COVID-19 Pandemic: Trend Analysis with Respect to District Anantnag, Jammu and Kashmir, Northern India

With 1st case being reported in Wuhan city of China in December 2019, COVID?19 infection cases made their way to every corner of the world. Then, on January 07, 2020, laboratory results led to pneumonia being named as COVID?19. Scant data is available from Northern India, thus to reveal the trend of COVID?19 infection since last year of COVID?19 pandemic onset, this study took shape. The unit of analysis of our study was District Anantnag, Jammu and Kashmir. Till February 05, 2021, a total of 4625 cases of COVID?19 virus were reported in District Anantnag, Jammu and Kashmir. Negative history of close contact with COVID?19 patient (66.1%) constituted the most common exposure, majority (84.4%) were asymptomatic and comorbidities were present in 68 (1.5%). COVID?19 infection was more prevalent among younger age group, with higher male predominance, with comorbid being at higher risk, hence most stringent measures must be adopted.

Facing the evitable and the inevitable: perspectives of good death amongst Muslim patients and health care providers in Pakistan

Objective: To review the validity of the future of health and care of older people [TFHCOP], good death perception criteria in Muslim patients and health care providers in cultural background of Pakistan

Study Design: A mixed method design with qualitative and quantitative components

Place and Duration of Study: Oncology Department, Combined Military Hospital, Rawalpindi, from July 2015 to October 2015

Material and Methods: It is a sequential explanatory type of mixed method research. A total of 110 participants were included in the study by non probability convenient sampling technique. A modified questionnaire was used based on the principles of TFHCOP good death definition comprising of 8 questions. This was followed by interviews. For data collection and analysis grounded theory approach was used with constant comparisons and open coding. Descriptive statistics were used to analyze questionnaire responses. For bivariate analysis we used chi-square test

Results: There was a consensus on the principles presented in the modified questionnaire in the two groups studied. Total of three domains measured non-significant difference in patient's and health care provider's perspectives. Participants identified four more domains. The first domain was related to faith in Allah Almighty, second domain is about leaving the will for bereaved, third domain was about the concerns to finish unfinished agendas and the fourth domain was related to the importance of family security over treatment or death

Conclusion: Perception of good death by Muslim patients and health care providers in Pakistan is different from that of Western and Arab communities in certain domains like religious beliefs, leaving will for the bereaved, finishing unfinished work and the importance of family concerns

Perceptions of faculty and health care managers about managerial skills and training needs of doctors working as house officers in medical institutions

Objective: To find out the perceptions of faculty and health care managers about the managerial skills of house officers, areas in which they are deficient and the learning strategies to improve these skills

Study design: Cross sectional study

Place and Duration of Study: The study was carried out in affiliated institutions of Armed Forces Postgraduate Medical Institute Rawalpindi, Pakistan Institute of Medical Sciences, Islamabad, and Holy Family Hospital Rawalpindi, from 15[th] December 2014 to 15[th] February 2015

Material and Methods: Questionnaire was used for data collection. It consisted of three sections. It assessed the respondents' perceptions of house officers' managerial skills, areas in which they were deficient and learning strategies for these skills. A probability convenience sample of faculty members and health care managers of institutions affiliated to Army Medical College, Pakistan Institute of Medical Sciences and Holy Family Hospital Rawalpindi was selected

Results: A total of 106 health care managers and faculty members were approached, of which 88 responded. Respondents were equally divided among health care managers and faculty members. The following skills of house officers received the lowest ratings by the respondents, 'Skills of using evidence based guidelines for allocating health care resources', 'how to function in their position as a leader', 'how the Pakistan healthcare system is organized and financed'. Respondents were unanimous that medical graduates need training in managerial skills and majority [93%] of them preferred lectures as the teaching strategy

Conclusion: Health care managers and faculty members in Rawalpindi/Islamabad region perceive the managerial skills of house officers as inadequate. They believe that training is required at undergraduate level to improve these competencies

Early asymptomatic decline in left ventricular ejection fraction in adult cancer patients receiving doxorubicin

To determine the frequency of doxorubicin induced early asymptomatic decline in left ventricular ejection fraction by serial echocardiography and to identify risk factors associated with cardiotoxicity. Quasi-experimental study. Oncology Department, Combined Military Hospital, Rawalpindi from January 2012 to December 2012. Patients who were started on doxorubicin-based chemotherapy during the study period and had completed at least 300 mg/m[2] cumulative dose were included in this study. Electrocardiography, chest X-ray and echocardiography were done at baseline and one to three months after completion of chemotherapy. All patients were evaluated for the presence of the following risk factors: pre-existing coronary artery disease, diabetes mellitus, hypertension, chest wall irradiation and a cumulative dose exceeding 400 mg/m[2]. Asymptomatic cardiac dysfunction was defined as ejection fraction [EF] fall greater than 10% on follow-up echocardiography with minimum or no symptoms. Significant change was observed in ejection fraction after completion of chemotherapy. Out of 54 patients, 27.8% showed 5%, 13% showed 10% decline, 16.7% had 15% decline, one [1.9%] patient had 20% decline in EF after completion of chemotherapy while 40.7% had no change in ejection fraction. Thirty one percent of the patients developed > 10% decline, in left ventricular ejection fraction with the use of doxorubicin in the cumulative dose range of 300-400 mg/m[2]. Pre-existing coronary artery disease, hypertension and a cumulative dose exceeding 400 mg/m[2] are identifiable risk factors in this study. This entails regular monitoring for cardiac dysfunction by echocardiography during doxorubicin treatment

Antioxidant and antibacterial activities of Hibiscus Rosa-sinensis Linn flower extracts

Antioxidant and antibacterial potential of different solvent extracts of locally grown Hibiscus rosa-sinensis Linn was evaluated. The antioxidant activity was assessed by estimation of total flavonoids contents, total phenolic contents, DPPH free radical scavenging activity and percentage inhibition of linoleic acid oxidation capacity. Agar disc diffusion method was used to assess antibacterial potential of crude extract of H. rosa-sinensis. The yield of the crude extracts [23.21 +/- 3.67 and 18.36 +/- 2.98% in 80% methanol and ethanol solvents was calculated, respectively. Methanol and ethanol extract of H. rosa-sinensis showed total phenolics 61.45 +/- 3.23 and 59.31 +/- 4.31 mg/100g as gallic acid equivalent, total flavonoids 53.28 +/- 1.93 and 32.25 +/- 1.21 mg/100g as catechine equivalent, DPPH free radical scavenging activity 75.46 +/- 4.67 and 64.98 +/- 2.11% and inhibition of linoleic acid oxidation potential 75.8 +/- 3.22 and 61.6 +/- 2.01% respectively, was measured. Antibacterial study against three human pathogens such as staphlococus sp. Bacillus sp. and Escherichia coli showed growth inhibitory effect in the range of 12.75 +/- 1.17 to 16.75 +/- 2.10 mm. These results showed H. rosasinensis indigenous to Kallar Kahar and its allied areas bear promising medicinal values and could be used for developing herbal medicines to target oxidative stress and infectious diseases.

Pattern of extranodal involvement in non hodgkin's lymphoma

To study the anatomical and histomorphological pattern of extranodal non hodgkin's lymphoma [NHL]. Descriptive study. The study was carried out at oncology department combined military hospital rawalpindi during July 2012 to April 2013. All newly diagnosed patients of NHL with extranodal involvement were included in the study.They were categorized as primary extranodal or secondary extranodal lymphomas. Histological pattern and site of involvement were studied. The male to female ratio was 2.2:1 [Male 31, Female 14], and the mean age was 48.16 years[SD=13.40]. Primary extranoal involvement was seen in 55.6% of patients. Secondary extranodal involvement was seenin 44.4patients. Diffuse large B-cell lymphoma [DLBCL] was the most common type of NHL observed in both primary and secondary extranodal involvement. Gastrointestinal tract was the most common site for primary extranodal involvement and bone marrow was the most common site for secondary extranodal involvement.High freqency of primary extranodal involvement was noted in our study. DLBCL was the most common morphological type observed.Gastrointestinal tract and secondary bone marrow involvement were the most common anatomical sites for primary and secondary extranodal involvement respectively

Comparative Spectroscopic determination of Heavy Metals Profile of kidney Patients before and after Dialysis and Healthy voluntaries.

Present study was conducted to quantify and compare the levels of heavy metals in plasma sample of kidney patient before and after dialysis belonging to different areas of Sargodha region. In this study, the level of copper, zinc, cadmium, iron, manganese, lead, chromium and cobalt in plasma sample of Kidney patients has been investigated using atomic absorption spectrophotometer. Heavy metal profile in both normal and diseased subject was determined using dialysis time period and age factor parameters. The mean value of Zn and Fe was found lower in kidney patient as compared to normal subject and reverse was found in case of Pb, Mn, Co and Cr. The heavy metals composition in male patients were found somewhat higher but non-significantly (P>0.05). Age factor revealed that those patients whose age was >30 years have greater values of metals as compared to <30 years patients. Similarly, the patient on dialysis with <2 years have low concentration of metals as compared to >2 years.

Depletion of body and cerebellar weights after chronic lithium carbonate ingestion in Albino rats

The effect of Lithium on the body and brain are well known but enough literature is not available on the effects of Lithium on body and Organ weights. So this study was undertaken to see the effect of Lithium on body and cerebellar weights. An experimental study. This study was conducted at the Anatomy Department BMSI, JPMC, Karachi. April 2012 to June 2012. Thirty male albino rats of 200-250 grams were selected and divided into two major groups A and B. Each major group consisted of 15 animals each groups was further divided into three sub-groups according to the time period of the study which was 2 weeks, 6 weeks and 12 weeks. Group A served as control group which was given lab diet and B was the Lithium treated group. Lithium carbonate was given at a dose of 20mg/kg/day for 2, 6 and 12 weeks. Body weights were recorded at the start and of each time period, but cerebellar, Organ weights were recorded at the end of 2[nd], 6[th] and 12[th] weeks. The body weights and Organ weights are recorded on digital electronic weighing scale. Group B showed a progressive decrease of body and cerebellar weights as the time period of study advanced. But relative cerebellar weights of group B increased with increasing time period of study. The present study concluded that Lithium carbonate causes a significant decrease of body and cerebellar weights

Association of age with steroid receptor and her-2/neu receptor status in breast cancer patients at combined military hospital Rawalpindi

To determine the association of steroid receptor expression and HER-2/Neu expression in different age groups in breast cancer patients at Combined Military Hospital Rawalpindi. Descriptive study Department of Oncology, CMH Rawalpindi, from Jan 2009 to December 2010. A prospective study in which 257 patients, of both genders more than 18 years old with histopathological diagnosis of carcinoma breast, were stratified into three age groups [<35 years, 35-50 years and >50 years]. Estrogen and progesterone receptor and HER-2/neu receptor status was determined in all the patients. Positive status of either estrogen or progesterone receptor was considered as steroid receptor positive. Association of HER-2/neu with the steroid receptors was determined in all the age groups. Estrogen receptor was positive in 95 [38.2%] patients. Progesterone receptor was positive in 144 [57.8%] patients. Steroid receptor was positive in 160 [64.3%] patients. One third [32.9%] of the patients were positive for HER-2/neu. Positive cases of HER-2/neu were significantly higher in negative steroid receptor cases as compared to positive cases [50.6% vs. 23.1%, OR = 3.324, p<0.001]. In age groups "35 - 50 years" and "> 50 years", this inverse association of HER-2/neu status with steroid receptor was significant. HER2/neu receptor status should be determined in all patients but if it is not possible due to the local availability of facilities as well as affordablility of the patients, patients who are steroid receptor negative should be referred to laboratories capasle for accurate determination of HER-2/neu receptor status as these patients are more likely to be positive for HER-2/neu receptor status

Management options of basal cell carcinoma in surgery

To describe the prevalence, mode of presentation and various surgical options of reconstruction in the management of basal cell carcinoma. Descriptive Study. This study was conducted at Nishtar Hospital, Multan from 2006 to 2009. 60 patients were taken in this study. A separate file was maintained for each patient. A thorough history and full physical examination was conducted, relevant investigations were carried out. Out of sixty cases, 50 [83%] were male and 10 [17%] were female. Majority of the patients presented to us above the age of 45 years and the incidence of BCC increases with the age. The male to female ratio was 5:1. Out of 60 cases 26 [20 male, 6 female] 43.3% were farmer, 16 [all male] 26.6% wee construction workers, 10 [8 male, 2 female] 16.6% were unemployed and 8 [all female] 13.3% were household. No patient presented before 5 years after the development of the lesion. 34 [30 male, 4 female] 56.6% for the last 6-10 years, 20 [16 male, 4 female] 33.3% for the last 11-15 years, 2 [all male] 3.3% for 16-20 years and 4 [2 male, 2 female] 6.6% had lesions for > 20 years. Delay in presentation has an overall negative effect on the outcome

Which is better in care of volvulus sigmoid colon? primary repair or double barrel colostomy

Volvulus refers to torsion of a segment of the alimentary tract, which often leads to bowel obstruction. Sigmoid volvulus is the most common form of volvulus of the gastrointestinal tract and this condition is responsible for 8% of all intestinal obstruction. Sigmoid volvulus is particularly common in elderly persons. To compare the outcome of double barrel colostomy versus primary repair after on table lavage in cases of volvulus of sigmoid colon. Comparative study. This study was conducted in the Department of Surgery, from April 2010 to September 2010 in Nishtar Hospital, Multan. This study was conducted in the Department of Surgery, from April 2010 to September 2010 in Nishtar Hospital, Multan. A total of 100 patients were included in the study. Majority of the patients in the age group 41-50 years. Out of 100 patients, 80 [80%] were male and 20 [20%] were female. Out of 100 patients, 40[40%] belonged to Baluchistan, while 30 [30%] from DG Khan, 10 [10%] from Sindh and remaining 20 [20%] from Multan. It is concluded from the study that morbidity and hospital stay was significantly lower in patients with Group-A [sigmoidectomy and primary anastomosis after on table lavage] as compared to group-B [sigmoidectomy + double barrel colostomy], so economic burden and morbidity related to colostomy can be prevented

Frequency and severity of neutropenia in diffuse large beta-cell non Hodgkin's lymphoma after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolone

Chemotherapy used for malignant diseases may produce severe neutropenia in first cycle which may compel for dose modification and early termination of therapy. This descriptive cross sectional study was planned to see the frequency and severity of neutropenia after first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in patients of diffuse large B-cell non Hodgkin's lymphoma presenting at Oncology Department Combined Military Hospital Rawalpindi from August 2009 to July 2010. Thirty patients of diffuse large B-cell non Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department Combined Military Hospital Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Patients were then planned for first cycle of chemotherapy comprising cyclophosphamide, doxorubicin, and vincristine with prednisolon. After the first cycle of chemotherapy they were monitored for expected neutropenia in the ward. The neutrophil counts were repeated on days 7 and 10 following chemotherapy. Neutropenia was graded as defined in the operational definition and all the data was entered on a specially designed data card. As much as 3.3% of patients suffered from grade IV neutropenia [absolute neutrophil count of <0.5x10[9]/L], 3.3% had grade III neutropenia [absolute neutrophil count of 0.5x10[9]/L- 0.9x10[9]/L], 6.6% had Grade II neutropenia [absolute neutrophil count 1.0x10[9]/L-1.4x10[9]/L and 10% had Grade I neutropenia [absolute neutrophil count 1.5x10[9]/L-1.9x10[9]/L. Overall 23.2% suffered from neutropenia of all grades post 1st cycle of chemotherapy comprising cyclophosphamide, doxorubicin, vincristine with prednisolon in diffuse large B-cell non Hodgkin's lymphoma. Further studies are required to find the risk factors to predict this complication in our population

Moderate acute normovolaemic haemodilution - a limited experience with autologous blood transfusion

Blood is transfused to increase the oxygen carrying capacity and the intravascular volume. The requirement of blood transfusion is not simply dependent upon the haemoglobin or haematocrit values but the emphasis is also placed upon the age and health of the patient. The potential risks of blood transfusion have necessitated finding alternatives to allogeneic blood transfusion. This study was conducted to determine the efficacy and safety of moderate acute normovolemic hemodilution to reduce allogeneic red blood cells transfusion in operations in which blood transfusion was otherwise required. It is an interventional clinical trial. The study was carried out in the department of anaesthesia, operation theatre and intensive therapy care unit, Combined Military Hospital, Okara Cantt, during the period from January 2003 to October 2003. Twenty five patients of ASA-I and II status, who were undergoing elective surgical procedures, were subjected to the technique of moderate acute normovolaemic haemodilution. The intravascular volume of the patients was maintained with lactated Ringer's solution and 6% hexaethyl starch solution. Autologous blood was reinfused after the operation. All patients in this study remained haemodynamically stable. No patient required any homologous blood transfusion. Moderate ANH was found a useful, safe and economical technique. It can be used as an alternative technique in operations in which homologous blood is otherwise required

Presenting phases of chronic myeloid leukaemia

To determine the frequency of three phases of chronic myeloid leukaemia at first presentation. Department of Oncology, Combined Military Hospital [CMH], Rawalpindi, from June 2006 to December 2007. Forty-five patients of either gender with Chronic Myeloid Leukaemia [CML] at their first presentation in outpatient department were included in the study by consecutive sampling technique. All patients were diagnosed on blood complete picture and bone marrow examination including aspiration, trephine and cytogenetics at Armed Forces Institute of Pathology [AFIP]. Each phase was defined on the basis of World Health Organization [WHO] criteria. Out of 45, there were 31 [68.9%] male and 14 [31.1%] female patients. The mean age of presentation was 37.9 years. The pattern of presentation revealed 35 [77.8%] in Chronic Phase [CP], 7 [15.5%] in Accelerated Phase [AP] and 3 [6.7%] in Blast Crisis [BC]. Philadelphia chromosome was detected in 39 [86.7%] cases on culture method. Splenomegaly was observed in 37 [82.2%] patients. The mean total leukocyte count, platelet count, haemoglobin and marrow blast were 214.3x10[9]/L, 551.4x10[9]/L, 9.94 g/dl and 9.3% respectively. CML presented at a younger age in the chronic phase

Frequency of bone marrow involvement in Hodgkin's lymphoma on first presentation

To determine the frequency of bone marrow involvement in patients of Hodgkin's lymphoma on first presentation at oncology department. Case series. The Oncology Department, Combined Military Hospital, Rawalpindi, from April 2006 to February 2007. Thirty five patients of Hodgkin's lymphoma diagnosed on lymph node biopsy presenting for the first time at Oncology Department, Combined Military Hospital, Rawalpindi were included. They were admitted in the ward and evaluated with history, physical examination and staging investigations. Bone marrow trephine biopsy was performed in all patients. Descriptive statistics were used to analyze data. On clinical and radiological evaluation, 8 patients [22.9%] had clinical stage [CS], 12 [34.3%] had CS II, 9 [25.7%] had CS III and 6 [17.1%] had CS IV. The microscopic appearance in bone marrow trephine examination showed lymphoma infiltrates in 6 [17.14%] patients and chronic disorder in 29 [82.85%] patients. Among patients with bone marrow infiltration, one had CS II disease, three had CS III disease and two had CS IV disease. One patient had bone marrow infiltration as the only manifestation of disease. Bone marrow involvement was seen in patients with Hodgkin's lymphoma clinical stage II or higher

Endoscopic dilatation in cases of benign oesophageal stricture: experience at Nishtar Hospital, Multan

Endoscopic dilatation is most widely practiced mode of management in cases of benign oesophageal strictures. It is relatively simple and effective in most cases. Moreover, the procedure carries few complications in experienced hands. The objectives of this study were to establish the safety of Endoscopic dilatation in cases of benign oesophageal strictures in local setup and to evaluate the improvement of dysphagia score following the procedure. It was a prospective/Cohort-hospital based study, conducted from December 2006 to January 2008 at Surgical Unit-1, Nishtar Hospital, Multan. A total of 55 patients with the provisional diagnosis of benign oesophageal stricture were included in the study. Five patients were found to have malignant strictures and were subsequently excluded. Oesophagoscopy was done with rigid oesophagoscope while dilatation was performed with Maloney bougies in most patients. However, in some patients with difficult strictures, dilatation was done "under fluoroscope over the guide wire", using Savary Gillard's dilator system. The data was analyzed with SPSS version 10.0 to formulate the results. The male to female ratio was 1.5:1. Mean age of the sample was 34.50 +/- 4.75 years. The most common [64%] cause of benign stricture was corrosive intake. All the patients presented to us with history of dysphagia and patients with GORD [14%] had previous history of heart bums of long duration. More than half, 29 [58%] strictures were seen in upper 1/3[rd] of oesophagus. Most of the strictures [86%] were either less than 1cm [42%] or 1-3cm [44%]. All biopsy reports shown benign nature of the stricture. After dilatation therapy, average improvement in the dysphagia score was 2/5 to 3.4/5. Dilatation interval also increased with regular dilatations. Our patients required repeat dilatation after a mean of 16 weeks. Postoperative chest pain was observed in 20 [40%] patients and it was mild in intensity and relieved within six hours. Two patients [4%] developed haematemesis post-operatively. Patients with stricture due to GORD were put on proton pump inhibitors. Endoscopic dilatation is effective and safe procedure in cases of benign oesophageal stricture. It substantially improves dysphagia score postoperatively. Difficult strictures can be safely managed with dilatation under fluoroscopic control

Penile fracture: experience at Ayub teaching hospital

Penile fracture is a relatively rare traumatic rupture of the tunica albuginea of one or both corpora cavernosa of an erect penis. It is a real urological emergency which needs early assessment and surgical management. Twelve [12] cases of penile fracture were reviewed from July, 1997 to July, 2007 in the Department of Urology, Ayub Teaching Hospital Abbottabad. All cases presented with classical history of penile fracture and the diagnosis was made on the basis of history and clinical examination only. All the patients underwent immediate surgical repair with well preserved potency and excellent overall results. Penile fracture has typical signs. Standard treatment consists of immediate surgical repair of penile fracture with a low incidence of late complications. Post op complications including urethral strictures and erectile dysfunction should be ruled out by regular follow-up

Leucopenia as presentation of sarcoidosis

A 20-year-old male Saudi national presented initially with leucopenia and splenomegaly. The absence of other signs of disease, progressive pancytopenia and normal bone marrow examination posed a diagnostic dilemma as to the cause of hypersplenism. Subsequently, the patient had splenectomy the histopathological appearance of which was non-caseating granuloma. A high level of angiotension converting enzyme [ACE] was found in this patient. Sarcoidosis is a recognized cause of hypersplenism, and though the disease is not yet widely described in this part of the world. It is the most probable diagnosis in this patient