Primary Neuroendocrine Tumor of the Breast: A Case Report and Review of Current Guidelines.

Primary neuroendocrine tumor of the breast is a rare subtype of breast carcinoma that most commonly affects postmenopausal women in their sixth or seventh decade of life. We report a case of a 52-year-old female who presented to our clinic with concerns about a self-palpable mass involving her left breast that had not been detected on a routine mammogram five months prior. Upon clinical exam and diagnostic workup comprising imaging, a tissue biopsy, and immunostaining, she was found to have primary high-grade neuroendocrine carcinoma of the breast with necrosis.

SELF-REPORTED MULTI-MORBIDITY WITH TUBERCULOSIS: DATA FROM THE KHYBER PAKHTUNKHWA INTEGRATED POPULATION HEALTH SURVEY (KPIPHS) IN PAKISTAN.

Background: With the rise of non-communicable diseases (NCDs) in a country that is already facing high tuberculosis (TB) burden, TB multi-morbidity is likely to pose a significant public health challenge in Pakistan. Data were analysed to determine the prevalence of TB and explore the distribution and determinants of multi-morbidity associated with TB in the population of Khyber Pakhtunkhwa -a province of Pakistan.

Methods: This is a secondary analysis of data gathered as part of the KPIPHS survey conducted in 2016-17 in both the rural and urban areas of Khyber Pakhtunkhwa, Pakistan.

Supplementation of lactobacillus-fermented rapeseed meal in broiler diet reduces Campylobacter jejuni cecal colonization and limits the l-tryptophan and l-histidine biosynthesis pathways.

Background: Campylobacter jejuni (C. jejuni), a widely distributed global foodborne pathogen, primarily linked with contaminated chicken meat, poses a significant health risk. Reducing the abundance of this pathogen in poultry meat is challenging but essential.

Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App.

Background: Insufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals.

Healthcare workers safety in the COVID-19 era: the impact of pre-pandemic personal protective equipment (PPE) training in Pakistan.

Background: The COVID-19 pandemic has revealed vulnerabilities in healthcare systems worldwide, emphasizing the importance of healthcare worker safety through adequate utilization of personal protective equipment (PPE). This study aims to assess the impact of pre-pandemic PPE training on the practices and other associated factors among frontline healthcare workers during the COVID-19 pandemic in Pakistan and provide insights into the implications of such training programs for future initiatives.

Methods: A cross-sectional study from May 9th to June 5th, 2020 was conducted among the frontline healthcare workers against COVID-19 in Pakistan, utilizing an online structured questionnaire shared via WhatsApp and Facebook by using purposive sampling.

Sensitivity of broiler performance, organ weights and plasma constituents to amino acid supplementation and reused litter exposure using ideal protein-formulated rations.

Effects of amino acid supplementation to ideal protein (IP) formulated rations were investigated on growth performance, plasma metabolites and organ weights of broilers placed on 100% recycled (reused) litter. Day-old Ross308 male broilers were raised on either clean or reused litter and fed for three weeks on one of five isoenergetic diets, where an IP-based control diet (C) was compared with diets containing threonine (T) or arginine (A) at 25% above requirements, or with 1% supplemented glutamine (G), or with each amino acid added (TAG). Litter and diet treatments did not strongly interact on outcomes.

Trends and outcomes of combined percutaneous (TAVI+PCI) and surgical approach (SAVR+CABG) for patients with aortic valve and coronary artery disease: A National Readmission Database (NRD) analysis.

Background: In patients with severe aortic stenosis (AS) and concomitant severe coronary artery disease (CAD), the relative merits of a combined percutaneous (transcatheter aortic valve implantation [TAVI] and percutaneous coronary intervention [PCI]] versus surgical approach (surgical aortic valve replacement [SAVR] and coronary artery bypass graft [CABG]) remain unknown.

Aims: To determine the utility of combined percutaneous versus surgical approaches in patients with severe AS and CAD.

Methods: The National Readmission Database (NRD) (2015-2019) was queried to identify all cases of TAVI+PCI and SAVR+CABG.

Novel mutations in genes of the IL-12/IFN-γ axis cause susceptibility to tuberculosis.

Background: The IL-12/23/ISG15-IFN-γ pathway is the main immunological pathway for controlling intra-macrophagic microorganisms such as Mycobacteria, Salmonella, and Leishmania spp. Consequently, upon mutations in genes of the IL-12/23/ISG15-IFN-γ pathway cause increased susceptibility to intra-macrophagic pathogens, particularly to Mycobacteria. Therefore, the purpose of this study was to characterize the mutations in genes of the IL-12/23/ISG15-IFN-γ pathway in severe tuberculosis (TB) patients.

Patient Satisfaction and Utilization of Ambulance Services in Prehospital Services at a Tertiary Care Hospital: A Cross-Sectional Study in Peshawar, Khyber Pakhtunkhwa, Pakistan.

Objective: Patients reporting to emergency departments frequently use different ambulance services; therefore, the measurement of patient satisfaction is relevant to encouraging those services to meet patient expectations. The aim of this study was to determine the patients' satisfaction and utilization of different ambulance services at a tertiary health care hospital in Peshawar relating to prehospital services.

Methods: This cross-sectional study was conducted at Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from July 2019 to January 2020 using a consecutive sampling technique with a total sample size of 378.

Growth performance, caecal microbiome profile, short-chain fatty acids, and litter characteristics in response to placement on reused litter and combined threonine, arginine and glutamine supplementation to juvenile male broiler chickens.

Background: Exposure of broilers to litter microbiome may increase specific amino acid (AA) requirements towards activated immune responses. This may challenge the generality of the ideal protein (IP) concept, in which dietary essential AA to lysine ratios aimed to mimic presumably constant AA to lysine ratios in whole bird requirements. Therefore, we tested the effect of threonine, arginine and glutamine (TAG) supplementation to IP-based control diets (C) on performance, caecal microbiome composition, short-chain fatty acids and litter characteristics of broiler chickens placed on reused litter.

Septal Myectomy or Alcohol Ablation for Hypertrophic Cardiomyopathy: A Nationwide Inpatient Sample (NIS) Database Analysis.

Background: Comparison of the real-world cohort on the relative safety of alcohol septal ablation (ASA) vs. septal myectomy (SM) for the management of hypertrophic cardiomyopathy (HCM) has been lacking.

Methods: The National Inpatient Sample (NIS) (2012-2019) was used to select all cases of HCM.

Trends and Outcomes of Transcatheter Aortic Valve Implantation in Patients With Peripheral Arterial Disease: Insights From the National Readmissions Database.

Due to shared risk factors, many patients with severe aortic stenosis (AS) also have concomitant peripheral arterial disease (PAD). The readmission rates and long term clinical outcomes of these patients following transcatheter aortic valve implantation (TAVI) in a large sample has not been well defined. The National Readmissions Database (NRD) (2015-2019) was used to identify patients undergoing TAVI.

Analysis of associated risk factors among recurrent cutaneous leishmaniasis patients: A cross-sectional study in Khyber Pakhtunkhwa, Pakistan.

Background: Leishmaniasis is the second and fourth highest cause of mortality and morbidity respectively among all tropical diseases. Recurrence in the onset of leishmaniasis is a major problem that needs to be addressed to reduce the case fatality rate and ensure timely clinical intervention. Here we are investigating the association of risk factors with recurrent cutaneous leishmaniasis to address this issue.

Bacterial concentration and Campylobacter spp. quantification differ when fresh or ultra-frozen samples are analysed over time using molecular biology and culture-based methods.

The study aimed to delineate the robustness of the culture-based and molecular biology methods to assess the total bacterial concentration and Campylobacter jejuni (C. jejuni) quantification in caecal content, analysed as fresh or after being stored immediately at ultra-low (-80°C) temperature at different time points (for 3, 7, 14, 28 and 62 days post collection). The caecal content was collected from birds that were artificially colonised with C.

Diabetic ketoacidosis amongst patients with COVID-19: A retrospective chart review of 220 patients in Pakistan.

Objectives: To determine the frequency of diabetes mellitus and diabetic ketoacidosis and associated factors in COVID-19-positive patients.

Background: High mortality amongst SARS-Cov2 patients may be attributed to diabetes and diabetic ketoacidosis.

Methods: A total of 220 COVID-19 positive patients, hospitalized in North West General Hospital & Research Center, Peshawar, KP, Pakistan, from April to September 2020, were analysed using STATA 14.

A pilot trauma registry in Peshawar, Pakistan - A roadmap to decreasing the burden of injury - Quality improvement study.

Background/local Problem: In Pakistan, trauma is a significant public health issue accounting for the second leading cause of disability and fifth for healthy years of life lost. Well-developed trauma systems, utilizing trauma registries, have been proven to decrease morbidity and mortality from injuries, and helped to reduce the number of injured patients. In Pakistan, most data on injury are acquired through methods that are retrospective, incomplete, and open to recall bias.

Perceptions of COVID-19-related Risks and Deaths Among Health Care Professionals During COVID-19 Pandemic in Pakistan: A Cross-sectional Study.

COVID-19 is an established challenge to the health care professionals (HCPs) having physical, emotional, and psychological repercussions. We determine the perceptions of Pakistani HCPs regarding the risks and deaths related to COVID-19. A cross-sectional study was conducted among HCPs throughout Pakistan from 16th February 2021 to 6th March 2021 by disseminating an online Google questionnaire via all possible social media platforms including WhatsApp, Facebook, Twitter, and emails.

Novel IL-12Rβ1 deficiency-mediates recurrent cutaneous leishmaniasis.

Background: The IL-12/IFN-γ axis plays a vital role in the control of intramacrophagic pathogens including Leishmania infections.

Objective: The aim of this study was to investigate genetic defects in the IL-12/IFN-γ axis in cutaneous leishmaniasis patients, using immunological and genetic evaluation.

Methods: Enzyme-linked immunosorbent assay was used to quantify IFN-γ , while flow cytometry was performed to analyze surface IL-12Rβ1/IL-12Rβ2 expression and phosphorylation of signal transducers as well as the activator of transcription 4 (pSTAT4).

Prevalence of Parental refusal rate and its associated factors in routine immunization by using WHO Vaccine Hesitancy tool: A Cross sectional study at district Bannu, KP, Pakistan.

Objective: To determine the vaccination refusal rate, associated factors and perceptions of parents who refused routine immunization for their children using the World Health Organization (WHO) SAGE Working Group on Vaccine Hesitancy Survey Tool.

Materials And Methods: A cross-sectional survey was conducted using multi-stage cluster sampling in Bannu District, Khyber Pakhtunkhwa Province, Pakistan from March 2019 to July 2019. A WHO validated questionaire was used.

Access and Use Experience of Personal Protective Equipment Among Frontline Healthcare Workers in Pakistan During the COVID-19 Emergency: A Cross-Sectional Study.

Healthcare workers are at the highest risk of contracting novel coronavirus disease 2019 (COVID-19) and, therefore, require constant protection. This study assesses access to personal protective equipment (PPE), availability of adequate information about PPE use, self-reported ability to correctly wear and remove (donning and doffing) PPE, and risk perceptions associated with COVID-19 among frontline healthcare workers in Pakistan. Using a structured and validated questionnaire, an online survey was conducted from May 9 to June 5, 2020.

The effectiveness of Janus kinase inhibitors in treating atopic dermatitis: A systematic review and meta-analysis.

Primary studies have presented conflicting results on the efficacy of Janus kinase (JAK) inhibitors in treating atopic dermatitis. Hence, it is important to determine the summary effect of JAK inhibitors in order to guide the clinical application of this potentially beneficial drug. To determine the efficacy of JAK inhibitors in treating atopic dermatitis in all age groups.