COVID-19 Vaccine: Critical Questions with Complicated Answers

COVID-19 has caused extensive human casualties with significant economic impacts around the globe, and has imposed new challenges on health systems worldwide. Over the past decade, SARS, Ebola, and Zika also led to significant concerns among the scientific community. Interestingly, the SARS and Zika epidemics ended before vaccine development; however, the scholarly community and the pharmaceutical companies responded very quickly at that time. Similarly, when the genetic sequence of SARSCoV-2 was revealed, global vaccine companies and scientists have stepped forward to develop a vaccine, triggering a race toward vaccine development that the whole world is relying on. Similarly, an effective and safe vaccine could play a pivotal role in eradicating COVID-19. However, few important questions regarding SARS-CoV-2 vaccine development are explored in this review.

Pleomorphic Xanthoastrocytoma: clinicopathological spectrum of an intriguing neoplasm

Background and Objective: Pleomorphic xanthoastrocytoma [PXA] is a rare primary WHO Grade II astrocytic tumor comprising of < 1% of all astrocytomas. It is generally benign and slow growing however disease progression and malignant transformation with anaplastic features have been infrequently reported. Our objective was to assess clinicopathological characteristics of this rare tumor at our center

Methods: A retrospective study was conducted at Aga Khan University Hospital from January 1992 till January 2016. Data was entered on a proforma including patient demographics, clinical features, tumor location, histological features and follow-up, where available

Results: Forty Seven cases of PXA were retrieved during the study period. The mean age was 23.8 years [SD=15.1] and median age was 19 years. The most frequent symptom was head ache [n=31]. Male were more frequently affected [n=26]. The commonest location was temporal lobe. On microscopic examination, tumors were pleomorphic without mitoses or necrosis, however two cases showed increased mitotic activity, and one case revealed associated gliosarcoma. Follow-up of only 29 cases was available for a period ranging between 2 and 184 months [85 months +/- 56 months]. Outcome was good in 27 patients with the last follow up showing no radiographic or clinical evidence of tumor recurrence

Conclusions: PXA is an infrequent tumor in our population also, with less than 50 cases identified in two decades study period. Due to its rarity and its bizarre histomorphology, it should be diagnosed correctly, as it has got better prognosis than other astrocytic tumors

Primary hepatic carcinoid tumor with poor outcome

Primary Hepatic Carcinoid Tumor [PHCT] represents an extremely rare clinical entity with only a few cases reported to date. These tumors are rarely associated with metastasis and surgical resection is usually curative. Herein, we report two cases of PHCT associated with poor outcomes due to late diagnosis. Both cases presented late with non-specific symptoms. One patient presented after a 2-week history of symptoms and the second case had a longstanding two years symptomatic interval during which he remained undiagnosed and not properly worked up. Both these cases were diagnosed with hepatic carcinoid tumor, which originates from neuroendocrine cells. Case 1 opted for palliative care and expired in one month's time. Surgical resection was advised to the second case, but he left against medical advice

Infratemporal, masticator space infection and orbital abcess following carious maxillary first molar extraction in a four month pregnant patient. A case report

Odontogenic infections lead to life-threatening complications once they reach potential fascial spaces due to decreased immunity in pregnancy. It may also occur due to patient negligence, delayed diagnosis and mismanagemnet. Infratemporal space infection is a rare but a serious sequel of odontogenic infection. We report the case of a 20 year old, four months pregnant patient with carious left maxillary first molar with fascial space infection. Following extraction of this tooth and despite appropriate antibiotics the patient developed infection in the infratemporal and masticator space, followed by a orbital abscess

Periodontal health and oral hygiene status during the second trimester and its effects on pregnancy outcomes - preterm and low birth weight

Periodontal disease is one of the most prevalent chronic diseases known to mankind. Recently there have been studies that suggest a possible inter-relationship between periodontal disease and systemic diseases including, cardiovascular disease, diabetes, and adverse pregnancy outcomes including pre-term and low birth weight deliveries. However, most of these studies are carried out in the western part of the world and the results may not be directly applicable to the population in Pakistan. This research is an exploratory study that aims to find the relationship between periodontal disease and adverse pregnancy outcomes including preterm and low-birth weight in Pakistani population. The periodontal status in forty-five medically healthy pregnant females aged less than 35 years during the second trimester of pregnancy were assessed. A detailed periodontal examination, including plaque score, bleeding score, probing pocket depth and clinical attachment loss were recorded. Postpartum data was collected and the outcomes were recorded as pre-term [<32 weeks of gestation], term [on or >37 weeks], post term [>40 weeks] and low birth weight [< 2.5 kg]. Pregnant females in the second trimester had an average plaque score of 84% [95% C.I. 51.1-87], average bleeding on probing score of 66.3% [95% C.I= 60.4-72.2], and average clinical attachment loss of 2.5 mm [95% C.I= 2.35-2.6]. Thirty-four participants delivered on or term [>37 weeks] and 8 participants delivered pre-term [<32 weeks of gestation]. Only one patient delivered post term [>40 weeks]. This exploratory study highlights that the oral hygiene and periodontal status of these female patients in the second trimester of pregnancy is poor. These patients had high plaque scores, marked gingival inflammation as evidenced by high gingival bleeding score, and were diagnosed with mild generalized periodontitis. None of the periodontal variables had a significant correlation with pre-term or post-term pregnancy outcomes [p>0.05]

Polio vaccination; knowledge, attitude, and practice in district Abbottabad, Khyber Pakhtunkhwa, Pakistan

To assess knowledge, attitude and practice [KAP] about poliomyelitis [polio] vaccination in District Abbottabad, province Khyber Pakhtunkhwa [KPK], Pakistan, to identify reasons of failure of polio vaccination/ eradication campaign and to make recommendations in the light of the study. District Abbottabad, province KPK, Pakistan including both urban and rural areas. Three months from 1st June to 31st August 2012. This cross-sectional descriptive explorative study was conducted in District Abbottabad, of province KPK, Pakistan. A structured questionnaire was submitted to people in the urban and rural population using convenient sampling. Out of 200, only 142 questionnaires were filled by interviewing parents and guardians of the children followed by focused group discussions with the community heads and the parents of the children. Majority [61.78%] of respondents were of low income category with the mean age of 31 years. Amongst those [75%] were earning Rs.7,000-12,000 per month. Literacy rate was low with 45.77%. Out of which 40.67% fathers and 59.33% mothers were illiterate. Therefore a few respondents were aware about the mode of transmission of polio. Majority [80%] said that polio could be prevented by polio drops and about 86% said that this vaccine had no side effects. About 45% respondents refused to cooperate with polio teams, and 28% respondents believed, that Abbottabad Operation had bad effect on anti-polio campaign. Regarding the use of boiled drinking water, 95.8% respondents knew that it was good for health. While only 4.20% were using boiled water for drinking. Advice of the health professionals [69.71%] and other family members [7.74%] was respected in making health care decisions, therefore it was an opportunity for the government to involve these persons as well as media men in conveying message to the community to achieve ultimate goal of polio free Pakistan. Unawareness among the population of District Abbottabad, especially the knowledge about the disease, mode of transmission and its prevention are the most deficient areas. Secondly misconceptions about the nature of polio drops, and religious misinterpretations in masses, created by general public and religious leaders, are the major obstacles in the real success of vaccination campaign

Hereditary gingival fibromatosis diagnosis and treatment

Hereditary Gingival Fibromatosis [HGF] also referred to as idiopathic gingival hyperplasia is a rare type of slow growing gingival enlargement with great clinical and genetic heterogeneity inherited usually as Mendelian autosomal dominant fashion. Occurring as an isolated trait [HGF] and/or as a component of a syndrome, the affected gingival is characterized by firms, asymptomatic, non-hemorrhagic enlarged [hyperplastic] tissue with characteristic pale pink colour, covering most of the anatomic crown, involving usually all the quadrants. There is no definitive treatment present but post pubertal surgical intervention and good oral hygiene maintenance can improve the compromised esthetics and function of the patient. This paper presents a case report of a 15 year old male suffering from hereditary gingival fibromatosis with a positive family history. Periodontal management including gingivectomy [external bevel] was being undertaken after biopsy

Size or the number of portal tracts: which matters in a liver biopsy core in chronic hepatitis C?

Liver biopsy has an important role in staging of fibrosis [SoF] and grading of inflammation [GoI] in chronic hepatitis C [CHC] patients. The effect of size and number of portal tracts [NoP] on grading and staging of liver biopsy was evaluated. A total of 150 consecutive liver biopsy core [LBC] of patients with CHC were obtained. There were 98 [65.3%] males. Mean length of LBC was 1.45 +/- 0.48 cm. Mean number of portal tracts [NoP] was 11 +/- 4.6. Mean length of LBC was greater [1.60 +/- 0.45 cm] in stage 4 [n=41; 27.3%] and lesser [1.28 +/- 0.39] in stage 1 [n=23; 15%, p=0.04]. The mean NoP were 8.5, 10.6 and 13.1 in GoI 1, 2 and 3 respectively [p < 0.001]. The mean NoP were 7.6, 11.1, 11.3 and 14.5 in SoF 1, 2, 3 and 4 respectively [p < 0.0001]. There was a good correlation between number of portal tracts and length of LBC [r[2]=0.56]

Modified palatal stiffening procedure for snoring

To evaluate the efficacy of a modified procedure of palatal stiffening for the treatment of snoring. A quasi-experimental study. ENT, and Head and Neck Surgery departments of Pakistan Air Force [PAF] Hospital Masroor, Combined Military Hospital [CMH] Rawalpindi and PAF Hospital Sargodha, from January 2000 to January 2005. Patients of either gender and above 20 years of age having snoring as their primary complaint were registered. Patients with an obvious cause of upper airway obstruction like oropharyngeal swelling, growths and obstructive sleep apnea were excluded. A grading system was designed to classify the patients according to severity and criteria for successful outcome defined; grades were equated with VAS. Palatal stiffening was achieved by using an insulated 22 gauge LP needle for infiltration cautery. Results were analyzed at 6 weeks post operatively on SPSS-16. Paired t-test was applied to compare the improvement in snoring and significance was tested at p-value less than 0.05. Forty four [44] patients underwent the palatal stiffening procedure. Male to female ratio was 42:2. Twenty eight [28] patients [63%] had complete resolution of symptoms after first surgery. Out of the remaining, ten more patients [22.72%] became symptom free after 1st revision surgery while six patients [12.5%] needed 2nd revision. Pain in throat was the main post operative complaint which settled in 10 to 14 days. Palatal stiffening procedure causing relatively less morbidity, simple and minimally invasive, but effective at the same time

Effects of diuretic and vasodilator therapy in meniere's disease

Meniere's disease is recognised by frequent periods of remissions. The available wisdom about the disease and treatment reflects the openion of experienced clinicians, rather than scientific facts. To determine the efficacy of vasodilator and diuretic therapies in the prophylaxis of Meniere's disease. A randomized controlled trial. The study was carried in the ENT Department, Combined Military Hospital, March 2007 to Dec 2009. Subjects and Methods: All new patients [N=120] of clinically diagnosed Meniere's disease were included by consecutive non-probability sampling. Demographic characteristics of the patients were noted and the patients were divided into three groups irrespective of age and sex. Group A was placed on amiloride 5 mg and hydrochlorthiazide 50 mg combination, one tablet daily, the Group B on tablet betahistine hydrochloride 48 milligram in three divided doses and Group C patients on tab multivitamin once daily respectively. The patients were reviewed after 06 weeks. Improvement in vertigo was seen in 77% in group A, in 68% patients in group B and in 45% in group C [p=0.021]. Hearing thresholds improved in 54% in group A, 63% in group B and in 36% in group C [p=0.067]. There was subjective improvement in tinnitus in 54% in group A, 80% in group B and in 37% in group C. Diuretic and vasodilator had a definitive and significant effect in Meniere's disease, in controlling vertigo and tinnitus, when compared with placebo [p<0.05]. Diuretics and vasodilators do have a significant role in the prophylaxis of Meniere's disease

Conflicts of women health in teenage pregnancy

Early marriage and subsequent pregnancy is desired in Pakistan and is generally considered a blessing but it also carries some risks to the mother and resultant product. To determine the frequency of teenage pregnancy and complications it imposes on teenage mother when compared with non teenage mothers. It is a descriptive comparative study. A review of hospital record from 1st January 2008 to 31st December 2008 was carried out to compare the obstetric complications in 212 teenage pregnant mothers with that of 4052 non teenage mothers [Mothers =20 years of age] Prevalence of teenage pregnancy was 4.97% of the total pregnancies occurring at Sobhraj Maternity Hospital during the study period. 73.11% of all teenage mothers were primigravida and 48. 58% followed the proper antenatal care. Teenage pregnant mothers had significantly increased incidence of anemia, preterm labor, pregnancy induced hypertension, pre-eclampsia and decreased incidence of glucose tolerance as compared to non teenage mothers. Risks of ante partum hemorrhage [APH], post partum hemorrhage [PPH] and placenta previa were found similar in the two groups. The results indicated that the risks of complications of pregnancy like anemia, preterm labor, pregnancy induced hypertension and pre eclampsia were more in teenage pregnant mothers. This requires increased need of Pakistani communities to review and consider the correct age marriage, so that the health of pregnant mothers can be protected. A healthy mother is necessary to bring up a healthy child

Carcinosarcoma of the esophagus

Carcinosarcoma of the esophagus is a rare neoplasm characterized histologically by presence of carcinomatous and sarcomatous elements. Case report of Carcinosarcoma of the esophagogastric junction whose morphological and immunohistochemical features makes it quite distinctive from other tumours is presented. It was an ulcerated lesion diagnosed in an elderly Afghan lady located 34 cms from the incisor teeth. The patient was a smoker

Dubin-johnson syndrome

A young man presented with recurrent episodes of mild jaundice. Apart from conjugated hyperbilirubinemia, other liver function tests were always normal. Clinical suspicion of Dubin-Johnson syndrome was raised. Liver biopsy showed diffuse deposition of coarse granular dark brown pigment in hepatocytes. Dubin-Johnson syndrome is a benign condition, which results from a hereditary defect in biliary secretion of bilirubin pigments, and manifests as recurrent jaundice with conjugated hyperbilirubinemia. The defect is due to the absence of the canalicular protein MRP2 located on chromosomes 10q 24, which is responsible for the transport of biliary glucuronides and related organic anions into bile. No treatment is necessary and patients have a normal life expectancy

Anatomical and functional outcome following type-1 tympanoplasty in chronic tubotympanic suppurative otitis media

To assess the improvement in hearing and rate of graft uptake after type-1 tympanoplasty in chronic tubotympanic suppurative otitis media and to identify the complications of surgery. Interventional study [quasi experimental]. Department of Ear Nose Throat [ENT] and department of Head and Neck surgery at Combined Military Hospital [CMH] Rawalpindi from July 2002 to Feb 2004. A total of 107 cases of chronic suppurative otitis media tubotympanic type with dry central tympanic membrane [TM] perforations were selected. Out of these, 85 cases were available for follow-up. The patients were evaluated by history, clinical examination and by examination under otomicroscope. All other cases with ear discharge and cholesteatomas were excluded. Preoperative and postoperative audiograms were done, laboratory investigations and X-ray of mastoids were also carried out. All the patient underwent type-I tympanoplasty, using temporalis fascia with underlay technique. The postoperative results were evaluated with respect to anatomical and functional out come. Our study showed an overall success rate of 92.95% as far as the graft uptake was concerned. Out of 85 cases, on examination at the interval of three months the perforations was closed in 79 [92.94%] cases. Improvement in hearing was seen in 73 [85.88%] cases, with notable reduction in air-bone gap at the end of three months. The complications at the interval of three months were dislodgement of graft 1 [1.17%] case, residual perforation 5 [5.88%] cases, deterioration of hearing 1 [1.17%] case, small retraction pockets 3 [3.52%] cases and metallic taste in mouth 2 [2.35%] cases. From this study we concluded that in dry ears with central perforations, type-I tympanoplasty using temporalis fascia with underlay technique is a very satisfactory and reliable procedure for closing the tympanic membrane perforations and to restore hearing, provided attention is paid to aseptic technique, anatomical landmarks and by exercising good clinical judgment

Frequency of primary solid malignant neoplasms in different age groups as seen in our practice

To determine in a large series of surgical biopsies, the frequency of various histologic types of primary solid malignant neoplasms in males and females in different age groups. A retrospective study of 20,000 consecutive surgical biopsies reposted in the section of histopathology, AKU in 2004. Malignant neoplasms are commonest in the fifth and sixth decades of life. The commonest malignant neoplasms in the first decade were Hodgkin's lymphoma and Wilm's tumor in males and females respectively. In the second decade, osteosarcoma in males and Ewing's sarcoma/PNET in females. In the third decade, colorectal adenocarcinoma in males and infiltrating Ductal carcinoma of breast in females. In the fourth decade, squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females. In the fifth decade squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females. In sixth decade, squamous cell carcinoma of oral cavity in males and infiltrating ductal carcinoma of breast in females and in the seventh decade, prostatic adenocarcinoma in males and infiltrating ductal carcinoma of the breast in females. Above age of 70 years, the commonest malignant were again prostatic adenocarcinoma in males and infiltrating ductal carcinoma of breast in females. Malignant neoplasms are commonest in the fourth, fifth and sixth decades of life

Lower eye lid reconstruction using single stage Mustarde' cheek rotation flap

To determine the functional and cosmetic outcome of Mustarde' cheek rotation flaps performed for reconstruction of large lower eyelid defects. Bahawal Victoria Hospital, Bahawalpur from August 2003 to March 2006. All those patients in whom Mustarde 'cheek rotation flap was done for the reconstruction of large lower eyelid defects, were included. Follow up included assessment of position of eyelid, closure, presence of epiphora, aesthetic balance, and donor-site morbidity. Thirty patients, aged 2 year to 70 years, have been operated with this technique for total or sub total defects of the lower eyelid. Two patients received an auricular chondro-cutaneous graft. Rest of them received a nasal chondro-mucosal graft for inner lining. The flap remained viable in every patient, without total or partial necrosis. Mustarde cheek rotation flap is very reliable procedure that provides complete reconstruction and can be used with good functional and cosmetic results in patients with total and sub-total lower eyelid defects

Significance of immunohistochemistry in accurate characterization of malignant tumors

To determine in a large series of surgical biopsies the role and significance of immunohistochemistry in the adequate and accurate characterization of malignant tumors. A retrospective study of 20,000 consecutive surgical biopsies reported in the Section of Histopathology, AKU in 2003. Data was obtained by retrieving the filed surgical biopsy reports in the section. Out of the 20,000 biopsies, 6534 [32.67%] were neoplastic. 4726 neoplasms [72.33%] were malignant, and 1808 [27.67%] were benign. Immunohistochemistry was performed on 29.49% of malignant tumors, and 4.97% of benign tumors. Immunos were performed on only 2.82% of routine squamous cell carcinomas and adenocarcinomas of various organs, and in only 1.9% of infiltrating breast carcinomas, the commonest malignant tumors in females. In contrast, immunos were performed on 97.12% of non-Hodgkin's lymphomas, 97.94% of Hodgkin's lymphomas, 98.09% of malignant spindle cell neoplasms, 87.96% of small round blue cell tumors of childhood, 87.30% of neuroendocrine neoplasms, and 84.37% cases of malignant melanomas. In addition, immunos were performed on all cases of malignant undifferentiated neoplasms and were able to resolve the issue in over 89% of such cases. Immunos were also performed on 54.74% of metastatic tumors. Lymph nodes were the commonest organs on which immunos were performed i.e. 96.50% of lymph node tumors, followed by CNS and renal neoplasms with 33.01% and 25.92% respectively

Frequency and characteristics of breast lymphomas presenting to a tertiary care hospital Pakistan

To assess the relative frequency of [primary and secondary] mammary lymphomas presenting to a tertiary care hospital, Pakistan and its categorization according to WHO classification of lymphoid neoplasms. All NHLs [nodal and extra nodal] diagnosed in the section of histopathology during 1992-2004 were retrieved and reviewed. All patients [n=30] diagnosed with lymphomatous involvement of the breast were selected. Distinction between primary and secondary breast lymphomas was not made owing to lack of availability of clinical information. A total of 5637 breast malignancies were diagnosed in our department during the study period of 10 years and the total number of NHLs [Nodal and extra Nodal] was 2632. Thirty [n=30] patients accounting for 1.13% were diagnosed to have lymphomatous involvement of the breast. The Female to Male ratio was13.5:1; age range was 12-92 years with a median age of 43 years [Mean age 46.5 years and Standard deviation of age was 16.88 years]. The sites of the lesions were the right breast in 11 cases [37.93%], left breast in 9 cases [31.03%] and both breasts in 2 cases [6.89%], while the location of 8 masses [27.58%] was unknown. Immunohistochemical studies were negative for cytokeratins [MNF and Cam 5.2] in all cases. All cases of DLBCL expressed B cell lineage antigens and were positive for LCA and Pan B [CD20 and 79a]. We concluded that breast lymphomas represent 1.13% of all NHL and 0.5% of all breast malignancies in this study. The most frequent morphologic type was diffuse large B-cell lymphoma. As patients with primary breast lymphoma have a better prognosis than those with carcinoma of the breast or patients with extranodal lymphomas, a multidisciplinary approach including surgery, radiotherapy, and chemotherapy when needed would result in a more favourable outcome

Frequency of Hepatitis B, C and Human Immunodeficiency virus in blood donors at Shaikh Zayed Hospital, Lahore

To find out the frequency of hepatitis B, C and human immunodeficiency virus [HIV] in blood donors at Shaikh Zayed Hospital, Lahore. Design: This is a non-interventional study. Study Period: Period of this study is from 1-1-2005 to 30-6-2005. Study was conducted at the Blood Bank of Shaikh Zayed Hospital, Lahore. Subjects and Methods: In this study 18216 young healthy voluntary blood donors [age 16-50 years] comprising of 16611 males and 1605 females were included and tested for HBsAg, Anti-HCV and HIV by Accu check one step test [chromatographic immunoassay] in serum. Results: Frequency of hepatitis B, C and HIV infection was 3.36%, 4.16% and 0% respectively. We can get representative prevalence values of HBV, HCV and HIV infection in general population by collecting data from all blood transfusion centers of Pakistan. This is also helpful to create public awareness regarding hepatitis and HIV transmission through blood transfusion