The association of complex liver disorders with HBV genotypes prevalent in Pakistan

Background Genotyping of HBV is generally used for determining the epidemiological relationship between various virus strains and origin of infection mostly in research studies. The utility of genotyping for clinical applications is only beginning to gain importance. Whether HBV genotyping will constitute part of the clinical evaluation of Hepatitis B patients depends largely on the availability of the relevance of the evidence based information. Since Pakistan has a HBV genotype distribution which has been considered less virulent as investigated by earlier studies from south East Asian countries, a study on correlation between HBV genotypes and risk of progression to further complex hepatic infection was much needed Methods A total of 295 patients with HBsAg positive were selected from the Pakistan Medical Research Council\u27s (PMRC) out patient clinics. Two hundred and twenty six (77%) were males, sixty nine (23%) were females (M to F ratio 3.3:1). Results Out of 295 patients, 156 (53.2%) had Acute(CAH), 71 (24.2%) were HBV Carriers, 54 (18.4%) had Chronic liver disease (CLD) Hepatitis. 14 (4.7%) were Cirrhosis and HCC patients. Genotype D was the most prevalent genotype in all categories of HBV patients, Acute (108), Chronic (39), and Carrier (53). Cirrhosis/HCC (7) were HBV/D positive. Genotype A was the second most prevalent with 28 (13%) in acute cases, 12 (22.2%) in chronics, 14 (19.7%) in carriers and 5 (41.7) in Cirrhosis/HCC patients. Mixed genotype (A/D) was found in 20 (12.8%) of Acute patients, 3 (5.6%) of Chronic and 4 (5.6%) of carriers, none in case of severe liver conditions. Conclusion Mixed HBV genotypes A, D and A/D combination were present in all categories of patients except that no A/D combination was detected in severe conditions. Genotype D was the dominant genotype. However, genotype A was found to be more strongly associated with severe liver disease. Mixed genotype (A/D) did not significantly appear to influence the clinical outcome

Rescue therapy with Sofosbuvir /Velpatasvir/ Voxilaprevir in a patient infected with Hepatitis C virus multidrug resistant variant—a much needed option for DAA-treatment failures in Pakistan? A case-report

Primary non-response to the currently available direct acting anti-viral (DAAs) in chronic hepatitis C virus (HCV) is rare and expected in approximately only 3-4% of the patients. Among the plausible explanations, HCV resistant variant may be one of the causes among the several other viral and host factors implicated in cases who do not achieve cure. Ever since the approval of licensed DAAs in 2014, focus has been mainly on high cure rates. Hence, significantly less attention has been given to the few difficult to treat cases. We present, herein, the case of a 50-year old male who had previously failed to respond to the currently available first and second-line DAA treatment and was then approved for a special treatment access programme. According to our knowledge this is the first case-report from Pakistan in favour of the physician’s directive for special treatment access for HCV DAA-experienced patients. Keywords: Hepatitis C virus, Direct acting anti-virals, Standard of care, Pakistan

Spectrum of Spinal Dysraphism in Pediatric Patients in a Tertiary Care Hospital

Objectives:  To report the spectrum of spinal dysraphism presenting in pediatric patients admitted to the Department of Neurosurgery Lady reading hospital Peshawar. Material & Methods:  A descriptive case series was conducted and total of 89 patients (age between 2 months to 12 years) were included who underwent the surgical treatment. All patients were examined for clinical and radiological diagnosis of spinal dysraphism. Results:  The average age at treatment was 23 ± 39.77 months. The most recurring (52.8%) presenting symptom was the swelling on the back followed by lower limb weakness. Meningocele was reported in 11.2%, myelomeningocele in 47.2%, myelomeningocele & hydrocephalus in 12.4%, tethered cord syndrome in 25.8%, and diastematomyelia 3.4% of patients. Excision combined with the repair was done in 58.4%, release & repair done in 29.2% and endoscopic third ventriculostomy/ventriculoperitoneal shunts with the repair were done in 12.4% patients. Cerebrospinal fluid leak was reported in 3.7%, wound infection in 4.5% and mortality was reported in 3.4% patients. Conclusion:  Overall, a good outcome was reported in the majority of our patients. Surgical procedures like myelomeningocele’s excision & repair, tethered cord’s release & repair, and ETV/VP shunt in patients with hydrocephalus can lead to satisfactory clinical outcomes

Impact of Internal Physical Environment on Academicians' Productivity in Pakistan: Higher Education Institutes Perspectives

This study empirically examines the impact of indoor physical environment on academicians' productivity in different higher education institutes of Khyber Pakhtoonkhawa (KPK) province of Pakistan. The study is based on primary data collected from one hundred and forty four educationists' of various institutes in Pakistan. A structured questionnaire was used for data collection. The data was analyzed using the techniques of rank correlation coefficient and multiple regression analysis. All the findings were tested at 0.01 and 0.05 level of significance. The finding of this study shows that office design is very important in terms of increasing employee's productivity. The study opines that comfortable and contented office design motivates and energized the employees to increase their performance. Keywords: Ergonomics, Productivity, Office design, Higher education institutes, Correlation, Regression, Pakistan

Impact of Internal Physical Environment on Academicians' Productivity in Pakistan: Higher Education Institutes Perspectives

This study empirically examines the impact of indoor physical environment on academicians' productivity in different higher education institutes of Khyber Pakhtoonkhawa (KPK) province of Pakistan. The study is based on primary data collected from one hundred and forty four educationists' of various institutes in Pakistan. A structured questionnaire was used for data collection. The data was analyzed using the techniques of rank correlation coefficient and multiple regression analysis. All the findings were tested at 0.01 and 0.05 level of significance. The finding of this study shows that office design is very important in terms of increasing employee's productivity. The study opines that comfortable and contented office design motivates and energized the employees to increase their performance. Keywords: Ergonomics, Productivity, Office design, Higher education institutes, Correlation, Regression, Pakistan

Band Ligation VersusGlue Injection for Bleeding Gastric Varices

Background : To compare endoscopic variceal sclerotherapy with N-butyl-2-cyanoacrylate- Histoacryl (EVS) and endoscopic variceal band ligation (EBL) for treatment of bleeding gastric varices (GV).Methods: In this  randomized control trial 140 patients  with bleeding gastric varices were included.Bleeding GV patients diagnosed endoscoically were treated with EVS or EBL in two equal groups after randomization. Bleeding control or otherwise was confirmed during the procedure. Patients were followed for 1 month for re-bleeding. Comparison of the patients undergoing EVS or EBL was done in terms of bleeding control and re-bleeding during follow up period. Chi2 test was used to seek statistically significant association in this regard. Results: Endoscopic bleeding control was confirmed in all except 1 of EBL patients who expired. 4 (5.7%) of EVS 10 (14.28%) EBL patients had re-bleeding (P >0.05).Conclusion: EVS and EBL are comparative procedures for treatment ofbleeding GV for control of active bleeding and re-bleeding over one month follow up

Determination of risk factors for hepatitis B and C in male patients suffering from chronic hepatitis

<p>Abstract</p> <p>Background</p> <p>Hepatitis B and C is common in Pakistan and various risk factors are attributable to its spread.</p> <p>One thousand and fifty consecutive male cases suffering from chronic liver disease (327 HBV and 723 HCV) were selected from the OPD of public sector hospital and a private clinic dealing exclusively with the liver patients. To compare the results 723 age and gender matched controls were selected from the blood transfusion services of the public sector hospital. A standard questionnaire was filled for all patients and controls which included the information on possible risk factors.</p> <p>Findings</p> <p>Family history of liver disease was significantly higher (43% and 34%) in HBV and HCV positive cases as compared to 5% in controls [odds ratio 15.6; 95% Confidence Interval CI: 10.1 -- 24.1, 10.9; 95% Confidence Interval CI: 7.3 -- 16.4] and same trend was seen for death due to liver disease in the family. Majority 74% hepatitis B positive cases had their shaves done at communal barbers but this practice was equally prevalent amongst controls (68%), thus negating it as a possible risk factor, but there is a significant risk with p < 0.05 associated with HCV in male that get their shave in barber. Very strong association of the disease was found with history of dental treatment (38% HCV 36% HBV and 21% controls) [Odd ratio 2.3; 95% CI: 1.8-3.0, Odd ratio 2.1; 95% CI: 1.5-2.8], surgery (23% HCV cases,14% HBV cases and 12% controls), history of blood transfusion was significantly higher in HCV (6%) as compared to controls (2.1%) [Odd ratio 2.9; 95% CI: 1.5-5.5]. History of taking injections for various ailments by the general practitioners (over 90% patients in both hepatitis B and C cases) was significantly higher as compared to 75% in controls [Odds ratio 3.8, 6.9; 95% CI: 2.4-6.1, 4.5-10.4] but hospitalization was not significant in HBV and HCV cases.</p> <p>Conclusion</p> <p>Injections, surgery and dental treatment appear as major risk factors for the transmission of hepatitis B and C in the community. Massive health care awareness drives need to be done for both health care providers and the public to reduce this menace.</p

Comparison of Constrained Induced Movement Therapy and Bimanual Training on Functional Outcome of Hemiplegic Cerebral Palsy

OBJECTIVES The aim of this study was to compare the effects of constrained induced movement therapy (CIMT) and BimanualIntensive Training (BIT) on functional outcomes of hemiplegic cerebral palsy children. METHODOLOGY Cerebral palsy children with age groups of 5 to 12 years were included with a total sample size of 38. Simplerandom sampling was done, and data was collected from Islamabad. Two groups were formed and named groupA: constrained induced movement therapy with 19% and group B: bimanual training with 19% respectively. Thefunctional outcome for the CIMPT and for the BIT group was assessed on the pretest and post-test scoreevaluation of QUEST and JTHF tests. RESULTS Statistically significant (p &lt;0.05) improvement was found in The Quality of Upper Extremity Skills Test (QUEST)and Jebsen-Taylor Test of Hand Function (JTHF) in the between -group analysis. For within the group analysisthe p-value &lt;0.05 suggests that there was a significant diffe rence in within-group analysis too. The values forgrasp and dissociated movements suggest that QUEST post-test values are impactful in the CMIT group whereasin the BIT group simultaneous and spontaneous movement was increased but JTHF post -test values were moresignificant in CMIT. CONCLUSION BIT is more beneficial for both hand’s simultaneous and spontaneous movement, whereas CMIT is morebeneficial for grip and overcoming the “learned-nonuse” phenomena in cerebral palsy children

The Epidemiological and Clinical Characteristics of 2019 Novel Corona Virus Disease (COVID-19) in Balochistan, Pakistan

Background: The unprecedented outbreak of 2019 novel coronavirus disease (COVID-19) drastically spread worldwide. The study was aimed to articulate the findings of a descriptive and clinical characteristic, also to access the potential risk factors link with the spread of COVID-19. Method: The COVID-19 cases reported through April 30, 2020, were extracted from Balochistan’s COVID-19 Electronic Dashboard. All cases from March to April 2020 were included. The results of the laboratory finding as well as data acquired through COVID-19 Dashboard were cleaned; descriptive exploratory analysis and chi-square were calculated to demonstrate the association using Epi- Info. Results: A total of 1381 patient records extracted and screened. Of these, 1218 suspected cases and 1049 confirmed cases contributed to the analysis. Among confirmed cases, 77% (811) were male. The most affected age group was 60 – 69 years (attack rate 1.90/10,000), mean age was 36 ±17.11 SD with age range 2 months-94 years.&nbsp; District Quetta 82% (864) and district Pishin 5% (55) remained the epi-center for high attack rates. Among confirmed cases, a total of 14 deaths occurred for an overall Case fatality rate of 1.33%. The epi surge was peaked around March 19, April 5, and April 24, 2020. Among high-risk personals, those who had contact with infected individuals’ showed a high association of 97% (323/333) than without any contact 87% (221/254). Those who had travel history showed a prevalence of 86% (87/101) than in those who did not 59% (60/104) while those admitted in hospital with comorbid conditions showed a prevalence of 70% (26/37) than in those who did not 13% (6/46). Conclusion: COVID-19 epidemic has spread rapidly in the province. A series of multidimensional public health interventions, a cost-effective surveillance system, and the adoption of safe working practice, awareness sessions are necessary to control the COVID-19 outbrea

Land Use Analysis of Central Business District (CBD) of Metropolis Saddar Karachi through SRS/GIS Techniques

The high density of buildings and roads are commonly associated with the Central Business District (CBD) of a metropolitan and multicultural city Karachi, Pakistan. It is the highly interactive place of a metropolis, therefore, considers functionally effective zones. This paper will prove even with a high rate of urbanization and expansion due to urban sprawl, still Saddar is the focus of attraction concerning several facts. The main objectives of the study were to explore the land-based cataloging of Saddar based on activity and to assess the environmental issues which are associated with this land use classification for the sustainability of CBD the people perception methods of identification of research, Land-use (LU) Analysis of Area of Interest (AOI) via, questionnaire-based surveying, and geo-coding of activities methods have been used in this study.&nbsp; The obtained results revealed that Saddar town covers land use approximately, 4.28% Leisure, 9.38% Shopping, Business or Trade, 7.9% Social, Institutional, or Infrastructure Related, 4.62% Mass Assembly of People, 6.37% Industrial, Manufacturing, and Waste Related, while 5.68% Traveler Movement,5.9% Natural Resource Related,52.40% Residential,3.4% No Human Activity or Unclassified. Approximately, 44.2% of the land use was engaged in capita producing activities, which reflects CBD’s functional strength.&nbsp; Overall, it recommended that there should be more green spaces in the CBD to improve air quality. Vertical urban gardening/forest can be implemented as Saddar has limited space and it is a concrete jungle having very less open space