ABSTRACT
Spina bifida is an important developmental defect of vertebral column. There are various types of spina bifida. The commonest one is spina bifida occulta [SBO], in which patients do not show any sign and symptoms as there is no herniation of spinal canal contents. This lesion is present at birth. Incidence of spina bifida decreases with age. The prevalence of spina bifida is related to various factors. Genetic predispositions, environmental factors and teratogenic effects of the drugs are important. It may be caused by the prenatal use of drugs like valproic acid. Sacral hiatus is used for caudal epidural block. We conducted this cross sectional study to find out the incidence of SBO in our population. This was an observational descriptive study. This study was carried out in Islamic International Medical College Rawalpindi. The duration of study was six months. Bones were studied in five different medical colleges of Rawalpindi with the consent of the concerned authorities. A total of 200 sacra were selected. The damaged and defective bones were excluded. All the studied bones were complete. All bones were studied for prevalence of SBO in our population. Bones having apex of sacral hiatus till S4 were considered normal. The remaining bones were divided into four grades according to level of failure of closure of sacral laminae. Bones with partial closure between two or more adjacent sacral vertebrae [incomplete spina bifida] were included in Grade I and II. Bone with sacral hiatus extending beyond S4 [long hiatus]were included in grade III and all bones with open dorsal wall representing the complete failure of fusion of the laminae from S1-S5 were included in grade VI. Results were analyzed by SPSS 17. The spina bifida was found in 69 bones with an overall incidence of 34.5% among 200 bones. Out of 69 variants, bones were grouped in two groups; one having complete and incomplete SBO among adjacent vertebrae, other having long hiatus. Prevalence of grade-1 SBO was 5.5% while it was 4.5% for grade- IV SBO. Region between SI- 2 was the most common site for grade-1 anomaly. Incidence of long hiatus from S5-3 was higher i.e., 46 [23%] while 2 sacra had hiatus ending at S2. Presence of spina bifida occulta should always be kept in mind while dealing with patients of backache, urinary and neurological symptoms. It may also be the cause of failure of caudal epidural block. Studies with larger sample size and including different ethnic groups from different regions of Pakistan are required to note the regional and ethnic disparities in the anatomy of the sacral hiatuses
ABSTRACT
Anxiety and assertiveness lead to disorder achievement, destroying intelligence and learning abilities, decreasing thinking attention and declining talents. It causes damages to individuals, family and community. Several therapeutic procedures suggested such as drug therapy for solving anxiety and increasing assertiveness, one of none drug therapy [behavioral therapy] is assertive training. In respect of contradiction of any results in the field of assertive training, we decided to design and carry out the present study. In study of field trial, first, we distributed overt and latent Spilberger's anxiety questioner and Gambrilrichy's assertive questioner among all nursing students of nursing and midwifery department of Nassibeh in Sari by sensus, and a number of sixty students with anxiety ranging were from moderate to severe with low assertiveness were selected, after matching than on the bases of sex, degree of interesting, course of study the degree, anxiety and assertiveness, they are divided in case and control group equally. For case group, assertive training performed during six weeks, once in a week for half an hour and no training is considered for control group. Degree of anxiety and assertiveness of nursing students in control and case group assessed and compaired by the use of couple t-test. Couple t-test's presented that decrease of overt and latent anxiety of nursing students in case group pre and post assertiveness training was significant. [Latent anxiety, t=7.68, overt anxiety, t=4.97, P<0.05] on the bases couple t-test, increase of assertiveness degree in control group in pre and post assertive training was significant compairing to control group [t=-9.93, P<0.05]. Regarding that increasing anxiety and decreasing assertiveness has undesirable effect on job performance, individual achievement and ability and with respecting to usefulness of assertive training procedure in decreasing anxiety and increasing assertiveness, it is suggested that assertive training is used as an on therapeutic procedure for decreasing anxiety and increasing assertiveness for nursing student
Subject(s)
Assertiveness , Anxiety , Students, NursingABSTRACT
A controversy appears regarding the involvement of hormones in the occurrence of seizures in epileptic patients. We have recently reported the pattern of seizure occurrence and its relationship to oestrogen and progesterone concentrations during menstruation related cycle phases [MRCP], premenstruation [PRMP], menstruation [MP] and post-menstruation [POMP]. The present communication deals with the catamenial [n = 10; age range: 13-32] as well as noncatamenial epileptics [n: 23; age range: 12-40] under study periods of nonmedication [NMSP] and medication [MSP]. Our results did not show significant differences in cortisol levels [nmol/1] during MRCP in noncatamenial and catamenial epileptics from those in various cycle phases of controls except during PRMP [P< 0.05] in relation to increased seizure occurrence in catamenial epileptics. Relationship between cortisol and seizure occurrence seems evident and possibly the catamenial exacerbation of seizures is partly due to increased cortisol levels during PRMP