Vitamin D and the prevention of preeclampsia: a systematic review

To identify the effect of Vitamin D in reducing the risk of preeclampsia in pregnant women. The review was conducted from December 2011 to March 2012 at the University of Sheffield. Studies were included from the Medline data base, Web of Science [Web of Knowledge], Ovid database and Google Scholar. Studies were limited to published literature only; published between January 1992 to March 2012. A total of seven studies were selected for this review based on the inclusion criteria. One was non-r and omized clinical trial, three were cohort studies and three were nested case-control studies. The clinical trial showed a positive association between Vitamin D supplements and the reduction of preeclampsia risk in pregnant women. In addition, one large cohort and two nested case-control studies also showed a protective effect of vitamin D in preventing the risk of preeclampsia. However, the other two cohort studies and a nested case-control study could not find any association between vitamin D levels and the risk of preeclampsia in pregnant women. The studies included in this review show conflicting results about the association of vitamin D levels and the risk of preeclampsia. However, in this review more than half of the studies showed a positive link between Vitamin D deficiencies and Preeclampsia. There is a clear need for further trials and other robust studies to identify the effect of Vitamin D on preeclampsia.

CT pelvis in children; should we routinely scan pelvis for wilms tumor and hepatoblastoma? Implications for imaging protocol development

Wilms tumor and hepatoblastoma are the most common intra-abdominal solid organ childhood tumors. CT examination is one of the routinely performed procedures in hospitals for children with these tumors inspite of high radiation exposure associated with CT scans. Sixty patients [Wilms tumor = 45, hepatoblastoma = 16] were evaluated retrospectively. Higher proportion [44.4%] of metastatic disease was identified at presentation in the Wilms tumor subset as compared to hepatoblastoma [6.3%] [p=0.006]. Metastatic disease was noted in 6 patients having Wilms tumor on follow-up while it was also low in hepatoblastoma which was noted in only 2 patients [p > 0.05]. No significant difference was identified in pelvic extension of disease at presentation in both studied population [p > 0.05]. Pelvic metastasis was noted in 1 patient only with Wilms tumor on follow-up while no pelvic metastasis was seen in the hepatoblastoma patients [p-value > 0.05]

Interventions for improving research productivity in clinical radiology

The purpose of this study was to evaluate the effects of research promotion activities on overall quality and quantity of research output in a clinical department of a teaching tertiary care hospital. Simple research enhancing strategies including regular journal club, research hour, basic research skills training, hiring of research faculty, research awards, and annual research retreat and research board to increase research production were implemented in the Department of Radiology of a teaching hospital in Pakistan. A total of 77 papers were produced by the Department of Radiology before the intervention, which increased to 92 after the introduction of research initiatives. There was a significant increase in the overall proportion of publications in the international journals after the intervention [p < 0.001] with an increasing trend towards indexed journals [p < 0.001]. The research enhancing interventions had a positive effect on increasing clinical research output by the Department of Radiology. Such interventions can also be replicated in other clinical departments to increase their research productivity

Systematic review on [vitamin e and prevention of colorectal cancer]

Colorectal cancers [CRC] are highly prevalent cancer all over the world and need appropriate and timely prevention and treatment. Since years it has been argued that antioxidant vitamins have a potential role in the prevention of several neoplasm including colorectal cancer though the answer remained controversial. Most of the observational studies in past have shown that Vitamin E has some protective effect in the primary prevention of colorectal cancer, however its exact role is not yet established. On the other hand recently conducted experimental studies have shown variable results regarding the role of vitamin E in preventing colorectal cancers. Thus this review was conducted to study the role of vitamin E in preventing colorectal neoplasm. This review study was conducted from September 2008 to February 2009. We searched multiple electronic sources including [PUBMED] MEDLINE, Cochrane Database for identifying existing Systematic Reviews, OVID data base and other library sources to identify relevant studies for this review. Data was collected using data extraction form. Meta analysis was performed in Review Manager version 4.3. We identified four trials on vitamin E role for primary prevention of CRC, includes 94069 participants [47029 in vitamin E Vs 47040 in placebo], aged 40 years or above, who were randomized to vitamin E supplement versus placebo. The outcome measure in our review was incidence of colorectal cancer in the follow up period of 7 to 10 years. We found no sufficient evidence of vitamin E role for decreasing risk of CRC incidence [RR: 0.89, CI: 0.76, 1.05; p-value = 0.18]. It has been identified in the review that Vitamin E does not have protective role in the prevention of colorectal cancer. Further studies on diverse population are required to determine the role vitamin E for the primary prevention of colorectal cancer

Needle stick injuries among health care workers of public sector tertiary care hospitals of Karachi

To estimate the frequency of needle stick injuries [NSI] among health care workers [nurses, student nurses and paramedical staff] in public hospitals of Karachi. Cross sectional, observational. This study was conducted in three public tertiary care hospitals of Karachi, from November 2007 to January 2008. Data was collected by structured interview-based questionnaires in Urdu and English language. Questionnaire was designed to obtain information regarding demography, work experience, hepatitis vaccination status, and occurrence of needle stick injuries with associated factors. Needle stick injury that occurred in the previous month was the defined outcome. Data was entered in Epi Data and analyzed in SPSS version 15. A total of 417 health care workers participated in the study. Mean age of the participants was 24 +/- 11 years. Estimated proportion of participants with history of at least one time NSI was found in 66%. Around 13% [n=54] had one or more NSI in the previous one month at work and half of them were affected by non-sterile needle. None of them sought medical care. Almost 90% of them were not wearing gloves or taking any other protective measures at the time of injury. There can be serious consequences of needle stick injuries in public hospitals as large proportion of injuries involve non-sterile used needles and health care workers do not take appropriate measures of protection

Carotid artery disease in patients undergoing elective coronary artery bypass surgery

To determine frequency of carotid artery disease in patients undergoing elective coronary artery bypass grafting [CABG] using Doppler sonography. Observational study. Radiology Department, The Aga Khan University Hospital, Karachi, from January 2005 to September 2008. Patients with known cardiovascular disease waiting for CABG surgery were enrolled for carotid artery Doppler sonography. A predefined data entry form was used for data collection. Coronary angiography findings, carotid artery findings and other associated factors were noted from medical and radiological records. Frequency and pattern of carotid artery disease along with associated risk factors were evaluated. Data was entered and analyzed in SPSS version 15. Pearson chi-square for categorical and independent "t" test was applied for continuous variables at 95% confidence level. P-value of less than 0.05 were considered significant. A total of 176 patients [85% male, mean age=65 years] undergoing elective coronary artery bypass grafting were evaluated preoperatively for carotid artery disease by neck color Doppler sonography. Twenty percent of patients were found to have advanced carotid artery disease [> 50% stenosis], 6% had critical stenosis [> 75% stenosis] and 3% had complete stenosis. Frequency of atherosclerotic plaques was 50%, more common on right side and more prevalent in common carotid artery. Family background of carotid or coronary artery disease and history of smoking were significantly associated with presence of carotid artery disease [p < 0.05]. A sizeable proportion of patients undergoing elective coronary artery bypass grafting surgery for coronary artery disease were found to have coexistant carotid artery disease

Cleaning methods for ultrasound probes

To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. Experimental study. Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007. A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning ultrasound probe, which included sterilized paper towel, 0.9% saline and swipe over with standard bath soap applied on group A [n = 25], group B [n = 25] and group C [n = 25] respectively. Number of Colony Forming Unit [CFU] of bacteria were calculated on standard agar plate to find out the effectiveness of cleaning methods in reducing bacterial count from the ultrasound probe after the procedures. All samples were tested in single microbiology lab by using same bacterial growth media provided by same manufacturer. Kruskall Wallis, Jonchkheere-Terpstra and Wilcoxon sign rank tests were applied to find out statistical significance. There was a significant reduction in bacterial count after applying either of all three cleaning methods for ultrasound probe compared to count on the probes before cleaning [p < 0.001], however, soap cleaning method was the most effective in decreasing bacterial count to the minimum level in comparison to other two methods [p < 0.001]. The overall reduction in pathogenic bacterial count after performing each cleaning method was 45%, 76% and 98% for paper cleaning, normal saline and soap cleaning method respectively. Cleaning ultrasound probe after performing each procedure is a cost-effective practice with potential of reducing nosocomial infections. Soap cleaning technique is the most effective method for reducing bacterial count acquired due to patients' body contact with the ultrasound probes

Non-fatal limb injuries in motorbike accidents

To determine frequency and pattern of non-fatal limb injuries in motorbike accidents victims. Cross-sectional observational study. Study was conducted at Jinnah Postgraduate Medical Centre [JPMC], Karachi, from October 2006 to March 2007. Trained data collectors prospectively collected data from the emergency department of JPMC, Karachi using structured pre-tested questionnaires. All motorbike accident victims presented to Emergency department with single or multiple bone injury in body extremities were included. Head injury patients who had first presented to neuro-surgery department were excluded. Motorbike accident victims with soft tissue injuries were also excluded from this study. Chi-square test was applied to find out statistical significance at 95% confidence level. P-value <0.05 was considered as significant. A total of 137 [39%] patients presented with tibial injury among the study sample of 348 patients, which was significantly higher than the bone injuries of the body part [p<0.001]. Out of those, in 26% of patients, fibula was also involved along with tibia fracture. Other bone injuries included femur [16%], radius [9.2%], humerus [8.3%] and others. Radius was the commonest injured bone and in highest proportion among upper limb injuries [p<0.001]. Overall, 66% of the injuries in motorbike involved lower limb fractures. The highest proportion of motorbike accidents were observed on Saturdays [31%]. Majority of the accident victims were in the age group between 16 and 30 years [41% accident cases], 27% in age group 30 to 45 years, 15% in 45 to 60 years and 5% in >60 years. Those with less than 15 years accounted for 12% of cases. Tibial bone is at the greatest risk in motorbike accidents probably due to its superficiality and exposed position while riding motorbike. Protective measures need to be taken for the prevention of disability associated with lower limb involvement in motorbike accidents

Film retakes in digital and conventional radiography

To determine the film-retake rates and causes in digital radiography comparison to conventional X-rays method. Comparative study. Radiology Department, Aga Khan University Hospital, Karachi, from January 2004 to December 2006. X-rays of different body parts, conducted during the year 2004, with conventional radiography [n=170300], and in 2006 with digital radiography [n=174550], were included in this study. Measurements were done for number of X-rays re-take due to different quality control reasons for both the conventional and digital radiography. Quality control reasons included underexposure, overexposure, positioning errors, patient movements, portable X-rays, grid cut-off, and others [i.e. equipment related] due to which X-ray quality was questionable. Results were expressed in percentages. A total of 9423 X-rays [5.5%] were repeated in conventional radiography [n=170300] due to underexposure [38%], overexposure [28.5%], positioning errors [25%], portable procedures [4%], patient movement [2%], grid cut-off [0.5%], and others [2%]. Underexposure was the most frequently responsible factor for the X-ray repetition as compared to other factors [p<0.001]. In digital radiography [n=174550], 1464 X-rays [1%] needed to be repeated, which was significantly less in comparison to X-ray repetition in conventional method of radiography [5.5%] [p<0.001]. In digital radiography, the most frequent factor for X-ray re-take was positioning error [435, 30%]. Digital radiography is associated with significantly lesser number of re-take X-rays as compared to conventional radiography, hence minimizes the exposure of the patients to unnecessary radiations due to re-take X-rays. Positioning error remains a problem even in digital radiography, emphasizing training need for technologists