Health related quality of life of home dwelling vs. nursing facility dwelling elderly - A cross-sectional study from Karachi, Pakistan.

With the elderly population increasing in numbers, their demand of adequate medical and psychological care is also rising up. The key goal of promoting physical and mental health in elderly is maintenance of adequate health-related quality of life (QOL). A cross-sectional, descriptive study was conducted from December 2016 to February 2017 among 100 elderly living in nursing facilities and 100 in homes. Older people's quality of Life Questionnaire (OPQOL-35) was utilized to assess their QOL. In the nursing facility dwelling, 17% elderly reported good QOL with highest standardized score in "home and neighbourhood" and lowest in "health" domain. Of the home dwelling elderly, 74% reported good QOL with highest standardized score in "psychological and emotional wellbeing" and lowest in "health" domain.

Pheochromocytoma - An incidental finding in a child with acute appendicitis.

Pheochromocytoma, a rare tumour, arises mainly in the adrenal gland. It consists of chromaffin cells or sympathetic para-ganglia if extra-adrenal. It is an occurrence of rare nature with an incidence of two to eight cases per million annually. Incidence of paediatric pheochromocytoma is estimated at 0.11 benign and 0.02 malignant pheochromocytomas per million children. Children with it present with sustained hypertension in contrast to the adult triad of tachycardia, headache, and diaphoresis. We report a case in which the patient initially presented with right iliac fossa pain indicating appendicitis but later when evaluated and assessed, pheochromocytoma was diagnosed as well. The incidental nature of the finding, keeping in mind the rare occurrence makes the outcome interesting and intriguing at the same time.

Post-tuberculosis Aspergilloma in Undiagnosed Tetralogy of Fallot.

Tetralogy of Fallot (TOF) is the most common congenital heart disease (CHD) with an incidence of four in every 1000 live births in Pakistan. Classically, these children present with central cyanosis in early life; however, milder defects may remain asymptomatic for months or even years. We report a malnourished and anemic teenage male, who was admitted with shortness of breath, hemoptysis, fever, palpitations, and weight loss. On examination, vitals were stable, except for oxygen saturation, which was 84% on pulse-oximeter. Bilateral basal coarse crepitations were present on respiratory examination with a markedly reduced air entry in the right upper zone. A 2-3/6 systolic ejection murmur was appreciated on cardiac examination. The chest X-ray was consistent with a collapsed right upper lobe with fibrosis. Echocardiography was consistent with findings of TOF. Based on sputum for acid-fast bacilli (AFB smear) and GeneXpert (Cepheid Inc., Sunnyvale, California, US) Mycobacterium tuberculosis/resistance to rifampin (MTB/RIF), the patient was diagnosed with multi-drug resistant pulmonary tuberculosis (MDR-PTB). However, when the patient didn't improve with anti-tuberculous therapy, a computed tomography (CT) scan chest was done, which raised a suspicion of aspergilloma. The culture and cytology of bronchoalveolar lavage (BAL) were done, which confirmed pulmonary aspergilloma. Undiagnosed congenital heart diseases are rare in adults. Pulmonary TB is rarely reported in right-to-left shunts; however, clinicians should maintain a suspicion of this correlation.

Lupus Profundus: A Case Report from Pakistan.

Lupus erythematosus (LE) is termed as an autoimmune chronic condition which involves a spectrum of symptoms. It is a part of the connective tissue diseases. Its cutaneous form is termed as cutaneous lupus erythematosus (CLE). Prevalence of CLE is about 70 cases per 100,000 persons. The least common variety of CLE is lupus profundus (LP)-only 5% of cases. Lupus profundus, although rare, must be kept in the differential diagnoses of ulcerated lesions. It may present as a localized entity or in association with systemic lupus erythematosus (SLE) or it may lead to SLE later in life. Early diagnosis based on histopathology and aggressive treatment is essential to prevent significant physical morbidity and progression to systemic involvement. We report a case of biopsy-proven lupus profundus in a 40-year-old female who presented with high-grade fever and multiple ulcerated lesions. The lesions were appreciated on the left thigh, right gluteus, and left arm. They had an erythematous base and edematous necrotizing centers with purulent discharge. She had a history of oral ulcers, joint pain, photosensitivity, dyspnea, peptic ulcer disease, and signs of depression. Her autoimmune assays were unremarkable. We treated her with antibiotics, oral hydroxychloroquine, and oral corticosteroid. Potassium permanganate wash and methylprednisolone aceponate were applied locally on the lesions. Ulcerated LP is a rare cause of ulcerated/indurated, painful subcutaneous plaques. It may present as a localized entity or in association with SLE or it may lead to SLE later in life.

Physician's Perception Versus Patient's Actual Incidence of Drug Non-adherence in Chronic Illnesses.

Objectives Treatment adherence is crucial to the success of a management plan. The objectives of this study are (i) to assess medication adherence in patients with chronic diseases, (ii) to assess if physicians correctly perceive medication adherence among said patients, and (iii) to investigate the factors associated with low drug adherence. Materials & methods This observational cross-sectional study included 283 patients and 208 physicians from various hospitals in Karachi, Pakistan. The participants in the "patient group" completed the eight-item Morisky Medication Adherence Scale form. The participants in the "physician group" completed a questionnaire with questions related to their perception of their patients' characteristics of adherence to medical prescriptions. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) for Windows, Version 22.0. (IBM Corp., Armonk, NY). Results The actual incidence of low drug adherence among patients with chronic diseases is 85%. However, the perceived incidence by physicians is 40%. Low adherence was common in women, individuals aged 35 to 50 years, and individuals who were single and illiterate. Adherence decreased with an increasing number of pills, duration of treatment, and increasing average expense of medications. The actual most common barrier to adherence among patients is medication cost; however, physicians perceive forgetfulness to be the more common barrier. Conclusion Patients with chronic illnesses have low medication adherence levels. Physicians, however, misinterpret the frequency of low adherence. Our findings will help physicians have a more real and accurate understanding of the challenges their patients face in long-term adherence to treatment regimens. It may ultimately lead to improved treatment adherence and quality of management once patients' actual challenges are addressed and necessary steps are taken.

Development and characterization of 3D-printed feed spacers for spiral wound membrane systems.

Feed spacers are important for the impact of biofouling on the performance of spiral-wound reverse osmosis (RO) and nanofiltration (NF) membrane systems. The objective of this study was to propose a strategy for developing, characterizing, and testing of feed spacers by numerical modeling, three-dimensional (3D) printing of feed spacers and experimental membrane fouling simulator (MFS) studies. The results of numerical modeling on the hydrodynamic behavior of various feed spacer geometries suggested that the impact of spacers on hydrodynamics and biofouling can be improved. A good agreement was found for the modeled and measured relationship between linear flow velocity and pressure drop for feed spacers with the same geometry, indicating that modeling can serve as the first step in spacer characterization. An experimental comparison study of a feed spacer currently applied in practice and a 3D printed feed spacer with the same geometry showed (i) similar hydrodynamic behavior, (ii) similar pressure drop development with time and (iii) similar biomass accumulation during MFS biofouling studies, indicating that 3D printing technology is an alternative strategy for development of thin feed spacers with a complex geometry. Based on the numerical modeling results, a modified feed spacer with low pressure drop was selected for 3D printing. The comparison study of the feed spacer from practice and the modified geometry 3D printed feed spacer established that the 3D printed spacer had (i) a lower pressure drop during hydrodynamic testing, (ii) a lower pressure drop increase in time with the same accumulated biomass amount, indicating that modifying feed spacer geometries can reduce the impact of accumulated biomass on membrane performance. The combination of numerical modeling of feed spacers and experimental testing of 3D printed feed spacers is a promising strategy (rapid, low cost and representative) to develop advanced feed spacers aiming to reduce the impact of biofilm formation on membrane performance and to improve the cleanability of spiral-wound NF and RO membrane systems. The proposed strategy may also be suitable to develop spacers in e.g. forward osmosis (FO), reverse electrodialysis (RED), membrane distillation (MD), and electrodeionisation (EDI) membrane systems.