Ziauddin University Hospital Research Articles

Prognostic role of serum procalcitonin in neonatal sepsis at a tertiary care hospital.

Objective: To analyze the prognostic role of serum procalcitonin in neonatal sepsis at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric, Dr. Ziauddin University Hospital, Kemari, Karachi, Pakistan. Period: October 2023 to March 2024. Methods: Neonates of both genders aged between 1 to 28 days having confirmed neonatal sepsis were included. At baseline, demographic characteristics were noted and necessary laboratory investigations were performed. At baseline, serum procalcitonin levels were evaluated in all neonates. The prognostic value of baseline PCT was assessed by comparing its association with the mortality. Other outcome variables like need for non-invasive ventilation, mechanical ventilation, need for inotropics, and acute kidney injury were also documented. Results: In a total of 131 neonates, 76 (58.0%) were male. The median age was 2.00 days (IQR=1-7 days). The median baseline procalcitonin level was 3.17 ng/ml (IQR=0.55 to 10.34 ng/ml). Need for non-invasive ventilation, and mechanical ventilation was noted in 93 (71.0%), and 19 (14.5%) neonates, respectively. Need for inotropics was documented in 23 (17.6%) neonates. The median duration of NICU stay was 3.00 (2.00-5.00 days). Among neonates who died, procalcitonin levels were significantly higher than those who survived (p=0.015). Mortality was found to have significant association with need for mechanical ventilation (p<0.001), and need for inotropics (p<0.001). Conclusion: High serum procalcitonin was found to be a significant predictor of mortality in neonatal sepsis. Mortality was significantly associated with need for mechanical ventilation, and need for inotropics.

Association of Shock Index and Modified Shock Index with Mortality Rate in Emergency Department Trauma Patient

At the emergency room, triage was used to determine which patients were more seriously injured and in need of urgent care. Trauma remains one of the primary causes of morbidity and death even with the use of modern triage techniques. Objective: To find out the relationship between trauma patients' 48-hour mortality and the shock index and modified shock index at Emergency Departments (EDs). Methods: A study was conducted in the Emergency Ward of Ziauddin University Hospital, focusing on patients aged 18-65 who sustained trauma. The study involved 50 trauma patients admitted to a Level I trauma center. Data were collected on heart rate, blood pressure, and shock indices at the time of admission. A shock index cut-off value of 0.9 was used to determine its association with patient outcomes. Data collection involved patients visiting the emergency department, with informed consent obtained. SPSS version 21.0 was used for analysis. Results: The study involved 50 patients, with 25 in each exposed and unexposed group. Exposed patients had a higher average age, higher heart rates, and lower blood pressure. Road traffic accidents were the leading trauma mechanism in both groups. Open wounds were more common in exposed patients. Most exposed patients received intravenous fluids and inotropic support. Patients with a Shock Index ≥ 1 and a Modified Shock Index ≥ 1.3 had higher mortality rates. Conclusion: The study revealed a significant link between medical mortality in older adults and bruises in emergency departments, indicating that SI and Modified SI were effective markers for severity assessment.

Diagnostic accuracy of low dose CT-Scan abdomen in patients with clinical features of acute appendicitis.

Acute appendicitis is one of the commonest causes of acute abdominal pain presenting to emergency department (ED) and Computerized Tomography scan (CT) is considered gold standard for its diagnosis. Internationally Low Dose Computerized Tomography scan (LDCT) in emergency department is recommended as a beneficial tool to diagnose acute appendicitis with less exposure to radiation and reduction in the rate of negative laparotomy. Local trials are needed to determine the diagnostic accuracy of LDCT as the first line imaging test for acute appendicitis. Our objective was to determine the diagnostic accuracy of LDCT as the first line imaging test for acute appendicitis. An observational study was conducted over a sample of 147 patients presented with suspected acute appendicitis to the emergency department of Ziauddin University Hospital, Karachi from November 2018 till May 2019. Non-probability consecutive technique used. Aged ≥ 16 years presented in emergency department with the history (symptoms) and physical examination (Signs) suspecting acute appendicitis were included. Patients with contraindications to CT scan e.g. pregnant women. Patients with signs of Acute Peritonitis requiring immediate surgery. CT scan refused by the patient or patient's attendant were excluded. Histopathology was the gold standard in diagnosing acute appendicitis. The data was analyzed using open epi sample size calculator. One hundred forty six patients had positive findings on LDCT for acute appendicitis (99.3%) whereas only one patient had negative findings (0.7%). The sensitivity and specificity of LDCT for the detection of acute appendicitis were estimated as 96.45% and 16.67% by taking histopathology as gold standard. Negative predictive value (NPV) and positive predictive value (PPV) were estimated as 16.67% and 96.45% respectively. The overall accuracy of LDCT was 93.88%. Our study showed that for diagnosing acute appendicitis, LDCT is harmless, fast and economical imaging modality and has diagnostic accuracy with decrease in radiation dose.

Comparison of doses of Nebulized Magnesium sulphate as an adjuvant treatment with salbutamol in children with Status Asthmaticus.

To compare the response between different doses of nebulized magnesium sulphate along with Salbutamol in children between two to 12 years of age with status asthmaticus. This single blinded, randomized clinical trial was carried out at the Department of Pediatrics, Dr. Ziauddin University Hospital, Karachi, Pakistan during October 2021 to September 2022. A total of 104 children aged between 2-12 years, with the diagnosis of asthma having "Pediatric Rapid Assessment Measure (PRAM)" score>4 and with reactive airways were included. Children either received three back-to-back nebulization with salbutamol solution only (n=50) or salbutamol and MgSO4 with three different doses (250mg, 500mg or 750mg) after every 20 minutes for 60 minutes. The PRAM score was used as an assessment tool to clinically score asthma. In a total of 104 children, 53 (51.0%) were girls. The mean age was 5.25±2.86 years. No statistically significant difference was found in PRAM scores at baseline (p=0.448) and at 20-minutes (p=0.072) but significant differences were observed at 40-minutes (p=0.009), 60-minutes (p=0.011), 120-minutes (p=0.010), 6-hours (=0.034), 12-hours (p=0.018), 18-hours (p=0.033) and at 24-hours (p=0.029). The reduction in PRAM scores from baseline to 24-hours following treatment among Salbutamol, Salbutamol+ MgSo4 250mg, Salbutamol+ MgSo4 500mg and Salbutamol+ MgSo4 750mg group were 6.53±1.09, 7.22±1.09, 6.85±1.43 and 7.57±1.06 respectively (p=0.007). While children with status asthmaticus managed using salbutamol, with or without nebulized MgSO4, showed improved clinical outcomes, combining salbutamol with higher dosages of nebulized MgSO4 resulted in even greater clinical improvement.Clinical Trial Registry: https://clinicaltrials.gov/ct2/show/NCT04929626.

Effect of ABO blood group on the severity and clinico-pathological parameters of COVID-19.

The COVID-19 pandemic has highlighted the need to understand the factors affecting disease severity. Prior research has indicated the potential roles of the ABO blood group system in disease susceptibility and progression. Our objective was to investigate the association between ABO Blood groups and the severity of COVID-19 and clinicopathological parameters. An analytical cross-sectional study was conducted across three locations of Ziauddin University Hospital, including COVID-19 outpatient departments (OPDs), wards, and intensive care units (ICUs) from May 2020 to December 2020.The study utilized a non-probability convenient sampling technique with a sample size of 120 PCR-positive adult patients, as calculated by OpenEpi with a 95% confidence interval. Patients were excluded if they were under 14, intellectually impaired, post-chemotherapy or radiotherapy, or had a malignant condition. Disease severity was determined based on clinicopathological parameters and associated with blood group data using ANOVA and Chi-square tests in SPSS version 21. A significant association was found between the ABO blood groups and COVID-19 severity. Blood group-A was notably overrepresented in patients with severe COVID-19 and correlated with higher inflammatory markers and coagulation parameters. ABO blood group, particularly Blood Group-A significantly associates with the severity of COVID-19. This finding suggests the potential utility of ABO blood group typing as a predictive marker for disease severity, which could contribute to personalized patient management strategies. Further research is necessary to understand the mechanisms underlying this association.

Preventing Ocular Surface Foreign Body Complications: Enhancing Awareness and Precaution

Background: Ocular surface foreign bodies are the second most common emergency condition in the ophthalmology department OPD, which can be easily prevented through proper precautionary measures. Also, they can be either superficial or embedded into the cornea or conjunctiva. In this study, we aimed to create awareness regarding the prevention and management of such cases to reduce ocular complications. Methods: This prospective cross-sectional study was carried out in the Ophthalmology department of Ziauddin University Hospital Karachi. The study duration was 4 years from 16th November 2019 to 15 November 2022. Patients presented to the ophthalmology department OPD with complaints of ocular foreign bodies were examined clinically and a total of 427 patients were included in the study who fulfilled the inclusion criteria. The data was collected and analyzed on SPSS 23. The chi-square test was used to compare the variables. Results: Our study analyzed that ocular surface foreign bodies had a strong association with the profession. The metallic foreign bodies were found in 283(66.3%) patients and the remaining 144 (37.7%) were non-metallic. There was a strong correlation found between the type of foreign body and the site of ocular involvement. The p-value was significant with 0.0001. Conclusion: The majority of ocular surface foreign bodies were workplace-related due to a lack of awareness of protective measures. A counseling workshop should be arranged regarding its importance for workers in their workplaces which will improve their work capacity, and health and reduce economic burden.

Leaking Lymphatics to Resolution: Article On Conservative Management of Low-output Chylous Fistulae

Background: Chyle is an infrequent complication in neck dissections. It has been implicated on left side more than right however in 25% of cases they can occur on right side as well. Beside neck dissections, lymph node biopsy, penetrating or blunt trauma, and cervical rib resection. This article focuses on conservative management of low volume chylous fistula on both, right and left sides. METHODOLOGY: This study retrospectively examined all patient records from the past two years at Dr. Ziauddin University Hospital, Karachi, who underwent neck dissection. Six cases of chyle leaks were identified, and their medical records were reviewed. A data collection form was used to gather information on patient demographics, primary diagnosis, risk factors for chyle leaks, chyle leak diagnosis, and subsequent management strategies. RESULTS: A total of 160 neck dissections have been performed and 6 cases of chyle leak have been reported as a complication. Of the six chyle leaks, five (83%) occurred on the left side and one (17%) on the right. All identified patients had low output fistulae (<500ml in 24 hours). The peak 24- hour drain output ranged from 50ml to 330ml. Half of the patient were presented in first four days and all of them were treated with conservative management and were healed within two weeks. CONCLUSION: Chyle leak may persist for two weeks but may heal without any surgical intervention. This demonstrates importance of conservative management in low volume fistula.

The spectrum of measles in COVID-19 pandemic; An observational study in children.

Objective: To assess the spectrum of measles during COVID-19 era among children. Study Design: Cohort study. Setting: Department of Pediatric, Dr. Ziauddin University Hospital, Kemari Karachi. Period: February 2019 to February 2021. Material & Methods: Clinically diagnosed measles children of either gender aged between 3 months to 5 years admitted to our tertiary care center in the 2 years marked period of the study were analyzed. Measles was labeled as the presence of high grade fever (>104 0F) and maculopapular rash. Medical history was noted and clinical examination was performed in all children. Necessary laboratory investigations like complete blood count and chest X-rays (CXR) were evaluated. All patients were treated as per standard institutional protocols. Outcomes were noted in terms of successful discharge or expiry. Results: In a total of 88 children, 55 (62.5%) were male. The mean age was 1.61±1.12 years while 49 (55.7%) children were aged ≤ 1 year. Twenty four (27.3%) children were fully vaccinated appropriate to their age. Fever and rash were found among all children (100%) while respiratory distress and coryza were reported by 82 (93.2%) and 51 (58.0%) children respectively. Overall duration of hospitalization was 7.02±2.32 days. Mortality was reported in 11 (12.5%) children while 76 (86.4%) children were successfully discharged. Development of acute respiratory distress (p=0.0011) and shock (p<0.0001) proved to have significant association with mortality. Conclusion: Mortality was relatively high among children with measles during the COVID-19 pandemic era. During hospitalization, most frequent complications were pneumonia, and eye and/or mouth related complications. Development of acute respiratory distress and shock proved to have significant association with mortality.

Efficacy of Hematoma Block VS Conscious Sedation in Terms of Pain Relief for Manipulation and Reduction of Distal Radius Fracture

Objective: To compare the efficacy of hematoma block versus conscious sedation for closed reduction of distal radius fractures. Study Design and Setting: This was a Randomized Control Trial was conducted at Dr. Ziauddin University Hospital between 1st July 2018 and 31st July 2020. Methodology: A total of 158 patients underwent closed reduction of distal radius fractures in emergency department; these patients were divided in two groups of 79 each. Hematoma block was used as an analgesic in group A whereas conscious sedation was used on the patients in group B. Both groups were then compared for effectiveness in terms of pain reduction and SPSS software version 25 was used for data analysis. Results: Median age in group A was 44 years (IQR=37-48.5 years) and 40 years (IQR=30-47.50 years) in group B. The median pain score in group A [3 (IQR=2-5)] was significantly lesser than group B [5 (IQR=3-6)] with p=0.001. In group A effectiveness was achieved in patients was 69.6% and in group B effectiveness was achieved in patients was 35.44%. Statistically there was significant difference observed in proportion of efficacy between groups with p=0.001. Conclusion: This study show that hematoma block is more effective than conscious sedation in closed manual reduction of distal radius fractures in terms of pain relief.

ASSOCIATION OF INTRAVESICAL PROSTATIC PROTRUSION GRADE AND THE OUTCOME OF ALPHA BLOCKER TREATMENT FOR BLADDER OUTFLOW OBSTRUCTION

Benign Prostatic Hyperplasia (B.P.H) affects up to 80% of men older than 45 years of age worldwide, half of whom will eventually require treatment for its clinical manifestations such as bladder outflow obstruction (BOO) and its associated symptoms. There are various treatment strategies for B.P.H; alpha blockers being the most commonly employed. However, the outcome of said pharmacologic agent in treatment of BOO, in the presence of intra-vesical prostatic protrusion (IPP) of varying grades is less researched. The aim of the current study was to study the association IPP grade and the outcome of BOO treatment among patients with BPH. This prospective cohort comprised of a sample of 100 B.P.H patients, aged ≥ 45 years (chosen via non-probability – consecutive sampling), presenting to Ziauddin University Hospital, Karachi from June 2019 to December 2019. After taking written informed consent, data was recorded onto a pre-structured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, disease particulars, treatment outcome (gauged using IPSS, UFM and PVR) assessed at first contact and again after 1 and 3 months. The data obtained was analyzed using SPSS v. 21.0. The mean age of the sample stood at 68 years (SD ± 10.3).The mean prostate size was recorded to be 58 cm3 (SD ± 32) . The commonest grade of IPP was II (45%), followed by grade I (29%) and grade III (24%). The cumulative treatment outcome was poor, with only a meagre improvement (9.1% in IPSS score, 4% in UFM value and 13% in PVR) was recorded. Stratification revealed that the treatment outcome became progressively worse with increasing grade of IPP. After careful consideration, it can be concluded that the outcome of alpha blocker treatment for BOO among patients with IPP is poor. IPP serves to seemingly dampen the effect of alpha blockers with increasing grades corresponding to progressively worse outcome. Thus, additional modalities may be employed to supplement alphab blocker treatment for better patient outcome among patients with IPP.

Prevalence of nosocomial infection Pre- and Post-COVID 19 Pandemic in a Tertiary Care Hospital in Karachi.

Objective: To evaluate the role of the COVID-19 pandemic in the prevalence of nosocomial infections in patients admitted to the Ziauddin University Hospital, Clifton Campus, Karachi. Study Design: Retrospective Cross-sectional study. Setting: Ziauddin University Hospital, Clifton Campus, Karachi. Period: Pre-COVID: Feb 1, 2019 – Jan 31, 2019 Post-COVID: May 1 2020- Apr 30, 2021. Material & Methods: Clinicians retrospectively reviewed all Infectious Disease Department medical records for a list of all patients who developed a NI after 48 hours of admission to the hospital. The diagnosis of NI had been formulated by clinicians on the basis of clinical, radiological and microbiological findings. Results: We found an increase in certain types of NIs, and stability in the infection rate for many other organisms, which may be due to improved infection control practices during COVID. This information will lead to a better understanding of infection control practices in the future, and will better guide clinical decision making. Conclusion: The strict and proper implementation of infection control protocols during the COVID-19 outbreak has reduced the rate of NIs. It has been evident that NIs can be minimized by creating a positive attitude, improving awareness and staff hygiene practices and behaviours, and the provision of facilities to comply with the of infection control protocols’ standards.

Association of Elevated Heart Risk Score with Myocardial Infarction in Patients with Chest Pain

The HEART score is a widely used diagnostic tool in patients with chest pain. This tool is a very effective method for the stratification of patients with chest pain in the emergency department. It is composed of five components, i.e., history, ECG, age risk factors and troponins. Objective: To assess the importance of HEART score in our population. Methods: This study was conducted at emergency department of Ziauddin University Hospital, Karachi, Pakistan from 01 January 2021 to 30 June 2022. A cohort study of the HEART risk score in myocardial infarction (MI) patients presented with chest pain was conducted. 244 patients were selected by consecutive sampling and distributed into two groups i.e., non-exposed (HEART risk score 0-3) and exposed group (HEART risk score ≥ 4). The HEART risk score was calculated and patients were followed for the next 48 hours. Results: Patients of both groups were monitored for forty-eight hours and the results were myocardial infarction (MI) in 1 (0.8%) patient and 86 (70.5%) patients in group A (low risk) and group B (high risk) respectively. One patient (0.8%) in each group A (low risk) and in group B (high risk) left against medical advice (LAMA). One hundred twenty (98.4%) patients in group A and thirty-five (28.7%) patients in group B (high risk) were discharged. No patient (0.0%) expired in group A (low risk) and in group B (high risk) respectively. Conclusions: It was concluded from the study that the HEART risk score is very much helpful as a diagnostic tool in patients with chest pain, presented in the emergency

Comparison of efficacy of intravenous labetalol and intravenous hydralazine for management of pre-eclampsia in pregnant women.

To compare the efficacy of intravenous Labetalol and intravenous Hydralazine in reduction of blood pressure in patients with severe pre-eclampsia. This comparative study was conducted at the Department of Obstetrics and Gynecology at Ziauddin University Hospital, Karachi from1st June 2019 to 30th June 2020. Total 208 pregnant women having severe pre-eclampsia (systolic pressure ≥160 mmHg and diastolic pressure ≥110mmHg) were included in study. Group A received I/V Labetalol. Group B received I/V Hydralazine. Efficacy of drugs was observed by reduction in blood pressure and the number of doses administered. Data was analysed using SPSS version 26. Systolic blood pressure reduction in Labetalol group was significantly lower than in hydralazine group (105.5 ±11.3 vs. 115.8 ±17.1, p≤ 0.001). Diastolic blood pressure reduction was also lower in labetalol group than in hydralazine group (p= 0.03). Number of dosage of drugs in Group A (Labetalol) was 3.2 ±1.2 vs. Group B (Hydralazine) was 4.4±1.4, p =0.006). The results of this study show that Labetalol is more effective as compared to Hydralazine in terms of reducing the systolic and diastolic blood pressure and number of doses (Drugs) for in patients with severe preeclampsia.

Necrotizing Enterocolitis in Preterm Neonates: Prognostic Factors and Outcome

Necrotizing Enterocolitis (NEC) contributes significantly to a high neonatal death rate in Pakistan and other developing countries. A number of elements related to its development are modifiable and can be addressed. Objectives: To evaluate the frequency of NEC, its associated factors and outcome in preterm babies. Methods: This retrospective, cross-sectional study was conducted at Ziauddin University Hospital, Karachi. Medical records of admitted preterm newborns from 1st December 2020 till 1st December 2022 were reviewed and neonates meeting the modified Bell’s diagnostic criteria ,with NEC stage II and III were included. Data pertaining to antenatal period, delivery and postnatal course of the disease were recorded . Data analysis were done using SPSS version-20 and results expressed as frequencies and percentages. Chi square test was applied with p-value statistical significance set at <0.05. Results: The prevalence of NEC was observed to be 7.1%. Male to female ratio was 1.6:1 with 84.5% of the neonates being low birth weight and culture-proven sepsis present in 44.8%. The mortality rate was 32.7%. Thrombocytopenia, hypotension, formula feeds, a positive blood culture and invasive ventilation were significant risk factors for mortality (p-value 0.01) Conclusions: Necrotizing enterocolitis has a high prevalence and mortality in preemies. Sepsis, formula feeding and a low birth weight adversely affect outcome. Early diagnosis and timely intervention can improve survival

Bacteriological Profile and Antibiotic Susceptibility Pattern of Isolates in Neonatal Sepsis

Sepsis in newborns is a serious medical condition having a high mortality. Pakistan and other developing countries have a high burden of neonatal sepsis. Objectives: To determine the bacterial spectrum and antibiotic activity pattern in neonatal sepsis. Methods: This retrospective cross-sectional research was performed at the Pediatrics Unit of Ziauddin University Hospital Karachi from 1st June 2022 till 1st December 2022. A total of 120 medical records of neonates admitted with the clinical suspicion of sepsis were reviewed. Non-probability convenience sampling technique was used. Data regarding clinical characteristics of neonates, type of bacteria isolated and antibiotic susceptibility results were recorded. SPSS version 20 was used for statistical analysis. The results were written as frequencies / percentages. Results: Neonatal sepsis was suspected in 120 newborns but blood culture-proven infection was present in 32 (13.3%) neonates with 23(71.8%) having early -onset sepsis. The mean age on admission was 7.61±3.61 days. Acinetobacter was the commonest bacteria implicated in sepsis followed by Klebsiella ,Burkholderia and Serratia. The mortality rate in study population was 8.3%. Mortality was highest in Klebsiella sepsis. None of the bacterial species were sensitive to ampicillin while Acinetobacter and Burkholderia species responded to colistin, polymyxin and meropenem but showed resistance to imipenem. Conclusion: Early-onset neonatal sepsis has a high prevalence especially with gram -negative bacteria. Antimicrobial resistance to first line empiric therapy is common

Bacterial Spectrum and Associated Sociodemographic Factors in Pediatric Blood Stream Infections at Tertiary Care Hospital

Aim: To determine the bacterial spectrum and the frequency of sepsis in infants and children presenting to a tertiary care hospital, as well as its association with sociodemographic factors. Methods: This retrospective cross-sectional research was performed at the Department of Pediatrics, Ziauddin University Hospital Karachi. A total of 199 children records in the age group from 29 days to 12 years of age with a report of positive blood culture were included in the study. Non-probability consecutive sampling technique was used. Records were reviewed retrospectively and demographic data collected such as gender, age, diagnosis, type of admission (medical or surgical), length of stay in the hospital, and primary diagnosis with associated co-morbidities. SPSS was used for statistical analysis. The findings of quantitative variables were reported in terms of mean and standard deviation and qualitative variables in terms of frequency and percentages. Inferential statistics were analyzed by using Chi-square for comparing positivity of culture with baseline characteristics and a p-value of ≤0.05 was considered significant. Results: The mean age of the study population and the mean duration of hospital stay were 45.95±37.15 months and 7.61±3.61 days respectively. Out of a total of 199 cases with positive blood culture findings for bacterial isolates, coagulase negative staphylococci were found in 95(47.7%), Staphylococci Aureus in 57(28.6%), Streptococci species in 54(27.1%), E. Coli in 24(12.1%), Pseudomonas Aeruginosa in 14(7%), Klebsiella Pneumonia in 13(6.5%), Enterococcus species in 11(5.5%). Practical implication: Sepsis in the pediatric age group is associated with a high mortality and increased length of hospital stay. Early diagnosis and prompt treatment is the key to improve outcome of sepsis. Conclusion: There is a high prevalence of sepsis in children less than 48 months of age, more commonly in children with incomplete vaccination, female gender, decreased maternal educational level and a lower socioeconomic status especially in blood culture positive cases with unusual organisms such as Pseudomonas, Acinetobacter and gram-negative bacilli Keywords: Sepsis, Tertiary care, Pediatric intensive care, gram positive organism

Role of Salivary Chemerin in Oral Squamous Cell Carcinoma (OSCC) Patients with and without Chronic Periodontitis

Background: Chemerin is a multifunctional protein that plays a role in immunological function, chemotaxis, energy metabolism, and basic cell activities. Chemerin dysregulation contributes significantly to tumor angiogenesis and disease progression. The study aimed to assess salivary chemerin levels in Oral squamous cell carcinoma (OSCC) patients with/without chronic periodontitis, as well as, investigate the relationship between chemerin levels and OSCC stages. Methods: This case-control study was conducted at the Dental OPD of Ziauddin University Hospital and Liaquat National Hospital Karachi Pakistan from January 2020-2021. A total of n=60 participants, 15 each of OSCC with and without periodontitis and 15 controls of periodontitis alone and 15 healthy controls were included in the study. The salivary levels of chemerin were measured by ELISA. The mean salivary chemerin level was compared using Kruskal–Wallis’s test among the stages, sites and grades of OSCC. A p-value <0.05 was considered statistically significant. Results: The mean age of study participants was estimated as 43.42±13.19 years (range: 20-60 years). The mean salivary chemerin levels in OSCC were highest in the late stages; 18.88±8.8 ng/ml in stage III and 17.63±5.09 ng/ml in stage IV. A statistically significant difference was observed in mean salivary chemerin levels concerning the stage of OCSS (p=0.025). Furthermore, periodontal status was statistically associated with the site of the tumor (p<0.05). Conclusion: In OSCC and periodontitis, salivary chemerin levels were shown to be higher compared to healthy controls (p=0.025). Therefore, it can be utilized as a new therapeutic target for detecting tumorigenesis. Keywords: Chemerin; Oral Squamous Cell Carcinoma; Periodontitis; Periodontal Disease; Saliva; Salivary Chemerin Level.

Increasing Frequency of New Delhi Metallo-beta-Lactamase and Klebsiella pneumoniae Carbapenemase Resistant Genes in a Set of Population of Karachi.

To determine the frequency of Klebsiella pneumoniae Carbapenemase (blaKPC) and New Delhi Metallo-Beta-Lactamase (blaNDM) resistant genes among clinical isolates of Enterobacterales in a set of Karachi population. An observational study. Department of Microbiology, Dr. Ziauddin University Hospital, Karachi, Pakistan, from January 2019 to December 2020. A total of 2100 clinical isolates of Enterobacterales were collected. All isolates of Carbapenem-Resistant Enterobacterales (CRE) (Escherichia coli, Enterobacter and Klebsiella species) on the basis of Meropenem screening test positivity were included in the study. DNA was extracted and PCR was performed for resistant genes detection. Frequencies and percentages were computed for categorical variables and mean values and standard deviation for quantitative variables. Among 2100 isolates of Enterobacterales, the majority were E. coli 1260 (60%), followed by Klebsiella species 462 (22%), and Enterobacter species 210 (10%). The sources of CRE isolates included 34 (25%) from respiratory (tracheal aspirate, pleural fluid, and gastric lavage); 33 (24.26%) urine, 32 (25.53%) pus, 15 (11.03%) blood, and 20 (14.7%) others (ascitic fluid, stents, and tissue). All isolates of CRE were sensitive (100%) to Colistin, Tigecycline and Fosfomycin. Biochemically confirmed CRE 136 (6.5%) isolates, (79 (58%) males and 57 (42%) females), were selected for detecting resistant genes. The PCR showed 32 (23.52%) positive for both NDM and KPC resistant genes, 28 (20.58%) for NDM and 19 (13.97%) for KPC alone. Out of 79 followed up patients, 58 (73.4%) expired while 21 (26.6%) were discharged. The frequency of blaNDM and blaKPC resistant genes in CRE isolates depicted increasing trend. Colistin, Fosfomycin, and Tigecycline showed high antimicrobial sensitivities in vitro. Further measures need to be applied for CRE with comprehensive resistant genes detection to curtail antimicrobial resistance. Frequency, KPC, NDM, Klebsiella species, Carbapenemases, Enterobacterales E.coli.

Salivary miRNA 18a-5p Expression Level in Oral Squamous Cell Carcinoma

Aim: To determine the expression level of the salivary microRNA 18a-5p in Oral squamous cell carcinoma patients and healthy individuals Methodology: This case-control study was conducted on 40 samples out of which 20 were OSCC patients and 20 were healthy control patients. Saliva was collected from patients with newly diagnosed OSCC and healthy controls after getting informed written consent. All samples were recruited from Abbasi Shaheed hospital and Ziauddin University Hospital, Karachi. We evaluated the miRNA 18a-5p expression level in the saliva by reverse transcriptase polymerase chain reaction (RT-PCR) after isolating RNA through TRIZOL method. Results: microRNA 18a-5p expression level was significantly expressed and higher in OSCC samples compared with controls moreover in the OSCC samples with the progression of stages and grades, the expression increased suggesting it tumor-promoting role in OSCC. Conclusion: Our study concludes that the microRNA18a-5p can be the potential non-invasive biomarker for early detection of OSCC. Keywords: Oral squamous cell carcinoma, microRNA, salivary biomarker

Expression of CLEC3B in Oral Squamous Cell Carcinoma and its Association with Clinicopathological Features

Background: Oral squamous cell carcinoma is one of the leading causes of cancer related morbidity worldwide. The socioeconomic status and clinicopathological parameters have predictive importance specifically for head and neck squamous cell carcinoma. Literature has reported various studies on CLEC3B, and its correlation with OSCC has yet to be explored. Aim: To examine the association of CLEC3B expression with the clinicopathological parameters in the blood and saliva of OSCC patients and healthy individuals. Methodology: This case-control study was conducted on 40 blood and 40 saliva samples recruited from Ziauddin University Hospital and the Abbasi Shaheed Hospital. Blood and saliva samples were taken from 20 OSCC patients as well as 20 healthy individuals as controls. Demographic details including age, gender, and habits were collected directly from participants on a proforma. RT-qPCR was carried out to determine the association of CLEC3B expression in the blood and saliva of OSCC patients and healthy individuals with clinicpathological parameters. Result: Significant expression was observed in blood and saliva samples of OSCC (p-value 0.001*). CLEC3B was significantly expressed in saliva samples with respect to pathological grading and staging of OSCC. Moreover the foldchange analysis was considerably underexpressed in both samples (saliva p-value 0.042, blood p-value 0.014).Whereas no significant association was found with respect to the habits, age and gender of patients. The significant expression of CLEC3B in saliva may improve the ability of clinicians to detect OSCC at an early stage and may help to reduce the mortality rate of patients. Conclusion: A significant association of salivary CLEC3B was observed with the staging and grading of OSCC and it was found that CLEC3B may have the potential to be used as a suitable biomarker for the detection and diagnosis of OSCC. This study could provide insight into ongoing evidence on the importance of CLEC3B in early detection of oral cancer. Furthermore, the salivary gene expression can be used to characterize tumor grading and staging. Keywords: CLEC3B, Biomarkers, Gene expression, Oral cancer, RT-qPCR, molecular diagnostics