Azra Naheed Medical College

Monkeypox, caused by an Orthopoxvirus, poses a significant occupational risk to healthcare workers due to their frequent contact with infected patients and contaminated materials. This risk is increased by potential lapses in infection control protocols in hospitals, such as a lack of personal protective equipment (PPE), improper hand hygiene, and other issues, making hospitals a key site for occupational transmission of monkeypox. The objective of the study was to evaluate monkeypox transmission among healthcare workers and identify critical preventive strategies. A comprehensive literature search was conducted using PubMed, focusing on case reports and series published between 2000 and 2024. Eight studies comprising seven case reports and one case series, documenting a total of nine patients, were selected based on predefined inclusion criteria. Data regarding transmission routes, risk factors, and preventive measures were extracted and analyzed. The primary mode of monkeypox transmission among healthcare workers was percutaneous exposure, notably from needlestick injuries during the care of patients with active lesions. Fomite exposure accounted for 22.22% (2) of cases, highlighting the risk posed by contaminated surfaces and medical equipment. Respiratory transmission was suspected in some cases, though conclusive evidence remains limited. Key risk factors included inadequate use of PPE and breaches in infection control protocols. Post-exposure vaccination was administered to 33.33% (3) of patients, and post-exposure medication was given to 66.66% (6) of patients. Although respiratory transmission is not evident, asymptomatic or mildly symptomatic individuals may contribute to disease transmission. This highlights the need for improved surveillance and enhanced infection control protocols, including PPE utilization, hand hygiene, and avoidance of needlestick injuries. Post-exposure vaccination and antiviral treatment of exposed individuals effectively curb the spread of monkeypox.

Background: Diabetic kidney disease may begin silently, and serum creatinine can remain normal during early renal injury. Urine albumin-creatinine ratio is a practical screening test for detecting early albuminuria before routine renal function markers become abnormal. Objective: To determine the diagnostic yield of urine albumin-creatinine ratio for detecting microalbuminuria among adult diabetic patients with normal serum creatinine and to assess its association with diabetes duration and blood pressure control. Methods: This diagnostic yield study was conducted at a tertiary-care hospital in Bahawalpur, Punjab, Pakistan. A total of 180 adult diabetic patients with normal serum creatinine were included through consecutive sampling. Patients with known chronic kidney disease, raised serum creatinine, urinary tract infection, pregnancy, fever, heart failure, or acute severe illness were excluded. Microalbuminuria was defined as urine albumin-creatinine ratio of 30–300 mg/g. Associations with diabetes duration and blood pressure control were assessed using chi-square tests. Results: Microalbuminuria was detected in 62 of 180 patients, giving a diagnostic yield of 34.4% with a 95% confidence interval of 27.9–41.6%. Microalbuminuria increased with diabetes duration, from 20.7% in patients with duration below 5 years to 50.9% in those above 10 years. It was also more frequent in patients with uncontrolled blood pressure than controlled blood pressure, 48.6% versus 24.5%. Both associations were statistically significant. Conclusion: Urine albumin-creatinine ratio identified early albuminuria in a substantial proportion of diabetic patients with normal serum creatinine. Longer diabetes duration and uncontrolled blood pressure were associated with higher microalbuminuria frequency

BACKGROUND:Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder that often coexists with cardiovascular comorbidities, particularly heart failure (HF). OBJECTIVE:To evaluate the association between the severity of COPD and the prevalence of HF in patients treated at a tertiary care hospital. METHODOLOGY:This prospective cross-sectional analytical study was conducted at Dr. Faisal Masood Teaching Hospital, Sargodha, Pakistan, from July 2024 to July 2025 on 225 patients with confirmed COPD. The severity of COPD was classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Patients were evaluated for HF through clinical examination, echocardiographic assessment, and biomarker analysis, where available. RESULTS:The mean age of participants was 61.4 ± 9.7 years, with a male predominance (69.3%). Overall, 72 patients (32.0%) were diagnosed with HF. The prevalence of HF increased progressively with COPD severity: 5.9% in GOLD I, 17.7% in GOLD II, 42.7% in GOLD III, and 70.0% in GOLD IV (p < 0.001). On multivariate analysis, severe-to-very-severe COPD (OR = 5.4, 95% CI: 2.8-10.5, p < 0.001), hypertension (OR = 2.7, 95% CI: 1.4-5.3, p = 0.002), and age ≥ 60 years (OR = 1.9, 95% CI: 1.1-3.8, p = 0.04) were independent predictors of HF. CONCLUSION:It is concluded that increasing COPD severity is significantly associated with a higher incidence of HF. Patients with advanced COPD are at greater risk of developing cardiac dysfunction due to overlapping pathophysiological mechanisms and shared risk factors.

Background: Acute watery diarrhea remains a common cause of morbidity among young children, and adjunctive therapies that reduce stool frequency may improve clinical recovery when used with oral rehydration therapy. Objective: To compare the effectiveness of Bacillus clausii probiotic therapy and racecadotril in reducing stool frequency among children with acute watery diarrhea and mild dehydration. Methods: This randomized controlled study was conducted in the Department of Pediatrics, Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore, from July 30, 2023, to January 29, 2024. Ninety children aged 1–5 years with acute watery diarrhea, at least ten loose stools per day, and mild dehydration were enrolled and allocated into two equal groups. Group A received Bacillus clausii plus oral hypo-osmolar rehydration solution, while Group B received racecadotril plus oral hypo-osmolar rehydration solution. Stool frequency was recorded during follow-up, and treatment response was defined as more than 50% reduction in loose stool frequency. Results: The mean age was 3.32 ± 1.48 years. Reduction in stool frequency was achieved in 43 children (95.6%) in Group A compared with 31 children (68.9%) in Group B (RR 1.39, 95% CI 1.12–1.73; p=0.001). Mean loose stool frequency was also lower in Group A at 24, 48, and 72 hours. Conclusion: Bacillus clausii plus oral rehydration solution was associated with greater reduction in stool frequency than racecadotril plus oral rehydration solution in children with acute watery diarrhea and mild dehydration.