A Higher Altitude Is Associated with Increased Incidence of Infections following Primary Total Hip Arthroplasty / 대한고관절학회지

Purpose@#The purpose of this study was to evaluate whether patients undergoing primary total hip arthroplasty (THA) at a higher elevation have higher rates of: 1) in-hospital length of stay (LOS); 2) surgical site infections (SSIs); 3) periprosthetic joint infections (PJIs); and 4) costs. @*Materials and Methods@#The Medicare claims database was used to identify patients who underwent primary THA at an altitude higher than 4,000 feet (ft). High-altitude patients were matched to patients who underwent primary THA at an altitude less than 100 ft, yielding 24,958 and 124,765 patients respectively. Outcomes that were assessed included in-hospital LOS, SSIs, PJIs, and costs of care. A P-value less than 0.001 was considered statistically significant. @*Results@#Patients in the study group had significantly longer in-hospital LOS (4 days vs 3 days, P<0.0001). In addition, patients in the study group had a significantly higher incidence and odds of developing SSIs (1.16% vs 0.86%; odds ratio [OR], 1.34; P<0.0001) and PJIs (0.91% vs 0.58%; OR, 1.56; P<0.0001) within 90-days following the index procedure, compared to matched controls. Higher altitude patients incurred higher day of surgery ($16,139.76 vs $15,279.42; P<0.0001) and 90-day costs ($18,647.51 vs $16,401.62; P<0.0001). @*Conclusion@#This study demonstrated that primary THA procedures performed at an elevation higher than 4,000 ft are associated with longer in-hospital LOS, higher rates of SSIs, PJIs, and costs of care. Orthopedists and other healthcare professionals can use this information to provide adequate education for these patients regarding the potential complications that may occur following their procedure.

Perceptions of Saudi medical students on the qualities of effective teachers. A cross sectional study

To identify the attributes of an effective medical teacher that students value the most. A quantitative survey was performed in the College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia, between April and May 2012, using a pretested self-administered questionnaire distributed to all students. It captured their opinions on the qualities and attributes of good teachers. Each item was measured on a 5-point Likert scale. Data were entered and analyzed using the Statistical Package for Social Sciences Version 17. Three hundred and fifty-six students from all years responded. The most important attributes from the students' perspectives were "respectful to students", "expert on the subject", "organizes good lectures", "understands/relates to students", and "good communication skills". On the other hand, "good sense of humor", "explains and shares personal experiences", "self-sacrificing", "gives good marks to all students", and "dresses up appropriately" were least valued by students. Attributes related to performance were valued more by students compared to personality attributes. Medical teachers and administrators should focus on improving the attributes identified most important to the students. Future studies could define the important attributes more explicitly

Community participation eludes Pakistan's maternal, newborn and child health programme

This study looked at the comprehensiveness of the primary health care approach being applied in Pakistan's National Maternal, Newborn and Child Health [MNCH] Programme launched in 2005. The methods included a review of the programme's guideline documents, in-depth interviews with managers/advisors and focus group discussions with community groups and service providers. The MNCH Programme is applying a selective primary care model. Programme advisors and managers were concerned about the quality of training, political interference and incomplete implementation. Service providers were not working together as envisioned. Community midwives complained about the community's perceptions of them. Community members were unaware of MNCH Programme implementation in their areas. Pakistan's primary health care programme needs to be reviewed and revised according current thinking on community participation and inter-sectoral collaboration to accelerate progress towards achievement of Millennium Development Goals 4 and 5

[Fluoride uptake level of the enamel by a fluoride varnish and a fluoride gel [APF]]

Statement of Problem: Various forms of fluoride-contained products are used to increase the resistance of the tooth against caries for preventive purposes. Furthermore, studies demonstrated higher fluoride uptake with varnish and gel among the wide range of products

Purpose: This study compared fluoride uptake of Duraflor[registered sign] varnish [Practicon Dent, USA] with fluoride gel [APF, Sultan[registered sign]], used on the enamel surface of the intact teeth

Materials and Method: In this experimental in-vitro study, 20 intact pre-molar teeth extracted for orthodontic purposes were randomly assigned to two groups of 10 teeth. The teeth were sectioned into two mesial and distal halves as the control and experimental sides. Defined semi-circular areas on the enamel surface of the experimental halves were treated with gel or varnish for 1 hour. The sample halves were stored in artificial saliva for 24 hours at 37[degree sign]c, etched for 30 seconds by 0.5 M perchloric acid, and washed by 0.2 m KOH after each etching process. Biopsies of the samples were obtained by Acid Etch Enamel Biopsy technique and the fluoride and calcium concentrations were calculated by potentiometer and spectrophotometer, respectively. Kolmogorov-smirnov, Paired t-test and Student t- test were used for statistical analyses

Results: The results demonstrated an increase in the enamel fluoride content after exposure of the teeth to both Duraflor[registered sign] varnish and APF gel [Sultan[registered sign]]. The results of the paired t-test revealed significant differences between the experimental and control halves in both groups [varnish: p =0.002, gel: p =0.039]. The fluoride uptake value in varnish and gel groups was 2069.78 ppm and 1050.99 ppm, respectively. The student t-test showed a statistically significant difference [p =0.01]

Conclusion: Both APF gel and Duraflor[registered sign] varnish increased the fluoride content of the tooth enamel after application, although Duraflor[registered sign] varnish had a higher fluoride uptake level than APF gel

Assessment of a modification of bruckner's test as a screening modality for anisometropia and strabismus

Current amblyopia screening methods are not cost effective. To evaluate the diagnostic capability of a modified Br_ckner test [MBT] for amblyopiogenic risk factors. We applied the MBT using the streak retinoscope to identify anisometropia and strabismus by noting an inter-ocular difference in movement and glow, from children who failed 6/9 Snellen on community vision screening, followed by comprehensive eye examination. Data were analyzed by 2 _ 2 tables for diagnostic test parameters [95% CI]. From 7998 children vision-screened, 392 failed 6/9 VA and were referred. Since 34 failed to reach the centers, and 15 were excluded due to poor/ no glow, data from 343 was analyzed. The prevalence of anisometropia of 0.5D was 17%, of 1D was 11% and of strabismus 5%. For the MBT the accuracy was ? 90% [95%CI 89% to 97%] over the three outcomes. The sensitivity, specificity, NPV and +LR for anisometropia of 0.5D were: 0.57 [0.48, 0.64], 0.97 [0.95, 0.98], 0.92 [0.90, 0.93] and 18 [9.7, 35]; for 1D: 0.74[0.60, 0.82], 0.95 [0.94, 0.97], 0.97 [0.95, 0.98] and 16 [9.3, 28]; and for strabismus: 0.5 [0.32, 0.66], 0.98 [0.97, 0.98], 0.97 [0.96, 0.98] and 20 [9.1, 42]. Our data suggests that the MBT is highly accurate and useful for ruling in anisometropia and strabismus in children who fail 6/9 Snellen. The MBT needs further validation, both by different care givers and on differing populations. It offers an affordable, portable, and clinically useful tool to detect anisometropia and strabismus. We suggest that performing an MBT prior to uniocular retinosocpy should be a routine practice

Pakistan human resources for health assessment, 2009

Pakistan faces a human resources for health [HRH] crisis. A cross-sectional survey was conducted to overview frontline health workers. A total of 750 health facilities were surveyed across Pakistan. The median estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 doctors and 41 032 nurses. Another estimated 20 000 doctors work in public sector tertiary care hospitals across the country. A total of 3549 health care workers were interviewed regarding job satisfaction and work environment. The private sector had better work environment scores compared with the public sector. Policy dimensions showed an absence of robust policies in practice. The public sector is inadequately staffed and job satisfaction and work environment need improvement. HRH crisis countries should share experiences, and developmental partners should support them in overcoming the HRH crisis

OPD based study of correlation of socio-cultural variables in patients of pelvic inflammatory diseases

The present study was conducted on 350 ever-married females of reproductive age group [15 to 49 years] who were diagnosed on the basis of symptoms to have Pelvic Inflammatory Disease [PID]. The objective was to identify the socio-cultural variables in relation to PID. The period of study was one year 1st Aug 2001 to 31st July 2002 and the study design was cross-sectional. The socio-cultural variables taken into account were age, education, marital status, social class, reproductive profile, use of contraceptives, personal genital hygiene and nature of delivery conducted. The statistical tests used to analyse the data were percentage and Z-test. It was found that PID is significantly associated with all the above socio-cultural variables

CT virtual colonoscopy

CT Virtual Colonoscopy is a medical imaging procedure which uses x-rays and computers to produce two and three-dimensional images of the colon [large intestine] from the rectum, all the way to the lower end of the small intestine using only air as contrast medium and display them on a screen. The procedure is used to diagnose colon and bowel disease like polyps, diverticulosis and tumour. It also provides 3D reconstructed endoluminal views of the bowel. It holds significant promise for effective large-scale colorectal cancer screening. Although many radiologists continue to use the 2D images for polyp detection, more emphasis on the 3D images for primary detection of polyps has yielded the best results for screening. The primary target lesion for colorectal screening is the adenomatous polyp, since detection and removal of all larger or advanced lesions could potentially prevent approximately 95% or more of all colon cancers. A total of 13 cases were evaluated in our study. The patients presented with varying complaints ranging from abdominal pain to bloody diarrhoea. The age range was from 30-70 years. Eight cases turned out to be normal. One case showed synchronous carcinoma colon which was confirmed peroperatively and on histopathology. Two cases were of diverticulosis while one case showed inflammatory mass at the ilio cecal region while the other was of para rectal abscess. It is thus concluded that C. T. virtual colonoscopy is an excellent diagnostic modality for most of the co/owe lesions

Pharmacognostical studies of the Unani drug Kamala [Mallotous philippinensis MuelL-Arg

In the present paper an attempt has been made to find out, botanical, physico-chemical and phytochemical characteristics of the powdery covering of ripe fruits obtained from Kamala [Mallotus philippinensis Muell.-Arg.]. The important parameters are studied macro-microscopically characters, pH values, total ash, acid insoluble ash, water insoluble ash, sulphated ash, qualitative ash, analysis for inorganic constituents, qualitative analysis of different extractives for organic chemical constituents, successive extractive values, thin layer chromatography of different extracts and their analysis has also been performed. Detailed Phytochemical studies have been further confirmed that the main organic compound in the powder studied is [Rottlerin]. The compound has been found in dark brown rhombic crystal m.p. 203-05°C It is an important medicinal tree, which is used traditionally for the treatment of ringworm, scabies, herpes and other parasitic skin diseases. Kamala powder alone is applied over syphilitic ulcers

Utility of acid-fast staining in tubercular lymphadenopathy compared to cytopathology

Lymphadenitis is a common form of extra-pulmonary tuberculosis. As in peripheral health centers, the facilities for histopathology and culture are lacking, material obtained by fine needle aspiration [FNA] in suspected cases of tubercular lymphadenitis [TBL] can be stained for Acid Fast Bacilli [AFB] by Ziehl Neelson method as every Designated Microscopy centre under Revised National Tuberculosis Control Programme has facility to perform it. This study was conducted with the aim of establishing the utility of performing AFB on aspirated material at a DMC over performing cytology at a higher centre. Fifty eight suspected cases of TBL attending urban health training centre, Dept. of Community Medicine were included in the study. FNA was performed and at least two slides were prepared, one for acid fast staining at centre itself and the other was sent for cytology, in the Dept. of Pathology. SPSS 11.0 was used to data analysis. 75.9% slides were AFB Positive; there was significant correlation of duration of disease and cytomorphology with AFB positivity. It was concluded that performing AFB staining at a peripheral centre on material aspirated from lymph nodes could alone be sufficient for diagnosis of tuberculosis in majority of cases

comparative study of the aerial parts of punarnava [Trianthema portulacastrum Linn.] commonly used in traditional medicine and its adulterator boerhaavia diffusa Linn

The aerial part of Trianthema portulacastrum Linn, [white variety] is used in Unani Medicine to treat inflammation, asthma, dropsy, bronchitis, ascites, orchitis, and migraine. The practitioners of Ayurveda and Unani also employ it for diuretic action. Even involuntarily, Trianthema portulacastrum may be adulterated by Boerhaavia diffusa. The morphoanatomic features having diagnostic value for the identification of both species in their state of crude drug are evaluated. The important parameters are also studied as qualitative ash analysis for inorganic constituents, qualitative analysts of different extractives for organic chemical constituents, successive extractive values, thin layer chromatography of different extracts, total ash, acid insoluble and water soluble ash and their analysis have been performed

Ethno-botanical distribution and cultivation of some traditional medicinal plants of Delhi [India]

A survey has been carried out on the ethno-botanical distribution and cultivation of medicinal plants used by local people in various parts of Delhi [India] and its suburbs. The paper highlights experimental demonstrations and cultivation practices of some important medicinal plants of Delhi [India] viz., Chirchita [Achyranthes aspera Linn.], Atibala [Abutilon indicum L., Sweet], Greater ammi [Ammi majus Linn.], and Vasaka [Adhatoda vasica Nees.] etc. The species focused belong to families Amaranthaceae, Malvaceae, Apiaceae, Acanthaceae, Liliaceae, Cannabinaceae, Apocynaceae, Asteraceae, Cucurbitaceae, Caesalpiniaceae, Lamiaceae and Plantaginaceae and grow in Delhi and its outskirts. Thus, twenty-five medicinal plants belonging to eighteen families are described in alphabetical order along with the ethno-botanical distribution, cultivation, mode of administration, flowering and fruiting

Comparison of patterns of lipid profile in type-2 diabetics and non-diabetics

To determine the commonest pattern of lipid profile in type 2 diabetics presenting in Mayo hospital and to compare it with non-diabetics. It was a comparative study. It was conducted in all medical wards, medical OPD and patients seen in emergency. Material and method: Patients were selected according to inclusion criteria. After sampling for all relevant investigations, results were expressed after applying Chi-square test. Serum cholesterol> 240mg/dl seen in 25% diabetics and 11% non-diabetics [p <0.05]. Levels <240 and >200mg/dl seen in 35% diabetics and 19% non-diabetics [p <0.05]. Serum cholesterol < 200mg/dl seen in 40% diabetics and 70% non-diabetics [p<0.05].LDL >160mg/dl seen in 21% diabetics and 5% non-diabetics [p<0.01]. LDL < 130 mg/dl seen in 32% diabetics and 42% non-diabetics [p >0.05].HDL < 35 mg/dl seen in 67% diabetics and 43% non-diabetics [p <0.05]. HDL >35mg/ dl seen in 33% diabetics and 57% non-diabetics [p <0.05]. TG >400 mg/dl seen in 8% diabetics and 3% non-diabetics.TG >200mg/dl seen in 38% diabetics and 93% non-diabetics [p<0.01].TG <200mg/dl seen in 62% diabetics and 3% non-diabetics [p<0.01]. Diabetes and cardiovascular disease are closely associated. Diabetic dyslipidaemias are a major risk factor for athrosclerosis. The commonest dyslipidaemia found was low HDL cholesterol followed by high LDL, serum cholesterol and TG levels.The commonest dylipidaemia found among non-diabetics in this study is high TG and low HDL,which might be associated with dietary factors and lack of exercise. Correction of dyslipidaemia is important to retard the progression of atherosclerosis

Prevalence of cleft lip and palate in cousin marriages

Birth defects are one of the leading causes of paediatric disability and mortality in developing as well as developed countries. The purpose of this study is to report our 3 months experience regarding the prevalence of cleft lip and palate in cousin marriages. A retrospective review of 50 patients who presented with cleft lip or cleft lip/palate during 3 months, from 9th March to 8th June, 2005 was carried out. Among the risk factors cousin marriages is a most frequent risk factor. Cleft lip is more common than cleft lip/palate and cleft lip alone is a different entity than cleft lip and palate combined

Stroke in elderly patients admitted at Mayo Hospital, Lahore

Early constitute a major proportion of our population. Our study at West Medical Unit of Mayo Hospital, Lahore was based on elderly patients presenting with various types of stroke. Out of 206 elderly patients, 28 had stroke. 12 were female and 16 male. 3 had transient ischemic attack [TIA], 16 suffered from thrombotic stroke and 9 from haemorrhagic event. 6 patients from study group died and 2 left against medical advice. We concluded that stroke is a disease of the elderly imposing major impact on their mortality rates, age being a major risk factor. Hence stress should be laid on the disease as well on the elderly which constitute a major portion of our population

Stability of sulphacetamide sodium in eye preparations

The effects of light, temperature, pH and additives on the stability of Sulphacetamide sodium in eye preparations have been studied. The Sulphacetamide eye drops are stable at room temperature and lose potency at elevated temperature. The stability is also affected by light and pH of the solution. The eye drops are more stable when Sodium mctnbisulphitc and Phenyl mercuric nitrate are used as preservatives

Effects of quality of water on enteric disorders of protozoal origin

Enteric disorders of protozoal origin i.e. Amoebiasis and Giardiasis are a major health problem in India. They are mostly water-borne. The prevalence of these disorders largely depends on quality of water consumed. The quality of water in India is. still below the recommended standards i.e. zero coliform per 100 ml of water [W.H.O., 1984].The present study, which was conducted in Jamalpur a suburb of Aligarh District [U.P.], included a total of 1270 individuals. The period of study was one year. Water supply in these houses was mainly [89.2%] from standpost. A few have access to piped water supply, The occurrence of Amoebiasis was very high i.e. 20.1% which was found mainly after 19 years of age. The average episode of Amoebiasis in standpost group and piped water group was 3 and 4 respectively.In standpost group majority of sample [87.3%] was contaminated as compared to piped water supply. The morbidity rate was higher in males than in females. The frequency of Amoebiasis was 18.8% and Giardiasis 25.2%. The occurrence of Giardiasis was common in 1-12 years of age and Amoebiasis had no specific group. The frequency according to standpost group and piped water group for Amoebiasis was 15% and 13.1% while Giardiasis 20.1% and 17.5% respectively. Giardiasis was more common in both source of water supply than Amoebiasis. The morbidity rate in standpost group was slightly higher

Comparison of early intravenous to oral switch amoxicillin/clavulanate with parenteral ceftriaxone in treatment of hospitalized patients with community acquired pneumonia

To compare the clinical efficacy and cost effectiveness of early intravenous to oral switch Amoxicillin/Clavulanate and parenteral Ceftriaxone in treatment of hospitalized patients with community acquired pneumonia [CAP]. Open, randomized, parallel group comparative study. Department of Medicine at Services Hospital, Lahore. Fifty patients with community acquired pneumonia requiring intravenous antibiotics on admission to the hospital and fulfilling study criteria were enrolled and randomly assigned to receive therapy either with Amoxicillin/Clavulanate or Ceftriaxone. Patients in Amoxicillin/Clavulanate group were switched from IV to oral antibiotics based upon switch criteria whereas those in Ceftriaxone group completed the therapy parenterally. The two groups were compared to each other on the basis of clinical and bacteriological outcome at the end of treatment and follow up. Treatment costs were calculated for the two study groups. The two study groups had equal clinical efficacy, both at the end of treatment and follow up. Mean duration of treatment was equal for both groups [8 days]; however mean hospitalization stay was significantly shorter [4.1 day] for Amoxicillin/Clavulanate group as compared to Ceftriaxone group [8.2 days]. The cumulative savings for intravenous to oral switch Amoxicillin/Clavulanate was Rs. 1,70,137 or Rs. 7,397 saved per patient. Early intravenous to oral switch Amoxicillin/Clavulanate had comparable clinical efficacy to parenteral Ceftriaxone and resulted in reduced hospitalization stay and decreased treatment costs and is a more cost effective treatment of community- acquired pneumonia patients requiring intravenous antibiotics on admission