Low dose albumin for the prevention of renal impairment following large volume paracentesis in cirrhosis

Objectives: To evaluate the effect of low dose Albumin i.e. 4 grams per litre of ascitic fluid after large volume paracentesis [LVP] for the prevention of paracentesis induced circulatory dysfunction [PICD] related renal impairment in cirrhosis. Methods: Case records of all patients with cirrhosis who underwent LVP from January 12th, 2011 till December 29th, 2013 were reviewed. Patients were excluded if they had spontaneous bacterial peritonitis, creatinine >1.5 mg/dl, hepatoma or if volume of ascitic fluid removed was <5 litres. Data including age, gender, cause of cirrhosis, CTP score and volume of ascitic fluid drained were noted. In addition serum creatinine and serum sodium at baseline and one week post paracentesis were recorded. Results: Two hundred and fourteen patients with cirrhosis underwent LVP during the study period. One hundred and thirty nine patients met the inclusion criteria and were analyzed. Patients were divided into two groups based on the amount of albumin given. The amount of albumin given was 25 grams and 50 grams while the volume of ascitic fluid removed were 6.2+/-1 litres and 10.4+/-1.5 litres in groups A and B respectively. One hundred and eight patients were in group A while thirty one patients were in group B respectively. Both groups received albumin at a dose of 4 grams per litre of ascitic fluid removed. Mean age in both groups were 53 years. Hepatitis C was the commonest etiology in both the groups, followed by Hepatitis B. More than 70% patients in both the groups were in child class C. Serum creatinine at baseline and one week post LVP was 1.04+/-0.24 mg/dl and 1.07+/-0.35 mg/dl in GROUP A while 1.11+/-0.23 mg/dl and 1.41+/-0.94 mg/dl in GROUP B. [P value 0.35]. Similarly, serum sodium at baseline and one week post LVP was 130 +/-5.6 meq/lit and 129.6+/-5.9 meq/lit in GROUP A while 127.6+/-5.8 meq/lit and 128+/-6.2 meq/lit in GROUP B respectively. [P value 0.14] Conclusion: This study suggests that 4 grams of albumin per litre of ascitic fluid drained is effective in preventing the PICD related renal impairment following large volume paracentesis in cirrhosis

Significance of intercom missural width and anterior teeth selection

The objective of the present study was to determine the correlation between the intercommissural width and the combined mesiodistal width of maxillary six-anterior teeth in the study. It was a cross sectional study and was carried out from Aug 2011 to Jan 2012. Non-probability purposive sampling. The present study included 159 dentate subjects having Angle's class I molar and canine relationships. The patients were selected from the department of Prosthodontics, Lahore Medical and Dental College, Lahore. The subjects with history oforthodontic treatment, extractions, drifting and attrition of the teeth were excluded. All those subjects having any restoration in upper anterior segment, any facial deformity, crowding or spacing of anterior teeth were also not included. The informed consent was obtained. The patients were seated in the upright position and were asked to look straight. Before the measurement of intercommissural width subjects were asked to widely open and close the mouth several times. It was done to fatigue the muscles and to relax them during the measurement. The distance between the left and right commisures of mouth were measured using digital caliper. The casts of maxillary arches were used to measure the intercanine width. The distal margin of both the maxillary canines were marked on each sides of the maxillary cast. A dental floss was placed at the greatest curvature of the maxillary arch and was marked at the distal margin of the canines. The dental floss was sectioned at the markings and the distance was measured between the marks using digital caliper. Both the parameters were measured three times by the single person to ensure the accuracy and the mean was taken. The measurements were recorded in a Proforma. The statistical results of this study showed that there was no correlation between the intercommissural width and the combined mesiodistal width of maxillary anterior teeth. It was concluded that the intercommissural width was not a good predictor for the selection of maxillary anterior teeth width for edentulous patients in the study group

Newborn screening for congenital hypothyroidism in a public sector hospital

Congenital hypothyroidism if left untreated results in growth failure, irreversible mental retardation, and cretinism. National neonatal screening programs are therefore, launched to diagnose congenital hypothyroidism and manage it timely. To screen newborns for congenital hypothyroidism in two public sector hospitals of Lahore. Cross sectional descriptive study conducted at departments of Gynae/Obs and Pediatric Shaikh Zayed Hospital and Jinnah Hospital, Lahore from February 2010 to November 2011. Awareness brochures for congenital hypothyroidism were developed and attached with the antenatal card of each pregnant case attending antenatal clinic at Gynae/Obs OPD. Newborns who had stayed in hospital for more than 24 hour, and whose parents consented for heal prick were tested for blood spot thyroid-stimulating hormone. Results were reported within four days and thyroid-stimulating hormone >/= 20mIU/L was taken as high value. Parents of those neonates who had high value were contacted to give a fresh sample for confirmation. Confirmed results were provided within next 4-5 days to the parents and treating pediatrician for appropriate treatment. A total of 1357 samples were screened using blood spot thyroid-stimulating hormone and out of these 1330 were normal [< 20mIU/L] while 27 had high levels [>/= 20mIU/L]. These 27 neonates were further tested using confirmatory tests for serum thyroid-stimulating hormone, T3 and T4. After confirmatory tests only one case had congenital hypothyroidism who was referred for treatment. Three cases were suspected to have subclinical hypothyroidism and these were retested after six months which, picked another case of confirmed subclinical hypothyroidism who was referred for treatment. The incidence of congenital hypothyroidism was 2 out of 1357 cases. The screening could pick 2 cases of hypothyroidism from a total of 1357 cases which is high when compared to global rates. Routine screening of neonates for thyroid disease can pick the disease early and thus prevent later complications

role of interpupillary distance in the selection of anterior teeth

The objective of the present study was to determine the correlation between the interpupillary distance and combined mesiodistal width of maxillary six-anterior teeth in the study.It was a cross sectional studyand was carried out from May 2011 to November 2011. Sampling: Non-probability purposive sampling. A total of 159 dentate subjects with Angle's class I molar and canine relationships were selected from the department of Prosthodontics, Lahore Medical and Dental College, Lahore. The exclusion criteria included the subjects with history of orthodontic treatment, extractions, drifting and attrition of the teeth. Subjects having any restoration in upper anterior segment, any facial deformity, crowding or spacing of anterior teeth were also excluded. The informed consent was taken. The patients were seated in the upright position and were asked to look straight. The interpupillary distance was measured using the digital caliper. The measurement was made from the mid pupil of one eye to mid pupil of the other eye. The intercanine width was measured from the casts of maxillary arches with the help of dental floss placed at the greatest curvature of the maxillary arch. The distal surfaces of both the maxillary canines were marked on each sides of the maxillary cast. The dental floss was sectioned at the markings and made straight .The distance was measured between the marks using digital caliper. Both the parameters were measured three times by the single person to ensure the accuracy and the mean was taken. The measurements were recorded in a predesigned Proforma. The statistical results of this study showed that there was no correlation between the interpupillary distance and the combined mesiodistal width of maxillary anterior teeth. It was concluded that the interpupillary distance was not a reliable predictor to select maxillary anterior teeth width for edentulous patients in the study group

prospective study of factors predicting postoperative pulmonary complications [PPC] in patients undergoing noncardiothoracic surgery under general anaesthsia in a developing country

Post-operative pulmonary complications after non-cardiothoracic surgery are common and can adversely affect morbidity, mortality and length of hospital stay. Knowledge as regards factors predicting postoperative pulmonary complications in our local setting is imperfect. To study factors predicting post-operative pulmonary complications in developing countries. Data of consecutive 404 patients undergoing non-cardiothoracic surgery under general anesthesia with tracheal intubation was collected prospectively from Jan 2009 to Dec 2010. Chi-square was used for univariate analysis. Multivariate analysis was conducted using forward stepwise logistic regression. The mean age was 36 +/- 18 years with slight male predominence [54% vs 46%]. 22% [n=89] were smokers and the mean Body Mass Index was 23 +/- 4.5 kg/m2 with 35% [n=141] overweight and obese. 5% [n=20] of subjects had pre-existing chronic lung conditions while 23% [n=92] had non-pulmonary chronic conditions. 70% [n=282] of the surgeries were done electively and the mean duration of anesthesia was 78 +/- 44 minutes. The overall postoperative pulmonary complications rate was 8% [n=31] with atelactasis [48%, n=16] followed by bronchospasm [25%, n=8] and pneumonia [16%, n=5] being the commonest complications. The duration of hospital stay was significantly longer [11 +/- 9 days, p=0.00] in patients with post-operative pulmonary complications and 29% [n=9] of them required mechanical ventilation. Logistic Regression analysis identified premorbid chronic chest conditions, emergency surgery and prolonged duration of anesthesia as significant predictors of post-operative pulmonary complications while age, gender, Body Mass Index, smoking history and non-pulmonary premorbids were insignificant in this regard. Post-operative pulmonary complications after non-cardiothoracic surgery are common and lead to increased morbidity and prolonged hospital stay in our setting. We identified pre-existing chest disease, prolonged anesthesia and emergency surgery as significant predictors of post-operative pulmonary complications

role of the interalar width in the anterior teeth selection

The objective of the present study was to determine the correlation between the interalar width and the combined mesiodistal width of maxillary six-anterior teeth in Pakistani population. It was a cross sectional study and was carried out from May 2011 to November 2011. A total of 159 dentate subjects fulfilling the inclusion criteria were selected from the department ofProsthodontics, Lahore Medical and Dental College, Lahore. The demographic information like age *' and sex were recorded and the informed consent was taken. The patients were seated at upright position and asked to look straight. The interalar width was determined by measuring the external width of the alae of the nose at the widest point by using a digital caliper. With subject in a relaxed position, the recording part of the caliper was brought in contact with the outer surface of both alae without applying pressure. The inter canine width was measured from the maxillary stone cast with the help of dental floss, placed at the greatest curvature of the maxillary arch. The distal surfaces of both the maxillary canines were marked on the maxillary cast. The dental floss was sectioned and made straight. The digital caliper was used to measure the distance between the marks. Both the parameters were recorded three times by the single person to ensure the accuracy and the mean was taken. The measurements were recorded in a Proforma. The statistical results of this study have shown that there is no correlation between the interalar width and the combined mesiodistal width of maxillary anterior teeth. lt was concluded that the interalar width is not a reliable predictor for the selection of the width of maxillary anterior teeth in the edentulous patients in Pakistani population

Frequency of risk factors for ventilator associated pneumonia in paediatric population

Objective: To determine the frequency of risk factors for Ventilator Associated Pneumonia [VAP] in a pediatric population

Setting and Study Design: It was a cross sectional survey conducted at the Neonatal and Pediatric Intensive Care Unit, [NICU and PICU], Sheikh Zayed Hospital, Lahore from 31-10-2009 till 2010

Methods: 175 cases of VAP were enrolled by non-probability, purposive sampling technique Patients from birth to 12 years [144 months], admitted in NICU and PICU, who received mechanical ventilation for >48 hours, were analyzed retrospectively for the presence of risk factors such as reintubation, nosogastric tube feeding and thoracostomy tube and eventual development of Ventilator Associated Pneumonia

Results: Out of total 175 patients, 55.3% were < 1 month [neonates] admitted in NICU while 44.7% were between 1 month and 12 years [144 months] and admitted in PICU. Mean +/- S.D age for NICU and PICU patients was 3.76 +/- 1.10 days and 39.88 +/- 33.78 months respectively. In both NICU [male 53.2% Vs female 46.8%] and PICU [71.1% males Vs 28.96% female], there was male predominance. Regarding frequency of risk factors, in both NICU and PICU, reintubation was the most frequent risk factor [85.1% NICU, 73.1% PICU] followed by nasogastric tube feeding [17% NICU, 36.8% PICU] and tube thoracostomy [6.4% NICU, 10.5% PICU]

Conclusions: VAP is a common infection associated with process of patient care and certain interventions [such as reintubation, nasogastric tube placement and tube thoracostomy] might affect the incidence of VAP. ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk of VAP and thus modifying patient's care to minimize the risk of VAP

Yield of suprapubic aspirate versus bag collection in diagnosis of UTI in children 0 to 6 months of age

Objective: To evaluate the accuracy of urine sample collection methods among children suspected of having urinary tract infection

Subjects and Methods: Urine samples were collected in infants 0-3 months of age presenting with features of sepsis. Two methods of collection were used, one was bag attached to perineal skin and the other was suprapubic aspirate. Within 30 minutes of collection, all specimens were sent to the laboratory, refrigerated and processed according to standard hospital microbiological procedures. Urine samples were analyzed using routine culture technique

Setting: This cross sectional study was conducted at Shaikh Zayed hospital Lahore. The duration of study was six months. A total of 100 cases fulfilling the inclusion criteria were included in this study. Results were analyzed according to SPSS 16

Results: Out of 100 patients [n=100] 17 had positive bag culture, only 4 out of 17 had culture positive by SPA, so there were 13 false positives while using bag collection method

Conclusion: Suprapubic aspiration showed the positive yield in 4 SPA which does not indicate contamination and sterile urine bag showed the highest contamination rate among the two methods of urine sample collection. So urine bag leads to unnecessary treatment burden on the child and family. There fore we cannot rely on bag samples for diagnosis of urinary tract infections specially the bag collection method because the specificity of bag collection method is very low

Frequency of gastroesophageal reflux disease in children with chronic cough

Objective: To identify the frequency of gastroesophageal reflux disease in children with chronic cough aged 2 months to 2 years

Methods: This cross sectional survey was conducted in 75 children between 2 months to 2 years in the department of pediatrics, Shaikh Zayed Hospital, Lahore. Children having chronic cough of > 4 weeks duration included in study and were admitted in ward and barium swallow was done in the Radiology Department

Results: Total 75 of chronic cough were included in this study, out of these 75 patients GERD was diagnosed in 29 [39%] on barium study. Out of these 29 patients, 20[27%] were in the age group of 2-9 months, 9[12%] were between 10-17 months. No patients of age group 18-24 months were diagnosed as GERD on barium study. In this 29 patients, 18[24%] patients were male and 11[15%] were female

Conclusion: Gastro esophageal reflux disease is one of the most common reasons for chronic cough seeking consultation of pediatricians. Early diagnosis and management of GERD can lead to decrease morbidity in children

Role of C-reactive protein in the diagnosis of sepsis in early infancy

Objecctives: To assess the role of serial C-reactive protein in the diagnosis of sepsis during the early period of infancy [<90 days]

Materials and Methods: This cross sectional study was conducted in the pediatrics Department of Shaikh Zayed Hospital [SZH], Lahore. The duration of study was 6 months from 1[st] July to 31[st] December 2010. Total 150 cases fulfilling the inclusion criteria were enrolled randomly in the study. Babies were divided in two groups: Group 1 -Healthy babies. Group II- Babies with sign and symptoms of sepsis. The first C-reactive protein and blood cultures were sent in all cases at the time of admission. Antibiotics were started in the suspected cases of sepsis. After 48 hours of admission, second sample of C-reactive protein was again sent in all cases

Results: The study was carried out in babies <90 days admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 admitted in the neonatal and pediatric unit. All the cases were divided into two categories. There were 68 [45.33%] culture proven cases of sepsis and 82 [54.67%] cases were culture negative. Escherichia coli was the most common organism isolated followed by Staphylococcus aureus. Males [63%] were predominant as compared to females [37%]. 80% were term babies while 20% were preterm. 75% babies were born by lower segment caesarian section, 15% were delivered at home while 10% were born at the private clinics. Early onset sepsis was seen in 39.33% of cases while late onset sepsis was seen in 60.67% cases. Mechanical ventilation was done in 10 babies [6.6%]. 97.4% babies survived and 2.6% babies expired. The sensitivity, specificity, PPV, NPV of C-reactive protein was 91.18%, 53.66%, 62% and 88% respectively at the time of admission. The CRP level was statistically different between the two group [p<0.001], at the time of admission and at 48 hours after admission

Conclusion: Babies during the early infancy period are susceptible of developing sepsis that may lead to potential consequences if not treated in proper time. Also babies may be over-treated and may have prolonged stay in the hospital if not properly investigated, which may itself be a burden to the family members and have a financial instability also. So keeping in mind all these factors, were performed a serial CRP test at admission and after 48 hours for treatment monitoring and observing the response. Sensitivity of C-reactive protein and negative predictive value was high in this study at the time of admission. So, serial monitoring of C-reactive protein is recommended for the monitoring treatment response

Intraventricular haemorrhage amongst preterm babies-preventive role of dexamethasone

Objective: to determine the antenatal use of dexamethasone in preventing intraventricular haemorrhage [IVH] in preterm newborns

Setting and Study Design: descriptive case series study done in a prospective fashion at the Neonatal Unit [NNU] of the Department of Paediatrics in collaboration with the Department of Obstetrics and Gynecology, Sheikh Zayed Hospital, Lahore

Patients and Methods: 210 women from the Obstetrics and Gynecology Department, who gave bii1h to preterm babies from 0 1-05-2009 till 30-04- 2010 were included in this study; they received dexamethasone, 1/M, 6mg, in 4 doses, 12 hourly, antenatal. Deliveries were. Attended by trained pediatricians and new barns were followed up for any physical stress and birth asphyxia. The newborns were brought to ·NNU for postnatal care. Cranial ultrasonography [USG] was performed on these babies at 72 hours after delivery, at I week and then at 2 weeks of life. Outcome was recorded regarding presence or absence of IVH on cranial ultrasound at the end of 2 weeks

Results: the mean age of the mothers was 28.1+/- 4.3 years. The mean gestational age of the patients was 33.6+/-1.6 weeks. In 191 [91%] neonates IVH was not present while IVH was present amongst 19 [9%] neonates. There were 6 [3%] patients of IVH Grade I, 10 [5%] patients of IVH Grade II and 2 [1%] patient or IVH Grade III

Conclusion: dexamethasone is useful in prevention of IVH in preterm babies when it is used in the antenatal period

Frequency of meningitis among children 6-18 months of age with first episode of fever and fit

Objective: to determine the frequency of meningitis in children, 6 to 18 months of age, presenting with first episode of fit and fever

Study Design and Setting: this was a descriptive case series performed as a cross sectional survey carried out in the Department of Paediatrics, Sheikh Zayed Hospital Lahore

Patients and Methods: this study was; carried out from 1-04-2009 to 30-03-2010. 423 patients, who fulfilled the inclusion criteria, were selected for this study. Blood glucose was recorded before lumbar puncture to compare with CSF glucose. CSF was sent for analysis of protein, glucose and white blood cell count to assess the presence of meningitis

Results: mean age of the patients was 11.9+/-3.5 months with age range of6 to 18 months. There were 262 [62%] males and 161 [38%] female patients. The mean blood sugar at the time of lumbar puncture was 104.8+/-10.9 mg/di. There were 9 [2%] patients who had raised CSF leucocyte count, 9[2%] patients h11d raised CSF protein and 9 [2%] patients had reduced CSF Glucose There were 9 [2%] patients who had meningitis so frequency of meningitis was 2% in our population under study

Conclusion: frequency of meningitis in children presenting with first episode of fit and fever in the absence of any other symptoms is very low. Majority of children are, therefore, cases of simple febrile seizures rather than meningitis. It is suggested that unuecessary lumbar puncture can be avoided as this invasive procedure has its own complications

audit of fibreoptic bronchoscopy service at KRL Hospital Islamabad

Fibreoptic bronchoscopy is an important diagnostic and therapeutic tool for a wide spectrum of thoracic disorders in interventional pulmonology. The British Thoracic Society published comprehensive guidelines in 2001 on the use of fibreoptic bronchoscopy. The purpose of this audit was to evaluate the performance of our bronchoscopy service in the light of these guidelines with a view to identify areas for further improvement. In this prospective audit a series of 50 consecutive bronchoscopies performed at KRL Hospital Islamabad was studied. For each examination we recorded patient demographics, indication of the procedure, radiological information, pre-procedure evaluation by the pulmonologist, the bronchoscopic appearance and histopathological and microbiological findings, where indicated, and any untoward events associated with the procedure. The mean age was 48.8yrs [SD +/- 17.9] with male predominance [M 78%, F 22%].The main indication of the procedure was sampling of bronchial washings for microbiological assessment [n=25; 50%], followed by evaluation of suspected malignancy[n=15; 30%], hemoptysis [n=9; 18%] and persistent cough [n=1; 2%]. Chest X-rays were abnormal in majority of patients [n=46; 92%] and radiological appearance of pulmonary mass lesion was seen in 24% [n=11] of abnormal CXRs. Thirty percent [n=15] of bronchoscopies were abnormal with 93% diagnostic yield of specimens obtained for histopathological assessment. A low diagnostic yield of 24% was observed in cases of specimens collected for microbiological assessment. No major procedure related complications were observed during or after the procedures. Fibreoptic bronchoscopy is a safe procedure provided all basic precautions are taken. The procedure should be considered in all patients with a mass lesion on CXR. Although thehistopathological diagnostic yield was well above the recommended standard in cases of endoscopically visible malignancy but a low diagnostic microbiological yield was observed especiallyin cases being evaluated for tuberculosis. The latter may be attributed to less selective study population and sub-optimal microbiological service. Hence the audit was useful in identifying an area for furtherimprovement. In a developing country, like Pakistan, gender bias is rampant even when it comes to access the healthcare facilities

Factors associated with haematuria in children

Background: Haematuria is a common problem in pediatric clinical practice. It may be due to multiple causes. Timely diagnosis of this problem may be helpful in prevention of serious and progressive conditions

Objective: To identify the factors in children with haematuria in age group 1-14 years. Study design: Cross sectional study. Place and duration: Department of pediatrics, Shaikh Zayed Hospital, Lahore September 2006 to March 2007

Subject and Methods: All the patients with haematuria were included in the study. Haematuria was defined as presence of more than 5 red blood cells/HPF. Detailed clinical data was collected. Urine microscopy was performed after centrifugation of the urine. Other relevant investigations were performed depending upon the clinical data. The results were then tabulated and analyzed statistically

Results: Majority of the patients were male [54.66%] and in the age group 1-5 years [40%] and 6-10 years [30.66%]. The main presenting complaint was fever [54.66%], followed by red/cola color urine [41.33%] and peri orbital swelling [37.33%]. Oedema was observed in 37.33% and hypertension in 41.33% patients. Complications were seen in 20[26.66%] patients. These included hypertension, acute renal failure, nephrotic syndrome and end stage renal disease. Haematuria with protein uria was found in 30.66% and elevation of BUN/Creatinine in 42.66% patients. It was observed that out of 75 patients, 4 had SLE, 8 had renal stone, 3 had Henoch Schonlein purpura, 17 had urinary tract infection, and 27 had post streptococcal glomerulonephritis

Conclusion: The present study shows that a large number of patients with haematuria had treatable underlying cause. Therefore urine should be tested routinely in pediatrics patients for haematuria and investigated further as required

Children with acute viral hepatitis: a one year study at Shaikh Zayed Hospital, Lahore

Objectives: To study the clinical spectrum, outcome and etiological agents of acute viral hepatitis in admitted patients at Paediatric Department Shaikh Zaycd hospital, Lahore. Setting: Paediatric Department Shaikh Zayed hospital, Lahore

Duration: One Year from November 2004-0ctober 2005. Study design: Retrospective Descriptive study. Inclusion criteria: I. Age between 1-15 years; 2. All patients admitted with acute viral hepatitis in the Paediatric department. Exclusion criteria: 1. Children with drug induced hepatitis; 2. Children with chronic liver disease; 3. Children with obstructive jaundice

Results: A total of 69 patients out of 2391 admitted patients were included during that period out of them 43[62%] were males and 26 [38%] were females. In our study jaundice was the presenting complaint in 52[75%] patients, followed by vomiting in 48[69%], fever in 42[60%], dark colour urine in 30 [43%], anorexia in 25 [36%], abdominal pain in 24 [35%], yellow colour stool in 7[10%] and irritability in 2 [3%] patients. 13 patients had a positive family history of hepatitis out of them 3[4.3%] had Hepatitis A virus [HAY], 7[10%] Hepatitis B virus [HBY], and 3 [4.3%] had Hepatitis C virus [HCY]. History of blood transfusion was found in 7[10%] patients while it was negative in remaining 62[90%]. Only 2[2.8%] patients were vaccinated against HAY and 9 [13%] against HBY. Icterus was present in 52[75%], 65[94%] had tenderness in the right hypochondrium, hepatomegaly in 57 [83%] and splenomegaly in 7% and one patient was drowsy at the time of admission. All the patients were screened against HAY, HBY, HCY, HOV and HEY in a serial wise approach. Out of them 50[72%] patients were HAY IgM positive, 4[5.7%] HbsAg positive, 2[2.8%] had anti-HCY, 2[2.8%] had HEY lgM and 1[1.4%] had HDY+HbsAg. In 10 [14%] patients no viral marker was detected out of these five viruses. Out of 69 patients 4[5.7%] developed hepatic encephalopathy. Out of these 2 pts. expired and 2 survived. A total of 67[97%] were discharged and 2 [3%] expired

Conclusions: Jaundice was the main presenting complaint followed by vomiting with significant recovery and Hepatitis A was the· most common cause of acute viral hepatitis in children admitted in hospital

comparison of the level of anxiety among female and male Afghan refugees

The present research was deigned to study the relationship between anxiety in refugees and their gender. A sample of 200 adult Afghan Refugees residing in different Old Refugee Villages and Urban Refugee Settlements of NWFP, Pakistan was taken. It was hypothesized that Female Refugees would have a higher level of anxiety as compared with Male Refugees. IPAT Anxiety Scale Questionnaire [Self Analysis Form] was administered to see the difference in their level of anxiety. The results verified the hypothesis and it was found that Female Afghan Refugees possessed a higher level of anxiety then Male Afghan Refugees. The research supports previous studies conducted in this regard by confirming that gender difference is positively correlated with anxiety disorders

Presenting features of urinary tract infection [UTI] in children: a hospital based study

Urinary tract infection [UTI] is one of the most common disorders seen in children world wide but not as frequently as in adults. Because of high incidence of urinary tract infection and its associated morbidity and mortality, early diagnosis and treatment of this condition is essential. This study was carried out to see the common clinical presentations of UTI especially presenting with fever but no urinary symptoms, in children admitted in Department of Pediatrics at Sheikh Zayed Hospital, Lahore. 57 Children diagnosed as UTI, upto 15 years of age, admitted during years 2004 and 2005 in department of Pediatrics Sheikh Zayed Hospital, Lahore, were included in this observational descriptive study. Fever was the commonest clinical presentation [78%] followed by pain abdomen [54%] and dysuria [40%] Failure to thrive was observed in [12%] of patients. Fever was the main clinical feature observed in our study. Children who present with fever without focus should be investigated for UTI. so that early diagnosis and prompt management can reduce the risk of complications associated with UTI

Level of anxiety among married and unmarried afghan refugees

The present research was designed to study anxiety in refugees with reference to marital statas. A sample of 200 adult Afghan Refugees residing in different refugee's Villages and urban refugees settlements of NWFP, Pakistan was taken. It was hypothesized that there will be a difference in the level of anxiety between married and unmarried Afghan refugees. IPAT Anxiety Scale [Self Analysis Form; Krug, Scheier and Cattle. 1976] was administered to see their level of anxiety. The results verified the hypothesis and it was found that married Afghan refugees possessed a higher level of anxiety than unmarried Afghan refugees. The research supports previous studies conducted in this regard reflecting the relation of marital status with level of anxiety