Health outcomes in low, medium, high and very high human developed countries: a cross comparison with Pakistan

Background: Health is a key component of human development and economic growth of a country in addition to education and gross domestic product

Objectives: To determine the health outcomes in four human development index countries and to make a comparison of these with the heath indicators of Pakistan

Materials and Methods: The data used in the current study was a secondary data obtained from United Nations Development Report [UNDP] published in 2015 including several variables representing health outcomes of a country

Results: Pakistan spent 2.8% of its gross domestic product in public health programs which is lower than the average amount spent by low, medium, high and very high human development index countries. Number of medical doctors available per 10,000 people in Pakistan is 8.3 which is higher than the average number in low human development index [1.3], almost similar with the medium human development index [8.2] but much lower than the high [18.7] and very high [28.7] human development index countries. All the health outcome variables were significantly [p< 0.01] different across the four types of human development index groups

Conclusion: Low life expectancy, high mortality ratios, low vaccinations, child malnutrition, less number of physicians and a very low percentage of gross domestic product spent on health are the major barriers in human development of the country

Fluid volume measurement reliability of commercially available drainage bags

[1] To measure the difference between the actual and observed volumes of fluids as measured by the commercially available drainage bags. [2] To find out reliability of fluid volume measurements as observed in commercially available drainage bags. Surgical Unit II, IIMCT Railway Hospital, Rawalpindi. Descriptive. Commercially available drainage bags were used to observe the volume of fluid contained in it. The fluid [tap water] was introduced in the bag with a 50 cc syringe in 50 cc increments starting from 50 cc to 1050 cc. and the difference between observed volume and actual volumes were recorded. Data was analyzed with SPSS. A total of twenty-one observations were made in 02 different commercially available urine bags. Major differences were found in the observed and measured volume with minimum difference of 50 -230 ml and maximum difference of 200-520ml. Significant differences were found between the actual volumes and the volumes observed by the marks on the drainage bags. It is noted that the observed value of the fluid volume contained in a drainage bag is highly unreliable and should not be used for clinical decision making

Blood component support in the management of serious hematological disorders

To study the current blood transfusion trends in patients undergoing treatment for serious haemotological disorders and stem cell transplantation. Descriptive study. Armed Forces Institute of Transfusion [AFIT] from January 2008 to December 2008. Data of 719 patients receiving blood components support in Army Forces Bone Marrow Transplant Centre [AFBMTC] was analyzed. Patient's characteristics and type / frequency of blood component requirement were noted. Any reaction associated with blood transfusion was recorded on separate proforma. A total of 16767 units of different blood products were issued from AFIT to AFBMTC during a period of 12 months. Post transplant patients constituted the bulk of transfusion requirement in AFBMTC. The main bulk transfusion were made up of platelets [10949 units], followed by RCCs [2720 units] and FPP's [3477 units]. Acute febrile reaction was seen in 03patients following RCC transfusion and in one patient following platelet transfusion. The requirement of blood components in patients undergoing bone marrow transplantation and suffering from serious haemtological disorders is enormous. Prompt and safe supply of blood components is the life line for better result management in these patients

Patterns of presentation of chronic ischemic heart disease with and without previous myocardial infarction

The prevalence of Ischemic Heart Disease [IHD] is on the rise, from increasing lifespan of population and availability of better medical facilities. We studied chronic IHD cases with and without previous myocardial infarction, in Hazara, NWFP, Pakistan to evaluate left ventricular [LV] dysfunction, wall motion abnormalities and complications of IHD. All patients presenting with history of chest pain in Medical 'C' Unit, Ayub Teaching Hospital, Abbottabad from June 2004 to May 2005 were included in the study. Patients with non-cardiac chest pain were excluded from the study. Cases with congenital and rheumatic heart disease, cardiomyopathies, unstable angina and acute MI were excluded. Patients with IHD with or without myocardial infarction [MI] were studied for left ventricular dysfunction [ejection fraction, left atrial size, E/A ratio], wall motion abnormalities and complications of IHD [Mitral regurgitation, Ventricular Septal Defect [VSD], LV aneurysm, LV clot]. Clinical and echocardiographic evaluation was done in each case. Out of 183 cases of chronic IHD, 123 patients were without previous MI and 60 had had previous MI. Ejection fraction [EF] was 45% +/- 15 in the group without MI and 35 +/- 11% in cases with MI. Left Atrium [LA] size was 35 +/- 6 mm and 39 +/- 4 mm in the two groups respectively. LV diastolic dysfunction was seen in 17% in the first and 24% in the second group respectively. Global hypokinesia was seen in 8% and 17% in the 2 groups respectively. Regional Wall Motion Abnormality [RWMA] was observed in 12% in patients without MI and in 58% cases with MI. Mitral regurgitation was seen in 10 and 20% in the 2 groups respectively LV clots, VSD, LV and aneurysm were seen in 8.4, 5, and 6.5% respectively, only in cases with previous MI. LV dysfunction, wall motion abnormalities and mitral regurgitation were more common in IHD cases with previous heart attack

case series study of 26 subjects with left ventricular thrombus-to see its etiology and left ventricular function

To evaluate the left ventricular function and determine etiology of left ventricular thrombus in 26 cases. Design: Prospective observational study. Setting: Medical Unit of Ayub Teaching Hospital, Ayub Medical College, Abbottabad. Patient and Method: Patients with left ventricular thrombi diagnosed with echocardiography from May 1999 to June 2001 were studied for its etiology and left ventricular function. Fifty-six% of left ventricular thrombus cases were due to chronic ischemic heart disease while 36% had dilated cardiomyopathy. Left ventricular aneurysm was seen in 7.8% cases. Mean age was 54 +/- 3 years with 74% males and 26% females. Mean ejection fraction was 22 +/- 2.5% in dilated cardiomyopathy cases while it was 35 +/- 17% in cases with underlying coronary artery disease. Chronic ischemic heart disease and dilated cardiomyopathy are the main causes associated with left ventricular thrombi. Impaired left ventricular function is a common denominator in these cases

prevalence study of congenital heart disease in NWFP, Pakistan

To assess the frequency of congenital heart disease in patient referred for the echocardiography. This echocardiographic study focused on findings of congenital heart disease in unselected subjects referred for echocardiography. This study was conducted in a private cardiac diagnostic facility in Peshawar, NWFP, Pakistan between July 2000 to June 2001. Patients and Method: Patients referred for echocardiography were studied. Standard echocardiographic 2 doppler studies were done on all cases while TEE was not used in any case. Twenty three hundred and seventy four patients were studied in 12 months period. Three hundred and ninety eight cases of congenital heart disease were found, forming 16.76% of total VSD 45, ASD 14, PS 14, TOF 9.5 and PDA were found in 9.7 percent cases respectively. Congenital heart disease contributes significantly to the overall burden of cardiovascular diseases

Rabies and vaccination failure: two case reports

To highlight the health implications of increase in the stray dogs population and outline the problems of post exposure prophylaxis. Setting: Medical Unit, Ayub Medical College, Abbottabad. Findings: Both the cases developed rabies despite post exposure rabies vaccination. First case presented with psychiatric features. Post exposure rabies vaccination is difficult to rely upon in our healthcare setup, unless its efficacy has been confirmed by measurement of protective antibody titre. This may be expensive but strategies need to be worked out to make it cost effective

Dog bite, rabies and vaccination failure

To highlight the health implications due to increasing population of stray dogs and outline the problems of post exposure prophylaxis. Design: Two case reports on rabies with failure of postexposure prophylaxis. Setting: Medical unit of the teaching hospital, Ayub Medical College, Abbottabad. Both the cases developed rabies and expired despite postexposure rabies vaccination. First case presented with psychiatric features. Postexposure rabies vaccination should not be relied upon, in our health setup, unless its efficacy has been confirmed by measurement of protective antibody titre Case 1: A young man aged 21 years was admitted to the medical unit with complaints of headache malaise and nausea for the last two days. There was no history of fever, cough, diarrhea head injury or drug addiction. On further questioning he confided that he was harbouring snakes in his throat. He attributed his illness to something taken in the train while coming from Karachi to Peshawar three days ago. He was found to be anxious and agitated, was slow to respond. Neurological examination of the cranial nerves, sensory motor system, deep tendon reflexes and planter response did not reveal any abnormality. There was no spinal tenderness or neck rigidity. Rest of the systemic examination was also not of any positive diagnostic avail. A tentative diagnosis of psychiatric illness, possibly schizophrenia was made while encephalitis could not be excluded at this stage. His preliminary blood tests and serum biochemistry was reported as normal as were his chest radiograph and C.T. scan of the brain. C.S.F report revealed three white blood cells /ml and protein content of 55 mg/dl. He was empirically started on third generation cephalosporins and was given benzodiazepizes. He developed lacrimation and hypersalivation during the next two days and he was found affirmative for hydrophobia and aerophobia. He was alleged to be bitten by the dog ayear ago but was vaccinated from the local dispensary. He went into coma on the first day of hospitalization and died of hypoapnea the next day. His attendants were advised postexposure prophylaxis for rabies. Case 2: The second case of rabies was brought to the hospital with typical symptoms of rabies with aerophobia and hydrophobia and agitation. He drifted into coma over the next few days and was taken by the attendants to their home anticipating the impending death. He was bitten by the dog three months ago and was given vaccine from the office of the District Health Officer. The type of the vaccine and the vaccination schedule followed was not known

Lutembacher's syndrome

Lutembacher's syndrome comprises of atrial septal defect and acquired mitral stenosis. The two tend to influence each other's hemodynamics and hence clinical findings. This impact may extend to the over all management of the syndrome

echocardiographic study of 129 cases of cardiomyopathy

One hundred and twenty nine cases of cardiomyopathy [CMP] were diagnosed echocardiographically among 2374 patients 11 months and ten days period. The mean age was 50 years with no sex predominance. 91.47% had dilated CMP, with impaired left venticular [LV] systolic function. Echocardiographically detectable common features include, LV systolic dysfunction, pulmonary artery hypertension, and mitral regurgitation. The prevalence of CMP in the target population was 5.43%. More studies are needed to outline local prevalence and incidence of disease and to outline the aetiological and risk factors for cost effective primary and secondary preventive strategies

Atrial septal defect-II in the middle and old age

Ostium secondum atrial septal defect is the commonest of interatrial defects. However, interestingly, this hemodynamic disturbance is compatible with survival beyond middle age and the prognosis is related to duration and magnitude of shunting, relative compliance of ventricles etc. ASD-II usually goes unrecognized because of minor symptoms and subtle signs mistaken for physiological variations. New diagnostic techniques have enabled physicians to diagnose and treat such cases promptly. Two case are reported here which were diagnosed as ASD-II in advanced ages

Cerebral malaria

Cerebral Malaria is a common ailment throughout the world especially in the developing countries. Falciparum malaria, its complications and resulting mortality is on the rise. The understanding of the dis ease, its pathophysiology, diagnosis and treatment are essential for all medical personnel who encounter this problem in clinical practice. This review article describes the relevant aspects of cerebral malaria in the light of recent literature