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Objective: To assess the impact and effectiveness of a pan-genotypic Directly Acting Antiviral (DAA) based regimen for patients with chronic Hepatitis-C (HCV) infection in our setup. Study Design: Cross-sectional study. Place and Duration of Study: Departments of Pathology and Medicine, Combined Military Hospital, Malir, Karachi, from Dec 2019 to Jan 2021. Methodology: Sofosbuvir and Daclatasvir were administered orally at 400mg and 60mg daily, respectively, with or without Ribavirin to treatment-naïve and treatment-experienced adult patients with chronic HCV infection. End-of-treatment response and Sustained virological response were determined among these patients by monitoring viral load using quantitative HCV RNA PCR and various genotypes. Results: Of the 59 patients, 39(66%) patients received sofosbuvir (SOF)+Daclatasvir (DCV), 12(20.3%) patients were placed on SOF+Ribavirin (Rib) and 8(13.5%) were given triple regime of SOF+DCV+Rib for 12 and 24 weeks respectively. Most of our patients were females, 32(54.23%), with a mean age of 31±17 years. Forty-eight patients (81.35%) were infected with genotype 3, followed by genotype 1 and 2, respectively. The rapid viral response was noted after four weeks of therapy among 27(45.76%) patients. The sustained viral response was noted in 38(64.40%) and 21(35.59%) patients after 12 and 24 weeks, respectively. The end-of-treatment response was observed in 40(67.8%) patients. Conclusion: Direct-acting antiviral-based regimens have shown favourable results with fewer adverse effects in our patients.

Objectives: To determine the frequency of parasites detected in stool samples of children with symptoms of parasitic infections. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, in collaboration with Paediatrics Department of Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2020. Methodology: A Total of 138 stool samples were collected from children who were admitted or presented in the outdoor department and had symptoms of intestinal parasitic infections. Youngsters who had been dewormed within the previous six months or whose samples arrived at the lab more than three hours after the collection were not included. Stool samples were examined visually and by using a saline preparation followed by a method that involved the concentration of formal ether. This was done to determine the different kinds of trophozoites, adult worms, and eggs or cysts that parasites produce. Results: The study found that intestinal parasites were moderately prevalent (26.81%) among the pediatric population, with Giardia lamblia (54.05%) being the most frequent, followed by Entamoeba histolytica (35.14%) and Ascaris lumbricoides (5.41%). Conclusion: It is recommended to guarantee the accessibility of purified drinking water to decrease the incidence of parasitic infections within our populace.

Objective: To determine the association between elevated serum prolactin and the development of gestational diabetes mellitus in the first trimester. Study Design: Prospective longitudinal study. Place and Duration of Study: Pathology Department, Combined Military Hospital, Quetta Pakistan, from Apr 2021 to Mar 2022. Methodology: One hundred and twenty-one patients had a measurement of serum prolactin in the first trimester, along with an oral glucose tolerance test in the second and third trimester, at the Pathology Department Combined Military Hospital Quetta Pakistan. Results: In the study group, serum prolactin levels were raised in 51(42.1%) patients in the first trimester. A total of 44(36.3%) patients with raised serum prolactin had impaired oral glucose tolerance tests. A significant association was found between raised serum prolactin and subsequent development of gestational diabetes mellitus in pregnant females. Conclusion: Serum prolactin can be an important biomarker for early diagnosis and monitoring of gestational diabetes mellitus.

Objective: To study the patterns and distribution of various abnormal semen parameters in infertile males. Study Design: Cross sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital, Karachi, from Nov 2019 to Oct 2020. Methodology: The study included 364 patients who presented with primary and secondary infertility. Consecutive convenient sampling was done. Semen analysis was performed using World Health Organization latest guidelines. Samples were categorized as normospermia, azoospermia, oligospermia, asthenozoospermia and necrospermia. Results: The study comprised of 364 samples of infertile males. Normal sperm count was observed in 317 (87%) males, azoospermia in 28 (7.6%) and oligospermia in 19 (5.2%) males. Low ejaculated volume and higher non-motile sperms were noted in oligospermia samples in comparison with normospermia samples. Asthenozoospermia was observed in 102 (28%) and oligoasthenospermia was noted in 15 (4.1%) samples. Conclusion: Good quality semen analysis is a corner stone to diagnose the cause of male infertility. Sperm concentration and motility are the important markers of normal male reproductive system and are related to each other.

Objective: To evaluate the cytospin slide microscopy method for detection of acid fast bacilli (AFB) in bronchoalveolar lavage (BAL) fluid comparing it with concentrated smear microscopy. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from Dec 2016 to Sep 2018. Methodology: BAL specimens from suspected tuberculosis patients who were sputum smear negative, submitted to AFIP for diagnosis were included in the study. Smears for microscopy were prepared with the modified cytospin method as well as the standard concentrated technique. The prepared smears from both methods were stained with Ziehl–Neelsen (ZN) staining method and examined under 100 × oil immersion lens. TB culture performed on BACTEC MGIT 960 automated culture system (Becton Dickinson, USA) was taken as gold standard for TB diagnosis. The two methods were compared in terms of sensitivity, specificity, positive predictive value and negative predictive value. Results: Out of the 130 samples tested, 62 (47.7%) were positive on culture using MGIT 960 system. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the modified cytospin method for pulmonary TB diagnosis was found to be 68.3%, 100%, 100%, 77% and 84.6%, respectively. Conclusion: The sensitivity of the modified cytopsin smear method was significantly higher than that of the concentrated method. The study concludes that this is a simpler and more accurate method for BAL fluid microscopy.

Objective: To compare the in vitro disk diffusion method and agar dilution method for sensitivity of Polymyxin B against multi drug resistant Acinetobacter baumannii. Study Design: Comparative cross sectional. Place and Duration of Study: The study was carried out in the department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st Dec 2016 to 30th Dec 2017. Methodology: Total 253 clinical specimens received from intensive care units with yielded growth of multidrug resistant Acinetobacter baumannii were evaluated for Polymyxin B susceptibility. Both Kirby bauer disk diffusion and agar dilution methods were compared with a reference method, broth microdilution. Results: Among 253 multidrug resistant isolates, 180 (71%) were extensively drug resistant and 221 (87%) were carbapenem resistant. Comparison of the disk diffusion and the MIC method by Agar dilution showed 100% correlation. 251 isolates were sensitive and 2 were resistant to Polymyxin B with MICs and disk zone diameters within the range recommended by the CLSI (2014-17). MIC 50 and MIC 90 of Polymyxin B were found to be 0.5 and 1μg/ml with 99.2% susceptibility. Conclusion: Both disk diffusion and agar dilution can be used together as initial screening methods in low income countries for susceptibility reporting of polymyxins. They are simple, reliable and economical. Also hetero resistance shown by some Acinetobacter baumanii strains can easily be picked up by agar dilution method.

Abstract Background There are few published standards or methodological guidelines for integrating Data Quality Assurance (DQA) protocols into large-scale health systems research trials, especially in resource-limited settings. The BetterBirth Trial is a matched-pair, cluster-randomized controlled trial (RCT) of the BetterBirth Program, which seeks to improve quality of facility-based deliveries and reduce 7-day maternal and neonatal mortality and maternal morbidity in Uttar Pradesh, India. In the trial, over 6300 deliveries were observed and over 153,000 mother-baby pairs across 120 study sites were followed to assess health outcomes. We designed and implemented a robust and integrated DQA system to sustain high-quality data throughout the trial. Methods We designed the Data Quality Monitoring and Improvement System (DQMIS) to reinforce six dimensions of data quality: accuracy, reliability, timeliness, completeness, precision, and integrity. The DQMIS was comprised of five functional components: 1) a monitoring and evaluation team to support the system; 2) a DQA protocol, including data collection audits and targets, rapid data feedback, and supportive supervision; 3) training; 4) standard operating procedures for data collection; and 5) an electronic data collection and reporting system. Routine audits by supervisors included double data entry, simultaneous delivery observations, and review of recorded calls to patients. Data feedback reports identified errors automatically, facilitating supportive supervision through a continuous quality improvement model. Results The five functional components of the DQMIS successfully reinforced data reliability, timeliness, completeness, precision, and integrity. The DQMIS also resulted in 98.33% accuracy across all data collection activities in the trial. All data collection activities demonstrated improvement in accuracy throughout implementation. Data collectors demonstrated a statistically significant (p = 0.0004) increase in accuracy throughout consecutive audits. The DQMIS was successful, despite an increase from 20 to 130 data collectors. Conclusions In the absence of widely disseminated data quality methods and standards for large RCT interventions in limited-resource settings, we developed an integrated DQA system, combining auditing, rapid data feedback, and supportive supervision, which ensured high-quality data and could serve as a model for future health systems research trials. Future efforts should focus on standardization of DQA processes for health systems research. Trial Registration ClinicalTrials.gov identifier, NCT02148952 . Registered on 13 February 2014.