The current Zika outbreak is largest of its kind with 1.4 million cases in Brazil alone.World Health Organization declared the current outbreak as the public health emergency of international concerns.The major route ...The current Zika outbreak is largest of its kind with 1.4 million cases in Brazil alone.World Health Organization declared the current outbreak as the public health emergency of international concerns.The major route of Zika virus transmission is mosquito bites.Sexual transmission and monkey bites are also observed in few cases.There is dire need to evaluate the other routes of transmission like blood transfusion,lactation and contact with body fluids.Zika virus is infecting infants,not only causing microcephaly but also creating number of complications resulting in bad outcomes of pregnancy.In Brazil alone,4 000 cases of microcephaly have observed during the current outbreak.The incidence of Guillian-Barre(GB) syndrome is also observed during the current Zika virus outbreak.GB syndrome is acute medical condition leading the patients to death due to weakness of respiratory muscles or can cause the life time disability.There is no anti-viral drug or vaccine available for Zika virus.Zika infection can be prevented by using mosquito repellents,mosquito nets,cooling rooms by air conditions and wearing full sleeves or permethrin treated clothes.The current outbreak of Zika has not only affected the health care but also caused great economic loss.Estimated loss in Latin America and Caribbean is US$3.5 billion.United Nation's sustainable development goal 3.d stresses the strengthening of early warning,risk reduction and management of national and global health risks.The world will keep on facing new challenges in the form of Ebola or Zika;there is strong need to prepare ourselves for any disease outbreak.展开更多
Globally, over 300 million people are living with viral he-patitis with approximately 1.3 million deaths per year. In 2016, World Health Assembly adopted the Global Health Sector Strategy on viral hepatitis to elimina...Globally, over 300 million people are living with viral he-patitis with approximately 1.3 million deaths per year. In 2016, World Health Assembly adopted the Global Health Sector Strategy on viral hepatitis to eliminate hepatitis by 2030. Different World Health Organization member countries are working on hepatitis control strategies to achieve hepatitis elimination. So far, only 12 countries are on track to achieve hepatitis elimination targets. The aim of the study was to give an update about the progress and challenges to achieving hepatitis elimination by 2030. According to the latest data, 87% of infants had received the three doses of hepatitis B virus （HBV） vaccination in the frst year of their life and 46% of infants had received a timely birth dose of HBV vaccination.There is a strong need to improve blood and injection safety. Rates of hepatitis B and C diagnosis are very low and only 11% of hepatitis B and C cases are diagnosed. There is a dire need to speed up hepatitis diagnosis and find the missing millions of people living with viral hepatitis. Up to 2016, only 3 million hepatitis C cases have been treated. Pricing of hepatitis C virus drugs is also reduced in many countries. The major hurdle to ach-ieve hepatitis elimination is lack of finances to support hepatitis programs. None of the major global donors are committed to invest in the fght against hepatitis. It will be very diffcult for the low and middle-income countries to fund their hepatitis control program. Hepatitis elimination needs strong fnancial and political commitment, support from civil societies, and support from pharmaceutical and medical companies around the globe.展开更多
Objective:To predict the factors associated with progression to severe dengue infection to prevent potentially fatal complications and to identify the determinants of severe complicated dengue.Methods:The study was co...Objective:To predict the factors associated with progression to severe dengue infection to prevent potentially fatal complications and to identify the determinants of severe complicated dengue.Methods:The study was conducted in a tertiary care hospitaldengue ward from September to November 2021 including confirmed dengue infected patients(positive NS1 antigen or antidengue-antibodies IgM).Secondary dengue infection was labelled by positive anti-dengue-antibodies IgG in active dengue infected patients.Detailed history,physical examination,laboratory and radiological parameters,hospital stay(days)and mortality percentages were noted.Patients were classified into three groups according to disease severity:dengue fever(DF),dengue hemorrhagic fever(DHF)and dengue shock syndrome(DSS).The predictors of complicated dengue infection were determined by regression analysis.Results:The most common symptom was fever(96.9%).Among 129 patients,62.8%had DF,31.0%had DHF and only 6.2%developed DSS.History of previous symptomatic dengue and positive anti-dengue-antibodies IgG were present in 100%DSS patients and nearly 75.0%DHF patients(P<0.05).The moratlity rate in patients with DSS,DHF and DF was 50.0%,2.5%and none respectively(P<0.05).Clinical parameters(body aches,bleeding,conjunctival hemorrhage,maculopapular rash,right hypochondrial tenderness,ascites,pleural effusion)and laboratory parameters(thrombocytopenia,raised alanine aminotransferase and secondary dengue infection)were determinants that complicate the dengue infection.Conclusions:Thrombocytopenia,raised alanine aminotransferase and secondary dengue infection are important laboratory parameters to complicate the disease process of dengue infection.展开更多
Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients...Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients required either non-invasive[oxygen≤10 L/min or>10 L/min through mask or nasal prongs,rebreather masks and bilevel positive airway pressure(BiPAP)]or invasive ventilation.For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen,Kaplan Meier and log rank analyses were used.In the end,independent predictors of survival were determined by Cox regression analysis.Results:Invasive ventilation was required by 15.1%patients while 84.9%patients needed non-invasive ventilation.Patients with evidence of thromboembolism,high inflammatory markers and hypoxemia mainly required invasive ventilation.The 30-day in hospital mortality was 72.7%for the invasive group and 12.9%for the non-invasive group(1.8%oxygen<10 L/min,0.9%oxygen>10 L/min,3.6%rebreather mask and 4.5%BiPAP).The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group(P<0.05).Age,presence of co-morbidities,number of days requiring oxygen,rebreather,BiPAP and invasive ventilation were independent predictors of outcome.Conclusions:Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury.Thus,protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.展开更多
Background and Aims:Skeletal manifestation in liver dis-eases represents the minimally scrutinized part of the disease spectrum.Vitamin D deficiency has a central role in developing hepatic osteodystrophy in patients ...Background and Aims:Skeletal manifestation in liver dis-eases represents the minimally scrutinized part of the disease spectrum.Vitamin D deficiency has a central role in developing hepatic osteodystrophy in patients with chronic liver disease.This study aimed to investigate vitamin D levels and their relationship with disease advancement in these patients.Methods:Vitamin D levels were checked in 125 chronic liver disease patients.The patients were classified in three stages according to Child-Pugh score:A,B and C.The relationship of vitamin D levels with Child-Pugh score and other variables in the study was assessed by the contingency coefficient.Correlation and logistic regression analyses were also carried out to find additional predictors of low vitamin D levels.Results:Among the patients,88%had either insufficient or deficient stores of vitamin D,while only 12%had sufficient vitamin D levels(p>0.05).Vitamin D levels were notably related to Child-Pugh class(contingency coefficient=0.5,p<0.05).On univariate and multinomial regression analyses,age,female sex,MELD and Child-Pugh class were predictors of low vitamin D levels.Age,model of end-stage liver disease score and Child-Pugh score were negatively correlated to vitamin D levels(p<0.05).Conclusions:Vitamin D deficiency is notably re-lated to age,female sex and model of end-stage liver disease score,in addition to Child-Pugh class of liver cirrhosis.Vita-min D levels should be routinely checked in patients with ad-vanced liver cirrhosis(Child-Pugh class B and C)and this deficiency must be addressed in a timely manner to improve general well-being of cirrhotic patients.展开更多
基金University Medical College,Foundation University Islamabad,DHA-I Islamabad(44000),Pakistan
文摘The current Zika outbreak is largest of its kind with 1.4 million cases in Brazil alone.World Health Organization declared the current outbreak as the public health emergency of international concerns.The major route of Zika virus transmission is mosquito bites.Sexual transmission and monkey bites are also observed in few cases.There is dire need to evaluate the other routes of transmission like blood transfusion,lactation and contact with body fluids.Zika virus is infecting infants,not only causing microcephaly but also creating number of complications resulting in bad outcomes of pregnancy.In Brazil alone,4 000 cases of microcephaly have observed during the current outbreak.The incidence of Guillian-Barre(GB) syndrome is also observed during the current Zika virus outbreak.GB syndrome is acute medical condition leading the patients to death due to weakness of respiratory muscles or can cause the life time disability.There is no anti-viral drug or vaccine available for Zika virus.Zika infection can be prevented by using mosquito repellents,mosquito nets,cooling rooms by air conditions and wearing full sleeves or permethrin treated clothes.The current outbreak of Zika has not only affected the health care but also caused great economic loss.Estimated loss in Latin America and Caribbean is US$3.5 billion.United Nation's sustainable development goal 3.d stresses the strengthening of early warning,risk reduction and management of national and global health risks.The world will keep on facing new challenges in the form of Ebola or Zika;there is strong need to prepare ourselves for any disease outbreak.
文摘Globally, over 300 million people are living with viral he-patitis with approximately 1.3 million deaths per year. In 2016, World Health Assembly adopted the Global Health Sector Strategy on viral hepatitis to eliminate hepatitis by 2030. Different World Health Organization member countries are working on hepatitis control strategies to achieve hepatitis elimination. So far, only 12 countries are on track to achieve hepatitis elimination targets. The aim of the study was to give an update about the progress and challenges to achieving hepatitis elimination by 2030. According to the latest data, 87% of infants had received the three doses of hepatitis B virus （HBV） vaccination in the frst year of their life and 46% of infants had received a timely birth dose of HBV vaccination.There is a strong need to improve blood and injection safety. Rates of hepatitis B and C diagnosis are very low and only 11% of hepatitis B and C cases are diagnosed. There is a dire need to speed up hepatitis diagnosis and find the missing millions of people living with viral hepatitis. Up to 2016, only 3 million hepatitis C cases have been treated. Pricing of hepatitis C virus drugs is also reduced in many countries. The major hurdle to ach-ieve hepatitis elimination is lack of finances to support hepatitis programs. None of the major global donors are committed to invest in the fght against hepatitis. It will be very diffcult for the low and middle-income countries to fund their hepatitis control program. Hepatitis elimination needs strong fnancial and political commitment, support from civil societies, and support from pharmaceutical and medical companies around the globe.
文摘Objective:To predict the factors associated with progression to severe dengue infection to prevent potentially fatal complications and to identify the determinants of severe complicated dengue.Methods:The study was conducted in a tertiary care hospitaldengue ward from September to November 2021 including confirmed dengue infected patients(positive NS1 antigen or antidengue-antibodies IgM).Secondary dengue infection was labelled by positive anti-dengue-antibodies IgG in active dengue infected patients.Detailed history,physical examination,laboratory and radiological parameters,hospital stay(days)and mortality percentages were noted.Patients were classified into three groups according to disease severity:dengue fever(DF),dengue hemorrhagic fever(DHF)and dengue shock syndrome(DSS).The predictors of complicated dengue infection were determined by regression analysis.Results:The most common symptom was fever(96.9%).Among 129 patients,62.8%had DF,31.0%had DHF and only 6.2%developed DSS.History of previous symptomatic dengue and positive anti-dengue-antibodies IgG were present in 100%DSS patients and nearly 75.0%DHF patients(P<0.05).The moratlity rate in patients with DSS,DHF and DF was 50.0%,2.5%and none respectively(P<0.05).Clinical parameters(body aches,bleeding,conjunctival hemorrhage,maculopapular rash,right hypochondrial tenderness,ascites,pleural effusion)and laboratory parameters(thrombocytopenia,raised alanine aminotransferase and secondary dengue infection)were determinants that complicate the dengue infection.Conclusions:Thrombocytopenia,raised alanine aminotransferase and secondary dengue infection are important laboratory parameters to complicate the disease process of dengue infection.
文摘Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients required either non-invasive[oxygen≤10 L/min or>10 L/min through mask or nasal prongs,rebreather masks and bilevel positive airway pressure(BiPAP)]or invasive ventilation.For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen,Kaplan Meier and log rank analyses were used.In the end,independent predictors of survival were determined by Cox regression analysis.Results:Invasive ventilation was required by 15.1%patients while 84.9%patients needed non-invasive ventilation.Patients with evidence of thromboembolism,high inflammatory markers and hypoxemia mainly required invasive ventilation.The 30-day in hospital mortality was 72.7%for the invasive group and 12.9%for the non-invasive group(1.8%oxygen<10 L/min,0.9%oxygen>10 L/min,3.6%rebreather mask and 4.5%BiPAP).The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group(P<0.05).Age,presence of co-morbidities,number of days requiring oxygen,rebreather,BiPAP and invasive ventilation were independent predictors of outcome.Conclusions:Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury.Thus,protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.
文摘Background and Aims:Skeletal manifestation in liver dis-eases represents the minimally scrutinized part of the disease spectrum.Vitamin D deficiency has a central role in developing hepatic osteodystrophy in patients with chronic liver disease.This study aimed to investigate vitamin D levels and their relationship with disease advancement in these patients.Methods:Vitamin D levels were checked in 125 chronic liver disease patients.The patients were classified in three stages according to Child-Pugh score:A,B and C.The relationship of vitamin D levels with Child-Pugh score and other variables in the study was assessed by the contingency coefficient.Correlation and logistic regression analyses were also carried out to find additional predictors of low vitamin D levels.Results:Among the patients,88%had either insufficient or deficient stores of vitamin D,while only 12%had sufficient vitamin D levels(p>0.05).Vitamin D levels were notably related to Child-Pugh class(contingency coefficient=0.5,p<0.05).On univariate and multinomial regression analyses,age,female sex,MELD and Child-Pugh class were predictors of low vitamin D levels.Age,model of end-stage liver disease score and Child-Pugh score were negatively correlated to vitamin D levels(p<0.05).Conclusions:Vitamin D deficiency is notably re-lated to age,female sex and model of end-stage liver disease score,in addition to Child-Pugh class of liver cirrhosis.Vita-min D levels should be routinely checked in patients with ad-vanced liver cirrhosis(Child-Pugh class B and C)and this deficiency must be addressed in a timely manner to improve general well-being of cirrhotic patients.
