Pulmonary Nocardiosis in Renal Transplant Recipients From Pakistan: Risk Factors, Clinical Presentation, and Mortality.

OBJECTIVES: Nocardia is an opportunistic infection among renal transplant recipients with an incidence of <1% but high mortality. Data from Pakistan are scarce. Our aim was to find the risk factors, clinical and radiographic findings, antimicrobial sensitivity, and outcomes of Nocardia infection among renal transplant recipients in Pakistan. MATERIALS AND METHODS: All adult renal transplant recipients diagnosed with nocardiosis between 2013 and 2020 were included. The cases were matched 1:2 with controls based on sex, age (±1 year), and transplant date (±1 year). Risk factors, clinical features, antibiotic sensitivities and outcomes were analyzed. RESULTS: A total of 48 patients developed nocardiosis. Around 25% of patients presented with disseminated disease. Median time from transplant to disease development was 2.68 years. High-dose methylprednisolone and presence of cytomegalovirus infection within 90 days of disease development were independent risk factors for Nocardia infection. The mortality rate was 20%. Central nervous system disease and cytomegalovirus infection within 90 days were significantly associated with mortality. The most susceptible drugs were co-trimoxazole and linezolid. Imipenem susceptibility was only 20%. CONCLUSIONS: High-dose methylprednisolone and cytomegalovirus infection were independent risk factors for Nocardia infection. Central nervous system disease was associated with mortality. Nocardia species were highly resistant to ceftriaxone and imipenem in our patient population.

Healthy life expectancy with cardiovascular disease among Chinese rural population based on the prospective cohort study.

BACKGROUND: Limited research has explored the impact of cardiovascular disease (CVD) on healthy life expectancy (HLE) especially in resource-limited areas. This study aimed to investigate the association between CVD and HLE in Chinese rural population. METHODS: This study included 11,994 participants aged 45 years and older from the baseline and follow-up surveys of the Henan rural cohort study. Healthy status was measured via a Visual Analogue Scale. The multistate Markov model was applied to estimate the association between CVD and transitions in health, unhealthiness and death. Gender-specific total life expectancy, HLE and unhealthy life expectancy were calculated by the multistate life table method. RESULTS: During a mean follow-up time of 3.85 (3.84-3.86) years, there were 588 deaths recorded. For individuals with CVD, the risk of switching from health to unhealthiness status was increased by 71% [hazard ratio (HR) = 1.71, 95% CI: 1.42-2.07], the chance of recovery was reduced by 30% (HR = 0.70, 95% CI: 0.60-0.82). Men aged 45 years without CVD could gain an extra 7.08 (4.15-10.01) years of HLE and lose 4.00 (1.60-6.40) years of unhealthy life expectancy compared to their peers with CVD, respectively. The corresponding estimates among women were 8.62 (5.55-11.68) years and 5.82 (2.59-9.04) years, respectively. CONCLUSIONS: This study indicated that CVD was significantly associated with poorer health status and lower HLE among Chinese rural population. It is an important public health policy to adopt targeted measures to reduce the CVD burden and enhance the quality of life and HLE in resource-limited areas.

Prevalence of nonalcoholic fatty liver disease in Pakistan: a systematic review and meta-analysis.

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver condition globally and the leading cause of liver-related death and morbidity. The goal of this study was to collect current data in order to calculate the pooled prevalence of NAFLD in Pakistan. We conducted a comprehensive literature search on four electronic databases until March 2024 to find studies on the prevalence of NAFLD in Pakistan. Pooled prevalence estimates of NAFLD were obtained using random-effects meta-analytic models. The chi-square test was used to account for study heterogeneity, whereas the I2 statistic was used to assess inconsistency. The data were stratified by the general population (average risk) and individuals with metabolic diseases (high risk). Two reviewers thoroughly and independently screened, reviewed, and assessed all studies. In total, 468 studies were reviewed, and 34 were included. The pooled NAFLD prevalence in the general population was 29.82% (95% CI 21.39-39.01%; prediction interval: 2.98-68.92%) based on 13 studies. In individuals with metabolic disorders, the prevalence of NAFLD in patients with diabetes, hypertension, and obesity, was 58.47% (95% CI 54.23-62.64%; prediction interval: 38.16-77.40%), 74.08% (95% CI 60.50-85.70%), and 47.43% (95% CI 30.49-64.66%), respectively. There was no evidence of publication bias, although a statistically significant level of heterogeneity was seen among the studies (I2 ranged from 57.5 to 98.69%). The findings of this study indicate a substantial prevalence of NAFLD in the population of Pakistan. The Pakistani government must formulate a comprehensive approach and plan aimed at augmenting awareness, control, prevention, and treatment of fatty liver disease.Prospero Registration no: CRD42022356607.

Extra-Adrenal Paraganglioma on Fine-Needle Aspiration Cytology: A Case Series.

Paragangliomas (PGs) are rare tumors that most commonly occur in the head and neck region and along the sympathetic chain. Fine-needle aspiration cytology is not commonly used for the diagnosis of PG due to the potential risk of hemorrhage and hypertensive crisis. As a result, limited studies describe the cytological features of PGs. In this case series, we will discuss the fine-needle aspiration features of three cases of extra-adrenal PGs. The cellular arrangement in smears was either singly scattered or loosely cohesive clusters. The cells were polygonal with pleomorphic nuclei, abundant granular cytoplasm, and bland chromatin. Cellblock showed two types of cells with focal acinar formation. Immunohistochemistry also confirmed the diagnosis. These results were also in keeping with radiological findings. Fine-needle aspiration cytology, along with clinicoradiological findings, can help in making an accurate preoperative diagnosis of PG.

Assessing the potential of nano-formulated chlorfenapyr and clothianidin insecticides-treated sugar baits against Anopheles funestus, Anopeles coluzzii and Culex quinquefasciatus mosquitoes.

Mosquitoes serve as vectors for various diseases like malaria, dengue fever, yellow fever, and lymphatic filarial diseases causing significant global health problems, highlighting the importance of vector control. The study was conducted to assess the effectiveness of nanoformulated clothianidin and chlorfenapyr insecticides treated with ATSB in controlling three mosquito strains. The development of a natural thiolated polymer-coated ATSB nano formulation involved incorporating nano-carriers to deliver insecticides. Field- collected mosquito strains were subjected to laboratory-based bioassays using 1 % and 1.5 % concentrations of each conventionally used and nanoformulated insecticide with ATSB solution. Adult mosquitoes were left overnight to contact with N-ATSB and efficacy was recorded after 36 and 72 h. The results showed that nanoformulated chlorfenapyr was significantly more effective as compared to clothianidin against An. funestus and Cx. quinquefasciatus but the results were not significantly different against An. coluzzii (100 %). An. coluzzii was found to be the most susceptible strain followed by An. funestus and showed 100 % and ∼ 98 % mortality against nanoformulated chlorfenapyr (1.5 %). Nanoformulated clothianidin induced more than 92 % and ∼ 100 % mortality against An. funestus and An. coluzzii respectively. However, Cx. quinquefasciatus significantly showed less mortality against nanoformulated clothianidin (88 %) and chlorfenapyr (>95 %) as compared to Anopheline strains. Furthermore, results indicate that nanoformulated insecticides significantly caused greater and prolonged fatality as compared to conventional form, suggesting effective and suitable strategies for vector management.

Reference Interval of Serum Gastrin 17 (G-17) for Healthy Population: A Non-Invasive Screening Biomarker for Gastric Disorders.

OBJECTIVE: To analyse fasting serum concentrations of G-17 in healthy individuals to establish the reference intervals (RIs) in the Pakistani population. STUDY DESIGN: Cross-sectional, observational study. Place and Duration of the Study: Department of Clinical Chemistry and Immunology, Chughtai Institute of Pathology, Lahore, Pakistan, from October to December 2022. METHODOLOGY: Fasting serum samples from one hundred and twenty healthy individuals between the age of 18-65 years were collected according to the CLSI recommendations after taking written informed consent. Samples were analysed on the auto-analyser for the quantitative measurement of serum G-17 by sandwich chemiluminescence immunoassay. Kolmogorov-Smirnov test was applied to check normality. A p-value of <0.05 was considered significant; 2.5th and 97.5th percentiles were computed using the formula 0.025 (n+1) and 0.0975 (n+1), respectively. RESULTS: Of the 120 samples, 74 were obtained from male patients and 46 from females. The mean age was 30.2 ±10.36 years. The histogram revealed a non-parametric distribution of the data. The established reference intervals by the rank-based method were 2.31 pg/mL and 49.36 pg/mL which corresponds to 2.5th and 97.5th percentiles, respectively. These were markedly different from the Chinese reference ranges. CONCLUSION: Ethnic and geographic variations affect the trends of RIs of Serum G-17. There is a need to establish its population-specific RIs for G-17, so it can be used as a non-invasive option in identifying patients requiring invasive endoscopic intervention. KEY WORDS: Gastrin, Atrophic Gastritis, Biomarker, Reference values.

Assessment of Nano-Formulated Conventional Insecticide-Treated Sugar Baits on Mosquito Control and the Effect on Non-Target Aphidophagous Coccinella septempunctata.

Mosquitoes, as disease vectors causing global morbidity and mortality through diseases like malaria, dengue, and Zika, necessitate mosquito population control methods. This study investigated the efficacy of nano-formulated insecticide-based sugar baits in controlling Anopheles gambiae populations and assessed their potential non-target impact on Coccinella septempunctata. This laboratory-based study employed thiolated polymer-coated attractive toxic sugar bait (ATSB) nano-formulations, delivering pesticides via nano-carriers. Adult and larvae populations of insects were collected from rice and cotton fields subjected to bioassays with 0.5% and 1% concentrations of each nano-formulated and conventional insecticide within ATSB solution, alongside a control 100% attractive sugar bait (ASB). Mosquitoes interacted overnight with insecticide-treated baits, and mortality was assessed. Further observations up to 72 h were conducted for potential delayed toxic effects. Results highlighted nano-ATSB carbosulfan's effectiveness, particularly among organophosphates and pyrethroids. Among pyrethroids, nano-ATSB cypermethrin exhibited high efficacy, while Deltamethrin displayed lower mortality. Among organophosphates, nano-ATSB chlorpyrifos induced substantial mortality. The nano-formulations of insecticide were harmless against C. septempunctata compared to their conventional form. Nano-formulations demonstrated enhanced mortality rates and prolonged efficacy against mosquitoes, having a benign impact on non-target beetles. We expect these results to aid in developing effective plant protection products suitable for IPM practices.

Reference Interval of Soluble FMS­like Tyrosine Kinase­1 in Non-Pregnant and Pregnant Females: A Novel Biomarker for Pre-eclampsia.

OBJECTIVE: To determine the reference interval of soluble FMS-like tyrosine kinase-1 (sFIt-1) in healthy, non-pregnant and pregnant females. STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Chemical Pathology, Chughtai Institute of Pathology, Lahore, from January to May 2023. METHODOLOGY: Blood samples were collected from 120 disease-free non-pregnant females of reproductive age group and 120 disease-free pregnant females with singleton fetuses from 15 to 28 weeks of gestational age. Healthy reference individuals were selected by correlating history with medical disorders like diabetes mellitus, hypertension, autoimmune diseases, inherited disorders, and by excluding any other drug history. All findings were recorded on health screening questionnaire. Levels of sFlt-1 were measured by a fully automated immunoassay analyser Cobas e601. Kolmogorov-Smirnov test was applied. The value of p <0.05 was considered significant. The 2.5th and 97.5th percentiles were computed at 90% CI by using the formula 0.025x (n+1) and 0.975x (n+1) which corresponded to rank number 1 and 7, respectively. The reference interval was calculated by the Rank-based method. RESULTS: Reference interval of sFlt-1 in non-pregnant and pregnant females were determined on the basis of 2.5th and 97.5th percentiles which were 57.7 to 118.5 pg/mL and 563.5 to 3288.0 pg/mL, respectively. CONCLUSION: The present study determined reference interval of sFlt-1 in healthy, non-pregnant and pregnant females in Lahore. KEY WORDS: Reference interval, Soluble FMS-like tyrosine kinase-1, Pre-eclampsia, Rank-based method.

Microplastic Quantification in Aquatic Birds: Biomonitoring the Environmental Health of the Panjkora River Freshwater Ecosystem in Pakistan.

Microplastic pollution has become a global concern, with potential negative impacts on various ecosystems and wildlife species. Among these species, ducks (Anas platyrhynchos) are particularly vulnerable due to their feeding habits and proximity to aquatic environments contaminated with microplastics. The current study was designed to monitor microplastic (MP) pollutants in the freshwater ecosystem of the Panjkora River, Lower Dir, Pakistan. A total of twenty (20) duck samples were brought up for four months and 13 days on the banks of the river, with no food intake outside the river. When they reached an average weight of 2.41 ± 0.53 kg, all samples were sacrificed, dissected, and transported in an ice box to the laboratory for further analysis. After sample preparation, such as digestion with 10% potassium hydroxide (KOH), density separation, filtration, and identification, the MP content was counted. A total of 2033 MP particles were recovered from 20 ducks with a mean value of 44.6 ± 15.8 MPs/crop and 57.05 ± 18.7 MPs/gizzard. MPs detected in surface water were 31.2 ± 15.5 MPs/L. The major shape types of MPs recovered were fragments in crop (67%) and gizzard (58%) samples and fibers in surface water (56%). Other types of particles recovered were fibers, sheets, and foams. The majority of these detected MP particles were in the size range of 300-500 µm (63%) in crops, and 50-150 µm (55%) in gizzards, while in water samples the most detected particles were in the range of 150-300 µm (61%). Chemical characterization by FTIR found six types of polymers. Low-density polyethylene (LDPE) had the greatest polymer detection rate (39.2%), followed by polyvinyl chloride (PVC) (28.3%), high-density polyethylene (HDPE) (22.7%), polystyrene (6.6%), co-polymerized polypropylene (2.5%), and polypropylene homopolymer (0.7%). This study investigated the presence of microplastics in the crops and gizzards of ducks, as well as in river surface water. The results revealed the significant and pervasive occurrence of microplastics in both the avian digestive systems and the surrounding water environment. These findings highlight the potential threat of microplastic pollution to wildlife and ecosystems, emphasizing the need for further research and effective mitigation strategies to address this pressing environmental concern.

Association of Single Nucleotide Polymorphism in VDR, GC Globulin and CYP2R1 with the Risk of Esophageal Cancer.

BACKGROUND: The proactive role of vitamin D has been well determined in different cancers. The protein that encodes the components of the vitamin D metabolism could appear to play a pivotal role in vitamin D stability and its maintenance. A polymorphism in vitamin-D-receptor (VDR), carrier globulin/binding protein (GC) and cytochrome P-450 family 2, subfamily R, polypeptide 1 (CYP2R1) genes has been predicted to be associated with the development of cancer. This study was designed to detect the association of VDR, GC Globulin and CYP2R1 gene polymorphism with the risk of esophageal cancer in the North-east Indian population. METHODS: To carry out the study, a total of 100 patients diagnosed with esophageal cancer and 101 healthy controls were enrolled. In a case-control manner, all samples were subjected to do genotype testing for known SNPs on the VDR (rs1544410), GC (rs4588), and CYP2R1 (rs10741657) genes using Restriction-fragment length polymorphism (RFLP) followed by Sanger sequencing. The collected demographic and clinical data were analysed using the statistical software package SPSS v22.0. RESULTS: The VDR haplotype heterozygous TC was found strongly associated with the carcinoma group (OR:1.09, 95%CI:0.67-1.75). The risk factors analysis using the GC globulin rs4588 phenotype, found a positive correlation in terms of mutant AA's harmful influence on the cancer cohort (OR = 1.125, OR=1.125, 95% CI, 0.573-2.206). The influence of the CYP2R1 rs10741657 polymorphism on the malignant cohort revealed that the GG mutant had a significant negative influence on the carcinoma, has an influential role in disease severity ( OR:1.736, at 95% CI; 0.368-8.180). CONCLUSION: In conclusion, this study revealed the potential association of VDR gene polymorphism in the progression and development of esophageal cancer in north east Indian population cohort.

The prevalence of prostate cancer in Pakistan: A systematic review and meta-analysis.

Background: Prostate cancer is a significant public health issue, ranking as the second most common cancer and the fifth leading cause of cancer-related deaths in men. In Pakistan, the prevalence of prostate cancer varies significantly across published articles. This study aimed to determine the pooled prevalence of prostate cancer and its associated risk factors in Pakistan. Methods: MEDLINE (via PubMed), Web of Science, Google Scholar, and local databases were searched from inception until March 2023, using key search terms related to the prevalence of prostate cancer. We considered a random-effects meta-analysis to derive the pooled prevalence and relative risks with 95% CIs. Two investigators independently screened articles and performed data extraction and risk of bias analysis. We also conducted meta-regression analysis and stratification to investigate heterogeneity. This study protocol was registered at PROSPERO, number CRD42022376061. Results: Our meta-analysis incorporated 11 articles with a total sample size of 184,384. The overall pooled prevalence of prostate cancer was 5.20% (95% CI: 3.72-6.90%), with substantial heterogeneity among estimates (I2 = 98.5%). The 95% prediction interval of prostate cancer was ranged from 1.74%-10.35%. Subgroup meta-analysis revealed that the highest pooled prevalence of prostate cancer was in Khyber Pakhtunkhwa (8.29%; 95% CI: 6.13-10.74%, n = 1), followed by Punjab (8.09%; 95% CI:7.36-8.86%, n = 3), while the lowest was found in Sindh (3.30%; 95% CI: 2.37-4.38%, n = 5). From 2000 to 2010 to 2011-2023, the prevalence of prostate cancer increased significantly from 3.88% (95% CI: 2.72-5.23%) to 5.80% (95% CI: 3.76-8.24%). Conclusions: Our meta-analysis provides essential insights into the prevalence of prostate cancer in Pakistan, highlighting the need for continued research and interventions to address this pressing health issue.

An updated systemic review and meta-analysis on human papillomavirus in breast carcinogenesis.

Background: Breast Cancer (BC) stands out as the widely prevalent malignancy among all the types of cancer affecting women worldwide. There is significant evidence that the pathogenicity of BC may be altered by Human Papillomavirus (HPV) infection; however, conclusive data are not yet available. Methods: By searching five databases, including EMBASE, IBECS, PubMed, Scopus, Science Direct, Google Scholar, and Web of Science, a thorough systematic analysis was conducted on the prevalence of HPV in BC patients from 1990 to June 30, 2022. After applying extensive eligibility criteria, we selected 74 publications for further analysis based on the prevalence of HPV infections in breast tissues. All of the data were analyzed using a random-effects meta-analysis, Cochran Q test and I2 statistic were used to calculate the heterogeneity of the prevalence among these studies using subgroup analysis. Variations in the HPV prevalence estimates in different subgroups were evaluated by subgroup meta-analysis. Results: In total, 3156 studies were initially screened, resulting in 93 full-text studies reviewed, with 74 meeting inclusion criteria. Among a total of 7156 BC biopsies, the pool prevalence of HPV was 25.6% (95% CI= 0.24-0.33, τ2 = 0.0369 with significant heterogeneity between estimates (I 2 = 97% and p< 0.01). Consequently, 45 studies with available controls were further studied, and the prevalence of HPV in case-control studies was 26.2% with overall odds 5.55 (95% CI= 3.67-8.41, I 2 = 38%, τ2 = 1.4878, p< 0.01). Further subgroup analysis of HPV revealed HPV-16 had a maximum prevalence of 9.6% (95% CI= 3.06-11.86, I 2 = 0%, τ2 = 0.6111, p< 0.01). Among different geographical regions, Europe reported the maximum prevalence of HPV, i.e., 39.2% (95% CI=1.29-7.91, I 2 = 18%, τ2 = 1.2911, p< 0.01). Overall distribution showed HPV-18 was a frequent HPV subtype reported in Australia. Conclusion: Current study provides a global estimate of HPV prevalence in BC patients and demonstrates a significant association between this virus and BC etiology. Nevertheless, we recommend further investigation into the underlying mechanism is essential to validate this hypothesis.

Prevalence of type 2 diabetes and pre-diabetes in Sri Lanka: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this research was to determine the prevalence of diabetes and pre-diabetes in Sri Lanka. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE (via PubMed), Web of Science, Sri Lankan Journals online and Google Scholar were searched for relevant articles published between January 1990 and June 2022 investigating the prevalence of pre-diabetes and diabetes in Sri Lanka. METHODS: Random effect meta-analyses were conducted to derive the pooled prevalence of pre-diabetes and diabetes and their 95% CIs. Heterogeneity was explored by subgroup and meta-regression analyses. Sensitivity analyses were used to evaluate the impact of any single study on the pooled estimates. Two authors screened articles, extracted data and evaluated the quality of selected studies. RESULTS: A total of 479 articles were reviewed, and 15 studies (n=30 137 participants) were selected in the final analysis. The overall pooled prevalence of diabetes was 12.07% (95% CI, 8.71% to 15.89%; prediction interval: 1.28-31.35). The pooled pre-diabetes prevalence was 15.57% (95% CI, 9.45% to 22.88%; prediction interval: 0.02-49.87). The pooled type 2 diabetes prevalence was the highest in the latest period of 2011-2021 (17.25%) than in the period of 2000s (11.84%) and 1990s (5.62%). CONCLUSIONS: The growing trend of diabetes and pre-diabetes over the last 30 years is alarming in Sri Lanka. The government of Sri Lanka needs to take steps to improve diabetes education, screening, diagnosis and treatment. PROSPERO REGISTRATION NUMBER: CRD42021288591.

The prevalence of peripheral neuropathy among the patients with diabetes in Pakistan: a systematic review and meta-analysis.

The most frequent complication of diabetes is peripheral neuropathy. The estimated prevalence of peripheral neuropathy in people with diabetes varies substantially between published studies in Pakistan. We conducted this meta-analysis to summarize the prevalence of peripheral neuropathy in people with diabetes. Different electronic databases were systematically searched using keywords and MeSH terms. Random-effects meta-analysis was conducted to pool the prevalence of peripheral neuropathy in people with diabetes in Pakistan. Heterogeneity was investigated by random-effects meta-regression and stratification. Two independent authors reviewed studies, extracted data, and conducted the risk of bias analysis. Nineteen studies with a total of 8487 diabetic patients were included. The overall pooled prevalence of diabetic peripheral neuropathy was 43.16% (95% CI 32.93-53.69%), with significant heterogeneity between estimates. The prevalence of peripheral neuropathy among those newly diagnosed with diabetes was 26.52% (95% CI 14.97-39.96%, n = 5). According to the subgroup meta-analysis, the pooled prevalence of diabetic peripheral neuropathy was highest in Khyber Pakhtunkhwa (55.29%; 95% CI 23.91-84.50%), followed by Sindh (40.04%; 95% CI 24.00-57.25%), and the lowest was found in Punjab (34.90%; 95% CI 15.05-57.95%). A significant association was found between the pooled prevalence estimate and the duration of diabetes. The results of this meta-analysis indicate a relatively high prevalence of peripheral neuropathy in people with diabetes in Pakistan. The study protocol has been registered in the PROSPERO, with the registration number CRD42022371617.

Prevalence of dengue virus in Haripur district, Khyber Pakhtunkhwa, Pakistan.

Dengue virus (DENV) has caused about 12 large outbreaks in Pakistan, resulting in 286,262 morbidities and 1108 deaths. The most affected province is Khyber Pakhtunkhwa (KP). This study was conducted to determine the average DENV prevalence in different areas of the Haripur endemic district of KP and the causing factors of DENV. METHODS: This work was a cross-sectional study that was performed in the DENV endemic district Haripur. A total of 761 individuals were included in this study. The data were categorized according to sex, age and symptoms (like fever, body aches, bleeding, and skin rash). For data analysis, SPSS 23 version was applied. ArcGIS version 10.8 was used to map the study area. RESULTS: In this study, there were 716 confirmed cases of DENV fever, including 421 males (58.8%) and 295 females (41.2%). The most affected age range, 16-30 years, reported by 301 (42.0%), was followed by 31-45 years, 184 (25.7%), above 46 years, 132 (18.4%), and 0-15 years, 99 (13.8%). The positive IgG cases were 581(81.0%). Those whose age ranges from 1 to 15 years 82 (8.7%) cases, 16-30 years 244 (34.1%), 31-45 years 156 (21.8%), above 46-year age 99 (13.8%) cases. In addition, this suggests that those between the ages of 16 and 30 are at the highest risk for DENV infection. However, this might be the fact that individuals in this age range are more likely to be out in the environment, making them more vulnerable to the virus. CONCLUSION: Over the past ten years, DENV fever has become increasingly prevalent in Pakistan. The risk is substantially higher for males. Dengue outbreaks hit those between the ages of 16 and 30 the hardest. The proper monitoring and assessment of DENV are necessary for prevention and controlling the disease. Disease surveillance includes identification and molecular characterization of infected persons and monitoring mosquito populations in high-risk locations for the purpose of vector surveillance. In order to assess the community's willingness to participate in DENV preventive efforts, behavioral impact surveillance is also necessary.

Tuberous sclerosis associated lymphangioleiomyomatosis: A case report.

Lymphangioleiomyomatosis (LAM) is a multisystem disorder that primarily affects the lung. Tuberous sclerosis complex (TSC) is characterized by multiple benign tumours of the skin, brain, eyes, heart, lung, liver, and kidney. LAM can be either sporadic (sporadic-LAM) or in association with Tuberous Sclerosis (TSC-LAM). Many clinical, radiologic, and pathologic features are shared between TSC and sporadic variants. We present a case admitted at The Indus Hospital Karachi with pneumothorax and multiple manifestations of TSC-LAM.

An Overview of Complete Blood Count Sample Rejection Rates in a Clinical Hematology Laboratory Due to Various Preanalytical Errors.

Introduction The Chughtai Laboratory collects blood samples for complete blood counts from various hospitals, emergency departments, ICUs, and through home sampling services all across the country. The preanalytical phase is an integral component of laboratory medicine. A laboratory report has a key role in patient treatment and the clinician's decision in the management of the disease. Preanalytical errors are most frequently caused by the absence of a sample and/or inappropriate understanding of a test request, mislabeling, contamination from the sampling site, hemolyzed, clotted, insufficient samples, storage issues, and inappropriate blood to anticoagulant proportion or inappropriate choice of anticoagulant. Objective To identify the cause of rejection rates of the complete blood count samples and reduce the rejection rates by improving the accuracy of the results and lowering pre-analytical errors. Methods This cross-sectional study was done in the Hematology Department of Chughtai Laboratory's head office in Lahore between 19-06-2021 and 19-10-2021. Simple random sampling was applied to collect the data. About 3 ml of each blood sample was received in an ethylenediaminetetraacetic acid (EDTA) vial, inspected visually, run on Sysmex XN-9000 (Sysmex Corporation, Kobe, Hyogo, Japan), and was reviewed on peripheral smears. Results Out of 231,008 blood samples, 11,897 (5.15%) samples were rejected. The most common pre-analytical mistake was storage issues due to transportation delay (19.45%) followed by wrong medical records (19.16%), diluted samples (16.35%), incorrect tubes (16.01%), hemolyzed samples (15.13%), unlabeled samples (10.01%), and clotted sample (3.88%). Conclusion In the hematology department, the total rejection rate observed during the study period was 5.15%. Recognition of preanalytical errors and avoiding them will help us lower the sample rejection rate and raise the overall quality of laboratory management.

Prevalence of neuropsychiatric disorders in patients with systemic lupus erythematosus in Pakistan: A systematic review and meta-analysis.

Introduction: By conducting a systematic review and meta-analysis, we investigated the prevalence of neuropsychiatric (NP) symptoms among systemic lupus erythematosus (SLE) patients in Pakistan. Methods: In this review work, three electronic databases (Web of Science, MEDLINE, and Google Scholar) and local databases were screened for 20 years from 1 January 2002 to 30 September 2022, to identify the articles evaluating the prevalence of NP symptoms in SLE patients in Pakistan. We performed a random-effects meta-analysis to estimate the prevalence of NPSLE. Statistical heterogeneity was measured by the I2 index, and subgroup meta-analyses were used to access the statistical heterogeneity. Furthermore, meta-regression models were used to examine the associations between prevalence estimates and study characteristics of interest. Three independent authors reviewed existing studies, extracted data, and rated the qualities of selected studies. This review was registered on PROSPERO (Registration no. CRD42022361798). Results: Thirteen studies met the inclusion criteria out of the 322 studies with a total of 2,003 SLE patients for this systematic review and meta-analysis. The prevalence of NP disorders in SLE patients was estimated to be 30.42% (95% CI:18.26-44.11%), with cognitive dysfunction being the most common (31.51%; 95% CI:1.28-76.27%), followed by headache (10.22%; 95% CI: 0.00-33.43%), seizures (5.96%; 95% CI: 3.80-8.53%), psychosis (3.64%; 95% CI: 2.38-5.13%), and neuropathy is the least common (0.86%; 95% CI: 0.00-2.74%). The heterogeneity between studies was significant (p < 0.01). The pooled prevalence of NP disorders among SLE patients was found highest in Punjab (41.21%) and lowest in Sindh (17.60%). Conclusion: Findings from this study revealed that SLE patients have a high prevalence of NP disorders. The most common symptoms were cognitive dysfunctions, headaches, seizures, psychosis, and neuropathy. Clinicians can manage these potentially deadly and disabling diseases more effectively if they understand the incidence of each NP symptom in SLE patients. NP symptoms among SLE patients are at their peak in Pakistan; policymakers should devise preventive strategies to curb the disease. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record. php?RecordID=361798, identifier CRD42022361798.

Granular Cell Astrocytoma.

Granular cell astrocytoma (GCA) is a rare glial neoplasm composed of abundant granular cytoplasm gives immunoreactivity for GFAP and S100 stains. We report a case of GCA in a 64 years old male presented with history of fits, right sided weakness and loss of consciousness. The microscopy showed sheets of large cells with abundant eosinophilic granular cytoplasm. No high-grade features were seen. Its differential diagnosis includes most of the benign histiocytic conditions. Granular cell astrocytoma has an aggressive clinical course and its survival rate is less than 1 year. That's why early correct diagnosis is very essential.