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Purpose: To estimate the prevalence of diabetic retinopathy (DR), an emerging cause of sight threat and blindness from a large rural population in Pakistan. Methods: This was a population?based cross?sectional study. We selected a rural district of Matiari Sindh Province in Pakistan, where we selected all the health facilities and their attached Lady Health Workers (LHWs)/Lady Health Supervisors (LHSs). These female health workers were trained to identify high?risk diabetic individuals in their catchment areas using pre?defined criteria and to refer them to the nearest health facilities for screening and testing random blood sugar (BSR). Adults of 18 years or above, male or female, were included in the study for DM and DR screening. Ophthalmic examination was conducted by the optometrists on those who had BSR level >180 mg/dl for the evidence of DR. Identified DR patients were referred to a linked tertiary?level ophthalmology institute for their free DR treatment. Results: Of the identified and referred 24,463 participants, 23,999 were tested for BSR and 2,331 (9.74%) were found to be high?risk patients (BSR >180 mg/dl) and had ophthalmic examination conducted. Of these, 563 had clinically established DR, a prevalence of 24.2% (95% CI, 22–26%). Significantly more DR patients (228, 40.5%) were found in the age group >60 years, with more among female (327, 58.1%) with DR. Conclusion: DR is highly prevalent in the Pakistani rural population. The establishment of an integrated approach within the health care system could decrease the burden of DR in Pakistan
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Background: Primary percutaneous coronary intervention (PCI) is a recommended management strategy for patients with de novo ST-segment elevation myocardial infarction (STEMI). Still, the efficacy of primary PCI in-stent thrombosis (ST) induced STEMI is unclear. The aim was to assess the clinical characteristics and the in-hospital outcomes of patients undergoing primary PCI for STEMI caused by acute, sub-acute, or late ST. Methods: A sample of hundred consecutive patients who presented with STEMI due to ST were included in this study. The angiographic evidence of a flow-limiting thrombus or total vessel occlusion (thrombolysis in myocardial infarction (TIMI) flow grade 0 to II) at the site of the previous stent implant was taken as ST. Primary PCI was performed, and all enrolled patients and in-hospital mortality were observed. Results: Male patients were 69, and the mean age was 58.9 ± 7.78 years. ST was categorized as acute in 40 patients, sub-acute in 53, and late in the remaining seven patients. Killip class III/IV was observed in 45 patients. Dissection was observed in 25, under deployment in 74, and/or malposition in 24 patients. Thrombus aspiration was performed in 97, plain old balloon angioplasty in 76, and stenting in 22 patients. Final TIMI III flow was achieved in 32 patients. During a mean hospital stay of 4.93 ± 2.46 days, the mortality rate was 27%. Conclusion: In-hospital mortality after primary PCI was observed in more than 1/4th of the patients with STEMI due to ST undergoing primary PCI
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Objectives: Cardiovascular disease [CVD] represents the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus [T2DM]. Its incidence and risk factor patterns vary widely across different diabetic populations. This study aims to assess the incidence and risk factor patterns of CVD events among Omanis with T2DM
Methods: A sample of 2 039 patients with T2DM from a primary care setting, who were free of CVD at beseline [2009-2010] were involved in a retrospective cohort study. Socio-demographic data and traditional risk factor assessments at the baseline were retrieved from medical records, after which the first CVD outcomes [coronary heart disease, stroke, and peripheral arterial disease] were traced from the baseline to December 2015, with a median follow-up period of 5.6 years
Results: The overall cumulative incidence of CVD was 9.4% with an incidence density of 17.6 per 1000 person-years. Prevalence of poor glycemic control, hypertension, obesity, dyslipidemia, albuminuria, and current smoking were 40.0%, 56.3%, 39.0%, 77.3%, 18.7%, and 7.8%, respectively. The univariate survival analysis showed a significant association between CVD and the following factors: age, diabetes duration, body mass index, glycemic control, hypertension, total serum cholesterol, and albuminuria
Conclusions: This study revealed high incidence of CVD and high prevalence of its traditional risk factors among Omanis with T2DM. In addition, compared to global studies, important differences in the prevalence of some risk factors and their patterns in the univariate association with the cardiovascular outcome have been observed
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Background: diabetic foot ulcer is a major health problem around the world with a high morbidity and mortality rates. The good knowledge and practice pattern could decrease the diabetic foot ulcer complications
Objectives: this study aimed to evaluate knowledge of the diabetic patients regarding the complications of diabetic foot ulcer in Saudi Arabia [KSA]
Patients and Methods: this is a cross sectional community based study conducted from March 2017 to July 2017 among 920 diabetic patients. The subjects were interviewed in the shopping malls, pharmacies and coffee shops and asked to fill out a pre-tested questionnaire about the knowledge of complications
Results: the duration of diabetes was more than 10 years among 65% of them. About 40.9% of subjects were using oral hypoglycemic agents, 57.8% were using insulin for management of diabetes. The most common diabetic complication was retinopathy, while the most common foot ulcer complication was foot numbness and stiffness. The level of knowledge was good among most of subjects [77%], while 23% had insufficient knowledge regarding the diabetic foot ulcer. The good awareness was significantly associated with higher educational levels
Conclusion: the level of awareness about complications of diabetic foot was sufficient among most of Saudi subjects. But, there was an urgent need for raising the awareness and identifying the risk factors, educating the patients through increasing the patients and doctors relationship. The knowledge alone was not sufficient for assessing the practice pattern thus major studies must be conducted to assess the knowledge, attitude and practice pattern among Saudi subjects
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Objectives: transfusions are a common medical intervention. Discussion of the benefits, risks and alternatives with the patient is mandated by many legislations prior to planned transfusions. At the Sultan Qaboos University Hospital [SQUH], Muscat, Oman, a written transfusion consent policy was introduced in March 2014. This was the first time such a policy was implemented in Oman. This study therefore aimed to assess adherence to this policy among different specialties within SQUH
Methods: the medical records of patients who underwent elective transfusions between June and August 2014 were reviewed to assess the presence of transfusion consent forms. If present, the consent forms were examined for completeness of patient, physician and witness information
Results: in total, the records of 446 transfused patients [299 adult and 147 paediatric patients] were assessed. Haematology patients accounted for 50% of adult patients and 71% of paediatric patients. Consent was obtained for 75% of adult and 91% of paediatric patients. The highest adherence rate was observed among adult and paediatric haematology specialists [95% and 97%, respectively]. Consent forms were correctly filled out with all details provided for 51% and 52% of adult and paediatric patients, respectively. Among inadequately completed forms, the most common error was a lack of witness details [20-25%]
Conclusion: in most cases, the pre-transfusion consent policy was successfully adhered to at SQUH. However, further work is required to ensure full compliance with the consent procedure within different specialties. Implementation of transfusion consent in other hospitals in the country is recommended
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Objective: To compare the efficacy of topical Ciprofloxacin with Neomycin in the management of Chronic Supportive Otitis Media [CSOM]
Study Design: Randomized Clinical Trial [RCT]
Place and Duration of Study: Combined Military Hospital [CMH], Peshawar from Jan 2013 to Dec 2013
Patients and Methods: A total of 186 patients with the diagnosis of chronic suppurative otitis media were included in the study. Patients were randomly allotted to either group I that was treated by topical Ciprofloxacin eardrops [n = 93] or to group II, treated by topical Neomycin eardrops [n = 93]. Outcomes were measured by disappearance of discharge and congestion at follow-up examination. SPSS 16 was used for data analysis .Chi square test was used for analysis and p-values less than 0.05 were considered significant
Results: Topical Ciprofloxacin is more effective in earlier control of congestion and discharge of ear in CSOM; [p value = 0.001 and < 0.005 respectively] as compared to Neomycin
Conclusion: Topical Ciprofloxacin is a better drug for the treatment of CSOM as compared to topical Neomycin
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Ciprofloxacin , Neomycin , Drug Therapy, Combination , Treatment OutcomeABSTRACT
Objective: To determine the current preoperative informed consent practice in cases undergoing surgical procedures
Study Design: Observational / descriptive study
Place and Duration of Study: This study was conducted at the Surgery Department of PMC Hospital and PUMHS Nawabshah Sindh from Jan-2014 to April-2015
Materials and Methods: Following informed consent, 165 cases were incorporated in this study. Cases were randomly selected with suitable sampling technique and their surgical procedure was done electively, whereas those cases, which were treated conservatively and not capable of answering because of unconsciousness, eclampsia and shock, were not included in this study. Data was recorded on preplanned proforma concerning demographic information of cases, their knowledge regarding surgery carried out on them and the extent of data supplied them regarding risk, advantages of surgical procedure and other treatment choices
Results: Twenty nine [15%] cases were of age group of 20-35 yrs, whereas 104[53.88%] were of age group of 36- 50 yrs. Well-versed consent was obtained from the cases by surgeon in 63[32.64%] cases, by inhabitants in 105[54.40%], house officers in 10[5.18%] and by nurses in 15[7.77%] cases. This was ensured from the records of patients. When/ the patients were inquired, weather they completely grasped the data given to them, 86[44.55%] declared "yes" whereas 107[55.44%] did not grasp the data offered to them
Conclusion: Our study concluded that the majority of our contributors were conscious regarding the surgery done on them however they were provided little facts about risk, complications and advantages of the surgery
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Objective: The objective of this study was to find out the diagnosis of diagnostic laparoscopy in patients having chronic abdominal pain
Study Design: Descriptive / cross sectional study
Place and Duration of Study: This study was conducted at the Surgery Department of PMC hospital and PUMHS Nawabshah from February 2014 to March 2015
Materials and Methods: All the undiagnosed cases of chronic abdominal pain [by conventional methods and investigations such as clinical examination, urine examination, US abdomen etc], abdominal pain more than 3 months, cases age more than 18 years either gender and clinically diagnosed as chronic were selected in this study, while all the cases with known cause of pain, Acute inflammatory disease, cases having acute intestinal obstruction, coagulation abnormalities, critical illness, severe/decompensated cardiopulmonary failure and medically unfit for anaesthesia and surgery were not selected in this study. Diagnostic laparoscopy was performed in all selected cases and findings were entered in proforma
Results: Total 45 patients underwent diagnostic laparoscopy majority of the young patients was found. Female were found in the majority 60% as compare to males 40%. 13 [28.88%] patients had pain in right iliac fossa, 08 [17.78%] patients had hypogastrium pain, 10 [22.22%] cases were found with whole abdominal pain, 10 [22.22%] patients had pain in left iliac fossa and 04 [8.89%] patients were noted with pain at right hypochondrium. According to laparoscopy findings, appendicitis and adhesions were most common 14[31.11%] and 10[22.22%] respectively, following by Abdominal tuberculosis, Hernia, Mesenteric lymphadenopathy, Ovarian cyst and Dense adhesions + Thickened gall bladder wall with percentage of 06[13.33], 03[6.67%], 02[4.44%], 04[8.89%] and 02[4.44%] respectively, while 04[8.88%] cases were noted without any disease
Conclusion: Diagnostic laparoscopy in good tool for diagnosis of chronic abdominal pain, according to the assessment the commonest basis of chronic recurrent abdominal pain in this study was appendicitis followed by abdominal tuberculosis and adhesions
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Diabetes mellitus is a metabolic disease which poses a major challenge to healthcare and is characterized by elevated blood glucose levels resulting from either an underproduction or underutilization of the insulin hormone. The actual cause of Type 1 diabetes is unknown, but it most likely results from an autoimmune mediated destruction of the insulin producing pancreatic beta cells that reduces or terminates insulin production. On the other hand, type 2 diabetes is often caused by obesity and induces a gradual desensitization of the body’s cells to insulin. Recent advances in diagnostic methods have heralded in a new era of diabetes management with improved glucose control, reduced fear of complications and better compliance with intensive therapies. Additional efforts are being made to refine these methods to allow their implementation into clinical practice and gain universal acceptance. Advances in diagnostic methods for insulin delivery and glucose monitoring are an important step forward in greatly improving the lives of diabetic patients.
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Background: Different methods of heparin extraction are being used
Objective: To compare heparin extraction from bovine pancreas by using three different methods including method of Charles and Scott, Max and Volpi
Methodology: Design: Comparative Study. Setting: The University of Lahore with three month's duration starting from 1[st] July 2013. Fresh twenty samples of bovine pancreas samples were collected from the slaughterhouse of Lahore Pakistan and immediately placed in the ice buckets. The isolated heparin samples were separated into two species, slow moving and fast moving heparin by agarose gel electrophoresis. The anticoagulant activity of heparin samples was determined by using assay of Mitali et al [1982]
Results: The percentage yield of heparin extracted by Volpi method was significantly higher [P<0.001] i.e. 0.446% with the anticoagulant activity of 19 IU/ mg for bovine pancreas
Conclusion: Heparins are important in the field of medicine and pharmaceuticals. The results of our study showed that heparin isolated by the method of Volpi was significantly higher for bovine pancreas
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Objective: To compare the clinical outcome between mineral trioxide aggregate apical plug and mineral trioxide monoblock technique of endodontic apexification procedure of non vital permanent incisors with open apexes
Study design: Clinical in vivo Cross sectional comparative study
Place and duration: Endodontic department/College of Dentistry Ziauddin University, Karachi. Study duration was from January 2010 to January 2013
Methodology: Total fifty patients of male or female visited Endodontic department with non vital permanent maxillary incisors with open apexes were selected. The selected teeth were divided into 2 groups by simple random method. Group A was treated with MTA apical plugtechnique and the group B was treated with MTA monoblock technique. The assessment of clinical outcome was carried out at 12 and 24 month follow-up appointments. The presence of signs and symptoms with treated cases were considered as clinical failure, while treated cases without symptoms were considered as clinical successful cases. The treated cases were also checked radiographically according to the published criteria of evaluation and categorized as successful, uncertain outcome and failure cases. The recorded data were analyzed by using the statistical software
Results: The results of the study showed clinical success in both group and radiographic success was found to be 68% and 76% in MTA apical plug group and 84% and 92% in MTA monoblock group at 12 and 24 months intervals
Conclusion: This study have showed no significant difference in clinical outcome of MTA apical plug and mineral trioxide monoblock technique for endodontic apexification procedure of non vital permanent incisors with open apexes
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Ten patients presented with non-vital immature teeth for root canal treatment. In all these cases the pre-operative clinical examination revealed apical periodontitis with a buccal sinus tract of endodontic origin. These cases were treated by a mineral trioxide aggregate [MTA] monoblock obturation technique. Follow-up evaluations were performed at 1 - 2 years after treatment. Eight out of 10 cases were associated with periradicular healing at follow-up evaluation. Mineral trioxide aggregate Monoblock obturation technique appears to be a valid material to obtain periradicular healing in teeth with open apices and necrotic pulps
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Background: The normal vaginal flora contains a variety of microorganisms. Vaginal discharge is a common gynaecologic problem especially among sexually active females. Pathological vaginal discharges are usually due to infection or inflammation of vagina and/or cervix
Objective: To find out the frequency of aerobic gram negative rods in high vaginal swabs and to determine their antimicrobial susceptibility profile
Materials and Methods: This study was conducted in Microbiology laboratory, Pathology Department, SZMC/H, Rahim Yar Khan from 1[st] January, 2012 to 30[th] June, 2012. High vaginal swabs were collected from 100 females visiting antenatal clinics and gynae OPD of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Samples were cultured on blood and Mac Conkey agar plates. Plates were incubated aerobically at 35-37°C. All positive cultures were identified by gram staining, cultural characteristics and biochemical reactions. The antimicrobial susceptibility testing of all isolates was done by standard disc diffusion method
Results: Majority of culture positive females were between 25 to 30 years of age. Escherichia coli [72%] was the predominant organism, followed by Klebsiella spp [16%], Enterobacter [6%], Proteus spp [2%], Morganella [2%], Pseudomonas spp [2%]. All these isolates showed good sensitivity towards imepenem and cefoperazone-Sulbactam
Conclusion: In this study, E.coli were the predominant organism, followed by Klebsiella spp. Imepenem and cefoperazone-sulbactam were the most effective antimicrobials against all isolates
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Background: Worldwide, tuberculosis and viral hepatitis are common diseases and both remain underdiagnosed and under-treated. Co-infection with tuberculosis and hepatitis is likely to make diagnosis, management and control of either disease difficult and challenging
Objective: To determine prevalence of HCV and HBV infection among PTB patients at Rahim Yar Khan, Pakistan
Patients and Methods: One hundred sputum smear positive pulmonary tuberculosis patients were screened for HCV and HBsAg. In this cross-sectional study, from 1st April to 31st December, 2010 results were analyzed by age, gender, marital, educational and socioeconomic status by using SPSS version 15
Results: Sociodemographic data showed that 66% patients were young between 15-49 years. Only 8 patients had history of blood transfusion, 4 had traveled abroad and none was drug abuser. Most of them were poor. Out of 100 patients [56 male and 44 female] 22% patients were positive for HCV and 3% for HBsAg. Prevalence of HCV infection was significantly higher in married [p value 0.03] and in those with history of blood transfusion [p value 0.004]. No significant statistical difference of prevalence of HCV between male and female, urban and rural, educated and uneducated and in those who traveled abroad or not was found
Conclusion: Prevalence of HCV infection among the pulmonary tuberculosis patients at Rahim Yar Khan [22%] is alarmingly high as compared with general adult Pakistani population [approx. 4.7%]
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To determine the socio-demographic characteristics, clinical profile and outcome of the tetanus patients. Case Series SICU of Peoples University of Medical and Health sciences [PUMHS] Nawabshah, from January 2010 to December 2012. The information obtained from the attendants of patients who presented with clinical features of tetanus and classified into generalized and cephalic types and; severity was classified into mild, moderate severe and very severe. Treatment was started immediately with protocol of supportive care; neutralization of circulating toxin and eradication of the source of tetanospasmin. Details of socio-demographic data, clinical features, complications and outcome were recorded and entered in a questionnaire before analysis. Twenty two cases of tetanus were studied included males were 16 and females were 6. Six of 22 [27.3%] patients had prior tetanus immunization while the other sixteen [72.7%] patients were not vaccinated or did not know their tetanus immunization status. Lower limbs were most common of portal of entry 15 [68.2%]. Most of patients [95.5%] have generalized tetanus and 5 [22.7%] patients had very severe disease. Body stiffness/spasm [100%], trismus [100%] and dysphagia [68.2%] were the three commonest presenting complaints. Complications of tetanus were documented in 16 [72.7%] patients. Overall mortality was 68.2%. Tetanus prevalence is still high in interior Sind and is associated with high morbidity and mortality rate
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Infections due Hepatitis B and C with co-infection tuberculosis are important health issues all over the world. In TB patients, viral hepatitis infection increases risk of drug related hepatotoxicity up to three to five times more than TB patients which do not have viral infection. The study was designed to determine the frequency of Hepatitis B and C among the tuberculous patients admitted at Sheikh Zayed Hospital, Rahim Yar Khan. This is descriptive and cross sectional study which was conducted at Sheikh Zayed Hospital Rahim Yar Khan from September 2011 to April 2012.Blood samples were collected from TB patients aseptically from Pulmonology Department Sheikh Zayed Hospital Rahim Yar Khan. HBsAg and anti HCV antibodies were detected using ICT and ELISA techniques according to SOP of the kit manual. Among the 110 TB positive patients,5.5% were positive for HBsAg and 9.1% were positive for anti HCV antibodies using ELISA technique. Whereas, 5.5% HBsAg and 10% anti HCV antibodies were positive using ICT. The transmission of HBV and HCV was expected to have occurred were mostly found in barber shop and during ear nose piercing [30%], blood transfusion [20%], visit to quack [10%] as indicated from the history. Detection rate of HCV using ELISA is greater than ICT method. Male to female ratio 1:1 and age mean was 42 with standard deviation 18.2. We found a relatively increased frequency of HBV and HCV among TB patient. Therefore TB patients should also be screened for HBV and HCV for better management of the conditions
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Asthma prevalence is increasing worldwide. Asthma is more common in developed countries than in developing ones. The main objective of this study is to determine the prevalence of asthma among primary school- aged children in Hadhramout governorate /Yemen. The sample was taken at multistage randomization during the period from 1St of February to 30th April 2006 using special questionnaires completed by parents of the children. Of the 2400 children who were included in this study, 2062 completed the questionnaires giving a response rate of 84%. The prevalence of bronchial asthma among primary school-aged children in the total sample was 15.2%. with 16.7% males and 13.5% females. In the urban areas the prevalence was, 16.1% and in the rural areas it was 14.2%. The main clinical presentations in asthmatic children were cough [100%] and breathlessness in 85.1%.The prevalence of asthma among primary school children in Hadhramout Governorate is 15,2%, which is similar to other countries. The prevalence of asthma in urban areas is higher than in rural areas.
Subject(s)
Humans , Male , Female , Prevalence , Schools , Child , Cross-Sectional StudiesABSTRACT
The objective of the present study was to evaluate the effect of aspirin (Acetyl Salicylic Acid) on the developing teeth of the fetus while the mothers were treated through out the pregnancy. Aspirin is a widely used analgesic and antipyretic drug used for symptomatic treatment. However, recent animal studies have indicated a potent teratogenicity of Acetyl Salicylic Acid. Its easy availability without prescription has been associated with high possibility of misuse, especially in the developing world. An experimental control study was carried out where female rabbits being treated with aspirin were taken as mammalian model, and their offspring were used to evaluate the developmental defects in teeth. Quantitative analysis of minerals in three types of the sample teeth, was done using scanning electron microscope and energy dispersive X-ray spectroscopy (SEM-EDX). Calcium was the most affected mineral and incisors and mandibular molars were found to be the most affected teeth. Voluminous variations were observed in the mineral contents of samples from the treated and control group, however, significant results could not be achieved. A larger sample size could possibly be needed to produce more conclusive results.
El objetivo del estudio fue evaluar el efecto de la aspirina (ácido acetilsalicílico) sobre el desarrollo de los dientes en fetos de conejos, cuyas madres fueron tratadas durante toda la gestación. La aspirina es un fármaco ampliamente utilizado como analgésico y antipirético para el tratamiento sintomático. Sin embargo, estudios recientes en animales han indicado una teratogenicidad potente por parte del ácido acetilsalicílico. Su fácil disponibilidad, sin la necesidad de receta médica, se ha asociado con una alta posibilidad de su mal uso, especialmente en el mundo desarrollado. Se diseñó un estudio de control experimental, donde conejos hembras fueron tratadas con aspirina, tomándose como modelo de mamíferos, y sus crías fueron utilizadoa para evaluar los defectos en el desarrollo de los dientes. Se realizó el análisis cuantitativo de tres tipos de minerales en los dientes de la muestra mediante microscopio electrónico de barrido y espectroscopía de rayos X por dispersión de energía (SEM-EDX). El calcio fue el mineral más afectado y los incisivos y molares inferiores fueron como los dientes más afectados. Grandes variaciones se observaron en el contenido mineral de las muestras de los grupos tratado y control, sin embargo, no se lograron resultados significativos. Un tamaño de muestra más sería necesario para producir resultados más concluyentes.
Subject(s)
Animals , Male , Adult , Rabbits , Aspirin/administration & dosage , Aspirin/adverse effects , Aspirin/toxicity , DentitionABSTRACT
The aim of the study was to investigate the prevalence of gingival disease with regards to the age and sex of the patients who sought treatment from Baqai Dental Hospital. Out of 746 patients, 524 [71.18% male and 28.82% female] were diagnosed as suffering from gingivitis, both acute and chronic. Standard protocol procedures for examination and diagnosis of gingival disease were followed. Lack of proper oral hygiene was concluded as the dominant causative factor