Anemia in children of hazara division Anemia in Children

Objectives: To determine the frequency of anemia in children of Hazara Division

Study Design: Cross-sectional / observational study

Place and Duration of Study: This study was carried out at thePediatric Outpatient of Ayub Teaching Hospital Abbottabad from 1[st] January,2015 to 30[th]June,2015

Materials and Methods: Three hundred and seventy five children were selected randomly using random number tables from Hazara Division coming to Pediatric Outpatient of Ayub Teaching Hospital Abbottabad. Their age range was 0-18 years.Their diagnoses were ascertained, recorded and analysed

Results: Majority of the patients were male and were in the age-range of 2-10 years.Anemia was present in 3.9999 % of children.Iron deficiency anemia was the most common cause of anemia in these children

Conclusions: Majority of the children were male and were in the age range of 2-10 years.Anemia was present in 3.9999% of these children and iron deficiency was the most common cause of it

Melcmotic neuroectodermal tumour of infancy: a rare brain tumour of childhood

Melanotic neuroectodermal tumour of infancy is a rare, mostly benign but locally aggressive tumour of neural crest cell origin occurring in infants. The most commonly affected anatomic site is the maxilla. Such tumours of the brain and skull are very rare. We present the case of an 8 months old baby girl whose presenting complaint was a swelling in the scalp for 6 months. She was otherwise asymptomatic. CT imaging confirmed the presence of an osteolytic tumour in the anterior parasagittal skull with dural involvement. The tumour was surgically excised enbloc. The patient has been well at 2 years follow-up without any evidence of recurrence

physical characteristics of the vomeronasal organ in the Pakistani population

The vomeronasal organ [VNO] is an essential functioning organ in some animals. There are reports of its presence in humans as well. This study on the Pakistani population sets out to chart out the physical characteristics of this organ. A total of 503 subjects were recruited for this study with 258 [51.3%] males and 243 [48.3%] females. The organ appears on the nasal septum in different forms. On an average the VNO could be identified positively in 46.3% of the subjects. The organ was positively identified in almost half of the subjects. The presence of the organ was seen more on the right side of the septum. The minimum height of the opening of the VNO from the nasal floor came out to be 0.35 cm [average] and the maximum to be 2.5 cm [average]. The nasal septum was found to be deflected towards the right most of the time [45.2%]. The vomeronasal duct was found to be from 1 - 3 mm in length in most of the cases where it was present. Future research should focus on the functional aspect of the vomeronasal organ in the Pakistani population

Diagnostic accuracy of magnetic resonance cholangiopancreatography in diagnosis of obstructive jaundice

To compare the diagnostic accuracy of MRCP in diagnosing obstructive jaundice taking endoscopic retrograde cholangiopancreatography [ERCP] as gold standard. Cross sectional survey. This study was conducted Radiology and Gastroenterology Departments, Sheikh Zayed Post graduate medical Institute, Lahore for a period of Six months from August 2012 to January 2013. A total of 90 patients having history and clinical suspicion of obstructive jaundice were enrolled in this study. MRCP was obtained in all cases followed by ERCP was performed. All this information was recorded on proforma and results were evaluated. A total of 90 patients were included in the study. 40 [44.4%] were male and 50 [55.6%] were female. The age ranged from 15-80 years. Mean age of patients was 46.66 +/- 16.33 years. In our study the sensitivity of MRCP in diagnosing obstructive jaundice was found to be 86.0%, specificity 70%, positive predictive value 96.0% and negative predictive value was found to be 39.0% and diagnostic accuracy was 84.0%. The outcome of this study was that MRCP is reasonably good in diagnosing obstructive jaundice but is relatively less accurate as compared to ERCP

Assay for Molybdenum-99 breakthrough in PAKGEN, PINSTECH generators: a clinical audit at Akuh, Karachi

Molybdenum-99 breakthrough is a rare but potential cause of enormous and unjustified radiation exposure to patients and technologist in nuclear medicine. Recommended limit of [99] Mo in an eluate is 0.15 uCi of [99] Mo / mCi of [99m]Tc. The purpose of this clinical audit was to measure the Mo-99 concentration in eluate of PAKGEN [[99] Mo-[99m]Tc generator] before administering to patients as a part of Good Medical Practice [GMP]. This clinical audit was conducted at The Aga Khan University Hospital, Karachi from January to May 2012 and during this period we evaluated 44 [99] Mo-[99m] Tc generators [PAKGEN]. In 369 elutions during this audit period, we did not find any evidence of [99] Mo breakthrough. This clinical audit proves that PAKGEN generators supplied by IPD, PINSTECH, Islamabad had good performance and proved generally to be a reliable source of [99m] Tc-pertechnetate. The application was safe and fulfilled the requirements for good medical practice

High altitude headache - an etiological based study

To determine the various causes of headache in patients evacuated from high altitude. Descriptive study An observational hospital based study carried out on 50 soldiers evacuated from Northern Areas to Military Hospital Rawalpindi between Sep 2009 to Mar 2010 for evaluation of headache as their major complaint. Necessary investigations including neuroimaging were carried out in coordination with Department of Neurology, Military Hospital and an appropriate diagnosis was made in each case. The data was analyzed accordingly. A total of 50 patients were analyzed .They were all males and the mean age was 25 years. 52% patients had Acute Mountain Sickness, 12% hypertension, 10% High altitude cerebral edema, 8% Tension type headaches, 6% Dural venous sinus thrombosis, 6% migraine, 2% encephalitis, 2% were of Subarachnoid hemorrhage and 2% patients Hydrocephalus. Acute mountain sickness and high altitude cerebral edema accounts for a significant number of patients with high altitude headache

Frequency of headache with stress in adolescent and young adults

Objective of this study was to establish a link between stress as a cause of headache in young adults. Cross sectional study. Department of Neurology Military Hospital [MH] Rawalpindi from September 2009 to March 2010. Thirty young patients, referred for the complaints of headache to the Neurology out patient department, were included in this study. A detailed especially designed, pre tested headache questionnaire was devised which was filled for every patient individually included in the study. Twenty One [70%] of the patients in the study group did have the feeling of stress preceding the headache which sometimes persisted during the episode. Nine [30%] did not report any such feeling of stress before or during the episode. Out of the patients reporting stress 71% [15] were female patients and 29% [6] were males. These key findings suggest that stress and headaches may be related for adolescents and young adults and that this relationship may be reinforced over time. Moreover female patients were far more susceptible to this stressful stimulus as compared to the males

Wheat pill: clinical characterisitcs and outcome

To determine the clinical characteristics and outcome in patients presenting with wheat pill poisoning. Retrospective study. Department of medicine, Combined Military Hospital, Kharian from 1st July 2009 to 30 December 2010. Fifty two patients with wheat pill ingestion were included in the study. All patients' history, symptoms, signs and management data was collected on a pre-designed data collection form. Mean age was 25.10 +/- 5.35 years with 51.9% females. Time interval between ingestion of pills and presentation to hospital was 2.5 +/- 1.27 hours. Numbers of pills consumed were 2.73 +/- 20. Most common symptom seen in patients was vomiting seen in 88.5% of the patients. Other common symptoms were irritability in 63.5% and confusion in 55.8% patients. Most common clinical sign hypoxia in 75% patients. Overall mortality was 86.5 percent. Wheat pills are highly toxic with rapid and high mortality rate. These patients develop refractory hypotension and metabolic acidosis which progresses to death. More research is required to develop antidote and to minimize toxicity. Strict legislations are required to control sale of aluminium phosphide over the counter

Frequency of axonal variants of guillain-barre syndrome in Pakistan

To determine the frequency of axonal variants in our patients of Guillain-Barre Syndrome. Descriptive study. Department of Neurology, Military Hospital, Rawalpindi and Armed Forces Institute of Rehabilitation Medicine [AFIRM] from 01 Jan 2009 to 30 Jul 2010. Forty adult patients meeting the National Institute of Neurological Disorders and Stroke criteria for Guillain-Barre Syndrome [GBS] were consecutively enrolled in the study. Patient's data, detailed history, examination and electrophysiological studies were carried out and recorded on predesigned proforma. All patients were examined and reviewed by Consultant Physicians and neurologists. Electromyography and Nerve conduction study testing was done by experienced electro-physiologists. Axonal variants of Guillain-Barre Syndrome constituted 16[40%] in our study. The variants of Guillain-Barre syndrome were acute inflammatory polyradiculoneuropathy [AIDP] in 24[60%] patients followed by acute motor axonal neuropathy [AMAN] in 12[30%] and acute motor sensory axonal neuropathy [AMSAN] in 4[10%] patients. We report a high frequency of the axonal variants of Guillain-Barre Syndrome in Pakistan

Risk factors associated with childhood asthma among children aged 1-12 years in Rawalpindi

To explore various risk factors associated with childhood asthma in Rawalpindi garrison and city among children 1-12 years old. Case Control study. Pediatric departments of Military Hospital [MH] and Combined Military Hospital [CMH] Rawalpindi from 1st Aug to 30th Nov 2009. A total of 128 children with diagnosis of asthma presenting in outpatient and indoor pediatric departments of MH and CMH Rawalpindi between ages of 1-12 years were included. Age, gender and socioeconomically matched 112 children without diagnosis of asthma were included as controls. A predesigned questionnaire containing various factors associated with childhood asthma was filled by the researcher by detailed interview with either of parents. Data was analyzed by SPSS version 15 and chi-square test was applied to determine significance. p value <0.005 was considered significant. Out of 15 risk factors studied 8 were found significantly associated with childhood asthma. Significant factors were education of any of the parents more than matric, history of fever at least three times in last year, use of antibiotics, history of hay fever, raised IgE levels, exposure to passive smoking, living in urban areas and family history of asthma [p value<0.005]. Non significant factors were mode of delivery, exclusive breast feeding for more than 3 months, partial breastfeeding for more than 6 months, history of eczema, atopy, history of viral respiratory infections in infancy and less than three number of rooms at home. Male preponderance was noted amongst cases. Education of parents, fever, antibiotics, hay fever, raised IgE levels, exposure to passive smoking, living in urban areas and family history of asthma proved to be significant factors which are similar to those reported in other studies. However, difference was found in other factors. Recognition of these factors can help to optimize management of asthma in children in this area

Frequency and risk factors for chronic HCV infection: a community based study

It was a community based, cross-sectional study undertaken to assess the frequency of HCV infection and to find out the risk factors associated with its spread. Study was carried out from Oct 2004 to Mar 2005. One hundred and twenty five apparently healthy consecutive subjects not known to be infected with HBV or HCV, between the ages 13 and 60 years with equal sex distribution were selected from the population of the Village Mera Kalan near Rawalpindi. They were screened for Anti HCV antibodies using ELISA and interviewed in detail. Subjects found positive for Anti HCV Ab were tested for ALT [Alanine aminotransferase] levels and HCV RNA by PCR. The frequency of HCV was found to be 53.6%. The most important risk factor associated with the transmission of HCV infection was unsafe injection therapy with contaminated equipment. Other risk factors include ear and nose piercing by unsterilized means in females and sharing of razors in males. The prevalence of HCV infection in our population is significantly higher than in the developed world. Public awareness programs should target the identified risk factors to prevent HCV transmission

Comparative efficacy of amlodipine and hydrochlorthiazide-amiloride in cases of mild essential hypertension in outdoor patients at combined Military Hospital Multan

To compare antihypertensive effect of fixed dose combination Hydrochlorothiazide-Amiloride and Amlodipine in patients of mild essential hypertension. Randomized controlled trial [RTC]. Department of Medicine Combined Military Hospital Multan Cantt from 29 January 2007 to 29 June 2007. After fulfilling the inclusion criteria of mild essential hypertension, defined as per recommendations of Seventh Joint National Committee [JNC 7] for treatment of Hypertension as stage 1 hypertension, systolic blood pressure [SBP] >/= 140-159-mmHg and Diastolic blood pressure[DBP] >/= 90-99-mmHg, 100 patients were randomized into two study groups using a table of random numbers. Group 1 received tab amlodipine [5 mg] and Group 2 received tab hydrochlorothiazide-amiloride [25 mg-2.5mg]. Informed written consent was taken. The patients were followed on subsequent visits [6 in total] for five months and systolic and diastolic blood pressure was recorded carefully. All the data thus obtained were processed and analyzed using SPSS version 10.0. Mean and standard deviation [SD] were calculated for age, diastolic and systolic blood pressure. In group 1 the drop in mean SBP between first and last visit was 15.42 mm Hg. In group 2 the drop in mean SBP between first and last visit was 18.34 mm Hg. In group 1, the drop in mean DBP between first and last visit was 10.08 mm Hg. In group 2 the drop in mean DBP between first and last visit was 14.65 mmHg. Mean drop in SBP of both the groups were compared with each other and found to be significantly different [P=0.003]. Similarly mean drop in DBP of both the groups were compared with each other and found to be significant statistically [P=0.001]. Hydrochlorothiazide-Amiloride had significantly better antihypertensive effect than Amlodipine in patients of mild essential hypertension at the end of five months therapy

Assessment of knowledge and practice of contraceptives in females of reproductive age group at a tertiary care hospital

To assess the knowledge and practice of contraceptives in females of reproductive age group. Cross sectional descriptive. OPD of Fauji Foundation Hospital from February 2008 - September 2008. 339 females of age b/w of 15-49 years attending OPD of Fauji Foundation Hospital were included in study. A structured questionnaire was used to collect data. Eighty eight percent of the females in our study sample were familiar with one or more methods of contraception [72.7% were familiar with combined oral contraceptive pill [COCP], 60.7% were aware of intra uterine contraceptive device [IUCD] and 76% knew about condoms] whereas 12% showed ignorance. 64.4% of the study population was contraceptive users and 35.4% were not using any method of contraception. Regarding preferred method of contraception 34.6% of females said they are using COCP, about 21.8% females said their tubes had been liagated whereas 26.9% and 16.7% were using IUCD and condoms respectively. Almost 46% of our study population said that contraceptive method they were using was suggested by their husbands, 44% said by health professional. Only 10% of the study population were using a method of their own choice. The present study concludes that there is a gap between knowledge [88%] and use [64.6%] of contraceptives among females of reproductive age group. Another important inference drawn from the study is that men should be made equal targets of such programs in Pakistan since 46% females in our study population were using method of contraceptive suggested by their husband

Montelukast as add-on therapy to inhaled beclomethasone in persistent bronchial asthma

To evaluate the efficacy of Montelukast as add-on therapy in moderate persistent asthma with inadequate control on high dose inhaled beclomethasone. A quasi experimental study. The study is carried out at the Combined Military Hospital Multan, from 1st Nov 2006 to 30th May 2007. One hundred nonsmoking symptomatic asthmatics with one year history of moderate persistent bronchial asthma being treated with high dose inhaled beclomethasone dipropionate for at least 6 weeks before the study were selected as per inclusion criteria. Group-I [47 cases] was given inhaled beclomethasone [1000 µg daily in two divided doses] alone for 12 weeks. While Group-II [48 cases] received both inhaled beclomethasone [1000ug daily in two divided doses] and Montelukast Sodium 10 mg at bed time for 12 weeks. Seven-point global evaluation score and Pulmonary function test [PFTs] were done at 0, 6 and 12 weeks; and the need for use of rescue 2-agonist was also calculated in both groups. Mean age of patients was 29.30 years [SD +/- 7.04] with 64.22% males. There was significant difference in episodes of dyspnea and wheeze among group I and group II at 6 weeks while all four parameters including cough and nocturnal awakenings were significantly less at 12 weeks in group II. Similar comparative improvement in mean FEV1 was seen at 12 weeks in group II. Combined therapy also reduced the use of rescue inhaled 2-agonist treatment. Montelukast sodium as add-on therapy to high dose inhaled beclomethasone provides significant complementary clinical benefits in symptomatic moderate persistent asthmatics

Radial nerve injuries; presenting as wrist drop-analysis of 100 patients

To highlight etiological factors leading to radial nerve injury resulting in wrist drop, with particular reference to iatrogenic causes. Retrospection and Descriptive. One hundred patients of all ages and both sexes with wrist drop. Data of clinical assessment after detailed history and examination as well as electro diagnostic studies was recorded on pre-designed assessment proforma. The outcome was charted down for frequency of etiology of the wrist drop. Rehabilitation Medicine Department of Combined Military Hospital [CMH] Multan and Armed Forces Institute of Rehabilitation Medicine [AFIRM]. The major cause of injury was splinter/gun shot injury 31%, mis-placed injection at mid-arm 21%fracture of humerus was 21%, compression neuropathy 16%, and stab wound 11% caused wrist drop. Electro-physiological studies revealed that 85% patients had injury to radial nerve at mid-arm, 9% had injury to posterior interosseous nerve while 4% had injury to superficial branch of radial nerve and only 2% had normal study. Electrodiagnostic studies also revealed that majority of the patients suffered from axonotmesis [44%] and neurapraxia [38%], whereas [16%] were neurotmesis. The most common cause of radial nerve injury is trauma. It is also found that the frequency of radial nerve palsy due to iatrogenic causes is quite high. In addition to the clinical examination, the nerve conduction studies and electromyography proved to be the better investigation technique in the assessment of the location, severity and extent of the peripheral nerve injury and subsequently guides in starting the proper treatment option due to early referral of patient to the concerned fields

Errors in the diagnosis and treatment of pulmonary tuberculosis

The objective of this study was to evaluate the causes of treatment failures in patients diagnosed as pulmonary tuberculosis and started on ATT by general practitioners and general physicians. This was a descriptive observational study conducted at CMH Multan from 1st August 2004 till 31st July 2006. It included patients of all ages and both sexes. All of these patients received ATT for more than 2 months but failed to respond. All relevant investigations including sputum microscopy/culture sensitivity, bronchoscopy and CT scan chest were carried out. Total numbers of patients registered were 48. There were 27 males and 21 females and the mean age of patients was 42.75 years. Of these, 58.33% [n=28] were wrongly diagnosed. 25.02% [n=12] did not show proper compliance. 10.41% [n=5] were prescribed inadequate dosage. While 6.25 [3] were suffering from MDR-tuberculosis. Chronic bronchitis/ COPD, bronchiestasis and bronchogenic carcinoma were the commonest disease found in this series. All TB suspects should have a sputum microscopy done at the earlier stage. AFB culture/ sensitivity should be carried out whenever considered necessary. In Sputum smear negative patients high index of suspicion for non tubercular pulmonary diseases should be maintained. DOTS needs to be employed in all patients with active pulmonary tuberculosis

Dermatological disorders related to cultural practices in black africans of Sierra Leone

To describe various skin manifestations directly or indirectly related to the prevalent cultural practices in the local community of black Africans of Sierra Leone. Eastern province [Kenema] of Sierra Leone from November 2004 to October 2005. Local black patients of all age groups presenting in Dermatology Outpatient department of Pak Field Hospital [established as a part of UN peacekeeping mission in Sierra Leone] were included. After clinical history and physical examination, lesions were photographed. Laboratory investigations were carried out when indicated. Skin diseases were broadly classified into two major categories i.e. related to cultural practices and not related to cultural practices. Non-black settlers in the area and UN troops were excluded. Data was recorded and analyzed by Microsoft Excel. A total of 3011 patients belonging to different local tribes having a variety of skin disorders were seen during the study period. Patients ranged from 1 month to 73 years of age with almost equal gender ratio. Vast majority were from very low socioeconomic group. Skin manifestations related to cultural practices were seen in more than 20% patients and most prevalent were alopecia and hypertrophic scars followed by pomade acne, pseudofolliculitis and contact dermatitis. Prevalent cultural practices in black Africans do play a role in causation of various skin disorders. For a dermatologist, it becomes imperative to be cognizant of the signs and symptoms associated with these practices for proper diagnosis and appropriate treatment