Conditional trust: Community perceptions of drone use in malaria control in Zanzibar.

Background: The potential of drones to support public health interventions, such as malaria vector control, is beginning to be realised. Although permissions from civil aviation authorities are often needed for drone operations, the communities over which they fly tend to be ignored: How do affected communities perceive drones? Is drone deployment accepted by communities? How should communities be engaged? Methods: An initiative in Zanzibar, United Republic of Tanzania is using drones to map malarial mosqutio breeding sites for targeting larval source management interventions. A community engagement framework was developed, based on participatory research, across three communities where drones will be deployed, to map local perceptions of drone use. Costs associated with this exercise were collated. Results: A total of 778 participants took part in the study spanning a range of community and stakeholder groups. Overall there was a high level of acceptance and trust in drone use for public health research purposes. Despite this level of trust for drone operations this support was conditional: There was a strong desire for pre-deployment information across all stakeholder groups and regular updates of this information to be given about drone activities, as well as consent from community level governance. The cost of the perception study and resulting engagement strategy was US$24,411. Conclusions: Mapping and responding to community perceptions should be a pre-requisite for drone activity in all public health applications and requires funding. The findings made in this study were used to design a community engagement plan providing a simple but effective means of building and maintaining trust and acceptability. We recommend this an essential investment.

Development of a Nomogram Based on Preoperative Bi-Parametric MRI and Blood Indices for the Differentiation Between Cystic-Solid Pituitary Adenoma and Craniopharyngioma.

BACKGROUND: Given the similarities in clinical manifestations of cystic-solid pituitary adenomas (CS-PAs) and craniopharyngiomas (CPs), this study aims to establish and validate a nomogram based on preoperative imaging features and blood indices to differentiate between CS-PAs and CPs. METHODS: A departmental database was searched to identify patients who had undergone tumor resection between January 2012 and December 2020, and those diagnosed with CS-PAs or CPs by histopathology were included. Preoperative magnetic resonance imaging (MRI) features as well as blood indices were retrieved and analyzed. Radiological features were extracted from the tumor on contrast-enhanced T1 (CE-T1) weighted and T2 weighted sequences. The two independent samples t-test and principal component analysis (PCA) were used for feature selection, data dimension reduction, and radiomics signature building. Next, the radiomics signature was put in five classification models for exploring the best classifier with superior identification performance. Multivariate logistic regression analysis was then used to establish a radiomic-clinical model containing radiomics and hematological features, and the model was presented as a nomogram. The performance of the radiomics-clinical model was assessed by calibration curve, clinical effectiveness as well as internal validation. RESULTS: A total of 272 patients were included in this study: 201 with CS-PAs and 71 with CPs. These patients were randomized into training set (n=182) and test set (n=90). The radiomics signature, which consisted of 18 features after dimensionality reduction, showed superior discrimination performance in 5 different classification models. The area under the curve (AUC) values of the training set and the test set obtained by the radiomics signature are 0.92 and 0.88 in the logistic regression model, 0.90 and 0.85 in the Ridge classifier, 0.88 and 0.82 in the stochastic gradient descent (SGD) classifier, 0.78 and 0.85 in the linear support vector classification (Linear SVC), 0.93 and 0.86 in the multilayers perceptron (MLP) classifier, respectively. The predictive factors of the nomogram included radiomic signature, age, WBC count, and FIB. The nomogram showed good discrimination performance (with an AUC of 0.93 in the training set and 0.90 in the test set) and good calibration. Moreover, decision curve analysis (DCA) demonstrated satisfactory clinical effectiveness of the proposed radiomic-clinical nomogram. CONCLUSIONS: A personalized nomogram containing radiomics signature and blood indices was proposed in this study. This nomogram is simple yet effective in differentiating between CS-PAs and CPs and thus can be used in routine clinical practice.

Gingivitis and plaque prevention using three commercially available dentifrices: A comparative clinical and microbiological randomized control parallel study.

AIM: The aim of the study was to compare the clinical and microbiological efficacy of Group I-delmopinol dentifrice, Group II-chlorhexidine, and Group III-triclosan-containing regularly used control dentifrice on plaque formation and gingivitis. MATERIALS AND METHODS: A total of 45 healthy volunteer students fulfilling the inclusion criteria are recruited for this randomized control parallel study. All the individuals were randomly assigned into 3 groups depending on the dentifrice prescribed. After the selection of individuals, thorough scaling and polishing were performed for all the individuals, and in a 4 days' washout period, they were refrained from regular oral hygiene maintenance and 0.9% NaCl (normal saline) rinse was prescribed to obtain plaque regrowth. Microbiological morphotypes were assessed using darkfield microscope. STATISTICAL ANALYSIS: The data were analyzed using the SPSS-software 19.00 program. The intragroup comparison of clinical parameters was done using Kruskal-Wallis ANOVA test, and intergroup comparison was done by Mann-Whitney U-test. The intragroup comparison of clinical parameters including modified staining index, the supragingival microbiota such as cocci, bacilli, and spirochetes scores was done at various study intervals using one-way ANOVA, and intergroup comparison was done using Tukey's multiple post hoc test. RESULTS: The results showed that statistically significant correlation between Group II and Group III at 15 and 30 days and between Group I and Group II at 30 days with cocci and bacilli but not spirochetes. CONCLUSION: Group II showed better plaque and gingivitis reduction compared to other active groups. To validate the results of the present study, further long-term studies with larger sample size and evaluation using known and proven study designs on gingivitis patients are needed.

Histological and ultrastructural alterations of rat thyroid gland after short-term treatment with high doses of thyroid hormones.

The aim of the present study was to investigate histological alterations of rat thyroid gland after short-term treatment with supraphysiological doses of thyroid hormones. Rats from experimental groups were treated with triiodothyronine (T3) or thyroxine (T4) during five days. In both treated groups, thyrocyte height was reduced and follicular lumens were distended. Progressive involutive changes of the thyroid parenchyma were apparent, including follicular remodeling (fusion) and death of thyrocytes. Morphological changes confirmed by quantitative analysis were more pronounced in the T4-treated group. Our results demonstrate that thyrotoxicosis, whether induced by T3 or T4, leads to different grades of thyroid tissue injury, including some irreversible damages. These changes might be explained at least in part by lack of trophic and cytoprotective effects of the thyroid stimulating hormone. Since the period required for morphophysiological recovery may be unpredictable, findings presented here should be taken into consideration in cases where the thyroid hormones are used as a treatment for thyroid and non-thyroid related conditions.

Extra spinal osteoarticular tuberculosis: a case series of 66 patients from a tertiary care hospital in Karachi.

The demographic, clinical and laboratory data of patients diagnosed as extra-spinal osteoarticular tuberculosis, presenting at Department of Orthopaedic Surgery, Abbasi Shaheed Hospital, Karachi Medical and Dental College, Karachi, between December 2006 and January 2009 were analysed. There were 66 patients registered for the study. Forty four (66.66%) patients were females. The mean age was 26.5 +/- 13.5 years. Swelling and pain were the commonest symptoms. Knee and hip were the most frequent sites involved. The mean time to diagnosis was 12.32 +/- 18 months (range = 2- 96 months). Six (09.09%) patients had history of previous pulmonary kochs. Nine (13.63%) had concurrent pulmonary and 1(01.51%) had concurrent intestinal kochs. The average first hour ESR was 48 mm/h (16-102). Manteoux test was positive in 26/42 patients. Acid Fast Bacilli (AFB) stain was positive in 1/25 while culture was positive in 7/25 specimens. There was 1(14.28%) case of MDR tuberculosis. Most of the patients (95.45%), were diagnosed on positive histopathology report of involved tissues showing chronic granulomatous reaction with caseous necrosis.

Laparoscopic appendectomy for acute appendicitis: Is this a feasible option for developing countries?

BACKGROUND/AIM: The role of laparoscopic appendectomy is still not well defined in the literature. This study was conducted to evaluate the feasibility of laparoscopic appendectomy at a university hospital in a developing country. MATERIALS AND METHODS: Patients undergoing laparoscopic appendectomy (LA) from August 2002 to August 2006 were identified. For each case, a control was selected from patients undergoing open appendectomy (OA) during the same year by systematic sampling. The groups were compared in terms of duration of surgery, requirement of narcotic analgesia, length of hospital stay, postoperative complications and the overall cost for each patient. RESULTS: A total of 68 patients underwent laparoscopic appendectomy during the study period. Median duration of surgery was 82 minutes in LA group and 70 minutes in OA group (P < 0.001). Forty-five patients in LA group and 64 in OA group required narcotic analgesia (P 0.001). Median length of hospital stay (P = 0.672) and postoperative complications (P = 0.779) were comparable in both groups. Median cost of hospital stay was Pakistani Rupees (PKR) 47121/in LA group and PKR 39318/in OA group, the difference being significant (P = 0.001). CONCLUSIONS: Laparoscopic appendectomy is feasible in developing countries with similar postoperative outcome and less requirement of narcotic analgesia. The duration of surgery and overall cost were significantly higher and efforts should be made to develop expertise and reduce operative time with resultant decrease in cost. Development of standardized protocols for discharge of patients from the hospital after LA may further reduce the cost and benefit patients in developing countries.

Total contact cast for neuropathic diabetic foot ulcers.

OBJECTIVE: To determine the outcome of diabetic neuropathic foot ulcers treated with Total Contact Cast (TCC) in terms of percentage of ulcers healed and time to heal. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Department of Orthopaedic Surgery, Abbasi Shaheed Hospital, Karachi Medical and Dental College, from April 2005 to March 2007. METHODOLOGY: The study included diabetic patients with non-ischemic neuropathic foot ulcers of upto grade 2 of Wagner's classification. Ulcers were debrided off necrotic tissues and Total Contact Cast (TCC) was applied. TCC was renewed every 2 weeks till healing. Cases were labeled as cast failure when there was no reduction in wound size in 4 consecutive weeks or worsening to a higher grade. Main outcome measures were the percentage of ulcers healed and time to heal in the cast. RESULTS: Thirty four (87.17%) patients were males and 5(12.82%) were females. The mean age was 62 +/- 13.05 years. All patients had NIDDM. Out of the 52 ulcers, 41(78.84%) healed with TCC in an average 2 casts duration (mean 32 days). There were 11(21.15%) cast failure. Majority (63.63%) of cast failure ulcers were located on pressure bearing area of heel. Most (90%) of the ulcers on forefoot and midsole region healed with TCC (p < 0.001). Longer ulcer duration (mean 57.45 +/- 29.64 days) significantly reduced ulcer healing (p < 0.001). CONCLUSION: Total contact cast was an effective treatment modality for neuropathic diabetic foot ulcers of Wagner's grade 2, located on forefoot and midsole region.

Organophosphate induced delayed polyneuropathy.

Organophosphate induced delayed polyneuropathy (OPIDP) is a rare sensory-motor distal axonopathy, which usually occur after ingestion of large doses of certain organophosphate insecticide. The clinical picture is characterized by the distal paresis in lower limb associated with sensory symptoms. Electrodiagnostic studies show a motor axonal neuropathy. This case occurred in a 14 years old girl who developed cramping pain in both calves associated with lower limbs paresis 6 weeks after accidental organophosphate poisoning. After another week, she also developed weakness in both hands. Electrophysiological study was characterized by an axonal polyneuropathy pattern. Patient improved upon oral multivitamin therapy and physiotherapy.

Frequency of lower extremity amputation in diabetics with reference to glycemic control and Wagner's grades.

OBJECTIVE: To determine the frequency of minor and major amputations in diabetic patients at different Wagner s grades of severity and to correlate it with the glycaemic control. DESIGN: Cross-sectional analytical study. PLACE AND DURATION OF STUDY: Department of Orthopedic Surgery, Jinnah Postgraduate Medical Centre, Karachi, over a period of 3 years from August 1999 to August 2002. SUBJECTS AND METHODS: The study included 60 patients of diabetic foot disease, who were distributed in to six grades of severity according to the Wagner s method. Glycaemic control was determined by baseline fasting and random blood sugar and HbA1c levels. Patients were treated accordingly and followed-up. Frequencies of minor and major amputations were found and these were correlated with the glycemic control of the patients. RESULTS: There was no patient in grade-0, 6 (10%) patients in grade-I, 13 (21.6%) in grade-II, 14 (23.3%) in grade-III, 18 (30%) in grade-IV and 9 (15%) patients in grade-V respectively. Thirty-seven (61.6%) patients were male. The mean age of the patients was 50.88 +/- 11.06 years. In 40 (66.7%) patients, the duration of diabetes was 8 years or longer. Fifty six (93.3%) were having NIDDM and 35 (58.3%) were smokers. Staphylococcus aureus was the most common pathogen isolated from the wound. Only 1 (16.6%) patient in grade I underwent minor amputation, while 3 (23.7%), 8 (57.14%) and 8 (44.44%) underwent minor amputation in grades II, III and IV respectively. Three (21.42%), 10 (55.55%) and all 9 (100%) underwent major amputation in grade III, IV and V respectively. Below-the-knee amputation was the most commonly performed procedure. Overall frequency of minor and major amputation were 20 (33.3%) and 22 (36.3%) respectively. Patients with poor glycaemic control had higher percentage of minor and major amputation (p-value = 0.001). CONCLUSION: The frequency of minor and major amputation increases with the higher grades of diabetic foot. Poor glycaemic control is a significant risk factor for amputation in diabetic foot patients.