Blood lead level and seizure: a narrative review

Environmental pollution is one of the most serious and fast-growing problems in the world of today. Lead poisoning is a threatening environmental situation with the potential of causing irreversible health issues and serious negative consequences in adults and children. Lead proves to have almost no clear biological function. However, once it enters the body, it is known to cause severe health effects, which might be irreversible. In this article, we aimed to review the related literature to find evidence concerning the effect of lead toxicity on CNS, particularly its role in febrile convulsion. In this review, PubMed database was searched using MeSH terms. One hundred and fifty seven articles were retrieved, most of which were irrelevant to the topic. After a thorough search in PubMed and Google Scholar, seizure was shown to be one of the consequences of lead toxicity, but there was no evidence of epilepsy or febrile convulsion, induced by this metal contamination

Seasonal variation in stroke in a teaching hospital of Khyber Pakhtunkhwa

Objective: to determine seasonal variation in the occurrence of stroke and its subtypes [ischemic stroke and hemorrhagic stroke] during summer and winter and to observe the frequency of common risk factors for stroke

Methodology: the present descriptive study was conducted in the Department of Medicine, MTI Lady Reading Hospital Peshawar, Khyber Pakhtunkhwa, Pakistan, over a period of one year from 1st January 2014 to 31st December 2014. A total of 321 patients of any age and either gender were included. The diagnosis was established based on history, clinical examination and supplemented by CT scan of brain

Results: in winter 58.56% of patients and in summer 41.48% of patients were presented. Ischemic stroke was present in 66.04% patients while hemorrhagic stroke in 33.95% patients. Males had more strokes as compared to females [60.75% Vs. 39.25%]. In males highest number of strokes was found in 60-69 age groups whereas in females it was in 50-59 age groups. In winter the strokes increased in all age groups comparative to summer. Hypertension [34.26%] was the highest risk factor for stroke

Conclusion: stroke showed seasonal variation. Winter season was associated with increased frequency of stroke and its subtype of hemorrhagic stroke. There was variation of gender, season and stroke types in different age groups. Hypertension was found to be the highest risk factor

Genotoxic evaluation of synthetic hydroxyapatite using mammalian bone marrow chromosome aberration test

Some of the beneficial biocompatible properties of hydroxyapatite [Ca10(PO4)6(OH)2]; the major component and an essential ingredient of normal bone and teeth, are that it is rapidly integrated into the human body and will bond to bone forming indistinguishable unions. But, before new materials are approved for medical use, mutagenesis systems to exclude cytotoxic, mutagenic or carcinogenic properties are applied worldwide. This study aimed to detect any chromosomal aberrations induced by the synthetic hydroxyapatite granules [Manufactured by Universiti Sains Malaysia, (USM) Penang, Malaysia] in the bone marrow cells of mice. The mitotic indices of the groups treated with synthetic hydroxyapatite granules did not show any significant difference as compared to the negative control group treated with distilled water. Also the groups of mice treated with synthetic hydroxyapatite granules and distilled water did not induce significant change in chromosome aberrations as compared to the positive control group treated with Mitomycin C. The mitotic indices and chromosomal analyses indicate that under the present test conditions, synthetic hydroxyapatite granules (manufactured by USM) are non cytotoxic and do not induce chromosome aberrations in the bone marrow cells of mice.

Prospective study of the development of alveolar osteitis after 3rd molar impacted teeth extraction in randomly selected patients

Alveolar Osteitis is the most common post-surgical complication following extraction of impacted 3rd molar teeth. Various risk factors have been mentioned for this complication including gender, age, and amount of trauma during extraction, difficulty of surgery, inappropriate irrigation, infection, smoking, and oral contraceptive use. The aim of the current study was to evaluate the incidence of alveolar osteitis among patients who had undergone surgical removal of impacted third mandibular and maxillary molars in Oral and Maxillofacial Department of Khyber College of Dentistry, Peshawar, Pakistan and also to identify the background risk factors in terms of age of the patient and experience of the operating dentists. A total of 1026 patients with a total of 1345 extractions formed the study group. Extractions to remove impacted third mandibular and maxillary molar teeth from 2006 to 2007 were included in this study. A questionnaire was designed in which the inclusion criteria age, gender, site of extraction, smoking and experience of the dentist while in exclusion criteria oral contraceptive use, menstrual cycle phase, systemic disorders, and use of antibiotics prior to surgery were included respectively. The incidence of Alveolar Osteitis was 12.07% as a whole in both the genders, whereas 16.95% alveolar osteitis developed in mandible and 7.34% in maxillary third molars extractions. However, incidence of Alveolar osteitis was significantly relevant to the patient's age, as well as the experience of the dentist in the extractions of impacted third molars. Incidence of alveolar osteitis was higher where extractions were performed by the less experienced dentists due to the more traumas

Comparative efficacy of H[1] blocker, H[2] blocker, and corticosteroid individually and in combination in resolution of sign and symptoms of acute Urticaria

To compare the efficacy of H[1] blocker, H[2] blocker, corticosteroid in combination or individually in resolution of the sign and symptoms of acute urticaria. Randomized control trial. This study was carried out at Medical Department, Naseer Teaching Hospital, Peshawar, Khyber Pakhtunkhwa [KPK] for the period of six months [July 2012 through December 2012]. In this study 140 adult patients of both gender with acute urticaria were treated with either H[1] blocker [group A], H[2] blocker [group B] or in combinations of H[1] blocker + H[2] blocker [group C], H[1] blocker + H[2] blocker + dexamethasone [group D], H[1] blocker + dexamethasone [Group E], H[2] blocker + dexamethasone [Group F] or Dexamethasone [group G] alone. The end points were resolution of sign and symptoms in each group of patients [minimum 3 hours after treatment]. Pregnant females, anemic and Patients with cardiac disease were excluded. H[1]+ H[2] blockers + dexamethasone found to be most effective therapeutic combination [95% of patients] in resolution of sign and symptoms of acute urticaria, followed by H[1] blocker + dexamethasone [90%] and H[1]+ H[2] blockers [85%]. This study concludes that the combination of H[1]+H[2] blockers + dexamethasone is more effective in relieving the patient from the sign and symptom of acute urticaria as compared to H[1] blocker or H[2] blocker or dexamethasone given alone or in combination of any two

Male contraception; knowledge, attitude and practice among male population of Hansra Basti Bahawalpur

To determine the knowledge and practice regarding male contraceptive methods among married male population of Hansra basti Bahawalpur, Pakistan. This observational [Descriptive] cross sectional study was carried out at Hansra Basti Bahawalpur from May 2011, to June 2011. A total of 100 married males were selected by simple random sampling. Data was collected by pre-designed, pre-tested, questionnaire to collect the information from study population. An interview was conducted at respondents' house in local language. Privacy was ensured. About 82% have knowledge about any of the male contraceptive methods and out of those 18% were practicing any one of the family planning methods. Condom [Barrier] was most used method [77.7%] followed by the traditional methods i.e abstinence [27.7%] and coitus interrupts [11.11%] where as result regarding vasectomy was nil. Source of knowledge mainly was media [44%] followed by through health professional [30%], wife [25%] and friends [21%]. In present setting men have good knowledge of male contraceptive methods. However very small number is practicing the contraceptive measures

Hyperbilirubinemia and neonatal infection

Hyperbilirubinemia is a relatively common disorder among infants in Iran. Bacterial infection and jaundice may be associated with higher morbidity. Previous studies have reported that jaundice may be one of the signs of infection. The aim of this study was to determine the incidence rate, presentation time, severity of jaundice, signs and complications of infection within neonatal hyperbilirubinemia. This cross sectional study was conducted between 2003 and 2011, at Ghaem Hospital, Mashhad- Iran. We prospectively evaluated 1763 jaundiced newborns. We finally found 434 neonates who were categorized into two groups.131 neonates as case group [Blood or/and Urine culture positive or sign of pneumonia] and 303 neonates with idiopathic jaundice as control group. Demographic data including prenatal, intrapartum, postnatal events and risk factors were collected by questionnaire. Biochemical markers including bilirubin level, urine and blood cultures were determined at the request of the clinicians. Jaundice presentation time, age on admission, serum bilirubin value and hospitalization period were reported significantly higher among case group in comparison with control group [p<0.0001]. Urinary tract infection [UTI], sepsis and pneumonia were detected in 102 [8%], 22 [1.7%] and 7 [0.03%] cases, respectively. We concluded that bacterial infection was a significant cause of unexplained Hyperbilirubinemia among jaundice newborns [10%]. Therefore, we advise performing screening test for UTI as part of the evaluation in asymptomatic jaundice infants presenting after five days of life and sepsis workup should be request in symptomatic infant especially in the first week of life

diagnostic efficacy of adenosine deaminase in tubercular effusion

This study aims to evaluate the diagnostic efficacy of adenosine deaminase in tubercular effusions. This study was conducted at the Department of General Medicine and Cardiovascular and Thoracic Surgery, SKIMS, for a period of two years between November 2008 and November 2010. A total of 57 patients presenting with pleural effusions during the two-year study period, who presented with clinical manifestations suggestive of tuberculosis [i.e., the presence of productive cough, low-grade fever, night sweats, weight loss, and chest pain, especially if these symptoms last >/= 4 weeks] were included in the study. If the patients presented with less than two of these symptoms, and especially if the clinical manifestations were of <4 weeks duration, they were excluded from the study. The mean adenosine deaminase activity level in all the 57 patients was 109 U/L while the mean adenosine deaminase activity levels in pleural TB patients was 80 U/L, and 64 U/L in the controls [p=0.381]. Considering 40 U/L as the cut off, the results were positive in 35 out of 39 tuberculosis patients and 9 out of 18 controls. The sensitivity of adenosine deaminase for tubercular effusions worked out to be 90%, with only 50% specificity. This study suggests that the estimation of adenosine deaminase activity in pleural fluid is a rapid diagnostic tool for differentiation of tubercular and non tubercular-effusions. The sensitivity and specificity of adenosine deaminase for tubercular effusions in this study was 90% and 50% respectively.

Is esophageal atresia a natural way of fasting?

One day in spring, April 2010 a middle aged woman with her infant rushed into the emergency room at a local hospital. The patient was an infant, only 8 days old with a weight of 2300 grams. He had a weight loss of 400 grams since his birth. He had frequent vomits with no toleration to breast feeding. Because of severe dehydration and his poor physical condition, he was hospitalized in the newborn intensive care unit. The infant was firstly diagnosed with hypertrophic pyloric stenosis, but then his ultrasound did not confirm it. Four days later, the patient was referred to the surgery department with the diagnosis of esophageal atresia [EA]." This was a true story from my colleague working in the pediatric department. The patient was diagnosed with EA, type C, the most common form of EA, which the upper esophagus ends in a blind pouch and there is a tracheoesophageal fistula [TEF] that is connected to the distal esophagus. This type of TEF prevents the patient from swallowing anything, and management of dehydration and hypoglycemia is necessary for survival

Survival of a neonate after nine days without feeding: a case report

A male neonate from a 23 year-old mother by cesarean section without complication in labor or delivery had vomiting from birth for 9 days and lost 400 grams of body weight. He had severe dehydration upon admission to our hospital. After treating his dehydration and assessment of his problem by laboratory tests and radiography we found that he had esophageal atresia without hypoglycemia. We repaired his atresia and he is normal now 10 months post-treatment

value of family planning for improving maternal health in rural Afghanistan: the example of Kandahar

Women in Afghanistan face some of the highest risks of maternal mortality and morbidity globally. The situation in rural parts of the country is particularly troubling, with women and girls residing in these areas suffering from much higher rates of death due to pregnancy-and delivery-related complications compared to urban areas. With a goal of increasing the contraceptive prevalence rate, particularly to assist in birth spacing, the Basic Package of Health Services seeks to provide access to family planning services equitably, regardless of ability to pay and with a special focus on rural and hard-to-reach populations. Using Maywand district in Kandahar province as a representative example of rural areas, we evaluate the benefits and assess the value [i.e., cost-effectiveness] of family planning for birth spacing and limiting, and to prevent pregnancy-related deaths. We synthesize the best available data to adapt a previously validated maternal mortality model to the situation of maternal health in Kandahar. Outcomes include total fertility rate [TFR], pregnancy-related complications, unsafe abortions, pregnancy-related deaths, maternal mortality ratio [MMR], lifetime risk of maternal death, and proportionate mortality ratio [proportion of deaths among women 15-49 years that are pregnancy-related]. We also estimate the life expectancy gains, years of life saved [YLS], and lifetime costs in order to assess the cost-effectiveness of family planning interventions. We compute the reduction in total fertility rate and pregnancy-related deaths and estimate the economic impact and cost-effectiveness of family planning interventions. Model-generated estimates of maternal mortality indicators, total fertility rate, and distribution of maternal death by cause closely approximated empiric data. Increasing family planning coverage from a baseline of 8% in rural Kandahar to 30% and 50%, would be expected to reduce the total fertility rate from 6.6 to 5.1 and 3.9, respectively, reduce maternal deaths by 21% and 40%, respectively, and reduce the proportionate mortality ratio from 45% to 38% and 31%, respectively. Incremental cost-effectiveness ratios of family planning strategies were below $145 per YLS, representing just a fraction of the per capita gross domestic product [GDP]. Extrapolating our results in rural Kandahar to the country as a whole, these strategies would prevent between 166,000 and 210,000 maternal deaths for a very modest investment and in the context of the current infrastructure. Of importance, further gains will require improvements in skilled birth attendants, care during labor and delivery, and access to emergency obstetrical care. Increasing access to family planning will improve the health of Afghan women, save lives and provide high value for the resources invested. Through the efficient use of public health resources, enhanced family planning efforts will improve the public health sector capacity to make necessary investments in skilled attendants, care during labor and delivery, and emergency obstetric care. These results provide strong support for the high value of family planning investments included in the Basic Package of Health Services

HIV knowledge, attitude, and risk perception among healthcare workers in Afghanistan Hospitals

The knowledge and attitudes of healthcare workers regarding HIV infection are important factors influencing the readiness of people living with HIV to access care, and the quality of the care they receive. In addition to factors such as stigma and bias, how healthcare workers perceive their own risks in relation to caring for HIV-positive patients may potentially influence their willingness to provide care and their attitudes towards HIV-infected patients. In Afghanistan, there is a lack of information on the prevalence of HIV in general population. The country, however, has many risk factors that could facilitate HIV transmission. To assess HIV-related knowledge, attitudes, and risk perception amongst healthcare workers in Afghanistan national and regional hospitals. A cross-sectional survey among healthcare workers was conducted in five large hospitals selected in Afghanistan. Approval was obtained from the Institutional Review Board of the Ministry of Public Health of Afghanistan and interviews were voluntary. Data analysis was conducted using STATA 11.0 to calculate frequencies and to perform cross-tabulation and logistic regressions with adjusted odd ratio and 95% confidence interval in order to detect statistical significance on differences in knowledge and attitude among healthcare workers in the targeted hospitals. Among 741 healthcare workers who participated in the study, 34.4% [255] correctly identified all correct modes of HIV transmission and 32.1% [238] correctly identified all incorrect modes of HIV transmission. Only 10.4% [77] correctly identified both correct and incorrect modes of HIV transmission. Nurses 12.3% [27] were most knowledgeable by correctly identifying all correct and incorrect modes of HIV transmission. The majority of healthcare workers expressed a willingness to care for people living with HIV. While 88% of healthcare workers believed that it is necessary to take extra infection precautions for people living with HIV, 76% presumed that people living with HIV should be nursed separately from other patients. Nearly 2 of every 3 Afghan healthcare workers in this sample lacked basic knowledge about the routes of transmission of HIV. These findings provide support for both improving the education of current healthcare workers, and integrating teaching modules that include the topics of disease transmission, clinical care, and universal precautions into curricula of health educational institutions

Post extraction bleeding associated with long term maintenance dose of aspirin 75-150mg

The objective of this study was to see post extraction bleeding associated with long term maintenance dose of aspirin 75mg-150mg without discontinuation. This study was conducted at Lady Reading Hospital Peshawar from January 2009 to June 2010. Patients for simple single tooth extraction and on aspirin [75-150 mg] were included. Patients with systemic disease like hematologic, renal, or liver disease, bone marrow disorders, alcoholism, or any concurrent medication affecting hemostasis such as anticogulants or anti-inflammatory drugs and patients who needed extractions of deciduous teeth, surgical extractions, extractions in different quadrants, or multiple extractions [>1 tooth] were excluded. Patients were evaluated for immediate and late post extraction bleeding. A total of 254 patients were studied. Patients were categorized into two groups with equal number of patients in each group i.e. 127 each. Group 1 [study] on maintenance dose of Aspirin 75-150mg while group 2 [control] were not taking aspirin. In aspirin group 05 [03.93%] patients had post extraction prolonged immediate bleeding while 03 [02.36%] were in control group. This difference was not statistically significant [p=0.722]. In aspirin group 02 [01.57%] patients had late bleeding at 12 hour post extraction while one [0.78%] patient suffered in control group [p=1.00]. The bleeding was successfully controlled with pressure on gauze and no patient required suturing or re-hospital visit. There was no bleeding in post extraction period at 24 and at 48 hours. It was concluded that simple tooth extraction in patients on long term maintenance dose of 75-150mg aspirin without discontinuation is safe as far as post extraction bleeding is concerned

Post management complications of fracture mandible at the angle-an analysis

The aim of the study was to investigate post management complications of the fracture of mandible at the angle. Age and sex distribution was also studied. 750 patients who suffered maxillofacial trauma were seen during the period 1991-97 at Khyber College of Dentistry, Peshawar. 546 had mandibular fractures, 125 of these showed fracture at the angle. 20 [16%] suffered from some kind of complications. Break up showed five [25%] suffered from infection, seven [35%] had delayed union, one [5%] non-union, two [10%] showed malunion/malocclusion, two [10%] trismus and three [15%] anesthesia/paraesthesia. Study subjects from 21-30 years showed highest [46%] prevalence of management complications. Males dominated females 4:1. RTA remained highest causative factor in the fracture [65.20%]

Ophthalmic, hearing, speaking and school readiness outcomes in low birth weight and normal birth weight primary school children in Mashhad-Iran

Low Birth weight infants are at risk of many problems. Therefore their outcome must evaluate in different ages especially in school age. In this study we determined prevalence of ophthalmic, hearing, speaking and school readiness problems in children who were born low birth weight and compared them with normal birth weight children. In a cross-sectional and retrospective study, all Primary School children referred to special educational organization center for screening before entrance to school were elected in Mashhad, Iran. In this study 2400 children enrolled to study and were checked for ophthalmic, hearing, speaking and school readiness problems by valid instrument. Data were analyzed by SPSS 11.5. This study showed that 8.3% of our population had birth weight less than 2500 gram. Visual impairment in LBW [Low Birth Weight] and NBW [Normal Birth Weight] was 8.29% vs. 5.74% and there was statistically significant difference between them [P=0.015]. Hearing problem in LBW and NBW was 2.1% vs. 1.3 and it was not statistically significant. Speaking problem in LBW and NBW was 2.6% vs. 2.2% and it was not statistically significant. School readiness problem in LBW and NBW was 12.4% vs. 5.8% and it was statistically significant [P<0.001]. According to the results, neurological problems in our society is more than other society and pay attention to this problem is critical. We believe that in our country, it is necessary to provide a program to routinely evaluate LBW children

To study the microbiology of surgical site infections [SSIs] complicating abdominal surgeries at DHQ teaching hospital D.lkhan and the drug sensitivity against them

To collect data of pathogens responsible for surgical site infection in elective abdominal surgeries and the drugs effective against them. Department of Surgery, District Head-quarters Teaching Hospital, Dera Ismail Khan from 1[st] January 2005 to 31[st] December 2009. Retrospective study on all cases of surgical site infections in elective abdominal surgeries over five years. Pus and swabs from infected wounds were sent to find the pathogens responsible for these infections and the drugs highly sensitive against them. 175 cases of abdominal surgeries with surgical site infection were collected over duration of five years. Their culture sensitivity reports showed positive result in 160 cases and negative result in 15 cases. Organism most commonly responsible for abdominal wound infection in our study was Klebsiella pneumonae. It was found in 53 patients [33.12%] followed by pseudomonas aeriginosa in 43 patients [26.8%] and E coli in 40 patients [25%]. Other micro-organisms were Staph-aureus [6.8%], Enterobactor [3.75%], Streptococcus [3.12%] and Clostridia [1.25%]. Sensitivity report of these microbes showed that Sulzone [cefoperazone plus sulbactum] is the most effective antibiotic.i.e. In 90 patients [56.25%], followed by Amikacin in 40 patients [25%] and Ciprofloxacin in 15 patients [9.3%]. Other drugs showing higher sensitivity against these pathogens were Fosfomycin in 10 cases [6.25%] and Imipenum in 5 cases [3.125%]. The study gives us clues to the type of pathogens that we would expect in our surgical site infection wounds of abdominal surgery, and the antibiotics which can be empirically used against these infections

Third molar position as predisposing factor for mandible angle fracture

The aim of the study was to assess the position of 3rd molar as a predisposing factor in the fracture of the mandible at the angle. Age and sex distribution was also studied. Out of 125 mandibular fractures at the angle, during a study from 1991-97 at Khyber College of Dentistry, Peshawar, 108 [86.4%] cases had 3rd molar present while in 17 [13.6%] cases it was absent. In 108 angle fractures, 23[18.4%] were fully erupted, 42[33.6%] were partially vertically erupted, 3[2.4%] were partially erupted distoangular, 15[12%] partially erupted mesioangular, 13[10.4%] were unerupted vertically, 7[5.6%] were unerupted mesioangular and 5[4%] were unerupted horizontally. High prevalence was seen in the third decade i.e.46%. Male to female ratio was 4:1

Frequency of mandibular fractures at the angle as a result of maxillofacial trauma

The aim of this study was to determine the vulnerability of the angle of mandible to fracture in maxillofacial injuries. The etiological factors, distribution of age and gender of the patients with mandibular fracture were investigated. 750 patients were seen for maxillofacial trauma during the period 1991-97 at Khyber College of Dentistry, Peshawar. Out off 750, 546 suffered from mandibular fracture. 412 were males and 134 females. Regarding etiology of the fracture of the mandible road traffic accident [RTA] was the most common cause accounting 356 followed by fall 78, interpersonal violence [IPV] 47, firearm injuries [FAI]29, sports 23 and industrial injuries 13. Fracture of the body of mandible came out to be the frequent site [185 patients] suffered. Angle of the mandible was second most common site and accounted for 125 injuries. Other sites were symphysis [97], condyle [82], dentoalveolar process [38], ramus 16 while coronoid was the rare site [3] patients. Out of the 125 fractures cases at the angle 3[rd] molar were present in 108 cases. Among the total fractures at the angle 102 were favorable while 23 were unfavorable

study to determine risk factors for abruptio placentae in pregnant women attending B.V. hospital Bahawalpur

To identify the risk factors responsible for abruptio placentae and to suggest measures for its prevention. Case Control Analytical [observational] study. Department of Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. Fifty cases of abruptio placentae were selected from emergency department of Bahawal Victoria Hospital Bahawalpur on the basis of history, clinical examination and ultrasonography. Five risk factors [age, parity, hypertension, previous history of abruption and pre mature rupture of membranes] were included in this study. Fifty controls for each risk factor were selected after matching. The condition was more prevalent among women of older age [70%], grand multipara [62%], hypertensives [52%], prior abruption [24%] and patients with pre mature rupture of membranes [06%]. It was concluded that the complications due to these risk factors are preventable if they are identified in time in order to modify behaviors pre-conceptionally or during delivery

Risk factors for preterm labour

To identify most common risk factors related with preterm labour existing in the study area and to recommend some suggestions for preventive measures in high risk patients. It was a case control [analytical-observational] study. Department of Obstetrics and Gynaecology Unit-I, Bahawal Victoria Hospital, Bahawalpur. From 16[th] April 2005 to 16t October 2005. Fifty eligible consecutive cases and 250 matched controls were selected by purposive sampling technique. Results revealed that preterm labour was more prevalent in patients with previous history of preterm labour or second trimester miscarriages with odds ratio 4.3. Preterm labour was associated with bacterial vagenosis and cervical incompetence with odds ratio 18.6 and 3.4 respectively. Twin pregnancies and anaemia were also significant factors for preterm labour with odds ratio 4.7 and 2.6 respectively. Previous preterm labour, second trimester miscarriages, bacterial vagenosis, twin pregnancies and anaemia proved to be risk factors for preterm labour