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1.
Langenbecks Arch Surg ; 408(1): 308, 2023 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-37578661

RESUMO

PURPOSE: Thromboembolic complications remain a significant concern in postoperative patients, particularly those who have undergone liver transplantation. Warfarin has been the standard oral anticoagulant. Direct oral anticoagulants (DOACs) have several advantages over warfarin, including rapid onset of action and standardized dose guidelines. We aimed to assess the safety of rivaroxaban in living donor liver transplantation (LDLT) recipients. METHODS: This study was a single-center, retrospective descriptive analysis of LDLT recipients who received rivaroxaban between December 2020 and April 2022. A total of 27 recipients received rivaroxaban postoperatively. Liver function tests, immunosuppression levels, serum creatinine, and INR were recorded before the initiation of rivaroxaban and then on post-therapy days 1, 7, 14, 28, 90, and 180. RESULTS: Among the 27 recipients receiving rivaroxaban postoperatively, portal venous thrombosis was the most prevalent indication for anticoagulation (44.4%), followed by Budd-Chiari syndrome (29.6%). Nine patients had a twofold increase in either ALT or AST values, two of whom were treated for biliary strictures and the others for rejection. Eighteen patients were given tacrolimus, and eight were on cyclosporine, with one patient switched from tacrolimus to cyclosporine due to insufficient therapeutic levels. There were no incidents of bleeding or re-thrombosis during the 180-day follow-up period. CONCLUSION: Rivaroxaban may be a safe and effective alternative in LDLT recipients with no significant adverse incidents. Further studies with larger sample sizes are needed to confirm these findings and determine this population's optimal dose and duration of rivaroxaban therapy.


Assuntos
Ciclosporinas , Transplante de Fígado , Humanos , Rivaroxabana/efeitos adversos , Varfarina/efeitos adversos , Estudos Retrospectivos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Tacrolimo , Anticoagulantes/efeitos adversos
2.
Int J Mol Sci ; 24(2)2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36675138

RESUMO

Oral squamous cell carcinomas (OSCC) remain a major healthcare burden in Asian countries. In Pakistan alone, it is the most common cancer in males and second only to breast cancer in females. Alarmingly, treatment options for OSCC remain limited. With this context, investigations made to explore the inflammatory milieu of OSCC become highly relevant, with the hope of practicing immunotherapeutic approaches to address this highly prevalent tumor. We investigated the newly identified innate lymphoid cells (ILCs) and associated cytokines in well-defined human oral squamous cell carcinoma (OSCC) as well as in a 7,12-dimethylbenz[a]anthracene (DMBA)-induced murine model of OSCC using flow cytometry and quantitative real-time polymerase chain reaction (qPCR). We further went on to explore molecular circuitry involved in OSCC by developing a murine model of OSCC and using an α-Thy1 antibody to inhibit ILCs. Amongst the ILCs that we found in human OSCC, ILC3 (23%) was the most abundant, followed by ILC2 (17%) and ILC1 (1%). Mice were divided into four groups: DMBA (n = 33), DMBA+antibody (Ab) (n = 30), acetone (n = 5), and control (n = 5). In murine OSCC tissues, ILC1 and ILC3 were down-infiltrated, while ILC2 remained unchanged compared to controls. Interestingly, compared to the controls (DMBA group), mice treated with the α-Thy1 antibody showed fewer numbers of large tumors, and a larger percentage of these mice were tumor-free at this study's end point. We present novel data on the differential expansion/downsizing of ILCs in OSCC, which provides a pivotal basis to dive deeper into molecular circuitry and the OSCC tumor niche to devise novel diagnostic, therapeutic, and prognostic strategies to prevent/treat oral cancers.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Masculino , Feminino , Humanos , Camundongos , Animais , Imunidade Inata , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Linfócitos , Modelos Animais de Doenças , Neoplasias Bucais/patologia , Paquistão
3.
J Pak Med Assoc ; 73(1): 17-21, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36842000

RESUMO

OBJECTIVE: To assess the beliefs about causes of psychotic disorders and subsequent help-seeking behaviour in caregivers. Methods: The descriptive cross-sectional study was conducted at the Department of Psychiatry, Civil Hospital, Karachi, from September 2020 to February 2021, and comprised caregivers of patients with psychotic disorders. Data was collected using a questionnaire that was filled up by caregivers mentioning their beliefs about the cause of the disorder and subsequent help-seeking behaviour. Data was analysed using SPSS 22. RESULTS: Of the 162 participants, 69(42.6%) were male and 93(52.4%) were female. The overall mean age was 39.9+12.9 years. The majority 157(96.9%) subjects were Muslims. In terms of beliefs, anxious personality 62(38.3%), evil eye 62(38.3%) and God's will 56(34.6%) were the major choices picked. With respect to help-seeking behaviour, the choices most picked were taking the patient to a psychiatrist 129(79.6%), praying 108(66.6%) and taking the patient to a family physician 103(63.6%). CONCLUSIONS: There was found to be sufficient awareness among the caregivers, but help-seeking behaviour needed to improve considerably.


Assuntos
Comportamento de Busca de Ajuda , Psiquiatria , Transtornos Psicóticos , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Cuidadores , Estudos Transversais , Aceitação pelo Paciente de Cuidados de Saúde , Hospitais
4.
J Pak Med Assoc ; 72(1): 194-198, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35099470

RESUMO

OBJECTIVE: To assess the perception and attitude towards prostate cancer and its screening practices in Pakistan. METHODS: The cross-sectional study was conducted at Ruth Pfau Civil Hospital, Karachi June to October 2019, and comprised male subjects aged >40 years with no prior diagnosis of prostate cancer who were enrolled from the community. Data was collected using a structured questionnaire which was available in English and Urdu languages. Data was analysed using SPSS 23. RESULTS: Of the 383 subjects, 144(37.6%) were aged 40-49 years, 302(78.9%) were married, 120(31.3%) had received education up to the secondary level, and 204(53.3%) earned. CONCLUSIONS: The level of knowledge regarding prostate cancer and its screening practices was poor, and the attitude towards its screening was negative.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Neoplasias da Próstata , Estudos Transversais , Humanos , Masculino , Paquistão/epidemiologia , Percepção , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/epidemiologia
5.
J Pak Med Assoc ; 72(2): 253-259, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35320172

RESUMO

OBJECTIVE: To quantify the depiction of violence and vulgarity in television programmes for children, and to assess the perception and practices of parents and children about television programmes meant for children. METHODS: We conducted this mixed-methods cross-sectional study in Karachi, Pakistan in the months of August-September 2018, after approval from the ethics review board of Dow University of Health Sciences, Karachi. First, a content analysis of over 102 hours of various television programmes meant for children was performed in the light of the guidelines set out by the World Health Organisation, the United States Federal Communication Commission and the Pakistan Electronic Media Regulatory Authority. Seven trained researchers sampled the children prime time throughout a week, including the weekends, using a structured tally sheet. Subsequently, interviews were conducted with dyad of parent-children from the employees' list of a public-sector university. A questionnaire was also administered to assess the practices and perceptions of the parents-children dyad about the programmes. Data was analysed using SPSS 24. RESULTS: Of the 173 subjects, 84(48.6%) were parents and 89(51.4%) were children. The mean age of the children was 9.8±3.7 years. Content analysis comprised 6130 minutes, of which 5442(88.8%) had depictions of violence and vulgarity. Depiction of violence and vulgarity was prevalent on television channels that were watched the most, but there was no significant difference in this regard (p=0.238). Of the parents, 68(81%) expressed concern over the effect of screen time and content on the mental health of their children. CONCLUSIONS: Television programmes meant for children were found to be inappropriate with seriously high proportion of violence and vulgarity in their contents.


Assuntos
Pais , Televisão , Adolescente , Criança , Estudos Transversais , Humanos , Pais/psicologia , Inquéritos e Questionários , Violência
6.
J Med Virol ; 93(6): 3714-3729, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33289144

RESUMO

INTRODUCTION: HBV can evolve under selection pressure exerted by drugs and/or host immunity, resulting in accumulation of escape mutations that can affect the drug or the immune activity. Hepatitis delta virus (HDV) coinfection is also known to exert selection pressure on HBV, which leads to selective amplification of certain mutations, especially in genes that are required for HDV pathogenesis, such as HBsAg. However, little is known about the function of these mutations on HBV or HDV life cycle. The purpose of this study is to determine mutations selectively amplified in the backdrop of HDV, and how these mutations affect processing of CD4- and CD8-T cell epitopes. METHODS: HBsAg was successfully amplified from 49/50 HBV mono- and 36/50 coinfected samples. The sequences were used to identify mutations specific to each study group, followed by an in silico analysis to determine the effect of these mutations on (1) proteasomal degradation, (2) MHC-I and MHC-II biding, and (3) processing of T-cell epitopes. RESULTS: HBV-HDV coinfected sequences exhibited certain unique mutations in HBsAg genes. Some of these mutations affected the generation of proteasomal sites, binding of HBsAg epitopes to MHC-I and -II ligands, and subsequent generation of T- cell epitopes. CONCLUSION: These observations suggest that HBV selectively amplifies certain mutations in the backdrop of HDV coinfection. Selective amplification of these mutations at certain strategic locations might not only enable HBV to counteract the inhibitory effects of HDV on HBV replication but also facilitate its survival by escaping the immune response.


Assuntos
Apresentação de Antígeno/genética , Coinfecção/virologia , Epitopos de Linfócito T/imunologia , Evolução Molecular , Antígenos de Superfície da Hepatite B/genética , Vírus da Hepatite B/genética , Vírus Delta da Hepatite/genética , Mutação , Apresentação de Antígeno/imunologia , Linfócitos T CD8-Positivos/imunologia , Feminino , Genótipo , Hepatite B/virologia , Hepatite D/virologia , Humanos , Masculino , RNA Viral
7.
Pak J Med Sci ; 37(1): 93-98, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33437257

RESUMO

BACKGROUND & OBJECTIVES: The Chikungunya virus (CHIKV) transmitted to the humans through Aedes species of the mosquitoes. In December 2016, a severe outbreak reported from Pakistan. However, there is no vaccine or anti-viral treatment currently available so host immune response against CHIKV gained significant interest. Therefore, this study was conducted to identify the mutations in CHIKV E2 region of currently circulating Pakistani strains & determine their potential immunogenicity in Pakistani population. METHODS: It was a cross sectional study in which a total of 60 CHIKV PCR positive samples were collected from Molecular Department of Pathology, Dow University of Health Sciences (DUHS), Karachi during November 2017 to February 2018. CHIKV E2 gene was amplified by PCR & sequenced. Sequences were analyzed by using bioinformatic tools followed by epitope prediction in E2 sequences by In-silico immunoinformatic approach. RESULTS: Several single nucleotide variations (SNVs) were identified in Pakistani isolates with six novel mutations in E2 sequences. Immunoinformatic analyses showed more proteasomal sites, CTL & B-Cell epitopes in Pakistani strains with respect to S27 prototype with 69.4% population coverage against these epitopes in Pakistan. The study also identified key mutations responsible for generation of unique epitopes and HLA restriction in Pakistani isolates. The strain specific mutations revealed the current outbreak was caused by ESCA.IOL lineage of CHIKV. CONCLUSION: The evolution of E2 protein in Pakistani strains has increased its immunogenicity in comparison to ancestral s27 strain. The identification of most immunogenic and conserved epitopes with high population coverage has high potential to be used in vaccine development against these local strains.

8.
Acta Haematol ; 141(2): 68-78, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30616235

RESUMO

BACKGROUND: Bibliometric analyses are a tool employed by researchers and funding agencies to establish the most important areas of research in a particular field, and to determine which foci need increased research attention. Such analyses have been published in a variety of clinical specialties; however, a detailed literature search showed that no such study has been done for "myeloid neoplasms." In order to bridge this gap, we conducted a citation analysis of the 100 most influential articles on myeloid neoplasms. METHODS: Two independent researchers extracted relevant articles from the Scopus database. These articles were then ranked in descending order of citations and a list of the top 100 original articles was made. A further, more detailed list was created containing significant discriminating characteristics. RESULTS: The top cited articles were published over a period of 47 years, with most of them being published in the 5-year interval of 2001-2005. The citations ranged from 636 to 4,039. The articles originated from 28 different countries. Most of the articles were published in high-impact journals. CONCLUSION: Our analysis sheds light on the quality of work and driving trends, listing the most cited and impactful guideline articles within this field and aiding clinicians.


Assuntos
Bibliometria , Transtornos Mieloproliferativos/patologia , Bases de Dados Factuais , Humanos , Transtornos Mieloproliferativos/metabolismo , Editoração
9.
Environ Monit Assess ; 191(12): 770, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31768655

RESUMO

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.


Assuntos
Instituições de Assistência Ambulatorial , Resíduos Sólidos , Gerenciamento de Resíduos , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Monitoramento Ambiental , Análise Fatorial , Humanos , Paquistão , Projetos Piloto , Gerenciamento de Resíduos/economia , Gerenciamento de Resíduos/normas
10.
Waste Manag Res ; 37(9): 863-875, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266407

RESUMO

Healthcare waste encompasses a significant quantity of hazardous substances. Poor healthcare waste management can result in serious environmental and human health risks. Asian developing countries are densely populated, and some are highly resource constrained. These countries commonly fail to practice appropriate healthcare waste management. Moreover, facilities in these countries extensively lack proper waste segregation, collection, safe storage, transportation, and disposal. This mini-review recapitulates key issues of healthcare waste management confronting Asian developing countries. Regulations, legislation, and policies are found to be recent, and their implementation varies from one another. Variation in waste generation rate is common. Contradictory methods of waste measurement used by researchers leave these variations questionable. The absence of waste management training programmes roots ignorance among staff and handlers, which leads to unsafe waste handling and causes different health risks. Unsafe and illegal recycling of hazardous waste is a threat to human health, also landfilling is often confused with open dumping, causing environmental damage. Outdated incineration plants need to be replaced with autoclaving, steam sterilisation, and comparatively reasonable new practice of pyrolysis to avoid the emission of toxic gases. The significance of proper healthcare waste management cannot be ignored, especially in Asian developing countries; substantial improvements are required in order to protect the environment and human health from serious risks.


Assuntos
Eliminação de Resíduos de Serviços de Saúde , Gerenciamento de Resíduos , Ásia , Países em Desenvolvimento , Resíduos Perigosos , Humanos
11.
J Pak Med Assoc ; 68(8): 1267-1269, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30108401

RESUMO

28 years old, male patient was diagnosed with Metastatic Adrenocortical Carcinoma after extensive investigation. Patient's primary concern was only his right hip and right shoulder pain. On imaging investigations, the patient was diagnosed with Avascular Necrosis of the right hip joint. Further laboratory work-up for avascular necrosis showed Primary Hypercortisolism and eventually patient was found to have Adrenocortical Carcinoma base on CT and bone scan results, Avascular Necrosis usually presents with pain in the affected area, mostly involving shoulder, knee or hip joint. Among many of the causes of Avascular necrosis, one rare cause is hormone secreting Adreno cortical Carcinoma, a rare and a highly malignant tumour. Patients can present with Cushing's syndrome or can have atypical presentation like this patient. This patient did not have any symptoms related to malignancy such as loss of appetite and weight loss.


Assuntos
Neoplasias do Córtex Suprarrenal/complicações , Carcinoma Adrenocortical/complicações , Necrose da Cabeça do Fêmur/etiologia , Neoplasias do Córtex Suprarrenal/patologia , Carcinoma Adrenocortical/patologia , Adulto , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Humanos , Hidrocortisona/urina , Masculino , Necrose , Tomografia por Emissão de Pósitrons
12.
J Pak Med Assoc ; 67(9): 1438-1440, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28924290

RESUMO

Turner Syndrome was diagnosed in a 45 years old female, known case of Acute Myeloid Leukaemia (AML) with maturation, on Bone Marrow biopsy. She presented with blurred vision, vertigo, exertional dyspnoea and insomnia. She did not show the typical features of Turner syndrome, but her cytogenetis confirmed the diagnosis. Bone marrow biopsy showed diffuse infiltration of blast cells with cellularity around 80-85% and haematopoietic suppression. Karyotype analysis showed: 45 X, -X, t (8; 21) (q22; q22) [According to The International System for Human Cytogenetic Nomenclature (ISCN)]. Turner syndrome is caused by partial or complete absence of second X chromosome in a female. It is known to have Cardiovascular and Reproductive complications but it is rare to find haematologic malignancies. There are few similar reported cases of AML associated with Turner syndrome, therefore this is a unique case presented to Jinnah Postgraduate Medical Center, Karachi, Pakistan and further research should be done to identify more similar cases to explore the prognostic significance of this association.


Assuntos
Leucemia Mieloide Aguda/diagnóstico , Síndrome de Turner/diagnóstico , Amenorreia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Medula Óssea/patologia , Citarabina/administração & dosagem , Daunorrubicina/administração & dosagem , Feminino , Humanos , Achados Incidentais , Cariótipo , Cariotipagem , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/patologia , Pessoa de Meia-Idade , Síndrome de Turner/complicações
13.
J Pak Med Assoc ; 67(11): 1753-1755, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29171575

RESUMO

TA 58-61, XXXX, hypotriploid chromosome was detected in the cytogenetics report of a 28 years old female patient, known case of B-cell Acute Lymphoblastic Leukaemia. On admission, the patient had normal physical examination findings and mental status, except history of fever spikes and generalized bone pains. The patient was admitted for induction of chemotherapy. Bone Marrow/Trephine biopsy report showed diffuse infiltration with blast cells with overall cellularity around 80-85% and suppressed normal haematopoiesis. Hypotriploid chromosome number in patients with B-cell Acute Lymphoblastic Leukaemia is a unique finding which, according to WHO classification of ALL, is an important prognostic factor itself and these cases have a favourable prognosis. There are only a few medical reports published about cases with similar presentations in Pakistan. Therefore, this case is very unique and further work should be done for better understanding of similar presentations and to find out more about its epidemiology.


Assuntos
Aberrações Cromossômicas , Leucemia-Linfoma Linfoblástico de Células Precursoras , Triploidia , Cariótipo Anormal , Adulto , Análise Citogenética , Feminino , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/genética , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia
14.
J Pak Med Assoc ; 66(1): 122-4, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26712200

RESUMO

The medium of instruction for medical education in Pakistan is English, which results in several words being lost in translation due to the lack of equivalent words in English. "Ghabrahat" is one such commonly used symptom. We conducted a cross sectional descriptive survey of medical students and doctors from four tertiary care hospitals between November 2013 and April 2014 evaluating the term "Ghabrahat". Total 120 participants were interviewed. Of these, 65.8% had heard of "ghabrahat". Among those aware of this terminology, 60.8% believed they had a good understanding of it. Of the total 95% believed "ghabrahat" still needed further investigation. The participants classified, "Ghabrahat "as benign (18.3%), serious (23.3%) and as an indefinable/vague symptom (48.3%).We concluded that "ghabrahat" is a symptom commonly encountered in clinical practice. It has a wide variety of expressed meanings and should not be used as a term expressing a single entity, system or disease.


Assuntos
Idioma , Médicos , Estudantes de Medicina , Terminologia como Assunto , Adulto , Ansiedade , Arritmias Cardíacas , Atitude do Pessoal de Saúde , Estudos Transversais , Depressão , Dispneia , Medo , Hospitais Universitários , Humanos , Humor Irritável , Dor , Paquistão , Inquéritos e Questionários , Adulto Jovem
15.
Int J Surg Case Rep ; 111: 108902, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37806031

RESUMO

INTRODUCTION AND IMPORTANCE: Epithelioid hepatic angiomyolipoma (HAML) is a rare benign tumor predominantly found in women. Its occurrence during pregnancy is extremely rare. Accurate diagnosis of HAML is challenging due to its radiological resemblance to other hepatic neoplasms. We present a case of epithelioid HAML in a pregnant patient, highlighting the diagnostic and management challenges encountered. CASE PRESENTATION: A 24-year-old pregnant female, in her fifth month of pregnancy, presented with right hypochondrium pain and nausea. Radiological imaging suggested the possibility of a hepatic adenoma. The patient opted to continue the pregnancy with regular monitoring of the mass as well as fetal health. After delivering a healthy baby, the patient underwent successful mass excision and cholecystectomy. Histopathology of the liver mass confirmed the diagnosis of epithelioid HAML. CLINICAL DISCUSSION: Epithelioid HAML is a rare tumor often misdiagnosed. It is more aggressive and frequently associated with tuberous sclerosis complex (TSC) compared to other subtypes. The diagnosis of HAML can be challenging due to its resemblance to Hepatocellular Carcinoma and other hepatic neoplasms on radiological imaging. Immunohistochemistry plays a crucial role in confirming the diagnosis. Surgical excision is the recommended treatment, with complete removal to minimize the risk of recurrence. CONCLUSION: This case report highlights the rarity of epithelioid HAML during pregnancy and emphasizes the importance of a multidisciplinary approach in managing hepatic neoplasms. Close monitoring is crucial, considering the potential risks to the mother and fetus. Accurate diagnosis through histopathological evaluation, immunohistochemistry and a multidisciplinary approach are essential for appropriate management.

16.
J Coll Physicians Surg Pak ; 33(3): 297-302, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36945160

RESUMO

OBJECTIVE: To compare clinical and biochemical characteristics of hospitalised COVID-19 patients and risk assessment of disease outcomes Study Design: Descriptive study. Place and Duration of the Study: Department of Pathology, Dow International Medical College and Sindh Infectious Diseases Hospital and Research Centre, from January to March 2022 Methodology: SARS CoV-2 PCR-positive hospitalised patients were enrolled. Delta or omicron variants infected patients were followed till the last recorded event of hospitalisation. After a detailed history, clinical and biochemical profiles were recorded during the hospitalisation. Length of hospitalisation, ICU admission and in-hospital mortality were taken as outcomes and odd ratios were calculated. RESULTS: During the study period, omicron was the predominant SARS CoV-2 variant. Omicron-infected patient were older (67 vs. 62 years) and had a significantly shorter duration between appearance of symptoms and hospitalisation (5 vs. 8 days), when compared with the delta patients. Median values of LDH, ferritin and TLC were significantly higher in delta patients (p<0.05). Delta infected patients have a 3.9 times more risk of prolonged hospital stay. In patients with increased TLC, the risk of prolonged hospitalisation and ICU admission was found 16% and 23%, respectively. However, the aOR for ICU admission and in- Hospital mortality were not found significant for the delta and omicron-infected patients. CONCLUSION: The clinical course and biochemical profiles are diverse in delta and omicron patients. Hospitalised patients with omicron infection exhibit shorter stays. High values of TLC are found associated with an increased risk of longer hospital stay and ICU admissions. KEY WORDS: COVID-19, Delta variant, Omicron variant, Hospitalised patients, Outcomes, In-hospital mortality, Biochemical markers, Clinical severity.


Assuntos
COVID-19 , Humanos , SARS-CoV-2 , Hospitalização , Medição de Risco
17.
Rev Cercet Interv Soc ; 80: 7-17, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37082026

RESUMO

In recent years mental health has emerged as a major health threat in low income countries like India. In response, mental health care has been integrated into primary health care, in turn creating a rising demand for trained and skillful mental health professionals. This study was conducted in district Budgam (J&K), India with the aim of providing training to community health workers (CHWs) and measuring the change using pre- and post-training evaluations. The pre and post tests were undertaken, assessing changes in mental health literacy at three different points of time: pre-training, post-training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a five-day course based on a facilitator's manual developed specifically for community health workers in India. A total of 25 community health workers from rural areas of Budgam District (mostly Integrated Child Development Service supervisors), Health Educators and Anganwadi Workers, were engaged for the study. Findings demonstrate that the training course improved participants' ability to recognize any mental health disorders. There was a clear distinction between the level of awareness pre- and post- training. The results were statistically significant on various domains Ability to recognize disorders (Pre-post P= 0.001), Knowledge of the professional help available (Pre-post p= 0.000), Attitudes that promote the recognition or appropriate help-seeking behavior (Pre-post p= 0.000) (p<0.05). Further follow up after three months was done. The mixed findings from this study, suggesting the training course has potential to improve some aspects of mental health literacy among the CHWs, including their understanding of various mental health problems.

18.
ACG Case Rep J ; 10(10): e01163, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37799486

RESUMO

Calcifying nested stromal-epithelial tumor is a rare hepatic malignancy with approximately 50 cases reported in the literature. Its clinical presentation is nonspecific, and the diagnosis is mainly based on histology which shows nests of spindle and epithelioid cells along with a desmoplastic myofibroblastic stroma containing variable calcification and ossification. In this report, we present a case of a 24-year-old woman with a history of abdominal pain, distension, and dyspepsia. She had a palpable liver with normal liver function test results. Serum alpha-fetoprotein levels were within normal range, and serologies for hepatitis B and C virus remained negative. Radiological investigations (magnetic resonance imaging and computed tomography) showed a large, right hepatic lobe mass with tumor invasion into the right posterior portal vein, but the 2 modalities could not characterize the lesion. Finally, an ultrasound-guided biopsy of the liver lesion provided the diagnosis of calcifying nested stromal-epithelial tumor. The tumor was resected successfully.

19.
Transplant Proc ; 55(9): 2114-2120, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37748964

RESUMO

BACKGROUND: Living donor liver transplantation (LDLT) has become a popular treatment option because some countries lack a deceased organ program and the growing demand for liver transplants. Although postoperative outcomes are similar to deceased donor liver transplants, there is still an element of risk to the donor. The Clavien-Dindo classification system has been used to standardize reporting across different institutions and surgeons to categorize surgical outcomes. METHODS: Between January 1, 2022, and December 31, 2022, 207 living donors underwent hepatectomies at our center. All donors underwent a 3-step process of mandatory screening. Postsurgical complications were classified using the Clavien-Dindo classification. RESULTS: A total of 207 donor hepatectomies for LDLT were performed during our study period. Most donors (92.8%) were aged between 18 and 39 years. The most common type of graft used was a right lobe without the middle hepatic vein (82.6%). Most donors (91.7%) experienced an intraoperative blood loss of ≤500 mL. A total of 140 patients had an ordinary postoperative course. Grade 1 complications were observed in 16.9%, grade 2 in 12.1%, and grade 3 in 3.4% of the remaining patients. No grade 4 or grade 5 (patient death) complications were observed in this cohort. CONCLUSIONS: Living donor liver transplantation remains the most practiced liver transplant surgery in Pakistan. Our findings highlight the safety of the LDLT program with minimal risk of significant complications. The study also underscores the importance of careful screening and monitoring of living donors and the need for standardized reporting of surgical outcomes using the Clavien-Dindo classification system.


Assuntos
Transplante de Fígado , Doadores Vivos , Humanos , Adolescente , Adulto Jovem , Adulto , Transplante de Fígado/efeitos adversos , Hepatectomia/efeitos adversos , Fígado , Período Pós-Operatório
20.
Ecancermedicalscience ; 16: 1413, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36072235

RESUMO

Oral squamous cell carcinoma (OSCC) is the most common cancer in Pakistani men and the second most common cancer in women. The objective of our study was to devise a novel accelerated murine model of oral carcinogenesis that can be exploited as a tool to investigate the cancer circuitry involved in OSCC and to identify molecules of diagnostic, therapeutic and prognostic significance. A total of 40 healthy male, 6-8 weeks old, 22 ± 2 gram, Naval Medical Research Institute (NMRI) outbred strain mice were recruited in the experiment. NMRI mice are commonly used for animal experiments in various fields of biology and for drug toxicity. Of these, 25 mice underwent the oral carcinogenesis regimen via topical application of 0.5% 9,10-dimethyl-1,2-benzanthracene (DMBA) on the lower left lip for a maximum of 20 weeks and 15 mice were used as controls (without the carcinogenic regimen). Exophytic tissue masses were harvested, fixed in 10% formalin and stained with haematoxylin and eosin (H&E) for microscopic diagnosis. Additionally, the expression levels of CK 5/6, p53 and Ki-67 were investigated using immunohistochemistry. Of the 25 mice which underwent the carcinogenic regimen, 21 developed moderately differentiated squamous cell carcinoma and 1 showed dysplastic features with foci of invasion. Three mice were found dead with lesion(s). CK 5/6 showed strong positivity (100%) and p53 and Ki-67 showed patchy (<30%) strong positivity in OSCC, suggesting the similarity of our model to human OSCC. We present an accelerated, close-to-human carcinogenesis, model of oral carcinogenesis using DMBA in NMRI mice that can be exploited to study the pathogenesis of oral squamous cell carcinoma and subsequently devise immunotherapy or targeted therapy.

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