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Objective: This study aims to determine the diagnostic utility of IL-18 for early diagnosis of AKI by comparing it with the routinely used marker serum creatinine. Material and Methods: This validation study was carried out in the Department of Pathology, Khyber Medical College, Peshawar from September 2021 to February'2022. A total of 156 patients with Acute Kidney Injury were recruited from the intensive care units of three Peshawar tertiary care hospitals. Serum and urinary samples were taken at the time of admission and 48 hours after admission to estimate Serum creatinine level and urinary IL-18. Comparisons were made between the diagnostic utility of Urinary IL-18, and serum creatinine using the paired t-test. Sensitivity, specificity, positive predictive value, and negative predictive values were calculated. Results: This study included 156 acute kidney injury (AKI) patients. The mean creatinine level on admission was 0.90 ± 0.26 mg/dl; after 48 hours of admission, it was 1.38 ± 0.70 mg/dl. Similarly, IL-18 on admission was 130.14 ± 61.31 pg/ml while after 48 hours it was 290.32 ± 136.50 pg/ml. IL-18 levels of =75 pg/ml with a positive predictive value of 100% and a negative predictive value of 29% can be used as a cutoff in the diagnosis of AKI in patients after 48 hours of admission. Conclusion: Due to high sensitivity and specificity, Urinary IL-18 can predict AKI 24-48 hours before the onset of renal injury and can be used as an early marker for this purpose. [ABSTRACT FROM AUTHOR]

Objectives: Measles is one of the most familiar contagious diseases in children associated with numerous systemic complications. The aim of this study is to find the frequency of Myocarditis in children suffering from measles. Materials and Methods: This cross-sectional study was conducted in the department of pediatrics, MTI Lady Reading Hospital Peshawar from 6th December 2019 to 5th June 2020. Ninety-six patients of both genders and ages ranging from 1-12 years having measles for more than one week were enrolled in the study after informed consent. Ethical approval for the study was obtained from the Ethical Review Board. Patient demographic data were collected on a structured proforma and the frequency of children having clinical presentation of myocarditis was recorded. Data were entered and analyzed using SPSS 22. Results: The frequency of Myocarditis was 7.3% in children presented with Measles. The mean age was 6.6± 3.06 years. There were 47.9% males and 52.1% females. Most patients belonged to middle socioeconomic status i.e. 61.5%. Maternal education was 49% in the 6-10 age group. In sampled population, 46.9% belonged to urban areas and 5.1% belonged to rural areas. There were 18.8% vaccinated children and 81.3% were not vaccinated for measles. Myocarditis was significantly associated with the younger age group (p-value 0.028), however, there was no difference in gender (p-value 0.781). Children with low socioeconomic status had significantly higher frequency (p-value 0.05) of myocarditis. Conclusion: Myocarditis is commonly presented in children having measles especially patients in younger age groups and belonging to poor socioeconomic status. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the etiology, frequency, and results of respiratory distress in newborns in the intensive care unit. Study Design: Descriptive cross sectional study. Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital (CMH) in Peshawar, from Aug 2020 to May 2021. Methodology: It included neonates admitted to the Neonatal Intensive Care Unit between the ages of 0 and 28 days. Results: The study included 182 neonates, 107 (58.6%) of whom were boys and 75 (41.4%) were girls. The average age was 68.47 ± 98.60 hours, the average gestational age was 32.6 ± 23.52 weeks, and the average weight was 2.50 ± 2.6 kg. All (100%) of the neonates had a respiratory rate >60 breaths per minute. Regarding symptoms and signs, 110 (60%) reported grunting, 182 (100%) reported nasal flaring and subcostal retractions, and 72 (40%) reported cyanosis. Respiratory distress syndrome, meconium aspiration syndrome, pneumonia, transient tachypnea of the newborn, sepsis, and birth asphyxia was observed in 42 (22.8%), 30 (16.6%), 32 (17.6%), 26 (14.1%), 32 (18.04%), and 20 (10.8%) newborns, respectively. The number of 60 (33.2%) neonates were suffering from respiratory distress. Conclusion: High frequency of respiratory distress among the neonates was observed along with high rates of mortality in those having respiratory distress, especially in low birth weight and pre-term neonates. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to present six cases of cervical lymphadenopathy, diagnosed as Kikuchi's disease and raise the index of suspicion for this disease. Study Design: Case Series. Setting: Histopathology and Otolaryngology/Head & Neck Surgery Department at Rehman Medical Institute (RMI) Peshawar. Period: July 2016 to March 2021. Material & Methods: Records of patients for cases diagnosed as "histiocytic necrotising lymphadenitis" were retrieved, their corresponding patient files accessed from the archive, and case notes analyzed. Results: In this series, a total of six cases of Kikuchi's disease are presented. A female predominance is evident from the present data (2:1 female to male ratio). All patients presented with palpable lymph nodes in the neck, predominantly on the left (66.7%). Majority (66.7%) presented with neuralgic pain (on/off). Only one patient did not show weight loss and night sweating, the remaining had all the symptoms. All of the patients recovered spontaneously within 6 months (range 2 to 6 months) with symptomatic treatment for neuralgic pain. Conclusion: Kikuchi's disease should be kept in the differential diagnosis in young females with persistent neck masses, palpable lymph nodes and suspicious fine needle aspiration cytology (FNAC). [ABSTRACT FROM AUTHOR]

Objective: To account for the characteristic presentations, pathology and the post-operative complications of surgical treatment of retrosternal goitre. Study Design: Retrospective Descriptive study. Setting: Department of Otorhinolaryngology at Rehman Medical Institute, Peshawar. Period: July 2016 and December 2019. Material & Methods: All patients that underwent thyroidectomy during the study period were included in the study. The thyroid gland that did not have retrosternal extensions were excluded. Retrospective chart records of all these patients were analysed. Data obtained from the charts was recorded on Statistical package for social services version 23.0 and analysed for descriptive statistics. Results: 67 patients with goiters were at the tertiary care center of Peshawar, females (77.6%) and males (22.4%). 6 (8.9%) were retrosternal. The most common symptoms were neck swelling (83.3%) followed by shortness of breath (66.7%). Post-operative hypocalcaemia was the most common complication among retrosternal thyroidectomy patients (66.7%). Only one patient needed sternotomy. Conclusion: All patients with retrosternal goitre should be offered surgery. The post-operative complications are low and resolve uneventfully. [ABSTRACT FROM AUTHOR]

Objectives: Assessment drives learning and improving the quality of assessment has a remarkable impact on the quality of learning. Objective Structured Clinical Examination is termed more reliable and valid as compared to conventional practical examination. Objective: The objective of this study was to find the perception of postgraduate family medicine trainees about the OSCE assessment method and compare those having previous experience with those having no previous experience. Material & Mothods: This was a cross-section study conducted at the end of exit examination of diploma in family medicine at the Family Medicine Department. Khyber Medical University Peshawar. Data were collected on an eleven items questionnaire on a five-point Likert Scale. Study participants were categorized based on their previous experience of the OSCE. and were grouped into two categories. Data were analyzed by using Fisher's Exact test and a p-value of < 0.05 was considered statistically significant. Results: Out of 60. 56 candidates returned completed questionnaires. The response rate was 93.33% where the majority were males 52(92.9%). Participants with experience of the OSCE were 22 (39.3%) while 34 (60.7%) were having no experience of the assessment method. There was a significant difference (p= 0.001) in the perception about the OSCE with the simulated patient than real patient, fairness and reliability of the OSCE. stress and length of the OSCE and reduction of bias in the OSCE. The perception about weightage to be given to the OSCE in any examination was significantly different (p=0.004) between the two groups. Conclusion: Participants of both groups (experienced vs non-experienced) agreed on some aspects of the OSCE. Their opinion differed about the fairness, validity and stress related to the OSCE assessment method. This difference is probably explained by the inadequacy of an experience to form an opinion. [ABSTRACT FROM AUTHOR]

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To evaluate the genotoxic effects of gold jewellery fumes and its association with GSTM1 and GSTT1 genetic polymorphisms. We examined 94 subjects including 54 gold jewellery workers and 40 controls. The DNA damage was evaluated by alkaline comet assay and genotyping by PCR. The mean total comet score (TCS) in gold jewellery workers was significantly higher as compared to the control subjects (128.0 ± 60.6 versus 47.7 ± 21.4; p = 0.0001). Duration of occupational exposure had positive correlation (r = 0.453, p < 0.01) with DNA damage. Age and tobacco use had significant effects on the TCS of the exposed group as compared to the control group (p < 0.05). The frequency of the GSTM1-null genotype in the exposed group was significant (p = 0.004) as compared to the control group. No significant association (p > 0.05) between the GSTM1 and GSTT1 genotypes and DNA damage was found. Our results suggest that there is increased DNA damage in gold jewellery workers due to their occupational surroundings. Hence there is a strong need to educate the workers about the adverse health effects of potentially hazardous chemicals and highlight the importance of using protective measures. [ABSTRACT FROM AUTHOR]

Objective: To determine the bio-burden of isolated bacteria from multi-vitamin syrups manufactured by local industry of Peshawar. Methodology: This cross-sectional study was conducted at Sarhad University of Information Technology and Khyber Medical University Peshawar, from July 2017 to December 2017. Microbiological quantification of nine different multivitamin syrups purchased randomly from different medicine stores was performed. The microbial load was determined by using the viable cell count method. Sample preparation was done through serial dilution and identification of bacteria was made on the basis of morphological and colonial characteristics, and by using biochemical tests. Antibiotic susceptibility profiles were determined by the Kirby Bauer disk diffusion method and interpretations were made according to Clinical and Laboratory Standards Institute (CLSI) guidelines. A total of 9 different antibiotics were tested against gram-positive bacteria while 7 different antibiotics were tested against gram-negative bacteria. Results: All samples were found to be contaminated and the bio-burden exceeded the permissible limit set by the United States Pharmacopeia (USP). The overall frequency of Staphylococcus aureus was 55 % followed by Escherichia coli at 44%, Pseudomonas aeruginosa at 33% and Salmonella spp at 22%. All samples showed a pH within range of 5 to 9. Out of the gram-positive isolates, highest sensitivity (100%) was observed to Gentamycin, Ciprofloxacin, Chloramphenicol and Vancomycin. Pseudomonas aeruginosa was 100% sensitive to Ofloxacin, Gentamicin and Meropenem. Escherichia coli showed high sensitivity to Meropenem (100%) and Oflaxacin (100%) followed by Gentamicin (75%). Salmonella spp showed maximum sensitivity to Gentamicin (100%), Ofloxacin (100%) and Meropenem (100%). While high resistance was observed to Amoxicillin (100%), Cefotaxime (100%) and Clindamycin (50%). Conclusion: All samples were contaminated with pathogenic bacteria. Most of the bacteria were sensitive to antibiotics. [ABSTRACT FROM AUTHOR]

During the span of August–October, 2017 a major outbreak of Dengue fever happened in Khyber Pakhtunkhwa province of Pakistan. Cases were reported from all the major cities and rural areas, but Peshawar was more severely hit with more than half of the total cases belonging to central Peshawar city. The epidemic patterns reveal that dengue fever cases were mostly reported for plain areas and also low altitude mountainous regions. We employed the principle of maximum entropy to establish the underlying distribution of dengue presences and background data. A geostatistical analysis was conducted by modelling the spatial structure of the dengue fever risk and estimating the prediction maps with corresponding uncertainty taking into account some of the most significant covariates. The prediction maps were created using binomial kriging with a binary logistic drift. The analysis was carried out for the whole province as well as subregions to have a closer look of the spatial distribution at local level. Our results show that our methodology performed well. Vector distribution, population density, and distance to roads were found to significantly affecting the spatial distribution of risk and gives very informative pattern. [ABSTRACT FROM AUTHOR]

The objective of the current study was to estimate the frequency of pediatric dyslipidemia in overweight and obese students of private schools in Swat. Study Design: Questionnaire based cross-sectional study. Setting: Three private schools of district Swat. Period: 6 months. Materials and Methods: Study analysis was done in Research laboratories of Biochemistry Department, Institute of Basic medical Sciences (IBMS), Khyber Medical University Peshawar. Well-designed questionnaires were used for screening of 99 out of 1374 students, including both girls and boys. Anthropometric measurements were taken. Blood samples were collected for the analysis of serum lipids using an Automated Cobas Analyzer. SPSS version 20, Student's t test and Logistic regression method was used for statistical analysis. Results: The prevalence of dyslipidemia was measured to be 42.4%. A significantly direct association was found between the rate of dyslipidemia and BMI. Highly significant P values were found for serum lipids in obese children as compared to overweight children thus showing strong association between the biochemical Parameters and BMI. Even though rate of dyslipidemia was measured to be a little higher in boys as compared to girls, no statistically significant gender differences were found in serum lipid levels. Conclusion: Reduce long-term complications in adulthood is possible through controlling the serum lipid levels of children and adolescents. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic accuracy of C-reactive protein in the diagnosis of neonatal sepsis keeping blood cultures as gold standard. Study Design: Descriptive cross-sectional study. Setting: Pediatric Unit of Lady Reading Hospital Peshawar Pakistan. Duration: Six months from 09-06-2012 to 08-12-2012. Methodology: Total of 196 patients meeting the required inclusion criteria with clinical suspicion of sepsis. Those neonates were subjected to investigations. C.R.P. was tested using the Quantitative method according to the instructions provided with the kit. By keeping blood culture as gold standard, patients with both positive and negative cultures were taken and the results compared to the results of C.R.P. in these subjects being positive or negative. Results: Among the 196, majority of the neonates included were less than a week old having a mean age of 4.5 days. There were 57 (29%) females and 139 (71%) males, with male to female ratio of 2.4:1. Blood cultures were positive in 85 (43%) and negative in 111 (57%) cases, while C.R.P. was positive in 95 (48%) and negative in 101 (52%) cases. Sensitivity, specificity, and positive and predictive values of C-reactive protein were calculated using formulas, and they turned out to be 77.6%, 73.8%, 69.4%, and 81.2% respectively with accuracy being 0.41%. Conclusion: An accurate and timely diagnosis of early onset neonatal sepsis remains challenging to the clinician as well as laboratory. Physicians can prevent unnecessary antibiotic use by performing the qualitative estimation CRP as a single, rapid and inexpensive test with a negative predictive value of 81.2%. [ABSTRACT FROM AUTHOR]

Objective: To estimate age from mandibular third molar maturation stages in the patient presenting to the Combined Military Hospital, Peshawar Pakistan. Study Design: Cross-sectional. Place and Duration of Study: Department of Dentistry, Combined Military Hospital, Peshawar Pakistan, from Jun to Jul 2021. Methodology: One hundred and fifty participants of either gender, ages 14 to 24 years, with good quality orthopantomogram (OPG) showing mandibular third molar tooth germs and Pakistani nationals were included. Participants with hypodontia, oligodontia, Amelogenesisimperfecta, Dentinogenesisimperfecta, history of trauma /fracture in the third molar region and any systemic disease were excluded. Data like age, gender and tooth maturation stages of right mandibular molars were recorded. Results: The mean age was 16.76±2.19 years. In 111(74.9%) cases, the variation in chronological age can be explained by mandibular third molar maturation stages. The only statistically significant predictor for age was Demirjian's stage of lower third molar (p=0.002,95% CI=3.643-15.442), while gender was not a significant predictor. Conclusion: The age can be estimated from the mandibular third molar with reliability in our population. [ABSTRACT FROM AUTHOR]

The use of sewage-contaminated municipal water for irrigation of crops is an old practice in many big cities of Pakistan. Since the wastewater is rich in nutrients, it increases crops yield substantially but at the cost of food quality. The objective of this study was to investigate sewage water irrigation as a source of accumulation of heavy metals in soil and its subsequent transfer to crops and underground water. Sewage water, soil, groundwater, and crop samples were collected from selected areas around Peshawar city and analyzed for heavy metals concentration by atomic absorption spectroscopic method. Analysis of data revealed a considerable impact of the irrigation practices in the peri-urban Peshawar. Statistical analysis of the data showed a positive correlation between heavy metals concentration and soil carbon contents on the one hand and cation exchange capacity on the other. A strongly negative correlation was observed between metal contents and soil pH. The vertical movement of heavy metals from contaminated soil has polluted crops and underground water. The results indicated higher concentration of toxic metals in soil accumulated due to long-term sewage-contaminated water irrigation and their subsequent transfer to our food chain. The practice, if continued un-noticed may pose a threat of phytotoxicity to the local population. [ABSTRACT FROM AUTHOR]

Pakistan possesses the fourth largest irrigation network in the world, serving 20.2 million hectares of cultivated land. With an increasing irrigated area, Pakistan is short of freshwater resources and faces severe water scarcity and food security challenges. This is the first comprehensive study on the water footprint (WF) of crop production in Peshawar Basin. WF is defined as the volume of freshwater required to produce goods and services. In this study, we assessed the blue and green water footprints (WFs) and annual blue and green water consumption of major crops (maize, rice, tobacco, wheat, barley, sugarcane, and sugar beet) in Peshawar Basin, Pakistan. The Global Water Footprint Assessment Standard (GWFAS) and AquaCrop model were used to model the daily WF of each crop from 1986 to 2015. In addition, the blue water scarcity, in the context of available surface water, and economic water productivity (EWP) of these crops were assessed. The 30 year average blue and green WFs of major crops revealed that maize had the highest blue and green WFs (7077 and 2744 m3/ton, respectively) and sugarcane had the lowest blue and green WFs (174 and 45 m3/ton, respectively). The average annual consumption of blue water by major crops in the basin was 1.9 billion m3, where 67% was used for sugarcane and maize, covering 48% of the cropland. The average annual consumption of green water was 1.0 billion m3, where 68% was used for wheat and sugarcane, covering 67% of the cropland. The WFs of all crops exceeded the global average. The results showed that annually the basin is supplied with 30 billion m3 of freshwater. Annually, 3 billion m3 of freshwater leaves the basin unutilized. The average annual blue water consumption by major crops is 31% of the total available surface water (6 billion m3) in the basin. Tobacco and sugar beet had the highest blue and green EWP while wheat and maize had the lowest. The findings of this study can help the water management authorities in formulating a comprehensive policy for efficient utilization of available water resources in Peshawar Basin. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of chloroquine and clarithromycin against Leishmania tropica KWH23. Methodology: This experimental study was conducted at the Institute of Basic Medical Sciences, Khyber Medical University Peshawar, Pakistan. Pre-formed cultures of Leishmania tropica KWH23 were inoculated in Roswell Park Memorial Institute (RPMI) 1640 medium and incubated at 24°C for 7 days. Stock solution of chloroquine and clarithromycin of 1000 µg/ml were prepared and further diluted serially. Approximately, 180 µl of RPMI was added in different wells of 96 well microtiter plates. For the test compound, 20 µl was added in the first well and then serially diluted to keep the final volume up to 180 µl. Subsequently 20 µl was discarded from the last well. About 100 µl of parasites (2×106 cells/ml) were added in each well and 2 rows were left for positive and negative control. Dimethyl sulfoxide (DMSO) was taken as negative control and was serially diluted in RPMI 1640 medium. Amphotericin B was taken as positive control. Microtiter plates were incubated at 24o C for 72 hours. Assay was performed in triplicate. After the incubation period, 20 µl was taken from each dilution, put on improved Neubaur counting chamber and live parasites were counted under microscope. IC50 values of the compounds possessing anti leshmanial activity were calculated by GraphPad Prism 5 software. Results: The IC50 values of chloroquine dosage and pure forms (without excipients) against the promastigote of Leishmania tropica KWH23 were 0.023µg/ml and 0.019 µg/ml respectively while IC50 values of clarithromycin dosage and pure form were 4.548 µg/ml and 27.13 µg/ml respectively. Clarithromycin inhibited promastigotes growth but its IC50 was higher than chloroquine. The IC50 values of combination of chloroquine and clarithromycin dosage (500 mg) and pure form were recorded as 0.049 µg/ml and 0.0023 µg/ml respectively. Conclusion: Both chloroquine and clarithromycin are potential drugs for the treatment of cutaneous leishmaniasis. [ABSTRACT FROM AUTHOR]

Foodborne diseases are very frequent and can easily transmit from contaminated food and food handlers. Among the foodborne pathogens, strains of Staphylococcus aureus, Bacillus cereus, Listeria monocytogen and Clostridium are very important because of its presence in a wide range of foodstuffs. A total of 520 food samples were collected at Peshawar (50%) and Mardan (50%), Khyber Pakhtunkhwa, Pakistan, from April 2016 to March 2017. Isolates were cultured and discriminated by Gram stain, followed by biochemical identification, disk diffusion assay was performed using antibacterial and antifungal agents. Out of 520, only 122 (23.46%) samples were positive for various types of bacterial and fungal pathogens. Gram-positive bacteria was the predominant (70.49%) followed by fungal pathogens (26.23%) and Gram-negative bacterial pathogens (3.27%) among the total positive samples. Prominent bacterial samples were Staphylococcus aureus, Bacillus spp., Clostridium spp., Staphylococcus saprophytic, Listeria spp., Enterobacter spp., and Citrobacter spp., whereas four fungal pathogens were also identified in various food items. Among the fungal pathogens isolated were Aspergillus nigar (50%), Candida krusei (19%), Fusarium oxysporium (6%) and Mucor (25%). Antibiogram analysis reveals that Levofloxacin, Ceftriaxone Ciprofloxacin, Cefoxitin, Chloramphenicol, and Ceclor were more active against bacterial isolates. Fungal isolates had shown differential sensitivities toward Voriconazole. Local food markets of Peshawar and Mardan, KPK, Pakistan have more than 20% risk of foodborne pathogens. It is recommended that the general public should purchase neat and clean food and adopt mild processing techniques to make the food hygienic. [ABSTRACT FROM AUTHOR]