To determine the frequency of vitamin d deficiency in patients with chronic hepatitis c

Objective: To determine the frequency of vitamin D deficiency in patients with chronic hepatitis C [CHC]

Design: It was a Descriptive and Cross Sectional study

Place and Duration of Study: It was carried out in the Medicine Unit of Pakistan Naval Ship SHIFA, Karachi from Nov 29, 2016 to May 29, 2017

Patients and Methods: Approval was sought from Institutional Review Board before carrying out the study. Proper history, clinical examination and appropriate lab investigations were carried out. Standard techniques were used for blood sample collection. Site used for blood collection was antecubital fossa. Sterile method was used for fasting sample and about 10 ml of blood was collected from each patient

Results: A total of 289 patients were included. Strict exclusion and inclusion criteria was used for study cohort. Mean age [years] of study cohort was 34.51+8.32. There were 188 [65.1] male and 101 [34.9] female patients. Patients with CHC who were vitamin D deficient were 74 [25.6]

Conclusion: Patients of CHC had high frequency of vitamin D deficiency which suggests that further studies in the region will be conduct in our general population to know the exact statistics which will pave the way for future researchers

Strategies to avert preventable mortality among mothers and children in the Eastern Mediterranean Region: new initiatives, new hope

We conducted an assessment of maternal, newborn and child health and progress towards achieving Millennium Development Goals [MDG] 4 and 5 in the Eastern Mediterranean Region [EMR]. We provide recommendations for scaling up and sustaining gains post-2015. Data were obtained from global data repositories. We constructed time trends from 1990 to 2013 and evaluated inequities across the Region. Under-5, neonatal and maternal mortality rates decreased 46%, 35%, and 50% respectively from 1990 to 2013. Pneumonia and diarrhoea accounted for 50% of all post-neonatal deaths; pregnancy- and delivery-related complications were the leading causes of neonatal and maternal deaths. Coverage of maternal, newborn and child health interventions is suboptimal, and poverty, food insecurity and conflict are pervasive across the Region. The EMR has made progress but is unlikely to attain MDG 4 and 5 targets. To sustain and further accelerate gains, the Region must reduce inequities and scale up implementation of recommendations made by the independent Expert Review Group

design of an estimation model for environmental liability insurance [ELIS]

Pricing for an insurance policy can be described as the process of calculation of expected compensation to be paid to property losers as well as associated costs of potential risks. Loss forecast is accurate if the risks will be identified appropriately in order to calculate the frequency and expected severity of losses.This is particularly important about environmental risks since most of them appear in the long run. Environmental risk assessment model is both able to estimate the environmental liability premium for environmental pollution and degradation, and it can play a valuable role in promoting this industry. ELIS [Environmental Liability Insurance] software calculates the environmental risk number in industry sector and insurance charges for events resulting in environmental pollution. This paper deals with designing the model and outputs of the software. The user selects the type of project, and input the descriptive information concerning the occurrence of possible environmental pollutions. The model calculates risk numbers, the type of accidents, classification and weighting of severity of environmental impacts, risk priority numbers [RPN]; pollutant volume and environmental sensitivity, environmental cost of contaminates, and finally Net premium for Possible Accidents. The case study indicated the applicability of then model. For this case an oil refinery in Iran was selected with a capacity of 85,000.barrels of refined oil per day. The calculated premium on the basis of losses arising from air pollution was evaluated to be equivalent to 70,000$ US. The same procedure can be applied to evaluate the amount of premium for soil and water pollution

Medical students learning communication skills in a second language. Empathy and expectations

Communication skills [CS] training for medical interviewing is increasingly being conducted in English at medical schools worldwide. In this study, we sought to identify whether Arabic-speaking medical students experienced difficulty with the different components of the CS training that were conducted in English. Individual third-year preclinical medical students [N = 45] were videotaped while interviewing simulated patients. Each student assessed his/her performance on a 13-item [5-point scale] assessment form, which was also completed by the tutor and other students in the group. Of the 13 components of their CS training, tutors awarded the lowest marks for students' abilities to express empathy, ask about patients' feelings, use transition statements, ask about functional impact, and elicit patients' expectations [P <0.001]. The expression of empathy and the ability to elicit patients' feelings and expectations are difficult to develop in medical students learning CS in a second language

unique approach to learning/teaching anatomy

The present day teaching emphasizes on teaching methodologies that capture the interest of students and increase their satisfaction. To assess the effectiveness of nontraditional teaching methodologies such as storytelling for teaching anatomy and to determine whether this method enhances student satisfaction. The study was carried out in Foundation University Medical College, Rawalpindi [Pakistan]on first year MDBS students [n=87] The students were given a story, adapted from: [The case of the dividing cell: mitosis and meiosis in the cellular court [http:/www.sciencecases. org/mitosis_meiosis/mitosis_meiosis.asp] by Clyde Freeman Herreid. Copyright held by National center for case study teaching in science, University at Buffalo, state university of New York. Used with permission. The students were divided into small groups who discussed the learning issues in three interactive sessions, after which, they were given a surprise assessment test and an anonymous questionnaire which was to be answered on an open scale of 1-10 [1 being the minimum score and 10 maximum] regarding the effectiveness of this methodology. Students enjoyed the sessions and would like similar sessions in future [mean evaluation score: 5.92/10 +/- 3.15]. An overall satisfaction score of 6.52 +/- 1.75 was obtained. Mean of assessment results was 92.7% +/- 10.4. Some students felt that it was more time consuming as compared to lectures and could not be used to cover all topics. Teaching anatomy by storytelling captured the interest of majority of the students who found it an effective teaching methodology. However, other traditional tools of teaching should also be an integral part of anatomy curriculum

Vancomycin resistant enterococcal sepsis in an acute myeloid leu kemic patient

Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloid leukemia. Patients with acute myeloid leukemia are at increased risk of acquiring vancomycin resistant enterococcal infection and its treatment remains problematic. Vancomycin therapy for more than 7 days is usually associated with inducible vancomycin-resistant enterococcal infections. We report a case of vancomycin resistant enterococcal sepsis in a patient of acute myeloid leukemia

Comparison of serum bilirubin measurement in laboratory and transcutaneous bilirubinometry

Background and Purpose: Bili-Check is a simple method used to provide a rapid pain-free and noninvasive transcutaneous estimation of total serum bilirubin. The present study was conducted to compare estimates of serum bilirubin using Bili-Check [TCB] with total serum bilirubin [TSB] values determined in a clinical laboratory

Methods and Materials: This is a dehlive analytical cross-sectional study conducted in Ghaem Hospital NICU from September 2008 to March 2008. With a confidence interval of 95% and test power of 80% 109 neonates were selected through convenient non-randomized sampling as the study sample. TSB was determined in a clinical laboratory using the diazo with photometric method. Then within 10 minutes transcutaneous measurements were performed via Bili-Check. Data analysis was done in SPSS11.5 using correlation coefficient

Results: From 109 neonates included in the study 75 were male [68.8%] and 34 female [31.2%] with an age range of 1 to 26 days. Mean serum Bilirubin was 12.979 and TCB estimate was 12.219. Laboratory findings highly correlated with the results of TCB [r=0.766] [P=0.0001]

Conclusion: Bili-Check has the sufficient adequacy as the measurement and observation device for neonates and can replace serum bilirubinometry in laboratory fro Icteric neonates

Surgical management of head and neck vascular malformations

Background: vascular malformations cause functional and cosmetic abnormalities. This study presents experience of surgical management and outcome of these morphologic disorders

Place and Duration of Study: the study was carried out from January 2005 to December 2009 at the Department of Plastic and Reconstructive Surgery Shaikh Zayed Hospital, Lahore

Patients and Methods: all the patients with vascular malformations in the head and neck region above the age of 10 years were included

Results: thirty two patients were included in the study. Male to female ratio was 1:1.6. Slow flow malformations were 3.5 times more common than high flow malformations. Primary closure was achieved in 12 cases. Staged debulking was done in 10 patients with complete excision in 4 patients and incomplete excision in 6 patients. Full thickness skin grafting was performed in 6 cases while flap reconstruction was done in 4 cases. Overall complication rate was 22% with recurrence of lesion in 6.25% cases. Massive hemorrhage occurred in two patients during surgery requiring whole blood transfusion

Conclusion: proper diagnosis, knowledge and surgical expertise for excision and reconstruction is essential for favorable outcome in these lesions

[Identification of essential oil components of Thymus daenesis Celak. in field condition in Qazvin]

Thyme is a perennial plant from Lamiaceae family and an important medicinal plant worldwide. Thymus daenensis is distributed in Iran and used as a traditional medicine. Identification of Thymus daenesis components cultivated in Qazvin. Aerial parts of Thymus daenensis were collected from a research farm [Qazvin Agriculture and Natural Resources Research Center] at flowering stage in 1385. The essential oil was initially prepared by hydro-distillation technique followed by GC and GC/MS for determination of chemical compositions. The ratio of aromatic components to its dry weight in essential oil of Thymus daenensis cultivated in Qazvin was measured at 2.8 +/- 0.1% [w/w]. Twenty four components were identified. The main constituents of the essential oil were thymol [74.61%], p-cymene [4.6%], ?-terpinene [4.48%] carvacrol methyl ether [4.27%], 1.8 cineol [1.64%], borneol [1.61%], and carvacerol [1.40%]. The results of this study showed that the Thymus daenensis essential oil is rich in monoterpene phenols, especially thymol

Cytological and histological correlation of solitary thyroid nodule

To assess the role of fine needle aspiration cytology [FNAc] in the management of solitary thyroid nodule and to correlate the FNA cytodiagnosis with histopathological results of surgically excised specimens of thyroid. It was a retrospective study. This study was carried out at Jinnah Hospital Lahore in the year 2006. In this period patients files and slides were retrieved from record. Both FNA cytolodiagnosis and histopathological results were correlated. Out of these 64 cases, 5 cases were diagnosed malignant on histology. These were 2 cases of papillary carcinoma, 2 cases of Non Hodgkin's lymphoma [NHL] and I case of follicular carcinoma I case of NHL and 2 cases of papillary carcinoma were correctly diagnosed on FNA. 1 case of NHL was misdiagnosed as benign cystic lesion of thyroid on FNA and I case in which cytodiagnosis of hyperplastic colloid nodule/follicular neoplasm was made, turned to be follicular carcinoma on histology. In the remaining 59 benign cases, a wide range of overlap was seen among benign thyroid lesions. Despite, the overlap of the spectrum of cytological features of different thyroid lesions, FNA cytological examination of solitary thyroid nodules is strongly recommended

[Effect of estrogen and progesterone on baroreflex sensitivity in acute hypertensive rats]

Epidemiological studies suggested that incidence of cardiovascular diseases in menopause women is more than their nonmenopausal period. The cardioprotective role of estrogen may be responsible for some of these effects. In the present study we evaluated the role of female sex hormones on baroreflex sensitivity in acute hypertension state of rat.This was an experimental-interventional study that performed on 48 male and female rats. The male and female animals were separately divided into three groups included vehicle, estrogen and progesterone receiving groups [8 animals in each groups]. Anesthetized female animals were ovariectomised, and then all animals were encapsulated with capsules containing sex hormones or solvent. 2 weeks after that, each femoral artery and vein cannulated under anesthetization to record mean arterial blood pressure [MAP], heart rate [HR] and also infusion of phenylephrin. AHR and AMAP were recorded before and after injection of phenylephrin, to evaluate the baroreceptors function, baroreflex sensitivity [BRS [[delta]HR/[delta]MAP]] index was used. The data obtained from power lab instrument and processed by computer. HR and MAP in estrogen and progestrone received groups, before phenylephrin injection [rest state], have no statistical differences with control group. BRS in the male estrogen-receiving group [0.6 +/- 0.03] was higher [p<0.05] compared to sham [0.48 +/- 0.05], also estrogen increased BRS [p<0.05] in female estrogen receiving group [0.76 +/- 0.03] compared to sham [0.45 +/- 0.05]. Mean artrial pressure and heart rate in both estrogen receiving groups were reduced compared to vehicle group. Therefore it can be concluded that estrogen increased baroreflex sensitivity to prevent variation in acute blood pressure

[ survey of prevalence of pediculosis among primary school students of Guilin province in the school year of 2002-3]

Introduction: Head lice infestation is one of the most common diseases of children. The first major symptom of a louse infestation can be intense itching caused by the louse feeding. Breaks in the skin caused by the louse and resultant scratching can cause secondary bacterial skin infection

Objective: This descriptive study was conducted to evaluate the prevalence of pediculosis among primary school students of Guilan province in the school year of 2002-3

Materials and Methods: 2906 students of the first-fifth grades in the primary schools selected by cluster sampling were examined by experienced educators and instruments like lens, forceps and the qusetionnaire were used. The data were compared with chi square analysis

Results: Out of 2906 students selected in this study, 129[4.5%] persons were infected with pediculosis. The rate of infection in girls' school was 5.7% and in boys school was 3.3%. The rate of infection was 3.2% in urban and 5.7% in villages. Also, there was a statistically significant difference between infection and variables such as fathers occupation, health educator, rate of parents, education, rate of knowledge, educational level and there was no statistically significant difference between infection and mothers occupation

Conclusion: Results indicated that 129 [4.5%] students were infected with pediculus humanus capitis. The rates of prevalence in villages were more than those in cities. The prevalence among girls was more than boys. Also, results showed that the prevalence of pediculosis among Guilan primary school students was less than average percentages observed in other students inside and outside Iran. Regarding to the results obtained from the variables test showed that education of parents, fathers occupation, presence of health educator, rate of knowledge and perceptions, educational level play an important role in acquiring infection in students

Necrotizing fasciitis. Role of early surgical intervention

To evaluate our experience of management of necrotizing fasciitis [NF] particularly the role of early and aggressive surgical intervention. This is a retrospective review of the cases affected by this disease and managed at Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia, during 5 calendar years from 1996 through to 2000 [1416-1420 A.H]. The preoperative and operative data was collected, and postoperative morbidity and mortality were analyzed. A total of 25 cases of NF were treated during the 5-year period, 18 were males and 7 female. The majority of patients had perianal suppuration as the primary lesion, followed by groin area in drug addicts and only 2 cases were primarily in the upper limbs. Diabetes and drug addiction were the main predisposing factors. All but 3 infections were polymicrobial, with streptococci and acinobacter being the most frequent organisms. The mainstay of treatment depends on a high index of suspicion, aggressive early and repeated debridements and adequate antibiotic coverage. The overall mortality was 24% but the drastic reduction in mortality was observed with early surgical intervention. The results highlight the role of early diagnosis; prompt and aggressive surgical debridements are critical for improved survival

Typhoid perforation: an experience at Mayo hospital, Lahore

With the view of evaluating our own results with pertinent emphasis on surgical treatment, we conducted this retrospective study. This study consists of 53 cases of typhoid perforation treated in our unit in the last two calendar years from Jan 1997 to dec. 1998. We found that disease remains endemic in poor socioeconomic areas and usual sufferers are young active males[71.7%], with male to female ratio of 2.5:1. The diagnosis of the typhoid perforation should be made on physical examination, prolonged fever 02-03 weeks [62.2%] followed by pain abdomen usually 24-72 hours[68%]. The diagnosis is supported by pneumoperitoneun in 37[68.9%], the serological tests are neither very specific nor readily available in emergency laboratory. The surgical treatment is required in all cases. The majority of the patients had single perforation 39[78%], multiple in 07[14%] and mostly had established severe peritonitis 34[68%]. The single layer repair was performed in 18 [36%], double layer in 21[44%] which carries risk of leakage 01[5.5%] and 02[9.5%] respectively. Resection and anastomosis was performed in 10[20%] cases which resulted in very high morbidity and mortality 03[30%]. Wound infection was the commonest complication, leakage was seen in 06[12%] cases, incidence of leakage was minimum with single layer closure of perforation. The flouroquinolone are far superior with response rate of 92.3% as compared to chloramphenicol 66.6%. Hence single layer closure with aggressive peritoneal lavage under flouroquinolones is recommended. Exteriorization should be preferred choice than resection and anastomosis in high risk cases

Early cholecystectomy safe option in acute cholecystitis

This prospective study comprises of 108 patients. Early cholecystectomy was performed on 54 patients. The results were compared with similar number of patients undergoing elective cholecystectomy for symptomatic gall bladder disease. Diagnosis was based on history, clinical examination and ultrasound scan. The diagnostic accuracy of ultrasonography was similar in both groups. The degree of technical difficulty encountered as evaluated by surgeon and post-operative complications were also comparable. Early cholecystectomy was proved to be associated with advantages like avoidance of complications of acute cholecystitis, saves the patient from recurrent painful attacks and shorter duration of treatment. This comparative study revealed that early cholecystectomy performed by an experienced surgeon is a safe and better option in acute cholecystitis

ESWL versus open surgery for vesical calculi in children: a comparative study

This comparative study was conducted to compare open surgery and Extracorporeal Shockwave Lithotripsy [ESWL] in the management of vesical calculi in children. This study was aimed at finding ways to reduce hospital stay and surgical intervention and anesthesia in paediatric group of patients. Thirty two children underwent ESWL and another 10 cystolithotomy. All patients undergoing open surgery required hospitalization and general anaesthesia. 35% of children receiving ESWL did not require any kind of anaesthesia or analgesia. Lithotripsy was done on outpatient basis, only 2 [6.25%] children needed admission after ESWL for endoscopic removal of impacted stone fragments. There were no other complications following ESWL. Mean hospital stay in patients undergoing ESWL was 8.33 hours against 7.3 days in the other group. Success rate of ESWL was 100%. ESWL of vesicolithiasis has proved fairly simple, effective and safe modality of treatment, however it is not cost effective for the government considering the annual maintenance charges of the equipment. Vesicolithotomy is associated with more operative trauma, post-operative pain and prolonged hospitalization