Degree of blood safety of voluntary non-remunerated versus replacement blood donations: A multi-centre study of the large cohort of blood donors from two provinces of Pakistan.

BACKGROUND AND OBJECTIVES: Voluntary non-remunerated blood donors (VNRBDs) are recognized as being crucial for the safety and sustainability of national blood supplies. Systems based on replacement donors (RDs) pose high risks of transfusion transmissible infections (TTIs). Currently, only 10%-13% of blood donations are voluntary in Pakistan. No large-scale studies have been conducted to objectively evaluate the impact of the mode of donation on the frequency of TTIs, a gap this study aimed to fill. MATERIALS AND METHODS: The study was conducted at the Indus Hospital, Karachi. Data from a total of 591,820 blood donations were included from 1 October 2017 to 30 May 2021 and evaluated for type of donations and results of TTI testing, primarily performed on Architect i2000SR (Abbott). The TTIs tested include hepatitis B virus, hepatitis C virus, human immunodeficiency virus, syphilis and malaria. RESULTS: A total of 477,938 (80.7%) RDs and 113,882 (19.3%) VNRBDs were screened. Among these, 53,590 (9.06%) were positive for TTIs. There were 10.2% positive RDs (10.08-10.25 95% confidence interval [CI]) while 4.4% in VNRBDs (4.29-4.53 95% CI). Co-infections were observed in 2367 (0.4%) RDs, while 159 (0.02%) in VNRBDs. Geographically, the highest frequency of TTIs was observed in semi-urban areas of Sindh (11.2%) and Punjab (9.6%). A site-wise comparison of TTIs in RD versus VNRBD showed significant differences (p-value 0.00). CONCLUSION: RDs are associated with higher frequencies of TTIs, compared with VNRBD. However, the study was unable to assess whether the significant difference was related to individual risk or repeat/first time status of the donors. Other important variables affecting frequency are the catchment area of the blood donors in Pakistan. Urban areas have less prevalence than semi-urban areas.

Bacterial isolates and their antimicrobial susceptibility profile of superficial and deep-seated skin and soft tissue infections.

Background: Skin and soft tissue infections (SSTIs) are caused by microbial invasion of healthy or damaged skin. SSTIs are difficult to manage and contribute to chronicity and emergence of antimicrobial resistance. Objectives: To ascertain the prevalence of bacteria causing SSTIs and their antimicrobial susceptibility patterns. Methods: A prospective study between November 2020 and May 2021. A total of 447 samples from SSTIs were analyzed. Results: A total of 347 samples revealed mono-bacterial growth, of which 67% were male. SSTIs are common among patients aged 21-50 years with the dominance (78%) of gram-negative rods (GNRs). Escherichia coli (36%), Klebsiella spp. (22%), Staphylococcus aureus (16%), and Pseudomonas aeruginosa (11%) were predominant organisms. GNRs were highly resistant (>65%) to ciprofloxacin and trimethoprim-sulfamethoxazole. For injectable antibiotics, the highest resistance was determined against ceftriaxone, and the least resistance was determined against amikacin. Resistance against carbapenem was the highest among P. aeruginosa (53%) and Klebsiella spp. (32%). S. aureus showed the highest resistance against ciprofloxacin, and the least resistance was determined against clindamycin. Of 57 S. aureus isolates, 86% isolates were methicillin-resistant Staphylococcus aureus (MRSA). All isolates of P. aeruginosa and S. aureus were sensitive to polymyxin B and vancomycin, respectively. The prevalence of multidrug-resistant E. coli and Klebsiella spp. was higher among deep-seated SSTIs (dSSTIs). Conclusions: The predominant etiology of SSTIs is GNR. Currently, there is very high resistance against oral antibiotics. Antimicrobial resistance against carbapenem has also increased. Moreover, there is a high frequency of MRSA. MDR E. coli and Klebsiella spp. isolates are frequently involved in dSSTIs.

Outcome, risk factors and therapeutic strategies in carbapenem-resistant Gram-negative bacteraemia from Pakistan.

Background: Carbapenem-resistant Gram-negative (CRGN) bacteraemia has high mortality and limited therapeutic options. We assessed the risk factors and outcome of CRGN bacteraemia treated with limited options. Methods: A prospective cohort study done at a tertiary care hospital in Pakistan, from October 2021 to August 2022. All patients >18 years with CRGN bacteraemia were assessed for demographics, source, risk factors and treatment received. Outcome was assessed as bacterial clearance and all-cause mortality at Day 14 of bacteraemia. Results: We included 175 patients. Median age was 45 years (IQR 30-58) and the majority of our patients were on haemodialysis (75%). We found 14 day mortality in 26.8% of our patients; in addition, microbiological clearance was achieved in 95%. The central line (49.7%) was the most common source and Klebsiella spp. (47%) the most common organism. On multivariate analysis, risk factors for mortality were Foley's catheter [aOR 2.7 (95% CI 1.1-6.5)], mechanical ventilation [aOR 5.1 (95% CI 1.6-15.8)] and Pitt bacteraemia score >4 [aOR 3.48 (95% CI 1.1-10.5)]. Source control was a significant protective factor [aOR 0.251 (95% CI 0.09-0.6)]. The majority received a colistin-based regimen with no difference in mortality between monotherapy and combination therapy. Conclusions: Our cohort of CRGN bacteraemia is unique, comprising younger patients mostly on haemodialysis with a central line as the source of bacteraemia and we have found 14 day mortality of 27%. Colistin with various combinations can be an effective option in patients with renal failure having prompt source control.

Effect Of The Flavonoid 6-Aminoflavone In Aspirin Induced Gastric Ulcer In Sprague-Dawely Rats: A Histomorphological Study.

Background: The analgesic drugs are the main cause of gastric ulcer. The objective of this study was to determine the gastroprotective ability of flavonoid, 6-aminoflavone in a rat pyloric ligation model of aspirin associated gastro-ulcerogenesis. Methods: A laboratory based experimental study was conducted in the animal house and research laboratory at Khyber Medical College, Peshawar from July to November 2019. A total of 42 adult male Spargue-Dawely rats were divided into seven groups. Flavonoid, 6-aminoflavone was administered orally in doses of 10, 25 and 100 mg/kg with misoprostol, as standard at 50 µg/kg orally for 4 days. On the last day aspirin was given orally at 200 mg/kg and the pyloric ligation surgery was performed. After 4 hours all animals were killed by cervical dislocation. The gastric tissues were collected for histomorphological study. The obtained data were expressed as mean±SEM. Analysis was carried out by using ANOVA. p value ˂0.05 was considered significant. Results: The animals treated with the different doses of 6-aminoflavone showed a marked protective effect in the histological observations. The 10 mg/kg dose had a mild protective effect as occasional ulcerative changes were observed. However, doses of 25 and 100 mg/kg significantly caused the reduction in the ulcer score. These effects produced were equipotent to the gastroprotective effectiveness inherent in the misoprostol. . Conclusion: These findings conclude that 6-aminoflavone as like other flavonoids has a significant gastroprotective propensity with significant effect produced at doses of 25 and 100 mg/kg and can be used as a part of therapy management for the treatment of gastrointestinal disease particularly ulcerative condition.

Phytochemical profiling of antimicrobial and potential antioxidant plant: Nepeta cataria.

Traditional and phytochemical studies have confirmed the richness and diversity of medicinal plants such as Nepeta cataria (N. cataria), but more studies are needed to complete its metabolite profiling. The objective of this research was to enhance the metabolomic picture and bioactivity of N. cataria for better evaluation. Phytochemical analysis was performed by bio-guided protocols and gas chromatography-mass spectrometry (GC/MS). For this, solvents such as methanol, ethanol, water, acetone, and hexane were used to extract a wide number of chemicals. Antibacterial analysis was performed using the 96-well plate test, Kirby Bauer's disk diffusion method, and the resazurin microdilution test. Antioxidant activity was determined by the DPPH assay and radical scavenging capacity was evaluated by the oxygen radical absorbance capacity (ORAC) assay. GC/MS analysis revealed a total of 247 identified and 127 novel metabolites from all extracts of N. cataria. Water and acetone extracts had the highest identified metabolites (n = 79), whereas methanol extract was the highest in unidentified metabolites (n = 48). The most abundant phytochemicals in methanol extract were 1-isopropylcyclohex-1-ene (concentration = 27.376) and bicyclo [2.2.1] heptan-2-one (concentration = 20.437), whereas in ethanol extract, it was 9,12,15-octadecatrienoic acid (concentration = 27.308) and 1-isopropylcyclohex-1-ene (concentration = 25.854). An abundance of 2 methyl indoles, conhydrin, and coumarin was found in water extracts; a good concentration of eucalyptol was found in acetone extract; and 7,9-di-tert-butyl-1-oxaspiro is the most abundant phytochemicals in hexane extracts. The highest concentration of flavonoids and phenols were identified in hexane and methanol extracts, respectively. The highest antioxidant potential (DPPH assay) was observed in acetone extract. The ethanolic extract exhibited a two-fold higher ORAC than the methanol extract. This examination demonstrated the inhibitory effect against a set of microbes and the presence of polar and non-polar constituents of N. cataria. The results of this study provide a safe resource for the development of food, agriculture, pharmaceutical, and other industrial products upon further research validation.

Scabies Surrepticius (Bullous Scabies) Presenting as Bullous Impetigo in a Child.

Bullous scabies (BS) is a rare and atypical presentation of scabies, usually affecting elderly males during the seventh decade of life. BS is characterised by intense pruritic eruptions, nocturnal itch, and characteristic blisters with or without burrows in scabies-prone areas. The scabies lesions might predispose patients to bacterial super-infections, resulting in bullae formation similar to bullous impetigo. The diagnosis of BS is often puzzling and delayed. Few cases of BS have been reported among children globally. We, herein, report a case of BS in an eight-year boy from Pakistan, treated successfully with 5% topical permethrin and 2% mupirocin. Complete healing was noted within four weeks with no recurrence at two months follow-up. Key Words: Scabies, Bullous, Child, Diagnosis, Treatment.

A case series of multidrug-resistant tuberculosis in renal transplant recipients: Challenges in management from a TB endemic country.

Multidrug-resistant tuberculosis (MDR-TB) is caused by Mycobacterium tuberculosis that is resistant to isoniazid and rifampicin (Rif). The use of immunosuppressive drugs in solid organ transplant recipients can increase the risk of TB. Management of MDR-TB is quite challenging in the general population with poor compliance owing to lengthy treatment duration and drug toxicities. New drugs as well as shorter regimen have been used to increase the likelihood of adherence. The experience of treating MDR-TB in the transplant recipients is limited. New drugs like bedaquiline, linezolid, clofazimine, and delamanid have rarely been used in transplant recipients. To the best of our knowledge, only 14 cases of MDR-TB in transplant population have been reported in the literature and no case from Pakistan, a high TB burden country. We are reporting our experience of treating 4 renal transplant recipients. We used new drug regimen and found many side effects. Treatment outcome was successful with complete cure in 3 of our patients, however one died of severe drug toxicity. The most worrisome drug interaction was between azathioprine and linezolid, with life-threatening thrombocytopenia. There was no graft dysfunction noted at the end of the therapy. The management of MDR-TB in transplant recipients is challenging; excellent coordination between transplant team and Infectious Diseases Physician for close monitoring and follow-up is needed.

Remotely Piloted Life-Saving Effort vehicles and emergency management: An analysis on revolutionizing humanitarian assistance in Pakistan.

The majority of the Pakistani public has known little of the unmanned aerial vehicles, also known for their onomatopoeically inspired name "drones," except the fact that it regularly rains Hellfire missiles in Pakistan, claiming the lives of many innocent Pakistanis settled in the western provinces. In actuality, in addition to their destructive capacities, these remotely piloted vehicles have been used since the turn of the century in a variety of live-saving and risk-reducing roles. This research article primarily addresses the third stage of Emergency management-response, with Pakistan being the primary region of research. This research article will first begin by diagnosing and accurately delineating the types of humanitarian crisis that grip Pakistan, devastating its land, exhausting its limited resources in its weak, and now almost archaic, disaster response strategy that results in the prolongation of its citizens' plight. Subsequently, this article will describe the history of the usage of unmanned vehicles, its multi-functional capacities, and its relevance in aiding humanitarian response efforts in disaster-stricken areas. Finally, this article will propose the introduction of Remotely Piloted Life-Saving Effort (RELIEF) vehicles in performing analysis and surveillance roles in Pakistan's disaster-prone and disaster-struck areas and its capacity to dramatically improve and expedite the existing relief supply delivery systems in place.

Long-term outcomes in half-dose verteporfin photodynamic therapy for chronic central serous retinopathy.

OBJECTIVE: To evaluate the short- and long-term outcomes of half-dose verteporfin with photodynamic therapy (PDT) in the treatment of chronic central serous retinopathy (CSR). DESIGN: Retrospective case series. PARTICIPANTS: 45 eyes in 39 patients with chronic CSR were included. Diagnosis of chronic CSR was confirmed by fluorescein angiography and persistence of subretinal fluid by optical coherence tomography for a minimum of 3 months duration. METHODS: Each patient underwent treatment with half-dose verteporfin with full-fluence PDT; initial follow-up was defined as a 6-8 week visit following the treatment, and final follow-up ranged from 5 to 70 months. RESULTS: The average follow-up period for treatment was 19.3 months. Best-corrected visual acuity increased from logMAR means of 0.52 to 0.42 (p<0.05). Central retinal thickness and choroidal thickness also significantly decreased at last follow-up (p<0.05). Eight of 45 eyes (18%) demonstrated a recurrence of CSR following treatment within the follow-up period. At the final follow-up, 41 out of the 45 eyes (91%) had complete resolution of subretinal fluid accumulation. CONCLUSION: Half-dose PDT is an effective treatment option for chronic CSR in a Canadian population, and it is both safe and durable. The positive treatment effect is realized rapidly, with the initial 6-week result highly correlated with the final follow-up result.

Effect of HCV infection on hepatic fibrosis in patients of thalassaemia major.

OBJECTIVE: To investigate the effect of HCV infection on hepatic fibrosis in patients of thalassaemia major with iron overload in order to modify Pesaro criteria for classification into prognostic groups for allogenic haemopoietic stem cell transplant in these patients. DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Pathology, Armed Forces Bone Marrow Transplant Center and Departments of Pediatrics of Military Hospital and Combined Military Hospital, Rawalpindi, from July 2003 to June 2004. SUBJECTS AND METHODS: Twenty-eight HCV- and 18 HCV+ patients of thalassaemia major, who were prospective recipients of allogeneic bone marrow transplant, were included in the study. Serum ferritin was estimated by chemiluminescent immunoassay. Degree of fibrosis in liver biopsy was scored using Knodell s scoring system. Correlation between the two was evaluated statistically through Pearson s correlation coefficient. RESULTS: Mean serum ferritin was lower and degree of hepatic fibrosis was less in hepatitis C negative patients of TM. The correlation between serum ferritin and the degree of hepatic fibrosis was much stronger in hepatitis C negative patients with r value of 0.507 and p value of 0.006, which was statistically significant. CONCLUSION: A strong correlation between serum ferritin and degree of hepatic fibrosis was observed in patients of thalassaemia major not infected with hepatitis C infection. Serum ferritin levels alone are, therefore, not sufficient to assess degree of fibrosis in HCV positive patients of TM.

Red cell immunization in beta thalassaemia major.

OBJECTIVE: To find out the frequency, pattern and factors influencing red cell immunization secondary to multiple blood transfusions in patients of beta-thalassaemia major. DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: Armed Forces Institute of Transfusion, Rawalpindi, in November 2002. PATIENTS AND METHODS: One hundred and sixty-one patients suffering from beta-thalassaemia major and on regular blood transfusions were included in the study. Their blood samples were tested for blood grouping, direct antiglobulin test and antibody screening/identification using reagents of DiaMed-ID Gel microtyping system. RESULTS: The total rate of red cell immunization was found to be 6.84%. Red cell alloantibodies were detected in 4.97% patients, and belonged mainly to Rh system, with one example each of anti-K, anti-Jsb and anti-Jka. Direct antiglobulin test was positive in 3 patients (1.87%) with increased hemolysis. Two had warm panreactive IgG antibodies suggesting red cell autoimmunization. Red cells of the 3rd patient showed sensitization with c-3d, with presence of an autoreactive cold agglutinin in the serum having a titre of 1:4. The red cell alloantibody formation was not influenced by age at first transfusion, number of blood transfusions and ethnicity. CONCLUSION: The rate of red cell alloimmunization in beta-thalassaemia major is relatively low in our setup and may be related to red cell homogeneity between the donor and recipient population. Routine pre-transfusion matching of blood, other than ABO and Rh "D" antigens is not recommended because of low rate of red cell alloimmunization, and high costs associated with such testing. Hyperhaemolysis, due to acquired red cell autoantibodies was found to be an important complication. Patients who develop this complication should be tested for presence of underlying alloantibodies and considered for immunosuppressive treatment.