Fluoroquinolone consumption and -resistance trends in mycobacterium tuberculosis and other respiratory pathogens: ecological antibiotic pressure and consequences in Pakistan, 2009-2015

Objective/background: Fluoroquinolones [FQs] are important anti-tuberculous drugs for the treatment of multidrug-resistant [MDR] tuberculosis. Resistance to FQs leads to fewer options for treatment of tuberculosis [TB], and infection with such strains may also require longer treatment duration. Trends of resistance in Mycobacterium tuberculosis [MTB] are indicators of MTB-resistance evolution. Drivers of such resistance need to be understood and studied to inform preventive strategies

Methods: Here, we present FQ-resistance rates and trends in Pakistan from 2010 to 2015 and compare rates with FQ-consumption data and rates in other community pathogens

Results: Our results reveal a recent decrease in FQ-resistance rates in MTB, but an increase in resistance for Haemophilus influenzae and Shigella spp. Correlation of FQ resistance with FQ consumption at the population level was weak for MTB, although strong associations were noted for H. influenzae and Shigella spp

Conclusion: We discuss the possible reasons for the decrease in resistance rates in TB, putative drivers of resistance other than volume of FQ consumption, and the possible impact of the National Tuberculosis Programme and drug regulatory activities

Novel coronavirus infection in the Eastern Mediterranean Region: time to act

The Eastern Mediterranean Region of World Health Organization has been an emerging focus for global health after the discovery of a novel coronavirus infection in some countries in the Region. The Region has already witnessed a number of emerging zoonoses with epidemic potential. In view of this new virus, there is now an urgent need for strong public health vigilance and monitoring of the evolution of the virus in the Region. The situation will challenge and test the national health authorities' resilience and ability to respond in a timely manner. This review summarizes the evidence related to the emergence in the Region of new epidemic diseases of predominantly zoonotic origin and the challenges posed by the discovery of the novel coronavirus infection, and outlines recommendations for the countries for early detection, prevention and control of public health threats from this novel coronavirus infection

Highlights and conclusions from the technical consultative meeting on novel coronavirus infection, Cairo, Egypt, 14-16 January 2013

The emergence of a novel strain of coronavirus in the Arabian Peninsula raised a global health concern in 2012, partly because the majority of human infections were fatal and partly due to its presumed animal origin. An urgent meeting of scientific and public health experts was convened by WHO in January 2013 in view of the limited knowledge available on the epidemiological and natural history of infection with this novel virus. The meeting reviewed current evidence and identified critical knowledge gaps to improve better understanding of the public health risk associated with the virus so as to improve preparedness and to safeguard and protect global health

Report: strategic approach to control of viral haemorrhagic fever outbreaks in the Eastern Mediterranean Region: report from a regional consultation

The viral haemorrhagic fevers [VHF] are a growing public health threat in the Eastern Mediterranean Region. Nearly all of them are of zoonotic origin. VHF often cause outbreaks with high fatalities and, except for yellow fever, currently there are no specific treatment or vaccination options available. In response to this growing threat, the Regional Office for the Eastern Mediterranean of the World Health Organization convened a technical consultation in Tehran on 27-30 November 2011 to review the current gaps in prevention and control of VHF outbreaks in the Region. The meeting recommended a number of strategic public health approaches for prevention and control of VHF outbreaks through synergizing effective collaboration between the human and animal health sectors on areas that involve better preparedness, early detection and rapid response. Implementation of these approaches would require working together with vision, commitment and a sense of purpose involving partnerships and cooperation from all relevant sectors

Primary health care: what is it and what is it not? Views of teaching faculty at an undergraduate medical college in Pakistan

Over 30 years after the Alma-Ata declaration on primary health care in 1978 there are still misconceptions about the basic concept of primary health care. This study aimed to investigate the knowledge and opinions about various aspects of primary health care and its appropriate implementation among the teaching faculty at Shifa College of Medicine in Islamabad, Pakistan. A structured questionnaire was answered by 70 physicians present at the end of the month seminar. Two-thirds of the doctors [67.1%] believed that primary health care involved only basic health care for common illnesses. Few respondents suggested that community-oriented programmes [4.3%], maternal and child health [2.9%], screening [1.0%] or treatment of noncommunicable diseases [2.9%] should be components of primary care. The concepts to primary health care as defined at Alma-Ata in 1978 were not well understood by teaching faculty from the basic and clinical health sciences in this medical college

Functional and aesthetic management of worn dentition with direct composite restorations: a clinical report

The management of tooth surface loss [TSL] could be challenging in primary dental care settings. However the introduction of resin-based composite restorative materials have significantly changed our traditional mechanistic approach in favour of more tooth-tissues conservative treatments whilst improving both functional and aesthetic demands by patients. Direct banding to remaining toot tissues is more predictable than any time before, it has been clinically proven that the applications of direct composite restorations could be extended beyond building up a single tooth and become a viable option for full mouth rehabilitation. Economic factors are crucial elements in the success of our day to day dental treatments as there is more emphasis on implementing time and cost-effective and reversible treatments at low biological risks

Clinical management guidelines for pandemic [H1N1] 2009 virus infection in the Eastern Mediterranean Region: technical basis and overview

During the spring of 2009, a novel influenza a [H1N1] virus of swine origin caused human infection and acute respiratory illness in Mexico. After initially spreading in North America, the virus spread globally resulting in the first influenza pandemic since 1968. While the majority of illnesses caused by pandemic [HINT] 2009 were mild and self-limiting, severe complications, including fatalities, were also reported. In view of the increasing number of laboratory-confirmed cases and deaths from pandemic [HINT] 2009 in the Eastern Mediterranean Region of the World Health Organization, the Regional office convened a consultation meeting of experts involved in the clinical management of patients infected with pandemic [H1N1] 2009 virus. The consultation resulted in developing an interim guidance and algorithm for clinical management of pandemic [HINT] 2009 virus infection in health-care settings. This paper describes the process, the technical basis and the components of this interim guidance

Retinopathy: variable clinical spectrum and postendarterectomy changes

The Carotid Artery Insufficiency Retinopathy [CAIR] is an uncommon sign of carotid artery obstruction. It is mainly found in patients with complete occlusion or severe obstruction of Internal Carotid Artery [ICA]. Retinopathy is caused by progressive and chronic hypoxia to ocular tissues. The purpose of the study is to describe the variable presentation of CAIR in patients with internal carotid artery stenosis and to asses the resolution of retinopathy in patients who had carotid endarterectomy. Records of the patients with confirmed internal carotid artery stenosis were reviewed. Patients' demographic data and way of presentation to ophthalmologist was recorded. Associated systemic vascular diseases were also recorded on the proforma. Records of the patients with confirmed internal carotid artery stenosis were reviewed. Thirteen eyes of 10 patients were included in study with male to female ratio of 9:1. Patients' clinical presentation ranged from scattered blot haemorrhages to ocular ischemic syndrome. Patients presented with retinopathy at different stages. The presentation of retinopathy varied from scattered blot haemorrhages to ocular ischemic syndrome. Endarterectomy resolved CAIR in 2 out of 3 patients, with one patient having bilateral resolution. CAIR should be suspected if retinopathy is unilateral. On the other hand patients with asymptomatic Carotid artery stenosis should be examined for signs of ocular ischemia. All patients with CAIR should be investigated for cardiovascular diseases. Endarterectomy in selected patients can resolve CAIR

Prescription pattern of benzodiazepines for inpatients at a tertiary care university hospital in Pakistan

To determine the point prevalence of benzodiazepine prescriptions for inpatients at a tertiary care university hospital in Pakistan and to correlate it with prescription patterns of various specialties, indications and demographic variables of the patients. This 24-hours point prevalence study was done at The Aga Khan University Hospital, Karachi. By convenient random sampling, 208 inpatients were interviewed. Patients' files were also studied to record the drugs administered. Data was entered into questionnaires and analyzed by SPSS 10.0. The point prevalence of the benzodiazepines was 21.2%. It was higher among males than females and among surgical than non-surgical patients. Midazolam was the most commonly used benzodiazepine, followed by Alprazolam and Lorazepam. Pre-anesthesia and psychiatric symptoms were the two most common indications. Oral route was used in 84% patients for drug administration and mean Valium equivalent dosage was 4.86mg/day. Mean length of prescription was 3 days. Longer duration of hospitalization was a significant predictor of the requirement of benzodiazepine prescription [p-value=0.020]. Prescription pattern of benzodiazepines at a tertiary care university hospital is similar to that reported in the developed countries through monitoring at various levels by physicians, clinical pharmacist and nursing staff. Data regarding the prescription pattern of benzodiazepines is scarce, and it needs to be expanded to formulate clear guidelines regarding their prescription

Intrahepatic cholangiogastrostomy a safe palliation for unresectable hilar malignancies

Intrahepatic Cholangiogastrostomy is a modification of Longmire's procedure in which stomach instead of jejunum is used for the drainage of segment-II duct of liver. This operation was performed in 12 cases with locally advanced tumor, involving portahepatis, producing obstructive jaundice. In all cases, intrahepatic ducts of left and right lobes were dilated. All cases had prompt relief of jaundice. Gastroscopy was done in 8 cases, 6-8 weeks after surgery. There was no endoscopic evidence of gastritis. Ten patients have expired due to primary malignancy and remained an-icteric till death. One patient has been lost from follow up. One is alive and is free from jaundice. There was no operative mortality