Foreign body ingestion is a commonly encountered presentation.The majority of foreign bodies pass in stool spontaneously within one week or are managed endoscopically within the first 24e48 hours.No guidelines are ava...Foreign body ingestion is a commonly encountered presentation.The majority of foreign bodies pass in stool spontaneously within one week or are managed endoscopically within the first 24e48 hours.No guidelines are available for management of chronically retained foreign bodies at present.A unique case is presented of two chronically retained teaspoons in the stomach that failed endoscopic retrieval and required laparoscopic surgery.Post operatively,the patient did well with no complications.A large foreign body that is not amenable to endoscopic intervention will benefit from surgery.If expertise is available,laparoscopic intervention is a safe and feasible option to remove large foreign bodies from the stomach that is not amenable to endoscopic retrieval.展开更多
Acinetobacter baumannii is among the common nosocomial infections microorganisms in the Intensive Care Unit (ICU). Antimicrobial resistance (AMR) is one of the major significant concerns in developing nations due to e...Acinetobacter baumannii is among the common nosocomial infections microorganisms in the Intensive Care Unit (ICU). Antimicrobial resistance (AMR) is one of the major significant concerns in developing nations due to either over-use or inadequate use of antimicrobial agents. The purpose of this study was to emphasize the potential antimicrobial activity of Nepeta cataria and Basella alba against nosocomial diseases caused by Acinetobacter baumannii. Nepeta cataria and Basella alba leaves were collected from Oldonyo Sabuk National Park and Botanical garden JKUAT respectively. The leaves were dried under shade at room temperature for thirty days. After methanolic and aqueous plant extraction, the percentage yield was determined, and the extracts were subjected to toxicity testing using brine shrimp eggs and preliminary phytochemical screening. The results recorded from this study demonstrated that 70% methanolic extract of Nepeta cataria and Basella alba had greater antimicrobial effect against Acinetobacter baumannii than aqueous extracts. Nepeta cataria extracts showed greater antimicrobial effect than Basella alba extracts. The methanolic plant extracts had MIC values 60 mg/ml when tested against Acinetobacter baumannii. The phytochemical screening showed the presence of various phytochemical constituents from the methanolic and aqueous extraction of Nepeta cataria and Basella alba. The methanolic plant extracts revealed more phytochemicals as compared to aqueous extracts. More phytochemicals were detected from Nepeta cataria than Basella alba plant extracts.展开更多
BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literatu...BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.展开更多
BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HA...BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among adults.AIM To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)infection.METHODS This was a trend analysis conducted at Aga Khan University Hospital Karachi(Sindh,Pakistan)from February 2024 to May 2024.Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed.To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed.Data regarding clinical and laboratory parameters were recorded.The yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among adults.RESULTS A total of 396 patients were found to have acute hepatitis during our study duration.HAV was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV infection.Additionally,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute hepatitis.Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years.The patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV infection.However,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in HEV.CONCLUSION An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.展开更多
Parasites have coexisted with humans throughout history,forming either symbiotic relationships or causing significant morbidity and mortality.The liver is particularly vulnerable to parasitic infections,which can resi...Parasites have coexisted with humans throughout history,forming either symbiotic relationships or causing significant morbidity and mortality.The liver is particularly vulnerable to parasitic infections,which can reside in,pass through,or be transported to the liver,leading to severe damage.This editorial explores various parasites that infect the liver,their clinical implications,and diagnostic considerations,as discussed in the article“Parasites of the liver:A global problem?”.Parasites reach the liver primarily through oral ingestion,mucosal penetration,or the bloodstream,with some larvae even penetrating the skin.Hepatic parasites such as cestodes(Echinococcus),trematodes(Clonorchis,Opisthorchis),nematodes(Ascaris),and protozoa(Entamoeba histolytica)can also cause systemic infections like visceral leishmaniasis,malaria,cryptosporidiosis,and toxoplasmosis.Chronic infections like clonorchiasis and opisthorchiasis are linked to persistent hepatobiliary inflammation,potentially progressing to cholangiocarcinoma,a fatal bile duct cancer,particularly prevalent in Southeast Asia.The global nature of liver parasite infestations is alarming,with hundreds of millions affected worldwide.However,control over treatment quality remains suboptimal.Given the significant public health threat posed by these parasites,international medical organizations must prioritize improved diagnosis,treatment,and preventive measures.Strengthening educational efforts and enhancing healthcare provider training are critical steps toward mitigating the global impact of parasitic liver diseases.展开更多
BACKGROUND Neuroendocrine tumors(NETs)are rare malignancies arising from the diffuse neuroendocrine system,often in the gastroenteropancreatic(GEP)tract.GEP-NETs,primarily involving the intestines(50%)and pancreas(30%...BACKGROUND Neuroendocrine tumors(NETs)are rare malignancies arising from the diffuse neuroendocrine system,often in the gastroenteropancreatic(GEP)tract.GEP-NETs,primarily involving the intestines(50%)and pancreas(30%),may occa-sionally secrete hormones,causing syndromes.Diagnosis relies on markers like chromogranin A,synaptophysin,and Ki-67,along with imaging modalities.Ri-sing NETs incidence is attributed to advancements in diagnostic modalities,parti-cularly endoscopic ultrasonography(EUS).EUS demonstrates high accuracy in detecting small lesions,assessing tumor depth,and identifying locoregional lymph nodes.Despite its proven diagnostic utility,there is limited data on EUS's role in evaluating GEP-NETs in resource-constrained settings like Pakistan.AIM To evaluate the diagnostic role of EUS in characterizing GEP-NETs based on clinical,histopathological,tumor grading,and site-specific differences.METHODS This single-center retrospective descriptive study was conducted at Aga Khan University Hospital,Karachi,a tertiary care hospital,from January 2021 to December 2023.Fourteen adult patients(≥18 years)with suspected NETs who underwent EUS and were diagnosed via histopathology were included.Data on demographics,clinical features,radiological findings,and histopathological characteristics were collected.Descriptive analysis was performed using SPSS version 23,with descriptive statistics expressed as means±SD for continuous variables and frequencies/percentages for categorical data.RESULTS A total of 14 adult GEP-NETs patients who underwent EUS were included,with a mean age of 52±14 years and the majority being male(71.4%).Common clinical presentations included weight loss(85.7%)and abdominal pain(78.6%).Computed tomography scans were performed in 92.9%of cases,with pancreatic masses detected in 42.9%of patients.EUS-guided fine needle biopsy(FNB)had a 100%diagnostic yield.The pancreas was the most common tumor site(57.1%).Histopathology revealed 78.6%of cases as well-differentiated NETs with 42.9%being grade II.Metastases were seen in 57.1%of patients,with the liver being the most common site.Surgical interventions were performed in 28.6%of patients,and all patients were alive at the time of study analysis.CONCLUSION EUS,with accurate imaging and effective EUS-FNB,is the gold standard for GEP-NET diagnosis,aiding tumor assessment and prognosis.Larger studies are needed to validate its impact on management outcomes.展开更多
BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary dra...BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.展开更多
Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial ...Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial minireview cate-gorizes pediatric liver masses by age group to guide hepatology and radiology practice,with an emphasis on imaging characteristics.In children from birth to six years of age,the most common liver masses include hepatoblastoma,the most common primary hepatic malignancy in this age group;infantile hemangioma,a benign vascular tumor with a characteristic appearance on imaging;and mesen-chymal hamartoma,a rare developmental lesion.For children older than six years,liver masses are distinct,with hepatocellular carcinoma being the predo-minant malignant lesion.Benign masses such as focal nodular hyperplasia and hepatocellular adenoma also emerge in this age range,often linked to hormonal influences or metabolic disorders.The masses observed across all pediatric age groups include hepatic cysts,choledochal cysts,hydatid cysts,pyogenic and amebic abscesses,tuberculosis,lymphoma,and metastases,each presenting with unique imaging features essential for differential diagnosis.This minireview provides a comprehensive,age-based overview of pediatric liver masses,focusing on clinical presentation and key imaging findings to support accurate diagnosis and optimize management strategies in clinical hepatology,particularly in low resource settings.展开更多
Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS...Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS) guided, andpercutaneous approaches offers only modest success rates. Motorized spiralenteroscopy (MSE)-assisted ERCP (MSE-ERCP) has emerged as a potentialalternative. In a retrospective study by Nennstiel et al, MSE-ERCP achieved highsuccess rates for biliary entry (88%) and therapeutic intervention (83%). However,outcomes varied significantly between bilioenteric anastomosis (93%) and nativepapilla (63%), underscoring the importance of anatomy-driven proceduralselection. Despite encouraging efficacy, the global withdrawal of the MSE platformdue to serious device-related complications highlights the ongoing balancebetween feasibility and safety. Future directions should prioritize refinements indevice engineering, multicenter prospective trials comparing MSE with balloonassistedand EUS-guided techniques, and systematic outcome stratification byanatomical subgroup. Such efforts will be critical to defining the role of MSEwithin the therapeutic algorithm for surgically altered anatomy.展开更多
Due to sedentary lifestyle and rising prevalence of obesity,patients with general population and those who are infected with chronic hepatitis B are found to have metabolic dysfunction associated steatotic liver disea...Due to sedentary lifestyle and rising prevalence of obesity,patients with general population and those who are infected with chronic hepatitis B are found to have metabolic dysfunction associated steatotic liver disease(MASLD).Both chronic hepatitis B virus(HBV)infection and MASLD can damage hepatocytes in their own way,but concomitant HBV-MASLD has its own clinical implications.Cherry on top is the presence of diabetes mellitus,hypertension or obesity which added more chances of unfavorable outcomes in these patients.In this article,we co-mment on the article by Wang et al published in the recent issue.This article provides a comprehensive overview of the complex interaction between HBV-MASLD,HBV alone and MASLD alone patients.We discuss key findings from recent studies,including the promising outcomes observed in patients with concurrent HBV and MASLD,warrants further research.The insights presented here offer renewed understanding of this complex interaction.展开更多
Foreign body ingestion is a common gastrointestinal emergency,particularly in children,who account for 80%of cases.While most ingested objects pass spontan-eously,around 20%require medical intervention.In adults,incid...Foreign body ingestion is a common gastrointestinal emergency,particularly in children,who account for 80%of cases.While most ingested objects pass spontan-eously,around 20%require medical intervention.In adults,incidents often occur accidentally during meals,leading to impactions,especially in individuals with underlying esophageal conditions.Endoscopy remains the gold standard for foreign body retrieval,with a success rate exceeding 95%.The type,shape,and location of the foreign body determine the clinical presentation and management approach.Sharp objects,batteries,and large items pose the highest risk of complications,including perforation,obstruction,and chemical injury.Prompt endoscopic removal is guided by established protocols,with emergent inter-vention required for complete esophageal obstruction and high-risk objects.Various retrieval devices,including forceps,snares,baskets,and overtubes,are used based on the nature of the foreign body.Technological advancements,such as artificial intelligence-assisted imaging and endoscopic ultrasound,are impro-ving diagnostic precision and procedural outcomes.Despite these advances,foreign body ingestion can still lead to severe complications if not managed in a timely manner.Public awareness,preventive measures,and rapid medical res-ponse are essential in reducing morbidity and mortality associated with foreign body ingestion.展开更多
Online learning has taken root and with the advancement in technology more and more educators are embracing online learning.During the COVID-19 pandemic,with total shut down of face-to-face learning,the Kenyan governm...Online learning has taken root and with the advancement in technology more and more educators are embracing online learning.During the COVID-19 pandemic,with total shut down of face-to-face learning,the Kenyan government had moved learning online and remotely.To find out on how learners in remote areas were experiencing learning during the COVID-19 pandemic,a study was carried out using rapid ethnography design.Five final year secondary students were sampled.Data was collected through interviews,observations,and document analysis.This paper reports on the findings of online and remote learning platforms,which were available,accessed,and preferred by the learners in remote areas of Kenya during the pandemic.It also highlights the importance of e-learning platforms in addressing learning experiences and success.展开更多
Background:Epilepsy is a disease characterized by unprovoked seizures,and it affects around 70 million people worldwide.Standard treatment is ineffective in one third of all epilepsy patients.Temporal Lobe Epilepsy wi...Background:Epilepsy is a disease characterized by unprovoked seizures,and it affects around 70 million people worldwide.Standard treatment is ineffective in one third of all epilepsy patients.Temporal Lobe Epilepsy with Hippocampal Sclerosis(TLE-HS)is the most drug-resistant form of epilepsy,and it also impacts physical,mental,and psychological well-being of patients.Carum carvi extract has demonstrated anti-convulsant,anti-depressant,and anxiolytic properties.This study was designed to investigate if Carum carvi extract can alleviate depression and memory loss symptoms in a TLE-HS animal model.Methods:Male Sprague Dawley rats were used to create a model of TLE-HS and Carum carvi extract treatment,along with appropriate controls,was used to test the efficacy of this herbal extract in reducing the symptoms of depression and memory loss.Results:Forced swim test showed that Carum carvi extract treated TLE-HS rats resulted in significant improvement of the symptoms of depression.However,novel object recognition test showed that memory improvement did not occur.Conclusion:Depression significantly impacts the quality of life in TLE-HS patients,and this study has shown that Carum carvi extract should be explored further as an adjuvant treatment for TLE-HS patients to improve their quality of life.展开更多
BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitop...BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitopes of the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein.The purpose of this study is to report experience with tixagevimab/cilgavimab administered to KTRs who were within 1 year of transplantation.AIM To describe outcomes of KTRs who received tixagevimab/cilgavimab early posttransplant to prevent coronavirus disease 2019(COVID-19).METHODS This is a single-center retrospective cohort study of adult KTRs who underwent kidney transplantation from January 1,2022 to September 30,2022 and received tixagevimab/cilgavimab 300 mg/300 mg for prevention of COVID-19.Outcomes of interest were adverse events associated with tixagevimab/cilgavimab,COVID-19 breakthrough infection and COVID-19-associated hospitalization and complications.We also conducted a systematic review of the literature for the use of tixagevimab/cilgavimab as pre-exposure prophylaxis for COVID-19 in solid organ transplant recipients(SOTRs)from inception to December 31,2023.RESULTS There were 104 patients included with median age of 50 years(range 21-72 years).Omicron strain of the COVID-19 virus was the predominantly circulating variant at the time of current study.Patients testing positive for COVID-19 were given tixagevimab/cilgavimab for prophylaxis of complications during the median of 3 days(range 0-201 days)after kidney transplant,of whom 97(93.3%)received the antibodies prior to discharge.No discernable adverse effects attributable to the medication were observed during the time they received prophylaxis.The efficacy of the drug assessed through the absence of breakthrough infections were observed in 91 patients.13(12.5%)patients developed COVID-19 breakthrough infections during an overall median follow-up period of 125 days(range 10-257 days)after tixagevimab/cilgavimab.These infections were observed at median 105 days(range 6-211 days)after receiving the prophylactic medication.5(4.8%)of overall patients required hospitalization and there were no reported deaths in the cohort.Findings of the systematic review were consistent with our findings wherein tixagevimab/cilgavimab was well tolerated by SOTRs.CONCLUSION Tixagevimab/cilgavimab has a favorable safety profile when administered in newly transplanted kidney recipients.Although breakthrough infections were not uncommon,there was a low rate of hospitalization and no deaths.This study highlights the need to examine the efficacy of novel monoclonal antibodies administered for COVID-19 prophylaxis in newly transplanted recipients.展开更多
OBJECTIVE:To explore the potential of combining natural herbs like chamomile and saffron for the management of anxiety and depression.METHODS:A rodent model of Major Depressive Disorder(MDD)and anxiety,secondary to st...OBJECTIVE:To explore the potential of combining natural herbs like chamomile and saffron for the management of anxiety and depression.METHODS:A rodent model of Major Depressive Disorder(MDD)and anxiety,secondary to streptozotocin-induced diabetes mellitus was made.A total of 6 rat groups were chosen;healthy and diseased controls;and diseased test groups of fluoxetine,saffron,chamomile,and combined saffron and chamomile treated(n=6/group).Activity by forced swim test(FST),elevated plus maze test(EPMT),and correlations with biochemical markers like serum glucose,tryptophan,C-reactive protein(CRP),brain derived neurotrophic factor(BDNF)and 5-hydroxytryptamine 2C receptor(5HT2CR)expression,were assessed at the end of the 3rd week of the treatment.A one-way analysis of variance with a post-hoc Tukey's test was applied.RESULTS:The combined herbal treatment group showed significantly better(P<0.05)than all other groups in terms of anti-hyperglycemic effect.All treatments improved the CRP levels;however,the combination group was also significantly better than fluoxetine and the individual herb groups.Only the herb groups showed efficacy in the FST with added benefits of the combination group over the healthy controls and similar trends in the EPMT.However,expression of 5HT2CR was repressed while BDNF was elevated through treatment.CONCLUSION:This study shows that in comparison to treatment with a SSRI,and individual herbs,the combination of chamomile and saffron showed overall improved outcomes.展开更多
BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)wit...BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.展开更多
Objective： Terrorism-relatedbomb at- tacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to impro- vised explosive devices have not been widely reported in...Objective： Terrorism-relatedbomb at- tacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to impro- vised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan Uni- versity Hospital, Pakistan （AKUH）. Further, a few pertinent management guidelines have also been discussed. Methods： The hospital database and clinical coding during a 5-year period were examined for head injuries se- condary to terrorism-associated blasts. In addition to pa- tient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, manage- ment （conservative or operative） to associated complications, and discharge neurological status. Results： A total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients （mean follow-up： 7.8 months）, with most patients having no active complaints. Conclusion： The results of this series show that civi- lian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.展开更多
BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest cli...BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.展开更多
BACKGROUND Stem cells are undifferentiated cells that possess the potential for self-renewal with the capacity to differentiate into multiple lineages.In humans,their limited numbers pose a challenge in fulfilling the...BACKGROUND Stem cells are undifferentiated cells that possess the potential for self-renewal with the capacity to differentiate into multiple lineages.In humans,their limited numbers pose a challenge in fulfilling the necessary demands for the regeneration and repair of damaged tissues or organs.Studies suggested that mesenchymal stem cells(MSCs),necessary for repair and regeneration via transplantation,require doses ranging from 10 to 400 million cells.Furthermore,the limited expansion of MSCs restricts their therapeutic application.AIM To optimize a novel protocol to achieve qualitative and quantitative expansion of MSCs to reach the targeted number of cells for cellular transplantation and minimize the limitations in stem cell therapy protocols.METHODS Human umbilical cord(hUC)tissue derived MSCs were obtained and re-cultured.These cultured cells were subjected to the following evaluation pro-cedures:Immunophenotyping,immunocytochemical staining,trilineage differentiation,population doubling time and number,gene expression markers for proliferation,cell cycle progression,senescence-associatedβ-galactosidase assay,human telomerase reverse transcriptase(hTERT)expression,mycoplasma,cytomegalovirus and endotoxin detection.RESULTS Analysis of pluripotent gene markers Oct4,Sox2,and Nanog in recultured hUC-MSC revealed no significant differences.The immunophenotypic markers CD90,CD73,CD105,CD44,vimentin,CD29,Stro-1,and Lin28 were positively expressed by these recultured expanded MSCs,and were found negative for CD34,CD11b,CD19,CD45,and HLA-DR.The recultured hUC-MSC population continued to expand through passage 15.Proliferative gene expression of Pax6,BMP2,and TGFb1 showed no significant variation between recultured hUC-MSC groups.Nevertheless,a significant increase(P<0.001)in the mitotic phase of the cell cycle was observed in recultured hUC-MSCs.Cellular senescence markers(hTERT expression andβ-galactosidase activity)did not show any negative effect on recultured hUC-MSCs.Additionally,quality control assessments consistently confirmed the absence of mycoplasma,cytomegalovirus,and endotoxin contamination.CONCLUSION This study proposes the development of a novel protocol for efficiently expanding stem cell population.This would address the growing demand for larger stem cell doses needed for cellular transplantation and will significantly improve the feasibility of stem cell based therapies.展开更多
Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP lev...Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.展开更多
文摘Foreign body ingestion is a commonly encountered presentation.The majority of foreign bodies pass in stool spontaneously within one week or are managed endoscopically within the first 24e48 hours.No guidelines are available for management of chronically retained foreign bodies at present.A unique case is presented of two chronically retained teaspoons in the stomach that failed endoscopic retrieval and required laparoscopic surgery.Post operatively,the patient did well with no complications.A large foreign body that is not amenable to endoscopic intervention will benefit from surgery.If expertise is available,laparoscopic intervention is a safe and feasible option to remove large foreign bodies from the stomach that is not amenable to endoscopic retrieval.
文摘Acinetobacter baumannii is among the common nosocomial infections microorganisms in the Intensive Care Unit (ICU). Antimicrobial resistance (AMR) is one of the major significant concerns in developing nations due to either over-use or inadequate use of antimicrobial agents. The purpose of this study was to emphasize the potential antimicrobial activity of Nepeta cataria and Basella alba against nosocomial diseases caused by Acinetobacter baumannii. Nepeta cataria and Basella alba leaves were collected from Oldonyo Sabuk National Park and Botanical garden JKUAT respectively. The leaves were dried under shade at room temperature for thirty days. After methanolic and aqueous plant extraction, the percentage yield was determined, and the extracts were subjected to toxicity testing using brine shrimp eggs and preliminary phytochemical screening. The results recorded from this study demonstrated that 70% methanolic extract of Nepeta cataria and Basella alba had greater antimicrobial effect against Acinetobacter baumannii than aqueous extracts. Nepeta cataria extracts showed greater antimicrobial effect than Basella alba extracts. The methanolic plant extracts had MIC values 60 mg/ml when tested against Acinetobacter baumannii. The phytochemical screening showed the presence of various phytochemical constituents from the methanolic and aqueous extraction of Nepeta cataria and Basella alba. The methanolic plant extracts revealed more phytochemicals as compared to aqueous extracts. More phytochemicals were detected from Nepeta cataria than Basella alba plant extracts.
文摘BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.
文摘BACKGROUND For decades,hepatitis A virus(HAV)has been a leading cause of acute hepatitis among children and was less prevalent among adults.However,recently a paradigm shift has been observed in the epidemiology of HAV,as evident by cases of acute hepatitis due to HAV among adults.AIM To estimate frequency of HAV in acute viral hepatitis and compare characteristics in HAV and hepatitis E virus(HEV)infection.METHODS This was a trend analysis conducted at Aga Khan University Hospital Karachi(Sindh,Pakistan)from February 2024 to May 2024.Individuals aged 18 years and older diagnosed with acute viral hepatitis attributed to hepatotropic viruses in 2024 were reviewed.To compare the trend patients admitted with acute hepatitis during 2019-2023 were also reviewed.Data regarding clinical and laboratory parameters were recorded.The yearly trend of acute hepatitis due to HAV and HEV was analyzed,and comparative analysis was done between HAV and HEV cases among adults.RESULTS A total of 396 patients were found to have acute hepatitis during our study duration.HAV was diagnosed in 234 patients(59%)while 157 patients(39.6%)were found to have acute HEV infection.Additionally,acute hepatitis B virus infection was identified in 3 patients(0.7%),whereas acute hepatitis C virus infection was found in 2(0.5%)cases of acute hepatitis.Yearly trends showed increasing occurrence of HAV infection among adults over last 5 years.The patients with acute HAV were younger than patients with HEV(28 years±8 years vs 30 years±8 years;P<0.01).Higher levels of total bilirubin were seen in HEV infection,while higher levels of alanine transaminase were seen in HAV infection.However,a higher proportion of acute liver failure(ALF),coagulopathy,and mortality were observed in HEV.CONCLUSION An increase in acute hepatitis A cases among adults shows less severity than hepatitis E,highlighting the need for better sanitation,hygiene,and adult hepatitis A vaccination programs.
文摘Parasites have coexisted with humans throughout history,forming either symbiotic relationships or causing significant morbidity and mortality.The liver is particularly vulnerable to parasitic infections,which can reside in,pass through,or be transported to the liver,leading to severe damage.This editorial explores various parasites that infect the liver,their clinical implications,and diagnostic considerations,as discussed in the article“Parasites of the liver:A global problem?”.Parasites reach the liver primarily through oral ingestion,mucosal penetration,or the bloodstream,with some larvae even penetrating the skin.Hepatic parasites such as cestodes(Echinococcus),trematodes(Clonorchis,Opisthorchis),nematodes(Ascaris),and protozoa(Entamoeba histolytica)can also cause systemic infections like visceral leishmaniasis,malaria,cryptosporidiosis,and toxoplasmosis.Chronic infections like clonorchiasis and opisthorchiasis are linked to persistent hepatobiliary inflammation,potentially progressing to cholangiocarcinoma,a fatal bile duct cancer,particularly prevalent in Southeast Asia.The global nature of liver parasite infestations is alarming,with hundreds of millions affected worldwide.However,control over treatment quality remains suboptimal.Given the significant public health threat posed by these parasites,international medical organizations must prioritize improved diagnosis,treatment,and preventive measures.Strengthening educational efforts and enhancing healthcare provider training are critical steps toward mitigating the global impact of parasitic liver diseases.
文摘BACKGROUND Neuroendocrine tumors(NETs)are rare malignancies arising from the diffuse neuroendocrine system,often in the gastroenteropancreatic(GEP)tract.GEP-NETs,primarily involving the intestines(50%)and pancreas(30%),may occa-sionally secrete hormones,causing syndromes.Diagnosis relies on markers like chromogranin A,synaptophysin,and Ki-67,along with imaging modalities.Ri-sing NETs incidence is attributed to advancements in diagnostic modalities,parti-cularly endoscopic ultrasonography(EUS).EUS demonstrates high accuracy in detecting small lesions,assessing tumor depth,and identifying locoregional lymph nodes.Despite its proven diagnostic utility,there is limited data on EUS's role in evaluating GEP-NETs in resource-constrained settings like Pakistan.AIM To evaluate the diagnostic role of EUS in characterizing GEP-NETs based on clinical,histopathological,tumor grading,and site-specific differences.METHODS This single-center retrospective descriptive study was conducted at Aga Khan University Hospital,Karachi,a tertiary care hospital,from January 2021 to December 2023.Fourteen adult patients(≥18 years)with suspected NETs who underwent EUS and were diagnosed via histopathology were included.Data on demographics,clinical features,radiological findings,and histopathological characteristics were collected.Descriptive analysis was performed using SPSS version 23,with descriptive statistics expressed as means±SD for continuous variables and frequencies/percentages for categorical data.RESULTS A total of 14 adult GEP-NETs patients who underwent EUS were included,with a mean age of 52±14 years and the majority being male(71.4%).Common clinical presentations included weight loss(85.7%)and abdominal pain(78.6%).Computed tomography scans were performed in 92.9%of cases,with pancreatic masses detected in 42.9%of patients.EUS-guided fine needle biopsy(FNB)had a 100%diagnostic yield.The pancreas was the most common tumor site(57.1%).Histopathology revealed 78.6%of cases as well-differentiated NETs with 42.9%being grade II.Metastases were seen in 57.1%of patients,with the liver being the most common site.Surgical interventions were performed in 28.6%of patients,and all patients were alive at the time of study analysis.CONCLUSION EUS,with accurate imaging and effective EUS-FNB,is the gold standard for GEP-NET diagnosis,aiding tumor assessment and prognosis.Larger studies are needed to validate its impact on management outcomes.
文摘BACKGROUND Severe acute cholangitis is a potentially life-threatening disease in low-middle income countries(LMIC).Due to limited endoscopic services,these patients mostly undergo percutaneous transhepatic biliary drainage(PTBD).Studies from developed countries reported more complications with PTBD as compared with endoscopic retrograde cholangiopancreatography(ERCP).AIM To compare safety,therapeutic success,and survival among the PTBD and ERCP procedure in severe cholangitis in LMIC.METHODS A retrospective study was conducted in the Aga Khan University Hospital from January 2017 to December 2023.All patients who had severe acute cholangitis and underwent ERCP or PTBD were included.Patients were followed for complications,procedure success,and mortality.Data was gathered through an electronic medical record system and analyzed usingχ²and two sample t-tests.RESULTS A total of 33 patients were recruited,consisting of 12 females and 21 males with a mean age of 61 years.Among these participants,12 patients underwent ERCP,and the remaining 21 patients underwent PTBD.Therapeutic success was seen more in the ERCP group[11/12(97.1%)]than in the PTBD group[12/21 patients(57.1%)].Post-procedure complications were seen in both groups;however,more were observed in the PTBD cohort with a significant P value of 0.02.There were no mortalities among the patients who underwent ERCP while 5(23.8%)mortalities were seen in the PTBD group.CONCLUSION Fewer post-procedure complications and deaths were observed after ERCP than after PTBD,laying the foundation for large prospective studies and shifting the local paradigm of acute cholangitis treatment in LMICs.
文摘Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial minireview cate-gorizes pediatric liver masses by age group to guide hepatology and radiology practice,with an emphasis on imaging characteristics.In children from birth to six years of age,the most common liver masses include hepatoblastoma,the most common primary hepatic malignancy in this age group;infantile hemangioma,a benign vascular tumor with a characteristic appearance on imaging;and mesen-chymal hamartoma,a rare developmental lesion.For children older than six years,liver masses are distinct,with hepatocellular carcinoma being the predo-minant malignant lesion.Benign masses such as focal nodular hyperplasia and hepatocellular adenoma also emerge in this age range,often linked to hormonal influences or metabolic disorders.The masses observed across all pediatric age groups include hepatic cysts,choledochal cysts,hydatid cysts,pyogenic and amebic abscesses,tuberculosis,lymphoma,and metastases,each presenting with unique imaging features essential for differential diagnosis.This minireview provides a comprehensive,age-based overview of pediatric liver masses,focusing on clinical presentation and key imaging findings to support accurate diagnosis and optimize management strategies in clinical hepatology,particularly in low resource settings.
文摘Performing endoscopic retrograde cholangiopancreatography (ERCP) in patientswith Roux-en-Y-anatomy is technically challenging and additional techniquesincluding balloon-assisted enteroscopy, endoscopic ultrasound (EUS) guided, andpercutaneous approaches offers only modest success rates. Motorized spiralenteroscopy (MSE)-assisted ERCP (MSE-ERCP) has emerged as a potentialalternative. In a retrospective study by Nennstiel et al, MSE-ERCP achieved highsuccess rates for biliary entry (88%) and therapeutic intervention (83%). However,outcomes varied significantly between bilioenteric anastomosis (93%) and nativepapilla (63%), underscoring the importance of anatomy-driven proceduralselection. Despite encouraging efficacy, the global withdrawal of the MSE platformdue to serious device-related complications highlights the ongoing balancebetween feasibility and safety. Future directions should prioritize refinements indevice engineering, multicenter prospective trials comparing MSE with balloonassistedand EUS-guided techniques, and systematic outcome stratification byanatomical subgroup. Such efforts will be critical to defining the role of MSEwithin the therapeutic algorithm for surgically altered anatomy.
文摘Due to sedentary lifestyle and rising prevalence of obesity,patients with general population and those who are infected with chronic hepatitis B are found to have metabolic dysfunction associated steatotic liver disease(MASLD).Both chronic hepatitis B virus(HBV)infection and MASLD can damage hepatocytes in their own way,but concomitant HBV-MASLD has its own clinical implications.Cherry on top is the presence of diabetes mellitus,hypertension or obesity which added more chances of unfavorable outcomes in these patients.In this article,we co-mment on the article by Wang et al published in the recent issue.This article provides a comprehensive overview of the complex interaction between HBV-MASLD,HBV alone and MASLD alone patients.We discuss key findings from recent studies,including the promising outcomes observed in patients with concurrent HBV and MASLD,warrants further research.The insights presented here offer renewed understanding of this complex interaction.
文摘Foreign body ingestion is a common gastrointestinal emergency,particularly in children,who account for 80%of cases.While most ingested objects pass spontan-eously,around 20%require medical intervention.In adults,incidents often occur accidentally during meals,leading to impactions,especially in individuals with underlying esophageal conditions.Endoscopy remains the gold standard for foreign body retrieval,with a success rate exceeding 95%.The type,shape,and location of the foreign body determine the clinical presentation and management approach.Sharp objects,batteries,and large items pose the highest risk of complications,including perforation,obstruction,and chemical injury.Prompt endoscopic removal is guided by established protocols,with emergent inter-vention required for complete esophageal obstruction and high-risk objects.Various retrieval devices,including forceps,snares,baskets,and overtubes,are used based on the nature of the foreign body.Technological advancements,such as artificial intelligence-assisted imaging and endoscopic ultrasound,are impro-ving diagnostic precision and procedural outcomes.Despite these advances,foreign body ingestion can still lead to severe complications if not managed in a timely manner.Public awareness,preventive measures,and rapid medical res-ponse are essential in reducing morbidity and mortality associated with foreign body ingestion.
文摘Online learning has taken root and with the advancement in technology more and more educators are embracing online learning.During the COVID-19 pandemic,with total shut down of face-to-face learning,the Kenyan government had moved learning online and remotely.To find out on how learners in remote areas were experiencing learning during the COVID-19 pandemic,a study was carried out using rapid ethnography design.Five final year secondary students were sampled.Data was collected through interviews,observations,and document analysis.This paper reports on the findings of online and remote learning platforms,which were available,accessed,and preferred by the learners in remote areas of Kenya during the pandemic.It also highlights the importance of e-learning platforms in addressing learning experiences and success.
基金supported by the URC Aga Khan University(Project ID:212003)Pakistan Science Foundation(Project Code:710110-201-20001-500-53413-0000).
文摘Background:Epilepsy is a disease characterized by unprovoked seizures,and it affects around 70 million people worldwide.Standard treatment is ineffective in one third of all epilepsy patients.Temporal Lobe Epilepsy with Hippocampal Sclerosis(TLE-HS)is the most drug-resistant form of epilepsy,and it also impacts physical,mental,and psychological well-being of patients.Carum carvi extract has demonstrated anti-convulsant,anti-depressant,and anxiolytic properties.This study was designed to investigate if Carum carvi extract can alleviate depression and memory loss symptoms in a TLE-HS animal model.Methods:Male Sprague Dawley rats were used to create a model of TLE-HS and Carum carvi extract treatment,along with appropriate controls,was used to test the efficacy of this herbal extract in reducing the symptoms of depression and memory loss.Results:Forced swim test showed that Carum carvi extract treated TLE-HS rats resulted in significant improvement of the symptoms of depression.However,novel object recognition test showed that memory improvement did not occur.Conclusion:Depression significantly impacts the quality of life in TLE-HS patients,and this study has shown that Carum carvi extract should be explored further as an adjuvant treatment for TLE-HS patients to improve their quality of life.
文摘BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitopes of the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein.The purpose of this study is to report experience with tixagevimab/cilgavimab administered to KTRs who were within 1 year of transplantation.AIM To describe outcomes of KTRs who received tixagevimab/cilgavimab early posttransplant to prevent coronavirus disease 2019(COVID-19).METHODS This is a single-center retrospective cohort study of adult KTRs who underwent kidney transplantation from January 1,2022 to September 30,2022 and received tixagevimab/cilgavimab 300 mg/300 mg for prevention of COVID-19.Outcomes of interest were adverse events associated with tixagevimab/cilgavimab,COVID-19 breakthrough infection and COVID-19-associated hospitalization and complications.We also conducted a systematic review of the literature for the use of tixagevimab/cilgavimab as pre-exposure prophylaxis for COVID-19 in solid organ transplant recipients(SOTRs)from inception to December 31,2023.RESULTS There were 104 patients included with median age of 50 years(range 21-72 years).Omicron strain of the COVID-19 virus was the predominantly circulating variant at the time of current study.Patients testing positive for COVID-19 were given tixagevimab/cilgavimab for prophylaxis of complications during the median of 3 days(range 0-201 days)after kidney transplant,of whom 97(93.3%)received the antibodies prior to discharge.No discernable adverse effects attributable to the medication were observed during the time they received prophylaxis.The efficacy of the drug assessed through the absence of breakthrough infections were observed in 91 patients.13(12.5%)patients developed COVID-19 breakthrough infections during an overall median follow-up period of 125 days(range 10-257 days)after tixagevimab/cilgavimab.These infections were observed at median 105 days(range 6-211 days)after receiving the prophylactic medication.5(4.8%)of overall patients required hospitalization and there were no reported deaths in the cohort.Findings of the systematic review were consistent with our findings wherein tixagevimab/cilgavimab was well tolerated by SOTRs.CONCLUSION Tixagevimab/cilgavimab has a favorable safety profile when administered in newly transplanted kidney recipients.Although breakthrough infections were not uncommon,there was a low rate of hospitalization and no deaths.This study highlights the need to examine the efficacy of novel monoclonal antibodies administered for COVID-19 prophylaxis in newly transplanted recipients.
基金the Higher Education Commission,Islamabad,Pakistan(No.9447/Sindh/NRPU/R&D/HEC/2017)Aga Khan University Dean's Startup Fund,Role of Natural Remedies on Psychoneurological Deficits in Murine Model as Preclinical Studies Associated with or without Diabetes(2017-2021)。
文摘OBJECTIVE:To explore the potential of combining natural herbs like chamomile and saffron for the management of anxiety and depression.METHODS:A rodent model of Major Depressive Disorder(MDD)and anxiety,secondary to streptozotocin-induced diabetes mellitus was made.A total of 6 rat groups were chosen;healthy and diseased controls;and diseased test groups of fluoxetine,saffron,chamomile,and combined saffron and chamomile treated(n=6/group).Activity by forced swim test(FST),elevated plus maze test(EPMT),and correlations with biochemical markers like serum glucose,tryptophan,C-reactive protein(CRP),brain derived neurotrophic factor(BDNF)and 5-hydroxytryptamine 2C receptor(5HT2CR)expression,were assessed at the end of the 3rd week of the treatment.A one-way analysis of variance with a post-hoc Tukey's test was applied.RESULTS:The combined herbal treatment group showed significantly better(P<0.05)than all other groups in terms of anti-hyperglycemic effect.All treatments improved the CRP levels;however,the combination group was also significantly better than fluoxetine and the individual herb groups.Only the herb groups showed efficacy in the FST with added benefits of the combination group over the healthy controls and similar trends in the EPMT.However,expression of 5HT2CR was repressed while BDNF was elevated through treatment.CONCLUSION:This study shows that in comparison to treatment with a SSRI,and individual herbs,the combination of chamomile and saffron showed overall improved outcomes.
文摘BACKGROUND The World Health Organization(WHO)recommends lumbar puncture(LP)procedures to assess the diagnosis of cryptococcal meningitis(CM)among patients with advanced human immunodeficiency virus(HIV)disease(AHD)with positive serum cryptococcal antigen(CrAg)and do not have evidence of CM.AIM To estimate pooled prevalence of uptake of LP,CM and mortality among patients with AHD.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.LP uptake was defined as percentage of people who underwent LP procedures among those with AHD(CD4≤200 cells/mm3 or WHO stage III/IV)and positive serum CrAg.Using random effects models,we computed the pooled estimate of LP uptake,CM and mortality and 95%CI.Stratified analyses were used to compare uptake of LP between studies that involved multiple vs single sites,and mortality analyses between patients with positive and negative serum CrAg were performed.Sensitivity analysis on LP uptake was done by excluding prospective cohort studies that reported 100%uptake.RESULTS A total of 32 studies with 46890 people with AHD screened for serum CrAg and 2730(5.8%)had positive serum CrAg.Overall,pooled prevalence of LP uptake was 67.7%(95%CI:54.0-81.5).The overall pooled prevalence of CM was 54.3%(95%CI:39.7-69.0),and mortality was 6.2%(95%CI:4.5-8.0).There is disparities in the pooled prevalence of LP uptake with studies involving multiple sites having lower prevalence compared to those that involved single sites(54.8%vs 84.7%,P=0.004).By excluding prospective cohort studies that reported 100%uptake,the overall LP uptake was 54.5%(95%CI:38.8-70.1).The pooled prevalence of CM was significantly lower among studies that involved multiple sites compared to those that involved single sites(6.8%vs 8.1%,P≤0.001).Mortality was significantly twice as high among patients who had positive serum CrAg compared to those who had negative serum CrAg[risk ratio=2.0(95%CI:1.6-2.5),P≤0.001].CONCLUSION Nearly three to five in 10 people with AHD with positive serum CrAg did not have LP procedures done,indicating significant gaps in identifying patients with CM.Establishing a confirmed diagnosis of CM is critical to avoid exposing patients to subtherapeutic levels of antifungals preemptively.Capacity to perform LP and patient refusals are among the reasons for not performing the procedure.Capacity building in training health care providers to perform LP procedures and professional counselling to obtain patient consent are critical for appropriate treatment to reduce mortality associated with CM infection.
文摘Objective： Terrorism-relatedbomb at- tacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to impro- vised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan Uni- versity Hospital, Pakistan （AKUH）. Further, a few pertinent management guidelines have also been discussed. Methods： The hospital database and clinical coding during a 5-year period were examined for head injuries se- condary to terrorism-associated blasts. In addition to pa- tient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, manage- ment （conservative or operative） to associated complications, and discharge neurological status. Results： A total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients （mean follow-up： 7.8 months）, with most patients having no active complaints. Conclusion： The results of this series show that civi- lian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.
文摘BACKGROUND With 4.9 to 35 instances per 100000 cases,hyperparathyroidism is one of the rarest causes of acute pancreatitis.The major cause of primary hyperparathyroidism is a parathyroid adenoma,which can manifest clinically in various ways.CASE SUMMARY We discuss the unusual case of a 13-year-old boy with recurrent pancreatitis as the initial presentation of primary hyperparathyroidism.The cause of his recurrent pancreatitis remained unknown,and the patient had multiple admissions with acute pancreatitis over 3 years.His diagnosis was delayed due to the initial normal levels of parathyroid hormone,which were later reported elevated in a subsequent episode where ultrasound neck and thyroid scintigraphy revealed a parathyroid adenoma as the underlying cause.After the diagnosis was made,he underwent surgical resection of the adenoma.CONCLUSION This case study stresses the importance of considering uncommon causes for recurrent pancreatitis.
基金Supported by Higher Education Commission,Islamabad,Pakistan grant,No.20-17590/NRPU/R&D/HEC/20212021.
文摘BACKGROUND Stem cells are undifferentiated cells that possess the potential for self-renewal with the capacity to differentiate into multiple lineages.In humans,their limited numbers pose a challenge in fulfilling the necessary demands for the regeneration and repair of damaged tissues or organs.Studies suggested that mesenchymal stem cells(MSCs),necessary for repair and regeneration via transplantation,require doses ranging from 10 to 400 million cells.Furthermore,the limited expansion of MSCs restricts their therapeutic application.AIM To optimize a novel protocol to achieve qualitative and quantitative expansion of MSCs to reach the targeted number of cells for cellular transplantation and minimize the limitations in stem cell therapy protocols.METHODS Human umbilical cord(hUC)tissue derived MSCs were obtained and re-cultured.These cultured cells were subjected to the following evaluation pro-cedures:Immunophenotyping,immunocytochemical staining,trilineage differentiation,population doubling time and number,gene expression markers for proliferation,cell cycle progression,senescence-associatedβ-galactosidase assay,human telomerase reverse transcriptase(hTERT)expression,mycoplasma,cytomegalovirus and endotoxin detection.RESULTS Analysis of pluripotent gene markers Oct4,Sox2,and Nanog in recultured hUC-MSC revealed no significant differences.The immunophenotypic markers CD90,CD73,CD105,CD44,vimentin,CD29,Stro-1,and Lin28 were positively expressed by these recultured expanded MSCs,and were found negative for CD34,CD11b,CD19,CD45,and HLA-DR.The recultured hUC-MSC population continued to expand through passage 15.Proliferative gene expression of Pax6,BMP2,and TGFb1 showed no significant variation between recultured hUC-MSC groups.Nevertheless,a significant increase(P<0.001)in the mitotic phase of the cell cycle was observed in recultured hUC-MSCs.Cellular senescence markers(hTERT expression andβ-galactosidase activity)did not show any negative effect on recultured hUC-MSCs.Additionally,quality control assessments consistently confirmed the absence of mycoplasma,cytomegalovirus,and endotoxin contamination.CONCLUSION This study proposes the development of a novel protocol for efficiently expanding stem cell population.This would address the growing demand for larger stem cell doses needed for cellular transplantation and will significantly improve the feasibility of stem cell based therapies.
文摘Driving pressure(ΔP)is a core therapeutic component of mechanical ventilation(MV).Varying levels ofΔP have been employed during MV depending on the type of underlying pathology and severity of injury.However,ΔP levels have also been shown to closely impact hard endpoints such as mortality.Considering this,conducting an in-depth review ofΔP as a unique,outcome-impacting therapeutic modality is extremely important.There is a need to understand the subtleties involved in making sureΔP levels are optimized to enhance outcomes and minimize harm.We performed this narrative review to further explore the various uses ofΔP,the different parameters that can affect its use,and how outcomes vary in different patient populations at different pressure levels.To better utilizeΔP in MV-requiring patients,additional large-scale clinical studies are needed.
