ABSTRACT
Background: radial artery vasospasm is the most frequent complication of transradial cardiac catheterization. It causes discomfort and pain to the patient, prolongs the procedure and even makes it impossible for the interventionist to continue the procedure
Objective: to evaluate the efficacy of combined use of nitrate and calcium channel blocker [Verapamil] in prevention of radial artery spasm during coronary angiographies
Study design, settings and duration: it was a case control study conducted among 100 cardiac patients undergoing coronary angiography in Rehman Medical Institute [RMI] Peshawar from the duration of January 2016 to December 2016
Subjects and Methods: sample selection was done through convenient non probability sampling technique. Written informed consent was taken from the patients included in the study. Patients were divided into two group's control [50] and experimental [50]. One group was treated with heparin/nitrate as control group while other group was treated with heparin/nitrates/verapamil [Calcium channel blocker] as experimental group. Both groups were checked for radial spasm, pain and catheter resistance during angiography procedure. All other demography and history were collected through using a predesigned questionnaire. Data was collected, analyzed using SPSS version 16
Results: it was found that 63% patients were male, 37% were female and 68% cardiac patients were above the age 50 years. The study provided that using Verapamil as calcium channel blockers with nitrate does not put a significant effect on radial spasm with p value 0.806. The study provided that in comparison of cases and control for different variable, no significant difference was observed for radial spasm, pain, outcome, catheter resistance and time taken by the procedure. However the outcome of procedure was 100% successful among test group than control [98%]
Conclusion: calcium channel blocker [Verapamil] use with nitrate provided no significant difference in lowering radial spasm during coronary angiography. The assumption of using calcium channel blocker against radial artery spasm during angiography nullified
Policy message: economic burden due to use of calcium channel blockers along with nitrate during coronary angiograph
ABSTRACT
Background: neurological manifestations affecting the nervous system at all stages of Human Immunodeficiency Virus [HIV] infection are common. Neurological complications occur in more than 40% of patients with HIV infection. They are the presenting feature of Acquired Immune Deficiency Syndrome [AIDS] in 10-20% of cases. At autopsy the prevalence of neuropathological abnormalities is 80%. Although an ongoing decline in HIV associated Central Nervous System [CNS] diseases has been observed in very recent years, the mortality from these diseases remains high
Objective: to study the type and frequency of different neurological involvements in patients with HIV infection at tertiary care hospital in Peshawar, KPK and to correlate them with CD4 counts
Study design, settings and duration: this retrospective observational study was carried at Lady Reading Hospital, Peshawar, KPK, Pakistan over a period of 8 years from May 2009 to June 2017
Subjects and Methods: a total of 100 HIV sero-positive patients of both genders, aged >18 years, showing clinical evidence of central nervous system [CNS] involvement were included. Their clinical manifestations, laboratory investigations, and neuroimaging were studied. Laboratory investigations along with magnetic resonance imaging [MRI], EEG and nerve conduction study of the brain/spine was also performed
Results: tuberculous meningitis was the most common presentation as secondary CNS illness [49%], followed by cryptococcal meningitis [16%] and cerebrovascular accidents [7%]. Furthermore, 6% had neurosyphilis, 5% had acquired immune deficiency syndrome [AIDS] associated dementia and peripheral neuropathy occurred in 17% of the patients. Headache was the most common neurological symptom seen in 42% of the patients. Seizures were noted in 35% of the patients. CD4 was significantly low in most of the patients with progressive multifocal leukoencephalopathy, HIV associated encephalopathy [HAD] and cryptococcal meningitis compared with other neurological manifestations. CD4 counts in tuberculous meningitis and HIV associated encephalopathy were 115/microl and 83/microl, respectively
Conclusion: CNS tuberculosis was the most common secondary infection seen in HIV patients followed by cryptococcal meningitis. A high index of clinical suspicion of neurological involvement in HIV patients helps in the early diagnosis and early institution of specific treatment, which in turn decreases the morbidity and mortality considerably. Early treatment and prophylaxis of neurological problems in HIV patients is very important to decrease the mortality rate
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Objective: This study aimed to investigate influence of multiple sociodemographic characteristics on the patient satisfaction levels in outpatient public and private dental practices of Riyadh, Saudi Arabia
Methods: Questionnaire-based survey data were collected from 500 patients, 250 each from the public and private dental clinics of Riyadh, Saudi Arabia from September to December, 2017. Questions related to demographic factors and service attributes were included. A Likert scale of 5-points was used to measure satisfaction levels. Data was analyzed to calculate the descriptive and inferential statistics [analysis of variance and multiple regression analysis] to find the statistical difference [p < 0.01]
Results: Satisfaction level differed significantly by education level [P< 0.001] and the type of clinic [P<0.001]. The multiple regression analysis suggest that all variables influenced satisfaction, except age and marital status. The satisfaction score was higher by 27 percent for private clinics compared to public clinics
Conclusion: This study was exploratory and revealed an effect of individual variables on overall satisfaction score of the services attributes. Future plans for patient care could be developed with the help of this research
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Background and Objectives: Terrorist attack in Army Public School Peshawar, Pakistan left behind more than hundred children dead. It was the highest death toll of children in the world in a single terrorists attack. The attack dominated national and international news, high level security measures have been adopted in all school throughout Pakistan, which created fear and stress in children. The objective of the study was to determine post-traumatic stress disorder among children after six month of terrorist attack inspite of rigorous psychosocial support and rehabilitation
Methods: We wanted to determine Post Traumatic Stress Disorder [PTSD] among children of Army Public School of age range 10 to 18 years after 5 months of intervention and rehabilitation following terrorists attack. For this a self-report questionnaire, Child PTSD Symptom Scale [CPSS], which assess and identify symptoms matching DSM [Diagnostic and Statistical Manual of Mental Disorders] IV criteria for post-traumatic stress disorder of children, was filled. Informed consent was taken from school Principal and responders
Results: A total 205 students of age range 10 to 18 years participated in the study. The most frequent age group of the study were 16 years and 14 years students with frequency 58 [28.3%] and 46 [22.4%] respectively. Among 205 participated school children PTSD were found in 154 [75.2%] children while only 24.8% students had no PTSD symptoms. In more than 50% PTSD positive school children had functional impairment for each category of fun and hobbies, friendship, school work, family relation, doing chores, general happiness and saying prayers
Conclusion: Study found a very high prevalence of PTSD among 10 to 18 years age group students of Army Public School inspite of five months continuous intervention and rehabilitation services. Study showed that this age group needs long term psychosocial treatment in case of trauma
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Background and Objective: Dengue infection is an arthropod borne disease caused by Dengue virus in humans. Dengue virus infection has more potential to produce severe form of the disease with more severe symptoms. Proper diagnosis of dengue fever is very important for its safe management.The objective of this study was to evaluate the non structural protein-1 [NS1] positive parameter for identification of dengue fever by using ELISA from 2013 dengue outbreak in Khyber Pakhtunkhwa
Methods: It was a cross sectional study conducted among 384 patients tested for dengue admitted to different hospitals of Khyber Pakhtunkhwa April to December 2013 with symptoms related to classical dengue fever. Written informed consent was taken from 100 NS1 positive diagnosed patients, and 3 to 5 ml blood sample was collected for confirmation through ELISA testing. ELISA test for dengue IgG and IgM was performed two time in order to confirm the dengue cases. Data was entered and analyzed by using SPSS version 16
Result: The study performed on 100 NS1 positive samples of patients, admitted to hospitals with symptoms related to classical dengue fever, indicated that after performing the IgM and IgG capture ELISA test only 76 samples were actually found positive for dengue. The rest of the 24 samples were found negative for both IgM and IgG capture ELISAs. The study also revealed that 90.8 % patients had primary dengue infection and 35.5% patients had secondary dengue infection. Most patients were between the age of 10-20 years [26%], among them19.7% were having primary dengue infection. Among 10-20 years of age 50% female patients were false dengue patients
Conclusion: About 24 % NSI protein positive samples were found negative for both IgM and IgG capture ELISAs showed that NS1protein positivity does not confirm actual dengue infection
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Objective: This cross-sectional study aimed to examine the impact of learning management system and WhatsApp application as educational tools on students' academic achievement and attitude
Methods: The sample population was the students of six medical colleges of Riyadh, Saudi Arabia attending Medical Pharmacology's semester course in Bachelor of Medicine, Bachelor of Surgery [MBBS] program from September 2016 to January 2017. An exploratory approach was adopted based on a comparison between students exposed to only in-class lectures [Group-N], inclass lectures together with WhatsApp platform to disseminate the lecture slides [Group-W] and students group with in-class lectures facility blended with Learning Management System [LMS] and WhatsApp platform [Group-WL]. The students' grades were assessed using unified multiple choice questions at the end of the semester. Data were analyzed using descriptive statistics and Pearson correlation [p<0.01]
Results: Using learning management system [LMS] and/or WhatsApp messenger tool showed a significant positive correlation in improving students' grades. Additionally, use of WhatsApp enhances students' in-class attendance though statistically insignificant
Conclusion: The results are pivotal for a paradigm shift of in-class lectures and discussion to mobile learning [M-learning]. M-learning through WhatsApp may be as an alternative, innovative, and collaborative tool in achieving the required goals in medical education
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Background: Sexual dysfunction associated with the use of antipsychotic drugs is quite prevalent affecting the patients' quality of life and one of the reasons for non-compliance. This important aspect is underestimated and overlooked by the treating professionals, partly because patients rarely talk about their dysfunction. Due to the scarcity of local data on the subject the objective of the present study was to explore and compare the prevalence of sexual dysfunction associated with antipsychotic drugs
Methods: This was a hospital-based cross-sectional study comprising of comparative assessment among five antipsychotics being consumed by 91 male patients under this study
Results: Risperidone, haloperidol and olanzapine collectively as a group were associated with increased incidence of sexual dysfunction [42.43%] compared to quetiapine and aripiprazole group [16%] which was statistically significant. Individually risperidone [48%] and haloperidol [45.81%] were associated with highest incidence of sexual dysfunction followed by olanzapine [29.41%]. Quetiapine [16.67%] and aripiprazole [15.38%] were associated with the lowest incidence of sexual dysfunction
Conclusion: Risperidone and haloperidol are associated with a higher rate of sexual dysfunction compared to olanzapine. Quetiapine and aripiprazole have a significantly lower profile of adverse effects on sexual function
ABSTRACT
Cross infections occur frequently in dental health care personnel therefore, to protect themselves and their patients; they have to strictly follow infection control practices. To assess the impact of educational interventions on knowledge and practices of private dental practitioners. Interventional study, done from March 2012 to June 2013 in private practitioners of Peshawar using convenient sampling technique. After acquiring base line data on the practices, pertaining to prevention of cross infection in dental practitioners, educational knowledge intervention was applied to them on same day and repeated after two months. Post intervention data was collected using same questionnaire. The data was analyzed using Statistical Package for Social Sciences [SPSS] version 16.0. A total of 90 dental practitioners were included, of whom 49 [54.4%] were qualified and 41 [45.6%] unqualified. Their overall mean age was 33.77 +/- 8.97 years. The mean age of qualified practitioners was 36.24 +/- 10.40 years. Their pre and post intervention practices showed significant improvement in various practices like; screening of patients prior to procedure [p <0.043], hepatitis B vaccination [p < 0.000], type of gloves used [p < 0.031], hand washing [P < 0.004] separate instrument processing area [p < 0.004], floor cleansing with disinfectant [p < 0.000] and proper ventilation [p <0.021]. The mean age of unqualified practitioners was 30.80 +/- 5.73 years. Their pre and post intervention change in knowledge and practices showed poor compliance to most interventions. Qualified dental practitioners had a positive attitude towards educational infection as compared to unqualified practitioners. Yearly health education certification should be implemented for all health care professional [qualified and unqualified] to keep them abreast with the infection control practices
Subject(s)
Adult , Humans , Middle Aged , Dentists , Process Assessment, Health Care , Private Sector , Knowledge , Health Personnel , Dentistry , Surveys and Questionnaires , Cross InfectionABSTRACT
Background: Osteporosis is increasingly observed as a major public health concern as it leads to poor quality of life, pain and often disability for those effected. Especially in the developing countries, its prevalence in alarming in the face of poor awareness and management
Objective: To assess the risk factors for osteoporosis in females coming to a tertiary care hospital of Karachi
Methods: This was hospital based case control study conducted in a private tertiary healthcare facility of Karachi. It was carried out in 2012. 57 cases and 60 controls were selected through WHO Sample size calculator. Matching among cases and controls was based on gender, socioeconomic status and age group. Data was collected through questionnaire based personal interviews. Data entry and analysis was done using Epi Info. Association between categorical variables was found using chi square. Odds ratio was calculated for finding association between different risk factors and osteoporosis. The study was cleared through the Ethical review board
Results: One hundred and seventeen cases and controls were taken in this study with the age range of 45+ years [mean age 56.8 +/- 11.8]. Statistically significant difference was found in under 50 age group where cases were only n=8 [14%] as compared to controls n=25[42%]. Parsi ethnicity showed strong association with osteoporosis [OR 2.23]. Strong association was observed between smoking and osteoporosis with an Odds Ratio of 4.0. Strong association was observed with Rheumatoid arthritis [OR 2.8, CI at 95% 1.2-6.3] and Calcium deficiency [OR 2.2, CI at 95% 1.1-4.7]
Conclusion: The study revealed specific to Parsi ethnicity, family history, smoking, rheumatoid arthritis and Vitamin D deficiency were found to be potent risk factors. Therefore as reaffirmed from our study also, risk factors except from the non modifiable ones should be tackled well in advance through health education and interventions
ABSTRACT
To present the results of our experience with stereotactic surgery, which is a safe and minimally invasive technique, in the field of neurosurgery. Prospective study. Department of Neurosurgery, Ibn Sina Hospital, Kuwait. Forty patients underwent stereotactic surgery for diagnostic and therapeutic purposes during the five years between 2006 and 2011. There were 26 male and 14 female patients with a mean age of 47 years [range 9 - 70 yrs]. Twenty seven [67.5%] patients had diagnostic brain procedures and 13 [32.5%] had diagnostic as well as therapeutic procedures. The stereotactic surgery was carried out with the help of computerized tomography [CT] - guided Leksell stereotactic frame[registered] and Leksell SurgiPlan[registered] software. Stereotactic surgery. Outcome of surgery and complications. Stereotactic biopsies confirmed 28 [70%] patients with brain tumors; six [14%] with cerebral infections, four [10%] with multiple sclerosis and one with cerebral infarction. Stereotactic aspirations were performed in nine patients; four with cystic brain tumors and five with brain abscesses. Stereotactic insertion of Ommaya reservoir was performed in four patients with cystic brain lesions. Complication, related to the procedure was observed only in one patient and was managed conservatively. No other morbidity or mortality was noted. Stereotactic surgery is a minimal invasive technique that helps the neurosurgeon in further planning of an appropriate treatment after tissue biopsy. It can also be used as primary mode of treatment in patients with brain abscesses, cysts and intracranial hematomas
Subject(s)
Adult , Adolescent , Aged , Child , Female , Humans , Male , Middle Aged , Brain Diseases/diagnosis , Brain Diseases/therapy , Disease Management , Minimally Invasive Surgical Procedures , Prospective Studies , Brain Neoplasms , Brain AbscessABSTRACT
A cross-sectional study on blood calcium levels of pregnant women of low socioeconomic status was designed to find out the consequences of low levels on the outcome of pregnancy. Blood samples from 52 women and their cord were collected at the time of delivery. Calcium was analyzed calorimetrically in maternal as well as cord blood. For comparative analysis, levels of phosphorus were analyzed on atomic absorption spectrophotometer. The results were compared with 24 nonpregnant age matched controls. Calcium levels were significantly low [p < 0.01], in maternal [8.13 +/- 0.40 mg/dl] and cord blood [8.69 +/- 0.28mg/dl] compared to controls [10.5 +/- 0.6 mg/dl] and significantly higher in primiparous mothers [M=8.2 +/- 0.78 mg/dl,C=8.1 +/- 0.50 mg/dl] compared to multiparous [M=6.4 +/- 0.59 mg/dl,C=7.9 +/- 0.53 mg/dl]. Calcium levels were also found significantly lower in mothers who had a miscarriage [M=7.60 +/- 0.37 mg/dl,C=9.1 +/- 0.65 mg/dl] before this pregnancy than the primiparous and the controls. The results on the whole suggest that women tend to develop a marginal calcium deficiency after pregnancy
Subject(s)
Humans , Male , Female , Infant, Newborn , Fetal Blood , Cross-Sectional Studies , Pregnancy , Pregnancy Outcome , Phosphorus/blood , ParityABSTRACT
To introduce a novel treatment modality in neurosurgery practice in Kuwait and report our preliminary experience with this technique. Prospective study. Ibn Sina hospital, Kuwait. Fifty-seven patients who underwent radiosurgery in the first year of operation in our center. There were 32 [56%] male and 25 [44%] female patients with their age ranging from 12 to 76 years. Thirty five [61.5%] patients presented with benign tumors, 12 [21%] with malignant tumors [high grade gliomas, metastases], 8 patients [14%] with vascular malformations and two [3.5%] with functional disorders [trigeminal neuralgia]. Thirty one [57.2%] patients underwent radiosurgery for their residual lesions after attempted surgical excisions or other procedures. Gamma knife radiosurgery. Outcome of surgery and complications. The mean follow-up period was 9.7 months [range 3- 20 months]. The follow-up was achieved in 54 [95%] patients while three were lost to follow-up. Post-radiosurgery imaging demonstrated decrease in lesion size in 24 patients, no change in 27 and increase in three patients. These three patients were managed with surgery. Patients with trigeminal neuralgia were pain-free without any medications within three months of Gamma knife. Complications were observed in five [9.3%] patients, which were transient and improved after conservative treatment. No mortality was experienced in our patients, related to the procedure. Gamma knife radiosurgery is a safe and an effective treatment alternative to conventional neurosurgery in selected patients with brain disorders