An overview of dengue viral infection circulating in Pakistan.

BACKGROUND & OBJECTIVES: Dengue virus (DENV) is an RNA virus that infects approximately 2.5 billion people around the world. The incidence of dengue fever has rapidly increased at an alarming rate in the last few years and has affected thousands of people in Pakistan. This review explores the prevalence, serotypes and pathogenesis of dengue virus circulating in Pakistan. METHODS: A systematic review of observational studies published between 1994 and December 2019 was performed. All records of the confirmed outbreak of dengue fever in Pakistan were reviewed and articles containing no primary data were excluded. RESULTS: Four identified serotypes of dengue virus (DENV 1-4) circulate in different regions of the world causing epidemics. The most prevalent serotype, which is still epidemic and dominant in Pakistan, is DENV-2. Many factors like over-population, rapid urbanization, travelling, lack of vector control in dengue endemic areas and inadequate health-care are responsible of dynamic and huge raise of dengue in Pakistan. INTERPRETATION & CONCLUSION: Currently there is no specific treatment for prevention of dengue virus. Recently some antiviral compounds were being tested to eradicate this disease. There is a need to develop an efficient and safe vaccine for all four serotypes to combat dengue viral infection globally and particularly in Pakistan.

A unified technique for entropy enhancement based diabetic retinopathy detection using hybrid neural network.

In this paper, a unified technique for entropy enhancement-based diabetic retinopathy detection using a hybrid neural network is proposed for diagnosing diabetic retinopathy. Medical images play crucial roles in the diagnosis, but two images representing two different stages of a disease look alike. It, consequently, make the process of diagnosis extraneous and error-prone. Therefore, in this paper, a technique is proposed to address these issues. Firstly, a novel entropy enhancement technique is devised exploiting the discrete wavelet transforms to improve the visibility of the medical images by making the subtle features more prominent. Later, we designed a computationally efficient hybrid neural network that efficiently classifies diabetic retinopathy images. To examine the effectiveness of our technique, we have chosen three datasets: Ultra-Wide Filed (UWF) dataset, Asia Pacific Tele Ophthalmology Society (APTOS) dataset, and MESSIDOR-2 dataset. In the end, we performed extensive experiments to validate the performance of our technique. In addition, the comparison of the proposed scheme - in terms of accuracy, specificity, sensitivity, precision and recall curve, and area under the curve - with some of the best contemporary schemes shows the significant improvement of our techniques in terms of diabetic retinopathy classification.

Ureteral trauma during open surgery: aetiology, presentation and management.

BACKGROUND: Ureteric injury during a surgical procedure is a serious complication with significant morbidity. The objective of this research was to study the aetiology, clinical features and management of iatrogenic ureteric injuries after open surgical procedures. METHODS: This descriptive study was carried out in the Urology and Transplant unit of Institute of Kidney Diseases, Peshawar, from 1st August 2008 to 30th April 2011. Patients with clinical diagnosis of ureteral trauma due to open surgical procedures were included in the study through convenient sampling after informed consent. Important variables under study were: aetiology of ureteric injury, presenting features, time from injury to diagnosis, type of ureteric injury, treatment options, and outcome of treatment. Follow up was at 1, 3, 6 and 12 months. RESULTS: The study included 43 patients; 33 (76.7%) were females and 10 (23.3%) males. Abdominal hysterectomy was the commonest cause 20 (46.5%) of ureteric injury. Common presenting features were urinary incontinence 13 (30.23%), flank pain 7 (16.3%) and anuria 10 (23.3%). Median time from ureteric injury to urological referral was 10 days. Distal ureter was most commonly injured. Percutaneous nephrostomy was carried out in 14 (32.5%) cases. Ureteroscopic ureteric stenting was successful in 5 (11.6%) cases. Ureteroneocystostomy was carried out 25 (58%) cases. Two (4.7%) cases presented very late with non-functioning kidneys and required nephrectomy. Patients developing ureteric stricture after ureteroneocystostomy were managed successfully by endo-urological procedures. Renal function remained stable in all the patients during follow-up and there was no mortality. CONCLUSION: Timely recognition of ureteric injury and its management is associated with good outcome and decreased morbidity.

Role of clean intermittent self catheterisation (CISC) in the prevention of recurrent urethral strictures after internal optical urethrotomy.

BACKGROUND: Urethral stricture is one of the oldest diseases Urethral dilatation Internal optical urethrotomy,were the only treatment. Clean Intermittent Self Catheterisation was introduced by Lapides has greatly decreased the recurrence of stricture. Objectives were to determine the role of Clean Intermittent Self Catheterisation (CISC) in the prevention of recurrence of urethral strictures after Internal Optical Urethrotomy and to study the frequency of any postoperative complications and tolerability for the patients associated with this procedure. METHODS: A randomised controlled study conducted in the department of urology and renal transplantation, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar from June 2007 to June 2010. Total of 60 patients with mean age 48 years (range 20-73) were selected and randomly divided into Treatment Group (30 patients) and Control Group (30 Patients). Eight "drop out" occurred in the treatment group and four "drop out" occurred in the controlled group. All the patients were treated with Internal Optical Urethrotomy using Sachse method followed by indwelling catheter for 5 days. The treatment group was then taught to perform Clean Intermittent Self Catheterisation by inserting a Classic Neleton Catheter (No. 16 or 18) twice a day for 1 week, then once a day for another 4 weeks and then once weekly continued for one year. All the patients were followed up regularly at 1 month intervals during the first 6 months and then every 2 months for the next 6 months. RESULTS: Total of 48 patients completed the study, 22 in the treatment group and 26 in the control group. Within the first year, 4 patients (22%) in the treatment group developed urethral stricture. In the control group, 12 patients (46%) developed urethral stricture within the first year, showing a significant difference (p < 0.01). In the treatment group four patients developed simple UTIs while in the control group three patients developed UTIs, one with concomitant epididymitis. No other complications were noted up to one year follow up. CONCLUSION: Clean Intermittent Self Catheterisation is a simple and effective way of reducing stricture recurrence after Internal Optical Urethrotomy and is associated with less morbidity and is cost effective. CISC is an important modality for maintaining the normal urethral calibre.

Role of simplified admission criteria for predicting severe complications of gall stone pancreatitis.

BACKGROUND: Gallstone Pancreatitis (GP) is not an uncommon disease in our country and is associated with large number of morbidity and mortality especially if severe complications develop. Different criteria have been developed to predict the complications of GP. Simple admission criteria are better predictors of severe complications of GP than an APACHE II score of 5 or greater, a modified Imrie (Glasgow) score of 3 or greater, and a Biliary Ranson score of 3 or greater. The purpose of this study was to determine the role of simplified admission criteria in predicting severe complications of Gallstone Pancreatitis. METHODS: This was a descriptive study conducted in Surgical 'A' Unit, Khyber Teaching Hospital Peshawar between July 16th 2007 to November 30th 2008. Total 52 patients (42 women and 10 men, aged range from 18 to 76 years, with mean age, 39 years) who presented to our unit with gallstone pancreatitis were included in the study through technique of non-probability convenient sampling. The main outcome measures were major local and systemic complications requiring intensive care unit care, and death. Physiological factors and laboratory data were collected on admission and recorded daily. RESULTS: Seven patients (14%) had severe complications with mortality of 2%. On univariate analysis, a white blood cell count of 14500/dL or more (p = 0.03), a serum glucose level of or more > or = 150 mg/dL (8.3 mmol/L) (p < 0.001), an APACHE II score of 5 or greater (p = 0.008), a modified Imrie score of 3 or greater (p < 0.001), and a biliary Ranson score of 3 or greater (p = 0.03) were statistically associated with the development of severe complications. On multivariate analysis, only a serum glucose level of > or = 150 mg/dL or more (8.3 mmol/L) was predictive of adverse events (p < 0.001). CONCLUSIONS: Glucose level (> or = 150 mg/dL) is the best single admission predictor of severe complications of Gallstone Pancreatitis and is superior to an APACHE II score of 5 or greater, a modified Imrie score of 3 or greater, and a biliary Ranson score of 3 or greater.