Volume 6 Issue-4 Oct-Dec, 17

Certain somatic mutations are capable to confer a selective benefit to blood stem cells become much more common with aging1. This state was entitled “clonal hematopoiesis of indeterminate potential,” (CHIP), and found that it upsurges the risk of developing a blood cancer more than 10-fold and it seemed to escalate mortality from heart attacks or stroke. But looking at the current understanding of Coronary heart disease CHD is that CHD in the world is the solitary empire where death rules,dictated by tobacco smoking and metabolic syndrome. Worldwide the anticipated rise in CHD is twice in the next 20 years in South Asia compared to any where else..

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Background:

Respiratory Syncytial Virus(RSV) infection is a common worldwide problem. Childhood mortality and morbidity due to RSV is increasing. This study was aimed at determining the sero-prevalence rate of RSV IgG antibody and also to investigate some known risk factors for acquisition of RSV among children presenting with various forms of respiratory tract infections in Ilorin, Nigeria.

Methods:

total of 600 samples were collected from children (whose parent or guardian has consented) and analysed for anti RSV IgG antibody using ELISA. Information regarding socio-economic status and other demographic variables were recorded using well structured questionnaire.

Results:

A seroprevalence of 75% (450/600) was detected in the subjects. The seroprevalence among male was 72.70% and female 77.54% (P = 0.171). The age group 6-10 yrs had the highest prevalence of 80% while 0-5 yrs had 73.94%, with a highly significant association (P = 0.0001).

Conclusion:

This study showed high prevalence of RSV, with the highest prevalence in aged 6-10 years which suggests that, RSV is common among school-aged children. Thus the importance of RSV as an agent of respiratory tract infection in children is identified. Preventive measures should be adhered to in the control of the infection, as antiviral drugs are not readily available.

Key Words:

Respiratory Syncytial Virus, Children, Mortality, Infection.

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Background:

A number of demographic and clinical variables have an effect on NT-proBNP, which has been used as a serological marker for evaluating cardiovascular disease. This study was done to evaluate the effect of these confounding variables on NT-proBNP.

Methods:

A cross-sectional study was performed on 50 Coronary artery bypass grafting (CABG) patients. Data of demographic and clinical variables was obtained from the patients. Samples of serum and pericardial fluid were collected and NT-proBNP levels were assessed in all the samples by an electrochemiluminescence immunoassay. Transformation of NT-proBNP values into log was done. The effect of all the variables on pericardial fluid and serum levels of log NT-proBNP was statistically calculated.

Results:

In this study NT-proBNP was found to be increased significantly with age (p-value of 0.01 and 0.02). Males constituted 86 % of our sample and NT-proBNP was insignificantly higher in men than women (p =0.227 and 0.245). There was also no significant difference between the mean NT-proBNP levels in hypertensives and diabetics.

Conclusion:

Age is the confounding variable which has significant effect on NT-proBNP concentrations while other demographic and clinical variables did not show a significant effect. Therefore, a minute adjustment should be made for the independent effects of age.

Key Words:

Pro-brain natriuretic peptide, Coronary Artery Bypass Grafting, Heart failure, hypertension, Diabetes Mellitus

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Objective:

This study was conducted to collate and compare a 1 year post-surgical radiographic outcome of posterior spinalinstrumentation and correction in the coronal plane with the use of pedicle screws against hybrid fixation in patients with adolescent idiopathic scoliosis.

Methods:

Cross-sectional study involving 34 patients who underwent scoliosis correction. The variables were measured pre-operatively, immediately post surgery and in two 6 monthly OPD follow-ups. Data analysis of data was conducted in SPSS version 20.

Results:

Average major curve was corrected from 58.0 ± 13.0° pre-op to 16.0 ± 9.0° using pedicle screws fixation and increased to 18.4 ± 8.6° at first year follow-up and using hybrid construct, thenormal major curve was corrected from 62.0 ± 13.0° pre-op to 18.0 ± 8.0° and increased to 22 ± 9°. By 1 year of follow-up, differences were apparent between the two groups considering the curvature in the coronal plane.

Conclusion:

Cobbs angles between pre-operative and post operative correction and 1-year radiographic follow-up evaluation was better in the instrumentation fixation using pedicle screws compared to hybrid instrumentation. Using pedicle screws there was a correction loss of 12.5% as compared to the 16.6% using hybrid fixation Pedicle screw instrumentation. Pedicle screw fixation also has the advantage of allowing three dimensional correction of deformity.

Key Words:

Adolescent, Scoliosis, Pedicle Screws

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Objective:

This study aimed at designing an audit tool for better understanding of pre-operative blood requisition and transfusion practice. These findings may help to provide evidence that an organization is working towards/meeting JCIA quality criteria of Cross match Transfusion ratio of 2:1.

Methods:

Analysis of data over the first 3 months revealed over ordering of cross matched blood resulting in a high Cross match transfusion ratio. Some strategies were devised including: 1. Use of group and screen instead of routine cross matching.2.listing the major indications for cross matching of blood.3. Preoperative and antenatal anemia correction.4. All time availability of O negative blood. 4. Education of staff and doctors about these strategies.

Results:

In the next 3 months the number of units cross matched fell moving towards a trend of group n save of blood samples resulting in significant improvement of CT Ratio.This helped us in efficient utilization of this limited resource.

Conclusion:

Regular audits must be done in order to improve the blood ordering and utilization practice in every hospital setting.The audit tool developed for monitoring of Cross match transfusion ratio in Ob/Gyn surgeries and thereby strategies for improvement of this quality indicator was found very helpful.

Key Words:

Cross ratio (CT match Transfusion Ratio), Clinical audit, Blood Transfusion

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Background:

Obstetric emergencies are usually sudden, unpredictable and may lead to maternal death and morbidity. Each year about 5,36,000 women die worldwide from complications of pregnancy and childbirth. Health professionals should be trained in emergency, life saving skills. Emergency obstetrics skills workshops for medical students were aimed to train them in providing care in emergency situations like antepartum and postpartum haemorrhage, eclampsia, shock, obstructed labour and abortion. Thus the purpose of our study was to evaluate the effect of emergency obstetrics workshop after providing training in team work in fourth year medical students to fulfil our future needs. We have evaluated the effect of hands-on training of emergency obstetrics skills in medical students in small groups and assessed the difference in their knowledge before and after the workshop.

Methods:

This cross-sectional study was conducted at Obstetrics and Gynaecology Department of Ziauddin University, Karachi, Pakistan from 2015 to 2016. Fourth year MBBS students (n=146) were included in the study with their informed consent. The knowledge regarding pre & post workshop was evaluated regarding various emergency situations with the help of a questionnaire. A pre-workshop test of 10 multiple-choice questions was administered to all the participants. At the end of the workshop, the same 10 questions were administered and the two scores compared using Paired sample t-test for paired data on SPSS statistical software version-21. A paired-sample t-test was for pre & post test score.

Results:

The results of pre test and post test showed profound improvement. We have been observed that the post test mean value of knowledge was higher than the pretest mean value of knowledge. Finally p-value <0.05 was considered statistically significance. Students were able to identify basic need of obstetric care that should be provided in obstetric emergency, compared with the situation before receiving the training.

Conclusion:

Well defined and structured hands-on training is an effective way of improving skills of medical students and may reduce maternal mortality in Pakistan.

Key Words:

Emergency obstetric care workshop, Maternal mortality, Evaluation, lifesaving skills.

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Background:

Sophisticated health education is now become a prime requirement to bring improvements in health profiles of patients and their families. Health care activities play a significant role to keep health education at forefront. The aim of the present study isto determine the health care workers’ perception for the need of instituting health promotion and also identify their beliefs about the improvement of community health by conducting health literacy sessions.

Methods:

A cross sectional study was conducted from April to October 2016 in various districts of Karachi. A total 286 medical care providers including physicians, pharmacists, nurses, dispensers/compounders, academicians and medical officers/quacks belonging to different organizations/institutions were approached.A structured questionnaire was developed containing different close ended items, seems to be necessary to meet objective of the study.

Results:

About 82.42% of them felt the need of health promotion services owing to their belief that such counseling would be beneficial in maintaining better health status of population. The lack of information was seen regarding drug-drug (24.12%) and food-drug interactions (25.87%). The most common issue, addressed by health care providers (68.53%) was the improvement in physical fitness via life style modification. The healthcare providers utilized various ways for spreading of information; however the role of media was highly encouraged by them.

Conclusion:

Institution of health education programs for residents is indeed necessary to reduce the risks of many communicable and non-communicable diseases.Therefore, such activities should be planned on regular basisin various areas of the city to provide maximum opportunitiesto individuals for participation. Health counseling also played a vital role and considered to be beneficial in the development of healthy community/society.

Key Words:

Health education programs, Role of health education, need of health education

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Objective:

This study was conducted to explore breastfeeding practices and knowledge among postnatal mothers.

Methods:

Anobservational Cross-sectional study was carried out in the Neonatal Division, Department of Paediatrics and gynaecology at Mardan Medical Complex, Mardanfrom June 9 till September 30th, 2014.The data from 200 Nursing Mothers was collected using a structured Performa. In addition to demographic data, nursing mothers were questionedabout their knowledge and assessed about attitude towards breastfeeding. Questionnaire also included independent variables of the study. Data was analysed using SPSS version 21.

Results:

Out of total 200 children, 120(60%) were males while 80(40%) were females. Mothers who knew the importance of breast feeding were 178(89%), while 22(11%) didnot. Of total 116(58%)women added substitute for breast milk while 84(42%) didn’t. who consider breastfeeding causes maternal weakness were 50 (25%) while 20(10%) didn’t mentioned any reason, 20(10%) were employed while 180(90%) were not. Out of total the knowledge of the mothers with first baby was inadequate about initiation of breastfeeding of which 36% has no idea to breastfeed within 1/2 -1 hour after birth,44% have no idea about importance of colostrum feeding, 3% of mothers had problem in breastfeeding out of which 2% was because of sore nipple.The insufficient milk production was most common reason given by mothers for giving supplemental feed (65% cases).

Conclusion:

High scores were significantly correlated with high parity, better maternal education,higher maternal age,received antenatal care and higher socio economic status.

Key Words:

Breastfeeding, knowledge, attitude.

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Transverse vaginal septum, rare defect of mullerian duct is a congenital anomaly of female genital tract resulting in abnormal collection of menstrual blood in vagina and uterus i.e. hematometrocolpos. Septum may lie at any level in vagina but most commonly lies at uper1/3rd 46% and least likely in lower 1/3rd of vagina i.e. 14%. Mostly patients present with primary amenorrhoea, cyclical abdominal pain and some time abdominal mass and therefore easily diagnosed but problem arises when patient present with atypical symptoms like urine retention, constipation and leg pain. Here we report a case of 15 years old girl who presented in emergency department with acute retention of urine for seven hours. Ultrasound Pelvis showed huge cystic mass in pelvis and MRI pelvis showed distended uterus and vagina. So hematometrocolpos was diagnosed, examination under anaesthesia revealed thick vaginal septum1cm away from introitus, no bulging in hymen was noted. Septum was surgically resected and 2.5liters (2500ml) chocolate coloured fluid was drained.

Key Words:

Hematomatrocolpos, transverse vaginal septum, imperforate hymens

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Intrahepatic cholestasis of pregnancy (ICP) is a complex disease described by pruritus connected with elevated serum bile acid or amino transferase level. Usually,it occurs to the third trimester of pregnancy and improves itself after delivery.In 1970’s the prevalence was reported highest in Bolivia and Chile, however, the prevalence in United States (US) ranges in between 0.3 to 5.6%, whereas, in Europe it is 0.5 to 1.5%. The awareness campaigns of the disease showed an increase in incidence in the high-incidence regions because of more reporting of the cases.Ursodeoxycholicacid (dose) is the treatment of choice for ICP. This treatment provide improved liver function and relief in pruritus and is considered safe during pregnancy.At the molecular level, it offers cytoprotection against hepatotoxic effects of hydrophobic bile acids, improves hepatobiliary bile acid transport, and decreases plasma bile acids. Moreover, to alleviate the pruritus; hydroxyzine or an aqueous cream with 1% methanol were used.ICP is a unique hepatic disorder in pregnancy with possibly an interaction of genetic, hormonal, and environmental factors in its etiopathogenesis, although the definite etiology still remains obscure.

Key Words:

intrahepatic cholestasis, pruritus, pregnancy,

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With a population in excess of a 200 million coupled with an incommensurate allocation of resources, Pakistan has long fallen prey to the scourge of disease. Even more alarming is the insidious rise in the proportion of population 65 years or older; this group is particularly prone to non-communicable diseases (NCDs) which are estimated to contribute well over 50% to total deaths.

This article describes the epidemiologic distribution of NCDs in Pakistan, with a special emphasis on the 4 main afflictions (Cardiovascular diseases, Cancers, Chronic Respiratory Diseases, and Diabetes) which together account for 36% of total deaths, a disconcerting figure considering that the approach to these conditions is largely preventive. In addition, an overview of current response strategies are provided in the hopes that future policy may be better guided

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