Notes

Using a appliance studying way of identify important prognostic molecules regarding esophageal squamous cell carcinoma.
Lady Health Workers (LHWs) form the central cadre of community-based health workers in Pakistan. They must be trained well for implementing community-based interventions identified for Essential Package of Health Services (EPHS) by the government of Pakistan. This study aims to explore the perceptions of LHWs and their trainers about their existing curriculum and identifies gaps in the curriculum for effective implementation of the interventions identified in EPHS.

In this qualitative study, perceptions of 45 LHWs were taken through focus group discussions and their six trainers were interviewed as well. In addition, three experts analyzed the LHWs training curriculum to identify its relevance with achieving the community-based interventions as described in the EPHS by the government of Pakistan.

Thematic analysis of the information gathered by the interviews of trainers and focus group discussions from LHWs, was performed. Most participants were satisfied with their curriculum but suggested the addition of topics on emerging health issues, neonatal resuscitation, mental health and rehabilitation. Participants felt a deficiency in practical skills, communication skills and leadership skills. Experts identified gap in the current LHWs curriculum to address the recently identified community-based interventions.

The current curriculum of LHWs need reforms to make it compatible with Essential Package of Health Services for Pakistan. The suggested areas for improvement include knowledge of emerging health issues, neonatal resuscitation, adolescent problems, mental health and rehabilitative services.
The current curriculum of LHWs need reforms to make it compatible with Essential Package of Health Services for Pakistan. The suggested areas for improvement include knowledge of emerging health issues, neonatal resuscitation, adolescent problems, mental health and rehabilitative services.
Radiology has played a significant role in the diagnosis and quantifying the severity of COVID 19 pulmonary disease. This study was conducted to assess patterns and severity of COVID-19 pulmonary disease based on radiological imaging.

A prospective observational study was conducted in a large tertiary care public sector teaching hospital of Karachi, Pakistan from June 2020 till August 2020. All confirmed and suspected COVID-19 patients referred for chest X-rays and computed tomography (CT) scans were evaluated along with RT-PCR results. Suspected patients were followed for RT-PCR. Radiological features and severity of imaging studies were determined.

Of 533 patients in whom X-rays were performed, majority had severe/critical findings, i.e., 304 (57.03%). Of 97 patients in whom CT scan was performed, mild/moderate findings were observed in 63 (64.94%) patients. Of 472 patients with abnormal X-rays, majority presented with alveolar pattern 459 (97.2%), bilateral lung involvement 453 (89.6%), and consolidation 356 (75.4%). Moreover, lobar predominance showed lower zone preponderance in 446 (94.5%) patients. Of 88 patients with abnormal CT findings, ground-glass opacity (GGO) 87 (98.9%) and crazy paving 69 (78.4%) were the most common findings. An insignificantly higher association of PCR positive cases was observed with severe/critical X-rays (p-value 0.076) and CT scan findings (p-value 0.431).

Most common patterns on CT scans were GGO and crazy paving. While on chest radiographs, bilateral lung involvement with alveolar pattern and consolidation were most common findings. On X-rays, majority had severe/critical whereas CT scan had mild/moderate findings.
Most common patterns on CT scans were GGO and crazy paving. While on chest radiographs, bilateral lung involvement with alveolar pattern and consolidation were most common findings. On X-rays, majority had severe/critical whereas CT scan had mild/moderate findings.
2019-nCoV has become a global threat to human health. The primary objective of this study was to examine the hepatic damage in 2019-nCoV infected patients and the associated underlying causes.

In this retrospective study, a total of 68 laboratory-confirmed and 20 suspected COVID-19 cases from 23
January 2020 to 15
February 2020 were included. The study was conducted in The First People's Hospital of Jingzhou, Hubei. SPSS version 23.0. was used for Statistical analysis using the Student's t-test or Chi-square test. Data was analyzed for the clinical characteristics and underlying causes of liver damage. The outcomes were followed up until March 29, 2020.

Out of the 68 COVID-19 confirmed cases, 51 had an abnormal liver function, of which 15 had an abnormal liver function at the time of hospital admission. The relationship between the liver function and clinical prognosis of patients showed that the abnormal liver function was positively correlated with the severity of the infection (100% vs.70.2%, p=0.036). The proportion of patients with an elevated level of ALT and a depleted level of Albumin (ALB) were significantly lower in the COVID-19 suspected group than the confirmed group (5% vs. 50.9%, p=0.000; 10% vs. 35.8%, p=0.030, respectively). Besides, the utilization rate of lopinavir/ritonavir, azithromycin, and methylprednisolone in COVID-19 suspected patients were significantly lower than the confirmed patients (25% vs. 62.3%, p=0.004; 35% vs. 62.3%, p=0.037; 25% vs. 64.2%, p=0.003, respectively).

Liver function anomalies are one of the common symptoms associated with the COVID-19 infection, where virus-replication in the liver cells, virus-induced inflammatory response, and administration of clinical medication could be the plausible reason.
Liver function anomalies are one of the common symptoms associated with the COVID-19 infection, where virus-replication in the liver cells, virus-induced inflammatory response, and administration of clinical medication could be the plausible reason.
To compare the outcome of non-operative treatment (NOT) with antibiotics versus surgical management of uncomplicated appendicitis in children.

This randomized clinical trial (NCT04030741) was carried out in Pediatric Surgery Department, Mayo Hospital from September 2018 to September 2019. Total sample size was 180, and after informed consent patients were randomly allocated in two groups. All children between 5 and 15 years of age and having pediatric appendicitis score (PAS) >7 were included. Patients with previous abdominal surgery, peritonitis, appendicular mass, or intra-abdominal abscess were excluded. Children in NOT group (Group A) were given intravenous Meropenem and Metronidazole for 48 hours and after starting oral, antibiotics were continued orally for 7 days. In Group B, children underwent appendectomy. Failure of NOT was labeled if there was abscess formation or peri-appendiceal fluid collection on ultrasound, development of peritonitis or recurrence of appendicitis.

In Group A, mean age was 9.56±1.8 years and in Group B 10.11±1.8 years. There were 123 male and 57 female patients. Group B had 100% successful outcome. NOT (Group A) had successful outcome in 75 patients (83.3%) and failure was noted in 15 (16.7%). Five needed operation within 48 hours, all had appendicolith, and 10 patients presented within 6 months. Raised total leukocyte count (p value < 0.0001) and C reactive protein (p value < 0.04) levels were noted with failure of NOT.

In this study, success of NOT was 84% so a trial of NOT in cases of uncomplicated appendicitis should be considered in children.
In this study, success of NOT was 84% so a trial of NOT in cases of uncomplicated appendicitis should be considered in children.
Burnout is common in healthcare workers and affects multiple domains of functioning. The objective of this study was to assess burnout in medical teachers in a large public medical university in Lahore, Pakistan and explore the factors behind it.

Using an explanatory sequential mixed methods design, we first sent out the abbreviated Maslach Burnout Inventory (aMBI) to all teaching faculty of basic and clinical science at King Edward Medical University (KEMU) Lahore. Descriptive analysis was performed on the 203 respondents who returned the survey. Of those who scored higher on the aMBI, 10 respondents (8 clinical science faculty and two basic science faculty) were selected for detailed semi-structured interviews exploring possible reasons for burnout. Thematic analysis of interview transcripts was performed using Interpretive Phenomenological Analysis. Triangulation and member checking was used for validation.

About 38.9% of respondents scored high on the Emotional Exhaustion subscale and 31.5% scored hesponsibilities. The reasons are varied. Policy planners and University/College administrators must acknowledge the negative effects of burnout on medical teachers and take steps to ameliorate it in the interests of improving medical education and training.
To see perception and knowledge of women about Ramadan fasting and maternal effects of fasting.

The study design was prospective, case-controlled. This study was conducted at Holy Family Hospital from 1
May 2020 to July 2020. Pregnant women with spontaneous conception and singleton pregnancies, who fasted for seven or more days, were cases, and those who did not fast were taken as controls. Questionnaire was filled regarding perception of women about maternal fasting. Primary maternal outcomes included preterm delivery, pregnancy induced hypertension, and gestational diabetes mellitus. The analysis was conducted using Statistical Package for Social Sciences version 16.0.

A total of 215 women were included in the study, 123 women fasted, and 92 women did not fast. Only 2.8% of women knew that fasting is forbidden in pregnancy. Sixty five percent of women reported weakness as the main reason for not fasting. The rate of gestational diabetes, pregnancy induced hypertension and preterm delivery was higher among women who fasted (17% vs 14%, 7% vs 2%, 9% vs 9%) respectively, compared to non-fasting women, but were not found statistically significant. There was no difference in anthropometric measurements of newborn, among both groups.

Ramadan fasting does not affect maternal outcomes during pregnancy.
Ramadan fasting does not affect maternal outcomes during pregnancy.
The aim of this study is to describe the mortality among older adults in the first wave of COVID-19 in Colombia and Mexico.

This is an observational, prospective study on data obtained from open data sets that are publicly available on the websites of the health ministries of the respective countries. COVID-19 cases, age, sex, date to mortality, and mortality itself were analyzed with Kaplan-Meier curves and Cox regressions.

Data on 1 779 877 individuals were analyzed, 58.2% from Mexico, with a higher frequency of men for both countries, and 11.7% were older adults. Survival curves show a continuous increase in mortality for Mexico, with higher rates for older adults, while for Colombia the mortality was observed up to 50 days of the follow-up. FDA-approved Drug Library cell assay Finally, hazard ratios were higher for older adults in both countries. Colombia implemented a rigid curfew for older adults, and the effect on mortality is clear from the survival curves.

This finding shows the potential benefit that public policies could have on older adults.
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