National Journal of Health Sciences
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Coronavirus – Do We Know Enough?
No full textAbstract: Coronavirus 2019 (COVID-19), previously called as 2019-nCoV, was emerged from Wuhan, China in December 2019. It is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). By 22 March 2020, 323,265 people were infected from this virus, including 13,745 deaths globally. It is declared as pandemic by World Health Organization as it involved 185 countries of the world. World Health Organization also declared it as 6th public health emergency of international concern. COVID-19 presents as various outcomes; asymptomatic (carrier), pneumonia and acute respiratory disease. People of all ages can be affected from this virus but adult population is observed to be involved in high ratio. Additionally, there is possibility that infection can be spread as nosocomial infection to patients and healthcare workers. On chest imaging, ground – glass opacity with bilateral involvement is seen as most common abnormality in patients with pneumonia. Older patients are prone to develop more severe disease as compared to young population. Patients with underlying chronic co-morbidities are also more prone to develop poor outcome. Till now, specific treatment of COVID-19 is not available; however clinical trials are under investigation to see the clinical efficacy of various therapeutic agents in China e.g. remdesivir and chloroquine etc. At this time, standard infection control measures are only possible means for prevention of SARS-CoV-2
Procalcitonin (ProCT): A Reliable Marker of Sepsis. A Single Centre Experience
No full textAbstract: Objective: Sepsis occurs in hematological disorders due to neutropenia, clinical signs and symptoms are not specific for its diagnosis. Early biomarkers are potentially helpful for the diagnosis in these patients. This study was done to assess the utility of Procalcitonin (ProCT) as a marker of sepsis in patients with hematological disorders.Methods: A cross sectional study was conducted in the section of clinical chemistry, department of laboratory, National institute of Blood disease and Bone marrow transplantation (NIBD) Hospital in Karachi Pakistan. Total 366 patients with age groups of 15 to 60 years with suspected sepsis undergone ProCT test were enrolled in the study, their blood cultures results and biomarkers including; White blood cell (WBC) count, C-reactive protein (CRP) and Absolute Neutrophil count (ANC) were also recorded. Sepsis was labeled as per surviving sepsis campaign (SSG) international guidelines for management of severe sepsis and Septic Shock 2012 criteria. Results: Biomarkers of culture positive patients were compared with culture negative patients. The statistically significant difference was noted in ProCT (p value < 0.001) and CRP (p value < 0.003). However, no significant differences were noted in WBC count (p value > 0.05) and ANC count (p value > 0.05). ProCT had outstanding diagnostic accuracy with area under receiver operator characteristic curve (AUC) was 0.95 ; ( 95%CI0.89 - 1.00), that for CRP was modest (AUC 0.74; 95%CI 0.61-0.87), while that for WBC and ANC were poor with AUC 0.43; (95%CI0.311-0.58), AUC 0.44(95%CI 0.28-0.54) respectively.Conclusion: ProCT alone showed the excellent diagnostic power on ROC analysis which proves it as a stronger diagnostic biomarker for sepsis in hematological disorders
Disseminated Cytomegalovirus Infection in a Patient with RAG2 Mutation SCID Transmitted via Breast Feeding: A Case Report and Review of Literature
No full textAbstract: Cytomegalovirus (CMV) infection poses a serious threat to immunocompromised patients in early life. Transmission of CMV to newborn via breastfeeding is a recognized mode. In our case, the affected child presented with the aftermaths of CMV infection affecting gastrointestinal tract (GIT) and central nervous system (CNS) with over-whelming viral replication and via ingestion of infected breast milk many times a day. Worsening clinical manifestations prompted the investigations for a possible primary immune deficiency (PID) disorder, and rising CMV copies in blood despite institution of anti-CMV therapy led to check other body fluids of the infant. There were no viral copies detected in mother’s blood sample; so breast milk was tested to identify the source of CMV being transmitted to him. Here we describe an unusual case of RAG2 gene mutation induced PID presenting clinically as severe combined immunodeficiency (SCID) phenotype rather than Ommen’s syndrome, and acquired CMV infection via breast milk
Frequency of Zap-70 and CD38 in Newly Diagnosed Cases of B-Cell Chronic Lymphocytic Leukemia
No full textAbstract: Introduction: Amongst all chronic lymphoproliferative disorders B-CLL is the most common. Clinical behavior of CLL is very variable and in order to identify the clinical spectrum there is a need for risk adaptive prognostic markers which will further facilitate in management strategy. Currently available molecular biomarkers ZAP-70 & CD-38 have gain much interest in providing useful prognostic information in patients diagnosed as B-CLL. Objective: To assess ZAP-70 and CD 38 positivity in patients diagnosed with B-CLL. Material & Methods: This was a cross sectional study conducted between Jan 2014 to July 2018 at NIBD, Karachi. Patients with B-CLL meeting the inclusion criteria were enrolled in the study. All patients gave informed consent. Immunophenotyping data analysis was done on FASC Calibur flowcytometry and Cell Quest software. We defined ZAP-70 and CD38 positivity as the presence of this marker on at least 20% and 30% of the B-CLL cells respectively. All required information was collected on pre designed Performa. Results: Total of 101 patients diagnosed as B-Cell CLL were included in the study. Median age of enrolled patients was 64 years (range 43-85 years). Majority of the patients i.e. 69 out of 101 (68.32%) were males and the rest 32 (31.68%) were female. ZAP-70 was positive in 2.97% of patients (03/101), while CD 38 positivity was detected in 33.66% (34/101).Conclusion: ZAP-70 & CD-38 positivity was present in 2.97% & 33.66% of newly diagnosed B-CLL patients respectively. Screening for these biological markers in all newly diagnosed CLL patients will result in more dependable identification of disease clinical behavior. 
Forgery in Research
No full textAccording to one definition “intention or gross negligence leading to fabrication of the scientific message or a false creditor emphasis given to scientist’’ is known as forgery or misconduct in science [1]. There are three types of misconduct in science, fabrication, falsification and plagiarism. Fabrication is making up and recording of results. Minor form of fabrication is citation in references where references is either not included or not reinforcing the argument or sometime totally against the argument. Falsification is changing or misinterpreting material, equipment or protocol. Plagiarism is utilization of some ones ideas, process, result or words without giving him proper credit [2]
Knowledge, Attitudes and Practices of Nurses, Regarding Hepatitis B Prevention at Public Hospital Lahore
No full textAbstract: Background: Occupational exposure occurs frequently among Health Care Workers (HCWs). The most serious occupational health hazard faced by HCWs worldwide is exposure to Hepatitis B Virus (HBV). Having enough knowledge and proper attitudes toward this infection is crucial in prevention of occupational hepatitis infection. Methods: This cross sectional descriptive study conducted to assess knowledge, attitude and practice of nurses regarding Hepatitis B prevention and control at Services hospital Lahore. In this study well-structured close ended questionnaire adopted from a study, knowledge, attitudes and practices of healthcare workers at the princess Marina hospital in Botswana regarding Hepatitis B prevention and control will beused (Machiya, 2011). The study was conducted in Services hospital among 200 nurses to assess knowledge, attitudes and practices of Nurses, regarding Hepatitis B prevention and control at a tertiary care hospital Lahore. Results: It was found that most of the nurses were enough knowledge, positive attitude and better practice among nurses. Mostly, nurses response are positively very rare participant response are negative. The knowledge of Hepatitis B infection prevention, 81% of the participantsknew that Hepatitis B infection can be transmitted by carriers. Majority 89.5% knew that Hepatitis B infection cannot be spread through casual contact. Majority knew that open wound, contaminated blood and body fluids, unsterilized syringes, needles and surgical instruments could easily transmit the Hepatitis B infection. Among the participants 86.5% had knowledge that vaccines can prevent Hepatitis B. 23% of the participants had negative attitude towards Hepatitis B. The attitude was positive among 55.6% participants and 54.2% participants were performing safe preventive practices
Knowledge and Practice of Foot Care among Diabetic Patients at a Public Tertiary Care Hospital Lahore
No full textAbstract: Background: The diabetic foot complication is further complicated by some UN desired and wrong practices of such asSocio-cultural myths of walking barefoot and religious belief of walking on fire etc. Sometimes inappropriate use of footwear and lack of awareness regarding proper foot care during diabetes mellitus also make the foot complication severe [1]. Objective: The specific objectives of this research work are: To assess knowledge of Diabetic foot self -care among patients attending Diabeticclinic at LGH Hospital Lahore. Methodology: A structured questionnaire with demographic variables and causes variables was applied. The data was analyzed on SPSS version 21. Result: A high percentages of participants stated that mentioned factors causing medication errors among nurses. Conclusion: It is concluded that some people do not know good practice for the disease, so it is important for an organization to provide enough knowledge about the disease for better health and good practice
Optimal Gestational Weight Gain Based on Different Body Mass Index and its Relation with Adverse Pregnancy Outcome in a Tertiary Care Hospital
No full textAbstract: Introduction: Maternal and neonatal complications have been linked to pre-pregnancy Body Mass Index (BMI) and gestational weight gain. Controlling of BMI and weight gain during pregnancy is desirable in order to optimize the maternal and perinatal outcomes. The aim of this study is to determine gestational weight gain in different BMI groups and its relation with pregnancy outcomes. Methods: This observational study was performed on 370 reproductive age women with singleton pregnancy from January 2015 to December 2016 at Hamdard University Hospital, Karachi. BMI and total GWG were calculated and patients were followed to see pregnancy outcomes. Data was analysed by using SPSS 21. Results: Out of 370 participants, 8(2.2%) were underweight, 119(32.2%) were healthy, 126(34.1%) were overweight and 86(23.2%) were obese and 31(8.4%) were very obese. Overweight and obese multiparous women gained weight more than IOM recommendations. Adverse pregnancy outcomes like GDM 124(33.5%), PIH 69(18.6%), Pre-eclampsia 9(2.4%), placental abruption 14(3.8%), cesarean section 214(57.8%), postoperative wound infection 54(14.6%), macrosomia 27(7.3%), low Apgar score 112(30.3%) and NICU admissions 174(47%) were noted in overweight and obese women with excessive GWG. We interestingly, noted adverse pregnancy outcomes in women with upper limit of normal BMI and GWG ranges. Conclusion: Implementing optimal BMI and GWG helps to avoid adverse pregnancy outcomes. Asians especially Pakistani women need local BMI and GWG recommendations to have better pregnancy outcomes
Sero Prevalence of Brucellosis in Pregnant Women Visiting Gynaecology Department of Kathmandu Model Hospital, Kathmandu, Nepal
No full textAbstract: Introduction: Brucellosis is a highly contagious zoonotic disease caused by ingestion of unpasteurized milk or undercooked meat from infected animals or close contact with their secretions. Subject and Methods: Sero-prevalence of brucellosis in pregnant women was conducted for the first time in Kathmandu, Nepal. A total of 80 sera samples were collected from the pregnant women visiting Kathmandu Model Hospital. The patients were categorized on the basis of age, trimester and ethnic groups. The sera samples were tested by ELISA method. Results: The sero-prevalence of brucellosis among pregnant women was found to be 11.25%. Madhesi ethnic group showed the highest (16.66%) seropositivity rates followed by Janajati (11.53%) and the lowest was in Brahmin (8.33%) ethnic group. Similarly, the age group 31-35 years showed highest prevalence (29.41%) followed by the age group 26-30 years (13.33%). There is absence of seropositivity among the age group 16-20 years and 21-25 years. The highest sero-prevalence rate (12.76%) was found in the third trimester followed by first trimester (10%) and the lowest was in second trimester (8.69%). About 3% of them consume raw milk directly from milking animals which is one of the risk factor of brucellosis in pregnant women. Conclusion: The prevalence was found to be high in pregnant women and ELISA was a sensitive and specific test for the detection of IgG antibodies against Brucella
Indigenous Oil Degrading Bacteria: Isolation, Screening and Characterization
No full textAbstract: Background: Oil contamination is increasing at an alarming rate and to overcome to this problem the most efficient method used is biodegradation. Biodegradation is a natural mechanism that can be used effectively for degradation of recalcitrant hydrocarbon pollutants prevailed in the environment by employing environmentally friendly microbes. Methods: Strain CMG 457 was isolated from petrol pump site from Firdous Colony, Karachi and was identified as Enterobacter sp. aftermorphological and biochemical characterization. Strain resistance towards different organic hydrocarbons (paraffin, aromatics and pesticides) and utilization of various organic compounds as sole carbon source were analyzed on Nutrient agar. MIC of antibiotics and heavy metals was checked on Bushnell Haas (BH) agar at 37°C for 24 hrs. Results: Research investigated the role of Enterobacter sp. in biodegradation of petroleum hydrocarbons. The results showed that the bacterium is a gram-negative aerobic bacillus. Enterobacter sp. designated as CMG 457 was screened for oil degradation using BH agar. Resistance of strain against different organic hydrocarbons was tested and CMG 457 showed high resistance of upto 50% against paraffin. The Minimum Inhibitory Concentration (MIC) of heavy metals and antibiotic sensitivity were investigated for bacterial strains. Screening forantibiotic resistance revealed that CMG 457 was resistant to ampicillin and erythromycin and was able to tolerate heavy metals like CuSO4, CdCl2 and CrCl2 upto 3mM. Conclusions: From the study, it is concluded that oil contaminated areas are the best source for isolation of hydrocarbon degrading bacteria. Enterobacter sp. has a potential for oil degradation as it showed better hydrocarbon degrading ability.