SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...
Although the recent distribution of yellowfever mosquito, Aedes aegypti (L.), in Pakistan has been restricted to the port city of Karachi, adult and immature mosquitoes breeding in imported tires in warehouses at Landi Kotal (North-West Frontier Province) were identified as Ae. aegypti. The patterns of tire trade and the current disjunct distribution of Ae. aegypti indicated that the introduction into Landi Kotal may have been either from Karachi or India. Thermal fog application of pirimiphos-methyl and residual spray of malathion during 1993 reduced abundance in October-November. Living larvae or adults were not found during January 1994, apparently because of cold weather. However, Ae. aegypti reappeared during May-June 1994, most probably from eggs that overwintered. Population increased during late August when another round of spray using the same insecticides and fenthion as an additional larvicide again reduced abundance. Although this mosquito apparently has not spread into neighboring areas, its survival at Landi Kotal through all seasons despite control measures indicates its potential of becoming established in other areas of Pakistan.
from Khoshab and Chakwal districts of Punjab province for the prevalence of warble. The larvae were collected from the infested goats and identified as P. silenus. The results showed that the prevalence of GWFI was 17.8% (89/500). The number of nodules in the infested animals ranged from 1-14 (6.61±2.4). The breed wise prevalence was in beetle breed (13.2%), local breed (18%) and desi breed (22.9%), respectively. The sex wise prevalence was in male (15.3%) and in female (19.4%). The prevalence based on age showed that the rate of infestation in animals having age group (1-3 year) was 20.9%, (4-6 year) was 14.6% and (>6 year) was18.1%, respectively. The present study showed that these epidemiological factors have a significant effect on the prevalence of WFI in goats of Punjab Province. The results showed the effect of different treatments given to animals on the basis of sex, age groups, infested and non-infested animals. The results of this survey showed that the fly is active from March to June. It was first study on GWFI in Punjab Province; northern part of Pakistan. It would be very helpful in devising the future strategies towards the eradication and control of warble fly in other endemic areas of Pakistan. Keywords: Goat Warble Fly Infestation, GWFI, Prevalence, Przhevalskiana silenus, Khoshab, Chakwal districts, Pakistan Pakistan Punjab Eyaletindede Keçi Nokra Enfestasyonunun Prevalansı Üzerine Epidemiyolojik Bir Çalışma ÖzetBu çalışmanın amacı Pakistan'ın Punjab Eyaletinde Keçi Nokrasının prevalansını tespit etmektir. Keçi Nokrası Przhevalskiana silenus (Diptera: Oestridae) tarafından meydana getirilir. Prevalansın tespiti amacıyla Punjab'ın Khoshab ve Chakwal bölgelerinde Temmuz 2012 ile Ocak 2013 tarihleri arasında toplam 500 adet hayvan incelendi. Larvalar enfekte keçilerden toplandı ve P. silenus olarak identifiye edildi. Keçi Nokrasının prevalansı %17.8 (89/500) olarak tespit edildi. Hayvanlardaki nodüllerin sayısı 1-14 (6.61±2.4) olarak belirlendi. Türlere göre prevalans beetle ırkında %13.2, lokal ırklarda %18 ve desi ırklarda %22.9 olarak tespit edildi. Tekelerde prevalans %15.3 iken dişilerde %19.4 idi. Enfestasyon; 1-3 yaş arası keçilerde %20.9, 4-6 yaş arası olanlarda %14.6 ve 6 yaş üzerilerde %18.1 oranlarında mevcuttu. Araştırılan epidemiyolojik faktörlerin Punjab Eyaletinde Keçi Nokrasının prevalansı üzerinde önemli etkisi olduğu tespit edildi. Çalışmanın sonuçlarına göre nokranın Mart ayından Temmuz ayına kadar aktif olduğu belirlendi. Bu çalışma Keçi Nokrası üzerine Punjab Eyaletinde yapılan ilk çalışmadır. Çalışmanın Pakistan'ın diğer endemik bölgelerinde nokranın eradikasyonu ve kontrol edilmesine yönelik stratejileri belirlemede yararlı olacağı görüşündeyiz.
Introduction While computed tomography (CT) guided lung biopsy has been standard in histological diagnosis of pulmonary lesions, its use is limited to the interventional radiologists only. Ultrasound (US) guided biopsy of pulmonary lesions, which can be performed in-clinic by the pulmonologists only, is becoming a more popular technique. It also has the edge of real-time techniques, multi-planar imaging, and no radiation exposure to the patients. Methods This is a retrospective review of all the patients presenting with pleural-based lung lesions who underwent US-guided biopsy for diagnosis in the Department of Pulmonology, Liaquat University of Medical and Health Sciences Hospital, Hyderabad, Pakistan from 1 st January 2013 till 31 st December 2017. The diagnostic yield, sensitivity, specificity, and accuracy of US-guided biopsies were evaluated for diagnoses of peripheral lung malignancies. Results Ultrasound-guided biopsies for lung lesions has a diagnostic yield of 88.3%, sensitivity of 95.80%, and specificity of 90% with an accuracy of 95.35%. Pneumothorax as an immediate complication was seen only in 1.5% cases. Conclusion US-guided biopsies are a much safer diagnostic alternative to CT-guided biopsy for lung lesions and have high diagnostic yield. It doesn’t require special radiological interventionists, can be performed at patients' bedsides, and the equipment is not as expensive.
BackgroundVitamin D (Vit-D) plays a central role in calcium homeostasis and maintains skeletal integrity. Housewives in Quetta, Pakistan are at increased risk of vitamin D deficiency (VDD). They spend a greater part of their day in cleaning, washing, cooking, managing daily groceries, and other household chores. Thus, little time is left for self-care and outdoor activities. They wear hijab and have very little exposure to sunlight. In addition, their diet is deficient in Vit-D-rich food items, rendering them at high risk of VDD. Fear of getting tanned, melasma, and preference for a fair complexion further limit their sun exposure. This study evaluates the prevalence of VDD in housewives and determines its various risk factors to recommend screening guidelines for VDD. MethodsA cross-sectional study was performed between November 2020 and April 2021 and recruited housewives aged >18 from the outpatient department of a tertiary care hospital in Quetta. Informed consent was obtained from all participants. VDD was defined as a serum 25(OH)-D level <20 ng/mL (50 nmol/L). Sociodemographic variables and information about the dietary habits, perception, attitudes towards sunlight, and daily duration of sunlight exposure were collected. Mean and standard deviation (SD) were calculated for continuous variables and counts, and proportions were calculated for categorical variables like education, age. Univariate and multivariate logistic regression analyses were performed to determine the risk factors and associations of VDD. Data were analyzed by SAS/STAT software (version 9.4).
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