Association of dietary pattern and childhood obesity with cardiovascular disease in patients from Tangail city, Bangladesh

@#Introduction: Obesity in childhood is a major cause for developing cardiovascular diseases (CVD) at adulthood. The present study was a cross-sectional research aimed to examine the relationship between childhood obesity and dietary pattern with CVD in patients (n=100) from Tangail City, Bangladesh. Methods: Dietary patterns, laboratory tests, demographic, and anthropometric interrelated data were measured in patients with stroke and heart attack from five hospitals. The research also used 24-hour recall method and a food frequency questionnaire for assessing daily energy and macronutrient intakes. Results: Weight (p=0.004), body mass index (BMI) (p=0.001), mid-upper arm circumference (MUAC) (p=0.009), and waist circumference (WC) (p=0.030) was significantly different between males and females whereas lipid profile was not significantly different between genders. There were no significant associations between intakes of red meat, salt, fast food, fish, egg, nuts and seeds with heart attack and stroke. On the contrary, there were significant associations between fried food intake with heart attack and stroke (p=0.080 and p=0.020). The results indicated that there was a significant relationship between carbohydrate (p=0.001), protein (p=0.001), and fat (p=0.001) intakes with the total energy intake of respondents. The findings also showed that there was a significant relationship between carbohydrate (p=0.003), protein (p=0.001), and fat (p=0.001) intakes with body mass index of the respondents. Conclusion: CVD diagnosis in adult patients was found to be associated with fried food intake but not with childhood obesity.

Relationship of Dental Caries and Body Mass Index amongst School Children in Hail, Saudi Arabia: A Cross-Sectional Study

ABSTRACT Objective: To determine caries prevalence and its association with body mass index in school children between 9-12 years of age in Hail, Saudi Arabia. Material and Methods: This descriptive cross-sectional study included 524 school children 9-12 years of age. These children were selected from 9 Public schools in Hail Province. Dental caries was recorded as per criteria established by the World Health Organization using assessment form for children 2013. Children were weighed using an electronic scale nearest to 0.1 kg with children attired in light clothing and wearing no shoes. The height was measured using a stadiometer to the nearest full centimeter with the children in a standing position. Body Mass Index (BMI) was determined using the formula BMI = kg/m2. Results: Caries prevalence in the population was 86%. The comparisons of mean DMFT between the groups demonstrate higher scores in the overweight group (mean=2.43) compared to normal weight (mean=1.85) and underweight children (mean=1.56) which is statistically significant (p=0.000). Bonferroni Post hoc test to compare the underweight and overweight group (p=0.000) and overweight and normal weight (p=0.000) were highly significant. Conclusion: A positive correlation of caries severity, namely DMFT, with BMI is established.

Current perspectives of 3d printing in dental applications / Perspectivas Atuais Da Impressão 3D Em Aplicações Odontológicas

Objective: To evaluate the applications of 3d printing /additive manufacturing (AM) in dental education & clinical dentistry and elaborate various 3d printing technologies, its benefits, limitations and future scope. Methods: Research papers on the application of 3d printing in dentistry were searched in Scopus and Pubmed and studied using bibliometric analysis. This review briefly describes various types of 3d printing technologies with their accuracy, use of different materials for 3d printing and their respective dental applications. It also discusses various steps used to create 3D printed dental model using this technology. Furthermore, the application of this technology in dental education and various clinical procedures are discussed. Results: 3d printing is an innovative technology making a paradigm shift towards treatment customization. It helps in customized production of dental implants, surgical guides, anatomic models etc. using computer-aided design (CAD) data. This technology coupled with state-of-the-art imaging techniques and CAD software has enabled, especially oral surgeons to precisely plan and execute complex surgeries with relative ease, high accuracy and lesser time. 3d printing is also being utilized in other disciplines of dentistry to prepare aligners, crown and bridge, endodontic guides, periodontal surgery guides, surgical models for treatment planning and patient education. Alongside its possibilities have also been explored in preclinical skills in operative, endodontics etc (AU)

Objetivo: Avaliar as aplicações da impressão 3D/manufatura aditiva (AM) na educação odontológica e odontologia clínica, e elaborar várias tecnologias de impressão 3D, seus benefícios, limitações e escopo futuro. Métodos: Artigos de pesquisa sobre a aplicação da impressão 3D em odontologia foram pesquisados no Scopus e no Pubmed e estudados por meio de análise bibliométrica. Esta revisão descreve resumidamente vários tipos de tecnologias de impressão 3D a partir da sua precisão, uso de diferentes materiais para impressão 3D e suas respectivas aplicações odontológicas. Ele também discute várias etapas usadas para criar um modelo dentário 3D impresso usando essa tecnologia. Além disso, a aplicação desta tecnologia na educação odontológica e vários procedimentos clínicos são discutidos. Resultados:a impressão 3D é uma tecnologia inovadora que está mudando o paradigma em direção à personalização do tratamento. Ele ajuda na produção personalizada de implantes dentários, guias cirúrgicos, modelos anatômicos etc. usando dados de design auxiliado por computador (CAD). Essa tecnologia, combinada com técnicas de imagem de última geração e software CAD, permitiu, especialmente aos cirurgiões orais, planejar e executar cirurgias complexas com relativa facilidade, alta precisão e menor tempo. A impressão 3D também está sendo utilizada em outras disciplinas da odontologia para preparar alinhadores, coroas e pontes, guias endodônticos, guias de cirurgia periodontal, modelos cirúrgicos para planejamento de tratamento e educação do paciente. Ao lado de suas possibilidades também foram exploradas em habilidades pré-clínicas em cirurgia, endodontia etc (AU)

Prevalence of high risk group of obstructive sleep apnea among western region population in Saudi Arabia

Background: Obstructive sleep apnea is a chronic morbid condition characterized by frequent attacks of upper airway collapse during sleep leading to interrupted sleep cycle and daytime fatigue

Objectives: Assessment of the most affected group of adults by obstructive sleep apnea disorder in western area of Saudi Arabia and help them to get a good quality of life

Methods: Cross sectional study involving 214 adults with age between 18 and 80 years old in the western area of Kingdom of Saudi Arabia

Results: There was no relationship between specific genders with high risk of OSA, while there was strong relationship between participants from male gender with low risk of OSA. Also, there was no relationship between age and high risk of having OSA among our participants. In addition, there is no relationship between age and low risk of having OSA among our participants. There was a relationship between overweight participants from both gender and high risk of having OSA, while there was relationship between underweight participants from both gender and low risk of having OSA

Conclusion: Our study showed that around 28% of populations are in high risk group of having OSA. Also, sleep apnea in older patients is less severe than sleep apnea in the young

Better late than never: identification of children with hearing loss in Pakistan

Objectives: To ascertain the prevalence of late detection of hearing impairment [HI] among the children of Pakistan. It aimed at identification of children with hearing loss

Study Design: Cross sectional survey

Place and Duration of Study: The study was conducted at special schools in three major cities of Pakistan Rawalpindi, Islamabad and Lahore. Duration of study was six months i.e. from March to August 2016

Patients and Methods: A convenient sampling technique was adopted by collecting information through a questionnaire with 125 parents of children with impaired hearting. Children diagnosed with only HI and with no other disability were selected for the study and assessed with questionnaires filled by their parents

Results: The results revealed that late detection of HI was more manifested in the age bracket of 19-24 months at 48% followed by 22% at 0-6 months. The results showed that HI was noticed in 33% cases during 0-6 months age but first professional advise was sought in the age bracket of 19-24 months in 35% cases

Conclusions: The current study has established the prevalence of late detection of HI in Pakistan, as there is a significant time lag between HI being noticed and its final detection

Effect of herb-drug interactions of Bacopa monnieri Linn. (Brahmi) formulation on the pharmacokinetics of amitriptyline in rats

ABSTRACT Interactions between herbs and drugs may increase or decrease the pharmacological or toxicological effects of either component. Experimental data on the pharmacokinetic interactions between herbal products and drugs are limited. This study attempted to investigate the effect of Bacopa monnieri Linn. (Brahmi) formulation on the pharmacokinetics of amitriptyline in rats. In this study, rats were randomly divided into two groups (n = 6 each) which were served as a control (amitriptyline alone) and treatment group (amitriptyline with B. monnieri), respectively. Rats in the treatment group received B. monnieri (31 mg/kg/day) whereas the control group received normal saline by oral gavage for seven days before a single intragastric administration of 25 mg/kg amitriptyline. Plasma concentrations of amitriptyline were measured up to 24 h after its administration by a developed and validated high-performance liquid chromatography method. Pretreatment with B. monnieri produced a significant increase in the maximum plasma concentration (Cmax), area under the curve (AUC0-t) and elimination half-life (t1/2) of amitriptyline by 16.8%, 26.5%, and 15.5%, respectively, compared to amitriptyline alone. Moreover, oral clearance and volume of distribution (Vss) were decreased by 26.2% and 15.5% respectively. This study concluded that B.monnieri significantly enhanced the oral bioavailability of amitriptyline in rats.

To determine patients' perceptions and attitudes for blood transfusion

Background: Blood transfusion is a risky procedure due to transmission of various infections and reactions of unmatched blood transfusion. Many blood transfusion related problems can be prevented to some extent if patients and their family members are involved in transfusion related procedure

Objectives: To determine patients' perceptions for the recall of consent process, risks, benefits and attitude for blood transfusion

Study design, settings and duration: Hospital based cross-sectional study done on adult patients admitted in Orthopedic and Surgical wards of Civil Hospital, Karachi from November 2014 to January 2015

Patients and Methods: Using convenient sampling, a total of 350 patients who were admitted and received blood transfusion were included in the study. Variables included age, gender, educational status, language spoken, recall of consent for blood transfusion, risks, benefits and attitudes for blood transfusion. Questionnaire based instrument was used for data collection. SPSS version16 was used for descriptive frequencies

Results: Of the total 98% patients were neither asked nor recalled for the consent of blood transfusion. Only 19 [5%] patients were informed about the risks and 77 [22%] about the benefits of blood transfusion. About 236 [67%] patients were of the opinion that blood of family members, if transfused, carries fewer chances of risk/reactions and 213 [61%] patients stated that they will prefer to receive blood transfusion from their family members. Only, 16 [5%] said that would refuse blood transfusion even if it was needed and will prefer blood alternatives. Overall 326 [93%] patients had poor perception and 262 [75%] good perception for blood transfusion

Conclusion: The consent for blood transfusion was missing in majority of the cases and risks and benefits were not explained to the patients

Policy statement: Institutional Bioethics Committees should take notice of these shortcomings

Case-control study for measles outbreak in a tertiary care hospital

Objectives: To compare the profile of measles patients [cases] with non-measles [controls] admitted in Pediatric units of Civil Hospital, Karachi during the measles epidemic

Study type, settings and duration: Retrospective, case control, hospital record analysis of children admitted in pediatric units of Civil Hospital, Karachi from October 2012-March 2013

Subjects and Methods: From the list provided by the ward authorities, case records of children [cases] admitted in pediatric units of Civil Hospital, Karachi with the clinical diagnosis of measles were selected using convenient sampling. From the same wards, age and gender matched non-measles cases [controls] were also selected. The signs, symptoms, mortality and hospital stay of cases and controls were taken from the hospital record, while some information like socio-economic status, vaccination status, symptoms, number of days ill before presenting to health facility, health status of the child, history of similar illness in the family, neighbors, relatives and history of calamity in the area in recent past was taken from the parents or care givers telephonically. Sample size of 300 children [150 cases, 150 controls] was calculated

Results: Out of 150 children having measles, 84 [56%] were females. Most cases reported to health facility after a median of 8 days of onset of symptoms. Almost 98 [65%] children were vaccinated for measles and 52 [35%] were not vaccinated Median age of cases, vaccinated for measles was 30 months while median age of cases not vaccinated for measles was 21 months. All cases had history of fever and maculo-papular rash. Death occurred in 10 [7%] cases due to pneumonia. There was history of measles in their family in 90 [60%] cases, 54 [36%] had measles in neighbors and 30 [20%] in relatives. Out of 150 controls, 76 [51%] were vaccinated for measles and 74 [49%] were not vaccinated. The main reason for admission was pneumonia in 78 [52%] and bronchial asthma in 45 [30%]. The risk of measles was 0.83 times higher for cases who were vaccinated for measles as compared to controls who were vaccinated for measles. Using univariate analysis, symptoms of breathlessness and lower respiratory tract infection at the time of admission were significantly associated with measles disease. Using multivariate analysis, children between 9 to 60 months of age, presenting with breathlessness and lower respiratory tract infection had a significantly high chance of suffering from measles disease

Conclusion: Almost 65% who had received measles vaccination as per their mothers statement suffered from measles

Policy message: Measles outbreak occurring in many children despite getting measles vaccine needs further workup both for the timing of vaccination, actual verification of vaccination and its efficacy

Management of developmental dysplasia of hip in older children by triple procedure

Objective: To review the presentation and evaluate the radiographic and functional outcome of developmental dysplasia of hip [DDH] in older children treated by triple procedure surgery, consisted of open reduction, Salter Innominate Osteotomy [SIO], femoral shortening and derotation Osteotomy

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the BMC Hospital Quetta from January 2013 to December 2015

Materials and Methods: We assess the efficacy and safety of underwent triple procedure treatment of DDH in older children. The study series comprising 22 patients [25 hips].Patients were classified pre-operatively according to the Tonnis Classification, and post-operative functional evaluation was performed using modified Mackay's scoring system, while radiographic assessment considered Severin scoring method

Results: The average age at presentation was 5.60 years and the male to female ratio was 2:46 months. While the average follow-up were 16.4 months. The final outcome was successful in 19 hips [76%] in 16 patients. Patients younger than 5-6 years of age had a better radiological and clinical outcome as compared to older children. Although in the outcome of clinical and radiological assessment there were no significant different between group-I and group-II

Conclusions: Late presentation of DDH is still common in Quetta, Balochistan, which necessitates Triple procedure operative management given frequent occurrences of best result in younger children. Early diagnosis and surgical interventions is therefore imperative in the successful treatment of patients suffering from DDH

To determine the factors responsible for diagnostic delay of breast cancer among women

Background: Breast cancer is the most common cancer among women throughout the world. Early diagnosis of this cancer is important for its early treatment and favorable outcome. The diagnostic pathway is divided into patient, doctor and system interval. This study will look into the reasons for delay in diagnosis

Objectives: To determine the frequency of diagnostic delay [patient, doctor and system delay] of breast cancer among adult women [>/= 18 years] and factors responsible for it. Study design, settings and duration: Hospital based cross-sectional study conducted at Oncology/ Radiotherapy unit of Jinnah Post Graduate Medical Centre. Karachi from February 2015 to December 2015

Subjects and Methods: Adult women [2 18 years] diagnosed with breast cancer and reporting at Oncology/Radiotherapy unit of Jinnah Post Graduate Medical Centre, Karachi were enrolled. Convenient sampling was used, sample size was 288 women with breast cancer. Variables included age strata, socio-demographic characteristics, age at menarche, parity and breast feeding history [if applicable], intervals of diagnostic pathway [patient, doctor and system] and reasons of delay. Questionnaire based instrument was used for data collection. SPSS version 16 was used for data analysis and descriptive frequencies

Results: The mean age of the patients was 42 years [range 21-80 years]. Breast lump was the main presenting symptom [90%,]. Complete physical and breast examination was performed by health care provider in 97% cases. Median patient, doctor and system interval was 90, 45 and 35 days respectively. Median diagnostic pathway [patient+ doctor+ system] was 165 days [5.5 months] and ranged from 2- 405 days [13.5 months]. It was further found that after confirmation of the diagnosis, median interval to report to oncology/radiotherapy unit was 18 months. First consultation with the health care provider was delayed due to carelessness in 57%, due to financial reasons in 55%, due to fear of cancer in 23% and due to time constraints to visit hospital by the family members in 13% cases. Univariate regression analysis showed that late presentation to first health care provider by the patient [patient interval] was mostly seen in women having children who were less educated [illiterate/primary] without any ethnic group being specific. Univariate regression analysis showed that delay in reporting to oncology/radiotherapy unit was seen in women without any ethnic group been specific and those having children. Multivariate regression analysis showed that delay in reporting to oncology/radiotherapy units was mostly seen in women aged between 18-25 years who had children and belonged to either Sindhi, Baluchi or Pushto origin

Conclusion: Delay in the diagnosis of breast cancer among adult women attending the tertiary care public sector hospital as not due to doctor or system interval but was due to fear of cancer. Policy statement: Awareness campaigns should be used to communicate to women folks that breast cancer is curable if diagnosed and treated early

[Educational intervention on the health action model on employee safety behaviors in Tabas coal mine]

Background and Aim: Maintaining a huge elderly health, health promotion and community development is very important. Workers' health status is largely influenced by their working conditions and job. Work in mines, including those considered threats to workers' health

Materials and Methods: A number of 45 workers in each of the control and intervention groups participated in a quasi-experimental study. Demographic information and data related to HAM constructs and safety were collected through a HAM questionnaire and the safe operation checklist 3 months after the intervention. Cronbach's alpha coefficients were used to confirm properties of the tools. Educational intervention accompanied was applied in the form of four training classes. The Data were analyzed based on distribution of variables

Results: Before the intervention, there was no significant difference between the two groups in terms of demographics and the study main variables. After training, however, results showed significant changes of mean scores of attitude [P<0.001], norms [P<0.001], belief [P<0.001], intention [P<0.001], knowledge [P<0.001] in the experimental group

Conclusion: The research results show that HAM educational intervention is able to change workers' awareness, attitude, norm, belief, and intention towards unsafe behavior and improve their safety performance

Primary prevention with statins in cardiovascular diseases: a Saudi Arabian perspective

Cardiovascular disease [CVD] constitutes one of the major causes of deaths and disabilities, globally claiming 17.3 million lives a year. Incidence of CVD is expected to rise to 25 million by 2030, and Saudi Arabia, already witnessing a rapid rise in CVDs, is no exception. Statins are the drugs of choice in established CVDs. In the recent past, evidence was increasingly suggesting benefits in primary prevention. But over the last decade Saudi Arabia has a witnessed significant rise in CVD-related deaths. Smoking, high-fat, low-fiber dietary intake, lack of exercise, sedentary life, high blood cholesterol and glucose levels were reported as frequent CVD-risk factors among Saudis, who may therefore be considered for primary prevention with statin. The prevalence of dyslipidemia, in particular, indicates that treatment should be directed at reducing the disorder with lipid-modifying agents and therapeutic lifestyle changes. The recent American College of Cardiology [ACC]/American Heart Association [AHA] guidelines has reported lowering the low-density lipoprotein cholesterol [LDL-C] target levels, prescribed by the 2011 European Society of Cardiology [ESC]/the European Atherosclerosis Society [EAS]. The new ACC/AHA guidelines have overemphasized the use of statin while ignoring lipid targets, and have recommended primary prevention with moderate-intensity statin to individuals with diabetes aged 40-75 years and with LDL-C 70-189 mg/dL. Treatment with statin was based on estimated 10-year atherosclerotic-CVD [ASCVD] risk in individuals aged 40-75 years with LDL-C 70 to 189 mg/dL and without clinical ASCVD or diabetes. Adoption of the recent ACC/AHA guidelines will lead to inclusion of a large population for primary prevention with statins, and would cause over treatment to some who actually would not need statin therapy but instead should have been recommended lifestyle modifications. Furthermore, adoption of this guideline may potentially increase the incidences of statin intolerance and side-effects. On the other hand, the most widely used lipid management guideline, the 2011 ESC/EAC guidelines, targets lipid levels at different stages of disease activity before recommending statins. Hence, the 2011 ESC/EAC still offers a holistic and pragmatic approach to treating lipid abnormalities in CVD. Therefore, it is the 2011 ESC/EAC guidelines, and not the recent ACC/AHA guidelines, that should be adopted to draw guidance on primary prevention of CVD in Saudi Arabia

Aneurysmal subarachnoid hemorrhage: outcome of aneurysm clipping versus coiling in anterior circulation aneurysm

Objective: To compare the neurological outcome of microsurgical clipping versus coiling in patients with anterior circulation aneurysm

Study Design: Comparative study

Place and Duration of Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from January 2010 to December 2013

Methodology: Patients aged 14 - 60 years, with ruptured cerebral aneurysm of anterior circulation and World Federation of Neurosurgical Society [WFNS] grades 1, 2 and 3 were included. Patients more than 60 years, medically unfit patient and posterior circulation aneurysms and WFNS grades 4 and 5 were excluded. Aneurysm sac obliteration was done in randomized manner with microsurgical clipping or coiling. Postoperatively, the patients were assessed and followed-up upto one year for outcome parameters on the bases of WFNS grade and Modified Ranking Scale [mRS] as favourable [mRS 2]

Results: Among 140 subjects selected for study, 70 were included in group A, i.e. coiling and other 70 were in group B, i.e. clipping. The median age of patients in group A was 52.5 +/- 10 years and in group B was 51.00 +/- 10 years. Overall, 56 [40%] males, 28 [60%] males in each group; and 84 [60%] females, 42 [60%] in each group were included. The male to female ratio in this study was 1:1.5. In group A, i.e. coiling, 27 [38.6%] patients had no disability [grades 1 and 2], 25 [35.7%] were slightly disabled [grade 3] and 18 [25.7%] had moderate disability [grade 4]; whereas in group B, i.e. clipping group 23 [32.9%] patients had no disability [grades 1 and 2], 23 [32.9%] were slightly disabled [grade 3] and 24 [34.3%] had moderate disability [grade 4]. At one year follow-up, in group A, favourable outcome was achieved in 56 [80%] of patients compared to 48 [68.6%] in group B; whilst, 14 [20%] patients in group A and 22 [33.1%] in group B showed unfavourable outcome. Although mortality rate was higher in clipping [n=3, 4.3%] as compared to coiling [n=1, 1.4%], but was not statistically significant [p = 0.310]

Conclusion: Endovascular coiling of anterior circulation aneurysms is safe and as effective and successful as aneurysm clipping and is less invasive also

Economic burden of dengue in four major cities of Pakistan during 2011

To assess the economic burden of dengue infection by calculating cost per patient and disability adjusted life years lost. The cross-sectional study was conducted in Islamabad, Lahore, Faisalabad and Karachi from July 2012 to March 2013. Residential addresses and telephonic numbers of dengue patients were taken from the records of Pakistan Institute of Medical Sciences, Islamabad, Mayo and Ganga Ram Hospital, Lahore, Civil Hospital, Karachi, and Allied Hospital, Faisalabad. A total of 250 dengue confirmed cases - 50 from each hospital - were randomly selected. Information regarding duration of illness and out-of-pocket expenses were collected to estimate the direct cost, while indirect cost [number of work days missed by the patient] was calculated from disability adjusted life years using Murray's formula. Overall, there were 162[65%] men and 88[35%] with a mean age of 30.4 +/- 13.5years. More than half 138[55%] were below 30 years of age. Socio-economically, 145[58%] belonged to low, 70[28%] middle and 35[14%] to high socioeconomic groups. Of the total, 210[84%] cases had dengue fever followed by 32[12.8%] dengue haemorrhagic fever and 8[3.2%] dengue shock syndrome cases. Average duration of illness was 32 +/- 7.1 days. Overall direct cost per patient was Rs.35, 823 [US$358] and average pre-hospitalisation, hospitalisation and post-hospitalisation was Rs.6154, Rs.21, 242 and Rs.8, 427 respectively. The overall disability adjusted life years per million population was 133.76. Although the government had provided free treatment for dengue in public-sector hospitals, still patients had to pay Rs.21, 242 during hospital stay, resulting in substantial burden which needs to be addressed

Prophylactic Effect of Clofibrate on Hyperbilirubinemia in Very Low Birth Weight Twins.

Aims: To determine the prophylactic effects of clofibrate on hyperbilirubinemia in very low birth weight twins. Study Design: A randomized double blind clinical trial Place and Duration of Study: Department of Neonatal Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, between Oct 2010- Sep 2011. Methodology: Forty neonates with very low birth weight (20 pairs of twins) having same blood group and sex were elected. Infants with congenital anomalies, metabolic diseases, hemolytic disease, and infections were excluded. Case group received a single dose of clofibrate 100 mg/kg and control group received sterile water. Both clofibrate and sterile water were administrated through orogastric tube and were the same volume. Serum bilirubin levels were measured before administration, 24, 48, 72 and 96 hours after the administration. Data was analyzed using repeated measure ANOVA. Results: Total serum bilirubin after clofibrate administration was lower than control group (F= 6.48, P=0.02); however, the duration of phototherapy and hospitalization were not significantly different between the two groups (P=0.39 and 0.91 respectively). No side effects of drug were observed based on the physical exam and liver function tests. Conclusion: These findings suggest that clofibrate maintained total serum bilirubin lower in very low birth weight neonates but without effect on duration of phototherapy and hospitalization.

Pneumococcal infections in children under 5 in karachi: a retrospective analysis

To analyze the hospital case records of children under five years of age for Pneumococcal pneumonia. Retrospective case record analysis of children admitted in pediatric units of Civil Hospital, Karachi, from 2011 to 2012. This case record analysis was conducted on children under 5 years of age who were admitted and diagnosed to have pneumonia. The clinical criteria used for the diagnosis of pneumonia were taken from WHO [IMCI]. Variables studied included age, gender, birth and feeding history, vaccination status, symptoms/signs on admission and diagnosis. Information was collected on a questionnaire. SPSS version 15 was used for analysis. Out of 820 case records retrieved, diagnosis of pneumonia was written on the files in 637 [78%]. Fifty two percent [333] children were age appropriately vaccinated. Majority [62%] of children were up to 11 months of age and male to female ratio was 1.4:1. Commonest symptoms were fever, cough and respiratory distress. Pneumonia was severe in 124 [19%] children and out of these 96 children were less than 12 months of age and they had a respiratory rate of more than 50 per minute with more than two danger signs. Pneumonia was more severe among un-vaccinated [schedule EPI immunization] group. Blood culture reports were available in only 14 children and none were positive for Streptococcalpneumoniae. Majority of the children with pneumonia were less than 12 months of age and severity of pneumonia was more in un-vaccinated children. This study can be used as a baseline for pneumonia or pneumococcal disease in children under 5 years and compared with the drop in the pneumonia cases after the introduction of Pneumococcal Conjugate Vaccine in schedule EPI programme

Fracture shaft of femur; management outcome in children between 10 to 14 years of age treated by intramdullary rush nail

In school going children surgical treatment is favoured with the introduction of elastic intramedullary nails. The aim of this study was to determine the management outcome of fracture shaft of femur in children between 7-14 years of age by intra medullary rush nail. This study was conducted at department of orthopedic surgery, Dow University of health science and civil hospital Karachi. Duration of study was 12 months from 01-09-2011 to 31-8-2012. Children with closed fracture shaft of femur age 7-14 years of either sex meeting the inclusion criteria were included. Children were diagnosed clinically and confirmed on X ray, open reduction and internal fixation with appropriate size rush nail was done by senior orthopedic surgeon. Thereafter patients were followed every month and the final outcome was measured at the end of third month post operatively. Male were 58% while female were 42%, the average age of the patients were 11.78+/-1.40 years. Management outcome of fracture shaft of femur in children by intra medullary rush nail showed that 100% children fracture were healed. We found a very high success rate in the management of closed fracture shaft femur with intramedullary rush nail. This surgical procedure is simple, technically less demanding, and suitable in peripheral rural hospital in developing countries

Assessment of hepatitis B vaccination coverage in children under 5 years of age in two major public sector hospitals of Karachi

To assess Hepatitis B Vaccination coverage of children under 5 years of age attending Paedriatic units of Civil Hospital and National Institute of Child Health Karachi and to identify the reasons for non-compliance. Descriptive cross-sectional survey conducted in Paedriatic units of Civil Hospital and National Institute of Child Health of Karachi over period of eleven months. Subjects and A total 971 children under 5 years of age attending the selected hospitals were randomly selected. A structured questionnaire was used which included age, gender, EPI vaccination status, age at first dose of hepatitis B vaccination [Pentavalent vaccine], services utilized and payment if any, birth history, educational status of the respondent, knowledge about Hepatitis B vaccination, history of Hepatitis B in the family and reasons for non-compliance. SPSS version 15 was used for data analysis and chi-sq at 0.05 alpha level for statistical significance. Univariate and multivariate analysis were used for association of the variables. Out of 971 children who were enrolled, data of 969 children was analyzed. Majority [71%] were out door cases and only 284[29%] were indoor patients. Age distribution showed 447[46%] up to 12 months of age and overall male to female ratio was 1.3:1. Almost 80% children had received one dose of Hepatitis B vaccine, 72% had received two and 65% received all three doses. Age at vaccination showed that 677[70%] children were age appropriately vaccinated and out of these 469[48%] had received their first dose of Hepatitis B vaccination at six weeks. Reasons for non-compliance were parental/family objection 172[18%], intercurrent illness of children 44[5%], and other causes including no knowledge for the vaccination, long distance, loss of vaccination cards and non-availability of vaccine in 63[6%] cases. Univariate analysis showed that children who were vaccinated for BCG, Polio and Measles were more likely to be also vaccinated with Hepatitis B vaccine [significant]. Multivariate analysis showed that apart from above variables education of the respondent and place of delivery were significantly associated with Hepatitis B vaccination of the children. Only 65% children had received all three doses of vaccine and 48% received first dose at six weeks. Major reasons for non-compliance were parental/family objection. Policy message: Efforts should be made to increase the uptake of all 3 doses to ensure full protection against hepatitis B along with education of public to remove misconceptions about vaccination

Recent Advancement in Non-surgical Interventional Treatment in Congenital Heart Disease at National Institute of Cardiovascular Disease (NICVD)-a Tertiary Care Hospital of Bangladesh.

Background: Treatment of Congenital Heart Disease (CHD) is either Surgical or Interventional. Medical management is mainly symptomatic / palliative. Although surgery is the main mode of treatment but in the recent past non-surgical Interventional method is replacing it because of its multiple advantages over surgical procedures. Since 2005, we started our journey in National Institute of Cardiovascular Diseases with a PDA device closure. In this article we tried to review the success rate of the interventional procedures in this hospital. Methods: The aim of this retrospective study is to review the short term & Intermediate outcome of the non surgical interventional treatment of congenital heart diseases. We included all the interventional rocedures done in this Institute since 2005 upto December 2013. Results: During this period, we performed total 150 cases of patent ductus arteriosus (PDA) device, 20 cases of PDA Coil closure, 60 cases of atrial septal defect (ASD) device, 90 cases of Balloon Pulmonary Valvuloplasty (BPV), 20 cases of Balloon Aortic Valvuloplasty (BAV), 22 cases of Coarctation Balloon Angioplasty, 35 cases of Mitral Valvuloplasty (PTMC), 15 cases of Balloon Atrial Septostomy. Almost all of our intervention procedures were successful except one case of mortality related to procedure of PDA device closure, 4 device embolization (2 ASD & 2 PDA) and one case of PDA coil with persistent Intravascular hemolysis. All the embolized devices were subsequently retrieved surgically with repair. All other patients of interventional treatment are enjoying new life without any morbidity. Conclusion: Thus, we concluded that interventional methods of suitably selected case of congenital heart disease may be an alternative lucrative safe & effective option of remedy for many of the congenital heart diseases.