofresources and information with peer education will become a reference in efforts to prevent more nutritionin improving students’ healthy eating patterns through dissemination of resources and information.

Background Corneal diseases are a significant cause of visual impairment and blindness. Despite the treatable nature of many corneal diseases before visual demise, many cases of advanced disease necessitating keratoplasty for visual rehabilitation are encountered. A mismatch between the number of corneal donors and potential recipients also exists worldwide, with underutilization of certain types of keratoplasty techniques that may allow more efficient use of this limited resource. Methodology A retrospective cohort study of all cases of optical corneal transplantations performed from January 1, 2015 to October 31, 2020 was performed. Indications for keratoplasty, type of keratoplasty, complications, intraocular pressure elevation, and best corrected visual acuity (BCVA) by category and range at different time intervals were collected and analyzed. Findings were compared between penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) for all indications, specifically for keratoconus (KCN). Results A total of 58 corneal transplants meeting our criteria were performed during the study period. PK was performed for 29 eyes, DALK for 28 eyes, and endothelial keratoplasty for one eye. The most frequently encountered indication was KCN (62.1%). The number of eyes with BCVA of 20/100 or better increased from preoperative BCVA, 37/58 eyes had BCVA worse than 20/100 before keratoplasty (63.8%), while at the time of last follow-up 45/58 eyes had BCVA of 20/100 or better (77.6%). At the time of last follow-up 16/58 had BCVA in the range of 20/20 to 20/40 (27.6%) and 29/58 eyes had BCVA in the range of 20/50 to 20/100 (50%). Comparison of all cases of PK to DALK for all indications showed significantly better BCVA by category at one year, at last follow-up, and BCVA range at last follow-up (p = 0.032, 0.001, and 0.014, respectively). Although better visual acuity results by category and range at one year and last follow-up, respectively, were observed in more patients undergoing DALK than PK, for KCN the results were not statistically significant (p = 1.00, 1.00, 0.417, and 0.374, respectively). Overall, 70% of recorded complications, intraocular pressure (IOP) elevations, and graft rejections were seen in eyes that underwent PK; however, these findings were not statistically significant (p = 0.297). Graft failures occurred more frequently with PK than deep anterior keratoplasty when analyzed for all indications of keratoplasty (p = 0.010). Conclusions Despite advancement and improvements in surgical techniques, statistics continue to show underutilization of the invaluable resource of donor corneas, with PK still being performed more than DALK for diseases that do not affect the endothelium. Our study found superior visual acuity outcomes of DALK as well as the advantages of less frequent complications, IOP elevations, graft rejections, and graft failures. We encourage ophthalmologists to utilize DALK in appropriate candidates to more fully utilize the scarce and potentially vision-restoring resource of donor corneal tissue.

Background: Metabolic syndrome (MS) has become one of the major challenges to public health worldwide due to its significant association with increased risk of developing type 2 diabetes and cardiovascular disease (CVD) among children and adolescents. Therefore, this study aims to determine the prevalence and risk factors of MS in Saudi adolescents. Methods: This cross-sectional study was conducted in two female National Guard schools (Um Kalthoom Intermediate School and Zainab Bint Jahsh Secondary School) in Jeddah, Saudi Arabia, between January 2018 and March 2018. Of the 808 female students, 172 (age range of 12–19 years) participated voluntarily, with consent from their guardian(s), fasted for at least 8 h prior to the study, and represent the final study sample. Male students were not included due to cultural constraints in conducting the study. Demographic data, physical measurement (blood pressure, weight, height, body mass index (BMI) and waist circumference (WC)), and biochemical measurement (fasting plasma glucose and triglycerides, high-density lipoprotein (HDL), and low-density lipoprotein) were obtained. The International Diabetes Federation (IDF) criteria was utilized in the diagnosis of MS. Results: Of the 172 female adolescents, 24 (13.75%) are overweight, 20 (11.63%) are obese, and 3 (1.74%) are underweight. High-fasting plasma glucose (n = 85, 49.41%) and high waist circumference (n = 74, 43.02%) were the most common risk factors of MS among female adolescents. The overall prevalence of MS was 7% (n = 12/172). MS is more common among those who are obese or among those with a BMI that falls at the ≥95th percentile (n = 6/20, 30.0%) (p &lt, 0.05) as compared to those who are overweight with a BMI that falls within the 85th to &lt, 95th percentiles (n = 2/24, 8.33%). Interestingly, 3.20% of the sample (n = 4/125) with normal BMI were diagnosed with MS. Conclusions: Our study indicates that MS is common among obese and overweight female adolescents but is also present among those who are not obese or with normal BMI. Moreover, the prevalence of overweight, obese, and those with MS in this reference population are lower compared to the cities of Makkah and Riyadh, however, it varies widely around the world due to different criteria and cut-off values in the diagnosis of MS.

Background: Diabetic patients are at greater risk for many complications. They also are considered to be in hypercoagulable state. Larger platelets are associated with a prothrombotic states because larger platelets are more active. Patients with type 2 diabetes mellitus are usually found to have an elevated MPV. Albuminuria is a very important predictor for both cardiovascular complications and diabetic nephropathy. We aimed in this study to find the association between MPV in diabetic patients and microalbuminuria, HbA1c level, duration of DM, body mass index (BMI), hypertension, stroke, and ischemic heart disease. Methods: A cross sectional quantitative study of diabetic patients. The data was collected retrospectively from the patients’ electronic files. It included 480 diabetic patients from June 2016 until December 2020. Sample size consisted of 480 patients and it included both male and female patients who are 18 years or older. The data that was collected included gender, duration of DM, HTN, IHD, history of stroke, MPV, albuminuria, BMI and HbA1c. Results: There was no statistically significant association between MPV and most of the designated variables including Gender, IHD, Stroke, HTN and Albuminuria. Furthermore, there was no association between MPV and albuminuria according to blood sugar level. It was also found that the higher the albuminuria the higher the MPV; the mean MPV increases in patients with increased albuminuria. Conclusions: MPV and albuminuria were positively correlated. MPV was higher in the controlled diabetes group. However, the association was not statistically significant.

Background Poor cosmesis, secondary to keloid or hypertrophic scar, following thyroid surgery may cause considerable patient distress and be a significant challenge to treat. In this case series we examined the efficacy of prophylactic external beam radiation therapy (EBRT) for prevention of keloid formation in keloid-prone patients undergoing thyroid surgery. While much has been published about documenting the efficacy in reducing keloid formation following keloid excision, very little literature exists documenting prophylactic use related to surgeries with the goal of prevent de novo keloid formation. Methods We retrospectively evaluated a series of ten patients, who underwent a prophylactic EBRT for keloid prevention after thyroid surgery between January 2013 and February 2019. Patient demographics, primary diagnosis, surgical procedure, EBRT dosage, and post-operative visit records were reviewed. Results All ten patients who received EBRT for keloid prophylaxis following a thyroid surgery were female. Half of the patients were African Americans, 40% Caucasians, and 10% Hispanic. The mean age was 46.40±15.63 years with BMI of 31.5±5.5 kg/m2. Radiation was initiated within 6 hours of the surgery with an average radiation dose per session of 5.7±1.7 Gy. The total average EBRT dose delivered was 17.4±4.2 Gy. Mean follow-up period was 13 months post-thyroidectomy, with the longest follow-up at 23 months. One patient, who underwent a lateral neck dissection in addition to thyroid surgery, developed hypertrophic scar in less than 10% of her incision length. Nine other patients (90%) showed no post-surgical keloid nor hypertrophic scar formation and patients were satisfied with postsurgical cosmesis. Conclusions We examined the efficacy of prophylactic EBRT in keloid-prone patients undergoing thyroid surgery. Prophylactic EBRT following thyroid surgery is effective in achieving a satisfactory cosmetic outcome in patients at high risk for keloid formation.

Multimodal pain management is the most effective way to treat postsurgical pain. However, the use of opioids for acute pain management has unfortunately been a significant contributor to the current opioid epidemic. The use of opioids should be limited and only considered a “rescue” pain medication after other modalities of pain management have been utilized. It may be difficult to curtail the use of opioids in the treatment of chronic pain; however, in the postsurgical setting, there is compelling evidence that an opioid-centric analgesic approach is not necessary for good patient outcomes and healthcare cost benefits. Opioid-related adverse effects are the leading cause of preventable harm in the hospital setting. After the realization in recent years of the many harmful effects of opioids, alternative regimens including the use of multimodal analgesia have become a standard practice in acute pain management. Exparel, a long-lasting liposomal bupivacaine local anesthetic agent, has many significant benefits in the management of postoperative pain. Overall, the literature suggests that Exparel may be a significant component for postoperative multimodal pain control owing to its efficacy and long duration of action.

Objective: To determine the frequency, pattern and outcome of early complications after endoscopic third ventriculostomy (ETV) in Obstructive hydrocephalus. Material and Methods: The study included 160 patients from Neurosurgery department, Lady Reading Hospital Peshawar and private clinics over a period of twelve months. After performing ETV under general anesthesia by a single expert neurosurgeon, the patients were followed up for seven days post operatively for the CSF leak, wound infection, meningitis, seizures, bleeding and in hospital death. Results: Eighty five percent of the patients had no untoward complications, while 15% showed complications including CSF leak (5%), wound infection (3%), meningitis (2%), seizures (2%), bleeding (2%) and in hospital death (1%). Conclusion: Due to the less invasive nature, endoscopic third ventriculostomy is favored for treating obstructive hydrocephalus in select patient population as it is safe and have better outcomes.

Background Atrial septal defect secundum (ASD II) is the commonest of the congenital heart diseases in the adult population and the closure of ASD II causes a significant improvement in hemodynamics and the clinical status of the patient. However, it carries certain risks, especially the development of post-closure pulmonary edema and congestive cardiac failure, which may lead to death. Therefore, this study was designed to share our experience and to evaluate the immediate and short-term outcomes of percutaneous closure of ASD II in adult patients presenting at a tertiary care cardiac center in Karachi, Pakistan. Methodology In this study, we included 30 adult (≥ 40 years) patients who underwent percutaneous ASD II closure at the pediatric cardiology department of the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan, between June 1, 2017, and July 31, 2019. Data for this study were extracted from a prospectively collected departmental database. Extracted data for this study consisted of demographic profile, comorbid conditions, echocardiographic findings, cardiac catheterization data, pre and post six-month electrocardiographic findings, and New York Heart Association (NYHA) Functional Classification (FC). Results Out of 30 adult patients, 18 (60%) were female. The mean age of the patients at the time of ASD closure was 51.43 ± 7.09 years, ranging between 40 and 67 years. None of the patients had any post-intervention complications. Mean systolic pulmonary artery pressure (SPAP) on cardiac catheterization pre-implantation was 49.8 ± 16.3 mmHg range was 20-90 mmHg while SPAP immediately after device implantation was 37 ± 11.4 range 20 to 65 mmHg with p

Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome affecting adults and children. Collapsing focal segmental glomerulosclerosis (FSGS), one of five histologic variants of FSGS is described as segmental or global collapse and sclerosis of the glomerular tufts and has been frequently associated with human immunodeficiency virus-associated nephropathy (HIVAN). Its association with other viral and non-viral causes, medications and other disease states has since been established. Due to its resistance to therapy, rapid progression to end-stage renal disease (ESRD) and overall poorer prognosis, identification with electron microscopy examination of the kidney biopsy sample is required during evaluation.

Background & Objectives: Heart diseases in paediatric population are considered to be significant contributors to mortality and morbidity. Congenital heart disease (CHD) as well as acquired heart disease (AHD) are frequent causes of hospital admission among children. This study was aimed at finding out frequency and pattern of heart diseases in admitted patients at The Children’s Hospital, Multan. Methods: This study is a retrospective chart review of five years at Paediatric Cardiology Department of The Children’s Hospital and The Institute of Child Health, Multan, Pakistan, from January 2015 to December 2019. Children aged one month to 15 years, admitted as a diagnosed case of heart disease on the basis of echocardiography were included. Results: Out of a total of 4115 confirmed cases of heart disease admitted during the study period, 3250 (79.0%) were CHD while 865 (21.0%) were AHD. Overall, 2861 (69.5%) patients were aged less than one year. VSD followed by ASD were the commonest acyanotic heart lesion seen among 927 (28.5%) and 644 (19.8%) cases while TOF was the commonest cyanotic type heart lesion found in 396 (12.2%). Rheumatic heart disease (RHD) was the commonest type of AHD, seen in 330 (38.2%) cases followed by acute myocarditis found in 230 (26.6%) cases. Conclusion: Burden of heart diseases is rising in our region. VSD, ASD and TOF were the most common types of CHDs while RHD and acute myocarditis were the most frequent types of AHDs. doi: https://doi.org/10.12669/pjms.36.6.2312 How to cite this:Arshad MS , Anwar-ul-Haq HM, Adnan M, Zulqarnain A. Frequency and pattern of Paediatric Heart Diseases: Five years experience at The Children’s Hospital, Multan. Pak J Med Sci. 2020;36(6):1308-1312. doi: https://doi.org/10.12669/pjms.36.6.2312 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OBJECTIVE: To document the measures adopted during the COVID-19 pandemic strict lockdown on pediatric surgical services and residents' training at a tertiary care hospital. STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Department of Pediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, from April 2020 to June 2020. METHODOLOGY: Data from the Outpatient Department, Emergency Department, and Operation Theatre records were collected. The number of patients seen in the outpatient department, surgeries performed, index emergency cases dealt with, and the residents' duty roster and teaching methodology were documented. Descriptive statistics were used for reporting. RESULTS: During the strict lockdown period, outpatient services continued;however, elective cases were not operated. A total of 2,930 patients were seen in clinics, and 1,316 surgical procedures were performed. The index cases managed included anorectal malformation (n=35), esophageal atresia with and without tracheoesophageal fistula (n=13), small bowel atresia (n=11), omphalocele (n=6), acute appendicitis (n=35), intestinal obstructions (n=23), intussusceptions (n=18), and intestinal perforations (n=16). On-call days of residents were reduced from every third to the fifth day, and online educational sessions were added. During the pandemic, 13 members of surgical and anaesthesia teams got infected with COVID-19. CONCLUSION: COVID-19 pandemic elective surgical services were restricted;however, emergency cases were managed as per routine. In clinical teaching, virtual technologies were incorporated. Working hours of residents were limited to decrease the exposure to infected persons. Key Words: COVID-19, SARS-CoV-2 pandemic, Healthcare workers, Residency programme.

Dystrophic epidermolysis bullosa is an inherited skin disorder characterized by fragile skin that is prone to blistering. We report here a consanguineous Pakistani family with two siblings, in whom a severe recessive dystrophic epidermolysis bullosa was suspected. Using whole-exome sequencing for one sibling, the homozygous base substitution c.7249C>G in COL7A1 was identified, and could be confirmed in the other sibling by Sanger sequencing. In our exome data, this mutation was annotated as a missense substitution (p.Gln2417Glu), but in silico tools indicated a possible effect on splicing. Using the ExonTrap vector it was verified that the mutation leads to activation of a cryptic donor splice site, which leads to loss of 26 nucleotides, and a frame-shift event predicted to result in a truncated protein (p.Q2417Sfs*57). The present report de-scribes an apparent COL7A1 missense substitution with an unexpected consequence on splicing that leads to a severe recessive dystrophic epidermolysis bullosa phenotype.

Background:This study aims to compare the outcomes of COVID-19-positive disease in patients with a history of cancer to those without.Methods:We retrospectively collected clinical data and outcomes of COVID-19 positive cancer patients treated consecutively in five North London hospitals (cohort A). Outcomes recorded included time interval between most recent anti-cancer treatment and admission, severe outcome [a composite endpoint of intensive care unit (ITU) admission, ventilation and/or death] and mortality. Outcomes were compared with consecutively admitted COVID-19 positive patients, without a history of cancer (cohort B), treated at the primary centre during the same time period (1 March–30 April 2020). Patients were matched for age, gender and comorbidity.Results:The median age in both cohorts was 74 years, with 67% male, and comprised of 30 patients with cancer, and 90 without (1:3 ratio). For cohort B, 579 patients without a history of cancer and consecutively admitted were screened from the primary London hospital, 105 were COVID-19 positive and 90 were matched and included. Excluding cancer, both cohorts had a median of two comorbidities. The odds ratio (OR) for mortality, comparing patients with cancer to those without, was 1.05 [95% confidence interval (CI) 0.4–2.5], and severe outcome (OR 0.89, 95% CI 0.4–2.0) suggesting no increased risk of death or a severe outcome in patients with cancer. Cancer patients who received systemic treatment within 28 days had an OR for mortality of 4.05 (95% CI 0.68–23.95), p = 0.12. On presentation anaemia, hypokalaemia, hypoalbuminaemia and hypoproteinaemia were identified predominantly in cohort A. Median duration of admission was 8 days for cancer patients and 7 days for non-cancer.Conclusion:A diagnosis of cancer does not appear to increase the risk of death or a severe outcome in COVID-19 patients with cancer compared with those without cancer. If a second spike of virus strikes, rational decision making is required to ensure optimal cancer care.

Background : An emergency department is a medical treatment facility which is specialized emergency medicine, the acute care of patients who present without any prior appointment either by their own means or by that of an ambulance. Objective: To determine the efficiency of emergency services in a tertiary care hospital. Methodology : It was a cross sectional study, conducted at Emergency Department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from August to October, 2019. A total of 139 subjects who were patients attending emergency department were involved in the study by using random sampling technique. Data was collected by a pre-designed proforma. Variables included were age, sex, occupation, door to treatment time, presenting complaints of patient, designation of health care provider, further investigation advised, given treatment, referral to OPD or ward. Results: Mean age of patients was 33±19 years. Out of 139 patients, 59.7% were males and from urban area each, 44.6% were illiterate, 75% of the study subjects were treated by a doctor, and 25.9% came with GIT complaints. It was noted that 48.2 % of the patients had the first contact within 4 minutes, and treatment of 49.7% patients was started within 10 minutes, and 3.5% of the patients it took more than 25 minutes. Conclusion : This study showed that almost half of the patients received treatment within four minutes while few of the patients have to wait for upto twenty five minutes to get healthcare, which is quite a long time as for as emergency healthcare services is concerned., additionally only half of the patients were received by doctors.

BackgroundFour months after the first known case of the 2019 novel coronavirus disease (COVID-19), on the 11th March 2020, the WHO declared the outbreak a pandemic and acknowledged the potential to overwhelm national healthcare systems. The high prevalence and associated healthcare, social and economic challenges of COVID-19 suggest this pandemic is likely to have a major impact on cancer management, and has been shown to potentially have worse outcomes in this cohort of vulnerable patients (1). This study aims to compare the outcomes of reverse transcriptase polymerase chain reaction (RT-PCR) confirmed COVID-19 positive disease in patients with or without a history of cancer.MethodWe retrospectively collected clinical, pathological and radiological characteristics and outcomes of COVID-19 RT-PCR positive cancer patients treated consecutively in four different North London hospitals (cohort A). Outcomes recorded included morbidity, mortality and length of hospital stay. All clinically relevant outcomes were then compared to consecutively admitted COVID-19 positive patients, without a history of cancer (cohort B), treated at the primary centre during the same time period (12th March-7th April 2020).ResultsA total of 52 electronic patient records during the study time period were reviewed. Cohort A (median age 76 years, 56% males) and cohort B (median age 58 years, 62% male) comprised of 26 patients each. With the exclusion of cancer, both had a median of 2 comorbidities. Within cohort A, the most frequent underlying cancer was colorectal (5/26) and prostate cancer (5/26), and 77% of patients in Cohort A had received previous anti-cancer therapy. The most common presenting symptoms were cough and pyrexia in both cohorts. Frequent laboratory findings included lymphopenia, anaemia and elevated CRP in both cohorts, whilst hypokalaemia, hypoalbuminaemia and hypoproteinaemia was predominantly seen amongst patients with cancer. Median duration of admission was 7 days in both cohorts. The mortality rate was the same in both cohorts (23%), with median age of mortality of 80 years. Of cancer patients who died, all were advanced stage, had been treated with palliative intent and had received anti-cancer therapy within 13 days of admission.ConclusionOld age, late stage of cancer diagnosis and multiple co-morbidities adversely influence the outcome of patients with COVID-19 positive patients. Whilst extra caution is warranted in the administration of anti-cancer therapies pertaining to the risk of immune-suppression, this data does not demonstrate a higher risk to cancer patients compared to their non-cancer counterparts.

The physiological role of prolactin (PRL) in the heart, and in particular the diabetic heart, are largely unknown. The effects of PRL on ventricular myocyte shortening and Ca2+ transport in the streptozotocin (STZ) – induced diabetic and in age-matched control rats were investigated. PRL receptor protein, myocyte shortening, intracellular [Ca2+], L-type Ca2+ current were measured by Western blot, cell imaging, fluorescence photometry and whole-cell patch-clamp techniques, respectively. Compared to normal Tyrode solution (NT), PRL (50 ng/ml) significantly (p < 0.05) increased the amplitude of shortening in myocytes from control (7.43 ± 0.38 vs. 9.68 ± 0.46 %) and diabetic (6.57 ± 0.24 vs. 8.91 ± 0.44 %) heart (n = 44–49 cells). Compared to NT, PRL (50 ng/ml) significantly increased the amplitude of Ca2+ transients in myocytes from control (0.084 ± 0.004 vs. 0.115 ± 0.007 Fura-2 ratio units) and diabetic (0.087 ± 0.007 vs. 0.112 ± 0.006 Fura-2 ratio units) heart (n = 36–50 cells). PRL did not significantly alter the amplitude of caffeine-evoked Ca2+ transients however, PRL significantly increased the fractional release of Ca2+ in myocytes from control (21 %) and diabetic (14 %) and heart. The rate of Ca2+ transient recovery following PRL treatment was significantly increased in myocytes from diabetic and control heart. Amplitude of L-type Ca2+ current was not significantly altered by diabetes or by PRL. PRL increased the amplitude of shortening and Ca2+ transients in myocytes from control and diabetic heart. Increased fractional release of sarcoplasmic reticulum Ca2+ may partly underlie the positive inotropic effects of PRL in ventricular myocytes from control and STZ-induced diabetic rat., Cardiology; Cell biology; Endocrinology; Molecular Biology; Pathophysiology; Pharmacology; Physiology; prolactin; Diabetes mellitus; heart; Ventricular myocytes; Contraction; Calcium

Surgery planning in patients diagnosed with brain tumor is dependent on their survival prognosis. A poor prognosis might demand for a more aggressive treatment and therapy plan, while a favorable prognosis might enable a less risky surgery plan. Thus, accurate survival prognosis is an important step in treatment planning. Recently, deep learning approaches have been used extensively for brain tumor segmentation followed by the use of deep features for prognosis. However, radiomics-based studies have shown more promise using engineered/hand-crafted features. In this paper, we propose a three-step approach for multi-class survival prognosis. In the first stage, we extract image slices corresponding to tumor regions from multiple magnetic resonance image modalities. We then extract radiomic features from these 2D slices. Finally, we train machine learning classifiers to perform the classification. We evaluate our proposed approach on the publicly available BraTS 2019 data and achieve an accuracy of 76.5% and precision of 74.3% using the random forest classifier, which to the best of our knowledge are the highest reported results yet. Further, we identify the most important features that contribute in improving the prediction.

Malnutrition like hunger, deficiency of essential nutrients, and obesity is affecting more than 2 billion people worldwide. In mineral malnutrition, iron (Fe) and zinc (Zn) deficiency affect a very large portion of the global population. The deficiency of Fe is responsible for the initiation of anemia as Fe is the main part of hemoglobin, while Zn deficiency causes decreased immunity and retarded growth in humans. Keeping in mind the worldwide issue of Fe and Zn malnutrition, various practices are being proposed to add these minerals to human food. In this regard, biofortification is an attractive approach, and cereals being global staple food, if fortified, can significantly compensate for this issue. Cereal biofortification with Fe and Zn can be done via agronomic practices, breeding for efficient accumulators, and chemical fortification of cereal grains. Agronomic biofortification in this regard is the most efficient and acceptable approach, in which we grow cereals with significant availability of Fe and Zn, so that these metals can accumulate in edible portions of crops. Besides this, genetically engineered crops derived from biotechnology, conventional breeding, and artificial fortification are some other possible options being opted to cope with this issue. In recent advances, the use of soil conditioners and the application of various soil amendments have gained a pace to ensure a consistent supply of Fe and Zn to crop plants for insuring significant fortification. Among these amendments, biofertilizers containing Fe and Zn solubilizing bacteria or bacterial metabolites, and exogenous application of Fe and Zn compounds are most prominent. Though a wide range of Fe and Zn fortified food products are available in the market along with derived supplements, but cereal’s biofortification is the most economical and practical technique for the developing world. This chapter is an effort to discuss in detail, the worldwide issue of Fe and Zn deficiency coupled with the role of biofortification of Fe and Zn to counter this issue.

Artificial intelligence (AI) enabled radiomics has evolved immensely especially in the field of oncology. Radiomics provide assistance in diagnosis of cancer, planning of treatment strategy, and prediction of survival. Radiomics in neuro-oncology has progressed significantly in the recent past. Deep learning has outperformed conventional machine learning methods in most image-based applications. Convolutional neural networks (CNNs) have seen some popularity in radiomics, since they do not require hand-crafted features and can automatically extract features during the learning process. In this regard, it is observed that CNN based radiomics could provide state-of-the-art results in neuro-oncology, similar to the recent success of such methods in a wide spectrum of medical image analysis applications. Herein we present a review of the most recent best practices and establish the future trends for AI enabled radiomics in neuro-oncology.

Anxiety is a psycho-physiological phenomenon related to the mental health of a person. Persistence of anxiety for an extended period of time can manifest into anxiety disorder, which is a root cause of multiple mental health issues. Therefore, accurately detecting anxiety is vital using methods that are automated, efficient and independent of user bias. To this end, we present an experimental study for the classification of human anxiety using electroencephalography (EEG) signals acquired from a commercially available four channel headset. EEG data of 28 participants are acquired for a duration of three minutes. Five different feature groups in time domain are extracted from the acquired EEG signals. Wrapper method of feature selection is applied, which selects features from two feature groups among the five feature groups initially extracted. Classification is performed using logistic regression (LR), random forest (RF), and multilayer perceptron (MLP) classifiers. We have achieved a classification accuracy of 78.5% to classify human anxiety by using the RF classifier. Our proposed scheme outperforms when compared with existing methods of anxiety/stress classification.

Introduction: Knowledge and attitudes towards proper antibiotic usage among students in medical and other health allied fields play a vital role in limiting the pandemic of antibiotic resistance. This study aimed to assess knowledge and attitudes toward antibiotic usage among pre-professional students at King Saud bin Abdulaziz University for Health Sciences on Jeddah Campus, Saudi Arabia. Methods: A self-administered cross-sectional survey of 347 first year students was conducted at the College of Science and Health Professions, King Saud bin Abdulaziz University for Health Sciences using a validated questionnaire. Results: Nearly 63% of the students had a moderate level of knowledge. Two third of the students (69.7%) correctly knew that antibiotics are indicated for the treatment of bacterial infections. However, about 36% of the students incorrectly thought that antibiotics are also used to treat viral infections, while 28.5% were not sure. Only 38.8% of the students were aware of antibiotic resistance phenomena in relation to the overuse of antibiotics. Furthermore, only 27.3% correctly knew that penicillin is an antibiotic, and 74.4% were not sure if Paracetamol is an antibiotic. With regard to attitudes, 25.7% believed that taking antibiotics when having cold symptoms could help them to recover faster, while 39.6% expected antibiotics to be prescribed for common cold symptoms. Conclusion: The students have misconception regarding antibiotic use indications. Therefore, awareness campaigns are needed to promote student&rsquo, s use of antibiotics in young generations particularly among the pre-professional health sciences students.

Introduction: The use of warm compresses and warm sponge techniques as a modality therapy for the management of fever in typhoid children has a good influence. The purpose of this research was to learn of the differences between conventional warm compress and the tepid sponge technique as related to the body temperature changes of pediatric patients with typhoid fever. A fever that does not get a good standard of treatment can cause dehydration, neurological damage and febrile seizures. Methods: The research design was quasi-experiment with two groups pre-post test. The population was taken from the Kampili Community Health Center while the 20 samples were taken using the purposive sampling technique. Conventional warm compresses were placed on the forehead, while warm tepid sponges were compressed and placed on the forehead, armpits and the folds of the thighs simultaneously. Results: . The data of the results were significance tested using the General linear model repeated measure (p value 0.03 for conventional warm compresses and p value 0.01 on a warm compress tepid sponge technique). Conclusion: Statistically, the warm compress tepid sponge technique is more meaningful and qualitatively, the temperature change is better after the compression.