Analysis of human ABO Blood Group as a risk factor with knee osteoarthritis at tertiary care hospital in Pakistan.

Objective: To investigate the association and risk estimation of ABO blood group distribution and clinical attributes in patients with Knee Osteoarthritis. Method: This was a hospital-based study conducted at, Liaquat University Hospital Hyderabad from December, 2019 to December, 2022 to investigate this least researched area of highly prevalent musculoskeletal disease in Pakistan. Non-Probability Convenience Sampling was used for selecting 190 cases of confirm Knee Osteoarthritis patients diagnosed by Orthopedic surgeon based on standard clinical and radiographic criteria. Data were analyzed using IBM-SPSS version 23.0. Percentages and frequencies were counted for categorical data. Pearson Chi Square test and fisher's exact test were used to check the association and Multinomial Logistic Regression was used to estimate the risk for moderate and severe kellgren grading Knee Osteoarthritis (KOA) cases with ABO blood grouping in comparison of mild Kellgren grading. Results: A total of 190 cases of Knee Osteoarthritis (KOA) were included in the study. Females (61.6%) and patients with age 50 and above were 40.5 % were found in greater proportion. Majority (41.6%) were classified radiologically as mild cases with O group (39.5%) and positive Rh antigen (95.8%). Strong association (p = <0.01) was found between gender, age group and ABO blood group with KOA radiological Kellgren and Lawrence score. Conclusion: There is strong relation in between radiological grading of knee osteoarthritis severity and A blood group, gender and age.

Laser-assisted synthesis of nano-hydroxyapatite and functionalization with bone active molecules for bone regeneration.

The main goal of bone tissue engineering research is to replace the allogenic and autologous bone graft substitutes that can promote bone repair. Owing to excellent biocompatibility and osteoconductivity, hydroxyapatite is in extensive research and high demand for both medical and non-medical applications. Although various methods have been developed for the synthesis of hydroxyapatite, in the present study we have shown the use of nanosecond laser energy in the wet precipitation method of nano-hydroxyapatite (nHAP) synthesis without using ammonium solution or any other chemicals for pH maintenance. Here, the present study aimed to fabricate the nanohydroxyapatite using a nanosecond laser. The X-ray diffraction and Fourier transform infrared spectroscopy have confirmed the hydroxyapatite formation under laser irradiation in less time without aging. A transmission electron microscopy confirmed the nano size of synthesized nHAP, which is comparable to conventional nHAP. The length and width of the laser-assisted nHAP were found to be in the range of 50-200 nm and 15-20 nm, respectively, at various laser parameters. The crystallite size obtained by Debye Scherrer formulae was found to be in the range of ∼ 16-36 nm. In addition, laser-assisted nHAP based composite cryogel (nanohydroxyapatite/gelatin/collagen I) was synthesized and impregnated with bioactive molecules (bone morphogenic protein and zoledronic acid) that demonstrated significant osteogenic potential both in vitro in cell experiment and in vivo rat muscle pouch model (abdomen and tibia muscles). Dual-energy X-ray analysis, micro-CT, and histological analysis confirmed ectopic bone regeneration. Micro-CT based histomorphometry showed a higher amount (more than 10-fold) of mineralization for animal groups implanted with composite cryogels loaded with bioactive molecules compared to only composite cryogels groups. Our findings thus demonstrate a controlled and rapid synthetic method for the synthesis of nHAP with various physical, chemical, and biological properties exhibited as comparable to conventionally synthesized nHAP.

Strontium-Substituted Nanohydroxyapatite-Incorporated Poly(lactic acid) Composites for Orthopedic Applications: Bioactive, Machinable, and High-Strength Properties.

Traditional metal-alloy bone fixation devices provide structural support for bone repair but have limitations in actively promoting bone healing and often require additional surgeries for implant removal. In this study, we focused on addressing these challenges by fabricating biodegradable composites using poly(lactic acid) (PLA) and strontium-substituted nanohydroxyapatite (SrHAP) via melt compounding and injection molding. Various percentages of SrHAP (5, 10, 20, and 30% w/w) were incorporated into the PLA matrix. We systematically investigated the structural, morphological, thermal, mechanical, rheological, and dynamic mechanical properties of the prepared composites. Notably, the tensile modulus, a critical parameter for orthopedic implants, significantly improved from 2.77 GPa in pristine PLA to 3.73 GPa in the composite containing 10% w/w SrHAP. The incorporation of SrHAP (10% w/w) into the PLA matrix led to an increased storage modulus, indicating a uniform dispersion of SrHAP within the PLA and good compatibility between the polymer and nanoparticles. Moreover, we successfully fabricated screws using PLA composites with 10% (w/w) SrHAP, demonstrating their formability at room temperature and radiopacity when observed under X-ray microtomography (micro-CT). Furthermore, the water contact angle decreased from 93 ± 2° for pristine PLA to 75 ± 3° for the composite containing SrHAP, indicating better surface wettability. To assess the biological behavior of the composites, we conducted in vitro cell-material tests, which confirmed their osteoconductive and osteoinductive properties. These findings highlight the potential of our developed PLA/SrHAP10 (10% w/w) composites as machinable implant materials for orthopedic applications. In conclusion, our study presents the fabrication and comprehensive characterization of biodegradable composites comprising PLA and strontium-substituted nanohydroxyapatite (SrHAP). These composites exhibit improved mechanical properties, formability, and radiopacity while also demonstrating desirable biological behavior. Our results suggest that these PLA/SrHAP10 composites hold promise as machinable implant materials for orthopedic applications.

Maternal and fetal outcomes of SLE in pregnancy: a literature review.

Systemic Lupus Erythematosus (SLE) is an auto-immune disease in which the immune system assaults its tissues. We aimed to analyse the maternal and foetal outcomes during pregnancy in SLE mothers. A literature search was conducted by two investigators to assess SLE's outcomes on maternal and foetal during pregnancies. We searched PubMed/Medline, Embase, and Google scholar to collect evidence from different research studies, draw the conclusion, and report it. In our investigation, we found out that SLE could cause a spectrum of complications during pregnancy, not only for the mother but also for the foetus. It could affect fertility and cause difficult pregnancies for the couple as well which includes certain complications such as: preterm labour and delivery, high blood pressure (preeclampsia), placental insufficiency, miscarriage or stillbirth, whereas in the foetus SLE can cause mortality, preterm birth, and neonatal lupus (a temporary condition in the baby caused by SLE-related antibodies) and structural abnormalities. The literature suggests that SLE could prove fatal for the foetus and induce many complications in the mother. However, this could be avoided if pregnancy is planned right from the start and proper management is provided to the mother during pregnancy and delivery.p.

Redispersion of cryoaggregated gold nanoparticle by means of laser irradiation and effect on biological interactions.

Agglomeration/aggregation is an indispensable phenomenon observed by different nanoparticles. In the present study, commercial grade (50 nm) and chemically synthesized (40 nm) gold nanoparticles (AuNPs) were aggregated at sub-zero temperatures, followed by disruption of the AuNP aggregates via nanosecond laser-ablation and subsequent effect on biological interactions. AuNPs were characterized pre/post laser-ablation via UV-visible spectroscopy, transmission electron microscopy, atomic force microscopy, etc. The process of freezing (aggregation) and laser-ablation (dispersion) was performed multiple times, in order to compare the yield of nanoparticles after each cycle of laser-ablation. Further, AuNPs pre/post laser-ablation were assessed for cytotoxicity, protein-corona formation, and cell-uptake by in vitro studies using RAW264.7, Caco-2 and Neuro-2 a cell lines. Aggregates for both the types of AuNPs displayed fragmentation following first cycle of laser-ablation. In addition, AuNPs obtained after fragmentation of the aggregates showed reduction in diameter and reshaping, as compared to native AuNPs. The size and shape of the nanoparticles after second and third cycle of laser-ablation was same as that obtained after first cycle of ablation. Both laser-ablated and native AuNPs showed similar effects on viability of RAW 264.7 and Caco-2 cells, after 24 h and 48 h of exposure. Cell uptake of native and laser-ablated AuNPs was observed to be a size dependent phenomenon. Present findings showed that nanosecond laser ablation of cryoaggregated AuNPs lead to changes in the physical properties of AuNPs post ablation like size and shape, however, biological interaction with cells remained same. This work is first report on biological interactions of AuNPs generated via laser-ablation of cryoaggregated AuNPs.

Influencing factors behind inappropriate solid waste management of small clinics in a resource-constrained country.

Appropriate clinical waste management is a critical concern in today's era. Resource-constrained countries agonize greatly over this issue in order to mitigate inappropriate clinical waste management practices. The goal of this study is to assess factors behind inappropriate waste management of small clinics in resource-constrained countries. We tested the hypothesis that negligence of government, knowledge and awareness, and financial burden are three key factors behind inappropriate solid waste management of small clinics. A two-phase survey including a pilot study and a main study was conducted for exploratory factor analysis and confirmatory factor analysis, respectively, in the fourth largest city of Pakistan, i.e., Hyderabad. One sample t test was used to validate the hypothesis, the correlation between the three key factors, and the location of the clinics were established. These factors were found to have a contribution to inappropriate waste management of small clinics. The hypothesis was then validated, and all three factors were found to have no significant variation in responses with the contrast of three types of clinic locations, namely, low-, medium-, and high-income areas. Responses were almost identical and bear equal significance from all locations, the financial burden factor is at the highest, the second factor is the negligence of government, and the third factor is that of knowledge and awareness. This study highlights the factors that are usually neglected and can help to improve solid waste management of small clinics in resource-constrained countries.

A Study on Small Clinics Waste Management Practice, Rules, Staff Knowledge, and Motivating Factor in a Rapidly Urbanizing Area.

Thousands of small clinics in Pakistan are generating dispersed medical waste, unlike large hospitals, small clinic waste management is often ignored. This study was conducted on 135 small clinics in Hyderabad, Pakistan, with the aim to determine small clinics' waste management practices in contrast to rules, level of knowledge, the environmental impact of disposal methods, and motivating factor analysis to understand the current situation from multiple perspectives. Overall, the waste generation rate was calculated to be 2.01 kg/clinic/day and the hazardous waste generation rate was 0.89 kg/clinic/day, whereas the general waste generation rate was 1.12 kg/clinic/day. The hazardous waste generation rate percentage is found to be higher than those found in large hospitals by 20%. The waste management practice among surveyed clinics was deplorable; none of the clinics were completely following hospital waste management rules of 2005 and thus the absence of proper segregation, storage, transportation, and disposal was commonly encountered during the study. Clinic staff possessed low level of knowledge and awareness, and acquired no training about waste management practice and rules, moreover, frequent employee turnover was noticed too. Additionally, two hypotheses were checked for creditability of motivating factors with an exploratory factor analysis to check their contribution to motivating clinic staff to practice sound healthcare waste management. Out of 10 indicators, nine were found in support of the hypotheses. Hence, it was discovered that active government involvement and financial support in providing training and inspecting small clinics could help in improving the condition. The findings of the present study can play a vital role in documenting evidence, and for policymakers and governments to plan solid waste management of small clinics and other healthcare facilities.

BED OCCUPANCY RATE AND LENGTH OF STAY OF PATIENTS IN MEDICAL AND ALLIED WARDS OF A TERTIARY CARE HOSPITAL.

BACKGROUND: A good hospital management includes an effective allocative planning for beds in a hospital. Bed-occupancy rates and length of stay are the measures that reflect the functional ability of a hospital. METHODS: A cross sectional study of two months' duration was carried out in eight medical and allied wards of Liaquat University Hospital (LUH) Jamshoro with objective to estimate the bed occupancy rate and the average length of stay of patients. Data was collected by filling a predesigned check list and bed occupancy rate and average length of stay were computed. Associations were analysed by using SPSS version 16. The p-value 50.05 Was taken as level of significance. RESULTS: One hundred & seven admissions were recorded against 235 available beds. Average bed occupancy rate was 51.33%. The 51.4% of the patients in medical wards except paediatrics ward were of the age >50 years; the mean age was 45 years and standard deviation +/-6.4 years. Mean age in paediatrics was 3.89 years and standard deviation of +/-0.8 years. 55.1% patients had infectious diseases. The 32.7% patients stayed in hospital for up to 3 days showing significant association between nature of diseases and duration of stay (p=0.03). There was male preponderance, i.e., 54.2% males against 45.8% females. Showing significant association between gender and length of stay (p=0.01). CONCLUSIONS: Bed occupancy rate and average stay in hospital were found within recommended range; more improvement may be brought by doing further research on this issue.

Perception of community regarding common diseases prevailing in the a squatter settlement of Karachi, Pakistan.

OBJECTIVE: To determine the perceptions of the community about prevalence of different diseases in Gulshan-e-Sikandarabad, an urban squatter settlement in Karachi and compare them with the data about disease pattern available at Primary Health Care Center in the same community. METHODS: A stratified random sample of ten percent of houses of the community was selected and both male and female heads of household were interviewed. Open ended questionnaire was used to record perceptions of responders. A total of 336 persons were interviewed out of which 196 (58%) were females and 140 (42%) were males. RESULTS: Age, education, nationality and ethnicity (Sikandarabad has inhabitants from Afghanistan as well. In our study 12 were Afghan nationals. Among Pakistani responders majority were Pathans, some were Punjabi, Saraiki etc.) had no statistically significant difference in responses. Gender had the most significant difference in responses. The perceived nine top most common diseases were similar to the top nine common diseases according to data of the health center of Ziauddin University located in Gulshan-e-Sikandarabad. CONCLUSION: The perceptions of community members about most of the common diseases prevalent in their community was similar to the disease pattern maintained at Primary Health Care center in the same locality. Anaemia and helminth infestation although common according to the health center record were not perceived as common by the community members.

Awareness of hypertension among patients attending primary health care centre and outpatient department of tertiary care hospital of Karachi.

OBJECTIVE: To compare awareness of hypertension among patients attending Primary Health Care Centre (PHC) and outpatient department (OPD) of a tertiary care hospital of Karachi. METHODS: Cross sectional survey of patients more than 18 years of age without any complication of hypertension in a squatter settlement of Karachi through non-probability convenient sampling. RESULTS: A total 202 patients were approached, 49 (24%) were males and 153 (76%) were females. Majority of the patients attending tertiary care OPD (80%) and 56% from PHC group believed that hypertension could lead to cardiovascular disease (CVD). On inquiring the duration of taking antihypertensive drugs, 61% from tertiary care OPD group and 31% of PHC group said they are taken only for few months (p < 0.001). Over two-third (77%) of patient of tertiary OPD were not doing exercise and not avoiding oily and heavy food to keep their weight under control. Large number of OPD patients (91%) used oil for cooking in comparison to PHC group (78%) who utilized ghee (p < 0.001). CONCLUSION: This study showed a marked difference in awareness regarding hypertension in urban slum and middle class community, which can be attributed to the level of education. This outcome reveals need for more awareness campaigns especially in the squatter settlement with special emphasis on lifestyle modifications along with pharmacological therapy for the better control of hypertension.

Morbidity pattern and utilization of a primary health care center in a low socioeconomic area of Karachi.

OBJECTIVE: To identify the morbidity pattern according to age, gender and seasonal variation using the ICD coding and the utilization of Primary Health Care (PHC) center services in a demographically defined community. METHODS: The data collected from 2001-2003 was analyzed using the International Classification of Diseases-10 (ICD-10) coding for identifying the morbidity patterns presenting at the PHC Center. The age and gender distribution of the patients and the seasonal variation of few diseases were noted. Only the residents of the area visiting the center for preventive or curative services were included. A structured performa was designed to enter the age, gender, disease and ICD codes. The faculty was trained for using the coding system. RESULTS: A total of 13,519 patients visited the PHC during three-year period. On an average, 376 patients were seen during a month with male to female ratio of 1:2. The most common diseases presented belong to the respiratory system, followed by infections or parasitic infestations and diseases of the reproductive system. The women presented for first visit of antenatal check up were 960 out of 4614 women of reproductive age group. Among the adult population, 391 (6%) presented with hypertension, 64 (1%) were Type 2 diabetics and 86 (1.3%) were asthmatics. The paediatric population analysis showed that 918 (13%) had upper respiratory infections and 1339 (19%) had diarrhoea. CONCLUSION: Problem oriented medical records from health centers, computerized in a uniform standardized way, can give extensive information about the content and burden of health problems in family practice and presumably public health.

Improving vaccination status of children under five through health education.

OBJECTIVE: To improve awareness and knowledge of mothers regarding vaccine preventable diseases and the immunization status of children under five through health education messages by medical students, at Gulshane-Sikanderabad, a squatter settlement adjacent to Ziauddin Medical University, Karachi. METHODS: The undergraduate medical students' visit families in the squatter settlement. This study compared the effect of intervention by medical students on vaccination status of children under five in the intervention households versus those without intervention. A baseline study was done in 1998 and a follow-up study was done after four years to assess the differences in knowledge and practices of mothers regarding immunization. RESULTS: A total of 110 houses from block I and 207 houses from block V were selected. An increase of 22% (52% vs 30%) in block-I (p = 0.003) and 19% (32% vs 13%) increase in block V was seen in the utilization of PHC Center for vaccination (p = 0.001). Mothers' knowledge regarding the age when first vaccine is administered to the child, increased in the follow-up from 60% to 76.5% (p < 0.01) in block I and from 50% to 62% in block V. The immunization status increased significantly in block I from 46.5% to 75% after the intervention (p < 0.005), no significant difference could be seen in block V (p = 0.16). In the follow-up survey a significant difference was seen in the vaccination status between the two blocks (p = 0.001). CONCLUSION: The health education messages significantly increased the vaccination status of children under 5 in the intervention area.