Severity of Dengue Viral Infection Based on Clinical and Hematological Parameters among Pakistani Patients.

The global burden of dengue infections has increased dramatically. Early diagnosis of dengue infection is critical to proper medical management to avoid further complications in patients. This study was geared to assess the severity of dengue infections based on clinical and hematological examinations. A cross-sectional study was conducted among febrile patients with dengue infection in a teaching hospital in Pakistan. Blood samples were investigated for dengue-specific antibodies (IgM and IgG) and the nonstructural 1 antigen. The clinical findings of each subject were noted to assess the severity of the infection. Tests for hematological parameters were performed. Of 130 patients with confirmed dengue infection, 23 had severe and 107 had nonsevere dengue. Patients with severe dengue experienced mucosal bleeding (71.4%), fluid accumulation (57.1%), shock (35.7%), and gastrointestinal bleeding (28.6%). The most significant hematological findings among severe and nonsevere patients with dengue infection were thrombocytopenia, leukopenia, and a raised hematocrit level (P < 0.001). Patients with severe dengue infection showed marked thrombocytopenia, with a mean platelet count of 49.96 × 109 platelets/L. The clinical presentation of patients with dengue infection along with hematological markers are the most important clues for the diagnosis of, prognosis of, and therapy for dengue infection. Thrombocytopenia, leukopenia, and raised hematocrit levels were the most significant hematological parameters when assessing the severity of dengue infection.

Molecular Characterization of Extensively Drug Resistant Salmonella Enterica Serovar Typhi Clinical Isolates from Lahore, Pakistan.

Background: The emergence of extensively drug-resistant (XDR) typhoid in Pakistan has endangered the treatment options available to manage this infection. Third generation cephalosporin were the empiric choice to treat typhoid fever in Pakistan, but acquisition of ESBLs have knocked them out of the arsenal. The current empiric choice is azithromycin which is vulnerable to resistance too. This study aimed to assess the burden of XDR typhoid and the frequency of resistance determinants in blood culture samples collected from different hospitals in Lahore, Pakistan. Methods: A total of 835 blood cultures were collected from different tertiary care hospitals in Lahore during January 2019 to December 2021. Among 835 blood cultures, 389 Salmonella Typhi were identified, and 150 were XDR S. Typhi (resistant to all recommended antibiotics). Antibiotics resistance genes of the first-line drugs (blaTEM-1, catA1, sul1, and dhfR7) and second line drugs (gyrB, gyrA, qnrS, ParC and ParE) were investigated among XDR S. Typhi. There were different CTX-M genes isolated using the specific primers, blaCTX-M-U, blaCTX-M-1, blaCTX-M-15, blaCTX-M-2, blaCTX-M-8 and blaCTX-M-9. Results: Antibiotic resistant genes of the first-line drugs were isolated with different frequency, blaTEM-1 (72.6%), catA1 (86.6%), sul1 (70%), and dhfR7 (56%). Antibiotics resistance genes of second-line drugs were isolated as: gyrB (60%), gyrA (49.3%), qnrS (32.6%), parC (44%) and parE (28%). Among CTX-M genes, blaCTX-M-U (63.3%) was the most frequent followed by blaCTX-M-15 (39.3%) and blaCTX-M-1 (26%). Conclusion: Our study concluded that XDR isolates circulating in Pakistan have acquired first-line and second-line antibiotic resistant genes quite successfully along with CTX-M genes (ESBLs) rendering them resistant to the third generation cephalosporins as well. Emergence of azithromycin resistance in XDR S. Typhi which is currently used as an empiric treatment option is worrisome and needs to be monitored carefully in endemic countries like Pakistan.

Antibacterial assessment of commercially available hand sanitizers in Pakistan by EN-1500.

BACKGROUND: The effectiveness of hand sanitizers marketed to the general population is essential for infection prevention and control. Main theme of the study was that whether the commercially available hand sanitizers meet the WHO recommended standards in terms of efficacy? Current study aims to investigate the efficacy of ten commercially available hand sanitizers. METHODS: The methodology was based on European Standard EN-1500. Following the artificial contamination of hands, pre and post samples were obtained to determine the log reduction values for each sanitizer. RESULTS: The results showed that out of ten only one sanitizer showed highest log reduction which was comparable to the reference product. Product B was most efficient in sanitization of hands with mean log reduction of 6.00 ± 0.15. The lowest sanitization efficacy was recorded for product F with mean log reduction of 2.40 ± 0.51, however the reference product 2-propanol result in mean log reduction of 6.0 ± 0.00. The products used in this study show a statistical significant results (p value: < 0.01). CONCLUSION: It is concluded that only one product showed active sanitizer efficacy. This study provides an important insight for manufacturing company and authorizing authorities to assess the efficacy of hand sanitizer. Hand sanitization is one approach to stop the spread of diseases carried on by harmful bacteria inhabiting our hands. Apart from the manufacturing strategies, ensuring proper use and quantity of hand sanitizers is very important.

COVID-19 among health care workers and their impact on the health care system in a teaching hospital in Pakistan: A cross sectional observational study.

Background and Aims: Health care workers (HCWs) are thought to be high-risk population for acquiring coronavirus disease (COVID-19). The COVID-19 emergence has had a profound effect on healthcare system. We sought to investigate the COVID-19 among HCWs and their effects on the healthcare system. Methods: A cross sectional observational study was conducted at Timergara teaching hospital. The study included HCWs with positive real time polymerase chain reaction (Q-PCR) for severe acute respiratory syndrome coronavirus (SARS-CoV-2). The study duration was from April to September, 2020. The demographic profile of each recruited subject was collected through structured interview. The patient's admissions to hospital were collected for the 5 months before (October 2019-February 2020) and 5 months after lockdown (March-July 2020). Results: A total of 72 out of 689 (10%) HCWs were tested positive for SARS-CoV-2, of whom 83% were front-liners. The majority were male (72%), with comorbidities (14%) and no mortality. The structured interview of all participants showed that the healthcare setting was the major possible source of infection (97%). The patient admissions into the hospital were reduced by 42% during lockdown than prelockdown period. The patients admission was significantly decreased in the medical ward during lockdown (60% decrease; p < 0.01) with slightly similar trends in other departments. Conclusion: In conclusion, we found increased risk of COVID-19 for front-line HCWs. Lack of mortality was the favorable outcome. Lack of replacing the infected HCWs possibly explained the marked decrease in hospital admissions, and potential inadequate healthcare delivery during the lockdown. Understanding SARS-CoV-2 among HCWs and their impact on health-care system will be crucial for countries under COVID-19 crises or in case of future pandemic to deliver proper health services.

Investigation of Three Morchella Species for Anticancer Activity Against Colon Cancer Cell Lines by UPLC-MS-Based Chemical Analysis.

In search of new anticancer agents, natural products including fungal compounds had been used as potential anticancer agents. The aim of this study was to investigate the anticancer activity of Morchella extracts against colon cancer cell line and UPLC-DAD-MS/MS analysis for the identification of compounds. The cytotoxic activity of the three Morchella species was examined for their anti-carcinogenic properties against the colon cancer cell lines. Phytochemical analyses were performed to screen Morchella for the presence of anti-cancerous compounds. All the fungal extracts inhibited the viability of colon cancer cells in a dose-dependent manner. Major compounds identified in Morchella included amino acid, fatty acid, sterol, flavonoid, peptide, glutamic acid, alkaloid, terpenoid, cyclopyrrolones, and coumarin. Several new compounds were detected among all the three Morchella extracts. In conclusion, all the fungal extracts showed potential inhibition of colon cancer cells and actively arrested the cell viability. It was concluded that the identified bioactive compounds might be the main constituents contributing to the anticancer activity of Morchella against human colon cancer cell lines. Thus, Morchella extracts are a potential source of bioactive compounds with cytotoxicity and could potentially be used as functional food supplements. Due to the nature of impressive findings, this investigation should be undertaken further to allow the studies to explore and develop a potential cytotoxic agents against colon cancer.

Antibacterial Activity of Different Extracts of Ascomata of Morchella conica and M. esculenta (Ascomycota) against Salmonella Species.

Antibiotic resistance has become a worldwide concern, as it has reduced the clinical efficiency of multiple antibiotics. As a result, screening of novel antibacterial substances for antimicrobial potential has increased. Mushrooms are widely known as a source of antimicrobial agents. The current study was designed to investigate the bacteriostatic and bactericidal effects of Morchella conica and M. esculenta against typhoidal and nontyphoidal Salmonella species. The sensitivity of S. typhi, S. paratyphi-A, and S. typhimurium was determined using an agar diffusion assay. The standard broth microdilution method was used to assess the minimal inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). Bacterial growth and inhibition kinetics were evaluated spectrophotometrically. All of the mushroom extracts were able to inhibit the growth of typhoidal and nontyphoidal Salmonella species. Notably, all of the extracts possessed bacteriostatic effects (MIC: 3.33 ± 0.6 to 16.0 ± 0 mg/mL) and bactericidal effects (MBC: 8-16 mg/mL). The results showed statistically significant differences of antibacterial and bactericidal potential of mushroom extracts against the tested bacteria (P ≤ 0.05). Thus, extracts of Morchella species can be used as natural antibacterial pharmaceuticals. Further mycopharmacological studies must be performed to characterize their metabolites.

Investigation of Morchella esculenta and Morchella conica for their antibacterial potential against methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and Streptococcus pyogenes.

Antimicrobial resistance is an alarming problem, especially due to emergence of methicillin-resistance Staphylococcus aureus (MRSA). World Health Organization (WHO) has already listed MRSA as a top priority pathogen for the development of novel antibacterial agents. Presently, different therapeutic approaches against bacterial infections are in practice which includes targeting bacterial virulence factors, bacteriophage therapy, and manipulation of the microbiome. Natural products have been efficiently used for centuries to combat bacterial infections. Morchella is a natural fungal product which has been reported to possess broad-spectrum biological activities against bacterial infections. Hence, this study was aimed to evaluate the antibacterial efficacy of two macro-fungi against S. aureus, MRSA, and Streptococcus pyogenes (S. pyogenes). The antibacterial potential of both fungal extracts (Morchella esculenta and Morchella conica) was evaluated using disk diffusion and standard broth microdilution methods. The chemical compounds of both fungi were investigated using ultra-performance liquid chromatography mass spectroscopy (UPLC-MS) analysis. All fungal extracts inhibited growth of tested bacteria with inhibitory zone ranging from 10.66 ± 0.3 to 21.00 ± 1.5 mm. The minimum inhibitory concentration (MIC) of tested bacterial growth ranged from 03.33 to 16.0 mg/ml. It was noteworthy that Morchella extracts prevented S. aureus growth in a bactericidal manner with minimal bactericidal concentration (MBC) of 8-16 mg/ml. The extracts were also more effective against MRSA than currently available antibiotics. In conclusion, the growth inhibition of tested bacteria by fungal extracts revealed their potential as antibacterial agents and their compounds may be used as drug candidates.

Incidence of malarial infection and response to antimalarial drugs at Districts Lower Dir and Swat of Khyber Pakhtunkhwa, Pakistan.

Malaria is the leading cause of mortality and morbidity all over the world. Several antimalarial drugs are available for the treatment of malaria. The main objective of this study was to investigate the incidence of malarial infection and the use of prescribed antimalarial drugs. A cross-sectional study was carried out to collect quantitative data from selected sites in District Lower Dir and Swat of Malakand Division Khyber Pakhtunkhwa (K.P.), Pakistan. Screening of selected patients was performed using both thick and thin films and was observed with the help of a light microscope. In this study, a total of 2517 blood samples were tested. Overall positive infection was 12% Plasmodium vivax (99.07%) and Plasmodium falciparum (0.92%). Our results evaluate that infection with Plasmodium vivax was higher than Plasmodium falciparum. No other Plasmodium species or mixed infections were observed. The rate of infection was more frequent in males as compared to female patients. The highest percentage was recorded in the summer season (35.07%), while the lowest was documented in the winter (11.7%). Out of 325 patients, 311 (95.7%) were treated with Chloroquine, and the remaining were treated with Artemether. Chloroquine was used as a drug of choice for Plasmodium vivax infection. The present study concludes that Plasmodium vivax and Plasmodium falciparum are the two common agents for malaria in Malakand Division. However, Plasmodium vivax was dominant over Plasmodium falciparum. The infection rate was high in males from District Lower Dir during the summer season.

Impact of the COVID-19 lockdown on routine vaccination in Pakistan: a hospital-based study.

The effect of the coronavirus disease (COVID-19) pandemic on routine vaccination in low- and middle-income countries are scarce. The current pandemic has disrupted routine immunization globally. We aimed to analyze the effect of COVID-19 pandemic on routine immunizations practice in Pakistan. A retrospective study was conducted. The data were extracted from the immunization registry in order to assess the disruption in routine immunization coverage during 5 months of the lockdown period. We compared 5 months post lockdown against the baseline period of 5 months preceding lockdown. To broaden the horizon of our research we also collected data of vaccination from rural areas within the country. The results of the current study showed that on average, there was a disruption in routine immunization by 36% during lockdown when compared with the prepandemic period. The largest decline was observed for measles vaccination with a decline of 48%. In rural areas there was a lower decline in vaccination coverage with the highest decline noted for rotavirus vaccination of 15%. This monthly decrease in routine vaccination continued to be at a decline for several months during lockdown; however, it slightly increased post lockdown. In conclusion, on average, there was more than 30% declined in routine vaccination during the lockdown period, while somewhat improved post lockdown, i.e. 12%. Thus, this ongoing pandemic is a reminder for the national immunization programs to consider to tackle the disruption in routine immunization, otherwise, this continued disruption may lead to secondary outbreaks of vaccine preventable diseases amongst the public.