Dengue fever update

Dengue fever is being caused by Flaviviridae family and has four serotypes. The vector is mosquito Aedes aegypti and Aedes albopictus. Dengue fever also known as bone break fever. Primary infection with any one of the four dengue virus serotypes typically causing dengue fever [DF], which is a severe but self limited acute febrile illness, some primary infections and more of secondary infections with two different serotype results in very severe, debilitating and life-threatening DHF/DSS, which is characterized by increased vascular permeability and haemorrhagic manifestations. In rare cases of DHF/DSS, neurologic abnormalities, including encephalitis, may also occur. There are some evidence of other atypical manifestations of dengue fever as well such as a calculus cholecystitis, appendicitis, pneumonitis and myocarditis. Variations in virus strains within and between the four serotypes may influence disease severity. Secondary infections are more likely to result in severe disease and dengue haemorrhagic fever

Fatal intra-operative disseminated intravascular coagulation; extensive Surgery: a case report

Authors present a case of 26 years old female who was having Esophagectomy done due to esophageal perforation secondary to severe corrosive intake strictures. Pre-operative course was uneventful, but during 5 hours of extensive surgery, she developed fulminant disseminated intravascular coagulation [DIG] which was initially managed, but proved to be fatal after 4 hours of ICU stay. Surgeons should be alert that hypercoaguable state can develop in unprepared patients having extensive surgery

Glomerular filtration rate rather than serum creatinine should be used for recognizing patients at risk for development of contrast induced nephropathy

Serum Creatinine [SCr], widely used for renal function assessment is not an accurate measurement. SCr can be within normal range even when there is substantial nephropathy. The objective was to observe the incidence of contrast induced nephropathy [CIN] with normal SCr and low glomerular filtration rate [GFR]. This was a cross-sectional, observational study involving patients undergoing coronary angioplasty. During a period of 6 months, 64 patients having SCr ? 1.4mg/dl and a GFR of < 80ml/min were selected who underwent elective coronary angioplasty. SCr was measured again after 48 hours of the procedure. CIN was defined as a > 25% increase in SCr from the preprocedure level. For statistical analysis, SPSS version 10 was used to calculate one way Anova was used for comparing variables between CIN and No-CIN groups, while paired t-test was applied for comparison between pre and post procedure SCr. Out of 64 patients, CIN was seen in 14 patients [21.8%]. After the procedure, significant difference was seen in the mean creatinine levels [p < 0.001]. The before and after experiment creatinine values also showed a significant difference [p < 0.05]. SCr along with calculated GFR should be used to assess patients for underlying renal insufficiency undergoing contrast procedures like coronary angioplasty. Patients with low GFR and normal SCr have a significant risk of developing CIN. Identifying such patients before hand can help us decrease the overall incidence of CIN by administering timely prophylactic measures

Role of alfentanil in maintaining cardio-circulatory stability in pediatric age group anaesthesia: a phase ii comparative study

OBJECTIVE: The aim of our study was to evaluate the efficacy of fentanyl and alfentanil in relation to hemodynamic stability of pediatric patients during routine general anesthesia

PLACE AND DURATION OF STUDY: A prospective double staged clinical trial was conducted at Anesthesia department of the Hospital over a period of 1 year from June 2010 till May 2011

METHODS: Total of 102 children, aged 7.3+/-2.1years, scoring ASA ?-??, undergoing general anesthesia were recruited and randomly divided in two groups. Group A received fentanyl bolus injection while group B received alfentanil. High flow oxygen was followed by inflow of fentanyl and alfentanil administered in the respective groups. The dose was adjusted to 1.5?g/kg for both fentanyl and alfentanyl. Induction was done by 2mg/kg propofol and rocuronium was administered via automatic infusion pump system. Lungs were mechanically ventilated with a mixture of 60 % [NO] nitrous oxide and [O2] oxygen along with 1% isoflurane. Hemodynamic parameters in terms of blood pressure and pulse were recorded before and after intubations

RESULTS: Time for the systolic Blood Pressure to reach its peak value and then to normal i.e.: [51 +/- 16secvs.71 +/-34 sec, 95% CI 1.243-2.458, P 0.01] and [119 +/- 33 sec vs. 74 +/- 31, 95% CI 2.589-4.821, P 0.01] was statistically significant among the two groups. In addition to this, the time for the pulse to reach maximal value and then back to normal i.e., [54 +/- 27sec vs.103 +/- 39, 95% CI 3.035-4.786, P 0.01] and [123 +/-28sec vs. 59 +/-18, 95% CI 3.212-4.789, P 0.01] was also clinically and statistically significant among the two study groups. It shows that fentanyl group patients achieved maximal values of blood pressures and pulse quickly, but retained their peak and returned to baseline levels after a prolonged interval in comparison to the group of patients who received alfentanil

CONCLUSIONS: Alfentanil 1.5-2?g/kg bolus injection dose in children provides a safe circulatory and hemodynamic balance with minimal cardiovascular response and a stable anesthetic state

Assessment of Renal insufficiency in patients with normal serum creatinine levels undergoing angiography

To determine the frequency of patients with underlying renal insufficiency having normal serum creatinine level proceeding for coronary angiography. A total of 693 patients from September 2009 to February 2010 undergoing diagnostic coronary angiography at the National Institute of Cardiovascular Diseases [NICVD] with normal serum creatinine

Well baby visits - an experience in a squatter settlement of karachi

To determine the profile of healthy children visiting to the well child clinic in relevance to their growth and development. A cross-sectional study. The Study was conducted at the Primary Health Care [PHC] center in a squatter settlement of Karachi from December 2003 to December 2004. A cross-sectional survey of children under 3 years attending the Primary Health Care [PHC] center in a squatter settlement situated near Ziauddin Medical University [ZMU], Clifton. Karachi. It is divided into five blocks with a population of approximately 20,000. It is a low socio-economic area with poor literacy rate. For convenience of follow-up, only those children were enrolled in the well child clinic living within a distance of 5 kms. from the center. The information was recorded on a structured proforma, which included the introduction of the child; natal and pre-natal history; immunization and feeding history; past medical and surgical history; complete general and systemic examination. The growth parameters were recorded on growth chart recommended by the WHO. A total of 62 children were enrolled from birth to 3 years with a mean age and standard deviation of 2.2+1.3 years. Almost half the mothers [34 out of 62] preferred ghutti as a pre-lacteal feed, 6 preferred honey while the rest were unable to remember giving any prelacteal feed. Almost half of the children [n=31] were given colostrum. Breastfeeding was initiated in 18 children while the rest were bottle fed. The weaning age ranged from 4 to 24 months. All the children were fully immunized according to the EPI schedule. Majority of the children were malnourished [82%] and only 18% had normal weight for age according to the growth chart and Gomez's classification. It iwas found in this study that the improved nutrition can lead to improvement in child growth

Morbidity pattern and utilization of a primary health care center in a low socioeconomic area of Karachi

To identify the morbidity pattern according to age, gender and seasonal variation using the ICD coding and the utilization of Primary Health Care [PHC] center services in a demographically defined community. The data collected from 2001-2003 was analyzed using the International Classification of Diseases - 10 [ICD-10] coding for identifying the morbidity patterns presenting at the PHC Center. The age and gender distribution of the patients and the seasonal variation of few diseases were noted. Only the residents of the area visiting the center for preventive or curative services were included. A structured performa was designed to enter the age, gender, disease and ICD codes. The faculty was trained for using the coding system. A total of 13,519 patients visited the PHC during three-year period. On an average, 376 patients were seen during a month with male to female ratio of 1:2. The most common diseases presented belong to the respiratory system, followed by infections or parasitic infestations and diseases of the reproductive system. The women presented for first visit of antenatal check up were 960 out of 4614 women of reproductive age group. Among the adult population, 391 [6%] presented with hypertension, 64 [1%] were Type 2 diabetics and 86 [1.3%] were asthmatics. The paediatric population analysis showed that 918 [13%] had upper respiratory infections and 1339 [19%] had diarrhoea. Problem oriented medical records from health centers, computerized in a uniform standardized way, can give extensive information about the content and burden of health problems in family practice and presumably public health

Hepatitis - A associated with rhabdomyolysis

A case of a young boy is described who presented with pain and weakness of lower limbs and developed jaundice and acute renal failure secondary to severe rhabdomyolysis, with vigorous therapy he regained normal muscle power and renal functions. Immunological testing confirmed Hepatitis A as the cause for this presentation

Assessment of patients with hypertensive intracerebral hemorrhage at a tertiary care hospital, Pakistan

The assessment of outcome in admitted patients with hypertensive intracerebral hemorrhage in a tertiary care hospital on the basis of GCS and CT scan.The cases of hypertensive intracerebral hemorrhage admitted to neurosurgery department of a tertiary care hospital during the year 2004 were included in the study. Those with cerebral infarction, recurrent hematoma, or hemorrhage due to non-hypertensive causes were excluded. The parameters assessed included age and sex of the patient, associated comorbids like DM and IHD, GCS on admission, CT scan findings, management and outcome. A total of 84 cases with hypertensive bleed were analyzed, of which 52 [62%] were between 30-60 years and 32 [38%] were more than 60 years of age with equal sex distribution. Statistically significant association was observed between co-morbidity and outcome of patients [p 0.00 1], between CT scan findings and management [p 0.006], between management and outcome [p=0.02]. Management and outcome of hypertensive ICH is dependent on multiple factors like age of the patient, co-morbidity, CT scan findings and GCS. These are some of the direct predictors of assessing ICH. The aim should be to prevent such incidents secondary to hypertension

Awareness about common diseases in selected female college students of Karachi

To determine the level of awareness about five common diseases, namely: Tuberculosis [TB], Typhoid, Hepatitis B, Hepatitis C and HIV/AIDS among college female students of Karachi. A cross-sectional survey of female students aged 16-21 years from three colleges selected by convenient sampling method was conducted from January to May 2004. Data was collected through a self-administered questionnaire. A large number of students [71%] knew that typhoid spreads by eating contaminated food and drinking infected water. Majority [84%] knew about cough as a mode of spread for TB whereas 69% thought that TB could spread through sneeze of a TB patient. Regarding AIDS, 90% knew that it is sexually transmitted. Majority [87%] knew about the association of hepatitis B and contaminated needles; 64% were aware of hepatitis C and abuse of contaminated needles; 88% knew about the spread of HIV by the use of contaminated needles. A large number [92%] mentioned television as their main source of information. The general level of awareness regarding HIV/AIDS transmission was satisfactory among college girls in this study. The level of awareness of the young educated females about the modes of spread of typhoid, TB, hepatitis B and C is low. This study emphasizes the effectiveness of health education campaign regarding common infectious diseases, especially in young girls [JPMA 55:195;2005]

Hydrocephalus in children

The word "hydrocephalus" is derived from two Greek words: hydro meaning water; and cephalus meaning head; also known as "water on the brain". Historically it is believed to result from imbalance between CSF production and absorption, with net accumulation of fluid in the cranial cavity; characterized by increase in size of the cerebral ventricles. It is classified as: Communicating hydrocephalus, in which flow is not obstructed, but CSF is inadequately reabsorbed in the subarachnoid space and the Non-communicating hydrocephalus or the Obstructive type, in which flow of CSF from the ventricles to subarachnoid space is obstructed. This type may also be sub-classified into Congenital and Acquired. The overall incidence of hydrocephalus is not known. Approximately 55% of all hydrocephalus are congenital. The etiology depends upon the age of the child. The clinical features are increase in the size of head, with wide anterior fontanelle, prominent scalp veins, sun-setting eyes, optic nerve atrophy, nystagmus and increased muscle tone in children upto 2 years. Children more than 2 years may present with these as hydrocephalus progresses; or if the fontanelles are closed, head size may be normal. These may present with optic atrophy or papilloedema, abnormal hypothalamic functions [short stature or gigantism, obesity, delayed puberty, primary amenorrhea or menstrual irregularity and diabetes inspidus] and spastic lower limbs. Performance IQ is worse than verbal IQ and learning problems are common. The diagnostic procedures include measurement of head circumference, Plain X ray of head, Ventriculography, Pneumoencephalography, Ultrasonography, Computed Tomography and Magnetic Resonance Imaging. The management may be non-surgical and surgical

Knowledge of students regarding hepatitis and HIV/AIDS of a private medical university in Karachi

To determine and assess the level of awareness among students of a private medical college regarding HIV/AIDS, Hepatitis B and C. A survey was conducted to assess the awareness of medical students on HIV/AIDS, hepatitis B and C. They were asked to fulfill a pre-tested structured questionnaire. The variables accessed were their knowledge of disease regarding etiology, mode of transmission, and prevention. A total of 267 students participated, with 117 [43.8%] students from pre-clinical years and 150 [56.2%] from the clinical years. The male female ratio was 1:2, mean age of respondents was 21 + 1.5 years. Majority of the students [98%] agreed that an infected person is a major source of transmitting these infections. Almost all [95%] students knew that blood transfusion was an important source of transmitting these infections. Wearing gloves [87%] and safe disposal of sharps waste [98%] were known by the students to be the ways to protect against these infections. A significant difference was noted on comparing the knowledge between preclinical and clinical students regarding medical / surgical procedures causing these infections [p<0.001] and also regarding the ways to protect against these diseases [p=0.001]. There is a lack of awareness among the medical students entering into the profession. It is the need of the hour to emphasize on practicing universal precautions. In addition, some preventive measures should be taken by the management of the universities and medical students to avoid the occurrence of these problems

Risk factors assessment for hypertension in a squatter settlement of Karachi

To assess the risk factors for hypertension in adults [age more than 15 years] in a squatter settlement of Karachi. Cross-sectional survey of adults more than 15 years old in a squatter settlement of Karachi through random sampling method. A total of 327 adults were approached, 165 [50.5%] were males and 162 [49.5%] females. Blood pressure was measured in 63 [38%] males and 135 [83%] females. Out of which, 11 [17.5%] males and 19 [14%] females were screened hypertensive. Hypertensives were older as compared to normotensives [p<0.001]. The mean BMI of hypertensives [25.6 + 4.5 kg/m2] was significantly higher [p=0.008] than normotensives [22.9 + 5.0 kg/m2]. Hypertensives were 9.7 times more likely to be diabetic as compared to normotensives in this study [p<0.001]. On analyzing the relationship of hypertension with other variables, no significant difference was noticed for education [p=0.68], smoking status [p=0.46], family history [p=0.31] and occupation [p=0.27]. Prevention and control of hypertension is essential as the life expectancy is increasing in developing countries as well. The main emphasis according to this study, should be on controlling the BMI through weight reduction and regular exercise. Awareness about the risk factors for hypertension among the population is required to decrease the double burden on the society

Road traffic injuries: a new agenda for child Health

This paper reviews literature related to morbidity and mortality in South Asian children due to Road Traffic Injuries [RTIs], almost all of which are preventable. In South Asia after males 15-44 years, RTIs are most common in children 0-15 years old. Under-five fatality rates are about six times higher than in the developed world. Most injuries in low income countries occur in urban areas, where pedestrians, passengers, and cyclists account for around 90% of deaths due to RTIs. This higher fatality among pedestrians is probably due to wider traffic mix and lack of safe pedestrian walking areas. The WHO estimates that RTIs cost countries between 1 and 2% of their Gross Domestic Product. This has critical financial consequences. Vital statistics in South Asia are not reliable, and this leads to an underestimation of the magnitude of RTIs that hampers efforts for its acceptance as a preventable public health problem. Rapid urbanization, high motorization rates and failure to institute preventive measures predict a substantial increase in road traffic deaths in the coming years. Creating a safer environment is important. Use of child passenger restraints, bicycle helmets and targeted education campaigns are effective preventive measures. Legislation and implementation of traffic rules and regulations, road engineering and safe pedestrian areas would help reduce injuries. These measures are in accordance with the WHO's five-year strategy to address RTIs worldwide. This strategy includes national and local capacity building, inclusion of RTI in the public health agendas in the world for prevention and control of the health consequences. Child health in South Asia needs to integrate the new challenge of road traffic injuries for the region. It is critical that interventions for reducing this burden are developed, tested and implemented

Improving vaccination status of children under five through health education

To improve awareness and knowledge of mothers regarding vaccine preventable diseases and the immunization status of children under five through health education messages by medical students, at Gulshan-e-Sikanderabad, a squatter settlement adjacent to Ziauddin Medical University, Karachi. The undergraduate medical students' visit families in the squatter settlement. This study compared the effect of intervention by medical students on vaccination status of children under five in the intervention households versus those without intervention. A baseline study was done in 1998 and a follow-up study was done after four years to assess the differences in knowledge and practices of mothers regarding immunization. A total of 110 houses from block I and 207 houses from block V were selected. An increase of 22% [52% vs 30%] in block-I [p=0.003] and 19% [32% vs 13%] increase in block V was seen in the utilization of PHC Center for vaccination [p=0.001]. Mothers' knowledge regarding the age when first vaccine is administered to the child, increased in the follow-up from 60% to 76.5% [p<0.01] in block I and from 50% to 62% in block V. The immunization status increased significantly in block I from 46.5% to 75% after the intervention [p<0.005], no significant difference could be seen in block V [p=0.16]. In the follow-up survey a significant difference was seen in the vaccination status between the two blocks [p=0.001]. The health education messages significantly increased the vaccination status of children under 5 in the intervention area