A hidden dilemma; post COVID-19 first detection of Varicella zoster M4 genotype from Pakistan.

OBJECTIVES: During the COVID-19 pandemic, the risk of childhood infectious diseases was increased. Post-COVID-19 escalation of chickenpox cases, becoming an emerging public health concern. Thus, the study was designed to compare chickenpox prevalence and Varicella zoster virus (VZV) genotypes circulating before, during, and post-COVID-19 in Pakistan. METHODS: A total of 267 lesion specimens collected from tertiary care hospitals, and chickenpox outbreaks from Pakistan were analysed by a two-amplicon approach with phylogenetic analysis. RESULTS: Among suspected cases, overall 178/267 were VZV positive. Majority (84.2 %; 150/178) cases were of post-COVID-19 pandemic time. Small outbreaks occurred soon after COVID-19 in Rawalpindi and Islamabad (Pakistan), 40 positive cases out of 178 cases were outbreak cases. There was first time detection of the M4 genotype, which was significantly associated with disease severity (p = 0.0006) and post-COVID-19 chickenpox outbreaks in 2021 (77.9 %; 46/59; p < 0.00001). However, in pre-COVID-19 only M2 genotype was detected. The M2 prevalence varied from 2019 (100 %; 19/19) to 2022 (3.2 %; 3/91). However, the most prevalent strain of 2022 belonged to the M1 genotype (64.8 %; 59/91). CONCLUSION: A significant rise in chickenpox cases detected soon after COVID-19 in Pakistan, and oscillation of different VZV genotypes with first time detection of M4 genotype is an alarming situation. This demands further detailed genotypic studies on transmission dynamics of a rare M4 with other genotypes to protect the local population and restrict spread in other regions.

Efficacy of Probiotics Supplementation on Growth Performance, Carcass Composition and Hematological Parameters of Cyprinus carpio Fingerlings Fed Corn Gluten Meal-Based Diet

Abstract Plant based protein sources are one of the best, cost effective and easily available protein sources being used in fish feed. But due to a lower number of micro-biota in fish gut plant meal based diets cannot be digested and absorbed well in fish body. Probiotics were supplemented at 0, 1, 2, 3, 4 and 5 gkg-1 levels in fish feed for formulating one control and five test diets. In this study, three replicates of each treatment were used and number of fingerlings was 15 in each replicate. The C. carpio (common carp) fingerlings were fed at 5% of live wet weight on their prescribed diet twice daily. The results revealed that supplementation of probiotics in corn gluten meal based diets significantly (p<0.05) improved growth performance, carcass composition and hematological parameters. Most optimum values of growth performance parameters were noted at 2 gkg-1 level of probiotics supplemented diet. C. carpio fingerlings fed corn gluten meal based diet supplemented with 2 gkg-1 level of probiotics indicated significant (p<0.05) improvements in crude protein (17g) crude fat (9g) and gross energy (3 kcalg-1) whereas higher red blood cells (RBCs), white blood cells (WBCs) and hemoglobin (Hb) was also recorded in fish blood when fed 2 gkg-1 probiotics level diet. From these results, it was concluded that 2 gkg-1 probiotics supplementation in corn gluten meal based diet is optimum for improving growth performance, body composition and hematology of C. carpio fingerlings.

Emergence of hypervirulent K. pneumoniae causing complicated UTI in kidney stone patients.

K. pneumoniae termed as classical K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP) have significant role in pathogenicity of complicated UTI (cUTI). hvKP has not been ever reported from Pakistan. This study aimed to determine the prevalence of hvKP among kidney stone patients and their association with cUTI. Total 121 urine samples were collected from two tertiary care hospitals (Poly Clinic and Pakistan Institute of Medical Sciences hospital, Islamabad). From 43.5% (53) kidney stone patients, 61 isolates of K. pneumoniae (cKP 43, hvKP 18) were confirmed through standard microbiological and biochemical characterization methods. K. pneumoniae prevalence in kidney stone patients with cUTI was 67.6% (48) (hvKP 25%, cKP 75%). All K. pneumoniae isolates were strong biofilm formers. Age was important in development of cUTI in patients of age group 31-50 years in which biofilm formation and bactericidal activity of K. pneumoniae was significant with P = 0.017 and P = 0.05 respectively. Antibiotic susceptibility was tested and 20 (33%) isolates showed Multi-drug resistance (MDR). hvKP isolated from cUTI, showed comparatively enhanced virulence attributes with multidrug resistance, suggesting their role in development of cUTI in kidney stone patients, hence there is need for whenever prescribing antimicrobial therapy in these patients, hvKP should also be focused.

Ophthalmic injuries in orbito-zygomatic fractures.

OBJECTIVE: To assess the frequency and severity of ophthalmic injuries in patients with orbito-zygomatic fractures. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Oral and Maxillofacial Department, KEMU/Mayo Hospital Lahore, from January 2009 to December 2011. METHODOLOGY: Patients with orbito-zygomatic fractures were divided into three groups. Group-1 patients had fracture of floor/medial wall of the orbit (orbital-blow out fracture). Group-2 had comminuted orbito-zygomatic fractures. Group-3 had simple zygomatic bone fractures. Frequency and types of ocular injuries were determined on each group. RESULTS: There were 296 (260 male, 36 female) patients with mean age of 31.7 years. Group-1 (n = 20) had 28 ocular findings in 12 (60%) patients including diplopia (n = 10, 36%), enophthalmos (n = 6, 14%), and hyphema, vitreous hemorrhage, retinal hemorrhage, choroidal rupture, traumatic mydriasis, and commotio retinae in 2 cases, 7% each. In Group-2 (n = 106), 44 ocular findings were identified in 30 (28%) patients including diplopia (n = 10, 23%), enophthalmos (n = 4, 9%), commotio retinae (n = 10, 23%), reduced visual acuity (n = 6, 14%), retinal hemorrhage (n = 4, 9%) and corneal laceration, corneal abrasion, retinal detachment, traumatic mydriasis, and canthal laceration in 2 cases, 4.5%. In Group-3 (n = 170), 22 ocular findings were seen in 16 (9%) patients included diplopia (n = 10, 45%), enophthalmos (n = 4, 18%), and retinal tear, hyphema, angle recession, and traumatic mydriasis in 2 cases, (9%) each. CONCLUSION: Ophthalmic injuries are a common complication of orbitozygomatic fractures occurring in about 20% of patients in this study, most frequent in the orbital blow fractures subgroup. Ophthalmology consultation is recommended for patients presenting with midface fractures.