Comparison of chest percussion in supine with quarter prone position to reverse gravitational atelectasis among mechanically ventilated COPD patients

Objective. To compare the clinical outcome measures of chest percussion in supine with quarter prone position, in terms of changes In Fi02, heart rate[HR] respiratory rate[RR], peak pressures and SpO2 to resolve gravitational atelectasis among mechanically ventilated COPD patients

Methods: This is a Comparative cross sectional study in which 42 COPD patients with gravitational atelectasis were selected using convenient sampling and divided into two equal groups of21 participants in each group. Group A was provided with [CPT] in supine position while group B was with chest percussion in quarter prone position. Clinical outcome measures like FiO2, SpO2, respiratory rate, heart rate and peak pressure were measured before and after the treatment

Results: The mean age of the patients in group A was 58.71 +/- 956 years whereas in group B was 52.47 +/- 8.81 years. Using the paired t-test it was analyzed that before and after the treatment, there was significant difference in Sp02, respiratory rate, heart rate and peak pressure as the p value was highly significant [p-value=0.000] but no significant difference in FiO2 [p-value=0.08] in both groups. Paired sample t-test was applied for post treatment difference of Fi02, Sp02, RR, HR and peak pressure between group A and group B , showed no significant difference as the p value was not significant

Conclusions: Chest percussion was equally effective in both positions to resolve gravitational atelectasis by clearing the airways and improving oxygenation

Possible toxic effects of benzodiazepines; at therapeutic doses due to drug-drug interactions in hospitalized patients

Benzodiazepines and its derivatives are used widely as anxiolytics, hypnotics, seizure control and as muscle relaxants. The prescriptions of 270 patients were evaluated for moderate to severe drug interactions using drug interaction detection software. Teaching hospital in Gujrat, Pakistan. This study is used to evaluate the possible toxic effects of benzodiazepine related drug-drug interactions in prescriptions of indoor patients. The prescriptions were processed through a software program named, The Medical Letter Adverse Drug Interaction program. The randomly collected patient chart profiles included both male and female patients ranging from age of few months old children to old aged patients. Out of 270 patients medication charts 210 medication charts were having at least one or more drug interactions ranging from moderate to severe. Out of 80 interacting drug combinations found, 15 were benzodiazepine related drug interactions. So, percentage of benzodiazepines related drug interactions was 18.75%.Moreover, the data also showed that the percentage of DDIs increases as the prescription size increases. Our results indicate that hospitalized patients in Pakistan are at risk of ADRs caused by potential DDIs. Moreover, there are chances that the safe therapeutic doses of benzodiazepines may become toxic or ineffective due to drug-drug interactions and poly pharmacy. So, the use of DDIs detection software programs in hospitals and pharmacies should be promoted in order to minimize drugs especially benzodiazepines related injuries and to ensure patient safety

Surgical handover in an era of reduced working hours: an audit of current practice

To examine the current practice of handover and to record trainees' assessment of handover process. An audit study. Department of General Surgery, Scarborough General Hospital, Scarborough, United Kingdom, from January to April 2010. A paper-based questionnaire containing instruments pertaining to handover guidelines was disseminated to trainees on surgical on-call rota at the hospital. Trainees' responses regarding handover process including information transferred, designated location, duration, structure, senior supervision, awareness of guidelines, formal training, and rating of current handover practice were analysed. A total of 42 questionnaires were returned [response rate = 100%]. The trainees included were; registrars 21% [n=9], core surgical trainees 38% [n=16], and foundation trainees 41% [n=17]. Satisfactory compliance [> 80% handover sessions] to RCS guidelines was observed for only five out of nine components. Ninety-five percent of hand over sessions took place at a designated place and two-third lasted less than 20-minutes. Computer generated handover sheet 57% [n=24] was the most commonly practised method of handover. Specialist registrar 69% [n=29] remained the supervising person in majority of handover sessions. None of the respondents received formal teaching or training in handover, whereas only half of them 48% [n=20] were aware of handover guidelines. Twenty-one percent of the trainees expressed dissatisfaction with the current practice of handover. Current practice of surgical handover lacks structure despite a fair degree of compliance to RCS handover guidelines. A computerised-sheet based structured handover process, subjected to regular audit, would ensure patient safety and continuity of care

Factors associated with the spread of tuberculosis infection

Tuberculosis is the cause of morbidity and mortality' all over the world. It is the oldest documented infectious disease and it remains an ,important health problem, in most of the developed and many developing countries. The study was done at Pakistan Institute of Medical Sciences [PIMS], Islamabad, and the previous history of 300 incoming patients was recorded on a prescribed questionnaire, and it was concluded that prevalence of tuberculosis was high in patients belonging to low socio-economic status [71%], in those who live in joint family system [68%] and those who were regular smokers [42%]. Males were more susceptible i.e. 62% than females [38%]

Epidemiological and histopathological studies of goiter

Goiter can occur when the thyroid gland produces either too much thyroid hormone [hyperthyroidism] or not enough [hypothyroidism]. Diseases of thyroid gland can occur at any age and in both genders. Deficiency of iodine in the diet is the most common cause of goiter. The main purpose of this research is to find out the percentage of different goiters, malignancies and their histopathological examination. Data was collected from Pakistan Institute of Medical Sciences, Islamabad, Pakistan. The sample of thyroid tissue was drawn out by using fine needle aspiration. It was found that adenomatous/multinodular goiter [70.69%] is the most common, followed by colloid goiter [24.36], malignancy of thyroid [3.48] and other diseases of thyroid including benign thyroid neoplasm and Hashimoto's thyroiditis [1.47%]. It was found that the most susceptible age for the thyroid problem in this region is between 20 to 40 years. The result also shows that females [81.32%] are highly more susceptible than males [18.68% because of physiological stresses in females such as pregnancy and menses, which may increase the need of iodine

Relationship between lipids and cardiac enzymes following acute myocardial infarction

Acute myocardial infarction is a clinical syndrome that results from an injury to myocardial tissues that is caused by an imbalance between oxygen supply and demand. Hypertension, arteriosclerosis, strenuous exercise, smoking and alcohol consumption etc. are the risk factors causing acute myocardial infarction. The criteria for the diagnosis of acute myocardial infarction include changes serially obtained on electrocardiogram tracing, abnormal levels of lipids and cardiac enzymes. TO access the relationship between lipid and cardiac enzymes analytical study was carried out. About 250 samples were collected and centrifuged to get the serum. Then quantitative determination of Creatine kinase, and lactate dehydrogenase were performed. Enzymatic hydrolysis of triglyceride with subsequeht determination of liberated glycerol and CHOD-PAP [Cholesterol oxidase and peroxidase] method for cholesterol was performed. The results of the study showed that the level of cholesterol, triglyceride and low-density lipoprotein increases as the age increases showing a significant result and a non-significant result was obtained for low-density lipoprotein, as their value fell in normal range. A significant result was obtained for Creatine kinase and Lactate dehydrogenase. The value of Creatine kinase and Lactate dehydrogenase increases as the age increase

Prevalence of anemia and its risk factors in children of age group 5 to years

Anemia is a deficiency of red blood cells, which can be caused either by too rapid loss or too slow production of red blood cells. Maintenance of normal level of hemoglobin, which is > 11 g/dl/is very important in children, because low level of hemoglobin can lead to anemia. Malnourishment in children can be the cause of anemia, but lack of proper caring practice was an important contributing factor, which may be due to social and actual poverty, illiteracy of parents, poor personal hygiene and inefficient use of resources as factors related to cause of anemia. It was found that percentage of anemia in children [5-12 years] is higher in low socio-economic status 72% and in children with poor diet and presence of worms about 75%

Histopathological studies of breast lumps

Breast cancer is the most common cancer in women accounting for 24% of all female cancers that develop in one or both breasts. Breast cancer is either invasive or non-invasive. A woman's risk of developing breast cancer depends on several factors. The incidence of breast cancer increases with age, rising sharply after the age of 40 years. 79.45% patients of the total have breast problem at the ages between 15 to 45 years, which means that the breast problems are most common in younger women. The most common breast disease among women is fibroadenoma. Carcinoma is cancer in women's breasts and the most susceptible age for carcinoma is after 35 years. Fibrocystic diseases and mastitis are also common diseases of younger women. Gynocomatia is a breast problem in male. The chi square test shows that the value X2c is greater than X[2 0.01], which means that the result is highly significant i.e., 89.91> 26.22 and shows that age is associated with the breast diseases and cancer. On the basis of the available data we have concluded that the most susceptible age for breast diseases is from 15 to 35 years. This is due to many changes that occur in women's life during this period, which disturb the normal functions resulting in breast diseases which become cancer