Tertiary Research Articles

Utility of acid citrate dextrose‐acidification for platelet volume reduction protocols in the transfusion service

AbstractBackgroundVolume‐reduced platelets can minimize circulatory overload, allergic transfusion reactions, or out‐of‐group plasma infusion. Our center adopted a volume reduction protocol that includes acidification with acid citrate dextrose solution A (ACD‐A) before centrifugation and without any rest period prior to resuspension allowing a better turnaround time for platelet issue.Study Design and MethodsThis report compares corrected count increments (CCIs) from full‐volume and ACD‐A acidified volume‐reduced human platelets in a retrospective study at a single hospital and in a mouse model.ResultsAt a pediatric tertiary care hospital, 530 patients received conventional apheresis platelets during the 20‐month study period. Among all patients, the expected 4‐h mean CCI was 9.8 (95% CI: 8.7, 10.9) for full‐volume platelets, and 8.8 (95% CI: 7.3, 10.6) for ACD‐acidified volume‐reduced platelets (p = .29). A statistically significant difference (p = .01) was identified in the expected 24‐h mean CCI: 6.3 (95% CI: 5.5–7.0) with full‐volume platelet, 4.7 (95% CI: 3.6–6.0) with ACD‐acidified volume‐reduced platelet. Limiting CCI calculations to patients with Hematology/Oncology/Hematopoietic Progenitor Cell Transplant diagnosis (n = 296, 56%) indicated a statistically significant difference in both 4‐ and 24‐h predicted CCIs, showing lower CCIs in ACD‐acidified volume‐reduced platelet, although these were still similar to the CCIs observed in all patients and considered to be clinically acceptable responses similar to other volume reduction protocols. The recovery of count‐adjusted, volume‐reduced platelets was significantly lower in mice, suggesting a procedure‐related defect.DiscussionACD‐A acidification of platelets before volume reduction decreases turnaround time for platelet issue and provides clinically allowable 4‐h and 24‐h platelet increments.

Determination of Attitudes and Knowledge Levels of Pediatricians about Pediatric Medicolegal Problems in Turkey

Objective: In recent years, allegations of medical errors in Turkey have been increasing. These allegations are generally concentrated on the issue of consent. Since most children are medically and legally incapable of making their own decisions on consent issues and the decision is made by the legal representative instead, various legal and ethical dilemmas arise. Pediatrics ranks first in lawsuits filed for medical errors. In our study, we aimed to evaluate the awareness of forensic legal issues among pediatricians. Materials and Methods: Our study is prospective and cross-sectional. Participants were asked 25 questions based on 14 possible case examples. They were asked to give a score between 1 and 5 points for each question about their feeling of adequacy regarding the information, consent, documents, and procedures that should be done according to these cases. Mann‒Whitney U and Kruskal‒Wallis tests were used statistically; p<0.05 was considered significant. Results: Two hundred nine pediatricians answered the questions. Sixty-six percent of the participants were working in tertiary care hospitals. Pediatricians were undecided about feeling adequate regarding the necessary information, consent, documents, and procedures to be performed for children (3.19/5) and felt inadequate when facing the refusal of treatment (2.77/5). There was no statistically significant difference between feeling competent in terms of title and professional seniority. Only 2% of the pediatricians stated that children under 12 years of age have the power of discernment, and only 7% stated that children over 15 years of age do not have the power of discernment. Conclusion: The general conclusion we reached in our study is that pediatricians do not feel adequate even concerning basic legal issues such as information, consent, and refusal of treatment. Therefore, they need to gain knowledge of these issues. For this reason, educational activities such as adding legal education to the medical school curriculum, legal training for pediatricians, and regular seminars effectively eliminate the lack of knowledge on this issue and prevent lawsuits.

Comparative Study of Staphylococcus aureus Biofilm Formation among Clinical Isolates and Nasal Colonisers

Staphylococcus aureus (S. aureus) a noted versatile facultative commensal with pathogenic potential. This facultatively anaerobic cocci lives a commensal lifestyle in about a quarter of the world’s population awaiting a breach in the immune barrier to establish as a debilitating pathogen. This bacterium produces biofilms which acts as adhesive molecule enhancing the bacterial virulence and gives it an ability to withstand antibiotics, thereby causing tremendous burden on the healthcare community in terms of patient mortality and morbidity. This study assesses the biofilm producing ability among clinical isolates of staphylococci in comparison to colonizing staphylococci isolated from anterior nares of healthcare personnel. The present cross-sectional observational study was conducted in a tertiary care hospital in Mysore, India. In this study, 50 pathogenic isolates of S. aureus were assessed for phenotypic biofilm production. Additionally, 100 healthcare personnel were screened for nasal colonisation with S. aureus and the colonizing isolates were also screened for phenotypic biofilm formation. Phenotypic biofilm formation was evident among 22% of the pathogenic isolates. 23% of clinical S. aureus isolates demonstrated methicillin resistance (MRSA). There was no significant association of MRSA status with biofilm production (p > 0.05). Out of the 100 healthcare professionals screened for nasal carriage of S. aureus, 30% were colonized with S. aureus. Biofilm production among colonizing S. aureus isolates was found to be 26.6%. Methicillin resistance was a whopping 40% among the colonising strains. MRSA carriage was found to be highest among those healthcare personnel who had worked for an average of 20-30 years in the hospital environment. The Present study showed no significant association of biofilm production with the pathogenic potential of the S. aureus isolates (p > 0.05). Additionally, there was no significant association of methicillin resistance with the pathogenicity of the isolate. In conclusion, the interplay of virulence genes, biofilm forming ability, drug resistance of the isolate in coordination with the host immune status dictate the fate of the colonising as well as clinical isolates of S. aureus.

Comparison of HPLC with Tinia for hba1c measurement in diabetic and non-diabetic patient; a study from a tertiary care hospital of Baluchistan

Background: Diabetes mellitus, a disease with serious implications on human health ,is on continuous rise. It is the need of hour to find and establish the markers to measure its long term effects. Diabetes Control and Complication Trial has confirmed role of HbA1c in effective blood glucose level monitoring .New methods are being developed for measurement of HbA1c .Before using these methods, it is essential to analyze these methods for reliability .Therefore in our study we will compare and evaluate correlation and agreement between Turbidimetric Inhibition Immunoassay TINIA and High Performance Liquid Chromatography HPLC for HbA1c measurement. Methods: Three hundred and ninety-four samples were analyzed simultaneously on Roche Cobas 501 and D-10 HbA1c analyzer by Bio-Rad for HbA1c level estimation. The results were entered into SPSS version 26 for method validation. This is an observational study conducted at Department of Pathology CMH Quetta from January 2022 to August 2023. Results: Inter and intra run coefficient of variation (CV) was within the allowable limit of 2 %. Mean difference between results of Turbidimetric Inhibition Immunoassay TINIA and High-Performance Liquid Chromatography HPLC was very low with HPLC results slightly on higher side. For low control TINIA had between run CV of 0.3% (Low control) 0.8 % (High control) and within run CV of 0.3% (Low control), 0.6% (High control); while HPLC had between run CV of 0.6%(Low control) 1.8% (High control), and within run CV of 0.3% (Low control), and 0.7%. Linear regression analysis displayed high concordance and agreement between the results of both methods. Conclusion: Both methods have comparable results in HbA1c estimation.

A Prospective Study of Adverse Drug Reactions to Antipsychotic Agents and its Causality Assessment in Psychiatry Ward of a Tertiary Care Hospital

A Prospective Study of Adverse Drug Reactions to Antipsychotic Agents and its Causality Assessment in Psychiatry Ward of a Tertiary Care Hospital

Detection of BRCA-1 gene mutations in epithelial ovarian tumors at tertiary care hospital Karachi

ABSTRACT Background: Ovarian cancer is the most common and lethal gynecological malignancy. Ovarian malignancy is the 3rd most common cancer in Pakistan. More than 90% ovarian cancers are of epithelial cell origin, about 24-40% such cancers have hereditary or sporadic mutation in the BRCA-1 or BRCA-2 genes. The present study was designed to detect BRCA-1 gene mutations in different histological sub-types of epithelial origin of benign, borderline and malignant ovarian tumors. Methods: This cross-sectional study was based on the analysis of BRCA-1 gene mutations in the epithelial origin of benign, borderline and malignant ovarian tumors received at the department of Pathology, Basic Medical Sciences Institute, Jinnah Post graduate Medical Centre, from 01-01-2011 to 31-12-2015. A total of 80 diagnosed cases were selected and analyzed for PCR. Results: BRCA-1 gene mutations were detected in 22 (27.5%) cases out of the 80 randomly selected epithelial ovarian tumors. Serous cyst adenocarcinoma was the commonest including 63% cases. BRCA-1 gene mutations were also positive in other epithelial ovarian tumors, including Mucinous cyst adenocarcinoma (13.6%), Endometroid adenocarcinoma and Mixed Mullerian tumor (4.5% each). In addition mutations were also detected in borderline tumors including Mucinous borderline tumor (9.09%) and Seromucinous borderline tumors (4.5%).The observations and results of the study were elaborated with the assistance of tables, figures and photomicrographs. Conclusion: BRCA-1 gene mutations manifestations were identified in a large number of serous malignant ovarian tumor cases. Small percentages of borderline and malignant mucinous tumors, endometroid adenocarcinoma and mixed mullerian tumor were also positive for BRCA-1 gene mutations.

Are the discoveries directed to applications? Translating the status of translational research in Peshawar, Pakistan

Background: Translational research plays a pivotal role in transforming basic scientific discoveries into practical applications, such as drugs and treatments, to address community health needs. This study aims to assess the awareness and perceptions of translational research among healthcare professionals in Peshawar, Pakistan. Methods: A cross-sectional descriptive design was employed, with data collected between January and July 2023 from public and private tertiary care hospitals in Peshawar, Pakistan. The study was approved by Ethical review board of Northwest School of Medicine via letter number: IRB & EC/2022-SM/074 dated: 15 Nov 2022. A sample size of 472 healthcare professionals was determined using the OpenEpi sample size calculator. The study utilized a self-structured questionnaire covering demographic information, awareness of translational research, and knowledge of its various aspects. Data analysis was performed using SPSS version 26, employing descriptive statistics and a one-sample t-test. Results: The study included 472 participants, with a mean age of 30.8 years, comprising various healthcare roles. Gender distribution showed 62.7% males and 37.3% females. Only 25% of respondents reported familiarity with translational research, while 75% indicated a lack of awareness. Information sources varied, with conferences/seminars (16.1%) and colleagues (5.5%) being prominent. Regarding the understanding of translational research, 64.2% admitted to having no idea. Identified barriers included lack of resources (14.8%), lack of awareness (7.6%), and lack of a sense of responsibility (1.3%). A significant majority (87.3%) reported poor knowledge of translational research, while only 12.7% indicated good knowledge. Conclusion: The findings highlight a substantial lack of awareness and understanding of translational research among healthcare professionals in Pakistan.

Isolation and Identification of Bacterial Pathogens from Blood Cultures in a Tertiary Care Hospital and Their Clinical Correlation

Objective: This study aimed to isolate and identify bacterial pathogens from blood cultures of patients with suspected bloodstream infections (BSIs) in a tertiary care hospital, analyze their antimicrobial susceptibility patterns, and establish clinical correlations. Methods: A cross-sectional study was conducted in the Microbiology Department of a tertiary care hospital. Blood samples from 60 patients were collected aseptically, processed using BACTEC, and cultured on blood and MacConkey agar. Bacterial isolates were identified based on colonial morphology, Gram staining, and biochemical tests. Antibiotic susceptibility testing was performed using the modified Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The overall culture positivity rate was 26%, with higher positivity among female patients (31.57%) and neonates or infants under six months (26%). Klebsiella pneumoniae was the most frequently isolated pathogen (53.33%), followed by Staphylococcus aureus (20.00%), Escherichia coli (13.33%), and Citrobacter species (13.33%). Klebsiella pneumoniae showed high resistance to ceftazidime and piperacillin, while remaining sensitive to cefoperazone and tobramycin. Staphylococcus aureus isolates were resistant to penicillin and erythromycin but sensitive to vancomycin and cefazolin. The prevalence of multidrug resistance among isolates underscores the need for targeted empirical therapy. Conclusion: Klebsiella pneumoniae emerged as the primary pathogen in BSIs, with significant resistance to commonly prescribed antibiotics. These findings highlight the necessity for enhanced infection control measures, especially in NICUs, and the implementation of local antibiograms to guide effective antibiotic therapy and mitigate resistance trends. Further research across multiple centers is recommended to validate these findings and inform broader clinical guidelines.

Watch your eyes: Workplace ocular hazards presenting at a tertiary eye care centre in south India

: Eye injuries can majorly affect individuals by reducing quality of life. In this study we report the prevalence of ocular trauma and the proportion of vision loss due to trauma presenting in tertiary care center.To evaluate the prevalence of occupational ocular injuries and the degree of visual loss in patients attending a tertiary eye care hospital in South India.The study was a retrospective observational study, which included patient’s aged 16 years and older attending Outpatient department of a tertiary eye care hospital following ocular trauma at workplace. The study took place across a six-month duration. A detailed demographic profile and history of the patient was documented. Patient underwent comprehensive ocular examination and further orbital imaging if necessary. The ocular injuries were classified using the Birmingham Eye Trauma Terminology System.This study included 210 patients, with a mean age group of 21-30 years. Men had a more than five-times higher rate of eye injury at work than women; with the most common mode of injury being metallic foreign body (75%). The predominant ocular injuries were categorized as closed globe injuries with 83 % incidence. 67% of the patients needed surgical intervention.Most work-related eye injuries often result from inadequate eye protection, with the majority of affected patients being young men, which highlights the importance of implementing preventive measures early in their careers. This study underscores the need of awareness and prevention programs for eye protection at workplace.

Attitude Toward Psychiatrists and Psychotropic Medication among Persons with Mental Illness and their Primary Caregivers at a Tertiary Care Hospital in North Gujarat

Attitude Toward Psychiatrists and Psychotropic Medication among Persons with Mental Illness and their Primary Caregivers at a Tertiary Care Hospital in North Gujarat

A Prospective Comparative Study Between Laser Hemorrhoidoplasty and Conventional Hemorrhoidectomy Procedure in Patients with Grade 3 Hemorrhoids Admitted in Tertiary Care Hospital

A Prospective Comparative Study Between Laser Hemorrhoidoplasty and Conventional Hemorrhoidectomy Procedure in Patients with Grade 3 Hemorrhoids Admitted in Tertiary Care Hospital

Tubal pathologies in benign hysterectomies

Fallopian tube is a pair of hollow, muscular tubes that are located at the upper margin of the uterus's broad ligament on each side of the uterus. The most frequent illness among women in the reproductive age range is salpingitis, where about 11% of females are affected. Para tubal cysts, hydrosalpinx, endometriosis and walthard cell nests are one of the common lesions of the fallopian tubes. To evaluate the tubal pathologies in benign hysterectomies done in a tertiary care hospital. We conducted a retrospective observational study for 15 months from October 2022 to December 2023 on 110 women who underwent hysterectomies along with salpingectomies or undertook the procedure as a part of tuboovarian masses in our hospital. These surgically resected specimens of fallopian tube which were received during the study period were included. Haemotoxylin and eosin stained histopathology slides of these cases were examined for a detailed analysis of histological patterns of various fallopian tube lesions. The data was represented in percentages and frequencies.: Among the 110 study participants, the minimum age of the women were 35 years and the maximum age was 64 years. The most common diagnosis in our study was Abnormal uterine bleeding (AUB) which was among 87 (78.8%) of the patients, followed by ovarian cyst (8.1%) and fibroid (6.3%). The tubal pathology was abnormal in 54.5% of the study participants. Majority of the abnormal tubal pathology was found to be paratubal cyst corresponding to 30.6% and 18% in the right and left fallopian tubes respectively followed by hydrosalphinx in the right fallopian tubes corresponding to 10.8%. This study concluded that more than 50% of fallopian tubes had aberrant diseases. Thus, a salpingectomy along with hysterectomy is beneficial to the patient in order to prevent further morbidity.

STUDY OF HUMAN LEPTOSPIROSIS IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

Objective: Prevalence of leptospirosis in humans is found in an alarming number in recent times. This endemic zoonotic disease is widespread and potentially fatal. It is usually seen in areas with poor socioeconomic conditions, water stagnation, garbage accumulation, which becomes breeding sites for the rodents. Infection may turn epidemic during monsoon. Reservoir of infection is rat scientifically named as Rattus rattus and infection results from direct or indirect exposure to host animals that carry the pathogen in their renal tubules and shed pathogenic leptospires in their urine. The main objective of this study was to estimate the seropositivity of leptospirosis in patients presenting with undifferentiated acute febrile illness for 5 to 7 days during one year period from February 2023 to February 2024 in a tertiary care hospital, Visakhapatnam, India. Methods: A total of 279 blood samples received from suspected cases of leptospirosis were subjected to IgM ELISA. Results: Out of total 279 cases, 20 were positive for leptospirosis (OD ratio ≥1.00). All the positive cases presented with a fever more than 99.5°F, chills and headache with elevated serum procalcitonin levels. Peak incidence of cases was recorded during July and August 2023. Conclusion: Seroprevalence of human leptospirosis in this study was found to be 7.2%.

A Case Series of Foreignbody Oesophagus and its Management at Tertiary Care Hospital

Objectives: To study the role of clinical examination as well as radiological investigations to rule out oesophageal foreign bodies as well as its plan of management.  Methodology: In total 10 patients with foreign body oesophagus came to Emergency department and ENT OPD in GGH, Anantapuram were prospectively analysed. The study period was from january 2023 to june 2023.A detailed clinical examination and radiological investigations done.  Results: There was male preponderance with children younger than 10 years compromising 50% of the patients. Upper oesophagus 80% was the favoured site for foreign body lodgement. were coins (60%) ,bones of chicken and meat(30%) gold chain (10%). There were no mortality or no major complications in this study group.  Conclusion: The complications due to oesophageal foreinbodies can be prevented by the early identification as well as referring the patients helps in proper management.The treatment of foreign body of oesophagus with the help of rigid esopaghoscopy was an effective ,safe and reliable procedure.

Implementing a colostrum-kit reduces the time to first colostrum for neonates admitted to the NICU - a retrospective observational study.

The World Health Organisation states that newborns should receive colostrum as soon as possible after birth. However, among newborns needing neonatal intensive care, initiation of lactation and access to colostrum might be delayed. At the centre of this study, a tertiary care hospital in Sweden (10,000 deliveries/year), few admitted infants received colostrum within the day of birth, warranting a quality improvement. In order to reduce the time from birth to first colostrum received by infants admitted to the Neonatal Intensive Care Unit (NICU), a new clinical routine including a colostrum-kit, was implemented as standard care in June 2018. The colostrum-kit contained information about hand expression of breastmilk as well as material for collecting, labelling and transporting the colostrum. The kit should be handed to all birthing parents with infants admitted to the NICU. Data on time in minutes from birth to first colostrum administered to the infant (oral mouth care, oral feeding or gavage feeding) was retrieved for all infants born between 1 September 2016 and 31 October 2023, admitted to the NICU within 1h from birth. Infants were divided into four time-cohorts, compared with nonparametric ANOVA. The study included 3618 infants born at 22 + 0 - 43 + 0 weeks gestational age, of whom 2814 (78%) had available data on time to colostrum. Median (IQR) time in hours was 35 (20-36) pre-implementations, followed by 18 (7-38), 11 (4-26) and 8 (3-22) in the subsequent follow-up cohorts, p < 0.001. Subgroups of mode of delivery had median (IQR) pre-implementation of 30 (19-54) for vaginal and 47 (23-72) for caesarean section that reached 7 (2-18) and 9 (3-26) in the last follow-up. Subgroups of gestational age (< 28, 28-31, 32-36, > 36 weeks) had a pre-implementation time of 48 (26-80), 46 (23-73), 33 (20-60) and 32 (19-57), that in the last follow-up was reduced to 4 (2-20), 7 (2-29), 9 (2-33) and 9 (4-19). Implementing a colostrum-kit for infants admitted to the NICU significantly reduced the time to first colostrum administered to the infant in all gestational ages. The difference between subgroups of gestational age or mode of delivery was reduced. The effect persisted over time.

Prospective randomised study comparing concomitant chemoradiotherapy using weekly paclitaxel versus weekly cisplatin in locally advanced carcinoma cervix (FIGO STAGE IB2 – IVA) in a tertiary care hospital

Concomitant chemoradiation(CRT) with weekly Cisplatin is presently the treatment of choice for locally advanced cases of carcinoma cervix. Despite it’s proven benefit in reducing disease recurrence by as much as 50%, our search is on for further improvement of treatment efficacy. This trial was done for comparing the response and toxicity of CRT with weekly Paclitaxel versus weekly Cisplatin in carcinoma cervix with locally advanced staging. Biopsy proven cases of squamous cell Ca stage IB2 to IVA were randomized into two arms (1:1 ratio). Arm A- patients received concomitant weekly cisplatin(40mg/m2)for 5 weeks during external radiation. For arm B-patients received weekly paclitaxel(60mg/m2) for 5 weeks concomitantly. EBRT dose of 50.4 Gy in 28 #was given alongwith followed by brachytherapy. Institutional and ethical clearance was obtained. Paclitaxel, when given concurrently with EBRT in cases of carcinoma cervix with locally advanced staging produces comparable response to that of cisplatin.

STUDY OF PREVALENCE OF MULTI-DRUG RESISTANT ACINETOBACTER SPECIES IN VENTILATOR-ASSOCIATED PNEUMONIAE CASES IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

Objective: Acinetobacter sps are important oppurtunistic pathogens with their significance in colonising and persistent biofilm production capabilities. The aim of the present study was to assess the prevalence of multidrug-resistant Acinetobacter sps in ventilator-associated pneumoniae cases in a tertiary care hospital Visakhapatnam. Methods: A prospective study was conducted on 328 endotracheal aspirate samples received in Clinical Laboratory, Department of Microbiology for a period of 1 y, from June 2023 to June 2024, in mechanical ventilated cases, admitted in intensive care units, in a tertiary care hospital, Visakhapatnam. Results: Out of 328 samples received, 42 (12.8%) were Acinetobacter isolates with resistance to Aminoglycosides (66.7%), Cephalosporins (57.1%), Quinolones (52.4%), Carbapenems (42.9%). Biofilm production was identified in 31 isolates (73.8%) by Congo Red Agar method in this study. Conclusion: The potential ability of Acinetobacter sps to form biofilms and antibiotic selective pressure leading to emergence of resistant clones is directly proportional to the injudicious use of antibiotics. There is a strict need of antibiotic stewardship measures in intensive care units to restrict development of pan-resistant strains.

An observational study of diagnostic hysterolaparoscopy for evaluation of infertility at a tertiary care hospital

Infertility is an illness recognised by the World Health Organisation (WHO) that refers to the inability to achieve a clinical pregnancy after engaging in regular, unprotected sexual intercourse for a period of 12 months or more. The incidence of primary infertility in India ranges from 3.9% to 16.8%. Hysteroscopy has emerged as a crucial technique for diagnosing infertility, providing a direct view of the uterine chamber to detect any possible abnormalities. The objective of this research is to analyse the use of diagnostic hysterolaparoscopy (DHL) in the evaluation of infertility. This research was a retrospective observational study that included 150 female patients who had a previous history of infertility. The study was done from May 2022 to September 2023. Information on the social and demographic characteristics of individuals and their medical history pertaining to infertility were collected by conducting interviews using a pre-tested, semi-structured questionnaire. Every participant took Dual-Hemisphere Language testing, and the gathered data were organised in Microsoft Excel. The significance threshold was established at 5% with a significance level of α = 0.05.: Out of the 150 patients that received DHL, 89 (59.33%) had primary infertility, whereas 61 (40.67%) had secondary infertility. Laparoscopy detected abnormalities in 35 (39.3%) of the individuals with primary infertility and 26 (42.6%) of the cases with secondary infertility. Abnormalities identified during hysteroscopy were 12 (13.4%) of the individuals with primary infertility and in 6 (9.83%) of the cases with secondary infertility. The prevalent abnormalities detected during hysteroscopy were uterine synechiae, fibroids, and uterine septa. The incidence of tubal obstructions was higher in the primary infertility group compared to the secondary infertility group.Diagnostic hysterolaparoscopy (DHL) is a very useful method for assessing infertility, namely in identifying adnexal adhesions, endometriosis, and uterine septa. In addition, DHL has the ability to detect several structural abnormalities in the uterus, fallopian tubes, and pelvis, which may assist in formulating suitable treatment strategies. So, both diagnostic and therapeutic intervention can be done at same sitting.

Assessment of Immunological, Skeletal, and Thyroid Function Abnormalities in Paediatric Morphoea

Abstract Background: Morphoea is a sclerosing disorder of skin and subcutaneous tissue. Paediatric morphoea shows increased prevalence of various auto-immune diseases, bone deformities, and systemic abnormalities. There is paucity of studies on various immunological, skeletal, and thyroid function abnormalities in paediatric morphoea. Aims and Objectives: To describe immunological, skeletal, and thyroid function abnormalities present in paediatric morphoea patients. Materials and Methods: This cross-sectional study was conducted from January 2021 to March 2023 in the Dermatology outpatient department in a tertiary care hospital. All paediatric morphoea patients were included in this study. All were subjected to detailed history, clinical examination, and investigations including complete blood count, serum IgE, anti-nuclear antibody, thyroid function tests, anti-thyroid peroxidase antibodies, and radiological investigations. Results: A total of 42 children were recruited, out of which 61.90% were females and 38.09% were males. The majority were in the age group of 4–8 years. The most common type of morphoea was encoup de sabre. Anaemia was present in 14.28% patients. Serum IgE levels were raised in 33.33% patients. Thyroid stimulating hormone was raised in 11.9% patients. 33.33% had raised anti-thyroid peroxidase levels. Anti-nuclear antibody titres and rheumatoid factor were raised in 7.14% and 4.76% patients, respectively. Magnetic resonance imaging brain revealed abnormalities in three patients as hyper-intensities in subcortical white matter. Conclusion: Morphoea in children can be associated with varied immunological, osteoarticular, and neurological abnormalities. This study highlights the multi-system involvement in morphoea and the need for larger data and well-designed therapeutic trials for generating evidence-based treatment of this potentially disfiguring disease.

Incidence of colistin heteroresistance among carbapenem-resistant Acinetobacter baumannii clinical isolates in a tertiary care hospital in Pakistan.

The emergence of colistin-resistant and heteroresistant strains of carbapenem-resistant Acinetobacter baumannii (CRAB) complicates treatment and exacerbates the global health crisis of drug-resistant bacteria. This study aims to investigate the incidence and clinical implications of colistin heteroresistance in carbapenem-resistant Acinetobacter baumannii isolates from a tertiary hospital in Pakistan. A total of 130 CRAB isolates were collected from December 2022 to December 2023. Colistin susceptibility was assessed using broth microdilution, and heteroresistance was detected through population analysis profiling. Heteroresistance (HR) was identified in 31.5% (41/130) of the isolates, while 7.7% were colistin-resistant, despite initial susceptibility indicated by broth microdilution. Clinical data revealed that HR was associated with significant 14-day clinical failure but not with 30-day all-cause mortality. Heteroresistant strains showed extensive multidrug resistance, posing a serious threat to effective treatment. The study highlights the critical need for accurate detection of colistin HR to prevent treatment failure and improve patient outcomes. The prevalence of colistin HR underscores the necessity for revised diagnostic and treatment strategies in Pakistan, emphasizing the importance of recognizing and addressing this emerging threat in healthcare settings.