Community diagnosis by conducting family health survey in the field practice area of a medical college

Background: In a developing country like India, with limited resources health needs of individuals and community are enormously increasing. Health related problems may be addressed amicably by community diagnosis. Assessment and prioritization of health issues followed by formulation of action plans with strategies and their implementation can be effectively achieved, by using family health surveys.Methods: Using family health survey 500 families, constituting 2640 individuals were studied. Their health status and socio-demographic details were taken. Households and families were selected randomly. Data entry and analysis was done by appropriate use of statistical tools.Results: Study showed 52.27% males and 47.73% females. Majority (51.5%) belonged to 16-45 years followed by 6-15 years of age (25%). Among 9.09% of the under-five, fully immunized were 90.4% and partially immunized were 9.6%. 6.06% were above 60 years. Nuclear families were 68%. Majority (36%) of the families belonged to socio-economic class II (modified B.G. Prasad classification). 10.6% were illiterate and 11.3% were below seven years of age. Overcrowding was present in 24% of the families. Common morbidities were hypertension (32.2%), diabetes (26.9%), respiratory diseases (19.2%) eye problems (6.2%) and skin diseases (3.8%). Geriatric problems were present in one out of four individuals.Conclusions: Family health survey can be used as an educational tool for undergraduate medical students to understand common morbidities and determinants of diseases in the community. Family health surveys are important for a community as necessary intervention can be done for illnesses and health-related problems.

X-ray chest findings in children aged 2 months to 59 months classified as pneumonia according to IMNCI guidelines

Objective: To determine the x-ray chest findings in children aged 02 months to 59 months classified as pneumonia according to IMNCI guidelines. Study Design: Descriptive case series. Place and Duration of Study: This descriptive case series study of six months was carried out in the Department of Pediatric Medicine, Liaquat University Hospital Hyderabad

Material and Methods: The study was conducted on the children who met the inclusion as well as exclusion criteria of the study. All the patients presented with history of cough and/or difficult breathing, on physical examination having [i] fast breathing [respiratory rate >50/min if age 2-11 months, rate >40/min if age 12-59 months] or [ii] lower chest wall in-drawing was admitted in the ward and further evaluate for x-ray chest findings specific for pneumonia by advising chest radiograph

Results: The mean age of the patients was 11.2 +/- 5.6 months with age range of 02-59 months. There were 92 [55.8%] male and 73 [44.2%] female patients. There were 64 [38.8%] patients who had consolidation and 66 [40%] patients had reticular shadowing on chest x-ray

Conclusion: It is concluded from this study that considering/ evaluating x-ray chest findings in children according to IMNCI guidelines was a better approach for diagnosing pneumonia. This would certainly contribute towards evidence based clinical assessment of suspected cases of pneumonia

A report on the molecular detection and seasonal Trypanosoma brucei in Dromedary Camels from Dera Ghazi Khan District in Southern Punjab (Pakistan)

The present study was designed for molecular detection of Trypanosoma brucei through PCR, by using kinetoplast DNA (kDNA) maxicircle primers, on seasonal basis and to demonstrate the effect of this parasite on complete blood count and selected parameters of serum biochemistry in camels from Southern Punjab (Pakistan). A total of 291 camel blood samples (61 male, 230 females) were collected from Dera Ghazi Khan District in Pakistan during March 2012 till February 2013 for Trypanosoma brucei detection by blood smear screening, micro hemato centrifugation and Polymerase chain reaction techniques. Twenty eight out of 291 blood samples (9.62%) produced a 164 bp DNA fragment specific for T. brucei . Only 6 blood samples (2.06%) were found parasite positive by microscopic examination and 13 (4.46%) were positive for microhematocrit centrifugation technique. Seasonal PCR based prevalence of trypanosomiasis was 6.9%, 13.7%, 9.7% and 8.1% during spring, summer, autumn and winter seasons respectively. T. brucei prevalence was not restricted to a particular age group or and gender of the studied animals (P > 0.05). A significant increase in WBC (P = 0.001), neutrophils (P = 0.004), ALT (P = 0.028) and decreased RBC (P < 0.000), hemoglobin (P < 0.000) and packed cell volume (P < 0.000) were detected in parasite positive as compared to the parasite negative blood samples. In conclusion, PCR is a more reliable and sensitive technique than conventional microscopic blood screening and microhematocrit centrifugation for the detection of T. brucei in camel blood. We recommend the use of PCR for the effective prophylactic detection of T. brucei in livestock in order to reduce economic losses.

[Effect of bobath's therapeutic approach on spasticity and quality of movement patterns in hemiplegic patients]

Hemiplegia is a complication, results from upper motor neuron lesions and is usually associated with spasticity and movement disorders. To control spasticity and accomplish functional activities, several approaches have been presented such as Neurodevelopment treatment [NDT], according to Bobath's assumptions. Although lower limb spastic hemiplegia is common and its management is time-consuming, in this study we were intended to examine the effectiveness of this therapeutic approach on spasticity management and quality of lower limb movement patterns. Fifteen hemiplegic patients [age range, 44-75] participated in this study. Baseline assessments before and after the treatment included: spasticity measurement of plantar flexor muscles of ankle according to the Original Ashworth Scale [OAS], measurement of active and passive range of motion of ankle dorsiflexion and defining the quality of lower limb movement patterns according to "Standing test" of Bobath's approach. Following intervention [20 sessions], there was a significant decrease in spasticity and a significant increase in an active and passive range of motion and quality of movement patterns. According to the obtained results, by modification of excitation - inhibition in CNS and transmitting it to the peripheral region [muscles], Bobath's approach can reduce the spasticity of plantar flexor muscles, subsequently, the dorsiflexion range of motion increases. Indeed, this therapeutic approach increases coordination in movement patterns and improves quality of movement patterns by retraining balance in various positions. Results of this study may be used extensively in management of patients with upper motor neuron lesion referred to rehabilitation centers

[ effect of "constraint induced movement therapy" on velocity and gait kinetics in hemiparetic patients]

Balance and gait disorders are common motor complications after stroke. Studies have revealed that conventional physiotherapy cannot manage these disorders efficiently; so more studies addressing the causes of these complications and presenting efficient treatment protocols are crucial. Thirty hemiparetic patients [age range 40-60 years old] participated in this experimental study. Patients were randomly divided in to 2 groups. One group received Constraint Induced Movement Therapy [CIMT] [group1] and the other Mass Practice [group 2] for 3 weeks. Experimental assessments included stride velocity and kinetic parameters of gait [amplitude and velocity of center of pressure sways of paretic and non-paretic limbs in sagittal and frontal planes] that were recorded and compared before and after treatment. For statistical analysis of data, if distribution of data was normal, parametric tests of t and pair t-tests were used. If distribution of data was not normal, non parametric tests of Wilcoxon and Mann-Whitney were used. SPSS V.11.5 was also used for data analysis. In both groups, stride velocity increased [p=0.03, p=0.01]. In CIMT group, COP sway for paretic and non-paretic limbs decreased in frontal plane [p=0.03, p=0.008]. COP sway velocity for paretic limb decreased in both planes [p=0.01, p=0.03]. For mass practice group, only COP sway amplitude for non-paretic limb decreased in sagittal plane [p=0.03]. Physical therapy based on "Constraint Induced Movement Therapy" can more efficiently manage dynamic balance gait disorders by overcoming "learned non-use" phenomena and improving somato-sensory deafferentation to central motor controllers

Hepatic steatosis

Objective: to determine the frequency of hepatic steatosis by ultrasonography in diabetics and compare with non-diabetics

Material and methods: this case-control study was carried out in a private clinic at Hyderabad, Sindh - Pakistan, on 100 patients out of which 50 were known diabetics and 50 were controls. Liver ultrasound findings were studied in both study groups

Results: bright liver was shown in 20 [40%] diabetics out of which 12 were females and 8 were males. Control group showed bright liver in 15 [30%] out of which 6 were males and 9 were females. Focal/patchy infiltration was seen in 4 [16%] of diabetic men and 5 [20%] of diabetic women, whereas control group showed patchy infiltration in 10 [20%] patients, equals in males and females. In addition peri-portal fibrosis was found in 4 males and 6 females in the diabetic group. Liver biopsy/CT-scan confirmed the sonographic findings

Conclusion: ultrasonography is a cost effective and non-invasive procedure to diagnose steato-hepatitis. It is readily available and the results are comparable to other invasive and or expensive diagnostic tools

Effect metformin on urinary VMA levels in type II diabetic subjects

The purpose of this study was to observe the effect of metformin on 24-hours urinary VMA levels in newly diagnosed untreated type 2 diabetic subjects. The study consisted of four weeks for each participant with weekly follow up visits. Samples were collected at 0800-0900 hours after over night fast. Study was conducted in the Department of Pharmacology and Therapeutics, BMSI, JPMC, Karachi. Total duration of study was six months. Fifteen newly diagnosed untreated type 2 diabetics, with fasting plasma glucose levels >/= 126 mg/dl on two occasions and/or postprandial glucose levels >/= 200 mg/dl were enrolled in the study. Patients with concurrent illness or diabetic complications were excluded. Metformin was started from 500 mg/day and titrated at weekly intervals according to glycaemic control and the subjects tolerance to the drug. A 24-hour urinary VMA was assessed at day - 0 [before metformin therapy] and day - 28 [4 weeks after metformin therapy] by using VMA reagent kit of Biosystems Spain on Spectronic -21 spectrophotometer USA. Metformin caused highly significant [P < 0.001] reduction in mean fasting plasma glucose from 233.33 +/- 15.62 mg /dl on day-0 to 151.53 +/- 6.02 mg/dl on day - 28, and a significant [P < 0.01] decrease in 24 - hour urinary VMA levels from 5.18 + 0.50 mg / 24 hours on day-0 to 3.32 + 0.28 mg / 24 hours on day-28. Our results indicate that metformin causes highly significant reduction in fasting plasma glucose and a significant decrease in 24 - hour urinary VMA levels in newly diagnosed untreated type 2 diabetic subjects

[Examination of mechanisms involved in spasticity reduction after BTX-A injection in hemiplegic patients]

Spasticity is a common and disabling complication that occurs as a result of upper motor neuron lesion. Recently, Botulinum Toxin - A [BTX-A] has received a pronounced position in spasticity treatment because of its efficacy, high capability of selective effects and low side effects. In this study, through electrophysiologic tests, mechanisms involved in spasticity reduction following BTX-A injection were studied. This descriptive study was carried out in the year 2006, on 15 hemiplegic patients [age ranged 44- 70 yrs] with spasticity of ankle plantar flexors at Tehran University of medical Sciences. According to the Original Ashworth Scale [OAS], before and after intervention, spasticity of muscles was assessed. Electrophysiologic measurements consisted of amplitude of maximum H- reflex, M response and H / M ratio of soleus muscle, were recorded before and after injection. Toxin was injected in Gastrocnemius [200 units], soleus [75 units] and posterior tibialis muscles [50 unit]. Data were recorded in a questionnaire and analyzed by descriptive statistics and frequency distribution tables. Four weeks after injection, significant reduction in H- reflex, M response amplitudes and H / M ratio were seen. According to the OAS, severity of spasticity also, showed a meaningful reduction. H - Reflex amplitude had more expressive reduction than M response. Reduction of H -reflex amplitude and H / M ratio is the result of toxin effect on intrafusal fibers and reduction of M response amplitude is the result of toxin effect on extrafusal fibers. More significant reduction of H - reflex amplitude in comparison to M response, showed that BTX-A can reduce the spasticity through modification of gamma motor neuron system. Results of this study could help the therapists, in selecting the most efficient therapeutic exercises, for application after the BTX-A injection

evaluate and compare the effects of first generation anti-histamine [chlorpheniramine maleate] and second generation anti-histamine [Cetirizine dihydrochloride] on isolated trachea of rabbit

Histamine is generally considered as the principal mediator of the acute inflammatory process and the allergic and anaphylactic reaction in both the upper and lower respiratory airways. Chlorpheniramine maleate is a stable, most potent, .first generation antihistamine. It is clinical efficacy in the treatment of IgE mediated histamine disorders is well established. Cetirizine dihydrochloride is a potent, non-sedative HI receptor antagonist, belongs to second generation antihistamines. It is highly effective and safe drug for treating seasonal and perennial allergic rhinitis amid urticaria. Also used in chronic idiopathic urticaria and atopic dermatitis. The purpose of study was to evaluate the antagonostic effects of chlorpheniramine maleate and cetirizine dihydrochloride on histamine induced contractions in isolated trachea of rabbit and to compare the effects of first generation anti-histamine [chlorpheniramine maleate] and second generation anti-histamin [cetirizine dihydrochloride] on isolated trachea of rabbit. In this study twenty-four experiments were performed on isolated trachea of rabbit, in the presence of selected standard concentration of histamine dihydrochloride antagonistic effects of various concentrations of chlorpheniramine male-ate [10e-18 to 10e-3 gm/ml] and cetirizine dihydrochloride from concentrations to 10-3 gml ml were recorded by Polygraph Model 7B in terms of rate and amplitude. Chlorphenimmine maleate showed non-significant antagonistic effect from concentrations 10e-18 to 10e-9 gm/ml in case of rate and 10e-18 to 10e-8 gm/ml in case of amplitude. Significant response showed from concentrations 10e-8 to 10e-3 gm/ml in care of rate [P<0.001] and 10e-7 to 10e-3, gm/ml in case of amplitude [P<0.001] while, cetirizine showed non-significant response front concentrations to, gm/ml in case of rate and 10e-18 to 10e-12 gm/ml in case of amplitude. Significant response observed from concentrations 10e-12 to 10e-3 gm/ml in case of rate [P<0.001] and 10e-11 to 10e-3 gm/ml in case of amplitude [P<0.001]. It was concluded that chlorpheniramine maleate antagonized thetukl tisatnmd mine induced contractions 80.65% at concentration la, gm/ml in case of amplitude 11.35% at concentration 10e-3 gm/ml in case of rate and cetirizine dihydrochloride 82.69% in case of amplitude and 12.33% in case of rate

Antibiotic sensitivity pattern in burn wound cultures

To find out the pattern of microbial flora and their sensitivity to antibiotics in burn wounds cultures. Design: Descriptive study. Place and Duration During year 2003, at Burns unit, National Institute of Child Health, Karachi. Subject And Twenty five consecutive patients were included in the study and pattern of most common pathogens was studied with special reference to their antibiotic sensitivity. The bacterial cultures were taken at different intervals during the hospital stay, first on the second day of admission and then subsequently, following every 7-10 days. Antibiotic sensitivity pattern was correlated to the antibiotic the patients were receiving. Our results revealed that the most frequent isolate was pseudomonas [80%] followed by staphylococcus aureus [40%], klebsiella [28%], proteus [16%] and streptococcus [8%]. Time related changes showed that the bacterial isolates were predominantly gram negative rods [70%]. in the first culture taken on the 2nd day of admission and remained high throughout the hospital stay and was up to 90% in the final culture. There is a specific pattern of burn wound microbial colonization, with time related changes in dominant flora. Antibiotic sensitivity profile is helpful to make guidelines for dealing with the burn wound at the outset and for which antibiotic to start with. Following this protocol the morbidity and the resistant flora could be avoided

Thymolipoma in a child [a case Report]

A 2 year old male child with history of mild respiratory difficulty and repeated chest infection on CT scan, found to have an anterior mediastinal mass, which pre operatively was suspected as thymolipoma. Through median sternotomy mass was removed in totto. Histopathology confirmed the pre operative diagnosis. Post operative recovery was uneventful. At 6 months follow up there was no recurrence

Tuberculosis as an occupational hazard in ward workers

The present study was designed to estimate the risk of tuberculosis in ward workers in a tertiary care hospital, Lahore. A total 53 ward workers who had been working in chest medicine and internal medicine wards for the last one year, were assessed. As regards demographics, 34 were male and 19 were female with mean age 34.3 years. Out of these workers, three [5.6%] were diagnosed as case of active tuberculosis and all these workers were male. Sputum AFB microscopy was positive in one case. Nosocomial transmission of tuberculosis is known to occur and this risk is much more common in ward workers than that of general population. So it is concluded that there is a significant increased [P<0.001] risk of tuberculosis in ward workers

Pregnancy in a patient with acute porphyria

A 27 years old female was diagnosed to have acute intermittent porphyria in 1997. In 2002 she became pregnant. The first trimester was uneventful obstetrically but the duration, frequency and severity of porphyria attacks increased. As the pregnancy advanced to second trimester the condition of patient deteriorated. The symptoms were continuous with no period of relief. In the third trimester she became increasingly irritable and dyspnoeic, and developed facial edema, muscle weakness, and fecal and urinary incontinence. At 33 weeks of gestation USG showed absent liquor and decreased fetal movements; S/D [systolic diastolic ratio] was increased [>4.3]. Elective Cesarean-section was performed at 33 weeks. Her condition settled in one week. Porphyria is an uncommon disorder. It affects women more frequently than men. Not only it has adverse effects on pregnancy but the frequency of porphyria attacks also increases during pregnancy. We herewith present a case report of a female with acute intermittent porphyria who conceived

population genetic study of southern Sindh [Hyderabad and Jamshoro] Pakistan: Distribution of ABO and Rh blood alleles

A Sample of 38360 human individuals from population of Hyderabad and Jamshoro yield allelic frequencies of 0.1157 +/- 0.00246, 0.1397 +/- 0.00254 and 0.7479 +/- 0.00150, for A[p], B[q] and O[r] alleles, respectively and 0.2209 +/- 0.0088 for d allele. The data suggests that no significant difference between sexes and study years in the distribution of allelic frequencies. The Jamshoro population runs close to Sindhi, Baloachi, Siraiki, Punjabi and Urdu speaking groups of Hyderabad population, explained on similarly of genetic composition of these populations

Incidence of gall bladder malignancy in patients with cholelithiasis

A prospective study was carried out in the Department of Surgery, Chandka Teaching Hospital Larkana from January 1997 to December 1998. One hundred cases of cholelithiasis were reviewed for malignancy [80 females and 20 males]. Out of these 10 percent patients were found to have carcinoma of the gall bladder. Their ages ranged from 41 to 69 years, with mean age of 52.2 years. Carcinoma of the gall bladder was found to be more common in the 5th decade of life. Common presenting symptoms were upper abdominal pain [100 percent] nausea and vomiting [80 percent], weight loss [50 percent], jaundice [40 percent] and anorexia [20 percent] Abdominal mass was palpable in two patients. Preoperative diagnosis with the help of ultrasound was possible only in three cases. Histopathologically, all the cases were adenocarcinomas. In majority of the cases, stones were mixed with cholesterol as a predominant component

albuminuria as a predictor of diabetic long term complications

This study was conducted to determine the prevalence of microalbuminuria and macroalbuminuria in insulin dependent diabetes mellitus [IDDM] and non insulin dependent diabetes mellitus [NIDDM] patients and their relationship with some known chronic complications of diabetes. Four hundred sixty two patients attending the diabetic clinic Chandka Medical College Hospital, Larkana during the period from January 1995 to June 1997 were evaluated for urinary albumin excretion rate [UAE] on 24 hour urine collection. One hundred forty six patients [31.6%] 82 males [56.2%] and 64 [43.8%] females were positive for pathological albuminuria. One hundred eight patients [62 males + 48 females = 23.4%] have microalbuminuria and 38 [2 males + 16 females = 8.2%] have macroalbuminuria. Disease duration was 11.6 +/- 7.3 years [9.8 +/- 6 years in patients with microalbuminuria and 13.4 +/- 5.6 years in those with macroalbuminuria. This prevalence was associated with retinopathy [19%] neuropathy [5.5%] cardiopathy [2.8%]. As albuminuria is a good predictor of early diabetic nephropathy so it is advisable to carry out UAE estimation on first visit and annually so as to prevent and or postpone end stage renal adequate therapy

Frequencies of ABO blood alleles in human population of Pakistan: Southern Sindh in focus

The distribution of ABO blood group was studied in a sample of 2910 individual donors and recipients, at random of both sex who have visited the Liaquat Medical College Hospital Hyderabad. The analysis shows that blood group A,B,O and AB individuals are 15.60%, 21.79%, 60.15%, 2.99%, respectively. The allelic frequencies of A,B and O is computed out to be 0.0948, 0.1294, 0.7756, respectively

Results of six months treatment of chronic hepatitis B with recombinant interferon alpha therapy

Several trials for chronic hepatitis B virus [HBV] have shown the usefulness of interferon alpha [INF-alpha] in eliminating the HBV. The present study was designed to assess its safety and efficacy in chronic HBV. Fifty-two cases [37 males and 15 females] of histopathologically proven chronic active hepatitis [CAH] with either hepatitis B surface antigen [HBs-Ag] positive or hepatitis Be antigen [HBe-Ag] positive underwent INF-alpha therapy with a dose of 3 million units [MU] intramuscularly [IM] on alternate day for a period of 4-6 months. Twenty-four cases [46.15%, 17 males and 7 females] showed a complete response. Trivial side effects were reported which resolved with symptomatic treatment. Thus INF-alpha at a low dose is equally effective and safe in a proportion of cases of Chronic Hepatitis B