An overview of dengue viral infection circulating in Pakistan

Background & objectives: Dengue virus (DENV) is an RNA virus that infects approximately 2.5 billion people around the world. The incidence of dengue fever has rapidly increased at an alarming rate in the last few years and has affected thousands of people in Pakistan. This review explores the prevalence, serotypes and pathogenesis of dengue virus circulating in Pakistan. Methods: A systematic review of observational studies published between 1994 and December 2019 was performed. All records of the confirmed outbreak of dengue fever in Pakistan were reviewed and articles containing no primary data were excluded. Results: Four identified serotypes of dengue virus (DENV 1-4) circulate in different regions of the world causing epidemics. The most prevalent serotype, which is still epidemic and dominant in Pakistan, is DENV-2. Many factors like over-population, rapid urbanization, travelling, lack of vector control in dengue endemic areas and inadequate health-care are responsible of dynamic and huge raise of dengue in Pakistan. Interpretation & conclusion: Currently there is no specific treatment for prevention of dengue virus. Recently some antiviral compounds were being tested to eradicate this disease. There is a need to develop an efficient and safe vaccine for all four serotypes to combat dengue viral infection globally and particularly in Pakistan.

Pharmacokinetic of florfenicol in pulmonary epithelial lining fluid of swine and effects of anesthetic agent on drug plasma disposition kinetics / Farmacoqu'imica de florfenicol em fluido de epitélio pulmonar de suínos e efeitos de agente anestésico em cinética de droga em plasma

The primary objective of the current study was to compare the pharmacokinetic (PK) of florfenicol (FFL) in pulmonary epithelial lining fluid and the plasma in swine. The second objectives were to evaluate the effect of anesthesia with ketamine and propofol on the PK of FFL in plasma. Bronchoaveolar lavage was utilized for quantification of PELF volume and the urea dilution method was used to determine the concentration of FFL in PELF. FFL was administered intramuscularly (IM) to swine in a single dose of 20mg/kg body weight. The main PK parameters of FFL in plasma and PELF were as follows: the area under the concentration-time curve, maximal drug concentration, elimination half-life and mean residence time were 69.45±4.36 vs 85.03±9.26µg·hr/ml, 4.65±0.34 vs 5.94±0.86µg/ml, 9.87±1.70 vs 10.69±1.60hr and 12.75±0.35 vs 14.46±1.26hr, respectively. There was no statistically significant difference between the PK profiles of FFL for the anesthetized and unanesthetized pigs. This study suggest that (i) FFL penetrated rapidly into the pulmonary and the drug concentration decay faster in plasma than in the pulmonary, (ii) the PK profile of FFL in swine was not interfered after administration of anesthetic agent.(AU)

O objetivo primário desse estudo foi comparar a farmacocinética de florfenicol (FFL) em fluido epitelial pulmonar à farmacocinética (PK) de FFL em plasma suíno. O segundo objetivo foi avaliar o efeito de anestesia com ketamina e propofol no PK de FFL em plasma. Lavagem broncoalveolar foi utilizada para quantificar volume de fluido epitelial pulmonar (PELF) e método de diluição de uréia para determinar FFL em PELF. Injeção de FFL foi administrada intramuscular a suínos em dose única de 20mg/kg de peso corporal. Os principais parâmetros de PK em FFL em plasma e PELF foram os seguintes: a área sob a curva de concentração-tempo, concentração máxima da droga, eliminação de meia-vida e média de tempo de permanência foram 69,45±4,36 vs 85,03±9,26µg·hr/ml, 4,65±0,34 vs 5,94±0,86µg/ml, 9,87±1,70 vs 10,69±1,60hr e 12,75±0,35 vs 14,46±1,26hr, respectivamente. Não houve diferença estatisticamente significante entre os perfis de PK de FFL para os porcos anestesiados e não anestesiados. Esse estudo sugere que (i) FFL penetrou rapidamente no pulmão e concentração da droga sofre queda mais veloz em plasma que líquido pulmonar, (ii) o perfil de PK de FFL em suínos não modificou após administração de agente anestésico.(AU)

Cognitive dysfunction in patients with systemic lupus erythematosus

Objective: To determine the frequency of cognitive dysfunction in patients with Systemic Lupus Erythematosus in a Pakistani population, presenting at a tertiary care Rheumatology setting

Methods: This cross-sectional study was conducted at the Division of Rheumatology, Fatima Memorial Hospital, Lahore, from March to June 2016. A total of 43 consecutive patients, who fulfilled the 2012 SLICC [Systemic Lupus International Collaborating Clinics] classification criteria for Systemic Lupus Erythematosus [SLE], were enrolled. Cognitive function was assessed using Montréal Cognitive Assessment [MoCA] questionnaire. Demographic data and disease dynamics were collected in a proforma. Cognitive dysfunction was defined as score < 26/30, adjusted for duration of formal education. SPSS version 16.0 for windows was used to analyse data and to calculate frequency of cognitive dysfunction

Results: Out of 43 enrolled patients, 95.3% were females and 4.7% were males, with mean age of 28.72 +/- 9.25 years and mean formal education duration of 10.98 +/- 3.29 years. The mean disease duration was 24.21 +/- 30.46 months. Anti-nuclear antibodies [ANA] were present in all patients and anti-ds DNA in 93% patients. Cognitive dysfunction according to MoCA score was found in 65.1% [n=28] patients. For patients with disease duration more than two years, cognitive dysfunction was found in 60% patients [p>0.05] and for duration of formal education less than 12 years in 74.1% patients [p>0.05]

Conclusion: In this study, two third of SLE patients had Cognitive dysfunction. Hence, there is an increasing need to recognise and initiate early therapy for this overlooked aspect of SLE with an aim to achieve better quality of life

Frequency of dyslipidemia in patients with lupus nephritis

Objective: To determine the frequency of dyslipidemia in patients with lupus nephritis and its association with the degree of proteinuria

Methods: This cross-sectional analytic study included 65 patients who fulfilled the ACR [American College of Rheumatology] criteria for SLE and had renal involvement, presenting to the Division of Rheumatology, Fatima Memorial Hospital [FMH], and Lahore from 21[st] Sep 2016 to 20[th] Dec 2016. After 12 hours overnight fast their blood samples were assessed for total cholesterol [TC], triglycerides [TG], high density lipoprotein [HDL] and low density lipoprotein [LDL]. Patient demographic variables [age, sex] and disease characteristics [disease duration, degree of proteinuria, steroid dose] were noted. Patients were categorized into two groups on the basis of degree of proteinuria: having proteinuria >1gm or

Results: Most common lipid abnormality found in our study was hypertriglyceridemia [58.5%]. Total Cholesterol and LDL-C was high in 55.4% and 30.8% subjects respectively. Low HDL was found in 21.5% subjects. Increased frequency of dyslipidemia was noticed in those subjects who had proteinuria >1gm [P value < 0.05]

Conclusion: Dyslipidemia was observed in a high frequency in patients with lupus nephritis and was strongly associated with their degree of proteinuria

Prediction of preterm birth in women with short cervix

Background: Second trimester short cervical length identifies women at increased risk for an early spontaneous Preterm birth [sPTB], hence raising a compelling needed for Cervical Assessment for prediction and possible Preventing Preterm Delivery

Objective of the study: to assess the implications associated with a short cervical length as well as the use of ultrasonographic-derived cervical length measurement in predicting preterm birth. Methods: the present review includes relevant randomized controlled trials [RCTs] that investigated the in Medline [via PubMed], Cochrane Library and Embase. Retrospective and Prospective Cohort studies, Case-control and Randomised controlled trials. There were no restrictions by outcomes examined, language or publication status

Results: The critical search results yielded 6 articles [randomized trials=2, cohort studies=3, case-control study=l] representing 653 patients . Five of the 6 presented similar pregnancy outcomes [spontaneous preterm birth or pregnancy Joss < 24 weeks' gestation] between the ultrasound-indicated and the history-indicated cerclage groups. 45-69% of the patients followed with cervical ultrasound were able to avoid cerclage

Conclusion: Evidence from randomized trials supports that transvaginal ultrasound is predictive of preterm birth in women with prior preterm birth and a short cervix. The thresholds proposed vary from 15 mm to 28 mm and cerclage is thus recommended

Adherence to methotrexate therapy in rheumatoid arthritis

Objective: To determine adherence to methotrexate [MTX] therapy in patients with Rheumatoid Arthritis [RA] and to identify factors that promote either adherence or non adherence

Methods: One hundred Rheumatoid Arthritis patients on MTX for at least two months were enrolled. Questionnaire was completed by direct interview. Details recorded were, demographics [age, sex, education, monthly income], disease duration, duration on MTX and current dose. Disease Activity Score on 28 joint counts [DAS 28] at the current visit, concomitant drugs taken and number of doses of MTX missed in the previous 8 weeks were noted. Non adherence was defined as omission of any three or more prescribed doses of MTX in previous 8 week. Patients were asked for the factors that motivated their adherence to MTX as well as factors for non adherence. Presence of side effects due to MTX was also recorded

Result: Non adherence was found among 23% of cases. Patients of low socioeconomic group [p <0.0001] and on MTX for longer duration [p <0.001] had higher non adherence. Non adherent patients had significantly higher disease activity as measured by DAS 28 [p<0.001]. Good counseling and education by the doctor was a strong predictor of adherence [p <0.001]. Lack of affordability [p <0.001]; lack of availability at local pharmacy [p <0.001]; lack of family support [p <0.001] and lack of awareness regarding need and importance of MTX [p < 0.001were found as significant factors for non adherence

Conclusion: MTX non adherence in RA is noted in about one fourth of study group. Various economical and social issues lead to non adherence but good patient education and counseling by doctor could promote adherence in this study group

Pattern of initial clinical manifestations of systemic lupus erythematosus in a tertiary care hospital

Objective: To determine the pattern of initial clinical manifestations of Systemic Lupus Erythematosus [SLE] and to compare these features with those recorded elsewhere in Pakistan

Methods: This cross-sectional, descriptive study was performed in the Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan, from November 2015 to January 2016. Sixty one patients of SLE diagnosed as per ACR [American College of Rheumatology] 1982 revised criteria, were enrolled. The patients were evaluated for the initial clinical manifestations of SLE. The information was collected on a specially designed proforma and analyzed by using SPSS version 17

Results:Out of 61 patients, 49 [80.3%] were females and 12 [19.7%] males, showing a female to male ratio of 4:1. The mean age of patients was 26.2 +/- 7.9 years. Fatigue was the most common presenting feature in 56 [91.8%] patients, followed by joint pains in 55 [90.2%] and fever in 54 [88.5%]. Renal involvement was found in 46 [75.4%]. Comparison of these presenting features was made with other studies carried out in Northern Pakistan [Islamabad] and in central Punjab [Pakistan]. There were statistically significant differences in fever, fatigue and arthritis between our patients and the other two above mentioned study groups. However, comparison of renal manifestations showed significant difference only with Islamabad study, and not with previous study from central Punjab

Conclusion:In this study, majority of patients presented with combination of fatigue, fever, rash and arthritis. Almost three-fourth of patients had renal manifestations at initial presentation. Therefore, it is important for clinicians to have high index of suspicion for SLE, when patients present with above symptoms

Use of social media in education among medical students in Saudi Arabia / 한국의학교육

PURPOSE: Social media (SM), a virtual place where people can share, exchange, and communicate their ideas and knowledge, has become the new trend in communication and learning. This study aims to explore Saudi Arabian medical students' usage of SM and to discover the most common resources used in medical education. Furthermore, it aims to illustrate students' belief about the influence of SM on their learning. METHODS: This cross-sectional study administered validated questionnaires to medical students from different universities in Saudi Arabia, via emails, Twitter, Facebook, and short message service. A non-probability sampling technique was utilized and a sample size of 381 students was arrived at, using 95% confidence interval and 5% margin of error, since the total number of medical students in Saudi Arabia is approximately 36,000. The total respondents were 657 students from 23 different Saudi Arabian medical schools (females: 60.5%, n=397; males: 39.5%, n=260). RESULTS: The questionnaires of 21% of the students (n=139) were excluded from the analysis since they were incomplete. The most common website used by both genders was YouTube (42.3%, n=185); however, males preferred using Twitter and Wikis (p=0.001). With regard to utilizing SM for learning, 95.8% (n=419) of the students believed that it is beneficial. Females stated that SM helps them link basic and clinical science (p=0.003). CONCLUSION: Medical schools need to improve the utilization of SM by their faculty and students by developing activities and encouraging the usage of SM in education.

Depression in rheumatoid arthritis and its relation to disease activity

To determine the level of depression in Rheumatoid Arthritis and its relationship with severity of Rheumatoid Arthritis. This cross sectional analytical study was conducted from March 2014 to May 2014. Total 102 cases of Rheumatoid Arthritis [RA] diagnosed as per ACR [American College of Rheumatology] 1987 criteria were enrolled from Rheumatology Department, Fatima Memorial Hospital. Severity of Rheumatoid Arthritis was assessed by Health Assessment Questionnaire [HAQ] and disease activity score [DAS - 28] while severity of depression was measured by Beck Depression Inventory [BDI] scale II questionnaire. The relationship between depression and disease activity [severity] of Rheumatoid Arthritis was assessed by calculating correlation coefficient between depression, disease activity score [DAS 28] of Rheumatoid Arthritis and health assessment questionnaire [HAQ]. Out of 102 patients, 77 [75.5%] were females and 25 [24.5%] males. The mean age of patients was 43.5 +/- 11.9 years and the mean duration of disease was 7.8 +/- 5.5 years.71.5% of Rheumatoid Arthritis patients were found to have some degree of depression and this was directly related to the severity of disease. Moderate and severe depression were present in 23 [22.5%] and 19 [18.6%] patients respectively. In this study, almost three-fourths of Rheumatoid Arthritis patients were found to have depression. There was a strong association between Rheumatoid Arthritis disease activity and the level of depression. So it is imperative for clinicians treating Rheumatoid Arthritis patients to screen them for co morbid depression and manage it accordingly

Treat-to-target approach in daily clinical practice in Pakistani patients with early rheumatoid arthritis

To determine the frequency of patients with early Rheumatoid Arthritis [RA] achieving disease remission and/or low disease activity after 6 months of treatment with conventional Disease Modifying Anti-Rheumatic Drugs [DMARDs] by using treat-to-target approach in routine clinical practice. Descriptive study. Division of Rheumatology, Fatima Memorial Hospital [FMH], College of Medicine and Dentistry, Lahore, from March 2011 to February 2012. Patients with early RA defined as disease duration

Primary bone lymphoma mimicking as polyarthritis

A 17 years old boy presented with warm, tender and swollen joints of both upper and lower limbs along with inflammatory back pain and heel pain since 7 months. He had developed continuous high grade fever 3 days ago and complained of marked weight loss during the last 6 months. On examination his liver, spleen and cervical lymph nodes were palpable. X ray of the affected joints revealed osteolytic lesions in tibia, fibula, and humerus and fracture head of femur. Bone marrow examination revealed infiltration by sheets of lymphoid cells which were positive for leukocyte common antigen and CD[20]. The bone biopsy from a lytic lesion in proximal left tibia revealed a similar picture of infiltration with sheets of CD[20] positive lymphoid cells. Need to remember that lymphoproliferative disorders can mimic rheumatological disorders in clinical practice. The case is presented to share the experience of others

Epidemeology of homicidal deaths; in Sargodha, Pakistan

1] To observe and analyze the different aspects of homicidal deaths in Sargodha in terms of age, sex, weapon involved and seasonal variation. 2]]. To compare it with other studies conducted in Pakistan and all over the world. Non-interventional descriptive study. The study was done on autopsies conducted at mortuary, District Headquarter Teaching Hospital Sargodha from January 2012 to December 2012 [one year]. 82 cases of homicidal deaths which were brought by police for autopsy examination at DHQ Teaching Hospital Sargodha from Jan. 2012 to Dec. 2012. These cases include both sexes of all age groups. Manner of death was decided on the basis of police inquest and autopsy report. The relevant data was collected on prescribed performa and statistically analyzed. On analysis of recorded data, the homicidal rate in Sargodha, Pakistan is 7.59 /100,000 populations per year. Homicide manner of death was observed 51.25% of total autopsies. 39% of the victims were in the third decade of life. Males predominated females by a ratio of 2.28:01 Firearm was used in most of homicidal deaths i.e. 67%. A rise in homicidal cases was observed in the months of summer i.e. June to September 2012 and a fall was observed in the months of winter i.e. November, December, January and February, 2012. Homicide rate is high as compared to other manners of death in Sargodha. Firearm is the major weapon used for committing homicide

Anserine bursitis among patients with knee osteoarthritis

Anserine Bursitis [AB] is often associated with Knee Osteoarthritis [OA], and if identified can be easily treated. The objective of this study was to determine the percentage of patients with painful OA knees having accompanying, clinically diagnosed AB. This case series was conducted at Division of Rheumatology, FMH College of Medicine and Dentistry, Lahore from September 18[th], 2009 to February 28[th], 2010. Sixty consecutive rheumatology out-patients meeting the American College of Rheumatology [ACR] criteria for the diagnosis of OA knees. Patients with rheumatoid arthritis, other inflammatory arthritis and trauma were excluded. Patients with OA were examined specifically for any tenderness on the upper medial aspect of the tibia. Radiographic severity of OA knees was scored for each patient by a rheumatologist on a standing X-ray of knees in antero-posterior view. The Kellgren-Lawrence [K-L] grading scheme was used to score the severity of OA. In these 60 patients, AB was clinically present in 23[38]%. Females were 57[95%]. The mean age of patients with AB was 58.6 +/- 8.1 years whereas it was 57.9 +/- 9.2 years in patients without AB [p-value 0.66]. The mean BMI was 30.6 +/- 4.9 in patients with AB whereas it was 30.0 +/- 4.9 in patients without AB [p-value 0.64]. K-L score >/= 3 was present in 61% of the patients with AB Vs 78.4% of the patients of OA without AB [p-value 0.06]. Anserine Bursitis was present in about one third of patients with painful OA knees and its presence was found to be un-related to age, weight and severity of OA

Frequency of urolithiasis in patients from Southern Governorates in Yemen: Ultrasonographic findings

Urolithiasis is the third most common pathological disease affecting the urinary tracts. Although epidemiological studies about this condition are lacking in our country, the work and expertise of physicians indicate that the occurrence of urolithiasis is extremely high. We performed a prospective study of the frequency of urolithiasis in a sample of 480 patients, including males and females of all ages, who underwent ultrasound examinations in our private clinic in Aden. 136 patients [28.3%] were affected with urolithiasis. The rate was higher in males [71.3%] than in females [28.7%], with a male to female ratio of 2.5:1. The frequency of urolithiasis was high on average [67.6%] among patients in the age groups 21-50 years old, declined among patients over 51 years of age, and was markedly low among patients more than 70 years of age. Fourteen [10.3%] cases of urolithiasis were found in patients at the age group

Morbidity patterns for patients admitted to the medical wards at Algamhouria Teaching Hospital, Aden: 2007

This is a retrospective analysis of the disease patterns in the medical wards at Al-Gamhoria Teaching Hospital, Aden. All cases were admitted and discharged in the period from January 1, 2007 to December 31, 2007. A total number of 1107 Patients were admitted during the study period. Males were 58.5% [647] and females were 41.5% [460]. The male and female ratio was M:F=1.4:1. The age range of the patients was 16-78 years and the mean age was 41.5 years. 31-60 years age group accounted for 77.2% [855]. The difference between frequencies is significant [p<0.05]. Overall, the study revealed that diseases of the digestive system were the most cause of admission in the medical wards during 2007, with 20.8% [230]. In males, diseases of the digestive system were the most common [15.1%], whereas in females, infectious and parasitic diseases represented the first place [10.5%]. Infectious and parasitic diseases comprised 212 patients [19.1%] as the second cause of admission. In females it represented the first cause of admission, while in males represented the 5th cause of admission, [p<0.05,]. We concluded that the patterns of diseases observed in this study showed that diseases of non-communicable diseases represented the most common causes of admission to the medical wards, and this means that the proportion and presentation of non-communicable diseases has changed in this governorate and the neighboring governorates

Cancer in Aden-Yemen: a retrospective study [2005-2006]

The collection of credible information on cancer patterns is an important basis for determining the priorities for cancer control. There is no reliable information about the incidence or pattern of cancer in Yemen and, hence, an attempt was made to assess the situation based on hospital data which is the only way to achieve the source of cancer in Aden, Yemen. Four hundred and seven confirmed cases of cancer[155 males, 252 females], seen at the three hospitals from January 2005 to December 2006, were included in the study. The mean age of male and female patients was 48.5 and 48.7 years, respectively. The majority of the patients i.e. 286 [70.2%] were above 41 years of age. The difference between values is statistically significant [p<0.05]. Overall, the most common cancer patterns were from the gastrointestinal tract [28%], breast [22.8%], lymphoma [9.6%], and leukemia [6.9%]. The most common cancer patterns among males was gastrointestinal cancer [36.8%] and among females was the breast cancer [36.9%]. Our study provides valuable leads to cancer epidemiology in Aden, and is considered as useful information for health planning and future researches

Endothelial dysfunction and secondary hyperparathyroidism in end stage renal disease [ESRD]

Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease. Endothelial dysfunction represents an obligatory, prodromal phase in the atherosclerosis process. Secondary hyperparathyroidism is an integral component of the uremic syndrome. The aims is to study endothelial dysfunction in patients with uremia in relation to secondary hyperparathyroidism. Two groups of patients were studied: a group of 40 patients on regular hemodialysis 3 times/ week, 4 hours/ session, and a group of 30 patients with chronic kidney disease on conservative management. They were compared to 30 healthy age and sex matched normal controls. Measurement of flow-mediated [FMD] and nitroglycerine-induced vasodilatation [NMD] were done, in addition to routine laboratory investigation including intact PTH assay. Both flow-mediated vasodilation [8.52+/- 2.9% in hemodialysis patients and 13.33 +/- 1.44% in CKD patients] and flow-independent vasodilation [nitroglycerine mediated] [15.93 +/- 3.4% in HD group and 17.06 +/- 2.02% in CKD] were compromised when compared to controls [FMD 16.02 +/- 2.9% and NMD 20.76 +/- 4.3%] [p < 0.05]. FMD was significantly compromised in HD versus CKD group [p < 0.05] but this was not the case for NMD. Both FMD and NMD were significantly negatively correlated with serum createnine and PTH. Control of PTH levels in different stages of kidney disease may be part of the strategy to reduce the burden of atherosclerosis associated with CKD and PTH levels could be useful to identify patients at higher risk of future cardiovascular events

Pattern of Juvenile Rheumatoid Arthritis seen in 91 patients, presenting to an urban rheumatology clinic in Pakistan

To determine various types of Juvenile rheumatoid arthritis [JRA] seen in patients visiting our rheumatology clinic. A retrospective review of case records of 91 patients ages

Five years audit for presence of toxic agents / Drug of abuse at autopsy

To know the frequency of fatal poisoning in Peshawar regarding the toxic agents mostly involved and yearwise percentage. To know the age group and the gender that is most vulnerable to fatal poisoning. Design: Non-interventional [descriptive] type. Place and Duration of Study: This study was conducted over a period of five years [1997'2001] at Forensic Medicine Department, Khyber Medical College, Peshawar. Methodology: The study included 3508 autopsies conducted at Khyber Medical College, Peshawar. Out of these, 52 cases were those caused by fatal poisoning. These were analyzed according to age, gender and the toxic agent involved. t-test was applied as the test of significance. Poisoning was the cause of death in 1.48% of the total autopsies conducted during the five years. Males were more involved than the females, 90.38%. Suicidal poisoning was present in 17.30% of the total cases and accidental poisoning was found in 80.72% cases, while homicidal cases were 1.29% only. Diacetylmorphine [heroin] was the most commonly involved agent, 65.38%, of the total cases. The incidence of poisoning was more during the third and fourth decades of life. Diacetylmorphine [heroin] was the main causative agent involved in young males due to accidental over- dosage. Accidental and suicidal deaths should not be considered as inevitable. More elaborative studies are required in this area of recent research to adopt appropriate and adequate measures to save precious lives