Novel Coronavirus-2019 (2019-nCoV): Perspectives of emergence, prophylaxis and predicted treatment approaches.

Emergence of novel coronavirus-2019 has become an international health concern. The objective of this review is to focus on 2019-nCoV emergence, prophylaxis and to predict the treatment approaches. The first case of 2019-nCoV was noted in Wuhan, China. The WHO has announced this epidemic as pandemic. The 2019-nCoV has +ve ssRNA (29903bp), lipid-bilayer envelope spiked with glycoprotein and bears genome sequences similar to bat coronavirus RaTG13. Antiviral agents like Interferon, Darunavir, Ribavirin, Lopinavir, Remdesivir, Chloroquine and Camostat mesylate may be considered for clinical trials. Chinese herbals may be effective against 2019-nCoV. These include Saikosaponins (triterpene glycosides), Amentoflavone, Scutellarein, Myricetin, extracts of Isatis indigotica, and Houttuynia cordata. Another treatment approach is to administer plasma from COVID-19 recovered patients. RNA vaccines, recombinant vector based vaccine and ACE-2 receptor like molecules may be employed for immunization against COVID-19. Moreover, immunity can be boosted against 2019-nCoV by regular exercise. We have checked Thymoquinone as ligand for various targets of 2019-nCoV (receptor binding domain of spike, RNA polymerase, protease, Nsp9 RNA binding protein, nucleocapsid phosphoprotein, endoribonuclease) by protein-ligand docking server SwissDoc. Thymoquinone can bind effectively to the targets of 2019-nCoV. Hence, it may be an effective candidate for the treatment of COVID-19.

Prevalence and antibiotic resistance profiles of Gram negative bacilli associated with urinary tract infections (UTIs) in Karachi, Pakistan.

The aim of this investigation was to determine the prevalence and antibiotic resistance profiles of Gram negative bacilli (GNB) responsible for urinary tract infections (UTIs). Urine specimens were cultured on Cysteine Lactose Electrolyte Deficient Agar (CLED) medium and pathogenic GNB were identified by conventional biochemical methods and automated profile index (API) system and further subjected to antibiotic sensitivity testing by disk diffusion method. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii were encountered as most frequent GNB in sequence. Among them E. coli (71%) was the most prevalent GNB. About 77% E. coli isolates of indoor patients and 59% of outdoor patients were found resistant to Cefotaxime. Kleb. pneumoniae were 100% resistant to Ampicillin. Higher resistance in Ps. aeruginosa was noticed in isolates of indoor patients i.e. Ciprofloxacin (76%), Cefoperazone-sulbactam (60%), Ceftazidime (59%), Piperacillin-tazobactam (53%), Imipenem (49%) and Amikacin (39%) in contrast to that of outdoor patients. Slightly lower resistance in Acinetobacter baumannii against Ampicillin (86%), Nitrofurantoin (81%) and Fosfomycin (12%) was witnessed in indoor patients' urine specimens compared to outdoor patients' urine. Polymyxin B, Imipenem, Fosfomycin, Piperacillin-tazobactam, Cefoperazone-sulbactam, Amikacin and Nitrofurantoin were most effective in GNB induced UTIs. This study revealed elevated resistance profiles in GNB against Ampicillin, Amoxicillin-clavulanate, Cefotaxime, Aztreonam, Ciprofloxacin, Nalidixic acid and Trimethoprim/sulfamethoxazole. Emergence of antibiotic resistant GNB was due to the frequent use and misuse of antibiotics in our region.

Muscle paralysis in thyrotoxicosis.

Thyrotoxic periodic paralysis (TPP) is a condition characterised by muscle paralysis due to hypokalaemia usually secondary to thyrotoxicosis. We report a case of a 31-year-old man with no known comorbidities who presented to a tertiary healthcare unit with a 1-month history of difficulty in breathing, palpitations, weight loss and hoarseness of voice. On examination, his thyroid gland was palpable and fine hand tremors were present. An initial provisional diagnosis of hyperthyroidism was made. Three months after initial presentation, the patient presented in emergency with severe muscle pain and inability to stand. Laboratory results revealed hypokalaemia. All the symptoms reverted over the next few hours on administration of intravenous potassium. A diagnosis of TTP was established. After initial presentation, the patient was treated with carbimazole and propranolol. Once he was euthyroid, radioactive iodine ablation therapy (15 mCi) was carried out as definitive therapy, after which the patient's symptoms resolved; he is currently doing fine on levothyroxine replacement and there has been no recurrence of muscle paralysis.

Surviving shot through the heart: Management in two cases.

Penetrating cardiac injuries after gunshot are usually fatal and are very challenging to manage for surgeons even in fully- equipped centres. Such injuries can cause ventricular septal defect (VSD) or cardiac tamponade depending upon the distance, direction and velocity of the bullet. Stable patients can be subjected to investigations like computed tomography (CT) to avoid unnecessary intervention, but unstable patients should be rushed to the operating room. We discuss management in two cases of traversing bullet injury to the heart. In the first case, traumatic VSD was significant, requiring closure on cardiopulmonary bypass (CPB) along with repair of right and left ventricular injury. In the second case, only the repair of right and left ventricles was performed without CPB. They both had traversing bullet injury through the heart.

Burden of asthma among children in a developing megacity: childhood asthma study, Pakistan.

OBJECTIVES: Global burden of childhood asthma has increased in the past few decades, particularly in low-income countries. In Pakistan, there is a lack of community-based epidemiological studies estimating the burden of asthma among children. This study determined the prevalence and predictors of asthma among children 3-17 years of age in Karachi, Pakistan. METHODS: A two-stage community-based representative cross-sectional survey was conducted in Karachi from March 2012 to April 2013 comprising 1046 children aged 3-17 years. Of 7500 clusters, 80 were randomly selected, and of these, 15 children per cluster were enrolled randomly. A translated and pre-tested version of International Study of Asthma and Allergies in Children questionnaire was administered. RESULTS: The overall prevalence of asthma among study participants was 10.2% (95% CI: 8.4-12.0). Asthma was more likely to occur among boys (adj. OR: 2.5, 95% CI: 1.6-4.0), children in the younger age group (3-7 years) (adj. OR: 2.9, 95% CI: 1.7-4.8), those living in households with ill-ventilated kitchens (adj. OR: 1.8, 95% CI: 1.1-3.1), having family history of asthma (adj. OR: 2.3, 95% CI: 1.3-3.9) and those of the Sindhi ethnicity (adj. OR: 2.2, 95% CI: 1.1-4.4). CONCLUSION: This study is the first robust evidence regarding asthma among children in Pakistan, reporting a high burden in this group. Family history, male gender, Sindhi ethnicity and ill-ventilated kitchen were identified as important predictors of asthma. Targeted preventive measures and intervention studies are required to better understand and reduce the burden of asthma among children in Pakistan.