Nutritional assessment of school going children in district Abbottabad, K.P. Pakistan

Background:To assess the nutritional assessment of the primary school children in Abbottabad. Methods:A descriptive cross-sectional study, conducted among children of private and public sectors primary schools of Abbottabad from January -September 2018 by simple random sampling. 200 students from each school (7 and 13 years), present on the day of data collection were included in this study and those who were absent, sick or not willing, were excluded. The data was collected on apre-tested questionnaire.Results:Total 200 students, males 49.5% (n=99) and females 50.5% (n=101) were interviewed and assessed for their nutritional assessment. Their mean age was 11.67±1.66years, height was 144.93±12.34 cms and weight was 37.69±12.96 kgs. Male students (n=67) 67.7% and from private schools (n=67) 65.7% were healthier then female (n=55) 55.4% and government schools (57.1%), P valve 0.085 and 0.026. Most of the students with grade C in last year school performance were underweight (100%). Raven Test for both types of school gave 0.012 P value which indicated more intelligent students resides in private schools. Furthermore, children of well-serviced fathers and qualified mothers were healthy, more intelligent and practiced good hygiene.Also, children of a private school who has better nutritional status scored more than Public school children.Conclusions:Nutritional status of children have a direct effect on their cognitive abilities. Private school children who have scored better in the intelligence test, have better nutritional status. Socioeconomic status and mother qualification have a direct effect on children’s nutrition, health status, school performance and hygiene.

Epigenetics: Quest for no-escape to HIV, a persistent pathogen

Acquired Immune Deficiency Syndrome [AIDS] is a disease infection mix, which is primarily because of 'deficient' immune system. Human Immune-deficiency Virus [HIV] makes the immune system susceptible to many infections by infiltrating it. Many researchers believe that HIV is a mutated form of Simian Immune-deficiency Virus [SIV]. After being clinically discovered in 1981 in America, it is said to have caused 36 million deaths. Treatment of AIDS has been a 'burning ' issue ever since its discovery. There is no cure for AIDS! Although, Recombinant Transcriptase Inhibitors [RTis] are being considered a major treatment against HIV that can not only lessen the effect of HIV but also can prolong the life of HIV positive patients. More recent advancement includes 'transplantation of transgenic stem cells' in HIV positive patients. As latency of HIV provirus in host genome is the preeminent weapon of this virus against RTis that compel it to hide from host immune system and a persistent pathogen thereof. Thus, epigenetic activation of latent provirus pool by methyl inhibitors along with nontoxic chemical drugs seems to be a more promising treatment to avoid the burden of lifelong RTI

Causes and adverse impact of physician burnout: a systematic review

Objective: To review the significant causes and effects of physician burnout in published literature

Methodology: A systematic review was conducted for searching published literature on the causes and effects of burnout in three online databases. Inclusion and exclusion criteria were developed for final selection of papers. The selected papers were critically appraised and thematic analysis was done to identify major themes related to physician burnout

Results: Thirty-one papers were finally selected among the 2,828 identified studies. The thematic analysis revealed demographic factors, e.g. age, gender, marital status, specialty and job position; and organizational factors, e.g. workload, interpersonal demands, job insecurity and lack of resources, as significant causes of burnout. The consequences of burnout included individual and organizational effects. The individual effects of burnout included physical health problems; while organizational effects included poor job performance, low organizational commitment, and turnover intentions

Conclusion: Burnout is a recognized workplace hazard in the healthcare sector. The individual characteristics of physicians and working environment within hospitals are contributory factors of burnout. Therefore, proactive interventions should be taken at individual and institutional levels for preventing physician burnout by improving the personal lifestyle of physician and working environment in hospitals

potential effect of technology and distractions on undergraduate students'concentration

Background and Objectives: In the present era, it is difficult to keep the concentration of college students at its maximum potential during the class time, as there are many distractions that negatively impact students' concentration and prevent optimal learning. Technologies such as laptops and cell phones have invaded the classroom, raising considerable concerns about their effects on college students' attention in the classroom. Despite these concerns, no research has been done in Saudi Arabia on the effects of technology and other types of classroom distractions on students' concentration. In the current study, we have attempted to identify students' perceptions of major distractions in the classroom based on seventeen internally [self-produced] and twenty-four externally produced classroom situations

Methods: The students participating in this study rated the degree to which each distraction interferes with their concentration on the class materials and their ability to learn. Data were collected through surveys of 265 students ]66 and 199 students from medical and basic classes, respectively], including 97 females and 168 males 17-23 years of age from the academic years 2010 to 2014. A validated self-administered questionnaire was handed to the students in the classroom

The students were asked to report and rate the classroom distraction produced by 24 external internal distracters [Table-ll], on a 5-point scale

Results: The results revealed that ringing cell phones in the class were the most commonly reported electronic external distractor for 68% of students, and 21% of them reported being extremely distracted by this noise. Having an instructor who is difficult to understand was the most commonly reported external behavioral distractor for 75% of students, and 48% of them rated this as extremely distracting. Students talking in class were the most self-produced distractor for 72% of students; negatively impacting their concentration and ability to learn, and 42% of them rated it as an extreme distractor. Wearing clothing with unusual words, drinking and eating in the classroom were minimally distracting colleagues. Overall, distractions [internal and external] were more significant for fifth-year students than the other years at a p-value< 0.001

Conclusion: Students believed that laptop and cell phone use in the classroom can effect their concentration and ability to learn. The students also felt that inappropriate behavior is a major distraction for students as well, and thus necessitates monitoring and improvement

Frequency of early atrial fibrillation in post mitral valve replacement surgery

Objective: To determine the frequency of atrial fibrillation after mitral valve replacement surgery

Methodology: This study was performed in cardiac surgery ward of Lady reading Hospital [LRH] Peshawar. It was a descriptive cross sectional study. Data was collected from 1.3.2014 to 28.02.2015. Statistical analyses were performed using SPPS version 14. Mean +/- SD were used for quantitative and Frequencies and percentages were used for categorical variables

Results: Total 120 patients undergone through mitral valve replacement. Male patients were 48 [40%], Mean age of the study population was 46.20 years +/- 9.14SD. Atrial fibrillation [AF] was observed in 45 [37.5%] patients. Post operative AF was similar between both gender and all ages

Conclusion: Atrial fibrillation is common finding in patients undergoing Mitral valve replacement surgery and is not affected by age and sex

Frequency of acute kidney injury in patients undergoing coronory artery bypass grafting

Objective: To find the frequency of acute kidney injury in patients undergoing coronary artery bypass grafting

Methodology: The study was conducted in cardiovascular unit Lady Read-ing Hospital Peshawar. It was cross sectional study. Sampling technique was non probability convenient sampling. Data was collected from 20.2.2013 to 20.8.2013. Total 179 patients included in the study. All patients with known coronary artery disease were included in the study whom were planned for revascularization in the form of coronary artery bypass grafting [CABG]. Post-operatively all patients' serum creatinine till 48th post op hour was observed to detect acute kidney injury. Acute Kidney Injury [AKI] was defined as more than 50% or elevation of 0.3 mg/dl of creatinine level from base line

Results: A total of 179 patients undergoing coronary artery bypass grafting were included in the study. Average age of the patients was 46.88 years +/- 9.91 with range 20-60 years. Patients were divided into four groups according to age. The acute kidney injury after coronary artery bypass grafting was observed in 14 [7.82%] patients. Acute kidney injury was more common in old age and it was non significantly more common in male gender

Conclusion: In spite of current highly advance cardiac surgery techniques and post operative care still there is high incidence of acute kidney injury following revascularization and subsequent worst outcomes

Normal anatomical variations of renal artery pedicle: a review of 100 renal angiograms of healthy proposed renal donors

Objectives: To present variations in renal arterial anatomy. To document renal artery number, source, course and patterns

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Angiography suite, Radiology Department, Sindh Institute of Urology and Transplantation from May 2011 to Oct 2011

Materials and Methods: A total of 100 healthy adultswho underwent renal angiography for renal donor assessment in living related transplant programwere included. Both male and female with age group between 20-50 years having normal clotting profile, renal function and normal morphology on IVP were fully evaluated by predesigned performa including number, source, course and pattern of renal artery

Results: Out of 100 cases of healthy renal donors, 66 were male and 34 were female. Fifty four percent were in 20 - 30 years of age group while 30% between 31 - 40 years and 16% in between 41 - 50 years. In 56% right renal artery found to be higher than left, where as 40% had both the arteries at same level. Right renal artery longer in 52% and left in 46%. Only 2% had same length of both renal arteries. Regarding the number, 66% had bilateral single, 24% unilateral double, 6% bilateral double and only 4 % unilateral triple. Out of 100 renal donors with 200 renal pedicles [each donor having 2kidneys], single hilar artery seen in 75% in single hilum with inferior polar aortic branch in 14% and single hilar with suspicious polar aortic branch seen in only 4%. Double hilar arteries seen in 1% and hilar with extrahilar branch in 4%. Triple vessels found in 4% cases

Conclusion: The study shows that normal variation of vascular anatomy of renal pedicle is clinically very important to perform urological interventional procedures and transplantation. This study providesinformation concerning renal artery anatomy not only for interventional radiologists but also to urologic surgeon

Use of antibiotics within the integrated management of childhood illness [IMCI]: guidelines in pediatric outpatient settings

Background: The success of standardized measures for disease classification and treatment has led disease-specific approaches led WHO and UNICEF to incorporate them into a set of guidelines for the integrated management of childhood illness [IMCI], which includes modules or subsets of guidelines for the recognition and management of children with acute respiratory infections, diarrhea, measles, malaria and other febrile illness, and malnutrition

Objective: To assess the use of antibiotics within the IMCI Guidelines in Pediatric Outpatient Settings of Jinnah Hospital

Methodology: It was a cross-sectional study conducted at Pediatrics OPD Jinnah Hospital from May 1, 2014 - August 21, 2014. The 150 children and their parents / accompanying person fulfilling the inclusion criteria after consultation from pediatric consultation were interviewed regarding their disease status and prescription by the doctor regarding antibiotics and other conditions. All the information was entered in a structured questionnaire. The samples were collected by non-probability / purposive sampling technique

Results: Among 150 children included in study mean age of children was 36 months SD 20.42 months. 60% were male and 40% female. Presenting complaints among children were, 75.0% presented fever, 26.4% had loose motions, 22.3% has vomiting, 20.3% had cough. 12.8% presented with abdominal pain. Among those who received antibiotics, 10% received third generation cephalosporin [ceftriaxone, cefexime], 10.7% penicillin's [mostly amoxicillin and piperacillin], and 4% ciprofloxacin. 30% received combination of 2 or 3 antibiotics [14.7% combination of ceftriaxone and amikacin [aminoglycoside], According to IMCI guidelines 34% were not appropriately treated, 20.7% received antibiotics when they should not and 13.3% did not received antibiotics when they should have

Conclusion: Their low adherence to integrated management of childhood illness [IMCI] recommendations for prescription of antibiotics in routine outpatient settings the study shows highly prevalent use of third generation cephalosporins

Assessment of early childhood caries [ECC] and its relationship with feeding practices - a study

Early childhood caries remains a problem in both developed and developing countries and has been considered to be in an epidemic proportion in developing countries. The aim of this study was to asses the prevalence of Early Childhood Caries and its relationship with feeding practices. It was carried out at Khyber College of Dentistry Hospital. It was spread over a period of three months. This was cross sectional analytical study children of 2-6 years old formed the study group. Sample size was 194 children and sampling technique was convenience purposive. Children were examined on dental unit by the principal author and caries were detected using dft index. A parent or care giver, after taking the informed consent, was asked to complete a self-designed questionnaire regarding information about the child's pattern of feeding, mother education level, socio economics status age of starting brushing, having snack between meals and dft status. The study showed prevalence of ECC was 55.2%. In this study breast, fed children were 84% and bottle-fed were 16%. Pecentage of ECC in breast-fed children was 51.6%, which was less than the percentage of ECC in bottle-fed children, which was 72.25%. Those children who took bottle at nighttime had more carries [72.5%] as compared to those who did not [50%]. Caries in children was 89% who took milk with sugar at night as compared to those who did not. Incident of carries was more in the children of illiterate mothers [56%] than those of educated mothers [10%]. This study documented high prevalence of ECC among 2-6 year olds children. Prevalence of ECC was more in bottle fed children specially in those children who were given milk with sugar in bottle at night. Results reveal an urgent need of increased awareness among the public about ECC and their attitude towards the importance of primary teeth. This is high time to institute preventive strategies to control ECC

Awareness and practices of oral health among patients seen at khyber college of dentistry hospital

The aim of this study was to assess the awareness and practices of oral hygiene maintenance among both genders of the groups who were seen in the hospital ofKhyber College of Dentistry. Three hundred and fifty subjects were randomly selected and interviewed on a semi-structured questionnaire for age, gender, education, frequency of tooth brushing, use of dentifrices and dental floss. SPSS version 17.0 was used to analyze the data. Out of the total 350 subjects, 160 [45.7%] were male and 190 [54.3%] were female, with mean age of43.9 +/- 17.2 The age range was 12-80 years. 45.14% brushed their teeth twice, 35.71% reported once and 8.57% thrice daily. Awareness about the use of dental floss was 18%, while 82% did not use. Regarding the use of dentifrices, 90% were using tooth paste followed by 7.4% tooth powder. Male dominated females in frequent dental check up. In conclusion females were more aware and in practice of maintenance of oral hygiene compared to males

Frequency of complete heart block after surgical closure of perimembranous ventricular septal defect

Objective: to find the frequency of complete heart block [CHB] in patients undergoing surgical perimembranous Ventricular septal defect [VSD] closure

Methodology: this was a Descriptive cross sectional study performed in Cardiovascular Department Lady Reading Hospital Peshawar. Data was collected from 28 January 2013 to 28 July 2013 with sample size of 103.Sampling technique was non probability consecutive. All patients with perimembranous ventricular septal defect, aged 5 years to 25 years with any gender were included in the study

Results:-mean age was 12.63 years +/- 6.63. Patients were divided in four categories according to their age. Over all complete heart block in the perimembranous ventricular septal defect after surgical closure was 10[9.71%]. Age wise distribution of complete heart block shows that majority of the complete heart block 6[12.8%] were found in age less than or equal to 10 years

Conclusion:-VSD closure is less often associated with CHB but there should be arrangements for pace maker to timely pace the patient in case of any emergency

Non-invasive positive pressure ventilation facilitates early extubation in post operative cardiac patients

To assess the use of NIPPV [non-invasive positive pressure ventilation] during weaning from mechanical ventilation in post-op patients in an ICU and compared this procedure with intermittent mandatory ventilation [IMV] by analyzing cardiac and respiratory parameters and complications. A randomized clinical trial was conducted from June 2009 to July 2010 on Post-operative surgical patients that were on IMV for more than 48 hours, who failed at 30 minutes of spontaneous breathing T-piece trial [SBT]. If failure occurred before the 30th minute, he/she was included in the group previously defined by random assignment. Patients in the experimental group were extubated and placed on NIPPV, whereas other patients [the control group] returned to IMV. Daily SBT was carried out thereafter in order to evaluate the possibility of extubation in control group. Of 60 patients who failed T-piece trials, 30 patients were placed on NIPPV and 30 on [IMV]. The ages of patients in the NIPPV and IMV groups were 45.7 +/- 18.11 and 47.10 +/- 18.45 years respectively. In both groups, ventilation time before T-piece trial was 2-3 days. Patients of the NIPPV group had a shorter stay in the ICU and in the hospital i.e., 2.93 +/- 0.785 days versus 7.4+1.11 days for IMV group. No serious complications were observed in both groups. The results of this study suggest that the combination of early extubation and NIPPV is a good alternative

De vega's tricuspid annuloplasty for severe tricuspid regurgitation - early and midterm follow up

To assess early and midterm outcome of De Vega's Repair of Tricuspid Valve in Severe Tricuspid Regurgitation [TR]. This was a prospective observational study conducted from January 2007 to June 2011, at Cardiovascular department PGMI, Lady Reading Hospital Peshawar. De Vega's surgical repair of tricuspid valve was done in severe tricuspid regurgitation patients with mitral valve replacement [MVR] or with double valve replacement [DVR=MVR+ AVR [Aortic valve replacement]]. Pre operative and post operative early [with in 1month] and midterm [at 6 month] follow up data was collected and analyzed on the basis of New York Heart Association [NYHA] functional status and echocardiographic finding. The outcome of De Vega's repair was assessed. Total study population was 160, with age ranging from 14-52 years [mean age 21 years]. Out of these 160 patients 89 [55.60%] patients were female and 71 [44.40%] were male. Preoperative diagnosis of 118 patients was related to pure mitral valve disease, and 42 cases were having aortic valve disease along with mitral disease. All patients had severe TR. Patients who were free from TR in MVR group were 81.3% and 75.0% patient were TR free in DVR group at 6 months follow up and the repair was intact on echocardiography. De Vega's repair in Severe TR is a safe and economical procedure in our setup

Diffusion weighted MR imaging of ring enhancing brain lesions

To evaluate the role of diffusion weighted imaging in differentiating the cause of ring enhancing brain lesions. Analytical, descriptive study. Department of Radiology, The Aga Khan University Hospital, Karachi, from March 2007 to July 2011. Diffusion weighted imaging [DWI] was performed on 37 patients having ring enhancing lesions on their post-contrast brain MRI scans. These lesions were characterized into neoplastic and abscess cavity on the basis of diffusion restriction. Correlation of all these findings was done with histopathology obtained in all these patients. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of DWI were calculated. Comparisons of mean ADC values of abscess and neoplastic lesions were also done using t-test. DWI had a sensitivity of 94.73%, specificity of 94.44%, positive predictive value of 94.73%, and negative predictive value of 94.44% and diagnostic accuracy of 94.5% in differentiating brain abscess from neoplastic brain lesions. Mean ADC value in central cavity and wall of neoplastic lesions and brain abscesses were calculated with significant p-value of 0.001 and 0.025 respectively. Diffusion weighted imaging is non-invasive method with high sensitivity and specificity which can help in differentiation of ring enhancing neoplastic lesions and brain abscesses. This modality should be read in conjunction with conventional imaging

Dental ailments among low and high socioeconomic status school children aged 11-12 years

A cross sectional study was undertaken to compare the dental ailments in school children's among low and high socioeconomic status. The data was randomly collected from children, of two schools one in Private sector [High socioeconomic status, Group A] and one in Public sector [Low socioeconomic status, Group B] from Sep 2011 to Oct 2011. School going children boys and girls were selected, and the final sample size was 216, one hundred and eight from each group with ages 11-12 years and with mean of 11.57 and SD of +/- .659, the levels of DMFT were identified by clinical examination only, using WHO standardize forms for data collection. There was high percentage [62.06%] of DMFT with SD +/- 1.84 and with mean 1.44 in the low SES group compared to the [50%] of DMFT with high SES group. The oral hygiene status was good in high SES compared to low SES

Prevalence of cusp of carabelli in permanent teeth in a group from Khyber Pakhtunkhwa, Pakistan

The aim of this study was to determine the prevalence of cusp of carabelli in permanent teeth in a sample from the population of Khyber Pakhtunkhwa. A special proforma was developed to collect the data. A total of 400 subjects [patients attending Khyber College of Dentistry hospital and students of Khyber College of Dentistry] were included in the study. Cusp of Carabelli was present in 29.7% of the study population in maxillary first permanent molar and was totally absent in maxillary second permanent molars. Prevalence in males [31.9%] was slightly greater than females [25.9%]. Similarly unilateralism was also greater in males than females. It was concluded that the prevalence of cusp of Carabelli is lowest in the population sample of Khyber Pakhtunkhwa as compared to other similar Asian population's samples. However, unilateralism was at par with other Asian studies. In permanent teeth the Cusp of Carabelli occurs only on maxillary first molar

Paraneoplastic manifestations of hepatocellular carcinoma- are we different?

Objective: to determine the frequency of paraneoplastic manifestations in patients with hepatocellular carcinoma [HCC] presenting at tertiary care center

Design: descriptive study

Place of study: department of Gastroenterology - Hepatology, Shaikh Zayed Federal Post Graduate Medical Institute, Lahore

Patients and Methods: patients of hepatocellular carcinoma were interviewed for symptoms suggestive of paraneoplastic manifestations of HCC. The patients were subsequently examined and investigated. The frequency of paraneoplastic features was determined using SPSS 13.0

Results: of the total 100 patients included, musculoskeletal involvement with joint pain [11%] and muscle tenderness [4%] was noted. Skin lesions were noted in 2% of patients. On investigation 1% patient had erythrocytosis, 3% had thrombocytosis and eosinophilia was noted in 10% of patients. Calcium and cholesterol level were raised in 7% of patients each

Conclusions: paraneoplastic features are seen in significant number of patients with hepato cellular carcinoma

Gastro esophageal reflux: an over investigated entity in neonates and infants

To determine the outcome of clinically suspected gastro esophageal reflux in neonates and Infants. To find a protocol for evaluation of these patients in order to reduce unnecessary radiation to neonates and infants. Fifty three neonates and infants of up to 1 year of age with clinical suspicion of gastro esophageal reflux [GER] were referred for Upper gastro intestinal barium studies. This retrospective descriptive case study was carried out over a period of one year starting from October, 2006 to September, 2007. Positive cases were followed for another one year to see the final outcome. The neonate and infants of upto one year of age, referred from Neonatal intensive care unit [NICU], Paediatric ward and Out Patient Department [OPD] were included in this study. Out of 53 cases 32 were positive for G.E.R and no reflux could be identified in rest of the patients. Out of these positive cases only 4 had massive or severe G.E.R. These patients were prescribed conservative and medical treatment and were advised to follow up in the O.P.D where on subsequent follow ups the medical treatment was stopped as there were no further complaints These patients showed normal weight gain on subsequent O.P.D visits. Other positive cases only had mild to moderate G.E.R and they were managed conservatively. These patients showed normal weight gain on subsequent O.P.D visits with complete resolution of symptoms. Regurgitation or gastro esophageal reflux is a common finding in the first 3 months of life [especially in preterm infants] and usually resolves by 6-12 months of age and should not be over investigated

Association of aetiology, presentation and post-operative complications of post-traumatic peripheral artery pseudoaneurysm

To describe post traumatic pseudoaneurysms and its association to causes, presentation and conventional surgical treatment modalities. This Descriptive study carried out in the Department of Cardiovascular Surgery, Lady Reading Hospital, Peshawar from January 2003 to December 2007. Patients with associated arteriovenous fistula were excluded from this study. All the demographics including age, sex, type of injury, site, associated complications operative details, pen operative morbidity and mortality were prospectively recorded in a data base. The total number of patients was seventy five. All the patients underwent conventional surgical procedures. Reverse saphenous graft was received by 34%, 24% had end to end anastomosis, 12% had interposition synthetic graft, 8% had rent repair while 21.33% had primary ligation of the involved artery. There was no pen operative mortality. Six patients had post operative complication in the form of graft, thrombosis and or infection. Three patients had amputation, two in lower limb and one in the upper limb. Majority of them were male 90.66%. Age ranged from 7 years to 75 years. Most of the patients [77.3%] were in second to fourth decade of life. The most common cause of injury was gunshot wound [56%] followed by stab wounds [13.33%] and road traffic accidents [12%]. Few cases of bomb blast [6.66%], Post cardiac catheterization [4%], glass injury [4%] and intravenous drug abusers [2.66%] were also reported. The commonest site of injury was fern oral artery [37.33%].In this study majority of patients were male with gunshot wound as commonest cause. Reverse saphenous vein graft was treatment of choice. Infection and thrombosis were the commonest postoperative complications

Prevalence of dental caries among 3-12-years-old children of Swat - Pakistan

The aim of the study was to determine the prevalence of dental caries among 3-12 years old children in Swat, Pakistan. A total of 646 children were examined. The sample consisted of 231, 358, and 57 children in the 3-5, 6-8 and 9-12 years of age group, respectively. Dental caries and gingival index were examined and recorded accordingly. Dental caries was diagnosed according to criteria recommended by World Health Organization. The relationship of the DMFT index to the following factors was investigated: age, sex, and personal hygiene. The sample consisted of 513 males and 133 females who ranged in age from three to twelve years. Their mean age was 6.25 years. For the entire sample, the mean DMFT index was 4.02. The prevalence of dental caries was highest in 6-8 year of age group compared to 3-5 years and 9-12 years age groups. The increase in prevalence of dental caries needs dental health programs to be arranged in the specified population