Journal of Liaquat University of Medical & Health Sciences

HIV Infection in Sindh, Pakistan: Outbreaks, Challenges, and Recommendations

Nasreen Inayat Bughio — Fri, 28 Jun 2024 00:00:00 +0500

Human Immunodeficiency Virus (HIV) infection remains a significant public health and medical problem worldwide. Today, there are over 40 million persons living with HIV (between the age of 15-49) worldwide. More than 630,000 individuals have died from AIDS-related illnesses in 2022. However, due to adherence to HIV Anti-Retroviral Therapy (ART), AIDS-related deaths have decreased by 69% in 2022.

Prevalence and Characteristics of Hypertension among CKD Patients in Sudan: A Systematic Review and Meta-analysis

Gasmelseed Ahmed, Ahmed A. Osman, Abdelraheem Ali, AbdAllah Basheer — Fri, 28 Jun 2024 00:00:00 +0500

The rate of chronic kidney diseases (CKD) is increasing steadily in Sudan, and hypertension remains one of the most common coexisting conditions among the patients. In this meta-analysis, we aimed to answer the review question (what is the prevalence of hypertension among patients with advanced CKD in Sudan?). We applied a guidelines checklist for the literature search about the (PRISMA-P 2015). We searched Google Scholar, PubMed, Cochrane Library, Embase, and Medline electronic databases for all articles on CKD conducted in Sudan. Eventually, we identified 23 studies, and only eight were included in the final meta-analysis. Out of the eight articles, there is a total sample of 2682 patients who were presented and diagnosed with advanced stage CKD; among them, 864 were found to be hypertensive, and the overall pooled prevalent rate of hypertension was 32% (95% CI 25% to 39%) with 91% heterogeneity. The lowest rate of hypertension among patients diagnosed with CKD was falling in the range of (14%-21%). We assessed the heterogeneity among studies using the I2, T2, and Q statistics. The results showed a funnel plot with asymmetrical distribution for effect sizes. The literature and evidence-based data on CKD in Sudan are scarce. However, the eight studies reviewed revealed elevated odds of CKD among patients with hypertension. The burden of the increased rate of CKD associated with prevalent hypertension and DM is a call for authorities for urgent interventional response.

Lymphocytic Choriomeningitis Virus (LCMV): Current Status and Future Directions for Clinical and Molecular Diagnostic Techniques

Fri, 28 Jun 2024 00:00:00 +0500

Lymphocytic choriomeningitis virus is an RNA virus that is often overlooked despite the potential to cause severe illness. It is a significant cause of viral meningitis, particularly in specific clinical situations. LCMV is transmitted to humans when they come into contact with the secretions of infected mice, and its strong neurotropism primarily results in neurological symptoms. The most vulnerable populations are fetuses and immunosuppressed individuals. LCMV infection acquired through various means can manifest with a wide range of clinical symptoms, varying from being asymptomatic to severe manifestations.

Additionally, in cases where individuals are affected by this viral infection, it can result in fatal central nervous system disorders. Specifically, in pregnant women, intrauterine LCMV infection has been observed to lead to fetal or neonatal mortality. Furthermore, it can cause chorioretinitis and hydrocephalus in infants, which not only causes significant harm but also results in long-term impairments.

Timely identification and immediate intervention are crucial in improving the prognosis, especially among high-risk groups and regions where the infection is prevalent. Failure to promptly diagnose the condition can lead to significant mortality rates and leave survivors with long-term neurological complications. Consequently, it is imperative to utilize the most appropriate laboratory diagnostic approach, considering the patient's clinical symptoms, exposure history to the virus, and the prevalence of the pathogen in the area, to facilitate accurate clinical detection. This comprehensive review encompasses various diagnostic methodologies employed in managing LCMV, encompassing clinical manifestations, diagnosis, treatment, and potential complications associated with viral infections affecting the central nervous system.

Frequency and Antifungal Susceptibility of Candida Albicans and Non-albicans Candida Isolates from Diabetic Foot Ulcer at Tertiary Care Hospitals of Peshawar

Haider Ali, Sehar Khaliq, Bushra Ali, Nimra Ali, Shahid Ahmad Abbassi — Fri, 28 Jun 2024 00:00:00 +0500

OBJECTIVE: To study the frequency and antifungal susceptibility of the Candida albicans and non-albican species in diabetic foot infections from samples collected in a tertiary care hospital of district Peshawar.

METHODOLOGY: This cross-sectional study was conducted from March 2020 to February 2021 in Khyber Teaching Hospital and Hayatabad Medical Complex, Peshawar. Specimen for culture swabs or tissue from diabetic foot ulcers was taken using aseptic methods. If pus was absent in the wound, ulcer scraping was collected. One tissue sample was soaked in 10% KOH for microscopy, while the second sample was used for fungal culture and sensitivity using Sabouraud dextrose agar.

RESULTS: Of the 600 samples, 200 patients had diabetic foot ulcers with positive fungal culture from Males 102(51%) and Females 98(49%). The age range was 40-78 years. The frequency of C. albicans, C. dubliniensis, C. famata, C. glabrata, C. parapsilosis, and C. lusitaniae was 23(11.5%), 27(13.5%), 19(9.5%), 19(9.5%), 88(44%) and 24(12%). C. albicans was the most common fungal species. Antifungal susceptibility testing was done, and resistance to drugs like Amphotericin, Caspofungin, Fluconazole, Flucytosine, Itraconazole, Micafungin, Voriconazole which was 6.5%, 16%, 25.5%, 5.5%, 3%, 22.5%, 21% respectively. Resistance to Fluconazole, Micafungin and Voriconazole was the highest among all commonly used antifungal drugs.

CONCLUSION: Fungal infection in diabetic foot ulcers usually does not respond to antibiotics. Candia albicans and non-albicans spp are also associated with diabetic foot ulcer infection and inflammation, and these fungi have the highest resistance to commonly used antifungal agents.

Association of Maternal Factors with Low Birth Weight Newborns

Hamayun Anwar, Anila Farhat, Ajaz Ahmed, Bushra Bashir, Khalid Khan, Irfan Khan — Fri, 28 Jun 2024 00:00:00 +0500

OBJECTIVE: To determine the association of maternal factors with low birth weight (LBW) newborns at King Abdullah Teaching Hospital, Mansehra.

METHODOLOGY: This descriptive cross-sectional study was done at the Department of Pediatrics and labor room of King Abdullah Teaching Hospital, Mansehra, Pakistan, from June to November 2021. A total of 171 women aged 18-30 who had a singleton pregnancy ?37 completed weeks of gestation were enrolled and evaluated for the presence of risk factors associated with the incidence of LBW in infants. The outcome regarding the frequency of low birth weight and its associations with Maternal factors were recorded.

RESULTS: In a total of 171 women, 77(45.0%) had short stature, while 57(33.3%) weighed 50 kg or less. The frequency of anemia was noted in 56 (32.7%). Out of 171 women who gave a singleton live birth, 63(36.8%) newborns were LBW. A significantly less proportion of mothers had maternal age between 18-25 who delivered LBW babies (74.6% vs. 44.4%, p=0.0001). Short stature among mothers was significantly associated with LBW (58.7% vs. 37.0%, p=0.0060). Maternal weight less than or equal to 50 kg was also linked with LBW (42.9% vs. 27.8%, p=0.0436). Anemia is significantly associated with LBW (49.2% vs 23.1%, p=0.0005).

CONCLUSION: The frequency of LBW was noted to be high. Maternal age between 18-25 years, short stature, low maternal weight (>50 kg), and anemia during pregnancy can significantly raise the risk of LBW.

Effects of Virtual Reality on Static and Dynamic Balance Among Individuals with Down Syndrome

Fri, 28 Jun 2024 00:00:00 +0500

Objective: To determine the effects of virtual reality on static and dynamic balance among individuals with Down syndrome.

Methodology: A quasi-experimental study was conducted at Imran Rehabilitation Center, Karachi, Pakistan, from Nov 2020 to April 2021 through a randomized sampling technique. Twenty-four Down syndrome individuals between 6 and 9 years of Age were included. Children who could stand and walk independently, comprehend the instructions and were diagnosed with 50% to 70% IQ level (assessed using the Stanford Binet Intelligence Scale) were included. In contrast, DS children with autism, impaired vision or hearing loss and any associated neurological disorders, i.e. Epilepsy, muscular dystrophies and traumatic brain injury (TBI), were excluded. Data was analyzed using the SPSS version 23.

Results: Group A (n=12) participants had a mean age of 8.08±0.79 years, and Group B (n=12) participants had a mean age of 7.61±0.94 years. Both groups had similar gestational Age and IQ levels. The Pediatric Balance Scale (PBS) and Rhomberg test assessed balance and motor control. Within-group analysis revealed significant improvements in both groups for PBS scores. Group analysis did not demonstrate significant differences in the PBS scores or Rhomberg test outcomes. The mean PBS scores for Group A and Group B were 50.33±2.22 and 49.41±3.20, respectively. In the Rhomberg test, no significant differences were found between the two groups with eyes open or closed.

Conclusion: The study concluded that static and dynamic balance was significantly improved in both groups; however, virtual reality group intervention showed a more significant improvement in static balance.

Prevalence and Risk Factors of Metabolic Syndrome in Women with Polycystic Ovarian Syndrome

Fri, 28 Jun 2024 00:00:00 +0500

Objective: To find out the prevalence and risk factors of metabolic syndrome among females presenting with polycystic ovarian syndrome (PCOS) in a tertiary care setting.

Methodology: This cross-sectional study was performed at the Department of Obstetrics and Gynecology, The Combined Military Hospital (CMH), Rawalpindi, Pakistan, from January to December 2022. A total of 277 non-pregnant females aged 18-35 years and diagnosed with PCOS presenting in the outpatient department were analyzed. Metabolic syndrome was diagnosed according to the AHA/NHLBI (ATP III) definition, while PCOS was labeled as per Rotterdam consensus guidelines. Prevalence of metabolic syndrome and associated risk factors were noted.

Results: In a total of 277 women with PCOS, the mean age was 27.4±5.6 years, while 149 (53.8%) women were aged between 18 and 25. The residential status of 189 (68.2%) women was rural. There were 81 (29.2%) women with PCOS who were found to have metabolic syndrome. Waist circumference ? 80 cm (p=0.0031), HDL cholesterol < 50 mg/dl (p<0.0001), triglyceride ? 150 mg/dl (p<0.0001), hypertension (p<0.0001) and fasting blood glucose (FBG) > 110 mg/dl (p<0.0001) were having significant association with the presence of metabolic syndrome.

Conclusion: A high prevalence of metabolic syndrome was found among women with polycystic ovarian syndrome. Central obesity, hypertension and abnormal levels of FBG, triglyceride and high-density lipoprotein were found to have a significant association with MBS among women with PCOS.

Exploring Perspectives of Disaster Survivors on Islamic-Based Nurses' Disaster Response Competencies: A Study from Disaster Front Area

Cut Husna, Hajjul Kamil, Mustanir Yahya, Teuku Tahlil — Fri, 28 Jun 2024 00:00:00 +0500

Objective: The study aims to explore the perspective of disaster survivors on Islamic-based nurses' competencies in response to disasters, principally in handling psychological, psychosocial, and spiritual conditions.

Methodology: A qualitative study with a descriptive phenomenology design was conducted. The data collection using a focus group discussion with five interview guides for nine disaster survivors was involved in this study. The data was evaluated through thematic analysis using sub-themes and themes, followed by qualitative steps.

Results: The study identified three themes related to disaster survivors' perspective: 1) Perception of disaster: tests and punishments, 2) Nurses' competencies: skills and attitude, and 3) Integrating Islamic values: spiritual support and motivation.

Conclusion: The study indicated that the Islamic-based nurses' disaster response competencies identified an essential role in dealing with psychological, psychosocial, and spiritual problems among disaster survivors from the Islamic perspective.

The Outcome of Endonasal Endoscopic Versus Transcanalicular Laser Dacryocystorhinostomy

Fri, 28 Jun 2024 00:00:00 +0500

OBJECTIVE: The purpose of our research was to analyze and compare the outcome of Endonasal Endoscopic (EE-DCR) versus Endoscopic Trans-canalicular Laser assisted Dacryocystorhinostomy (TC-DCR) for the treatment of Dacryocystitis

METHODOLOGY: This study was a non-randomized control trial executed by the Department of Ophthalmology in collaboration with the Otorhinolaryngology (ENT) department at Ziauddin University Hospital Karachi. The study spanned two years, from August 2021 to July 2023. All patients were selected based on inclusion criteria, presented with complaints of epiphora in the ophthalmology department, and were assessed clinically by an ophthalmologist and ENT surgeon. The data was compiled in SPSS 23, and comparative data was analyzed using a chi-square test.

RESULTS: In this research, we analyzed and compared the functional and anatomical outcomes of EE-DCR versus TC-DCR. The mean age of participants was 39.4± 2.3 years in both groups. In the EE-DCR group, there were 15 men (26.3%) and 42 women (73.7%), while in the TC-DCR group, there were 13 men (22.5%) and 27 women (67.5%). The outcome for TC-DCR was successful in 90% of cases, slightly higher than 84.2% for EE-DCR.

CONCLUSION: TC-DCR is considered a better surgical approach than EE-DCR because it is minimally invasive, safe and less time-consuming. The outcome of both procedures was assessed postoperatively in terms of functional and anatomical success rate, and TC-DCR showed slightly better results.

Mutation Screening of the CYP1B1 Gene Reveals Novel and Recurrent Pathogenic Variants in Pakistani Primary Congenital Glaucoma Patients

Fri, 28 Jun 2024 00:00:00 +0500

OBJECTIVE: To identify the pathogenic alleles in primary congenital glaucoma patients for early cure of the disease

METHODology: A cross-sectional descriptive study was carried out after approval from the ethical committee of SIOVS from December 2022 to November 2023 at Sindh Institute of Ophthalmology & Visual Sciences, Hyderabad. The consanguineous pedigree consisting of more than one affected was included, and the pedigree consists only one affected or secondary cause of vision loss was excluded. After getting informed consent, ten cc blood samples from all available participants in the pedigree were drawn, and DNA was extracted. The ARMS Assay and Sanger sequencing methods were adapted to analyze the CYP1B1 gen.

Results: In the present study, one novel c.1187C>T, p.Pro396Leu and one reported c.1169G>A, p.Arg390His allele in CYP1B1 gene were found in two isolated pedigrees enrolled from Sindh Pakistan. ARMS Assay method and the Sanger sequencing method were adopted to detect pathogenic variants. Bioinformatics tools were used to analyze the pathogenesis of identified alleles and compare phenotype-genotype correlation.

CONCLUSION: The findings of novel and frequently reported mutations have a significant role in advancing genetic testing protocols, enabling more accurate targeting of diagnoses and identified alleles that may be added to existing repositories of the genetic database.

A Comprehensive Cross-sectional Analysis of Prevalence of Congenital Color Vision Deficiency among Patients

Fri, 28 Jun 2024 00:00:00 +0500

Objective: To determine the frequency of color vision impairment among Pakistani adults at Polyclinic Hospital Islamabad.

Methodology: This descriptive, cross-sectional study was conducted at Federal Government Polyclinic Hospital, Islamabad. The research was conducted from March to May 2022, employing a consecutive non-probability sampling methodology. The study centred on a cohort of participants aged 10 to 55 who received medical attention at the Ophthalmology Outpatient Department. Sampling was done using the non-probability consecutive sampling technique. The sample size was 104 patients. All adults aged between 10-55 years were included except Patients having a history of Ocular or Neurological surgery, Trauma and Patients diagnosed with Diabetes or Hypertension were excluded. The gathered data was entered and analyzed using IBM SPSS Statistics version 20.

Results: A total of 104 candidates underwent color vision assessment. 3.8% (4/104) of the candidates were color vision deficient. All of them were unaware of their condition.

Conclusion: The screened Population showed color blindness in 3.8% of the candidates. All of the individuals were unaware of the condition.

Risk Factors, Site and Outcome of Intracranial Hemorrhage in Young Adults

Salma Haji, Munir Afzal — Fri, 28 Jun 2024 00:00:00 +0500

Objective: To determine risk factors and the site and outcome of intracranial Hemorrhage in young adults.

Methodology: This cross-sectional observational study was conducted in neuromedicine ward 28 at Jinnah Postgraduate Medical center, Karachi, from September 2020 to August 2023. All emergency patients with evidence of Neuroimaging and symptomatic intracranial Hemorrhage were included. Using the Glasgow outcome scale, we investigated the risk factors, cause, location and prognosis of intracranial hemorrhage. Traumatic hemorrhages, primary sub-arachnoid hemorrhage and brain tumors were excluded.

Results: 72 patients aged 16 to 40 years were included. Forty were Male patients, 55%, and 32 were female patients, 45%. The risk factors for intracranial hemorrhages were hypertension 60/72 (83.33%), ArterioVenous malformation 7/ 72 (9.33%), Cryptogenic 2/72 (2.77%), drug-induced 1/72 (1.38%), hypocholesterolemia 1/72(1.38%) and tobacco and alcohol intake 1/72 (1.38%). In 36/72 (50%), the location was basal ganglia, 25/72(34.72%) was in lobar, 7/72 (9.72%) in Subarachnoid, and 4/72 (5.55%) in other locations. The outcome was favorable in 65/72 (90.27%) patients.

Conclusion: It has been found that hypertension, even in adults, is the leading risk factor for intracranial Hemorrhage below 40 years of age. Intracranial Hemorrhage is primarily present in the basal ganglia. AV malformation is the second most common risk factor in adults at our setup, and the outcome is good in adults. Drug, smoking, and hypocholesterolemia are less common causes of intracranial Hemorrhage in young adults.

Frequency of Skin Disorders in Type 2 Diabetes Mellitus: A Cross-Sectional Study

Fri, 28 Jun 2024 00:00:00 +0500

Objective: To determine the frequency of different Skin Manifestations in people with type II Diabetes Mellitus who visit a tertiary care unit in Karachi, Pakistan.
Methodology: This cross-sectional study was conducted at Liaquat College of Medical & Dentistry & Darul-Sehat Hospital Karachi from July to Nov 2023. A total of 200 patients with Type II Diabetes Mellitus, attending endocrine & dermatology OPD, were enrolled in this study by using consecutive, non-probability sampling techniques. Demographic parameters were noted. Data was analyzed by SPSS version 20.
Results: Two hundred type II Diabetes Mellitus patients (125 Females and 75 Males) were enrolled in the current study. The mean Age of the patients was 49.62± 10 years, and the mean duration of diabetes was between 6.74± 5.55 years. 115 out of 200 (57.5%) patients showed some skin manifestations. The skin manifestations observed were: Infections (bacterial/fungal) (17.38%), Ulcer & gangrene of foot (6.08%), Pruritis (13.33%), Diabetic dermopathy (10.42%), Foot swelling (7.81), Thick and scaly skin(8.68%), Pigmentation including shin spots (7.81%), Cellulitis (6.07%), Acanthosis nigricans (5.2%), Yellow nails (5.2%), Skin tags(3.46%), Psoriasis (3.46%).
Conclusion: Participants having Diabetes Mellitus type II are found to have a high frequency of skin manifestations (57.5%). The ratio for females was higher than for males. The majority of participants had only one skin manifestation. A noteworthy association was found between higher HbA1c levels (8.1 to 14%) & the presence of cutaneous manifestations.