Perceptions Of Intermediate Students Towards Nursing As A Career Choice In Swat Khyber Pakhtunkhwa.

The study aimed to explore the views of intermediate students toward nursing as a career of choice. A cross sectional design was used for the study conducted between June and July 2022, in two public colleges in district Swat Khyber Pakhtunkhwa. The sample size of the study was 146, obtained through random sampling using a self-administrated questionnaire on a 3-point Likert scale. Previous studies show that (61%) agreed, (19%) were neutral, and (20%) disagreed for selecting nursing as a career. Eighty-two (56%) students in the current study agreed, 47 (32%) disagreed, and 17 (12%) were neutral when asked if they planned to enrol in nursing school. The study noted that intermediate students in district Swat have a positive attitude towards nursing as a result of the establishment of multiple nursing colleges and the opportunity to work as a nurse in government hospitals or as a nurse educator.

Molecular characterization of plant growth-promoting vermi-bacteria associated with Eisenia fetida gastrointestinal tract.

Earthworms are highly productive invertebrates and play a vital role in organic farming and improving soil structure and function. The gastrointestinal tract of earthworms possessed agricultural important bacteria. So, the current research aimed was to examine, screen, and identify the plant growth promoting bacteria existing in the digestive tract of Eisenia fetida called plant growth promoting vermi-bacteria. The plant growth promoting traits such as siderophore, phytohormone, and hydrolytic enzymes production, and phosphate solubiliation were assessed. Eleven vermi-bacteria i.e. Bacillus mycoides, B. aryabhattai, B. megaterium, Staphylococcus hominis, B. subtilis, B. spizizenii, B. licheniformis, B. mojavensis, B. toyonensis, B. anthracis, B. cereus, B. thuringiensis, and B. paranthracis were isolated and identified based on microscopic studies, biochemical tests, ribotyping, and agricultural traits. All vermi-bacteria are Gram-positive rods except Staphylococcus hominis and produce different compounds such as siderophore, indole acetic acid, catalase, oxidase, proteases, amylases, and lipases. All vermi-bacteria also act as phosphate solubilizers. Therefore, all isolated vermi-bacteria could be used as potential microbial biofertilizers to enhance crops production in Pakistan.

Chemoradiation with Weekly Paclitaxel and Carboplatin in Esophageal Squamous Cell Carcinoma: A Prospective Study.

Objective Neoadjuvant chemoradiation (CRT) using paclitaxel and carboplatin has significantly improved the survival rates in carcinoma esophagus, especially in squamous cell carcinoma (SCC). This regimen has not been adequately explored prospectively as a definitive CRT strategy. Our aim was to evaluate the efficacy, toxicity, and compliance to this regimen in a prospective setting in locally advanced esophageal SCC. Materials and Methods Patients with locally advanced esophageal SCC were planned for definitive CRT by using weekly paclitaxel 50 mg/m 2 and carboplatin area under curve 2 along with radical radiotherapy to a dose of 50.4 to 54 Gy. Treatment-related toxicity was assessed by using the common terminology criteria for Adverse Events Version 4.0, and the response was assessed by using endoscopy and computed tomography (CT) 4 to 6 weeks following CRT. The pathological response was documented for those who underwent surgery. Results Fifteen patients were included in the study, and all patients completed the planned course of radiation. The median number of chemotherapy cycles received was four. In total, 66% of the patients had delay or interruptions in chemotherapy, mostly due to neutropenia, and 66% of the patients had a clinical complete response (CR). Four patients underwent definitive esophagectomy, and the histopathology revealed pathologic CR. Overall CR rate was 80%. The median overall survival was 14 months, and 1-year survival was 57%. Conclusion Definitive CRT in esophageal SCC using weekly paclitaxel and carboplatin was relatively well tolerated with manageable toxicities and good clinical response rates. It may potentially represent a new standard of care as definitive therapy in the management of these tumors.

Accuracy of Spontaneous Breathing Trial Using ET-CPAP in Predicting Successful Extubation of Neonates.

OBJECTIVE: Extubation failure is common in mechanically ventilated neonates. Finding objective criteria for predicting successful extubation may help to reduce the incidence of failure and the length of mechanical ventilation (MV). We conducted this study to determine the accuracy of the spontaneous breathing trial (SBT) and lung function measurements in predicting successful extubation in neonates. METHODOLOGY: This cross-sectional validation study was conducted at a tertiary care neonatal intensive care unit (NICU) over 12 months from December 2019 to December 2020. Neonates intubated for >24 hours and considered ready for extubation were enrolled in the study. Neonates who met defined eligibility criteria underwent a three minutes SBT using endotracheal continuous positive airway pressure (ET-CPAP) before extubation. The primary clinical team was blinded to the results, and all neonates were extubated after SBT. Extubation was considered successful if patients remained extubated for 48 hours. RESULTS: Among the 107 infants, 77.5% (n=83) of infants passed the SBT. Of these, 78 were successfully extubated, giving the positive predictive value of 93.97%. The overall extubation success rate was 90% (n=96). The sensitivity and specificity of SBT were 81.2% and 54.5%, respectively. VE (ET-CPAP) and VE-ventilator at a cutoff of ≥238 ml and ≥143.7 ml have an area under the curve (AUC) of 0.77 and 0.75 respectively to predict successful extubation (p-value 0.003, 0.008 respectively). CONCLUSION: SBT predicts extubation success with pronounced accuracy. Therefore, we propose SBT as a valuable and crucial step that guides clinicians' decision-making regarding extubation preparedness or impending failure in neonates.

Efficiency of cow dung based vermi-compost on seed germination and plant growth parameters of Tagetes erectus (Marigold).

Vermi-composting is an environmental friendly and economic process to decompose organic waste. The objective of this study was to produce vermi-compost using E isenia fetida and to investigate the impact of vermi-compost (VC) and organic manure (cow dung) on seed germination, seedlings, and growth parameters of Tagetes erecta. Physio-chemical parameters of vermi-compost and organic manure were recorded. A potting experiment was designed, germination medium containing soil, sand, and various concentrations of vermi-composts. The composition of germinating media was: TO (Sand + Soil), TCC (Sand + Soil + Cow dung), 10% VC (Sand + Soil + 0.1 kg VC), 15% VC (Sand + Soil + 0.15 kg VC), 20% VC (Sand + Soil + 0.2 kg VC), 25% VC (Sand + Soil + 0.25 kg VC), 30% VC (Sand + Soil + 0.3 kg VC), and 35% VC (Sand + Soil + 0.35 kg VC). Seed germination, seedling, vegetative plant growth, and flowering parameters were evaluated in different germinating media. Pre and post-physio-chemical parameters of germination media were also recorded to check their stability and quality. Results showed that 20% VC was effective for the early initiation of seed germination (2.0 ± 0.0 days) and all growth parameters of marigold seedlings. The germination percentage at 20% VC was recorded as 87.5 ± 1.40 %. The best vegetative plant growth and flowering parameters of marigold plants were observed with 35% VC after transplantation. Findings showed that vermi-compost is the best-suited germination and growing media, which not only improved the soil health but also promoted seed germination and plant growth. Our study undoubtedly indicates that vermi-compost is a more encouraging and advantageous bio-fertilizer and can be used as a powerful and effective for immediate marigold production.

Frequency of Early Morbidities in Low Birth Weight Neonates at The Aga Khan University Hospital, Karachi.

Background Globally, approximately 14.6% children are born with low birth weight (LBW) annually. In Pakistan, this figure however reaches approximately 16%. Low birth weight infants are vulnerable to develop early morbidities like hypothermia, hypoglycemia, respiratory distress syndrome and hypocalcemia. There is a scarcity of statistics which creates a gap in development of strategies for improving quality of care in developing countries. The aim of our study was to determine the frequency of early morbidities such as respiratory distress syndrome (RDS), hypoglycemia, hypothermia and hypocalcemia in low birth weight neonates. Methodology A prospective descriptive study was conducted via non-probability sampling technique from 1st April 2016 to 30th September 2016 at The Aga Khan University Hospital, Karachi. All low birth weight infants, i.e., those with birth weight < 2500 grams were included in this study and observed for early morbidities, including hypothermia, hypoglycemia, hypocalcemia and respiratory distress syndrome. Descriptive analysis was done using SPSS version 22 (IBM Corp., Armonk, NY), mean and standard deviation were determined for quantitative variables, whereas frequency and percentages were calculated for qualitative variables. Results A total of 2082 neonates were born during the study period, of which 271 (13%) were born with low birth weight. One hundred and eighty-five (68.1%) of these LBW neonates were preterm babies while 86 (31.9%) were born at term. Among LBW neonates 137 (51.0%) were males and 134 (49.0%) females. In the study population, hypoglycemia was seen in 17.3%, hypocalcemia in 13.6%, respiratory distress syndrome in 11%, and hypothermia in 2.5%. Conclusion Our study highlighted major early morbidities of LBW neonates, and their association with birth weight, gestational age and gender. Significant association of birth weight was found with hypothermia and hypocalcemia, whereas hypocalcemia and RDS were significantly associated with gestational age. However, none of the early morbidities had significant association with gender. Keeping in perspective the early morbidities in this population we propose that priority be given to providing adequate attention to low birth weight neonates.

Factors Leading To Meconium Aspiration Syndrome in Term- and Post-term Neonates.

Background Meconium aspiration syndrome (MAS) is considered a major cause of respiratory morbidity. It is a common issue encountered in the delivery room and newborn nursery. There is a need to identify the factors that lead to MAS to develop strategies to screen such patients at an early stage to decrease the mortality and morbidity. The objective of this study was to determine the factors leading to MAS in neonates delivered at ≥37 weeks of gestational age. Methods A cross-sectional study was conducted through non-probability consecutive sampling technique at Liaquat University Hospital, Hyderabad from August 2016 to February 2017. All neonates at ≥37 weeks of gestation with meconium-stained amniotic fluid (MSAF) detected during delivery were included in this study after obtaining informed consent from their parents. The demographic and factors related to MAS were recorded through predesigned proforma and analyzed using SPSS version 22. Mean and standard deviation were determined for quantitative variables whereas frequency and percentages were calculated for qualitative variables. Results Overall 136 neonates were included in the study. The mean gestational age was 38 ± 1.43 weeks. The major factors for MAS were detected as fetal distress (67.0%, n = 91), non-reassuring fetal heart rate (54.0%, n = 73), cesarean birth (48.0%, n = 65), intrauterine growth restriction (IUGR; 17.0%, n = 23), and post maturity (12.0%, n = 16). Conclusion We conclude that the major factors for MAS are fetal distress, non-reassuring FHR tracing, cesarean birth, IUGR, and post maturity. Screening of such patients at an early stage may minimize morbidity and mortality related to MAS.

Off-pump pulmonary embolectomy.

Pulmonary embolism is a common clinical condition associated with high mortality. Surgical pulmonary embolectomy (SPE), despite having been in existence for over 100 years, is generally regarded as an option of last resort with high mortality rates. Prompt recognition of predictors of mortality, such as right ventricular stress on echocardiography, helps decision-making for immediate surgical pulmonary embolectomy prior to development of significant circulatory collapse, with promising results.We present a 71-year-old male, with recent intracranial bleed and acute massive bilateral pulmonary embolism. The patient underwent successful off-pump surgical pulmonary embolectomy.

Universal salt iodization is successful in Kashmiri population as iodine deficiency no longer exists in pregnant mothers and their neonates: Data from a tertiary care hospital in North India.

INTRODUCTION: Normal pregnancy results in a number of important physiological and hormonal changes that alter thyroid function. In pregnancy, the thyroid gland being subjected to physiological stress undergoes several adaptations to maintain sufficient output of thyroid hormones for both mother and fetus. Consequently, pregnant women have been found to be particularly vulnerable to iodine deficiency disorders (IDD), and compromised iodine status during pregnancy has been found to affect the thyroid function and cognition in the neonates. OBJECTIVES: Two decades after successful universal salt iodization (USI) in the country, there is scarce data on the iodine status of the pregnant women and their neonates. This is more relevant in areas like Kashmir valley part of sub-Himalayan belt, an endemic region for IDD in the past. The objective was to estimate Urinary Iodine status in pregnant women, the most vulnerable population. MATERIALS AND METHODS: We studied thyroid function [free T3 (FT3), T3, free T4 (FT4), T4, thyroid stimulating hormone (TSH)] and urinary iodine excretion (UIE) in the 1(st), 2(nd), and 3(rd) trimesters and at early neonatal period in neonates in 81 mother-infant pairs (hypothyroid women on replacement) and compared them with 51 control mother-infant pairs (euthyroid). RESULTS: Mean age of cases (29.42 + 3.56 years) was comparable to that of controls (29.87 + 3.37 years). The thyroid function evaluation done at baseline revealed the following: FT3 2.92 ± 0.76 versus 3.71 ± 0.54 pg/ml, T3 1.38 ± 0.37 versus 1.70 ± 0.35 ng/dl, FT4 1.22 ± 0.33 versus 1.52 ± 0.21 ng/dl, T4 9.54 ± 2.34 versus 13.55 ± 2.16 µg/dl, and TSH 7.92 ± 2.88 versus 4.14 ± 1.06 µIU/ml in cases versus controls (P > 0.01), respectively. The 2(nd) to 6(th) day thyroid function of neonates born to case and control mothers revealed T3 of 1.46 ± 0.44 versus 1.48 ± 0.36 ng/dl, T4 of 12.92 ± 2.57 versus 11.76 ± 1.78 µg/dl, and TSH of 3.64 ± 1.92 versus 3.82 ± 1.45 µIU/ml, respectively. DISCUSSION: UIE was similar (139.12 ± 20.75 vs. 143.78 ± 17.65 µg/l; P = 0.8), but TSH values were higher in cases (7.92 ± 2.88) as compared to controls (4.14 ± 1.06). Although UIE gradually declined from 1(st) trimester to term, it remained in the sufficient range in both cases and controls. Thyroid function and UIE was similar in both case and control neonates. CONCLUSION: We conclude that pregnant Kashmiri women and their neonates are iodine sufficient, indicating successful salt iodization in the community. Large community-based studies on thyroid function, autoimmunity, malignancies, etc., are needed to see the long-term impact of iodization.

A double-blind, randomized, clinical trial on the antileishmanial activity of a Morinda citrifolia (Noni) stem extract and its major constituents.

A controlled study was conducted to determine the efficiency of a topical ointment prepared from the stem extract of Morinda citrifolia against cutaneous leishmaniasis. Similarly, the in vitro antileishmanial activity of morindicone and morinthone isolated from the extract were investigated against Leishmania major. These compounds displayed good activity. Out of 40 patients, 50% showed an excellent response and 30% exhibited good improvement.

Combined use of Impella left ventricular assist device and extracorporeal membrane oxygenation as a bridge to recovery in fulminant myocarditis.

Myocarditis may result in cardiogenic shock, and when medical therapy is unable to maintain adequate cardiac output, mechanical circulatory support is indicated. This is the first reported case of a percutaneous left ventricular assist device being used in combination with extracorporeal membrane oxygenation in a patient with biventricular and respiratory failure, as a bridge to recovery.

Infection level of the Asian tapeworm (Bothriocephalus acheilognathi) in the cyprinid fish, Schizothorax niger, from Anchar Lake, relative to season, sex, length and condition factor.

Various studies have shown that the Asian fish tapeworm, Bothriocephalus acheilognathi causes great economic loss in hatcheries, fish farms as well as in lakes. In order to understand the seasonal variation of infection in a nutrient-enriched lake, parasitological investigation was carried out in the indigenous cyprinid fish, Schizothorax niger Heckel 1838 from September, 2008 to August, 2009. Overall, this study revealed definite seasonality of infection (p < 0.05), with greater infection in summer (prevalence = 39.5%) and lesser in winter (prevalence = 8.1%). The prevalence among different seasons revealed significant differences (p < 0.05). Sex was not an important factor influencing the prevalence of the Asian tapeworm. A strong positive correlation (Pearson's correlation, r = 0.7; p = 0.02) between total length of S. niger and number of Asian fish tapeworms was observed. Similarly, a strong positive correlation existed between weight of fish and number of tapeworms (Pearson's correlation, r = 0.7; p = 0.005). Prevalence and mean abundance were positively and significantly correlated with water temperature (r = 0.8, p < 0.01 and r = 0.8, p < 0.01, respectively). Thus seasonal dynamics, total length and weight of the host significantly influenced the tapeworm infection. The above findings will be useful in devising the appropriate control strategies for the Asian tapeworm in wild fish in Kashmir valley as well as in similar climatic zones of other parts of the world. Also, information from this study will be used to assess the spread and extent of B. acheilognathi which is a potential threat to the indigenous fish fauna of Anchar Lake.

Steroidal constituents from the aerial parts of Lippia nodiflora Linn.

The methanolic extract of the aerial parts of Lippia nodiflora Linn. afforded one new and two known steroids. The structure of the new steroid had been elucidated as 4',5'-dimethoxybenzoloxystigmasterol (1) by an analysis of the spectral data, including extensive NMR experiments and its chemical transformation to stigmasterol. The known steroids were identified as stigmasterol and beta-sitosterol through comparison of their spectral data with those reported in the literature.

Management of Diarrhea in Under-fives at Home and Health Facilities in Kashmir.

BACKGROUND: Diarrheal disease forms one of the two major killer diseases in children under five years of age in the developing world. There are inherent cultural practices for management of diarrhea at the domestic level. Also, the treatment practices at health centers vary, with inappropriate use of antibiotics, and iv fluids observed commonly, while ORS is less frequently used. METHODOLOGY: Cross sectional study was carried out using pretested interview schedule between January and December 2006, in villages of Kashmir Valley. RESULTS: The ORS use rate is low (24.4% and 8.4%) respectively in past and current episode. Cultural practices include harmful ones like starving to overcome the episode. The rate of Antibiotic use is higher with 77.9%. CONCLUSION: Kashmir valley faces the same problems in effective diarrhea management as in other developing regions of India and the world, viz. less ORS use, high antibiotic use and harmful cultural practices like giving bowel rest.