Severe Bladder Outlet Obstruction in a 7-Week-Old Infant Presenting with Features of Prune Belly Syndrome: A Case Report

Prune Belly syndrome is characterized by urinary tract anomalies, deficient abdominal muscle and bilateral cryptorchidism. It has an incidence of about 1 in 50,000 live births with male preponderance in 95%. This is a 7 weeks old male infant that was referred from a peripheral health care centre for a micturating cystourethrography on account of difficulty in micturition, distended abdomen and restlessness since birth. The patient had an abdominal ultrasonography that showed bilateral severe hydronephrosis, megaureters and thick-walled urinary bladder. A micturating cystourethrogram showed pine shaped urinary bladder with bilateral vesicoureteric reflux more marked on the right. Plain abdominal radiograph showed markedly distended abdomen and gas distended bowel loops with thinning of anterior abdominal wall muscles. The referring physician was advised to make a prompt referral of this case to a higher centre for better management. We report the radiologic findings of this case presenting with features of Prune Belly syndrome.

Delays in accessing antenatal care services in a developing nation tertiary health center

Background: Delay in seeking medical care is common and constitutes a major unresolved public health problem. It could contribute immensely to maternal mortality, especially in developing countries, where access and availability of functional health­care facility have remained a challenge. Objective: This study aimed at identifying the forms of delays encountered by pregnant women seeking antenatal care (ANC) services and also factors responsible for such delays. Materials and Methods: This was a cross­sectional study among women attending antenatal care clinic of our hospital. Data were obtained through an interviewer­administered questionnaire and were analyzed by the Statistical Package for the Social Sciences version 17. Results: The mean age of the respondents was 28.6 (standard deviation [SD] ± 5.44) years. About a third (31.5%) experienced Type II delays due to inaccessibility to the mode of transportation and traffic deadlock; while majority (77.1%) experienced intrahospital delays due to delay in retrieving cases notes, seeing an obstetrician, inadequate health personnel, and consulting rooms. The average waiting time was 3.1 ± 0.91 SD hours (188 min). The waiting time was not statistically associated with time of arrival to the clinic. Conclusion: Most women experience intrahospital delays while seeking ANC. Intervention by policymakers and adequate staffing coupled with provision of necessary health­care amenities will go a long way in reducing patients waiting time

Frequency of GERD in COPD patients

Objectives: To determine the frequency of GERD in COPD patients. Study Design: Cross-sectional study. Place and duration of study: Department of Pulmonology, DHQ Hospital, Faisalabad from 1/03/2014 to 31/08/2015

Methodology: 95 patients of COPD [All patients with established diagnosis of COPD according to operational definition, Age > 40 years, Either Gender, FEV1/FVC <0.7 with >20 pack-year history of smoking]

Results: In our study, out of 95 cases of COPD, 38.95% [n=37] were between 40-60 years of age, while 61.05% [n=58] had >60 years of age, common age was 58.37+8.36 years, 90.5% [n=86] were male and 9.5% [n=9] were females. Frequency of GERD in COPD patients was recorded in 43.16 % [n=41]

Conclusion: it was concluded that the frequency of GERD is high among patients with COPD. So, it is recommended that every patient who present with COPD, should be sort out for GERD. However, it is also required that every setup should have their surveillance in order to know the frequency of the problem

Bed side diagnosis of pleural fluid using reagent strips

Introduction: on average, the total volume of pleural fluid in a 70-kg non-smoking human is 18mL

Objectives: to determine the frequency of correctly diagnosed type of pleural effusion by reagent strips in comparison to Light's criteria

Study Design: cross sectional Analytical study

Setting: Department of Pulmonolgy DHQ Hospital Faisalabad

Duration of Study: study was carried out over a period of six months from 01-06-2015 to 31-11-2015

Materials and Methods: total one hundred patients with pleural effusion were included in this study. The pleural fluid was tested by use of a reagent strip. Different cut off values for reagent strip were:[specific gravity; dark green 1.005, light green 1.015, brown 1.02, orange 1.03] and [protein; 1+ 30, 2+ 100, 3+ 500 mg/dl]. The type of pleural effusion [exudative or transdative] obtained from reagent strips as per according to operational definition were compared with results according to Light's criteria which was taken as Gold Standard

Results: regarding age distribution, majority of the patients i.e. 38 [38.0%] were between 40-59 years of age while minimum 9 [9.0%] were < 20 years. Mean age of the patients was observed 41.3+/-6.9. Distribution of cases by gender shows 63 [63.0%] patients were male while remaining 37 [37.0%] were females. Out of 100 patients, 84 [84.0%] were correctly diagnosed type on reagent strips

Conclusion: pleural effusion is a commonly encountered problem in medical practice in our country. The initial step in evaluating case of pleural effusion is to establish the type of pleural effusion