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Abstract The objective of this study was to conduct a systematic review and meta-analysis of relevant randomized control trials (RCTs) to determine the role of ibuprofen, as well as the optimum dose and duration of therapy, in preventing the incidence of heterotopic ossification (HO) after primary total hip arthroplasty (THA). A literature search was performed using the PubMed/MEDLINE and Cochrane Library databases for RCTs that compared the use of ibuprofen versus placebo as prophylaxis for HO in patients after THA. The main outcomes for this study were overall occurrence of HO, occurrence according to the Brooker classification, and gastrointestinal complications. A total of 27 potential articles were identified from the database. Eventually, four trials with 1,153 patients were included in the final analysis. When compared with placebo, the use of ibuprofen is associated with a reduction in the incidence of HO at the 3- and 12-month follow-up appointments, as well as the incidence of Brooker II and III HO (p < 0.05). However, there was no significant difference between the ibuprofen and placebo groups in terms of treatment discontinuation due to gastrointestinal complications or the incidence of Brooker I and IV HO (p > 0.05). The existing data indicates that ibuprofen is safe and efficacious in reducing the total incidence of HO along with Brooker II and III HO at follow-up. However, due to the small number of studies, the conclusions are limited; therefore, more high-quality clinical trials are required to develop guidelines for optimal dose and duration of therapy.
Resumo O objetivo deste estudo foi realizar uma revisão sistemática e metanálise de estudos clínicos randomizados (ECRs) relevantes para determinar o papel do ibuprofeno, sua dose ideal, e a duração do tratamento na prevenção de ossificação heterotópica (OH) após a artroplastia total primária do quadril (ATQ). Uma pesquisa bibliográfica foi feita nos bancos de dados PubMed/MEDLINE e Cochrane Library para a obtenção de ECRs quecomparassem ouso de ibuprofeno edeplacebo como profilaxiaparaOHem pacientes submetidos à ATQ. Os principais desfechos deste estudo foram ocorrência geral de OH, classificação de Brooker da OH, e complicações gastrintestinais. No total, 27 artigos foram identificados nos bancos de dados e 4 estudos, com 1.153 pacientes, foram incluídos na análise final. Em comparação ao placebo, o uso de ibuprofeno reduziu a incidência de OH aos 3 e 12 meses de acompanhamento e a incidência de OH Brooker II e III (p < 0,05). No entanto, não houve diferença significativa entre os grupos que receberam ibuprofeno e placebo em termos de interrupção do tratamento devido a complicações gastrintestinais ou da incidência de OH Brooker I e IV (p > 0,05). Os dados existentes indicam que o ibuprofeno é seguro e eficaz na redução da incidência total de OH e de OH Brooker II e III durante o acompanhamento. No entanto, as conclusões são limitadas devido ao pequeno número de estudos; logo, mais estudos clínicos de alta qualidade são necessários para o desenvolvimento de diretrizes em relação à dose e duração ideal da terapia.
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Humans , Ibuprofen , Ossification, Heterotopic , Arthroplasty, Replacement, HipABSTRACT
The study aimed to find the incidence and awareness of endodontic instrument separation and its management among dental house officers, postgraduate trainees, demonstrators, consultants, and general dentists. Methods: This online questionnaire-based cross-sectional study was conducted with the approval of the IRB in private and public dental hospitals and dental clinics in Punjab. The authors developed the survey tool, which comprises 24 closed-ended items regarding demographics, the incidence of file separation, and awareness about its management. The data were analyzed using IBM SPSS version 24. The Chi-Square Test was used to compare percentages of categorical variables. Results: Postgraduate trainees experienced the most instrument separations (43.6%), made the most retrieval attempts (49.2%), and experienced the most secondary errors during retrieval (52.1%) (p<0.001). Around four out of ten respondents always informed the patients (39.6%) and department (41.6%) about errors. Manual files (69.8%), stainless steel files (75.8%), and short files (60.4%) were more frequently separated, and the most frequent cause was older fatigue files (57.7%). Manual files were more frequently broken in public dental institutes (p=0.003). Two-thirds of the file separations (72.5%) occurred during cleaning and shaping in the apical third of molars (65.1%), especially in mesiolingual canal (56.4%). Bypass attempt was the most common in symptomatic teeth (47.7%). Conclusions: Preventive approaches such as limiting file reuse and constructing a glide path can reduce the occurrence of file separation. Operators should be familiar with the number of uses of the instrument before fatigue and should be trained through workshops and refresher courses
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Humans , Male , Female , Root Canal Preparation/instrumentation , Dental Instruments , Equipment Failure , Endodontists/statistics & numerical data , Pakistan , Root Canal Therapy/instrumentation , Incidence , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Introduction : We are moving towards a technically advanced Medical Education. However, effectiveness of online Teaching, Learning (T/L) remained unknown until COVID-19 pandemic.Aim : This study was planned to assess the perception of e-educators towards online T/L, the challenges and possible solutions during pandemic. Methodology : A mixed method cross-sectional study was conducted among 126 medical educators through online google survey from July to September, 2020 in a Tertiary Heath Care Institute & 2 neighbouring medical college. Result : Non response rate was 32%, 72.2% were males, 63.9% were between 31 to 50 years of age, 58% were having 10 or more years teaching experience. 36.2% were from basic sciences, 69.5% were holding higher academic post. 61% preferred combination of face to face and e-learning Although online classes were helpful in terms of 63.8% convenience, (54%) flexibility, 77.5% felt difficulties teaching and assessing skills domain. The major challenges encountered were technical glitches, no active participation and suggested solutions were technical assistance, formative assessments and use of new T/L, assessment tools. Conclusion : Although the change was negatively perceived, it’s inevitable. Training of faculties, sensitization of students and conducive environment is needed to combat the challenges, to improve the e-education system in health profession.
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Purpose@#Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer. @*Methods@#Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study. @*Results@#A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant. @*Conclusion@#This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.
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A series of new 2, 4-disubstituted quinazolines were synthesized by an analog design approach. The synthesis oftitle compounds (3a–f, 4a–c, 5a–c, and 6a–c) was achieved from the corresponding key intermediates 2-(pyridin3-yl) quinazolin-4(3H)-one(2a), 2-(pyridin-3-yl) quinazolin-4(3H)-one (2b) and 2-(pyrazin-2-yl)quinazolin-4(3H)-one (2c) with appropriate amines. The synthesized compounds were characterized by the spectral studies. All thesynthesized compounds were evaluated for in vitro anticancer activity employing 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay against human adenocarcinoma (HT-29), breast cancer (MDA-231), and Ehrlichascites carcinoma cell lines. Among the tested compounds, 5a has a significant anticancer activity (5.33 µM/ml)against the human adenocarcinoma cell line. Other compounds have shown a moderate anticancer activity against thetested cell lines.
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Background: Atherosclerotic coronary artery disease particularly myocardial infarction is the leading cause of morbidity and mortality all over the world and its incidence is also on the rise in Pakistan. This study was done to assess the effectiveness of thrombolytic therapy in patients with acute myocardial infarction and comparison between diabetics and non- diabetics.Methods: This cross sectional study was conducted at Department of Cardiology, Bahawal Victoria Hospital, Bahawalpur from January to June 2019. Total 380 patients of aged 30-70 years either male or female with diagnosis of acute ST-elevation myocardial infarction presenting within 12 hours of the onset of chest pain were selected. Patients were given thrombolytic therapy with Streptokinase 1.5 MIU over 1 hour and post therapy, efficacy was assessed.Results: Mean age of the patients was 51.37±10.08 years. Mean duration of diabetes mellitus was 5.99±3.47 years. Duration of chest pain ranged from 1 hour to 12 hours with mean duration of 4.66±2.98 hours. Out of 380 patients of MI, treatment was found effective in 202 (53.2%) patients. Female gender, type of MI, and duration of chest pain were significantly associated with reduced efficacy (p value < 0.05). Presence of hypertension, smoking, dyslipidemia or family history of MI did not alter the efficacy significantly (p>0.05) while patients having diabetes had significantly reduced efficacy (p value < 0.001).Conclusions: There is reduced effectiveness of thrombolytic therapy in diabetic patients with ST elevation myocardial infarction.
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Background: To compare the effectiveness of postpartum intrauterine contraceptive device (PPIUCD) with interval IUCD in terms of effectiveness, expulsions, bleeding pain and other complications at Tertiary care Hospital.Methods: Current study was conducted among 224 women, at Gynaecology and Obstetrics of Reproductive Health Services-A (RHS-A) Centre of Jinnah Post Graduate Medical center, Karachi, for a period of Six months. Approval from Ethical committee and informed consent was taken from women and her husband before starting the study. The WHO medical eligibility criteria for contraceptive use (MEC) were followed and IUCD was inserted in 112 women in PPIUCD group and in 112 women in interval IUCD group. These cases were followed at 15 days, 6 weeks and 6 months. Results of PPIUCD group were compared with interval IUCDs group. Data was analyzed by using SPSS version 18.0. Continuous variables like age, parity, hemoglobin level were analyzed as mean±standard deviation. Frequencies and percentages were calculated for infection, expulsion, bleeding per vagina and effectiveness. Chi-square was applied to assess the difference between the categories. p value <0.05 was taken as significant.Results: The two groups were identical in mean ± SD age, parity, residence and baseline hemoglobin level. PPIUCD (Group-A) was more effective i.e., 87.5% as compared to interval IUCD (Group-B) i.e., 83.9%. Pain, PID, bleeding and expulsion of IUCD were more prevalent with interval IUCD (Group-B) than PPIUCD (Group-A) patients. Stratified analysis showed that age, parity & mean baseline hemoglobin were non-significant effect modifiers on the effectiveness among the two groups.Conclusions: Postpartum IUCD use was found to be a safe, simple, inexpensive and reversible procedure with higher chances of retention for a longer period. Additionally, there is decreased risk of complications and lower expulsion rates when compared with interval IUCD.
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Background: Most of the complications are developed after modified radical mastectomy in breast cancer patients, hence to avoid and reduces the postoperative complications, this study is performed to identify the frequency of early post-operative complications of modified Radical Mastectomy within the period of four weeks.Methods: Cross-sectional case series using non-probability convenient sampling technique was conducted in surgical unit I of Tertiary care hospital, for 1 year from 15 January 2018 to 14 January 2019. 89 patients FNAC proved breast cancer were included, patients that received neoadjuvant chemo or radiotherapy or with inflammatory breast cancer, metastasis and with co-morbid were excluded. After taking consent patients were operated by senior consultant. Follow up was taken daily 7th post-operative day and then followed in OPD on weekly basis fourth week and final outcome was noted. SPSS version 23 was used for data analysis. Quantitative data was reported as frequency in percentages.Results: Total 31 patients developed complications during the study, accounts 34% of total patients. The most common complication was breast seroma in 12(13.48%) of cases with an increased risk in cases of age >50 yr, size of tumor >8 cm, weight >70 kg and increased number of lymph nodes [3 or above] palpable after wards hematoma in 6(6.74%), lymphedema in 5(5.62%), wound infection 4(4.49%) and shoulder dysfunction in 4(4.49%) patients, no patient was found scar hypertrophy.Conclusions: Seroma formation, hematoma were found most common early complications after modified radical mastectomy, lymphedema, wound infection and shoulder dysfunction were observed in small number of patients.
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Background: The diagnosis and prognosis of patients with breast cancer is routinely carried out with biopsy of growth by H&E staining but it is not commonly practice with various immunomarkers including HER2/neu. However HER2/neu association in breast tumour patients with prognosis has not been studied much, so this study is aim to evaluate the frequency of HER2 (human epidermal growth factor receptor) amplification and its effects over prognosis among the patients with breast cancer.Methods: After ethical approval, retrospective observational study was conducted from October 2014 to September 2017. All operated patients with biopsy proven breast cancer, the patients having any stage of disease, with sufficient data present in hospital record and patients who received neo-adjuvant chemo-therapy/radio-therapy were included. Patients unfit for surgery due to co-morbidities like cardio renal diseases and patients having insufficient hospital record or who missed follow-ups were excluded. SPSS version 20.0 was used for data analysis for data analysis with qualitative data presented as frequency and percentages.Results: A Total 120 patients, 48(40%) had HER-2/ neu positive. Among the HER2 +ve patients, 17(35.4%) had local recurrence within 03 years while 21(43.7%) cases had distant recurrence. The disease free survival rate in 03 years was observed in 22(45.83%) out of 48 HER2 +ve cases.Conclusions: Study reveals 40% patients had HER-2/neu positive expression and was associated with poor outcomes and disease free survival time period in comparison to patient with HER-2/ neu negative.
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Background: Diabetes, hypertension, oxidative stress, obesity, adipocytokine dysfunction, and dyslipidemia are causative factors in development of Chronic Kidney Disease (CKD). Adiponectin secreted from adipose tissue, has Reno protective effect against development of albuminuria in animal studies. The previous studies investigated the relationship between serum adiponectin level and urinary albuminuria in kidney disease patients, but the results are conflicting.Methods: The pre diagnosed kidney disease patients were divided into microalbuminuria and macroalbuminuria groups, while control subjects were called as normoal buminuria group. The pre diagnosed adult kidney disease patients of both genders with age matching control subjects with no known comorbidity were included in the study. Whereas pregnant female patients and the patients with comorbidity were excluded from the study. The demographic data and the anthropometric data of control and kidney patients were recorded. The blood was analyzed for Glycosylated Hemoglobin (HbA1c), electrolytes, glucose, calcium, total protein, albumin, urea, creatinine adiponectin and malondialdehyde. The Urine was analyzed for Creatinine and albuminuria. The glomerular filtration rate was estimated.Results: The blood pressure, blood urea, creatinine, glycated hemoglobin, malondialdehyde, adiponectin levels were higher in albuminuric kidney patients as compared to normal control subjects. The mean glomerular filtration rate was lowest in macroalbuminuric patients as compared to micro and normoalbuminuric patients. The serum adiponectin and serum malondialdehyde both showed positive correlation with serum creatinine, and with albuminuria/urinary creatinine ratio.Conclusions: The study concludes that, positive correlation of serum malondialdehyde with adiponectin and albuminuria.
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Objective: To profile the secondary metabolites and to evaluate the antidiabetic potential of hydroethanolic leaf extracts of Conocarpus lancifolius.Methods: The various hydroethanolic extracts o f Conocarpus lancifolius leaf were prepared by ultrasonication assisted freeze-drying. Total phenolic contents, flavonoid contents, antioxidant activity, α-glucosidase and α-amylase inhibitions of leaf extracts were determined. The metabolite profiling was accomplished by UHPLC-Q-TOF-MS/MS analysis. The antidiabetic assessment of the most potent extract was carried out by measuring the hypoglycemic and hypolipidemic effect in the high fat diet-fed diabetic albino mice. The blood glucose level, haemoglobin, total cholesterol, high-density lipoproteins (HDL) and low-density lipoproteins (LDL) were determined. Results: The 60％ ethanolic extract exhibited the highest phenolic and flavonoid contents of (349.39 ± 2.13) mg GAE/g dry extract and (116.95 ± 2.34) mg RE/g dry extracts, respectively, and the highest DPPH scavenging activity with an IC50 value of (32.87 ± 1.11) μg/mL. The IC50 values for α-glucosidase and α-amylase inhibitions were (38.64 ± 0.93) μg/mL and (44.80 ± 1.57) μg/mL, respectively. UHPLC-Q-TOF-MS/MS analysis confirmed the presence of gallic acid, ellagic acid, corilagin, kaempherol-3-O-rutinoside, caffeic acid derivative, isorhamnetin and galloyl derivatives in the 60％ ethanolic extract. Plant extract at a dose of 450 mg/kg body weight reduced blood glucose level, total cholesterol, LDL and HDL, and increased haemoglobin in alloxan-induced diabetic mice, Conclusions: Conocarpus lancifolius leaves are proved as a good source of biologically functional metabolites and possess antidiabetic activity which may be further explored to treat diabetes.
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Background: Migraine is one of the most common primary headaches, accounting for significant morbidity in patients suffering from it. An association between obesity and migraine has been documented in the past, despite some studies pointing to the contrary. Author’s purpose is to calculate the prevalence of obesity in migraine patients in order to contribute to the existing concepts. A positive correlation could lead to the employment of weight loss interventions in the management of obese patients with migraine.Methods: In this cross-sectional study, 400 patients, recently diagnosed with migraine, attending the Neurology Outpatient Department at the Dr. Ruth KM Pfau Civil Hospital Karachi were enrolled after taking informed consent. Migraine was diagnosed using International Classification of Headache Disorders III (ICHD III) criteria. Height (meters) and weight (kilograms) were measured and body mass index calculated. This data was kept confidential. The results were tabulated and analyzed using SPSS version 19. Continuous quantitative data were analyzed using chi square test. A p Value of less than or equal to 0.05 was considered significant.Results: The mean age of enrolled participants was 30.69±6.96 years, 204(51%) were >30 years of age, 159(39.8%) were male and 241(60.3%) were female, mean height was 1.55±0.1 meters, mean weight was 56.26±12.98 kg, and mean duration of migraine was 5.04±2.02 weeks. The prevalence of obesity in patients with migraine was 108 (27%).Conclusions: It was concluded that the prevalence of obesity in patients with migraine was 27%.
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Background: Procalcitonin in cerebrospinal fluid has been evaluated with regard to its usefulness in distinguishing between the possible causative organisms for infections. CSF PCT as a diagnostic marker has also been evaluated for differentiating bacterial from viral meningitis with conflicting results obtained so far. The current study was designed to see the role of procalcitonin as diagnostic marker and in differentiating bacterial from aseptic meningitis in pediatric age group.Methods: Children from 5 months to 15 years of age who were suspected cases of meningitis and were admitted to Pediatric Department in SKIMS Srinagar, Jammu and Kashmir were included in this case control prospective study conducted from 2014 to 2016. The total number of 200 children participated in the study among which 100 were cases and 100 controls. Serum and CSF PCT was measured by a fluorescence immunoassay using QDX Instacheck with a detection limit of 0.25-100 ng/ml. Data was analyzed by using standard statistical tests using SPSS 20.Results: The mean CSF PCT in ng/ml in our study for viral meningitis was 0.59'0.43 (range=0.00-1.90), for bacterial meningitis 4.92'1.50 (range=2.89-10.82) and for controls 0.22'0.11 (range=0.00-0.32), respectively. CSF PCT was significantly higher in viral and bacterial meningitis as compared to controls (p<0.01) and significantly higher in bacterial meningitis as compared to viral meningitis (p<0.01). An AUC of 1.000 was established using serum and CSF PCT for bacterial meningitis. The diagnostic accuracy of serum and CSF PCT was almost 100% at cut-off of 2.2 ng/ml and 2.89 ng/ml, respectively.Conclusions: Author have concluded that CSF PCT can be used as a diagnostic marker with better results in differentiation of bacterial from aseptic meningitis.
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Present work was conducted to determine the total aerobic plate count of raw chicken meat samples, isolation of the Listeria spp. and determining their pathogenicity along with antibiotic susceptibility pattern. The 100 raw chicken meat samples, collected from different retail outlets in and around Durg district of Chhattisgarh, revealed mean APC of 23.67×105 cfu/g (6.374 log10 cfu/g). Cultural examination of raw chicken meat samples showed an overall 37% prevalence of Listeria spp., comprising of L. monocytogenes (16%), L. grayi (11%), L. welshimeri (5%), L. ivanovii (3%) and L. innocua (2%). All the Listeria isolates exhibited a typical β-heamolysis with narrow zone on sheep blood agar and enhancement of hemolytic zone in CAMP test. The haemolytic Listerial isolates developed kerato conjunctivitis in Anton’s test and stunting as well as hemorrhages in liver and heart along with conspicuous thickening of CAM in chicken embryos. Results of antibiotic susceptibility testing of all Listerial isolates further revealed that most of isolates were multidrug resistance to antibiotics. The present work revealed that the raw chicken meat may act as an important source of Listeria for human being. The presence of multiple drug resistance among Listeria spp. isolates provides a evidence of the emergence of multi drug resistant Listeria strains, pointing to an increase in the potential threat to human health
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Background: In Pakistan age related vision disturbances are mainly due to cataract. Various studies have reported relationship of ocular lesion with senile changes and diabetes mellitus resulting in reduced quality of life due to vision. Oxidative stress is an important factor in the process of cataractogenesis. The pathogenesis of the cataract may involve decreased activity of antioxidant scavenging system which includes non-enzymatic natural antioxidants as biomolecules such as carotenoids and vitamins. So, it is planned to investigate the level of serum antioxidant vitamins in diabetic cataract patients and in non-diabetic cataract patients.Methods: The study was conducted at Biochemistry department, Al-Tibri Medical College Karachi from October 2016 to October 2017. Ninety pre diagnosed cataract patients were selected from Al-Ibrahim Eye Hospital Karachi 40 normal control subjects were selected from the same population with same socioeconomic group. The demographic data was analyzed. The random blood sugar, antioxidant vitamins (C, A and E) and malondialdehyde were analyzed in the blood sample of control and cataract patients. The data was analyzed by SPSS version 20.Results: There was no significant difference in the level of vitamin C, A, E and MDA between diabetic and non-diabetic cataract patients, but the blood levels of vitamins of control are higher as compared to the cataract patients. The level of MDA is significantly high in cataract patients as compared to control. Antioxidant vitamin E was negatively correlated with serum malondialdehyde in cataract patients.Conclusions: It is concluded that in diabetic and non-diabetic cataract low level of serum antioxidant vitamins may be a contributory factor for cataractogenesis.
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Background: Tuberculosis is fundamentally a disease of the lungs, however, it can influence any organ in the body. Objectives: Primary objective was to improve the patient compliance or medication adherence and to identify, detect, monitor ADRs induced by anti-tubercular drugs and report them. A secondary objective was to prevent the emergence of drug resistance and treatment of prolongation/failure in TB patients. Methods: A prospective, observational, cohort study was carried out for 6-months in tertiary care hospital. There were 60 patients included in the study. The data were evaluated for patients’ demographic profile, type of TB, medication adherence and occurrence of ADRs. Adverse drug reactions were observed and recorded. The causality of ADRs was assessed using WHO-causality assessment scale and Naranjo causality assessment scale. The severity of ADRs was determined using Hartwig’s severity assessment scale. Results and Discussion: Total of 60 patients were included in the study. Results showed that among 60 patients included in the study, 44 patients experienced ADRs. Among all age groups, the highest numbers of ADRs were seen in the age group 19-30 (43.1%) years. The occurrence of ADRs was noticed more in females (77.7%). The majority of ADRs occurred in patients was general (28.4%), and gastrointestinal effects (23.8%). Conclusion and Scope of the Study: Adherence to treatment is crucial for the cure of individual patients, controlling the spread of infection, minimizing the development of drug resistance and to reduce the chances of re-infection. Proper therapeutic monitoring of regimen, dose management, and pharmacovigilance activities are necessary. Such approaches will not only improve the treatment outcomes but also minimizes the chances of treatment prolongation/failure. All the health care professionals should interpret their responsibility in this domain of the health care profession.
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Background: Self medication is becoming very popular among medical students as they get exposed to knowledge about diseases and drugs, but which is very superficial in second year undergraduates, so the present study was conducted to evaluate the knowledge, attitude and practice (KAP) of self medication among second year undergraduate students.Methods: A questionnaire based study containing 12 questions was conducted in 175 second year undergraduate students after taking informed consent. Statistical analysis was done by using descriptive statistics by Graph Pad Prism version 6.01.Results: Out of the 175 students, 155 (88.57%) students have taken self medication. The common reason for taking it was no need to visit the doctor for minor illness (64%), quick relief (48.57%) and time saving (34.29%). The common indications for taking self medication were fever (69.14%) and cough and cold (69.14%) followed by headache (64%). Although students rarely practised it due to risk associated like adverse effects 131 (74.86%) and lack of proper knowledge about drugs 118 (67.3%).Conclusions: Self medication is highly prevalent among students, as most of the students get it from pharmacies, it is necessary to make strict guidelines for availability of such medicines over the counter and also there is need to educate the students about harmful consequences of self medication to make them responsible future doctors.
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Objective A short pre-hospital delay, from the onset of symptoms to rapid initiation of reperfusion therapy, is a crucial factor in determining prognosis of myocardial infarction (MI). The purpose of this study was to evaluate symptoms and presentation delay times in MI patients with and without diabetes. Methods This cross-sectional study was conducted in 3 tertiary care hospitals of Pakistan over a period of 6 months. The study sample consisted of 280 consenting individuals diagnosed with ST-elevation MI (STEMI) or Non-ST elevation MI (NSTEMI), out of which 130 were diabetic and 150 were non-diabetic. Data was collected using a standardized questionnaire, investigating MI symptoms along with causes and duration of pre-hospital delay within 72 hours of admission. Results No significant difference was found in the intensity of chest pain between diabetics and non-diabetics. Atypical symptoms of MI such as anxiety (p < 0.001), cold sweats (p = 0.034) and epigastric pain (p = 0.017) were more frequently reported in diabetics. MI patients with diabetes had a significantly longer presentation delay time with 75% of the patients presenting after elapse of 3 h. Only a few patients reported to the hospital within an hour of onset of symptoms (n = 23, 8.2%), out of which majority were non-diabetics (n = 18). A majority of patients (n = 146, 52%) in both groups did not use emergency medical services. Conclusion This study provides an incentive for further research, aiming to reduce pre hospital delay along with investigating the effectiveness of emergency medical services.
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Abstract Objective: To assess the performance of cerebrospinal fluid (CSF) lactate as a biomarker to differentiate bacterial meningitis from viral meningitis in children, and to define an optimal CSF lactate concentration that can be called significant for the differentiation. Methods: Children with clinical findings compatible with meningitis were studied. CSF lactate and other conventional CSF parameters were recorded. Results: At a cut-off value of 3 mmol/L, CSF lactate had a sensitivity of 0.90, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.963, with an accuracy of 0.972. The positive and negative likelihood ratios were 23.6 and 0.1, respectively. When comparing between bacterial and viral meningitis, the area under the curve for CSF lactate was 0.979. Conclusions: The authors concluded that CSF lactate has high sensitivity and specificity in differentiating bacterial from viral meningitis. While at a cut-off value of 3 mmol/L, CSF lactate has high diagnostic accuracy for bacterial meningitis, mean levels in viral meningitis remain essentially below 2 mmol/L.
Resumo Objetivo: Estudar o desempenho do lactato no líquido cefalorraquidiano como biomarcador para diferenciar a meningite bacteriana da meningite viral em crianças, e definir uma concentração de lactato ótima no líquido cefalorraquidiano que possa ser significativa para a diferenciação. Métodos: Foram estudadas crianças com achados clínicos compatíveis com meningite. O nível de lactato no líquido cefalorraquidiano e outros parâmetros convencionais do líquido cefalorraquidiano foram registrados. Resultados: Em um valor de corte de 3 mmol/L, o lactato no líquido cefalorraquidiano apresentou uma sensibilidade de 0,90, especificidade de 1,0, valor preditivo positivo de 1,0, valor preditivo negativo de 0,963, com uma precisão de 0,972. Os índices de probabilidade positivo e negativo foram 23,6 e 0,1, respectivamente. Para comparação entre a meningite bacteriana e viral, a área abaixo da curva do lactato no líquido cefalorraquidiano foi 0,979. Conclusões: Concluímos que o lactato no líquido cefalorraquidiano possui alta sensibilidade e especificidade na diferenciação da meningite bacteriana da meningite viral. Embora em um valor de corte de 3 mmol/L o lactato no líquido cefalorraquidiano possua alta precisão de diagnóstico da meningite bacteriana, os níveis médios na meningite viral permanecem basicamente abaixo de 2 mmol/L.
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Humans , Male , Female , Infant , Child, Preschool , Child , Meningitis, Bacterial/diagnosis , Lactic Acid/cerebrospinal fluid , Meningitis, Viral/diagnosis , Reference Values , Biomarkers/cerebrospinal fluid , Prospective Studies , Sensitivity and Specificity , Meningitis, Bacterial/cerebrospinal fluid , Diagnosis, Differential , Meningitis, Viral/cerebrospinal fluidABSTRACT
Objectives: To determine the prevalence and correlates of elevated blood lead level inchildren (6-144 months) of Aligarh. Methods: A hospital-based cross-sectional study wasconducted. Venous blood was obtained for lead estimation and a structured questionnairewas filled. Results: A total of 260 children were enrolled. The prevalence of elevated bloodlead level was 44.2%, seen mostly in children below 5 years of age. Old and deteriorating wallpaints at home was found to be significantly associated with elevated levels. Conclusions:Lead-based house paints are potential source of lead exposure. Meticulous renovation andpainting of the walls with safe paints is desirable