Subclinical rickets

The study on sub clinical rickets is unique in the sense that it has not been preplanned conducted anywhere especially in Pakistan. The objective of present study was to explore the prevalence, gender and geographical distribution of sub clinical rickets and their related factors among school students. Out of total participants, 189[90%] students were finally included in the study from rural, urban and suburban high schools of Hazara Division, KPK. The age of boys and girls students was 11 years to 16 years. Anthropometrics data along with daily intakes of meal and availability of sun shine was noted on record form. Sub clinical cases were diagnosed with abnormal biochemical findings without physical indications of rickets. Sub clinical rickets was found in 51[27%] students, out of which 15[8%] were boys and 36[19%] girls. Geographically, 26 cases of sub clinical rickets were from rural schools, 16 of urban and 09 found in suburban school. All sub clinical cases had serum level of sunshine vitamin D in between >/= 18nmol/l to

Subclinical nutritional rickets among adolescents in kaghan valley

To determine the occurrence of subclinical rickets and its causing factors among adolescent students of schools in Kaghan Valley, Pakistan. Observation cross-sectional study. Department of Biochemistry and Health Sciences, Hazara University, Mansehra, Ayub Medical College and Teaching Hospital, Abbottabad, from March to April 2012. Sixty seven students [34 boys and 33 girls] age between 11 - 16 years included in the study from different schools of Kaghan Valley, Pakistan. Characteristic, serum biochemical and nutritional status were measured for all the participants. On the basis of biochemical finding the boys and girls students were divided in to two groups, normal subjects and subclinical rickets [absent symptoms with altered biochemistry]. Twenty six participants, 19 [73%] girls and 07 [27%] boys had biochemical abnormality but no clinical signs and symptoms of rickets. Low vitamin D and high alkaline phosphatase level were observed in 26 [100%], 21 [81%], low calcium in 17 [65%] and low phosphorus 7 [27%] subjects with subclinical rickets. None had high parathormone level above normal range. Nutritional intake of calcium, phosphorus and vitamin D was found less than the recommended daily intake in all the participants. Subclinical rickets is common problem among adolescent students especially in girls which is due to low nutritional intakes and avoidance of sunshine due to environmental and traditional impacts

Comparison of role stressors, job satisfaction and turnover intensions of dentists working in public and private sectors

The main purpose of present study was to determine the difference in level of role stressors [Role Conflict and Role Overload] and their effect on Turnover Intention or Job Satisfaction of dentists. The study also explored the impact of role stressors with reference to demographic factors of age, sex and experience level. The current research was consisting of two parts, a pilot study and then main study. In pilot study a sample of 50 respondents were taken to pre-test and establish instruments' psychometric properties in local socio-cultural context. Main study was carried out on 100 faculty dentists' working in public/private teaching institutes. Dentists with minimum of one year job experience were selected by using Convenience Sampling technique. This was analytical, cross sectional and correlation study. A specially designed questionnaire used in present study was based on General Health Questionnaire [GHQ], Role Stressors Inventory, Turnover Intentions and Job Satisfaction instruments. Multiple regression analysis was computed to examine the relationship between role stressors and outcomes. T-test and ANOVA analyses were used to examine the difference on the basis of gender and experience level respectively. In the present study 40% of the sample ware males and 60% females. Females were more stressed than male dentists. More workload and conflict was found among dentists working in public/government dental teaching institutes as compared to private dental teaching institutes but on the other hand turnover intentions were more in dentists who were working in private dental teaching institutes. The knowledge of how to manage stress at work may be beneficial to better manage job related attitudes and behaviors. Health sector reforms should emphasize management of the stressors by means of better organizational and job design

Aetiology and types of neonatal seizures presenting at ayub teaching hospital Abbottabad

Neonatal seizures [NS] affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5[th] day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12[th] December 2006 to 25[th] September 2007 on eonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. Tonic clonic seizure was the commonest type [28%] followed by multi-focal clonic, and focal tonic seizures [25% each]. Birth asphyxia was found to be the main aetiology [46%].Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures.

Prevalence of obesity in school children of Hazara division

Limited data is available in Pakistan regarding prevalence of obesity in school going children. The objective of this study was to find out obesity prevalence in school going children in Hazara division. It was descriptive study. Data of 3200 students was collected over six month period, from Hazara Division. Four schools were selected in each district two for boys and two for females. District Kohistan was excluded from study as female education is not permitted beyond primary education. Children 5-14 year age group were included in the study. Initial 20 students of each class were selected for study. Anthropometric data [weight, height] for each student was collected and entered on Performa structured for this purpose. BMI was calculated and values were compared with standard BMI charts of National Health Centre for health statistics. Prevalence of obesity was 4.78%. Out of 3,200 children enrolled 153 [4.78%] were obese. Male to female ratio was 1:1.2. The prevalence of obesity was high in private school students than government schools [66.66% and 33%]. The prevalence was high in both sexes in 12-14 years and 6-7 years age groups [49% and 20.26%]. Prevalence of obesity in present study is similar to the results from developing countries in the region but prevalence is lower than developed countries. Problem of obesity also exists in developing countries and there is need to create awareness about obesity and related complications

Hypoxic ischemic encephalopathy in neonates

Birth anoxia remains an important cause of mortality and morbidity in neonates. Hypoxia/ischemia can lead to permanent brain damage and also affects other tissues of the body. It results from lack of oxygen before, during or after birth. The study was designed to assess the risk factors of birth asphyxia, common presentations and association of Apgar score with grades of hypoxic-ischemic encephalopathy. The study is descriptive, prospective and carried out in the Paediatric Department of Ayub Teaching Hospital, Abbottabad from September 2007 till September 2008. A total number of 181 neonates [144 males and 37 females] who showed the neurological signs of hypoxic-ischemic encephalopathy were included in the study. Maternal history was taken, Apgar scoring was done and neurological grading was done for the assessment of brain damage. Out of 181 neonates 77.9% were full term, 8.8% were premature, 5.2% were having intra uterine growth retardation and 6.1% were post mature. 38.7% were diagnosed as having grade-3, 38.7% as grade-2 and 22.6% as grade-1 encephalopathy. Mortality due to hypoxic ischemic encephalopathy in our unit was 16%. 52.5% of the mothers were primigravida, 50% of the multigravid mothers had history of perinatal deaths, and 6.1% had ante-natal examination. Antenatal factors like lack of antenatal examinations, toxaemia of pregnancy and prolonged labour were major contributors to the mortality of neonates. Primigravid mothers, maternal anaemia, lack of antenatal examination, toxaemia of pregnancy and prolonged labour were the major contributors to the hypoxic ischemic encephalopathy. Early recognition of the risk factors and public health awareness needs to be addressed. Improvements in maternal health and regular antenatal checkups should be emphasised

Frequency and clinical presentation of UTI among children of Hazara division, Pakistan

Urinary tract infection is common in children and result in permanent renal damage and end stage renal failure in significant number of patients. It is imperative to diagnose urinary tract infection early and to treat adequately. We carried out this study to look into frequency and clinical profile of UTI in children admitted in our unit. Three hundred and seventy five patients with UTI, diagnosed by urine culture with age from 0-15 years admitted in pediatric unit during 2003-2006 were included in study. Urine sample for culture was collected by midstream clean catch, urine collecting bag and Suprapubic methods depending upon the age of patient. A proforma was used to record clinical presentation and laboratory findings of these patients. Frequency of Urinary tract infections among children examined by urine culture was 375 out of 1000 [37.5%] out of which 36 [9.6%] were male and 339 [90.4%] were females. Almost half of them 48.5% were less than 3 years old. About 60% of patients belong to Kohistan and Batagram districts and failure to thrive was common presenting feature [56.6%] in patients of these two districts. Fever was common clinical presentation 91% followed by Dysuria [65%] and failure to thrive [40%]. Frequency and clinical profile of urinary tract infection in children in Hazara Division is not significantly different from that of developing and developed countries

Clinical outcome in measles patients hospitalized with complications

Measles is a highly communicable viral illness and is common cause of childhood mortality and morbidity. Keeping in view the high prevalence of measles in the developing world, we carried out this study to look into the complicated measles cases and clinical outcome in patients admitted in children ward of Ayub Teaching Hospital. Detailed history and physical examination of all the hospitalized patients with complication of measles were recorded in a proforma. Immunization and nutritional status of each admitted patient was assessed and the clinical outcome of measles was compared with demographic profile. One hundred thirty six hospitalized patients with complications of measles were studied. There was 60.3% male and 57.3% of patients were vaccinated against measles. Malnourished patients were 71.35% and had longer hospital stay [>5 days]. Pneumonia [39.7%] and diarrhoea [38.2%] were the commonest complications. Seven children died and encephalitis [57.1%] was the commonest cause of death. The most common complications of measles are pneumonia and diarrhoea with dehydration requiring admission. Malnutrition results in more complications and longer hospital stay. Mortality is significantly associated with encephalitis

Frequency of dyslipidaemia in type 2 diabetes mellitus in patients of Hazara division

Diabetes mellitus increases the risk of atherosclerotic vascular disease because of associated dyslipidaemia. Many studies advocate aggressive management of lipid disorders in Type 2 Diabetes to decrease these complications. This study was carried out to know the frequency of dyslipidaemia in our patients and also to determine that whether patients with good glycaemic control [HbA1c /= 8%] emphasizing the importance of good glycaemic control. However none of our patients had a low HDL-Cholesterol as found in some other studies. Hypertriglyceridaemia along with impaired LDL-Cholesterol is present in majority of our patients. Good glycaemic control does affect the lipid profile in Type 2 Diabetes mellitus. However to provide the benefits of lipid lowering therapy to our patients, as confirmed in many studies, we need more awareness and placebo controlled double blind studies

Mushroom poisoning in children: clinical presentation and outcome

A variable clinical picture characterizes mushroom poisoning. The Amatoxin, the main toxic component of these fungi, are responsible for gastrointestinal symptoms as well as hepatic and renal failure. As acute gastroenteritis is extremely common in our set up, so every patient presenting with these symptoms is treated as gastroenteritis of viral aetiology. The authors present the clinical picture of the phalloid syndrome, its treatment and immediate outcome. All children age less than 16 years admitted in Saidu Hospital Swat from January to December 2006 with mushroom poisoning were included in the study. Patients with doubtful history or with associated illness were not included. The diagnosis was based on the clinical picture of the patient, history and the laboratory data. In addition to maintenance of fluid and electrolyte balance and treating sepsis, oral Silymarin and intravenous penicillin was started. Liver function tests, renal functions tests, serum electrolytes and coagulation profile was done in all the patients. The severity of poisoning was graded according to hepatic transaminase elevations and prolongation of prothrombin time. Of the 18 patients, fifteen were above five years of age. Female were twice in number. Fifteen patients developed hepatic failure and three patients developed renal failure. Thirteen patients expired. To start timely management, Mushroom poisoning should be considered in the differential diagnosis in patients presenting with food poisoning particularly coming in groups. Delay in diagnosis is associated with high mortality

Status epilepticus: aetiology and outcome in children

Convulsing Status Epilepticus [CSE] is a common paediatric emergency especially under 24 months age group. Present study was done to know causes of Status Epilepticus [SE] and outcome during admission and at the time of discharge. A descriptive study in children 2 months to 15 years of age, admitted in Department of Paediatrics, Ayub Medical College, Abbottabad with first status epilepticus, was done to evaluate aetiology, complications and immediate outcome after relevant history, examination, laboratory tests. All information was recorded on Performa designed especially for this purpose. Study was conducted over 2 year period from November 2005 to November 2007. Total number of children admitted with SE was 125. Majority of SE episodes were related to acute febrile illnesses. Acute viral encephalitis was the common cause of SE especially in children younger than 24 months followed by febrile convulsions. Fifteen [12%] patients expired while neurological complications secondary to brain injury developed in 10[8%] cases. Mean seizure duration was 4.92 +/- 9.18 hours in children with normal outcome, 5.93 +/- 5.76 hours in children who died, and 12.85 +/- 12.91 hours in children with abnormal neurological outcome at discharge [p > 0.05]. Correlation between age and duration of seizure was not significant [p > 0.05]. SE is a common paediatric emergency associated with high mortality and morbidity. In young children SE is commonly associated with acute viral encephalitis. Antiviral treatment should be started earlier in this group of young children after history, examination, laboratory tests along with appropriate management of SE

Estimation of foetal weight in third trimester using thigh measurements

Estimation of foetal weight is essential in daily obstetric practice particularly close to term. It guides clinicians to finalize important obstetrical decisions. Low birth weight and excessive foetal weight at delivery both are associated with an increased risk of neonatal complications during labour and the puerperium. The objectives of this cross sectional study were to estimate the foetal weight using only two thigh parameters and its comparison with birth weight. This study was conducted in Radiology Department PNS Shifa during 1st June, 2007 to 30 Nov, 2007. All pregnant females coming to Radiology Department for Ultrasound examinations in 3rd trimester were the Subjects of study. All infants were delivered with in 48 hour of ultrasound examination. 100 patients were included in this study. Thigh measurements were made by conventional two dimensional ultrasonography. The Isobe formula was compared with already established Aoki's formula and actual birth weight using paired sample t-test. Isobe's formula showed a significant correlation with the actual birth weight. In 90% of cases estimated foetal weight was within 10% of the actual birth weight The Isobe's formula was found to be convenient among all the established formulas for estimated foetal body weight. Measurement of head circumference was not necessary near term

Successful treatment of proximal white subungual onychomycosis with oral terbinafine therapy

Proximal white subungual onychomycosis [PWSO] is a rare form of onychomycosis of both fingernails and toenails. It occurs when the fungus invades the stratum corneum of the proximal nailfold followed by infection of the deeper parts of the nail plate. The surface of the overlying nail is usually normal. A case of PWSO is described with complete cure by the use of oral terbinafine 250 mg/day for 3 months continuously

Fixed drug eruption and intradermal provocation tests

To determine the role of Intradermal Provocation [IDP] tests in Fixed Drug Eruption [FDE]. Study Design: Quasi-experimental study. Place and Duration of Study: Dermatology Unit, Shaikh Zayed Hospital, Lahore, from August 2004 to July 2006. Methodology: The tests were performed in 96 patients in two stages. At stage I, suspected drugs were given intradermally. Changes at injection site in FDE lesions or any systemic effects were observed. In patients showing no response to IDP, Oral Provocation [OP] was performed [stage II] and its effects in FDE lesions or any systemic effect were observed. The positive response of FDE lesions after IDP and OP were compared with local changes at injection site. Control intradermal tests were repeated in normal persons with drugs and in FDE patients with distilled water on normal skin. At stage I, 46 positive cases had local signs of erythematous indurated nodule with or without hemorrhagic centre, urticarial weal with hemorrhagic centre and erythematous indurated nodule with central vesicle. At stage II, 41 patients had similar local signs. The changes at injection site to those of FDE lesions were compared. Z-test for proportions showed no significant difference between groups [p-value > 0.05]. Control tests were negative. The drug producing erythematous indurated nodule with or without hemorrhagic centre, vesicle or urticarial weal with hemorrhagic centre at injection site was the most likely drug causing fixed eruption

Prevalence of Hepatitis B surface antigen carrier state in patients with Lichen planus-Report of 200 cases from Lahore, Pakistan

To determine the prevalence of hepatitis B surface antigen carrier state in patients with lichen planus. A quasi experimental cross sectional study was done at Department of Dermatology, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan, from April 2003 to March 2005. Two hundred clinically diagnosed cases of LP and equal number of patients with other dermatoses not reportedly associated with hepatitis B virus [HBV] infection [control group] were collected from Skin Out Patient Department. They were screened for hepatitis B surface antigen [HBsAg] by Enzyme Linked Immunosorbent Assay [ELISA]. Statistical analysis was done by using SPSS package version 11. Out of 200 patients of each group, three patients with LP and seven patients from control group were positive for HBsAg. The test of significance for proportions revealed that there was no significant difference [p > 0.1] between two groups. No association between HBsAg carrier state and LP was found in our study

Efficacy and safety of quasi-continuous, frequency-doubled Nd:YAG [532nm] laser therapy of port-wine stains

The quasi-continuous, frequency-doubled neodymium yttrium aluminum garnet [Nd:YAG] 532nm laser has been used for the first time in the treatment of port-wine stain [PWS]. To determine the efficacy and side effects of quasi-continuous Nd: YAG 532nm laser in the treatment of PWS. Twenty patients were enrolled in the study. The site and colour of PWS were recorded and assessed subjectively and by photography both before and after treatment. The patients had test areas treated and followed up after four weeks. Maximally eight treatments were given on any one site or until >75%improvement occurred. Final evaluation was done one month after the last treatment session on a four-point scale. Twenty patients were treated, age range 15-35 years wit 14 females. All the patients had PWS in the head and neck region and achieved >25%improvement.Patients underwent a mean of 7.55 treatment sessions. Overall, fifteen [75%] showed 75-100%improvement. The side effects seen in the study were hyperpigmentation in 65%cases, textural changes in six [30%] and eczematization after laser therapy in four [20%] of patients. Other complications included intraoperative hemorrhage and pyogenic granuloma-like lesions that occurred in two cases [10%] each. We have shown that frequency doubled Nd: YAG 532nm is effective and safe in the treatment of PWS

Topical calcipotriol versus oral psoralen-UVA [PUVA] and topical calcipotriol in thetreatment of vitiligo in type IV skin

The treatment of vitiligo is a challenging task. Several therapeutic modalities have been tried till date. Topical calcipotriol alone and in conjunction with PUVA have shown good results in various international studies in the treatment of type I and II vitiliginous skin. Our aim was to evaluate and compare the efficacy of topical calcipotriol alone and in combination with PUVA in the treatment of vitiligo in type IV skin. Sixty patients of vitiligo [26 males and 34 females], aged 12-60 years and involving < 30% of the body surface area were enrolled and randomly divided into two equal groups. Group I patients were treated with twice daily application of topical calcipotriol for six months. In group II patients, in addition to topical calcipotriol, photochemotherapy [PUVA] was advised thrice a week for the same duration. Response was graded according to the degree of repigmentation. In group I, only one sixth [16.7%] of the cases responded and all of them had less than 50% repigmentation whereas in group II, all the patients responded. Seventy percent of the cases in this group showed excellent response [> 75% of repigmentation]. We conclude that topical calcipotriol alone has no role in the treatment of vitiligo in type IV skin but when combined with PUVA leads to an excellent response in greater than two third of the patients

aetiological study of moderate to severe hirsutism

Hirsutism is a common disorder of females. Most cases are idiopathic, however some studies claim polycystic ovarian syndrome to be the commonest cause. The objective of the present study was to evaluate the etiology of moderate to severe hirsutism and to devise a rational diagnostic approach in these patients depending upon age, severity of the problem and other clinical findings. Seventy four consecutive patients with moderate to severe hirsutism [i.e. Ferriman and Gallwey score of 7 and above] were enrolled and recorded on a standard Proforma. All patients were assessed clinically with particular emphasis on signs and symptoms of virilisation. Hormonal investigation as well as abdominal and pelvic ultrasonography for adrenals and ovaries was done in all patients. Of the 74 patients 35 [47.3%] were labeled as idiopathic hirsutism, while 33 [44.6%] were diagnosed as polycystic ovary syndrome. Other causes identified were hypothyroidism [4%], Cushing"s syndrome [2.7%] and congenital adrenal hyperplasia [1.3%]. Majority of patients belonged to the age group 21-25 years. The commonest cause of hirsutism in our study was idiopathic [47.3%]. This was followed by PCOS which accounted for 44.6% of patients