Vaccine usage and wastage in a designated Yellow Fever Vaccination Centre in North India

Purpose@#Yellow fever is a viral hemorrhagic fever transmitted through the bite of mosquitoes. World Health Organization guidelines advocate a single dose of vaccine for life-long protective immunity against yellow fever. Yellow fever vaccine is included in routine childhood immunization schedules in countries at medium or high risk of yellow fever. For some travelers, visiting endemic countries, yellow fever vaccination is recommended to protect the travelers. We calculated the yellow fever vaccine wastage rate at a designated center in North India. @*Materials and Methods@#This is a record-based study. The data for the study was obtained from the immunization center of Government Medical College, Srinagar, Jammu and Kashmir. The particulars for every vaccine recipient were present in the register. The vaccine wastage rate was calculated. The analysis was done in IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) and results were presented as numbers and frequencies. @*Results@#A total of 136 doses were issued out of which 111 doses were administered from November 2017 till October 2020. The maximum number of travelers was young adults (26.1%). In 83.7% of cases, the area of the visit was Africa. The vaccine wastage rate was 18.4%. @*Conclusion@#The vaccine wastage rate was not very high and was within that recommended for vaccines in routine immunization.

clinicoetiological study of Stevens-Johnson syndrome and toxic epidermal necrolysis

To present the pattern of morbidity associated complications, and causative factors in individual cases of Stevens-Johnson syndrome [SJS]/toxic epidermal necrolysis [TEN]. Patients and methods This case series descriptive study, using a convenience sampling technique, was carried out in the In-patients department of Dermatology Unit I, Mayo Hospital, King Edward Medical University, Lahore from January 2007 to September 2008. Thirty clinically diagnosed patients, suffering from SJS/TEN, fulfilling the inclusion criteria were included in the study. Patients' demographic data, symptoms, signs and any relevant investigations were recorded and scored. Using an appropriately designed pro forma, symptoms/ and signs were categorized into thirteen variables. The severity of each variable was scored froml-3 [total score range 13 to 39]. An association of these variables with patient outcome, in terms of either discharge from hospital or death, was calculated. Pain and gastrointestinal involvement were seen in all 30 [100%] patients. Mortality was found to be 13.3% and was significantly associated with infection, total morbidity score, area of epidermal involvement and respiratory system involvement. Similarly development of wound infection, area of epidermal involvement, fever and total score significantly affected the duration of hospital stay. While the causative drug/s remained unknown in 26.7% cases the most common identifiable drug was trimethoprim-sulphamethoxazole, causing disease in 13.3%. Conclusions Mortality in cases of SJS/TEN showed significant association with wound infection, area of skin involvement, total morbidity score and respiratory system involvement

Common trend of antibiotics usage in a tertiary care hospital of Peshawar, Pakistan

Antibiotics are used to eradicate the pre- and postoperative infections in surgical procedures and in all others medical cases. However, inappropriate and indiscriminate use of antimicrobial agents can potentially have a number of problems. The emergence of antimicrobial resistant bacteria, an increased number of patients experiencing adverse drug events, and increased drug-related cost have been documented. The objective of the study was to determine the trend of use of antibiotics and hospitalisation of patients in various units of a tertiary care hospital, to investigate practice variation of antimicrobial agents within the hospital, and to identify and document any opportunity for its improvement. A questionnaire containing relevant information about the study was prepared. Patients' age, sex, diagnosis, duration of hospital stay and type of antibiotic used were recorded and analysed, with particular reference to antibiotic group and disease pattern, in 3 different treatment areas of Hayatabad Medical Complex [HMC], Peshawar, Pakistan, from July 2006 to June 2007. During the period under report, a total of 519 patients were studied for their disease and the type of antibiotics used. The leading type of antibiotics reported were 3rd generation antibiotic used on 147 [28.33%] patients in the 3 units collectively, 1[st] generation 127 [24.47%], and penicillin 99 [19.08%], while macrolides were the least used. The available resources are needed to be effectively utilised, to minimise the hospital stay due to rational use of antibiotics, and to minimise burden of antibiotics on poor patients

Dental fluorosis - an orthodontic adhesive challenge

The purpose of this study, carried out in early 2010, was threefold: Firstly, to assess the frequency of mild to severe type of dental fluorosis in the school children of district Jhang, [Punjab], both males and females with an age range of 6-14 years. The ratio between girls [420] and boys [278] was 1.51:1. Out of a total sample size of 698, 76 girls and 90 boys suffered from dental fluorosis with a total frequency of 23.78%. Secondly, to give a wake up call to those who are responsible for the prevention of this menace from that specific segment of poor and neglected society. Lastly, to get an effective bonding clue for this pretty good quantum of patients who pose a great challenge in orthodontics, in terms of poor sheer bond strength of adhesives due to repeated bond failures while using "standard etching protocol", resulting in a poor treatment outcome. Current orthodontic literature hints that among the various orthodontic adhesive materials, self etching primer has so far played a promising role in these cases, as is evident from various studies

Study of lipoprotein patterns as an atherogenic factor in T2DM patients and their FDRS

The present study was carried out to determine the lipoprotein patterns as an atherogenic factor in T2DM [Type 2 Diabetes Mellitus] patients and their FDRS [First Degree Relatives]. In various previous studies it has been reported that hyperinsulinemia and hyperlipidemia frequently coexist in T2DM patients which indicate that the diabetic state it self is associated with atherogenic lipid disorders. The present study included 26 Type 2DM [T2DM] patients and 21 apparently healthy First Degree Relative [FDRs] of T2DM patients. Twenty three age matched control not related to diabetics were also included in the study. The BMI in male patients and FDRs were significantly higher as compared to controls but no significant difference was seen among the BMI of female FDRs. Fasting plasma glucose [FPG] levels of T2DM patients were significantly higher but no significant difference was observed among the FDRs and controls. FPG did not show any significant correlation with the BMI in diabetic patients, FDRs and controls. The lipid profile of patients showed no significant difference, except the mean LDL-Chol of female patients was significantly higher as compared to female controls. HDL-Chol of males FDRs was significantly lower as compared to male controls. LDL-Chol of female FDRs was significantly lower than the female controls. No significant difference was observed in the total cholesterol and the triglycerides level of the patients of T2DM and FDRs but those cases in which pre-beta band appear upon lipoprotein electrophoresis had significantly higher triglyceride levels as compared to those patients in which pre-beta band did not appear. Lipoproteins of the T2DM patients and FDRs group were found to be highly disturbed as compared to the control group and they show a trend of developing atherogenic states in future

Antioxidant status in coronary heart disease [CHD] patients with type 2 diabetes mellitus

The present study was carried out to see the levels of vitamin C, vitamin E and total antioxidant [AO] in Coronary Heart Disease [CHD] patients with and without Type-2 Diabetes Mellitus [T2DM]. In various previous studies it has been reported that, diabetes, hypertension and smoking are risk factors for CHD and all risk factors were common in these patients. Serum was tested from 80 CHD patients and 21 healthy controls, matched for age, height, and weight. No significant difference was seen between the age, height and weight of the subjects and controls. CHD patients were mostly male, smokers, over 40 year of age and belonging upper class families. The mean plasma glucose was significantly higher [p<0.05] in CHD patients having T2DM as compare to CHD patient with out T2DM. Risk factors for CHD, like diabetes, hypertension and smoking were common in these patients. No significant difference was seen in vitamin C level of patients of CHD. Vitamin E level was significantly [p < 0.05] low among the CHD patients as compared to controls and a significant [p < 0.05] decrease in mean vitamin E level was observed among smoker CHD patients as compared to non-smoker CHD patients. But no significant difference in vitamin C and vitamin E levels of CHD patients with diabetes and hypertension were observed when compared with CHD patients having no such complaints. The CHD patients' total antioxidant level was significantly [p < 0.05] decreased as compared to controls. The total AO [Vit. C and E] were not significantly higher in CHD patients with hypertension and diabetes as compared to those patients of CHD having no hypertension and diabetes

Optic neuritis: a three years retrospective study

The aim of our study was to review our clinical experience with optic neuritis. A retrospective review of the medical records of patients admitted for optic neuritis from January 2000 through December 2002, in Ophthalmology Department of Lady Reading Hospital, Peshawar was undertaken. Out of 28 cases of optic neuritis, 10 [35.7%] were male whereas 18 [64.3%] were female. The mean age was 31.25 years. Eight [28.6%] cases had bilateral and 20 [71.4%] cases had unilateral optic neuritis. Nine [25%] eyes had retrobulbar neuritis, 24 [66.66%] eyes had papillitis and three [8.33%] eyes had neuroretinitis. Visual acuity [VA] at presentation was between no perception of light-hand movement in 11 [30.55%] eyes, counting finger-6/60 in 18 [50%] eyes, 6/36-6/18 in five [13.88%] eyes and between 6/12-6/6 in two [5.55%] eyes. Patients had mean follow-up of 39.67 days. Final unaided VA of eyes with optic neuritis was between no perception of light-hand movement in 5 [13.88%] eyes, counting finger-6/60 in 9 [25%] eyes, 6/36-6/18 in 4 [11.11%] eyes and between 6/12-6/6 in 18 [50%] eyes. Two [5.55%] cases had recurrence of optic neuritis during study period. Young females are more affected then males. Majority cases were unilateral. Presentation is slightly late with marked impairment of vision. Papillitis is common clinical type of presentation. Fifty percent of patients regain good vision [6/6 6/12]

Ocular emergencies

To describe clinical data about ocular emergencies [OE] and their management. Design: Descriptive study. Place and Duration of Study: This study was conducted from 1st January, 2000 to 31st December, 2002 at the Department of Ophthalmology, Khyber institute of Ophthalmic Medical Sciences, Lady Reading Hospital, Peshawar. Material and A comprehensive analysis of the computer record available for admitted ocular emergencies was undertaken in terms of gender, age, etiology, procedure performed and hospital stay. Ocular emergencies [1961] were 18.49% of total admissions. Male to female ratio was 2:1. Non-traumatic ocular emergencies were 1058 [53.95%] with male to female ratio of 1.47:1. In the non-traumatic ocular emergencies, majority [67.2%] were 40 years or above. Traumatic ocular emergencies were 925 [47.16%] with male to female ratio of 2.77:1. Majority [83.78%] of traumatic ocular emergencies were below 40 years and 562 [60.75%] below 20 years of age. Only 150 [16.21%] cases were 40 years and above. Corneal ulcers [44.51%] and glaucoma [24.38%] were the most common non-traumatic ocular emergencies, whereas, open globe injuries [73.4%] were leading the traumatic ocular emergencies. Total surgical procedures performed were 1382 [13.7% of total major ophthalmic surgery]. Average stay in hospital was 5.5 days. Ocular emergencies predominantly affected the males in this series. Trauma related OE are almost as common as non-traumatic. Majority of OE need surgical intervention and the average hospital stay is longer than routine admissions

Hepatitis C seropositivity among chronic liver disease patients in Hazara, Pakistan

Hepatitis C is rapidly emerging as a major health problem in developing countries including Pakistan. The present study was conducted to document the frequency of Hepatitis C seropositive individuals reporting for hepatitis testing at a referral laboratory. Serum samples were collected from 614 people [436 males and 178 females] referred for chronic liver disease from all parts of Hazara division during the period July 2000 to July 2002. Hepatitis tests were performed by DOT immuno-chromatographic method for anti HCV antibodies. A total of 251 [40.8%] sera tested positive for anti HCV antibodies, including 184 males [73.3%] and 67 females [26.7%]. Of 436 males, 184 [42.2%] tested positive, while among females, 67/178 [37.6%] tested positive; this difference is not statistically significant. However the male/female ratio referred for testing was 2.4:1. There is a high frequency of HCV seropositive individuals of both sexes among patients referred for chronic liver disease. The frequencies obtained for Hazara division compare well with figures from other parts of Pakistan as well as developing countries. The male/female ratio could simply be a reflection of more males coming for treatment and testing in our setting

Hepatitis B seropositivity among chronic liver disease patients in Hazara division Pakistan

Hepatitis B virus infection is one of the major health problems in the developing countries including Pakistan. The present study was conducted to document the frequency of Hepatitis B seropositivity in patients with chronic liver disease in the Hazara Division. Serum samples were collected form 893 patients suffering from chronic liver disease [CLD] from all parts of the Hazara Division during period July 2000 to July 2002. Hepatitis HBsAg was detected by the immunochromatographic method. A total of 271 [30.35%] tested positive for HBsAg including 199 males [73.43%] and 72 females [26.56%]. There is a high frequency of HBV seropositive individuals of both sexes among patients referred for chronic liver disease. These frequencies obtained for Hazara Division compare well with figures from other parts of Pakistan as well as developing countries

Hyphaema due to blunt trauma

To study the causes, clinical presentation, complications and visual outcome of hyphaema following closed globe injury. Design: Prospective study. Place and Duration of Study: The study was conducted at the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, Pakistan, from May, 1996 to June 1997. Patients and All cases of hyphaema, due to closed globe injury, were included and history of patients was recorded on a comprehensive proforma designed for this purpose. All cases were admitted for at least 5 days. Ocular examination included checking visual acuity [VA], intraocular pressure [IOP], slit lamp and fundus examination. Patients were treated accordingly and followed up for 90 days. Thirty-six eyes of 36 patients with hyphaema were included in our study. Out of this, 88.89% were males and 11.11% females while 86% were 20 years of age or below. Almost 91.66% presented with primary hyphaema, 44.44% received trauma with stone and 27.77% with tennis ball while playing cricket. Trauma during playing was noted in 66.66% of cases. Almost 62% of cases were having visual acuity in the range of CF to perception of light with good projection. IOP was raised initially in 41.66% cases. Only 33.33% needed surgical intervention. Secondary glaucoma was present in 13.88% and 5.55% had corneal blood staining. Majority of patients [75%] improved to VA range of 6/6 to 6/12 and 19% patients in our study ended up with legal blindness in the affected eyes. Traumatic hyphaema is more frequently found among children and young male. Angle recession, traumatic cataract and maculopathy were common co-morbidities. Secondary glaucoma and corneal staining were the main complications. Nearly 1/5th of patients ended up with legal blindness in the affected eyes

Management of childhood squint

To evaluate the outcome of various modalities of treatment of childhood squint.The study was conducted from November 1994 to August, 1996 at the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar. A st and ard proforma was designed. After complete history and ocular examination; glasses, occlusion and surgery was advised accordingly. These children were re-examined after one month for glasses and on weekly, monthly and three monthly intervals after surgery. Out of these 50 patients 54% were males and 46% were females with the age range of 6 months and 16 years. The majority needed glasses, followed by surgery and occlusion. Improvement in visual acuity and fusion was observed and acceptable visual alignment was seen in most of the patients. A good number of patients can be managed with the use of proper glasses alone and improvement in visual acuity and binocular single vision [BSV] can be achieved with early recognition of the disease and timely intervention