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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. It also signifies the need for adequate funds and infrastructure in the health care system especially in rural areas of developing countries like Pakistan.

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BACKGROUND: Burnout amongst radiologists is common in many different institutions and is increasing day by day. To battle burnout, we have to address the root causes already recognized in published literature. Therefore, it is crucial to examine and discern important publications. AIM: To provide evidence-based data and trends related to burnout in radiologists so that researchers can work on it further and develop preventive strategies to overcome this problem. METHODS: Bibliometric analysis conducted by two independent reviewers separately used Scopus Library for data extraction by using medical subject heading and International Classification of Diseases keywords. Forty-nine articles were selected for analysis after an extensive scrutiny. Statistical Package for the Social Sciences version 20 was used for analysis. Pearson correlation coefficient, Kruskal Wallis test, and Mann-Whitney U test were applied. RESULTS: The most productive period with regards to the number of publications was between 2017 and 2019. A total of 160 authors contributed to the topic burnout among radiologists, with an average of 3.26 authors per paper. About 41.68% of the authors were female, whilst 35% of them were first authors. The co-citation analysis by author involved 188 cited authors, 13 of whom were cited at least 70 times. Only six out of forty-nine studies were funded by various government institutions and non-governmental organizations. CONCLUSION: Current analysis casts a spotlight on important trends being witnessed in regard to the mental health of radiologists, including lack of funding for mental health research, narrowing of female vs male citation gap, as well as authorship and citation trends.

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OBJECTIVES: To find out the association of weight, height and age with spirometry variables and to generate a regression equation by taking weight as an independent variable beside age and height among children and adolescents of Karachi. METHODS: A modified form of ISSAC questionnaire was used. The spirometry variables recorded were Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC, Peak expiratory flow rate (PEF), Forced expiratory flow between 25% and 75% expired volume (FEF25-75). A person's correlation coefficient among boys and girls were calculated for all spirometry variable considering age, height and weight as independent variables. The linear regression models were calculated. RESULTS: The results reported a linear correlation of lung function variables with all three independent variables (i.e. p-value = 0.000), in which age and height manifested a strong positive correlation while weight reported a moderately significant correlation. All spirometry variables such as FVC, FEV1, PEF and FEF25-75 reported a significant coefficient of dependency and coefficient of correlation individually with age, height and weight. CONCLUSION: It is concluded that beside age, height and weight both also have significant correlation with lung volumes so these should be taken into account when using spirometry as a diagnostic test.

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OBJECTIVE: To determine pathogen burden and susceptibility pattern of multi-drug resistant (MDR) Pseudomonas aeruginosa isolates from clinical specimens in Karachi. METHODS: It was In-vitro Clinical study, conducted in department of Pharmacology, Ziauddin University, and isolates were collected from various specimens such as pus, tracheal aspiration, wound swab, blood and urine in Microbiology department of Ziauddin Hospital, Nazimabad campus, Karachi. The antibiotic susceptibility pattern was determined by Kirby Bauer Disc diffusion method. Samples were processed as per procedures defined by Clinical and Laboratory Standards Institute (CLSI) guidelines 2018. RESULTS: About 55% were found to be multi drug resistant P. aeruginosa. Majority of the isolates (35.4%) were recovered from the age range 60-80 years. Maximum number of MDR P. aeruginosa was isolated from pus (33.1%) followed by tracheal aspiration (20.6%). Highest sensitivity was seen by colistin (100%) followed by ceftolozane/tazobactam (60%). Least sensitivity was observed with imipenem (19%). However, increase trend of resistance was seen among all antipesudomonal drugs. CONCLUSION: Increasing frequency of infections due to MDR P. aeruginosa is an emerging threat in our set up which can be prevented by prescribing antibiotics judiciously. Consistent lab detection and surveillance regarding this resistant pathogen is compulsory for providing effective health care to community.

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OBJECTIVE: To establish age-specific normative spirometry reference range along with regression equation for children and adolescents. METHODS: The cross-sectional study was conducted from April to October 2017, and comprised children and adolescents aged 7-18 years at 8 educational institutions representing various socio-economic strata of Karachi. A modified version of the International Study of Asthma and Allergies in Childhood Questionnaire was used. Spirometry variables including forced vital capacity, forced expiratory volume in 1 second, ratio between the two, peak expiratory flow rate, forced expiratory flow between 25% and 75% expired volume were recorded and interpreted. By normal distribution curve the reference values were established, and mean}2 standard deviation values were taken as significant. Pearson's correlation coefficient and linear regression models were calculated for all pulmonary variables with age. RESULTS: Of the 751 subjects, 484(64.4%) were boys and 267(35.5%) were girls. The overall mean age was 12.96}2.8 years. The mean lung volume for forced vital capacity was 2.21}0.75, forced expiratory volume in 1 second 2.08}0.73, ratio between the two 92.9}4.7, peak expiratory flow 231.3 } 70.5 and forced expiratory flow between 25% and 75% expired volume was , , , 2.68}1.2. These lung volumes directly increased with age from children to adolescents (p<0.05). All variables showed a significant difference between boys and girls (p<0.05). CONCLUSIONS: There was a linear positive correlation of age with lung function variables, while the boys presented higher values than the girls.

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This article was migrated. The article was marked as recommended. INTRODUCTION: Depression is a mood disorder characterized by loss of interest in daily activity, feeling of hopelessness and helplessness, decreased appetite, anger and irritability. The risk factors which leads to depression include academic demands, daily habits, sleeping hours, sedentary lifestyle, inability to cope, helplessness, increased psychological pressure, mental tension and increased work load etc. The objective of current study is to find out the prevalence of depression among students of different medical colleges of Karachi and its association with life style, habits and coping mechanisms. METHODS: A descriptive cross-sectional study was conducted in 6 months i.e. April 2018 to September 2018, using a self-designed, self-explanatory questionnaire which also included Public Health Questionnaire (PHQ-9) for identification of depression. The coefficient of reliability including Cronbach alpha was 0.839 for the questionnaire. The data was analyzed by using mean with standard deviation and frequency with percentages while association was calculated by using Chi-square test. RESULTS: The mean age of participants was 21.43 ±1.803. About 2/3 of the participants were female with marital status of 3/4th of participants being single. 92% of the medical students were found to be depressed while 26% of them have suicidal thoughts. Symptoms of depression were compared with depression score, which showed strong positive correlation. Depression scores were also compared with lifestyle habits of participants, including sleeping hours, exercise, recent trauma and multiple coping mechanisms, presented significant association with depression scores (p-value ≤ 0.01). CONCLUSIONS: It is concluded that depression is highly prevalent amongst medical student populations while the lifestyle habits, sleeping hours, physical activities, recent trauma and coping mechanism showed significant positive association with depression.

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Lung function tests are essential for the diagnosis and management of different respiratory tract diseases; among them the spirometry is the gold standard technique. The accurate diagnosis, management and monitoring require proper interpretation of the results which depends upon the availability of spirometry reference data for that particular region to differentiate the diseased condition from the normal ones. Multiple studies had been done to find out their own area specific reference ranges but it is still lacking. This need was fulfilled by the Global Lung Function Initiative (GLI) in 2012, which reported the first global spirometry equation for all of the age groups. But some of the studies reported difference among GLI reference range and the measured range for that particular region. So here is the review of the reference ranges among 35,603 Asian children and adolescents from the 32 studies done specifically in Asia. The aim was to compare them with the study done by GLI team, along with these, tried to rule out the causal factor that are responsible for the variations in the reference ranges among the children and adolescents of different population. The literature was searched by using Google scholar and PubMed during the month of March up to July 2017. The review of all the articles published in Asia, specifically accounting for normal reference ranges in children and adolescent exhibit a wide variation among the reference ranges. This also suggest involvement of multiple modifiable and non-modifiable risk factors. So it's necessary to update the reference ranges for spirometry and its prediction equation as well.

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BACKGROUND: Despite the high prevalence of human immunodeficiency virus (HIV) in Pakistan, no prior work has been done to specifically highlight the importance of education as a social vaccine against HIV. Therefore, our study focuses on differences in knowledge and practices regarding HIV and acquired immunodeficiency syndrome (AIDS) among educated and uneducated adults. METHODOLOGY: A cross-sectional study was carried out in which data was collected from all over Karachi. An individual was designated as educated if he had received education above primary school level. Individuals who had studied till primary school or less were considered uneducated. The questionnaire was split into four sections that assessed respondents' demographics, knowledge, attitudes, and practices regarding HIV/AIDS. Chi square test was used as the primary statistical test. RESULTS: Out of the 446 adult participants, 235 (52.7%) were educated and 211 (47.3%) were uneducated. Educated participants were significantly more likely to have heard about HIV (183 vs. 39, p < 0.001) and had better knowledge about the symptoms of HIV/AIDS (p < 0.001). Among the participants who knew about AIDS, a greater percentage of uneducated (n = 28, 53%) than educated individuals (n = 68, 37%) believed that people suffering from AIDS should be isolated (p = o.o16) and that HIV can spread through water (40% vs 20% respectively, p < 0.001). Both educated (n = 49, 27%) and uneducated (n = 46, 89%) adults believed that awareness would help prevent the spread of HIV (p = 0.978) and were willing to educate their children about it (p = 0.696). CONCLUSION: Our study revealed a gap in the knowledge about HIV/AIDS between educated and uneducated adults. There is an urgent need for awareness programs that especially reach out to the uneducated masses that are otherwise uninformed about HIV and are under high risk of acquiring HIV.