Low Socioeconomic Countries Research Articles

Risk Factors Associated With Anastomotic Stricture in Patients Undergoing Minimally Invasive Esophagectomy: Experience From a High-Volume Center.

Esophageal cancer is aprevalent cancer, with a high incidence in low socioeconomic category countries. Minimally invasive esophagectomy is increasingly being used to treat this malignant condition. However, anastomotic stricture is a serious complication post esophagectomy. The study aims to enhance diagnostic consistency, improve treatment methods, guide patient management, stratify outcomes, and offer evidence-based preventive interventions. A retrospective analysis of 550 patients who had minimally invasive esophagus surgery was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore between 2015 and 2020. All patients were treated with radical resection. For tumors of the lower esophagus and gastroesophageal junction, transhiatal esophagectomy was used; for tumors of the middle and upper thoracic esophagus, right video-assisted thoracoscopic surgery (VATS) was used in a three-stage procedure. Patients were routinely followed up two weeks after discharge, then every three, six, and 12 months. The mean age and BMI were 46.7 years and 19.4 kg/m2, respectively. Anastomotic leaks were rare, with only 13 patients experiencing them. The grade of tumor differentiation was poor, moderate, and well-differentiated. The study found that older age, high Eastern Cooperative Oncology Group (ECOG) performance status, and malignancies located in the upper and middle one-third of the esophagus had significant associations with anastomotic stricture. However, some variables, like sex, did not show significant associations in either analysis. The study reveals that factors such as older patient age, high ECOG performance status, single comorbidity, and malignancies located in the upper and middle one-third of the esophagus significantly influence anastomotic stricture. The study suggests that measures against anastomotic stricture such as endoscopic procedures and minimally invasive esophagectomy should be implemented to minimize the complications.

Role of ERG11 and MDR1 genes in cycloheximide and multidrug resistance in Candida species.

Candida species are amongst the commensals of the mucosal surfaces of the human body which include the oral cavity, vagina, and intestinal mucosa. Fungal infections are on the rise worldwide. The overall burden of infections due to fungi is difficult to estimate because the majority of them remain undiagnosed. The present study aims to determine the burden of antifungal resistance in low socioeconomic country, Pakistan and the frequency of ERG11 and MDR1 genes involved. A total of 636 Candida isolates were obtained from various tertiary care institutions in Lahore in the form of culture on various culture plates. Sabouraud agar culture plates were used to culture the Candida spp. Antifungal resistance was determined against Fluconazole, Itraconazole, Ketoconazole, and Nystatin via disk diffusion technique. Most resistance was observed against Fluconazole followed by Itraconazole, Ketoconazole, and Nystatin. The Candida isolates recovering from CVP tip and tissue have a high resistance profile. Candida species resistant to at least two antifungals were chosen for further ERG11 and MDR1 detection through real-time PCR. Among 255 Candida isolates, 240 contained ERG11 gene while MDR1 gene is present in 149 Candida isolates. The isolates carrying both genes were tested by the broth microdilution technique for the susceptibility against cycloheximide, all of them were able to grow in cycloheximide. The genetic determinants of antifungal resistance such as ERG11 and MDR1 are as important in the multidrug resistance against a variety of compounds and antifungal drugs.

Bundle care approach to reduce device associated infections in post-living-donor-liver transplantation in a tertiary care hospital, Egypt

BackgroundDevice-associated infections (DAIs) are a significant cause of morbidity following living donor liver transplantation (LDLT). We aimed to assess the impact of bundled care on reducing rates of device-associated infections.MethodsWe performed a before-and-after comparative study at a liver transplantation facility over a three-year period, spanning from January 2016 to December 2018. The study included a total of 57 patients who underwent LDLT. We investigated the implementation of a care bundle, which consists of multiple evidence-based procedures that are consistently performed as a unified unit. We divided our study into three phases and implemented a bundled care approach in the second phase. Rates of pneumonia related to ventilators [VAP], bloodstream infections associated with central line [CLABSI], and urinary tract infections associated with catheters [CAUTI] were assessed throughout the study period. Bacterial identification and antibiotic susceptibility testing were performed using the automated Vitek-2 system. The comparison between different phases was assessed using the chi-square test or the Fisher exact test for qualitative values and the Kruskal-Wallis H test for quantitative values with non-normal distribution.ResultsIn the baseline phase, the VAP rates were 73.5, the CAUTI rates were 47.2, and the CLABSI rates were 7.4 per one thousand device days (PDD). During the bundle care phase, the rates decreased to 33.3, 18.18, and 4.78. In the follow-up phase, the rates further decreased to 35.7%, 16.8%, and 2.7% PDD. The prevalence of Klebsiella pneumonia (37.5%) and Methicillin resistance Staph aureus (37.5%) in VAP were noted. The primary causative agent of CAUTI was Candida albicans, accounting for 33.3% of cases, whereas Coagulase-negative Staph was the predominant organism responsible for CLABSI, with a prevalence of 40%.ConclusionThis study demonstrates the effectiveness of utilizing the care bundle approach to reduce DAI in LDLT, especially in low socioeconomic countries with limited resources. By implementing a comprehensive set of evidence-based interventions, healthcare systems can effectively reduce the burden of DAI, enhance infection prevention strategies and improve patient outcomes in resource-constrained settings.

Evaluation of Dyslipidaemia in Patients with Chronic Viral Hepatitis in a Lower Socio-Economic Country

Patients having chronic viral hepatitis do have disturbances in their serum lipid profiles, still the monitoring of dyslipidemia is not a routine part of management in low socio economic countries. Objective: To investigate the status of lipid profile among patients with chronic hepatitis and compare them with non-infected individuals. Methods: A cross-sectional study was done in a Tertiary Care Hospital of Karachi, from 5th September 2022 to 31st May 2023. Patients with chronic hepatitis B and C, diagnosed within two years with a body mass index (BMI) of 25-29.9 kg/m2 were included. Their comparison was done with non-infected individuals of the same BMI. All patients were evaluated with different parameters of lipid profile along with haemoglobin, alanine aminotransferase, albumin and international normalized ratio. Results: Among 521 participants of the study, the grouping was almost equal. The age range was 12-75 years, with an increased number of females in each group. In comparing the different statuses of lipid profile, each parameter including cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, all were significantly much less in patients with chronic viral hepatitis as compared to controls with a p-value of 0.000 in all. Conclusions: It was concluded that Dyslipidaemia is not common among chronic viral hepatitis patients’ despite being overweight, particularly among patients with child’s class A.

Qualitative Analysis of English as Foreign Language (EFL) teachers’ Job Satisfaction in Ningxia, China

Job satisfaction is the positive expressive feedback and attitudes workers have toward their jobs. It is viewed as a very significant issue within all types of establishments. But there is limited research exploring job satisfaction in the educational context, and as such, there is a deficiency in the understanding of the issues that particularly affect university English as Foreign Language (EFL) teachers’ perceptions about their job satisfaction. Therefore, this study explored, within the precinct of Herzberg (1959) theory, the EFL teachers job satisfaction in Ningxia, China. A purposive sampling design was used to select 10 informants chosen from Ningxia in China while series of in-depth interviews were conducted and data analyzed thematically using NVIVO software. The study analysis, assessed job satisfaction through multiple facets that revealed job satisfaction as depending basically upon what the university English as a Foreign Language (EFL) Teachers in Ningxia, China gets from their job. Thus, it is recommended that the management of university where English as a Foreign Language are taught should set in motion strategies to sustain the current situation. Similarly, future researchers should extent the focus of job satisfaction research to low socioeconomic countries in relation to intrinsic values.

Beta-defensin index: A functional biomarker for oral cancer detection

There is an unmet clinical need for a non-invasive and cost-effective test for oral squamous cell carcinoma (OSCC) that informs clinicians when a biopsy is warranted. Human beta-defensin 3 (hBD-3), an epithelial cell-derived anti-microbial peptide, is pro-tumorigenic and overexpressed in early-stage OSCC compared to hBD-2. We validate this expression dichotomy in carcinoma in situ and OSCC lesions using immunofluorescence microscopy and flow cytometry. The proportion of hBD-3/hBD-2 levels in non-invasively collected lesional cells compared to contralateral normal cells, obtained by ELISA, generates the beta-defensin index (BDI). Proof-of-principle and blinded discovery studies demonstrate that BDI discriminates OSCC from benign lesions. A multi-center validation study shows sensitivity and specificity values of 98.2% (95% confidence interval [CI] 90.3-99.9) and 82.6% (95% CI 68.6-92.2), respectively. A proof-of-principle study shows that BDI is adaptable to a point-of-care assay using microfluidics. We propose that BDI may fulfill a major unmet need in low-socioeconomic countries where pathology services are lacking.

Blood Component Usage and Discard in the Blood Centre of a Tertiary Care Hospital in a Remote Part of North-east India: A Cross-sectional Study

Introduction: Blood and its various components are valuable resources for sustaining life. They are routinely used and form an integral part of patient care. The judicious use of blood and its components is necessary in low socio-economic countries. Aim: To estimate the usage of blood and blood components and its discard in a tertiary care hospital. Materials and Methods: A hospital-based retrospective cross- sectional study was conducted in the Blood Centre, Diphu Medical College and Hospital, Karbi Anglong, Assam, India. Data was retrieved from Blood Centre registers over a period of 12 month, from July 2021 to June 2022. Both replacement and voluntary donors were selected based on donor selection criteria. All collected blood units were stored and subsequently subjected to Transfusion Transmitted Infections (TTI) testing. The data was tabulated using Microsoft Excel sheet. Results: During the study period, a total of 4,525 units of whole blood were collected, and 7,539 blood units, including both whole blood and blood components, were prepared. The highest number of issues during the period comprised of whole blood at 2,468 units. Among blood components, 1,854 units of Packed Red Blood Cells (PRBCs) were most commonly utilised, followed by 1,824 units of Fresh Frozen Plasma (FFP). A total of 334 units (4.43%) of blood/ blood components were discarded due to various reasons, with the highest discard rate observed for Platelet Concentrates (PC) at 71 (6.28%) units. The major reason for discard was seropositivity, accounting for 212 (63.5%) units. Conclusion: Adequate blood inventory, along with proper training and sensitisation of hospital staff, should be conducted at timely intervals regarding proper donor selection, collection, and storage of blood/ blood products. Clinicians should also be engaged to optimise the usage of blood/ blood products. These steps can help minimise wastage in resource limited countries.

Respectful Maternity Care: A Narrative Review

Respectful Maternity Care (RMC) is a fundamental right of every childbearing woman. It is aimed at lessening disparities in medical care and assists in achieving an optimal outcome for both mothers and newborns. However, studies have shown that Disrespect and Abuse (D&A) are extremely widespread in low socio-economic countries and that care quality has been neglected at all levels. To minimise disrespectful Maternity Care, we must create situation-specific, proof-based interventions as well as strategies and plans of action. RMC needs a lot more than the ending of misconduct. Care should be provided to all women in a way that safeguards their respect, privacy, and confidentiality. They should not be ill-treated and constant support should be provided at the time of labour and childbirth. Respectful treatment should not be dependent on the social status of the mother. The implementation of RMC through the labour and delivery process is a complicated procedure that demands that healthcare providers possess both interpersonal and scientific abilities. In this regard, it is crucial to recognise the probable hurdles and execute efficient approaches for implementing RMC into action. The present review aimed to further focus the discussion around the creation of RMC policies for various healthcare settings. The authors emphasise the value of RMC and highlight that poor treatment and disrespectful care are issues that are essential to be addressed across all research fields, including community health, quality assurance, administration, and human rights.

Bactericidal effect of low-temperature atmospheric plasma against the Shigella flexneri

BackgroundShigella flexneri (S. flexneri) is a common intestinal pathogenic bacteria that mainly causes bacillary dysentery, especially in low socioeconomic countries. This study aimed to apply cold atmospheric plasma (CAP) on S. flexneri directly to achieve rapid, efficient and environmentally friendly sterilization.MethodsThe operating parameters of the equipment were determined by plasma diagnostics. The plate count and transmission electron microscope were employed to calculate bacterial mortality rates and observe the morphological damage of bacterial cells. Measurement of intracellular reactive oxygen species (ROS) and superoxide anions were detected by 2,7-dichlorodihydrofluorescein (DCFH) and Dihydroethidium fluorescence probes, respectively. The fluorescence intensity (a. u.) reflects the relative contents. Additionally, the experiment about the single effect of temperature, ultraviolet (UV), and ROS on bacteria was conducted.ResultsThe peak discharge voltage and current during plasma operation were 3.92kV and 66mA. After discharge, the bacterial mortality rate of 10, 20, 30 and 40 s of plasma treatment was 60.71%, 74.02%, 88.11% and 98.76%, respectively. It was shown that the intracellular ROS content was proportional to the plasma treatment time and ROS was the major contributor to bacterial death.ConclusionIn summary, our results illustrated that the plasma treatment could inactivate S. flexneri efficiently, and the ROS produced by plasma is the leading cause of bacterial mortality. This highly efficient sterilization method renders plasma a highly promising solution for hospitals, clinics, and daily life.

The burden of vision loss in the Middle East and North Africa region, 1990–2019

BackgroundThe loss of vision is a substantial public health concern that has important implications for an individual’s quality of life. The primary objective of this research was to document the burden of vision loss in the Middle East and North Africa (MENA) region, spanning the years 1990–2019, by age group, sex, underlying cause and sociodemographic index (SDI).MethodsPublicly available data concerning the burden of vision loss were acquired from the Global Burden of Disease study 2019. The data encompassed all 21 countries within the MENA region for the period spanning 1990 to 2019. The estimates were reported as raw counts and age-standardised rates per 100,000, accompanied by their corresponding 95% uncertainty intervals (UIs).ResultsIn 2019, MENA had an age-standardised point prevalence of 7040.0 (95% UI: 6195.0, 8002.7) and an YLD rate of 314.5 (222.1, 427.6) per 100,000 for vision loss, which were 11.1% (-12.5, -9.7) and 24.3% (-27.6, -20.8) lower, respectively, than in 1990. In 2019, Afghanistan [469.6 (333.0, 632.8)] had the largest age-standardised YLD rate and Turkey [210.7 (145.3, 290.9)] had the lowest. All countries showed a decrease in the age-standardised point prevalence and YLD rate between 1990 and 2019, except for Oman, Afghanistan, and Yemen. Furthermore, in 2019 the largest number of prevalent cases and YLDs were found in the 65–69 age group. Also in 2019, the age-standardised YLD rates in MENA exceeded the global averages for most age groups, for both males and females. In 2019, refractive disorders were the most common types of vision loss among children, adolescents, and middle-age adults in MENA, while near vision loss and cataracts were the most common among older adults. Finally, the burden of vision loss had a slightly negatively association with SDI over the period 1990–2019.ConclusionAlthough the burden of vision loss has decreased over the last three decades, the prevalence remains high. These results underscore the importance of healthcare policymakers taking action to implement preventive measures, especially among the elderly and those living in low socioeconomic countries, to decrease the attributable burden in MENA.

Prevalence, drug-susceptibility pattern and associated factors of Mycobacterium tuberculosis infection among prisoners in western Arsi zonal prisons, Oromia, South West Ethiopia

ObjectivesEach year, tuberculosis (TB) in prisons is a major worldwide health concern that results in millions of diseases. It is particularly prevalent in low socio-economic countries like Ethiopia because of the poverty, overcrowding, starvation, lack of access to basic healthcare services, and high prevalence of HIV infection in these countries. MethodsA cross-sectional study with 259 prisoners was carried out in the western Arsi zonal prison from November to January 2021. The sputum samples were taken from suspected TB patients and evaluated using the Gene Xpert Mycobacterium tuberculosis/rifampcine test. Line probe assay was used to assess the molecular drug susceptibility of isolates from positive sputum. A bivariate and multivariate logistic regression was analyzed using SPSS version 24 packages. Odds ratio (OR) and corresponding 95% CI were used to quantify the degrees of association between target potential risk factors and Mycobacterium tuberculosis positivity. P-value of less than 0.05 was considered statistically significant. ResultsThe prevalence of undiagnosed pulmonary TB (PTB) verified positive cases was 5.4% (95% CI 2.7, 8.5) out of 259 research participants that were recruited in this study. One (0.38%) occurrence of mono-drug resistance to isoniazid was found among them. In this study, variables that were significantly linked with PTB positive were age ≥30 years, smoking (adjusted OR [AOR] = 0.087, 95% CI = 0.01-0.93, P = 0.043), body mass index 18.5 kg/m2, cough duration 4 weeks (AOR = 0.03, 95% CI = 0.1-0.13 P = 0.001), and coughing before incarceration (AOR = 6.2, 95% CI = 3.6-10.59, P = 0.004). ConclusionIn West Arsi zonal prisons, PTB and mono-drug resistance for isoniazid were found to be more common than in the general population.

“Make and Use” All Suture Anchor—A Cost-Effective Method of Making an All-Suture Anchor

All-suture anchors (ASA) are newer anchors that anchor soft tissues to the bone. It has several biomechanical and clinical advantages; however, the high cost of this anchor limits its use in low socioeconomic countries. The cost of the anchor dramatically increases the cost of surgery; hence, acceptance of surgery is also affected if patients have to pay their expenditure from their pocket. We have designed a simple, cost-effective method of making an ASA, which can be made instantly and used during surgery; hence, the name “make-and-use anchor.” To make this anchor, few high-strength sutures are required. Over the suture, a sleeve of suture was created using an Ethibond. This sleeve will create a “ball” after deployment under the cortical bone, which provides anchorage to the sutures serving as an anchor. This anchor can be deployed both in the pull-in and push-in methods. This technical note aims to share the technique of making this cost-effective anchor, which is made instantly using locally available suture materials and can be used in various surgeries requiring anchors.

To Evaluate the Level of Awareness of Patients About Existing Oral Precancerous Lesions: A Longitudinal Study.

The prevalence of oral cancer and other oral premalignant diseases (OPMDs) is increasing. Particularly among lower socioeconomic countries, awareness with respect to oral cancer is quite poor. The aim of the current study is to evaluate the level of awareness of patients about existing oral precancerous lesions. Fifty people with existing oral precancerous lesions whose diagnosis was confirmed by a clinician's examination were included in this research. Questions were asked of patients to fill out a questionnaire; those with cancer, non-precancerous red or white lesions, or no lesions in the mouth were not included. Questions on demographics, precancer knowledge, precancer information sources, and tobacco/betel chewing, smoking, and alcohol use were included in the survey. Informed by prior research and knowledge of precancerous lesions and circumstances, a closed-ended questionnaire was developed. The study found that just 44 percent of participants were aware that they had oral lesions or diseases. Self-examination was the most common method (81.82%), followed by inquiring with friends and family (9.09%) and medical professionals (9%). Most patients (41.67 percent) learn about oral precancers via the media, followed by posters and banners (33.33%), friends and family (12.5%), other sources (8.33%), and physicians (4.17%). About half of the patients with oral precancers chewed tobacco for 11 years on average, doing so 4-5 times a day. Another 38% smoked and drank alcohol, also at 4-5 times a day. Oral lichen planus (16%), Oral Submucous fibrosis (12%), and Erythroplakia (12%) were shown to be the next most common oral lesions after tobacco pouch keratosis (30%) and leukoplakia (30%). Research indicates that few people are aware of the existence of oral precancerous lesions or diseases. Patients' awareness of oral precancerous lesions/conditions was shown to be significantly influenced by media such as television, radio, posters, and banners.

Burnout and resilience at work among health professionals serving in tertiary hospitals, in Ethiopia.

The quality of healthcare service is strongly affected by the health professionals' levels of burnout and resilience at work (RaW). Developing resilience is a key component of medical professionalism. Although burnout and resilience are indicators used to assess the level of workplace hardship, there is a dearth of information in most developing countries, including Ethiopia. To assess the levels of burnout and 'resilience at work' among health professionals who work in the surgical care departments in teaching Ethiopian hospitals. A cross-sectional study design was applied among health professionals employed in surgical, gynecologic, and obstetric (Gyn/Obs) departments of two acute-care hospitals (n = 388). A structured self-administered English version questionnaire, consisting of validated scales to measure RaW and burnout, was used to collect the data;22 items of Maslach's burnout inventory human service survey tool and 20 items of Win wood's resilience at work' measuring tool" was employed to assess the health professionals' burnout level and Resilience at work, respectively. Linear logistics regression was employed for inferential statistical analysis to identify factors that predict RaW and burnout. Burnout syndrome was shown among 101 (26.0%) study participants. Furthermore, 205 (52.8%), 150 (38.7%), and 125 (32.2%) participants presented high emotional exhaustion, high depersonalization, and low personal accomplishment, respectively. Emotional exhaustion was predicted by the participants' profession, the hope of promotion, professional recognition, and workload. Depersonalization was predicted by age, profession, and perceived workload of the participants. The predictors for personal accomplishment were profession, relationship at work, professional recognition, and having a managerial position in addition to clinical duty. The participants' mean RaW score was 78.36 (Standard deviation ±17.78). A negative association was found between RaW and emotional exhaustion and depersonalization. In contrast, a positive association was identified between RaW and personal accomplishment. The type of profession and marital status were positive predictors of RaW. A substantial amount of health professionals experience high burnout in one or more burnout dimensions. Level of RaW is more affected by burnout syndrome. Therefore, promoting activities that increase the level of professional RaW and recognition in their professional practice is needed to reduce job burnout. These findings are especially important concerning low socio-economic countries, as resilience is a vital component of the development of healthcare systems.

Establishing a Multidisciplinary Team Meeting and an Online Platform for Cancer Cases in a Low Socio-Economic Country by a Tertiary Care Hospital without Oncological Facilities

Rafique, Muhammad Nouman MBBS; Chishti, Bilal MBBS; Ul Mubeen, Noor MBBS; Waris Farooka, Muhammad MBBS, FCPS, FACS Author Information

Development of Low-Cost Portable Defibrillator for Sudden Cardiac Arrest Management

Defibrillation is the mainstay of treatment of cardiac arrest especially ventricular fibrillation (VF) which occurs in more than 70%. The survival in out of hospital cardiac arrest is 30–35% in the western world whereas it is low in low socioeconomic countries. At present patients/persons suffering from cardiac arrest especially outside the hospital settings has high mortality of 70% or more. As per American Heart Association guidelines, early defibrillation within minutes is the prime treatment to improve the survival. In a country like India, defibrillators are not available and it may take hours for a victim to reach appropriate centres for defibrillation causing loss of life. However, defibrillators are currently expensive, not readily available. In a vast country, it is difficult for patient to access the major hospitals, lack of beds and other facility causes delay in treatment and death of patients. Hence there is high demand for the development of an alternate defibrillator readily available everywhere. The aim of this paper is development of a low-cost portable disposable defibrillator for the management of cardiac arrest victims. The design consists of an encasing a portable battery with capacitor which stores and delivers biphasic shock of 50 J for paediatric and 150 J for adult via two paddles attached to the assembly. Up to 6 shocks can be delivered with the stored energy. The casing will have a facility to view the heart rhythm such as VF and sinus rhythm via small display. Hence the project is aimed to develop a low-cost ultraportable defibrillator that aims to provide widespread availability, early defibrillation and improve survival. The proposed diagnosing system in hardware design was tested on safety analyser and defibrillator analysers in Clinical Engineering department of Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) and the accuracy was achieved of 98.03%.

Synchrotron-Infrared Microspectroscopy of Live Leishmania major Infected Macrophages and Isolated Promastigotes and Amastigotes.

The prevalence of neglected tropical diseases (NTDs) is advancing at an alarming rate. The NTD leishmaniasis is now endemic in over 90 tropical and sub-tropical low socioeconomic countries. Current diagnosis for this disease involves serological assessment of infected tissue by either light microscopy, antibody tests, or culturing with in vitro or in vivo animal inoculation. Furthermore, co-infection by other pathogens can make it difficult to accurately determine Leishmania infection with light microscopy. Herein, for the first time, we demonstrate the potential of combining synchrotron Fourier-transform infrared (FTIR) microspectroscopy with powerful discrimination tools, such as partial least squares-discriminant analysis (PLS-DA), support vector machine-discriminant analysis (SVM-DA), and k-nearest neighbors (KNN), to characterize the parasitic forms of Leishmania major both isolated and within infected macrophages. For measurements performed on functional infected and uninfected macrophages in physiological solutions, the sensitivities from PLS-DA, SVM-DA, and KNN classification methods were found to be 0.923, 0.981, and 0.989, while the specificities were 0.897, 1.00, and 0.975, respectively. Cross-validated PLS-DA models on live amastigotes and promastigotes showed a sensitivity and specificity of 0.98 in the lipid region, while a specificity and sensitivity of 1.00 was achieved in the fingerprint region. The study demonstrates the potential of the FTIR technique to identify unique diagnostic bands and utilize them to generate machine learning models to predict Leishmania infection. For the first time, we examine the potential of infrared spectroscopy to study the molecular structure of parasitic forms in their native aqueous functional state, laying the groundwork for future clinical studies using more portable devices.

Identifying the current status and future needs of clinical, educational, and laboratory genetics services in Pakistan: a web-based panel discussion.

While the prevalence of genetic disorders has been well documented in the Muslim-majority, low-socioeconomic country of Pakistan, the provision of medical genetic services remains limited and cost-prohibitive to the masses in the country. With the objective of identifying gaps in the provision of medical genetics services as perceived by the healthcare providers and the general public, the Pakistani Society of Medical Genetics and Genomics (PSMG) organized a needs assessment webinar on December 6, 2020, titled, “A Vibrant Discussion on the Current Status and Future Needs of Medical Genetic Services in Pakistan.” The objectives of the webinar were (1) to explore the current availability of medical genetics services, (2) to identify areas in clinical genetics delivery models needed to improve the state of medical genetics in the country, and (3) to garner the interest in such provisions from the expert and lay audience. The webinar consisted of a moderator-led, structured interview of an expert panel including the following topics: (1) postgraduate clinical genetics and genetic counseling training programs, (2) medical genetics clinics and formal genetic counseling services), (3) clinical genetic testing and (4) patient support and advocacy groups. The webinar was followed by a short, web-based survey completed by 35 of the 60 attendees. The results of this survey indicated overwhelming support for establishing formal genetic counseling educational opportunities (91.6%) and increasing the availability of genetic testing (100%). This report further summarizes the opinions and recommendations of the panelists and the audience survey results.

Twins in Guinea-Bissau have a 'thin-fat' body composition compared to singletons.

The 'thrifty phenotype' hypothesis proposed that fetal undernutrition increases risk of diabetes in later life. Undernourished low birthweight Indian babies are paradoxically more adipose compared to well-nourished European babies, and are at higher risk of diabetes in later life. Twin pregnancies are an example of in utero growth restrictive environment due to shared maternal nutrition. There are few studies of body composition in twins. We performed secondary analysis of anthropometric body composition of twins and singletons in Guinea-Bissau, an economically deprived African country.Anthropometric data were available on 7-34 year-old twins (n = 209, 97 males) and singletons (n = 182, 86 males) in the Guinea-Bissau Twin Registry at the Bandim Health Project. Twins had lower birthweight (2420 vs 3100 g, p < 0.001); and at follow-up, lower height (HAZ mean Z-score difference, -0.21, p = 0.055), weight (WAZ -0.73, p = 0.024) and BMI (BAZ -0.22, p = 0.079) compared to singletons but higher adiposity (skinfolds: +0.33 SD, p = 0.001). Twins also had higher fasting (+0.38 SD, p < 0.001) and 2-hour OGTT glucose concentrations (+0.29 SD, p < 0.05). Linear mixed-effect model accounting for intrapair correlations and interactions confirmed that twins were thinner but fatter across the age range. Data on maternal morbidity and prematurity were not available in this cohort.African populations are known to have a muscular (less adipose) body composition. Demonstration of a thin-fat phenotype in twins in a low socio-economic African country supports the thesis that it could be a manifestation of early life undernutrition and not exclusive to Indians. This phenotype could increase risk of diabetes and related conditions.

Posterior Urethral Valves; Outcome Analysis after Endoscopic Valve Ablation

Introduction: Posterior urethral valves, a major male infra-vesical obstructive uropathy leading to chronic renal failure are most common paediatric urological emergencies with an incidence of 1:5000 -1:8000. Early diagnosis, management and follow up of these patients is challenging in low socio-economic countries like Nepal. This study evaluates the cases with posterior urethral valves and their outcomes after endoscopic valve ablation over a period of five years.&#x0D; Methods: In this five year retrospective study from January 2016 to December 2020, all the cases with posterior urethral valves undergoing endoscopic valve ablation were reviewed and data were analysed for age, presentation, diagnosis and outcome at follow-up after management.&#x0D; Results: A total of sixty patients with posterior urethral valves were managed with definitive endoscopic ablation in the five year period. Median age at ablation was 11 months (10 days to 4 years). Commonest presentation was features of bladder outlet obstruction evident by poor stream, straining and dribbling of urine. Only 26.7% cases were managed in neonatal period due to low suspicion of valve in prenatal fetal scan. 83.3% of patients had complete relief from obstruction with normal urinary stream at follow up after ablation of valves with 15% of cases needing re-ablation of the residual valve. Two cases had to undergo anti-reflux surgery two years after valve ablation. Mortality was seen in one case due to cross sepsis. Majority of patients were in regular follow-up which showed its direct relationship to the outcome of the disease after valve ablation.&#x0D; Conclusion: Early detection, proper relief of obstruction and regular follow-up strategies can avoid life threatening complications of posterior urethral valves. Only treating posterior urethral valves is not the aim of obtaining successful relief of obstruction. Parent’s education, developing prenatal ultrasound skills to detect or suspect prenatal PUVs and early referral to tertiary centers where these patients can be managed promptly are equally important.