Preoperative two dimensional echocardiography in patients with lower limb fractures; its relationship with time of surgery, postoperative ambulation and hospital stay

Objective: To determine the effect of two dimensional echocardiography on time of surgery, post-operative ambulation and hospital stay among patients with lower limb fractures. Study Design: Descriptive cross sectional study. Place and Duration of Study: Combined Military Hospital Rawalpindi, from Sep 2015 to Dec 2015

Patients and Methods: A total of 123 patients were included in study based on non-probability convenient sampling who presented with lower limb fractures. The patients were divided into two groups, group A included those who underwent only electrocardiogram [ECG] for assessment and group B included those patients who were further assessed by echocardiography

Results: There was significant delay in group B patients from time of admission to surgery [p=0.0001] as well as post-operative ambulation [p=0.0001] and mean hospital stay was also longer [p=0.0005]. However the postoperative complications were similar in two groups

Conclusion: Pre-operative cardiac evaluation by echocardiography is associated with delay in surgery and increases overall hospital stay. The implementation of the American College of Cardiology/American Heart Association guidelines may prevent unnecessary cardiac consultations which can minimize use of preoperative resources, delay in time of surgery and early post-operative recovery

Assessment of quality of sleep and its relationship with psychiatric morbidity and socio-demographic factors in the patients of chronic renal disease undergoing hemodialysis

Objective: To assess the subjective sleep quality and its relationship with the presence of psychiatric morbidity in the patients suffering from chronic kidney disease [CKD] and undergoing the procedure of hemodialysis [HD]; and analyze the associated socio-demographic factors

Study Design: Cross-sectional descriptive study

Place and Duration of Study: Nephrology Department, Military Hospital, Rawalpindi, from July to December 2016

Methodology: Patients of CKD undergoing the HD were included in the final analysis. Quality of sleep was determined by using the Pittsburgh Sleep Quality Index [PSQI]. Psychiatric morbidity was determined by the General Health Questionnaire 12 [GHQ-12]. Relationship of education, BMI, gender, age, duration of dialysis, dialysis count per week, marital status, level of family income, psychiatric morbidity, occupation, biochemical markers [urea, creatinine, BUN, albumin, calcium, phosphorous and hemoglobin], tobacco smoking, and use of naswar was determined with the sleep quality

Results: One hundred and forty patients were screened through the PSQI; 44 [31.4%] had good quality of sleep while 96 [68.6%] had poor sleep quality. Statistical analysis revealed that presence of psychiatric morbidity, increasing age, female gender, being unmarried, low family income, and low frequency of dialysis had significant association with the poor sleep quality

Conclusion: Poor sleep quality was highly prevalent among the patients of CKD receiving the hemodialysis. The patients with low family income, more age, and with two or less dialysis sessions per week should be screened thoroughly for the sleep problems. Presence of psychiatric morbidity emerged as an independent factor responsible for the poor sleep quality in our target population

Near miss obstetric events as a reflection of quality of maternal health care

Objective: To determine frequency and nature of near-miss cases in obstetric patients in a tertiary care hospital

Study Design: Cross-sectional descriptive study

Place and Duration of Study: The study was conducted in obstetrics unit of Combined Military Hospital [CMH] Kharian from Jan 2013 to June 2013

Material and Methods: The WHO near miss criteria 2009 was followed including clinical, laboratory and management based criteria for case identification. Main outcome measures were frequency of near miss and maternal mortality cases, near miss on arrival and during hospitalization, ICU admission and total hospital stay, calculating the mortality indices, maternal mortality ratio, mortality to near miss ratio, near miss cases/1000 deliveries were calculated

Results: There were 76 near miss cases. Maternal mortality ratio was 676. Near miss cases were 70.3%. Maternal death to near miss ratio was 1:10. Mortality index for near miss cases was 8.4%. In near miss group most significant was cardiovascular 46% and hematologic system 32%. Interventions, renal, neurological and respiratory were 9.2%, 5.2%,3.9% and 2.6%respectively. In near miss cases 86% were referred and 14% booked

Conclusion: This study showed that uniform criteria for identifying near miss cases can be used in a tertiary referral hospital setting especially for comparison of results and audit. Near misses provide relevant controls for maternal deaths since most women who die presumably pass through a phase of organ dysfunction before dying and evaluation of circumstances leading to this can help in formulating and revising health care protocols

Psychiatric morbidity and associated socio demographic factors in young unemployed people

Objective: To determine the prevalence of psychiatric morbidity in young unemployed people and analyze associated socio demographic factors

Study Design: Cross sectional study

Place and Duration of Study: Enrollment camps at Punjab and Kashmir, from Jan 2014 to March 2014

Material and Methods: The sample population comprised of unemployed people who came for recruitment in Pakistan Army at different parts of the country. General Health Questionnaire 12 [GHQ12] was used to screen the population for psychiatric morbidity, 3 was used as cut off score. Age, province, education, level of family income, tobacco smoking, naswar [a tobacco based substance] use, marital status, dependent family members, worrying about the future and social support status were correlated with high GHQ score. Descriptive statistics were used to describe the characteristics of participants and the distribution of GHQ score

Result Out of 2511 people 1887 [75.1%] had GHQ score more than 3 showing some psychiatric morbidity. A total of 696 were Kashmiris out of which 540 [77.5%] were GHQ positive, 1329 were Punjabis out of which 978 [73.5%] were GHQ positive, 339 were Pakhtoons out of which 258 [76.1%] were GHQ positive, 129 were Balti out of which 102 [79%] were GHQ positive and 18 were from other ethnicities out of which 9 [50%] were GHQ positive

With logistic regression we found that family size, smoking, naswar use, family income, family history of psychiatric disorder, lack of social support, and low education were significantly correlated with high GHQ score while age of individual, worry about future and marital status had no significant relation with high GHQ score among unemployed people in our study

Conclusion: This study showed a high prevalence of psychiatric morbidity among unemployed youth of our country. Special attention should be paid to poor people, people with low education and large families. Adequate social support should be provided to young people with no jobs and use of cigarette and naswar should be discouraged

Depressive symptoms in pregnancy only frequency and association among wives of deployed military soldiers

Objective: To determine the frequency and association of depressive symptoms during pregnancy among wives of deployed Military soldiers

Study Design: Cross-sectional study

Place and Duration of Study: Combined Military Hospital Kharian from Oct 2013 to Dec 2013

Material and Methods: The sample population comprised of pregnant ladies who were wives of deployed military soldiers reporting for ante natal checkup at Combined Military Hospital Kharian. Beck Depression Inventory [BDI] was used to record the presence and severity of depressive symptoms. Age, gestation, parity, planned or unplanned pregnancy, education, level of family income, tobacco smoking, Family history of depression, Infertility treatments, previous pregnancy loss or complications, partner support and history of abuse or trauma were associated with depressive symptoms

Results: Out of 188, 41.5% had no depressive symptoms, 25.5% had mild, 20.2% had moderate and 12.8% had severe depressive symptoms. Advancing age, family history of psychiatric Illness, partner abuse, low family income and education, lack of partner support, smoking, increasing parity and gestation age are all significantly related to presence of depressive symptoms

Conclusion: This study showed a high frequency of depressive symptoms among wives of military soldiers during pregnancy. Special attention should be paid in elderly, multiparous and less educated ladies. Partner should avoid abuse and provide good support especially as the pregnancy advances. Declaration of interest: No conflict of interest for any author

Predictive accuracy of model for end stage liver disease [MELD] as a prognostic marker for cirrhosis in comparison with Child - Pugh score

To compare Model for End Stage Liver Disease [MELD] and Child-Turcott-Pugh [CTG] scoring as predictors of survival in cirrhotic patients. Observational prospective study. Military Hospital, Rawalpindi from 1[st] Dec 2008 to 30[th] April 2009. The study was carried out at Military Hospital, Rawalpindi a tertiary care hospital of Pakistan. Study included 55 patients suffering from cirrhosis of both genders being above 12 years of age, admitted in medical wards during the period from 1[st] December, 2008 to 30[th] April 2009. Each patient was assigned a MELD and CTP score. On discharge, these patients were followed up at 03-months, O6months and 1-year duration through telephone. Thirty seven [67.3%] patients were male while 18 [32.7%] were female patients, with age ranging from 27 years to 75 years [mean 53]. Fourteen [25.4%] patients were dead at 3-months, 22 patients [40%] were dead at 6- months and 29 [52.7%] patients were dead at 1-year follow up. MELD score proved to be a better indicator of survival than CTP score over a period of 01 year follow-up. MELD score is a better prognostic marker for cirrhotic patients as compared to CTP score

Free medical camps in rural areas of Azad Jammu and Kashmir

To describe the demographics, diagnoses and treatment offered to the people attending five free medical camps in various rural areas of Azad Jammu and Kashmir [AJK] during 2012. Cross sectional descriptive study. Bhimber district of AJK from January 2012 to December 2012. Five free medical camps each of two days duration were established during this period in Nihala, Gola, Poona, Nalee and Barroh which are located in the Bhimber district. Camps were staffed by Army doctors and nursing assistants. The particulars of the attending patients were recorded at the reception and diagnoses along with the medicines dispensed noted at the dispensary. A total of 7320 patients attended the five medical camps. The age of the patients ranged from 05 days to 101 years, mean age being 35 years. Females constituted 59% [4319] of the patients. Majority of the patients were agricultural workers. The most frequent complamts were gastrointestinal [30.4%] musculoskeletel [25.5%] and visual acuity problems [15.1%]. Other common complaints were related with dermatology, ear, nose and throaf [ENT] and gynecology. A total of 5010 prescriptions were recorded and the commonest medicines prescribed were multivitamins [30.5%], analgesics [28.3%], antibiotics [22.3%] and antihelminthics [21.7%].Gastrointestinal and musculoskeletal ailments dominate in the rural population of AJK. Recruiting a pediatrician, gynecologist and ophthalmologist in rural medical camps would greatly improve the efficiency of such camps and increase patient satisfaction. Such camps are recommended until the indigenous healthcare system is developed enough

Assessment of patients with chronic liver disease qualifying for liver transplant

To determine the frequency, etiology and pattern of patients with chronic liver disease at a tertiary care hospital qualifying for a liver transplant. Cross-sectional Study Military Hospital Rawalpindi from December 2008 to May 2009. Study included all patients of Chronic Liver Disease, admitted in medical wards. Diagnosis was made on the basis of clinical and ultrasonographic findings suggestive of chronic liver disease. Etiology was identified by serological tests [ELISA or PCR] and immunological tests. Metabolic screening was done for Wilson's disease and haemochromatosis. HCC was diagnosed and staged by biopsy and CT scan. After taking informed consent, detailed medical history, physical examination and required biochemical tests were carried out. All patients of age 12 years and above were evaluated according to Model for End Stage Liver Disease [MELD] and those below 12 years of age were evaluated by Pediatric End Stage Liver Disease [PELD]. Milan's Criteria was used for hepatocellular carcinoma and Mayo risk scores [MRS] for patients with Primary Biliary Cirrhosis and Primary Sclerosing Cholangits. A total of 212 patients suffering from chronic liver disease were included. Out of these, 164 [77.4%] were suffering from chronic hepatitis C, 16 [7.5%] from chronic hepatitis B, 2 [0.9%] from autoimmune hepatitis, 2 [0.9%] from hepatocelluar carcinoma, 1 [0.5%] from alcoholic hepatitis, 2 [0.9%] from Wilson's disease, 1 [0.5%] from haemochromatosis and 24 [11.3%] were Cryptogenic. All these patients were evaluated for liver transplant according to the appropriate criterion. Out of 212 patients, 43 [20.3%] patients had MELD/PELD Score of /=36 [79.71]. Patients with MELD/PELD score more than 10 are considered for liver transplant but the MELD/PELD score at which a patient will realistically receive a liver varies by region and organ demand as defined by the number of candidates on the waiting list and their blood type. High frequency of patients of chronic liver disease in our setup qualify for a liver transplant. It provides preliminary data for the need of liver transplant centers in our region