Factors associated with incomplete child immunization in Pakistan: findings from Demographic and Health Survey 2017-18.

OBJECTIVE: The objective of this analysis was to explore the determinants of incomplete immunization in children aged 12-23 months. STUDY DESIGN: A secondary analysis was conducted on cross-sectional survey data from Pakistan Demographic and Health survey 2017-2018. METHODS: The present study was confined to children aged 12-23 months at the time of survey giving a sample size of 2048. Complete immunization was described as having received a dose of BCG (Bacille Calmette Guerin), four doses of oral polio vaccine (OPV0, OPV1, OPV2, and OPV3), three doses of pentavalent and pneumococcal vaccine, and one dose of measles vaccine. Multivariable logistic regression was used to explore the association between outcome and predictor variables. RESULTS: The findings showed that the likelihood of being incompletely immunized was higher for the children of Baluchistan (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI] = 4.18-9.71), Federally Administered Tribal Areas (aOR = 6.2; 95% CI = 3.97-9.71), Sindh (aOR = 3.24; 95% CI = 2.33-4.49), Khyber Pakhtunkhwa (aOR = 2.13; 95% CI = 1.54-2.97), Islamabad (aOR = 3.656; 95% CI = 2.34-5.69), and Gilgit Baltistan (aOR = 2.320; 95% CI = 1.50-3.57) relative to those of Punjabi children. Lower odds of partial vaccination were seen among the children of educated mothers (primary or higher) and those who were born at a health facility. CONCLUSION: Improving maternal literacy rate, providing easy access to health facilities, and minimizing regional disparities can improve the immunization status of children in Pakistan.

Anti-bacterial activity of essential oils against multidrug-resistant foodborne pathogens isolated from raw milk.

The presence of pathogenic bacteria in food is considered as a primary cause of food-borne illness and food quality deterioration worldwide. The present study aimed to determine the effectiveness of five essential oils (EOs) against multidrug-resistant foodborne pathogens. In the current study Gram-negative bacteria (Escherichia, Enterobacter, Citrobacter, Proteus, Pseudomonas, and Klebsiella) and the Gram-positive bacteria Staphylococcus were isolated from raw milk and biochemically characterized. The anti-bacterial effect of different antibiotics and EOs (thyme, oregano, lemongrass, mint, and rosemary) was determined using the standard disc diffusion method. The antibiogram study revealed that Gram-negative bacteria were highly resistant to penicillin while Staphylococcus was resistant to streptomycin, amoxicillin, and lincomycin. Moderate resistance was observed to doxycycline, amikacin, enrofloxacin, kanamycin and cefixime. Isolates were found less resistant to gentamycin, chloramphenicol, and ciprofloxacin. EOs showed a broad range of antimicrobial activity against all bacteria except P. aeruginosa. Of these, thyme was more effective against most of the multi-drug resistant bacterial strains and formed the largest zone of inhibition (26 mm) against Escherichia followed by oregano oil (18 mm) against Staphylococcus (p<0.05). Klebsiella spp and Citrobacter spp showed resistance to mint and lemongrass oil respectively. The EOs such as lemongrass, mint and rosemary were less active against all the bacteria. The findings of the recent study suggest the use of EOs as natural antibacterial agents for food preservation.

Laparoscopic inguinal hernia repair: a rare case of colonic mesh migration.

Inguinal hernia repair can be performed via either an open or laparoscopic technique. Use of a mesh to repair the abdominal wall defect is now common practice, leading to a reduction in hernia recurrence but also associated with a number of complications. We report a rare case of a 49-year old man who presented 3 years after laparoscopic hernia repair with right-sided abdominal pain and loose stools. Colonoscopy and computed tomography revealed a mesh and fixation devices within the lumen of the caecum and ascending colon. The mesh was successfully excised with primary closure of the bowel defect. This case highlights the importance of recognising mesh migration as a complication of hernia repair, a phenomenon which can lead to serious morbidity. We suggest that patients should be informed of this risk during the consent process, while further research is needed to investigate how this occurrence can be prevented.

Rapid identification of Vibrio cholerae serotype O1 from primary isolation plates by a coagglutination test.

A coagglutination test was developed for identifying suspected colonies of Vibrio cholerae serotype O1 directly from primary isolation plates. Visible agglutination occurs when V. cholerae O1 antibody attached to cell-wall protein A of Staphylococcus aureus reacts with its homologous antigen. From 314 faecal samples from clinically suspected cases of cholera, 210 colonies from thiosulphate citrate bile salts sucrose (TCBS) agar and 222 colonies from taurocholate tellurite gelatin (TTG) agar were tested as suspect V. cholerae. In each case 204 isolates were identified as V. cholerae O1 by conventional methods and also gave positive results for V. cholerae O1 in the coagglutination test; with one partial exception, no other colonies tested gave positive results. The coagglutination test is simple and inexpensive and provides a result 24 h earlier than conventional methods.

Systems of analysis of posterior capsule opacification.

This paper demonstrates the wide variety of systems for the analysis of posterior capsular opacification (PCO). No single system has been proved to be a gold standard and it is difficult to comment on the advantages of one system over another with the limited current knowledge on the effects of PCO on vision. There are few studies that actually compare the different systems of analysis. Researchers must ensure that the systems they use for PCO analysis are objective and must give maximum consideration to ensuring potential systematic errors are reduced to a minimum. Further research is required into how the various types and locations of PCO affect vision and how well different systems of analysis perform.

Enteric pathogens and their isolation at a cancer hospital in Pakistan.

Diarrhoeal diseases remain a major cause of mortality and morbidity in developing countries. However, due to lack of funds, supply problems and some inexperience, some laboratories have difficulty identifying a causative agent in stool samples. In the year following the opening of the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan, the microbiology department had not isolated a single enteric pathogen. From January 1996, new culture techniques were introduced, with a resulting increase (10%) in identification of these pathogens. In addition, the introduction of formol-ether concentration made a significant contribution to the number of intestinal parasites seen. This report demonstrates how simple microbiology methods made a difference to the running of the department and, ultimately, to the patients.

Effects of Acacia arabica and Caralluma edulis on blood glucose levels of normal and alloxan diabetic rabbits.

The powdered seeds of Acacia arabica and roots of Caralluma edulis were administered in doses of 2, 3 and 4 gm/kg body-weight to normal and alloxan-diabetic rabbits. The blood glucose levels were estimated before and 2, 4, 6 and 8 hours after the administration of plant suspension. The powdered seeds of Acacia arabica exerted a significant (P less than 0.05) hypoglycemic effect in normal rabbits. The hypoglycemic effect was not significant (P greater than 0.01) in alloxan diabetic rabbits. The powdered roots of Caralluma edulis did not produce any significant (P greater than 0.01) hypoglycaemic effect in normal as well as in alloxan diabetic rabbits. The doses used did not show any acute toxicity and behavioural changes. From this study it may be concluded that the powdered seeds of Acacia arabica act by initiating the release of insulin from pancreatic beta cells of normal rabbits. Moreover, Caralluma edulis did not show any hypoglycaemic effect in normal as well as in diabetic rabbits.

Plastination of whole brain specimen and brain slices.

BACKGROUND: The human dead body specimens are plastinated for teaching purposes in medical institutions, using silicone. The silicone impregnated whole brain specimens and brain slices do not give satisfactory results. METHODS: In the present study the brain specimens were plastinated with another polymer known as Polyester-Copolymer. The brain specimens were first preserved and then fixed with 5% formalin. The specimens were then dehydrated and degreased in a volatile solvent acetone. The specimens were placed in Polyester-Copolymer solution which penetrated the brain tissue both intracellulary and intercelluraly. The specimens were then cured by gas method. RESULTS: The whole brain specimens and brain slices plastinated with Polyester-Copolymer were dry, odorless, handy and durable. It also gives a clear visual contrast between grey and white matter in brain slices whereas the brain specimens plastinated with silicone are flexible and sticky. There was no color contrast between grey and white matter. CONCLUSION: The polyester impregnated brain specimens and slices are non-toxic and ideal for teaching purposes and examinations. They require minimal aftercare. The whole organ serial sections of plastinated brain specimens will help 3-dimensional study of the normal brain and will improve the assessment of brain pathology.

Malaria burden in human population of Quetta, Pakistan.

Malaria is a serious global health challenge, which is responsible for more than one million deaths a year. Malarial infection is more prevalent in developing countries including Pakistan. Significant efforts have been made to control malaria; however, due to socio-environmental factors, it remains a frequent problem in Quetta. The present study was undertaken to determine the malarial incidence, species prevalence, and its demographic evaluation in human population of Quetta, Pakistan. A total of 1831 subjects, comprising 1072 male and 759 female presenting symptoms of malaria, were included in this study. Blood samples from clinically suspected individuals were subjected to the standard immunochromatographic and malaria parasite smear analysis for malaria diagnosis. Out of 1831 subjects, 338 (18.45%) patients were positive for malarial parasite while the species prevalence was found as 276 (81.66%) and 62 (18.34%) for Plasmodium vivax, and Plasmodium falciparum, respectively. Furthermore, seasonal variations gradual increase in the prevalence rate. The age group of 21-30 years (30.47%) was found more prone to malaria. The suspected malaria cases were found more frequent in rural (72.1%) as compared to urban (27.9%). In addition, the malaria burden was high in urban area (22.89%) population as compared to the rural area (16.74%) population. It was observed that the highest disease occurrence was caused by P. vivax, which reflects a serious threat for public health. The current findings will be helpful to plan effective strategies to prevent and control malaria in this area.

Effect of Tinospora cordifolia on blood glucose and total lipid levels of normal and alloxan-diabetic rabbits.

The aqueous, alcoholic, and chloroform extracts of the leaves of Tinospora cordifolia were administered in doses of 50, 100, 150 and 200 mg/kg body weight to normal and alloxan-diabetic rabbits. The blood glucose and total lipid levels were estimated before and 2, 4, 6, and 8 hours after administration of the extract. The extract exerted a significant (P less than 0.5) hypoglycaemic effect in normal as well as in alloxan-treated rabbits. The extracts, however, had no significant (P greater than 0.05) effect on total lipid levels in normal as well as in alloxan-treated diabetic rabbits. The doses used did not show acute toxicity or result in behavioural changes. From this study, it may be concluded that extracts of the leaves of Tinospora cordifolia have an insulin-like action and can significantly reduce the blood glucose but not the total lipid levels in normal rabbits and in alloxan-induced diabetic rabbits.

Antigenic behaviors of two axial flagellar proteins detected in Treponema denticola.

Two polypeptide antigens with molecular sizes of 34,000 daltons (34 kDa) and 38 kDa were separated from heated cells of a human clinical treponeme strain G7201 and Treponema denticola ATCC 35404, respectively. The rabbit polyclonal antisera against these antigens were produced and examined for their immunological reactions with the two heated antigens or intact spirochetal cells. Immunoblot analysis showed that the 34-kDa protein was also detected in T. denticola ATCC 35404 and ATCC 33520, and the 38-kDa protein was detected only in the two ATCC strains. Immunoelectron microscopy using the two rabbit antisera and protein A-gold complexes demonstrated that the 38-kDa protein antigen was present on the axial flagella of two T. denticola strains, and that the 34-kDa protein was located in the axial flagella of the G7201 cell, but neither in axial flagella nor on outer envelopes of the two ATCC strains cells, suggesting that the native 34-kDa axial flagellar protein of the G7201 strain may be different from that of T. denticola in terms of immunological reactivity.

Common and specific antigens of several treponemes detected by polyclonal antisera against major cellular proteins.

Thirteen polypeptide antigens with molecular weights ranging from 34 kDa to 83 kDa were selected and their antigenic behaviors and distribution were examined in 12 strains of microorganisms including Treponema, Borrelia, Leptospira and Leptonema. Immunoblot analysis demonstrated that 45 kDa and 83 kDa polypeptides of Treponema socranskii subsp. buccale ATCC 35534, 53 kDa antigen of Treponema denticola ATCC 33520 and 44 kDa polypeptide of the strain G7201 were strain-specific. The 34, 62, 66 and 84 kDa polypeptide antigens were detected in all 8 treponemal strains examined. T. denticola ATCC 33520 and ATCC 35404 possessed 38 kDa, 48 kDa, 52 kDa and 72 kDa common polypeptide antigens. All 12 strains possessed the 84 kDa polypeptide antigen. Immunoelectron microscopy demonstrated that the 34 kDa and 38 kDa polypeptide antigens were located on the axial flagella and that other polypeptide antigens were located on the outer envelopes or wall-membrane complexes.

Delayed diagnosis of HIV infection in ophthalmic practice.

The introduction of potent antiretroviral drug combinations has transformed human immunodeficiency virus/acquired immunodeficiency disease syndrome (HIV/AIDS) from an intractable and rapidly fatal disease to a chronic manageable illness with prolonged life survival for many patients. This paper discusses the ophthalmic and medical histories of two young female patients who presented with 'atypical' optic neuropathy and toxoplasma gondii retinochoroiditis and were later found to be HIV infected. We discuss the need for increased vigilance in the ophthalmic community for suspecting HIV infection to allow optimal management of the ophthalmic and systemic manifestations of the disease spectrum associated with HIV/AIDS.

Comparison of two fast strategies, SITA Fast and TOP, for the assessment of visual fields in glaucoma patients.

PURPOSE: To compare two fast threshold strategies of visual field assessment; SITA Fast (HSF) and Tendency Orientated Perimetry (TOP), in detecting visual field loss in patients with glaucoma. METHODS: Seventy-six glaucoma, ocular hypertensive and normal patients had HSF and TOP performed in random order. Quantitative comparisons for the global visual field indices - mean deviation and defect (MD) for HSF and TOP, and pattern standard deviation (PSD) for HSF and loss variance (LV) for TOP - were made using correlation coefficients. Humphrey global parameters were converted to Octopus equivalents, and method comparison analysis was used to determine agreement between the two strategies. Test duration times were compared using t-test. Sensitivity and specificity for these two algorithms were determined according to predetermined criteria. RESULTS: High correlation coefficient values were obtained for MD measurements between HSF and TOP ( r=-0.89, P<0.0005) and for PSD (HSF) and LV (TOP) ( r=0.88, P<0.0005). Following conversion of HSF values to Octopus equivalents the TOP strategy estimated MD to be greater and LV to be less than HSF values, the difference increasing as the magnitude of the defect increased. The mean test duration time was 4.04 (0.87) min for HSF and 2.38 (0.34) min for TOP ( P<0.0005). Sensitivity of diagnostic criteria ranged from 86.4% to 89.2% for HSF and from 84.7% to 85.2% for TOP. Specificity ranged from 80.0% to 93.8% for HSF and from 76.5% to 86.7% for TOP. CONCLUSION: There was a high correlation between the HSF and TOP strategies for measurements of global indices. However, the TOP strategy tended to underestimate focal visual field loss compared with SITA Fast. The TOP strategy was faster than SITA Fast. The sensitivity and specificity of the two algorithms were similar. This study establishes the ability of these fast strategies to successfully assess visual fields in glaucoma patients with perimetric experience.