Epidemiology of acute poisoning in children due to household substances. Mortality and morbidity in Hazara division

Acute Poisoning in children due to house hold substances is a global problem, however mortality and morbidity is nowadays very less in developed countries due to precautionary measures and better treatment facilities while situation in developing countries like Pakistan is alarming one. The present study was conducted to know about the death and injuries due to household poisoning in children in Hazara Division. The purpose of study was also too seek measures to reduce the risk factor. This prospective study was carried out in the Paedriatic unit of Ayub Hospital Complex and Department of Forensic Medicine and Toxicology, Ayub Medical College, Abbottabad from July to 2008 to September 2009. A total number of 6 leases of acute poisoning of children were brought to emergency department of Ayub Hospital Complex. 45 cases were admitted in Paedriatic unit while 16 were treated in emergency department were sent back to home. There were 37 male children [60.65%] and 24 [39.34%] female. The maximum number of cases were between age group 1-5 years 43 [70.49%]. 99% percent cases in our this study were of accidental nature only one case was homicidal nature while suicidal was none. Insecticide / rodenticide were the commonist agent ingested, followed by pharmacutical products. Kerosene oil was the third commonist agent ingested in our studies. Mortality rate was 3.27%. Organo-phosphorus compound [insecticide], rodentcide and kerosene oil [petroleum products] and pharmaceutical products are common source of household accidental poison globally. In developed countries there frequencies is decreasing rapidly due to health education and precautionary measures adopted mandatorily by manufacturers but in developing countries like Pakistan the situation is same as 50 years back. The risk factor can be reduced by adopting preventive measures at national level through health education of masses and parents and making products safety measures mandatory for manufacturers, moreover parents must be educated about the harms of some Herbal agents containing Opiates and on safe storage of medicines and house hold poisonous agents

Changing pattern of fabricated injuries in Larkana region

Man has been egotist by nature and from Ancient time man has been endeavouring to bring under power other human beings. With the passage of time and growth of civilization this trend has been increased. Now there are more dangerous ways of violence and torture in use for twisting and turning people around. Inflection of fabricated injuries is one of the ways for fulfillment of his lust. Incidence of fabricated injuries is related with crime rate in any society, and this practice is carried out through out the world. Fabricated Injury is a major problem which forensic expert/causality medical officer face during their duty. Very little literature is available regarding study of fabricated injuries and no authentic criteria has so far been developed for labeling an injury as fabricated one. The present study is about 130 challenged medico-legal cases in Larkana Division which were studied in special medical board held in the Department of Urology Chandka Medical College Larkana. Out of 130 cases 50 were proved to be fabricated. The total number of challenged cases was 130, out of these 50 [38.46%] cases were of fabricated injuries. Out of 50 fabricated cases, 46 [92%] were males and 4 [8%] were female, thus the male to female ratio was approximately 11:1. Maximum cases [25] were from Larkana District, 15 cases were from Shikarpur and 10 cases from Jacobabad. The majority of fabricated injuries from Larkana District were nose injuries as out of 25 fabricated injuries from Larkana district 10 were nasal injuries, while from district Jacobabad and Shikarpur there was no nasal fabricated injury. Most of the fabricated injuries are caused on accessible part of the body like arms, legs, abdomen, chest etc. The pattern of fabricated injuries is changing in Larkana district as out of 25 fabricated injuries in this district 10 were nasal injuries while in District Jacobabad and Shikarpur there was no nasal fabricated injury

Spectrum of precipitating factors of hepatic encephalopathy in liver cirrhosis

To ascertain the spectrum of precipitating factors of hepatic encephalopathy in patients with liver cirrhosis. descriptive study. The study was conducted in the department of medicine, medical B unit of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar over six months. All patients with cirrhosis of liver[CL] of more than 12 years of age, manifesting signs of hepatic encephalopathy [HE] were included and those who had acute fulminant hepatitis or had noncirrhotic portal hypertension were excluded from the study. Detailed history, clinical examination and thorough investigations were done to look for any precipitating factor and the findings were recorded on a proforma. Fifty patients [32 males and 18 females] were enrolled. 47 patients had hepatitis B, C or both positive. 64% were in the age group of 45-60 years and 76% were having either grade III or IV coma. Thirty three [66%] patients had asterixis which was found to be a sensitive index for the diagnosis of HE in patients who were not in coma. Jaundice and Ascites were other common presenting features. Electrolytes imbalance in 28[56%] patients, diarrhea in 20[40%], constipation in 16[32%], infections in 12[24%] and gastrointestinal bleed in 11[22%] patients were amongst the commonest precipitating factors. None gave the history of alcoholism or recent surgery Occurrence of precipitating factors for HE in patients with CL is a common phenomenon and all such patients must be hospitalized to ascertain and manage such factors