Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis.

Background: For decades, poor treatment options and low-quality evidence plagued care for patients with rifampin-resistant tuberculosis. The advent of new drugs to treat tuberculosis and enhanced funding now permit randomized, controlled trials of shortened-duration, all-oral treatments for rifampin-resistant tuberculosis.

Methods: We conducted a phase 3, multinational, open-label, randomized, controlled noninferiority trial to compare standard therapy for treatment of fluoroquinolone-susceptible, rifampin-resistant tuberculosis with five 9-month oral regimens that included various combinations of bedaquiline (B), delamanid (D), linezolid (L), levofloxacin (Lfx) or moxifloxacin (M), clofazimine (C), and pyrazinamide (Z).

Type and physical intensity of occupations at pulmonary TB diagnosis.

Background: Pulmonary TB (PTB) predominantly affects individuals of working age. We sought to characterise the occupations of people newly diagnosed with PTB in Karachi, Pakistan, by type and physical intensity.

Design/methods: We did a secondary analysis of data from a study evaluating the diagnostic accuracy of artificial intelligence-based chest X-ray (CXR) analysis software, where individuals had been evaluated for active PTB using sputum cultures and had provided information on occupation.

Outcomes of external versus internal fixation for traumatic lower limb fractures in low- and middle-income countries.

Aims: Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate.

Epidemiology and outcomes of out of hospital cardiac arrest in Karachi, Pakistan - A longitudinal study.

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of morbidity and mortality globally, with survival outcomes remaining poor particularly in many low- and middle-income countries. We aimed to establish a pilot OHCA registry in Karachi, Pakistan to provide insights into OHCA patient demographics, pre-hospital and in-hospital care, and outcomes.

Methods: A multicenter longitudinal study was conducted from August 2015-October 2019 across 11 Karachi hospitals, using a standardized Utstein-based survey form.

Consensus guidelines for the management of pediatric medulloblastoma in low and middle-income countries.

The management of medulloblastoma, a pediatric brain tumor, has evolved significantly with the advent of genomic subgrouping, yet morbidity and mortality remain high in LMICs like Pakistan due to inadequate multidisciplinary care infrastructure. This paper aims to establish evidence-based guidelines tailored to the constraints of such countries. An expert panel comprising neuro-oncologists, neurosurgeons, radiologists, radiation oncologists, neuropathologists, and pediatricians collaborated to develop these guidelines, considering the specific challenges of pediatric brain tumor care in Pakistan.

International Alliance of Urolithiasis (IAU) guidelines on the management of pediatric urolithiasis.

The aim of this study was to construct the sixth in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis (IAU) that by providing a clinical framework for the management of pediatric patients with urolithiasis based on the best available published literature. All recommendations were summarized following a systematic review and assessment of literature in the PubMed database from January 1952 to December 2023. Each generated recommendation was graded using a modified GRADE methodology.

Peripheral intravenous catheter-induced phlebitis in a tertiary hospital of Karachi: a cohort study.

Purpose: This study aimed to determine the incidence of peripheral intravenous catheter (PIVC)-induced phlebitis and its predictors among adult patients hospitalized at Dow University Hospital, Karachi, Pakistan.

Methods: A sample of 258 adult patients admitted in the selected wards and planned for peripheral intravenous catheter insertion were recruited through consecutive sampling during March to May 2019. Daily follow-ups were performed to observe signs of phlebitis using a validated tool.

Anthropometry of Proximal Tibia in Patients Undergoing Total Knee Replacement at a Tertiary Care Hospital.

Introduction Total knee arthroplasty is the standard of care treatment for advanced knee osteoarthritis. However, patients frequently continue to have pain and disability after surgery, with one of the most common reasons being a bone-implant mismatch. Notably, there is a significant difference reported in proximal tibia morphometry between Asian and Caucasian populations, and the currently available implants do not account for the anthropometric variations observed across ethnicities.

Publications in paediatric critical care medicine: Trends from Pakistan.

Objective: To analyse the characteristics of research published from Pakistan on paediatric critical care medicine.

Methods: The exploratory study was conducted at the Aga Khan University, Karachi from July 2021 to March 2022, and comprised a comprehensive search on MedLine, Google Scholar and PakMediNet databases for literature from Pakistan pertaining to paediatric critical care medicine published between January 2010 and December 2021. The search was done using appropriate key words.

A three month old infant with severe respiratory distress.

This case report discusses the diagnostic challenge of congenital lobar emphysema (CLE) in a three-month old infant with severe respiratory distress. The infant was initially misdiagnosed and managed as a case of pneumothorax. This case highlights the importance of CT scans as a diagnostic tool for early diagnosis and lifesaving management of CLE.

Survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association.

Unlabelled: A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific.

Purpose: Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies.

Nutritional status and its associated factors among the geriatric population in outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

Context: Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi.

Aims: To assess nutritional status and its associated factors among the elderly population.

The safety and efficacy of Houtou Jianweiling tablet in patients with chronic non-atrophic gastritis: a double-blind, non-inferiority, randomized controlled trial.

Common symptoms of Chronic Non-atrophic Gastritis (CNAG) include nausea, stomach distension, and abdominal pain. The Houtou Jianweiling Tablet (HTJWT) is a chinese patent medicine (CN1368229A) and it has been used clinically for more than 20 years with proven clinical efficacy in treating CNAG, prompted us to establish the clinical efficacy and safety of HTJWT on patients with mild to moderate CNAG symptoms in Pakistani population. This phase II, double-blind, randomized, parallel-controlled trial was conducted in a single center between November 2022 and February 2023 in Pakistan.

The clinical manifestations and pregnancy outcomes of COVID-19 infection at a tertiary care hospital.

Objective: To evaluate clinical presentation and pregnancy outcomes in pregnant women with Covid-19 infection in our local tertiary care from lower middle-income country.

Methods: A retrospective study was conducted at Obstetrics & Gynecology department, Sheikh Saeed Memorial Hospital (SSMH) of The Indus Hospital and Health Network (IHHN) from March 2020 to August 2021. Data of 422 admitted pregnant women with COVID-19 infection was retrieved for demographic and clinical information, laboratory tests, pregnancy outcome, and neonatal outcomes on RED-Cap and analyzed on SPSS 26.

Efficacy of 0.5% timolol maleate gel in the management of infantile hemangiomas.

Objective: This study aimed to evaluate the efficacy and safety of 0.5% timolol maleate gel, reported as an efficacious option for management of infantile hemangiomas (IH) in children.

Methods: A retrospective study was conducted among patients diagnosed with IH from January 2019 to December 2021.

Task-shifting in asthma and chronic obstructive pulmonary disease management: A review of the obstructive lung disease program.

Objective: Task shifting, an approach to address physician shortage through redistribution of clinical tasks, may help address the high burden of chronic respiratory diseases like asthma and COPD. We aimed to measure its utility and impact in the Obstructive Lung Disease program (OLD).

Methods: A retrospective, cross-sectional study was conducted at five integrated outpatient departments of Primary Care Program within Indus Hospital & Health Network, Pakistan, from January 2018 to March 2023.

The rise of the throat distemper.

Diphtheria vaccination in the EPI program has controlled much of the childhood infection. Nevertheless, sporadic adult cases of Diphtheria come up every now and then in Pakistan and other South-Asian countries. This is, most likely, due to the lack of booster dosing of Diphtheria vaccine in adulthood.

Giant cell tumor of soft tissue: GCT arising from periosteum of tibia.

Primary Giant Cell Tumor of Soft Tissue (GCT-ST) is a rare disease, a neoplasm with low potential for malignancy. It belongs to the group of Fibrohistiocytic tumors with borderline malignancy. Most commonly it presents as a painless, slow-growing mass in a superficial location.

From mosquitoes to menace: Unveiling the dangers of West Nile virus in Pakistan.

Pakistan, a subtropical nation, has seen a rapid rise in Arboviral transmission in the past decade. Environmental hazards such as intense monsoon rains and yearly floods in addition to unsanitary living conditions pose an increased risk of arboviral infections. In recent years, the emergence and spread of West Nile virus (WNV), which can lead to a life-threatening meningoencephalitis, in Pakistan has alarmed the health care authorities of an impending outbreak.