High measles incidence and frequent epidemics are reported in Pakistan, given the low coverage for measles vaccine. This study evaluated coverage of mass measles campaign 2011 and estimated parental awareness and determinants for low/no coverage. Household survey was conducted 4 months after the measles campaign in Karachi, Pakistan. Parents of children younger than 5 years were administered structured questionnaire about their knowledge and participation in measles campaign. Of 1020 eligible households, only 282 (28%) parents knew about measles supplementary immunization activity, mainly from public announcements (49%). Of these, 174 (62%) children received measles vaccine, whereas, 108 (38%) parents refused measles vaccine. Overall, only 17% children received measles vaccine during this campaign. Low maternal education, not having received DPT/Pentavalent-3 vaccine, and routine vaccination from public Expanded Program on Immunization facility were significant determinants for low coverage. Measles vaccine coverage in Karachi remains low, and sporadic outbreaks of measles every 2 to 3 years are expected unless population coverage can be rapidly increased.
There are limited data on the outcome of emergency endoscopic retrograde cholangiopancreatography (ERCP) performed in the intensive care unit (ICU). We sought to assess the frequency, indications, and clinical outcomes of ERCPs performed in ICU patients who were too unstable to be transported to the endoscopy unit. An electronic endoscopy database was used to identify the patients (n = 22) and to assess procedural success, complications, and mortality. The indications for ERCP included suspected biliary sepsis, suspected gallstone pancreatitis, and known choledocholithiasis with cholangitis. Biliary cannulation, which was attempted in all patients, was successful in 19 patients (86 %), and of these 18 (95 %) underwent a technically successful endoscopic therapy. There were no apparent endoscopic complications. Therefore, emergency bedside ERCP in ICU patients, which is primarily performed for the management of suspected biliary sepsis and gallstone pancreatitis, can achieve high technical success rates when performed by experienced endoscopists, although the 30-day mortality rate remains high due to multiorgan dysfunction.
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The COVID-19 pandemic has created challenges, particularly for underdeveloped countries with fragile healthcare systems. These nations are experiencing increased pressure due to the pandemic and ongoing illnesses. This research aims to evaluate how the pandemic has indirectly impacted mother and newborn health in Pakistan, resulting in higher stillbirth rates. The study will analyze data from pre-pandemic and pandemic years to determine how healthcare interruptions, fewer prenatal visits, and infection concerns have affected stillbirth occurrences in tertiary-care hospitals. It is a cross-sectional study conducted at the Department of Obstetrics and Gynecology at Lady Reading Hospital, Peshawar, Pakistan, from January 2019 to January 2020. The Department of Obstetrics and Gynaecology at Lady Reading Hospital in Peshawar, Pakistan, conducted this cross-sectional research. Approved by ethics was acquired. Using internet calculators, the sample size of 200 was determined with a 5% margin of error, a 95% confidence interval, and a stillbirth percentage of 16%. Consecutive non-probability sampling was used. Patients who were at term and gave birth to stillborn children were included in the study; instances involving twin pregnancies, fetal abnormalities, and early neonatal deaths were not. For 2019 (before COVID-19) and 2020 (the pandemic year), retrospective data on medical problems, reasons for stillbirth, demographic traits, and prenatal visits were gathered. The causes of stillbirths were compared between the two years using chi-square testing. A p-value of 0.05 was considered statistically significant. The research discovered notable differences in stillbirth rates and associated variables between 2019 (before COVID-19) and 2020 (the pandemic year). The proportion of multiparous women increased to 62% in 2020 from 57% in 2019. A decline in prenatal bookings from 64% in 2019 to 52% in 2020 suggests that antenatal visits were fewer throughout the epidemic. There were notable variations between the two years in several stillbirth-related factors, including abruption, placenta previa, type II diabetes, gestational diabetes mellitus (GDM), malpresentation, intrauterine growth restriction (IUGR), obstructed labor, eclampsia, postdates, and unknown causes. These results demonstrate how the pandemic affected maternity care and how stillbirth rates are related to it. In an environment with inadequate resources, the research shows a significant rise in stillbirth rates during the COVID-19 epidemic. This increase is attributed to fewer prenatal visits, interruptions in healthcare services, and the pandemic's collateral consequences. These results highlight the need for tailored treatments and program changes for maternal health during medical emergencies.
Abstract: The World Health Organization (WHO) has categorized acute undifferentiated leukemia (AUL) as a rare subtype of acute leukemia of ambiguous lineage (ALAL). The prognosis of AUL is considered poor and it expresses no known lineage-specific markers. In majority of the cases, AUL has been associated with karyotypic abnormalities, most commonly deletion 5q and complex karyotype. Deletion 17p correlation with acute myeloid leukemia and myelodysplastic syndome has been previously established and is associated with poorer outcomes. Herein we are reporting a case of forty years old male who was referred to National institute of blood diseases and bone marrow transplantation with complains of fever, multiple neck swellings, and early satiety and was diagnosed as Acute Undifferentiated Leukemia along with deletion 17p. This is a rare entity and can aid in further diagnostic and therapeutic approaches. Keywords: Acute undifferentiated leukemia, Deletion 17p, Flourescnece in situ hybridization, Allogeneic haematopoetic stem cell transplantation, Flow cytometry.
Lactic acid bacteria are a safe and healthy alternative to antibiotics that have been attracted in many recent studies Methods: Salmonella.Typhi was diagnosed with the VETIC system, biofilm formation was detected by Congo red method and the microtiterplate method.L. plantarum capsule from (Swanson) company ATCC 53103 was used to obtain L.plantarum life cells.Results: The diagnostic results showed that 11 bacterial isolates from feces with a percentage 1.27% and 37(61%) bacterial isolates from blood represented S. Typhi bacteria with a total of 48 isolates and various levels of biofilm productivity, which were categorized as having strong production by 87%, average production by 6.25%, and weak production of membrane bioavailability by 2.1%.The inhibiting effect of L. Plantarum potential as a probiotic was investigated using the bacterial Cell Free Supernatant (CFS) of the same bacteria, which gave the highest inhibition area for S. Typhi and for three bacterial isolates, it was (16,18,17) mm compared to the inhibition of suspension which gave the lowest inhibition areas (16,15,15)mm.The results also showed that the CFS produced by L. plantarum had the ability to inhibit biofilm formation by 20 isolates of S.T. bacteria, in comparison with the positive control reading.The highest inhibition rate was 84.5% towards isolate S.T.4 and the lowest 70.8% inhibition of the S.t.35 isolate trend.Therefore, L. plantarum suspension can be presented as a viable healthy and therapeutic probiotic agent.
Administration of 1/5th dose of Inactivated poliovirus vaccine intradermally (fIPV) provides similar immune response as full-dose intramuscular IPV, however, fIPV administration with BCG needle and syringe (BCG NS) is technically difficult. We compared immune response after one fIPV dose administered with BCG NS to administration with intradermal devices, referred to as Device A and B; and assessed feasibility of conducting a door-to-door vaccination campaign with fIPV. In Phase I, 452 children 6–12 months old from Karachi were randomized to receive one fIPV dose either with BCG NS, Device A or Device B in a health facility. Immune response was defined as seroconversion or fourfold rise in polio neutralizing antibody titer 28 days after fIPV among children whose baseline titer ≤362. In Phase II, fIPV was administered during one-day door-to-door campaign to assess programmatic feasibility by evaluating vaccinators' experience. For all three poliovirus (PV) serotypes, the immune response after BCG NS and Device A was similar, however it was lower with Device B (34/44 (77%), 31/45 (69%), 16/30 (53%) respectively for PV1; 53/78 (68%), 61/83 (74%), 42/80 (53%) for PV2; and; 58/76 (76%), 56/80 (70%), 43/77 (56%) for PV3; p < 0.05 for all three serotypes). Vaccinators reported problems filling Device B in both Phases; no other operational challenges were reported during Phase II. Use of fIPV offers a dose-saving alternative to full-dose IPV.
Abstract Background Preliminary data on COVID-19 in the pediatric population has revealed that children account for a milder clinical course and better prognosis compared with adults. However, infants are at the greatest risk within this subset, with studies demonstrating the highest proportion of critical cases in this age group. The clinical spectrum of the disease in these children remains largely unexplored. Similarly, there is a dearth of research on the potential vertical/perinatal transmission of SARS-nCoV and the clinical outcomes of infants born to mothers who have been tested positive for the virus. In this review, we aim to summarize available literature on the clinical spectrum of COVID-19 in neonates and infants. Methodology This review will explore the clinical characteristics of COVID-19 in infants tested positive for SARS-nCoV using RT-PCR assays as well as neonates born to mothers who were detected with the virus during pregnancy. We will conduct a comprehensive search of two large databases, i.e. PubMed and Google Scholar and shortlist published and unpublished (pre-proof and pre-proof accepted) articles in English between 1 st November 2019 and 15 th May 2020 that meet the eligibility criteria. Keeping in view the paucity of data on the study topic, we plan to include all relevant articles irrespective of study design. The findings will be synthesized narratively following an analytical interpretation to capture emerging themes. Discussion Through this systematic review, we hope to provide an evidence-based framework for pediatricians to incorporate into their practice while managing neonates and infants tested positive for COVID-19 or those born to mothers who tested positive for the disease. This will set the stage for prospective clinical research to address the questions that remain unanswered. More importantly, exploring disease pathogenesis and transmission in pediatric patients could provide practical insights to guide future therapeutic and preventative measures and, perhaps, vaccine development. Systematic review registration: This review has been submitted for registration with PROSPERO (acknowledgement of receipt -185333).
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