Center In Pakistan Research Articles

Long-Term Outcome of Children With Steroid-Resistant Nephrotic Syndrome: A Single Center Experience From Pakistan

Objective: To determine the long-term outcome of children with steroid-resistant nephrotic syndrome at a single center in Pakistan. Study Design: Retrospective, observational study. Place and Duration of Study: Pediatric Nephrology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from July 2008 to June 2014. Methodology: The study included 153 children aged 4 months-12 years with steroid-resistant nephrotic syndrome. We collected data at the time of diagnosis and the last follow-up. The data was entered and analyzed by SPSS version 20. Results: Among 153 children, 84(55%) were males and 69(45%) females. At the time of diagnosis, 118(77%) were hypertensive and 65 (42.5%) had microscopic hematuria. Histopathological spectrum included focal segmental glomerulosclerosis, 63(41%); minimal change disease, 33(22%); IgM nephropathy, 9 (6%); mesangioproliferative glomerulonephritis, 26(17%), membranous glomerulonephritis, 13(8%) and membranoproliferative glomerulonephritis, 9(6%). Complete remission with cyclosporine was seen in 53(34.6%), partial remission in 36(23.5%), while 53(35%) developed chronic kidney disease, of which 26(78.8%) needed renal replacement therapy. Mortality was 21(13.7 %) and 11(7.2%) were lost to follow-up. Calcineurin inhibitors’ toxicity was seen in 52(34%). One patient received renal transplant but lost the graft 6 years post-transplant due to disease recurrence. Conclusion: Steroid-resistant nephrotic syndrome has significant long-term morbidity and mortality. Recurrence of disease in transplanted kidney is common and can result in graft loss.

Frequency of Central Serous Chorioretinopathy in a Tertiary Care Center in Pakistan

Frequency of Central Serous Chorioretinopathy in a Tertiary Care Center in Pakistan

Prognosis of Zero Coronary Artery Calcium Score in Symptomatic Patients of South Asian Descent - an Experience from a Tertiary Care Center in Pakistan.

The absence of CAC in asymptomatic individuals is associated with a very low incidence of cardiovascular events. Of symptomatic patients, 1-2% with zero CAC score have non-calcified coronary artery atherosclerosis, and at least one third of cardiovascular events occur in individuals with zero CAC. South Asians (SA) have proportionally higher case fatality rates for CVD, relatively younger age of presentation, and accelerated rate of atherosclerosis when compared with other ethnic groups. All consecutive patients who underwent a CTCA to evaluate angina or angina-equivalent symptoms during the study duration were enrolled retrospectively. Patients with prior myocardial infarction, history of revascularization, and congenital heart disease were excluded. MACE was defined as the total of cardiac death, non-fatal myocardial infarction, and/or non-elective revascularization. A total of 534 patients were enrolled after final exclusion. The mean age was 53 years ± 11. Males constituted 68.4% of the study population. Dyslipidemia was the most common co-morbid condition identified (50%), followed by diabetes (18.4%) and hypertension (3.6%). At least 28.8% of patients with zero CAC scores had the presence of coronary artery disease (soft plaque) of any degree. Obstructive CAD (>50%) was present in 5.8% of patients. Follow-up was available for 61.4% of patients. On a mean follow-up of 96.6 months ± 49.8 (range 21-194 months), all-cause MACE was observed in 8.8% of patients. The most common MACE was angina (3.96%) and all-cause mortality (3%). The baseline characteristics and MACE did not differ in patients with and without obstructive CAD. The baseline characteristics did not differ significantly between patients with and without MACE. The incidence of soft plaque in this SA cohort is higher than that reported in international studies. However, in symptomatic SA, a CAC score of zero carries a good long-term prognosis, irrespective of the degree of CAD.

Normative values and factors affecting saphenous nerve responses in a south Asian population: a cross-sectional neurophysiological study at a tertiary care hospital in Pakistan

BackgroundThe saphenous nerve, a sensory branch of the femoral nerve, is not commonly included in routine lower extremity nerve conduction studies due to a high frequency of non-recordable responses in healthy subjects. However, saphenous nerve conduction studies are sometimes utilized for the diagnostic assessment of isolated lumbosacral plexus, femoral, or saphenous mononeuropathies. Our study aims to determine normative saphenous nerve response values in a healthy Pakistani population and to investigate their associations with patient body mass index, age, and gender.MethodsThis cross-sectional descriptive study was undertaken over a 3‑month period (May to July 2021) at a neurophysiology department of a tertiary care center in Pakistan. Healthy subjects underwent neurological examination, anthropometric measurements, and bilateral SN nerve conduction studies, with recording of peak-latency, peak-to-peak amplitude and conduction velocity. Statistical analyses and linear regression were conducted to evaluate associations between nerve conduction study variables and patient characteristics. Statistical analyses were also run to assess patient characteristics affecting recordability of saphenous nerve responses. A p-value < 0.05 was considered statistically significant.ResultsAmong 117 subjects, 79.5% (n = 93) had recordable saphenous nerve responses. Median peak-latency, amplitude, and conduction velocity were 3.2 (3.0-3.3) m/s, 7.7 (5.8–9.9) uV, and 44.0 (42.0–47.0) m/s, respectively. Bilaterally absent responses were observed in 20.5% (n = 24) of subjects. Obese participants had a significantly higher number of absent saphenous responses (p = 0.033). Females had shorter peak-latency (p = 0.006) and higher conduction velocity (p = 0.012).ConclusionsSaphenous nerve responses can be used to assess unilateral femoral and saphenous nerve pathologies, provided they are recordable on the asymptomatic side for comparison. Absent bilateral saphenous nerve responses should be interpreted with caution given their prevalence in healthy individuals. Patient characteristics should be taken into consideration when interpreting recordable and nonrecordable saphenous nerve responses.

Short- and medium-term longitudinal outcomes of children diagnosed with multisystem inflammatory syndrome in children - report from a single centre in Pakistan.

To determine the short- and medium-term cardiac outcomes in children admitted with multisystem inflammatory syndrome in children at a tertiary care centre in Pakistan. Children fulfilling the criteria for multisystem inflammatory syndrome and admitted to the hospital between April 2020 and March 2022 were enrolled in this prospective longitudinal cohort study. From admission to discharge, laboratory and cardiac parameters were recorded for all patients, who were subsequently followed up in clinics at various intervals. Data analysis was conducted using STATA version 15.0. A total of 51 children were included, with viral myocarditis (41.2%) and toxic shock syndrome (33.3%) being the most common phenotypes. The cardiovascular system was most commonly affected in 27 children (53%) with laboratory evidence of inflammation and myocardial injury with median and interquartile levels of ferritin 1169 (534-1704), C-reactive protein 83 (24-175), lactate dehydrogenase 468 (365-1270), N-terminal pro-B-type natriuretic peptide 8,656 (2,538-31,166), and troponin 0.16 (0.02-2.0).On admission, decreased left ventricular ejection fraction was observed in 58.8% of patients and impaired global longitudinal strain in 33.3%. At discharge, left ventricular ejection fraction had normalised in 83% of patients. Pericardial effusion resolved in all patients, and valvulitis resolved in 86% by 12 months. Paediatric ICU admission was required in 42 (82%) of patients with an overall mortality of 12% (n = 6). Our study finds high hospital mortality for multisystem inflammatory syndrome in children compared to 1-2% from previous studies. Yet, in Pakistan, surviving children with multisystem inflammatory syndrome show favourable short- to medium-term cardiac outcomes.

A Comparative Analysis of Automated Machine Learning Tools: A Use Case for Autism Spectrum Disorder Detection

Automated Machine Learning (AutoML) enhances productivity and efficiency by automating the entire process of machine learning model development, from data preprocessing to model deployment. These tools are accessible to users with varying levels of expertise and enable efficient, scalable, and accurate classification across different applications. This paper evaluates two popular AutoML tools, the Tree-Based Pipeline Optimization Tool (TPOT) version 0.10.2 and Konstanz Information Miner (KNIME) version 5.2.5, comparing their performance in a classification task. Specifically, this work analyzes autism spectrum disorder (ASD) detection in toddlers as a use case. The dataset for ASD detection was collected from various rehabilitation centers in Pakistan. TPOT and KNIME were applied to the ASD dataset, with TPOT achieving an accuracy of 85.23% and KNIME achieving 83.89%. Evaluation metrics such as precision, recall, and F1-score validated the reliability of the models. After selecting the best models with optimal accuracy, the most important features for ASD detection were identified using these AutoML tools. The tools optimized the feature selection process and significantly reduced diagnosis time. This study demonstrates the potential of AutoML tools and feature selection techniques to improve early ASD detection and outcomes for affected children and their families.

The Factors Associated With Mutant Epidermal Growth Factor Receptor Positivity in Patients With Lung Cancer: A Study From a Tertiary Care Center in Pakistan.

Objective In this study, we sought to elucidate the relationship between demographic and clinical factors and epidermal growth factor receptor tyrosine kinase (EGFR-TK) positivity in patients with advanced-stage lung cancer at a tertiary care center in Pakistan. Methods This analytical cross-sectional study was conducted from February 2020 to July 2023 at Shaikh Zayed Hospital, Lahore, Pakistan, in collaboration with the Centre of Excellence in Molecular Biology (CEMB), University of the Punjab. The study included 70 consecutive patients with advanced-stage lung cancer, and aimed to identify common EGFR mutations (Exon 19 deletion and Exon 21 L858R mutation), determine their frequency, and correlate EGFR-TK mutation positivity with clinical and non-clinical factors. Tissue acquisition and processing involved bronchoscopy, pleuroscopy, or percutaneous ultrasound-guided lung mass biopsy, followed by molecular analysis using polymerase chain reaction (PCR) extraction, amplification, and sequencing. The study employed convenient sampling and included adults aged over 18 years with histologically confirmed lung cancer. Results We enrolled 70 lung cancer patients, with a mean age of 60.87 years, and a male-to-female ratio of 1.4:1. The majority (61.4%) had adenocarcinoma, and 34.3% harbored a mutant EGFR-TK. EGFR mutations were more common in adenocarcinoma (91.7%) and associated with female non-smokers. Binary logistic regression analysis revealed that age <50 years and adenocarcinoma type were significant predictors of EGFR mutations. We found no significant associations with gender, smoking status, or other variables. These findings have implications for personalized treatment approaches in lung cancerpatients. Conclusions Our study reveals a high frequency of occult EGFR mutations (Exon 19 deletion and Exon 21 L858R mutation) in non-small cell lung cancer (NSCLC) patients, particularly among male smokers and female non-smokers. These findings emphasize the importance of routine EGFR mutation testing to identify patients who may benefit from targeted therapies, ultimately improving treatment outcomes.

Community-led interventions to re-engage people living with HIV into care in Pakistan.

By 2021, Pakistan had an estimated 210 000 people living with HIV (PLHIV), and 27% of those initiated into treatment in 2020 had disengaged from care within one year. We assessed the effectiveness of an intervention to re-engage PLHIV lost to follow-up into care in Pakistan. Between September 2020 and May 2021, the Association of People Living with HIV (APLHIV) implemented a search and rescue intervention for PLHIV lost to follow-up in 2 large treatment centres in Pakistan. The centre staff reviewed records to identify those not in care for > 6 months and from September 2020 to May 2021, the APLHIV tracked them through telephone calls and home visits to re-engage them into care. We used SAS version 9.4 to analyse the data and univariate logistic regression to identify factors associated with disengagement and becoming untraceable. Among the 4184 PLHIV registered (74% male), 36% (1517) (83.9% male, 15.4% female, 0.7% transgender) had disengaged from care. APLHIV members tracked 696 (46%) of them; 295 (42%) were deceased and 325 (47%) were re-engaged into care. Reasons for disengagement were long distance from the ART centre or lack of resources (45%), injecting drug use (19%), adverse effects of antiretroviral therapy (9%), disinformation (9%), no male family member to accompany them to treatment centre after the death of husband (3%), and no reason given (15%). Injecting drug users and males were more likely to be lost to follow-up, and males were more likely to be untraceable. This community-led intervention successfully re-engaged many PLHIV into care. The community-led re-engagement intervention should be upscaled to reduce loss to care and follow-up in Pakistan, especially among injecting drug users and male PLHIV.

Role of Dietary Patterns in the Progression and Management of Heart Failure in Pakistani Patients: A Multicenter Study.

Heart failure (HF) is a chronic condition with increasing prevalence in Pakistan due to common cardiovascular risk factors. Dietary interventions are known to influence HF outcomes, but data specific to Pakistani patients are limited. This study aimed to evaluate the impact of dietary patterns on HF progression and management in Pakistani patients, alongside the effects on quality of life and biochemical markers. A prospective cohort study was conducted across four medical centers in Pakistan, enrolling 170 HF patients. Dietary patterns were assessed using a validated Food Frequency Questionnaire (FFQ) tailored to the South Asian population. The primary outcomes measured were changes in the ejection fraction, New York Heart Association (NYHA) class, and hospitalization rates. Secondary outcomes included changes in quality of life and biochemical markers. Multivariate logistic regression was used to adjust for confounding variables, and Bonferroni corrections were applied to account for multiple comparisons. Adherence to a heart-healthy diet significantly improved the ejection fraction (from 35% to 38%, p = 0.04), reduced hospitalization rates (22%, p = 0.03), and improved NYHA class (45%, p = 0.05). Subgroup analysis showed a 10% reduction in mortality among patients over the age of 65 (p = 0.01) and 18% in diabetic patients (p = 0.02). Dietary interventions play a critical role in HF management among Pakistani patients. Culturally tailored dietary guidelines should be integrated into clinical practice to improve patient outcomes.

In-hospital cardiac arrest in middle-income settings: A comprehensive analysis of clinical profiles and outcomes of both adults and pediatrics

BackgroundIn hospital cardiac arrest is associated with poor survival despite basic and advanced life support measures. This study aimed to identify the clinical characteristics and outcomes of cardiac arrests occurring during in-hospital admission to the tertiary care center in Pakistan. MethodA retrospective, cross-sectional study at Aga Khan University Hospital from 2021 to 2023 analyzed 230 cardiac arrest cases. Data included demographics, arrest type, timing, initial rhythm, resuscitation duration, and arrest location. American Heart Association guidelines were adhered to for life support. The main outcomes focused on the return of spontaneous circulation survival to hospital discharge. ResultsDuring the study, 230 cardiac arrests were observed: 152 in adults (mean age 57.8, 142 shockable cases, ROSC 52.6 %, alive at discharge 28.3 %) and 78 in pediatric patients (mean age 4.99, non-shockable rhythm 85.9 %, ROSC 51.3 %, alive at discharge 17.9 %). Adult Charles comorbidity index: 2.88 (SD±2.08), pediatric index: 0.610 (SD±0.88). Survival rates were lower with a high comorbidity index and code duration > 20 min. ConclusionThe study provides valuable observational data that challenges global survival rates for in-hospital cardiac arrest. It highlights how factors like being in monitored units and the presence of rapid response teams can lead to higher survival rates. The research underscores the influence of comorbidities, initial rhythms, and the duration of resuscitation efforts on patient outcomes, emphasizing the need for more research, especially in settings with limited resources.

Risk factors for mortality in hospitalized COVID-19 patients across five waves in Pakistan

This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44–69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28–34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13–9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38–3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26–4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28–3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95–3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35–0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39–3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37–5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves.

Effectiveness of bedaquiline containing all oral longer regimens in treating multidrug/rifampicin resistant tuberculosis in Pakistan

BackgroundDespite the introduction of bedaquiline (Bdq) containing all-oral regimens for treating patients with rifampicin resistant/multidrug resistant tuberculosis (MDR/RR-TB) in 2019, data on its effectiveness in Pakistan, which has the fifth highest MDR-TB burden, is lacking. This study evaluates treatment outcomes and identifies factors associated with unsuccessful outcomes among MDR/RR-TB patients treated with an all-oral longer treatment regimen (LTR). MethodsThis retrospective record review included all microbiologically confirmed pulmonary MDR/RR-TB patients treated with an all-oral LTR between August 2019 and February 2021 across nine PMDT centres in Pakistan. Sociodemographic and clinical data were retrieved from the Electronic Nominal Recording and Reporting System. Treatment outcomes, defined by WHO criteria, were analysed using SPSS and multivariate binary logistic regression to identify factors associated with unsuccessful outcomes. A p-value < 0.05 was considered statistically significant. ResultsThe final analysis included 644 MDR/RR-TB patients (mean age 37.9 ± 17.6 years), mostly male (53.0 %), underweight (68.0 %), with TB treatment history (66.1 %), MDR-TB (84.9 %), lung cavitation (71.0 %), and no comorbidities (86.4 %). Fluoroquinolone resistance was found in 41.9 %, 16 % had used second-line drugs, and 9.8 % had previous MDR-TB treatment. A total of 400 (62.1 %) patients were declared cured, 53 (8.2 %) treatment completed, 117 (18.2 %) died, 37 (5.7 %) lost to follow-up (LTFU), and 37 (5.7 %) treatment failures. Overall treatment success rate was 70.3 % (n = 453). In multivariate analysis, history of TB treatment (OR:1.63, 95 %CI:1.09–2.64, p = 0.023), previous SLD use (OR:2.09, 95 %CI: 1.20–3.37, p = 0.012), resistance to Z (OR:0.43, 95 %CI: 0.20–0.81, p = 0.023), and resistance to > 5 drugs (OR:3.12, 95 %CI:1.36–11.64, p = 0.013) were significantly associated with death and treatment failure. Whereas, lung cavitation had statistically significant association with LTFU (OR:2.66, 95 %CI:1.10–7.32, p = 0.045). ConclusionTreatment success rate (70.3 %) in this study fell below the WHO recommended target success rate (>90 %). Enhanced clinical management, coupled with special attention to patients exhibiting identified risk factors could improve treatment outcomes.

Correlation of Left Atrial Volume Index with Pro-BNP in Heart Failure with Preserved Ejection Fraction

Objective: To determine the correlation between left atrial (LA) volume index and Pro- BNP in heart failure patients with preserved ejection fraction. Methodology: This descriptive Cross-Sectional Study was conducted at Department of Cardiology, Liaquat University of Medical &amp; Health Sciences (LUMHS), Jamshoro, Pakistan, during Six months after the approval of synopsis from March 26, 2021 to September 25, 2021. All patients who fulfilled the inclusion criteria and visited to LUMHS, Jamshoro were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. Peripheral venous blood samples were obtained for assessment of pro- BNP level. A detailed comprehensive echocardiography was performed in all patients. All the collected data were entered into the proforma attached at the end and used electronically for research purpose. Results: The age of the patients ranged from 19 to 59 years with a median of 58 with interquartile range 12. In distribution of gender, 20 (60.5%) patients were male while 13 (39.4%) were female. Pearson’s correlation coefficient showed weak and non-significantly linear correlation between left atrial volume index and Pro-BNP levels i.e. (r= 0.134) in the region P &lt; 0.05. Conclusion: It is to be concluded that there was a weak correlation between left atrial volume index and Pro-BNP levels. More studies are necessary to evaluate the statistical association with a larger sample size and with more parameters in multiple study centers in Pakistan are needed to validate the findings of the present study.

Effect of Magnesium Sulfate with Propofol on Hemodynamic Stability during Tracheal Intubation in Patients Undergoing Coronary Artery Bypass Grafting: A Single-Center Study

Objectives: This study aimed to assess the hemodynamic response of magnesium sulfate (MGS) with propofol during tracheal intubation in patients undergoing coronary artery bypass grafting (CABG). Methodology: A cross-sectional study was conducted at a tertiary cardiac center in Pakistan, involving 100 patients undergoing elective CABG. Hemodynamic parameters were recorded before and after intubation, following the administration of MGS with propofol. Results: The mean systolic blood pressure was 114.9±9.4 mmHg, 120.3±3.4 mmHg and 111.1±6.4 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of &lt;0.001. The mean diastolic blood pressure was 66.2±10.3 mmHg, 67.8±6.1 mmHg, and 62±7.2 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of &lt;0.001. The mean arterial blood pressure was 82.5±9.2 mmHg, 85.3±4.5, mmHg and 78.4±6.4 mmHg before intubation, after 2 minutes and 5minutes respectively, with p-value of &lt;0.001. The mean heart rate was 65.1±8.8 bpm, 69.7±5.2 bpm and 71.3±4.6 bpm before intubation, after 2 minutes and 5minutes respectively, with p-value of &lt;0.001. Conclusion: The study concludes that the addition of MGS to propofol contributes to hemodynamic stability during tracheal intubation in patients undergoing CABG. Further research is needed to validate these findings and explore optimal dosing regimens.

Sustainable energy transition optimization through decentralized hybrid energy systems with various energy storage technologies under multi-criterion indices: A mid-career repowering scenarios

Sustainable energy transition (SET) refers to the formulation of effective policies for quantifying the paradigm shift from fossil fuels to carbon-neutral technologies. Despite the anticipation of sustainable solutions, many developing nations continue to experience unsustainable energy regimes. Understanding the potential of this transition demands a multifaceted approach, emphasizing techno-economic optimization and performance enhancement to address future decentralized energy constraints. Although one of several ways to enable SET, the consideration of renewable energy sources (RESs) coupled with energy storage technologies (ESTs), which can offer multi-dimensional decision flexibility in present energy policies, is quite restricted. Based on a comparative analysis of various ESTs, this paper provides insight exploration of the SET framework by leveraging a diverse range of renewable potentials. Utilizing a proprietary derivative-free algorithm (PDFA) and an original grid-search algorithm (OGSA), the study focuses on load forecasting across different time horizons using a real-time dataset from multiple load centers in Pakistan. Load forecasting is carried out based on a combination of seasonal naïve forecasting (SNF), seasonal and trend decomposition using loess forecasting (STLF), and artificial neural networks (ANN). Results reveal a minimum Levelized cost of energy (LCOE) ranging from $0.105/kWh to $0.109/kWh in the presence of solar and dispatchable renewable-based hybrid configurations. For battery ESTs, based on NPC and LCOE, the feasibility is observed in the order of lead-acid (La), lithium-ion (Li-ion), and vanadium redox flow (VRF) technology. From a technical and capacity shortage fraction (CSF) perspective, Li-ion performed better than both La and VRF in terms of storage depletion as well as annual losses. Finally, a mid-career repowering analysis examines the behavior of energy storage technologies (ESTs), while sensitivity analyses and results validation highlight the significance of the proposed study's findings.

The frequency and associated factors of typhoid carriage in patients undergoing cholecystectomy for gallbladder disease in Pakistan: A cross-sectional study.

Enteric fever is caused by Salmonella enterica serovars Typhi (S. Typhi) and Paratyphi A, B, and C. It continues to be a significant cause of morbidity and mortality worldwide. In highly endemic areas, children are disproportionately affected, and antimicrobial resistance reduces therapeutic options. It is estimated that 2-5% of enteric fever patients develop chronic asymptomatic infection. These carriers may act as reservoirs of infection; therefore, the prospective identification and treatment of carriers are critical for long-term disease control. We aimed to find the frequency of Salmonella Typhi carriers in patients undergoing cholecystectomy. We also compared the detection limit of culturing versus qPCR in detecting S. Typhi, performed a geospatial analysis of the carriers identified using this study, and evaluated the accuracy of anti-Vi and anti-YncE in identifying chronic typhoid carriage. We performed a cross-sectional study in two centers in Pakistan. Gallbladder specimens were subjected to quantitative PCR (qPCR) and serum samples were analyzed for IgG against YncE and Vi by ELISA. We also mapped the residential location of those with a positive qPCR result. Out of 988 participants, 3.4% had qPCR-positive gallbladder samples (23 S. Typhi and 11 S. Paratyphi). Gallstones were more likely to be qPCR positive than bile and gallbladder tissue. Anti-Vi and YncE were significantly correlated (r = 0.78 p<0.0001) and elevated among carriers as compared to qPCR negative controls, except for anti-Vi response in Paratyphi A. But the discriminatory values of these antigens in identifying carriers from qPCR negative controls were low. The high prevalence of typhoid carriers observed in this study suggests that further studies are required to gain information that will help in controlling future typhoid outbreaks in a superior manner than they are currently being managed.

The outcomes and complications of percutaneous interventions in chronic total coronary occlusion

BackgroundThe limited availability of complex coronary intervention facilities and qualified operators, due to the high cost associated with chronic total occlusion (CTO) percutaneous intervention (PCI) equipment and a shortage of necessary skills, has led to a scarcity of capable medical centers in Pakistan. This study seeks to examine the outcomes and potential complications associated with CTO PCI procedures conducted at the Cardiac Catheterization Laboratories of a prominent national institute in Pakistan, which handles a large volume of cases.ResultsThree hundred and six patients were included in the study in the study period of six months. The mean age was 59.49 (± 9.16) years: 256 (83.66%) were male and 50 (16.34%) were female. CTO was successfully re-vascularized in 237 (77.5%) with a complication rate of 13.7%. Two hundred and ninety-eight (97.39%) patients underwent an antegrade approach, while RCA was the most common target vessel (47.71%). Diabetes was the only significant associated risk factor with CTO PCI failure (30.43% vs. 30.43%, P-value = 0.015).ConclusionWe achieved an excellent procedural success rate with a low complication rate. CTO procedural failure is associated with a higher complication rate, and diabetes is among the risk factors that lead to higher procedural failure.

Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan.

Burn injuries pose significant challenges to both patients and healthcare systems globally. This retrospective observational study, conducted at the burn center in a tertiary care hospital in Rawalpindi, Pakistan, aimed to delineate the patterns of burn injuries and correlate them with demographic and clinical presentations. A total of 99 patients were included, with 54 males and 45 females, ranging in age from three months to 70 years. Flame burns were the most common type (n=69), with the majority being accidental (n=87). Limbs were the most frequently affected body parts (n=32), often with lesser-degree burns (n=28). Notably, self-inflicted injuries were predominantly observed in males (n=7), while assault cases were more common in females (n=4). Statistical analysis revealed significant associations between the degree of burn and the body parts affected, as well as between the mode of injury and the affected body parts. Burn injuries due to assault or self-infliction tended to have higher morbidity rates, often resulting in fatalities. Additionally, the cause of burn injury showed significant associations with the affected body parts, with contact and electric burns affecting limbs and chemical burns mainly affecting the head and face. These findings underscore the need for targeted burn prevention programs, emphasizing first aid education and addressing specific risk factors in high-risk groups and settings. By implementing preventive strategies and evaluating their effectiveness, the burden of burn injuries can be reduced, leading to improved patient outcomes and quality of life.

“Navigating the diagnostic challenges in Homocystinuria: Insights from a tertiary care center in Pakistan”

“Navigating the diagnostic challenges in Homocystinuria: Insights from a tertiary care center in Pakistan”

Clinical presentation and outcome of enteric fever in adult patients with cancer: a perspective from Pakistan.

Introduction. Enteric fever is a significant health concern in endemic countries. While extensive research has been conducted to understand its presentation and outcomes in non-cancer patients, limited data exist on its impact on cancer patients. This descriptive study aims to investigate the clinical presentation and outcome in cancer patients. Methodology. This retrospective observational study analysed 90 adult cancer patients from a single centre in Pakistan from January 2017 to December 2022. Inclusion criteria involved documented blood culture infections with Salmonella typhi or paratyphi A, B, or C. We examined clinical presentation, laboratory parameters, antimicrobial resistance, complications, and outcomes. Additionally, we explored the effects of chemotherapy, comorbidities, type of malignancy, and patient age on complications and mortality. Results. Salmonella typhi was the most prevalent organism (72.2 %), followed by Salmonella paratyphi A (22.2 %) and B (5.5 %). Variably-resistant isolates constituted 51.5 %, multi-drug resistant (MDR) isolates accounted for 20 %, extensively drug-resistant (XDR) for 14.4 % and ESBL-producers for 15.5 %, of all enteric fever infections. Enteric fever-associated complications were observed in 21.1 % of cases. Chemotherapy in the preceding month did not affect mortality, nor did age, gender, or malignancy type. However, comorbidities were statistically significant for mortality (p-value 0.03). A total of 8.8 % of patients required ICU care, and the all-cause 30 day mortality rate was 13.3 % Conclusion. Enteric fever remains prevalent in our geographical region. Unlike non-typhoidal Salmonella (NTS), enteric fever does not behave differently in an immunocompromised population, including cancer patients.