Planned Second look laparotomy in neonatal volvulus: a safe approach for bowel salvage

Midgut volvulus can result in gangrene and loss of large segments of intestine. After correction of volvulus the viability of intestine may improve and if given sufficient time a large portion of intestine may be saved. A planned second look laparotomy in babies with volvulus and doubtful gut viability can be helpful in saving large bowel segment. We present a case of a newborn baby admitted with bilious vomiting, abdominal distension and melena. An urgent exploratory laparotomy showed midgut volvulus with near gangrene of about 35 cm of proximal jejunum and bluish discoloration of the rest of the small bowel. After de-rotation and warm packs, the vascularity of ileum and distal jejunum returned to normal, however the proximal jejunum remained dusky and bruised. Ladd's procedure was done and a decision was made to close the abdomen with a plan for a 2nd look laparotomy after 24 hours. A relook laparotomy performed after 24 hours showed, a well vascularized small bowel. No bowel resection was required and abdomen was closed. The baby improved and was discharged in stable condition with no long-term ischemic complications. This case indicates that a second look laparotomy may provide time for revascularization of the intestine with doubtful vascularity and avoid unnecessary bowel resection

Are we missing the diagnosis of depression in patients with rheumatoid arthritis at a tertiary care facility?

Objectives: To determine if we are missing clinical depression in patients with Rheumatoid Arthritis and its relationship with functional disability and level of formal education in such patients

Methods: The data for this cross-sectional, analytical study was gathered from May 2015 till December 2015 and comprised of 128 with Rheumatoid arthritis diagnosed according to ACR/EULAR 2010 criteria. The study was conducted at Fauji Foundation Hospital Rawalpindi. Functional status was assessed with Modified Health Assessment Questionnaire [mHAQ] and Beck's Depression Inventory [BDI] was used for evaluation of symptoms of depression. The relation between depression, functional disability and educational status was established using Pearson correlation coefficient

Results: The study included 128 patients with no previous diagnosis of depression. 122 [95.3%] were females and 6 [4.7%] were males. The mean age was 51.75 +/- 9.25 years. Mean duration of disease was 8.95 +/- 7.1 years. According to this study, the diagnosis of clinical depression was missed in 47.7% of patients with Rheumatoid Arthritis who had been under regular follow up at a tertiary care facility. About 18% were keen to seek professional help for depressive symptoms while 62.6% had functional disability [mild - severe]. There is a positive correlation with BDI [Pearson's correlation +1] and functional disability. No correlation could be established between level of education and depression as out of 79 [61.7%] patients with no basic education, 45.5% had depression. In remaining 49 [38.2%] patients, with some formal education, 51.3% had clinical depression

Conclusion: Almost half of the patients with Rheumatoid Arthritis coming to a tertiary care set up had clinical depression but were never diagnosed or referred to a Psychiatrist. There is a positive correlation between depression and functional disability; however no statistically significant correlation could be established with the level of formal education. The study further emphasizes the importance of early recognition and swift referral of such patients to a psychiatrist since it is known to improve both treatment outcomes and functional status

Dental anxiety level of patients presenting to operative dentistry department

Dental anxiety is a fear of visiting a dental health care provider for preventive or therapeutic care that leads to deterioration in oral health. The aim of this study was to measure the dental anxiety levels of patients presenting to the Operative dentistry department of Dental Section Dow International Medical College. It was a cross sectional study conducted between December 2014 and February 2015. Norman Corah's dental anxiety scale was used to measure the anxiety levels of patients.1 A questionnaire was developed based on this scale and a valid record of 383 forms was obtained. Amongst 383 patients, 125 were male patients [32%] while 258[67%] were female. Descriptive analysis was performed. Frequencies and cross tab calculations were carried out using SPSS version 20. Among other stressors, dental handpiece stood out as the most frightening. 12% of the respondents replied that they would get extremely anxious, making them feel physically sick while anticipating the use of a dental drill. Result showed that most of the patients [49%] had moderate dental anxiety that could be managed by simple non pharmacological means and counselling. While only 5% and 8% of the patients had high and severe [phobia] dental anxiety respectively. The mean dental anxiety level was 9.35 with Standard Deviation of +/- 3.06. More females had severe dental anxiety as compared to males [9% as compared to 5%]

Knowledge, attitude and perception of dental fraternity towards practice of rubber dam

Rubber dam isolates operating field and makes treatment less invasive and safer for the patient. The aim of this study was to evaluate knowledge, attitude and practice of using rubber dam among different strata of dental fraternity. This cross sectional survey was conducted at Dental section, Dow International Medical College; DUHS from November 2014 till may 2015. Four hundred questionnaires were distributed amongst dental students, house officers and postgraduate trainee. General practitioners and retired dentist were excluded from the study. Three hundred and seventy four questionnaires were returned with over all response rate of 93.5%. Data was analyzed by using SPSS version 20. Statistically there was a significant association between knowledge and designation [p=0.031]. Dentist showed positive attitude towards rubber dam application [p=0.00]. It is concluded that dentists have significant knowledge about rubber dam use, but general reluctance towards it require change in the attitude by improvising regular practice

Comparison of post instrumentation pain in teeth during root canal treatment with or with out occlusal reduction

The objective of the study was to compare the post instrumentation pain in teeth undergoing root canal treatment with or without occlusal tooth reduction. This randomized control trial was conducted at Outpatient Department of Operative Dentistry at Altamash Institute of Dental Medicine from September 2011 to March 2014. A total of 402 patients with irreversible pulpitis and normal periapical radiographic appearance of posterior teeth were included in this study. Patients were randomly allocated into two groups i.e occlusal tooth reduction [OTR] group and no occlusal tooth reduction [NOTR] group. After root canal instrumentation, patients were instructed to complete a Visual Analogue Scale [VAS] to score their pain at 6 hours, 12 hours, 18 hours, 24 hours, 2 days, 3 days, 4 days, 5 days, and 6 days. The final outcome that is mean post instrumentation pain score was measured at 6 days of post instrumentation. This randomized control trial was conducted at Outpatient Department of Operative Dentistry at Altamash Institute of Dental Medicine from September 2011 to March 2014. A total of 402 patients with irreversible pulpitis and normal periapical radiographic appearance of posterior teeth were included in this study. Patients were randomly allocated into two groups i.e occlusal tooth reduction [OTR] group and no occlusal tooth reduction [NOTR] group. After root canal instrumentation, patients were instructed to complete a Visual Analogue Scale [VAS] to score their pain at 6 hours, 12 hours, 18 hours, 24 hours, 2 days, 3 days, 4 days, 5 days, and 6 days. The final outcome that is mean post instrumentation pain score was measured at 6 days of post instrumentation. Mean post instrumentation pain score at 6 days was significantly low in OTR group than NOTR groups [2.44 +/- 0.86 vs. 3.24 +/- 0.89; p=0.0005]. Thus, it is concluded that occlusal reduction help in the prevention of post instrumentation pain in teeth with irreversible pulpitis, sensitivity to purcussion, pre- treatment pain and absence of periradicular radiolucency. Whereas the presence of all four conditions are the strong predictors, the presence of any one or more of the conditions is enough to indicate a need for occlusal reduction

relationship between widths of upper anterior teeth and facial widths

The scope of the study was to determine the ratio between maxillary anterior teeth widths to width of facial proportions in a dental college in Karachi, Pakistan. The widths of facial proportions were determined using a Vernier Caliper. The widths of maxillary anterior teeth were measured intraorally using Boley's gauge on a sample of 116 human subjects visiting the Diagnosis Department in Dr Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, [DIKIOHS], Dow University of Health Sciences, Karachi, Pakistan. All readings were measured in millimeters. Pearson's correlation test was applied and it showed no significant relation between width of central incisor and bizygomatic width [0.11]. But a significant relationship was found between intercanine width and width of mouth [0.03], width of philtrum and mean width of central incisors [p=0.05], interalar width and intercanine width [p=0.00]. Facial proportions solely do not provide a secure prototype in selecting maxillary anterior teeth and could result in selecting larger teeth in size

Bonding of acrylic resin teeth with denture base resin

The debonding of acrylic resin teeth with the denture base resin has been related to several different factors of which contamination of the bonding surfaces with wax has been suggested as the major cause. The purpose of this study was to determine the efficient method of wax removal from denture teeth using hot water at different temperatures ranges. Acrylic rods were used as tooth analogues and Raman spectroscopy was used to detect the presence of wax on the surfaces of the specimens. It was found that none of the techniques studied was able to remove all of the wax. Abraded ridge-lap surface showed least wax contamination when dewaxed at 100 degree C as compared to dewaxed at 85 degreeC and 65 degree C respectively. The spectrum for each specimen demonstrated peaks at different wavelengths and varying intensities, the spectra demonstrated traces of wax on abraded surfaces showed least wax when dewaxed at 100 degreeC as compared abraded surfaces dewaxed at 65 degree C and 85 degree C temperatures respectively

Interferon-induced central retinal vein thrombosis

A middle-aged lady presented with sudden onset of unilateral central retinal vein thrombosis after completing 6 months course of interferon and ribavirin for chronic hepatitis C infection. She had no risk factors and all her thrombophilia workup was normal, however, she was found to be dyslipidemic which may have contributed to atherosclerosis and predispose to thrombosis. Despite anticoagulation, her visual acuity deteriorated. This case illustrates the possibility of unpredictable visual complication of interferon. Frequent eye examination should be undertaken in patients having underlying risk factors like diabetes, hypertension or dyslipidemia undergoing interferon therapy

Pattern of indications of flexible bronchoscopy among adult patients in a tertiary care hospital

Background: Flexible fiber optic bronchoscopy is frequently performed procedure in pulmonary medicine

Objective: To determine the Clinico-radiological indications of flexible bronchoscopy in a tertiary care hospital

Materials and Methods: This descriptive study was conducted in the bronchoscopy suit of pulmonology department post graduate medical institute[PGMI], Lady Reading Hospital, Peshawar from Jan 2008 to Dec 2010. This was a retrospective analysis of the well maintained records of patients in whom bronchoscopy was done in the above mentioned duration. All the patients above 15 years were included. All the bronchoscopies were done by expert brochoscopists under local aneasthesia. Data was analyzed by SPSS 13 to find the frequencies and percentages

Results: Total number of patients were 423, with a male to female ratio of 1.6:1, in which 191 had haemoptysis , 115 presented with chronic cough, 42 had shortness of breath [SOB] , 11 presented as superior venacaval [SVC] obstruction, 25 had lobar or full lung collapse on chest x rays and 9 patients had solitary or multiple nodules, 8 were scoped for removal of foreign bodies, 4 for medical fitness and 2 for persisted fever. After analysis of x-rays of proven malignancies out of 60 patients, 20 [33.33%] had right side non-resolving consolidation, 18 [30%] Left side consolidation,08 [13.4%] presented with hilar mass, 03 [5%] with multiple nodules, 04 [6.66%] with mediastinal widening , 03 [5%], with left sided lobar collapse, 02 [3.33%] with right lobar Collapse and 02 [3.33%] had either side full lung collapse

Conclusion: Bronchoscopy is an important tool for the diagnosis of the cause of radiological/clinical findings like haemoptysis, chronic cough, SOB, SVC obstruction, hoarseness of voice and persistent x-ray opacity, or lobar or lung collapse. Heamoptysis and chronic cough are the main indications in our setting. Bronchoscopy is minimally invasive procedure with high diagnostic yield for bronchogenic tumours especially central

Histamine receptors; responses and modulations towards agonist and antagonist on the rabbit ileum, in vitro study

This research work deals with the mechanism of action involved in determining the therapeutic potential of histamine and its blockers in gastrointestinal motility. Rabbits of equal weights were used in this study. They were brought from the animal house of BMSI, sacrificed in the Pharmacology Research laboratory. lleum strip were isolated and with special recommended methodology, longitudinal and circular muscles were separated. Individual muscle strip were then exposed separately to the desired drugs in the organ bath and reading were recorded on the polygraph machine. Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. 1996 to 1998. Histamine increases the contractile effects of longitudinal and circular muscle. H[1] and H[2] blockers potentiate its effects on longitudinal muscle while in circular muscle no change was observed with H[1] blocker whereas H[2] blocker antagonized the histaminic effects. However when H[1] blocker applied directly it increases the amplitude of contraction in longitudinal and circular muscle whereas H[2] blocker decreases the height of contractions. Histamine in the presence of H[1] and H[2] blocker augmented their effects in longitudinal muscle and antagonizes in circular layer. Gastrointestinal motility can be controlled through histamine and its antagonist. New drugs can be formulated on the basis of this study for the regulation of intestinal motility

Diabetic autonomic neuropathy: frequent life disabling complication of diabetes-mellitus in low socioeconomic group

To determine the frequency and pattern of au-tonomic neuropathy in diabetic patients belonging to low socio-economic group of Korangi industrial area, Karachi. A selective group of 400 [168 male and 232 female] were investigated for the pattern of autonomic neuropathy. Thorough history, detailed physical examination, ECG monitoring and all baseline investigations were done. Complete evaluation of cardiovascular, gastrointestinal, urogenital, vasomotor and central nervous system was carried out. Data was analyzed in SPSS ver.14. There were 42% male and 58% females in the study. All of the patients had poor glycemic control. Orthostatic hypotension [43% abnormal], Hand-grip test [20% abnormal] and Valsalva maneuver [46% abnormal] were performed to assess cardiovascular autonomic neuropathy. While gastrointestinal, urogenital, vasomotor and central nervous system was assessed on clinical grounds. Prevalence of 40% is high at an average diabetic duration of 5-10 years and is of considerable concern. Physicians can evaluate autonomic as well as peripheral nerve dysfunction among diabetics through simple tests. Therefore stress on patient's education and awareness about the disease, its complication, treatment modalities and glycemic control is important

Outcome of tuberculosis patients registered during 2007 in major teaching hospitals of Peshawar

To evaluate the efficiency of TB diagnostic centers of teaching Hospitals of Peshawar against the set target of treatment success rate of 85% in the teaching hospitals of Peshawar. This descriptive study on data analysis was carried out in National TB Programme [NTP] Centers in major teaching hospitals of Peshawar, NWFP. The patients included in this study were registered from 01/01/07 to 31/12/07. National TB Program [NTP] registers from the three teaching hospitals i.e. Lady Reading Hospital, Khyber Teaching Hospital, and Hayatabad Medical Complex, were studied. All the patients registered in year 2007 were studied for their outcome. The study included 306 patients. Male were 153 [50%] and 153 [50%] females. 191 [62.4%] patients were below 30 years of age, 87 [28.4] patients were between the ages of 31-60 years of age and 28 [9.2%] patients were above the age of 61 years. 149 [48.7%] patients had pulmonary tuberculosis, whereas 157 [51.3%] patients extra pulmonary tuberculosis. Among the Pulmonary tuberculosis patients 101 [67.8%] were smear positive, while 38 [25.5%] patients were smear negative. Out of these 306 patients, 294 [96.1%] patients were new cases and 12 [3.92%] patients were relapses. All registered patients included in the study were followed for 8 months at monthly intervals. 110 [35.9%] patients were cured, 194 [63.4%] patients completed their treatments. Only in 1 patient treatment failed, 1 died, while none of the patients defaulted. The treatment success rate was 99.4%.The performance of TB Control Programme at three teaching hospitals of Peshawar in year 2007 was excellent, showing treatment success rate of 99.4% which is way above the target set by W.H.O. of 85%

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

Study of current management of community acquired pneumonia and strategies for improvement

To see that the patients admitted with community acquired pneumonia [CAP] are managed in accordance with British Thoracic society recommendations and guidelines. All patients admitted with Community-Acquired Pneumonia in medical wards admitted in large district general hospital setting in UK, were audited. The study period was between September and October 2002. Permission for the study was taken from the local hospital trust audit department. Seventy one sets of notes were reviewed leaving 38 patients appropriate for inclusion into the study. The findings observed in the record revealed that, Respiratory rate was not recorded in 36.8% [n=14] patients, level of confusion not recorded in 47.4% [n=18], Blood cultures not sent in 42.1% [n=16] patients, sputum not sent for culture in 47.4% [n=18] cases. Inappropriate antibiotics used 18.4% [n=7], treatment time of senior review not documented in 36.8% [n=14], radiographic findings not documented in 13% [n=5] cases. No follow up arrangements were made in 13.2% [n=5]. Average time of senor review was 6 hours and average time of antibiotic given after admission was 2 hours. This audit shows that even in a developed country with well-established guidelines for management of different diseases, guidelines for management of community-acquired pneumonia are not strictly adhered to. More efforts need to be made for dissemination and implementation of these guidelines

To study the outcome of patients with Multi-Drug Resistant Tuberculosis and see the effectiveness of second line drugs available in Pakistan in the management of MDR TB

MDR TB is a difficult problem to treat specially in countries like Pakistan, where facilities to treat the patients in hospital for the whole course of treatment are limited and also all the effective second line drugs are not available. This study was aimed to see the effectiveness of second line drugs that are available in Pakistan in terms of sputum conversion and cure rate and to see the resistance pattern of MDR TB. This study was carried out from 1st March 1995 to 31st Dec 2001 in a Chest Clinic in Peshawar. All patients having active Pulmonary Tuberculosis with history of irregular treatment in past were included in the study irrespective of age and sex. Their sputum samples were sent for AFB culture and sensitivity and they were started on second line anti tuberculosis drugs. The pattern of drug resistance was noted from results of culture and sensitivity results, when available. The progress of the patient was monitored by clinical assessment, sputum examination and Chest Radiographs on subsequent follow up visits monthly for first three months and then at 2-3 months intervals until completion of treatment. 70 patients, [40 males and 30 females] were included in the study. 05 patients excluded after their sputum C/S showed that they were not having MDR TB. 38% patients had bacilli resistant to all 06 first line drugs, 20% resistant to 05% drugs, 25% resistant to 04 drugs, 12% resistant to 3% drugs and only 05% were only resistant to 02 drugs i-e Rifampicin and INH. Regimen used was Kanamycin 15 mg/kg, Ofloxacin 400-800 mg/day, PAS 150 mg/kg, Ethionamide 15 mg/kg and Thiacetazone and INH 2.5 and 5 mg / kg respectively. The regimen was modified after C/S report with addition of first line drugs to which the bacilli were sensitive. At the end of 02 months the conversion the conversion rate was 79%. Treatment Outcome: 55% patients were cured, 21% lost, 10% had treatment failure and 2% reported dead. Half of the patients cured have been attending for optional follow up for the period ranging from 1 to 6 years and only two patients have relapsed so for. The second line drugs that are available in Pakistan are effective both in terms of sputum conversion and achieving cure. Large number of patients lost signifies the fact that these patients need to be hospitalized and treated under direct supervision for the whole period of treatment as recommended

Indigenous development of antibody screening cell panels at armed forces institute of transfusion [AFIT]

To prepare good quality screening cells reagent according to the standards, at Armed Forces Institute of Transfusion [AFIT]. Random group O donors, seronegative for HBsAg, HCV and HIV were selected if they resided in Rawalpindi or Islamabad and could be contacted. Micro column Gel technique was used to find out R1R1, R1wr, R2R2 and rr phenotypes with or without K antigen. Repeat sample of these donors were phenotyped for minimum antigens required for reagent cells. Teams of three donors each were made on the basis of Rh, K antigens and homozygosity for E, Fya,Fyb, Jka, Jkb, S, and s antigens. The selected cells were added to preservative suspension containing neomycin and chloramphenicol and dispensed as 8% solution and labeled. Cells were submitted to quality control testing for 35 days shelf life and efficacy was compared with commercial cells. The cells of required phenotype were prepared according to UK guidelines and AABB standards with minor exceptions. Reagent cells had excellent quality confirmed by many quality control procedures and were comparable to commercial cells in efficacy. The cost saving was significant. AFIT can introduce type and screen policy and Maximum Surgical Blood Ordering Schedule using indigenously prepared cells, of good quality and at an affordable price. This will enhance serological safety of recipients and brings AFIT near to adopting standard practice of pretransfusion testing

Iron deficiency anemia as a cause of breath holding spells

To assess the efficiency of iron therapy in reducing the frequency of breath holding spells. Material and This was a prospective, interventional study conducted in the department of Pediatrics, Hayatabad Medical Complex, Peshawar. A total of 50 patients between the ages of 6 months and 5 years with breath holding spells and mild to moderate iron deficiency anemia were studied. After giving them iron therapy for 8 weeks, they were assessed for the improvement in their anemia and its impact on the frequency of breath holding spells. Fifty children with iron deficiency anemia and breath holding spells were studied prospectively. Thirty-one [62%] cases were males and 19 [38%] females. The mean age was 27 months [SD '12.6]. The mean baseline hemoglobin was 9.79gm/dl. After 4 weeks of iron therapy it was 10.54gm/dl and after 8 weeks it was 11.23gm/dl. There was a statistically significant rise in the hemoglobin level with 8 weeks of iron therapy [p<0.001]. This rise in the hemoglobin level was associated with a statistically significant fall in the frequency of breath holding spells with 8 weeks of iron therapy [p<0.001]. It appears that treating iron deficiency anemia is effective in reducing the frequency of breath holding spells

Survey of chest specialists and trainees knowledge and practice of TB guidelines

To investigate the fundamental knowledge of TB guidelines and their application in day to day practice by the chest specialists and trainees working in teaching hospitals. A questionnaire-based survey was conducted among the participants of 5th biennial chest conference. The data of 195 doctors was analyzed. 96% of doctors said they were treating their TB patients according to guidelines and categorize their patients for treatment, but only 54% knew the correct number of categories for treatment as recommended by the guidelines. Only 49% knew about the components of DOTS. 85% doctors considered sputum microscopy most important diagnostic test for TB and 61% would use it for monitoring of their patients. 88% would advise sputum AFB culture and sensitivity in suspected cases of suspected drug resistance, 59% doctors would treat MDR TB patients themselves and 33% would refer to specialized centers. 5 declared them incurable. 47% and 30% doctors respectively recommended changes in WHO recommended fixed drug combination FDC during pregnancy and lactation. 58% doctors recommended chemoprophylaxis for tuberculosis in our setting. Overall fundamental knowledge of consultants regarding management of TB was good. Knowledge about DOTS and TB guidelines among all the doctors was average and needs improvement. Management of MDR TB by trainees is alarming in the absence of adequate knowledge and experience

Survey of awareness and management attitudes of chest specialist and trainees towards asthma

The study was aimed at three objectives: i. To know about doctors understanding of pathophysiology of Asthma. ii: To assess the knowledge of treatment of asthma and actual treatment practices by Chest specialists and Postgraduate trainees. iii: To assess the baseline knowledge, attitude and treatment practice in the absence of any local treatment guidelines and then see the effectiveness of the guidelines in changing their practice. A preset questionnaire was distributed among doctors from all over Pakistan, during 5th Biennial Conference on Lung Health in 2002. Each question was followed by a set of answers, of which one was to be tick marked. 66 doctors participated, 14 teaching consultants, 24 chest specialists, 14 postgraduate students, and 14 other doctors. 82% doctors would treat their patients on long-term basis and 18% would treat them acutely. 71% thought asthma was chronic inflammation of the airways whereas 28% thought it was due to bronchoconstriction and mucus plugging. Airways remodeling was considered to be partially or fully reversible by 90% and not reversible by 8%, 2% did not respond. 89% were fully aware of stepwise management of asthma and 11% were little aware. The grading of asthma severity was done by clinical examination 44% and clinical plus spirometery 56%. Inhalers were prescribed always by 35%, frequently by 57% and sometimes by 6%. 78% prescribed steroid inhalers alone or in combination with Beta 2 agonist, whereas 12% used only Beta 2 agonist. 93% would teach inhaler technique by themselves or by trained technician and 7% would leave it to chemists or patients. 88% would check inhaler technique on follow-up visit. 92% used oral drugs with inhalers. The choice of oral drugs varied between steroid [8%], theophylline [28%], Beta 2 agonist [37%], and leukotriene inhibitors [18%], no response [9%]. 47% sometimes and 50% never advised desensitization while 3% recommended it frequently. A significant proportion of doctors lacked a good understanding of pathophysiology of asthma. Although the majority of chest physicians and trainees were fully aware and correctly practiced, a significant number [i.e. one fourth] of doctors were not managing their patients with asthma correctly according to the guidelines

Indigenous development of antibody screening cell panels at armed forces institute of transfusion [AFIT]

To prepare good quality screening cells reagent according to the standards, at Armed Forces Institute of Transfusion [AFIT]. Random group O donors, seronegative for HBsAg, HCV and HIV were selected if they resided in Rawalpindi or Islamabad and could be contacted. Micro column Gel technique was used to find out R[1]R[1], Ri[w]r, R[2]R[2] and rr phenotypes with or without K antigen. Repeat sample of these donors were phenotyped for minimum antigens required for reagent cells. Teams of three donors each were made on the basis of Rh, K antigens and homozygosity for E, Fy[a],Fy[b], Jk[a], Jk[b], S, and s antigens. The selected cells were added to preservative suspension containing neomycin and chloramphenicol and dispensed as 8% solution and labeled. Cells were submitted to quality control testing for 35 days shelf life and efficacy was compared with commercial cells. The cells of required phenotype were prepared according to UK guidelines and AABB standards with minor exceptions. Reagent cells had excellent quality confirmed by many quality control procedures and were comparable to commercial cells in efficacy. The cost saving was significant. AFTT can introduce type and screen policy and Maximum Surgical Blood Ordering Schedule using indigenously prepared cells, of good quality and at an affordable price. This will enhance serological safety of recipients and brings AHT near to adopting standard practice of pretransfusion testing