Booster Dose of COVID 19 and Ethical Issues

COVID 19 is a recent and global pandemic. Preventive medicine is not very popular in Pakistan. With the limited resources, an average Pakistani would spend on a medical treatment rather than on a preventive drug. In Pakistan, booster shots are recently made available only to those who can pay for the cost of the vaccine. A Utilitarian approach has been adopted at various levels since the pandemic emerged by health care organizations and the government. The purpose was to maximize the benefits and minimize the risk of harm. It is the need of the hour to think about health equity and justice in a pluralistic way and refrain from initiating booster shots for elite of a resource-poor country. This pandemic will never end if a maximum number of people are not vaccinated in each country. This is only possible if there is an equitable distribution of vaccines.

Monogenic diabetes in Pakistani infants and children: challenges in a resource poor country

Objectives To review the data of infants and children with suspected monogenic diabetes who underwent genetic testing. Methods Monogenic diabetes is a rare form of diabetes resulting from mutations in a single gene. It can be caused by dominant as well as recessive modes of inheritance. In a country like Pakistan where interfamily marriages are common the incidence of genetic disorders is increased. As Pakistan a resource-poor country, the diagnosis of insulin-dependent diabetes is often delayed and a genetic diagnosis of monogenic diabetes is extremely difficult. Children with clinical diagnosis of monogenic and syndromic diabates were recruited and blood samples were sent for genetic analysis. Results One thousand sixty four new cases diagnosed with type 1 diabetes were registered at the National Institute of Child Health, Karachi, in the last 10 years. Of these 39 patients were selected for genetic testing who were diagnosed with diabetes/had a sibling diagnosed with diabetes before the age of nine months (n = 27) or had extra pancreatic features ( n= 12). We identified mutations in 18/27 cases diagnosed with diabetes before nine months of age. The most common genetic subtype was WolcottRallison syndrome caused by EIF2AK3 mutations (seven cases). KCNJ11 mutations were identified in two cases, ABCC8mutations were identified in four cases from three families, GCK and INS mutations were each identified in two cases, and one SLC2A2 mutation was identified in one case. A genetic diagnosis was made in 12/12 children from six families with diabetes diagnosed after the age of nine months who had extrapancreatic features. Six patients had genetically confirmed Wolfram syndrome (WFS1), three had thiamine-responsive megaloblastic anemia (SLC19A2) and three were diagnosed with histocytosis lymphadenopathy plus syndrome (SLC29A3). Conclusions Genetic testing is essential to confirm a diagnosis of monogenic diabetes which guides clinical management and future counselling. Our study highlights the importance of diagnosing monogenic diabetes in the largely consanguineously-married population of Pakistan.

MORBIDITY AND MORTALITY OF EXTREMELY LOW BIRTH WEIGHT BABIES IN A TERTIARY CARE CENTRE IN EASTERN INDIA

Background: Being born preterm increases the risk of both morbidity and mortality but with improved care the chances of survival is increasing. The age of viability was earlier dened at 28weeks but in the best of centres it has now come down to 25weeks. Extremely low birth weight (ELBW) babies who weigh less than 1000gms are particularly at risk of dying with the overall mortality in this group ranging from 30% to 50 % in the best of centres. This study was conducted to nd out the immediate outcome of extremely low birth weight babies born in a tertiary care centre, of a resource poor country like India. Objective:To evaluate the immediate morbidity and mortality of Extremely Low Birth Weight Babies in the NICU setup of a tertiary care hospital. Study Design:Retrospective Observational Cohort Study Place of Study: Department of Paediatrics, Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata, India Period of Study:January 2018 to December 2020 Methods: The study was a retrospective analysis of data of babies born with a birth weight of less than 1000gms and admitted to the Neonatal Intensive care unit of Ramakrishna Mission Seva Pratishthan. The maternal demographic prole and delivery outcome were recorded along with the neonatal morbidity and mortality in a predesigned proforma. These data were then pooled and analysed. Results: The total number of ELBW babies born during this period was 31 out of whom 15 succumbed(48%). The studies in the developed world too shows the mortality in this group to range between 30 to 50 %. Most of the deaths occurred in the rst few days of life due to birth asphyxia. The commonest morbidity was Respiratory Distress Syndrome (RDS) (71%), followed by sepsis (64.5%), anemia (54.8%) and hyperbilirubinemia (51.6%). Necrotising Enterocolitis (NEC) was found in 9.7% of babies. 16 babies (52%) survived and went home in a stable condition. Retinopathy Of Prematurity (ROP) was detected in 11 of these babies for whom laser therapy was done with the advise for follow up. Conclusion: This study shows that in a resource poor country like India too, the percentage of babies who can be salvaged amongst the extremely low birth weight babies, matches with those in the developed countries, though a question remains about their long term morbidity

Mobile Swab Collection Vehicle; a Blend of Necessity, Innovation, and Technology in a Resource-poor Country

Mobile Swab Collection Vehicle is a concept that has been innovated by a team of medical and non-medical personals based upon the dire need to perform throat or nasopharyngeal swab collections to do reverse transcription polymerase chain reaction ‘RT-PCR’ quickly, safely, and comfortably during this Corona Virus Diseases 2019, ‘COVID-19’ pandemic in a resource-poor country like Nepal. Inputs from the health care workers, beneficiaries, and engineers have been taken to construct this vehicle-mounted booth for swab collection. This vehicle is the ‘first of its kind’ in Nepal. Keywords: COVID-19; Nepal; swab collection vehicle

Libya: Modern Political History

The modern Libyan state began to take shape within the Ottoman Empire from the mid-16th century onward. Libya’s path to independent statehood was violently interrupted in 1911 with the onset of an Italian conquest. Rome’s efforts to annex Libya through settler colonialism and ethnic cleansing were in turn disrupted by World War II. The United Nations (UN) helped to guide Libya to independence under the Sanusi monarchy in 1951, albeit in close collaboration with the United Kingdom and the United States. The Sanusi monarchy, founded in the eastern region of Cyrenaica in the late 19th century, faced substantial difficulties in its efforts to transform an incredibly vast, thinly populated, socially diverse, and seemingly resource-poor country into a modern nation state. Though the extraction and exportation of oil from the 1960s onward help to alleviate some of the financial constraints on the government, the increasing centralization of power within the monarchy eventually led to a military coup in 1969. Libya’s new regime, under the leadership of Mu‘ammar Al-Gaddafi, would eventually pursue a radical program involving centralized economic planning funded through oil sales, a baroque system of popular consultation, a terrifying array of “revolutionary” security institutions, military aggression in Chad, and confrontations with North Atlantic powers directly and indirectly. Though the Gaddafi regime was able to survive an array of domestic and international challenges for over four decades, a mass armed uprising in 2011, which precipitated a merciless civil war and foreign military intervention, led to its downfall. Subsequent international assistance and successive transitional authorities, however, were unable to address the spiral of insecurity that consumed Libya from 2012 onwards. A second civil war erupted in 2014, one fed not only by competing domestic visions for the future of Libya, but also by the competing ambitions of other states in the region.

Obstetrics Outcomes: A Comparison between Birthing Center and Conventional Labor Ward

Introduction: Birthing Centers (BC) are increasingly accepted worldwide as an alternate low cost place of birth. The concept is especially relevant for developing countries with limited resources and constraints regarding availability of specialists and hospital beds. The various studies have concluded that when proper risk analyses are conducted and referral rules followed, there is no evidence of increased maternal or perinatal risk at BC compared to standard hospital deliveries. Materials and Methods: This was a prospective, observational and comparative hospital based study done at Paropakar Maternity and Women’s Hospital (PMWH),Kathmandu. The study was conducted on pregnant women without any known risk factors for complications who were admitted in BC and labor ward (LW) for delivery. Details on mode of delivery, genital tract status, Postpartum hemorrhage (PPH) and neonatal outcomes were collected. Descriptive data analysis was done using SPSS. Results: Out of 5132 deliveries, 25.3% had no known risk factor and hence were eligible for study; no statistically significant difference was observed between BC & LW in relation to mode of delivery, perineal trauma, PPH and neonatal outcomes; however, practice of episiotomy was significantly less frequent in BC. Conclusion: When proper risk analyses are conducted and referral rules followed, there is no evidence of adverse obstetrics outcome at BC as compared to standard hospital deliveries. Triaging of low risk pregnancy to a BC is a viable strategy, especially in a resource poor country. This lessens the burden in standard maternity unit so that specialists will be able to provide a quality care to high risk pregnancies.

Management of Flood Disaster in Resource Poor Country: Bangladesh Perspective

not available Journal of Science Foundation 2019;17(2):40-41