The Clinical Profile and Risk Factors of Pneumonia in Children

Background: The problem of increased ARI morbidity and mortality has arisen as a result of modernization, industry, and urbanization. There is a deficiency of epidemiological studies on risk factors and treatment. There is a significant vacuum in our understanding of these issues, which must be filled by methodical research. The purpose of this study is to evaluate the risk factors developing pneumonia in our area.Material & Methods:This was a prospective clinical study of pneumonia conducted on 90 children who were admitted to Paediatric ward in Abdul MalekUkil Medical College, Noakhali, Bangladesh in study duration. Epidemiological factors affecting the same were studied and bronchoscopy was done whenever it was needed. A detailed history of the relevant symptoms, such as fever, cough, rapid breathing, refusal of feeds, noisy breathing, bluish discolouration etc., was collected.Results:The most affected children belonged to the age group of 1 year to 3 years (64.9%). Bronchopneumonia (86.2%) was the most common clinical diagnosis made at admission. According to WHO ARI control programme, 28.7% had pneumonia, 54.3% had severe pneumonia and 17% very severe pneumonia. It was found that younger age group, malnutrition, kutcha house, crowding, poor sanitation facilities, cooking with fuel other than LPG (indoor pollution) and low socio economic status and high respiratory rate were significant risk factors for pneumonia in children.Conclusions:One of the leading causes of mortality and death in children is particularly pneumonia. In newborns and preschool children, bronchopneumonia is the most common symptom.

Assessment of factors influencing health care service utilization in rural area of Bangladesh

Background: Access to health care services is one of the important preconditions for ensuring good health that is influenced by many socio-demographic characteristics of the individual population as well as policy interventions. The main objective of this study was to identify the factors that determine healthcare service utilization in rural area of Bangladesh.Methods: A cross-sectional descriptive study was carried out in the Rangpur union of Dumuria Upazila of Khulna division in Bangladesh. Data were collected from 195 household heads administering a structured questionnaire. The study applies principal component analysis (PCA) for determining the factors that affect health care services utilization.Results: Need factors (chronic diseases, disability, child sickness, and old aged parents) play the pivotal role to utilize the health care services. The second important factor that contributes to access to health care services is enabling factors consisting of income, distance to the nearest health care center, health cards/health insurance, land ownership, types of latrine use, and membership in a community group. The predisposing factors i.e. age, sex, religion, occupation and education have the least significant role in utilizing health care services.Conclusions: Utilization of health care services depends mostly on the perception and attitudes of people towards disease and disability. So, policy interventions should be taken to raise awareness among people along with regular monitoring of the activities of health care providers.

A qualitative and quantitative analysis of Turkish forest policy documents in the rural development scope / A análise qualitativa e quantitativa dos documentos da política florestal Turca no âmbito de desenvolvimento rural

ABSTRACT: The interaction between forest resources and forest villagers has made rural development a privileged component of Turkish forest policy. In this context the main aim of the study was to investigate the framing of rural development issues in national forest policy by using content analysis method. The economic aspect is the most prominent dimension regarding rural development in the context of national forest policy, environmental and socio-cultural factors follow it respectively. Also, the main approach depends on supporting the forest villagers and its development is seen as an essential tool to protect the forest resources.

RESUMO: A interação entre os recursos florestais e moradores florestais tornou o desenvolvimento rural em um componente privilegiado da política florestal turca. Neste contexto, o principal objetivo do estudo é investigar o enquadramento das questões do desenvolvimento rural na política florestal nacional usando o método de análise de conteúdo. Nós descobrimos que o aspecto econômico é a dimensão mais proeminente em relação ao desenvolvimento rural no contexto de política florestal nacional e fatores ambientais e sócio-culturais seguem a mesma respectivamente. Além disso, a principal abordagem para apoiar os moradores florestais e desenvolvimento deles é visto como um instrumento essencial para proteger os recursos florestais.

Comparing level of 4HNE in acute phase of ischemic stroke patients and its association with cognitive function after stroke event

Stroke is the leading cause of disability in the productive age, not only because of physical disability, but also due to impaired cognitive function following a stroke event. Brain damage-related stroke can be triggered by increasing the level of free radicals. 4HNE is the main and most toxic product that is released from free radical attack on polyunsaturated fatty acids. To determine plasma level of 4HNE in patients recovering from acute phase of stroke and these with normal subjects and calculate its relationship with cognitive function after 3 months of stroke event. Eighty four patients suffering from ischemic stroke and 42 normal subjects [controls] were studied. In patients plasma 4HNE was measured between 24-72 hours of stroke and cognitive function was examined using MoCA-Ina after 3 months of stroke. Plasma 4HNE was 2.5-fold increased in patients than controls [p < 0.05]. The elevation was found in patients having cognitive impairment as compared to those who did not have cognitive impairment, but this was not statistically significant and no relationship was found between plasma 4HNE level and cognitive impairment after stroke. Cognitive impairment at three months after stroke was found in 56% cases. Elevation of plasma 4HNE was seen in acute phase of stroke but it was not associated with impaired cognitive function after 3 months of stroke event

Incidence of QTc prolongation in type 2 diabetes mellitus and it's relation to cardiac autonomic neuropathy

Recently there has been growing interest in the relationship between diabetes and QTc. Prevalence of prolonged QTc interval is higher in people with type 2 diabetes as compared to non-diabetic subjects, especially in the presence of autonomic neuropathy. QTc prolongation in diabetic autonomic impairment has been reported by numerous authors and also has been reported to lead to sudden death. The main aim of this study is to estimate the incidence of QTc prolongation in type 2 diabetes mellitus and its relationship to cardiac autonomic neuropathy. From January 2009 to September 2009, we enrolled 150 type 2 diabetic patients attending the Sulaimani diabetic centre. We also enrolled 100 non diabetic control groups. Both group underwent measurement of QT interval, subsequently QTc estimated according to Bazett equation. We also performed 5 cardiovascular autonomic tests including resting heart rate measurement, heart rate variation with inspiration and expiration, valsalva maneuver, blood pressure response to handgrip and standing. Among the 150 cases 13 were found to have prolonged QTc [8.7%], 11 were females 2 were males [p value 0.041]. No one in the control group showed prolonged QTc. Regarding cardiac autonomic neuropathy [CAN], 106 cases had CAN 35, 40 and 31 for early, definite and severe cases, respectively. There was significant correlation between QTc and CAN [p value 0.000] QTc prolongation was significantly related with increasing age [p value 0.010] and female gender [p value 0.041] but no relationship was found with duration of DM [p value 0.520]. Sensitivity of prolonged QTc for detection of CAN was 20%, with specificity and positive predictive value of 98.7% and 92.3%, respectively. We realized that QTc prolongation occur in cardiac autonomic neuropathy due to DM and it´s highly specific for CAN but insensitive. It is significantly correlated with age and gender but no relation found with duration of DM

Can Lactobacillus acidophilus improve minimal hepatic encephalopathy? A neurometabolite study using magnetic resonance spectroscopy

Minimal hepatic encephalopathy [MHE] is diagnosed when hepatic patients perform worse on psychometric tests compared to healthy controls. This study aimed to evaluate probi-otics as alternative therapy in MHE. This is an open-label randomised controlled trial, performed in the Department of Tropical Medicine and Infectious Diseases, Tanta University Hospitals, from March 2010 to January 2012. A total of 90 patients with MHE were allocated by simple randomisation to three parallel equal groups. Group A received lactulose, group B a probiotic [Lactobacillus acidophilus] and group C served as the control. After informed consent, patients were tested for gut micrecology, fasting blood ammonia, liver functions and magnetic resonance spectroscopy [MRS] examination to study brain metabolites, mainly choline [Cho], myoinositol [ml], glutamine + glutamate [Glx] and creatinin [Cre]. Patients who developed overt encephalopathy were excluded from analysis. The whole battery of investigations was repeated in the same order after 4 weeks. The probiotic was better tolerated than lactulose. The relative risk reduction [RRR] of developing overt encephalopathy was 60% in the case of lactulose and 80% in the case of probiotic, with a number needed to treat [NNT] of 2.4 and 2.3, respectively. The differential but not total microecology count was significantly shifted towards saccharolytic rather than proteolytic bacteria. The ml/Cre and [Cho + mI]/Glx ratios were significantly increased and the Glx/Cre ratio was significantly reduced after 1 month-follow-up in the probiotic group compared to the lactulose group and in both treatment groups compared to the control group. Both probiotic and lactulose therapy can improve blood ammonia and psychometric tests in MHE and reduce the risk of developing overt encephalopathy. MRS showed more improvement in the levels of brain neurometabolites in the probiotic group

[ association of food security and dietary variety in subjects aged over 40 in district 13 of Tehran]

The purpose of this study was to investigate the relationship between food security and food variety in a population, aged over 40 years. From among the non-diabetic population, aged over 40 years of the Tehran Lipid and Glucose Study, 200 subjects were selected randomly to complete the household food security questionnaire and were divided into four groups including high food security, food security border, low food security, and very low food security. Demographic, anthropometric and dietary intake data of each subject were collected and the dietary diversity score [DDS] was determined based on five food groups of the food guide pyramid. Mean +/- SD for DDS of subjects was 4.94 +/- 1.35, and in the high food security group was significantly higher than in the food insecurity group [the other 3 groups]. Mean +/- SD for food security in the first quartile of DDS [3.04 +/- 1.95] was higher than in the third [1.94 +/- 2.1, P=0.005] and fourth quartiles [2.22 +/- 2.2, P=0.043]. The lowest and highest percentages of subjects with high food security were in the first and third quartiles of DDS, respectively. After adjusting sex, age, body mass index, energy intake, job and marital status, the odds of being in the lowest quartile of fruits variety for high food security group was 73% lower than for the low food security group. An inverse correlation was observed between food security score with the DDS [r=-0.42, P=0.012], the fruits variety score [r=-0.45, P=0.004], and the vegetables variety score [r=-0.37, P=0.046]. Dietary diversity as an indicator of a healthy diet is associated with food security and increases food security results in dietary diversity, especially in fruit and vegetable varieties

[Investigation of the safety of prescribed drugs during pregnancy]

This study was undertaken to assess the safety of prescribed drugs during pregnancy in five Sudanese cities. The sample consisted of 1012 randomly interviewed pregnant women visited hospitals and private clinics in Khartoum, Wad-Medanj, Hassahisa, Almanagil and Qusty cities .The prescribed drugs were thoroughly investigated and assessed according to the Food and Drug Administration's [FDA] Classification of Drugs in Pregnancy. The study revealed that, the prescribed drugs included dietary supplementations and vitamins 53.07%, anti-infective agents 13.8%, antimalarial drugs 8.96%, antihypertensive agents 3.21%, drugs for nausea and vomiting 4.56%. Regarding the FDA classification of drugs during pregnancy, most of the investigated drugs 779 [43.89%] were classified as class A, followed by 382 [21.52%] drugs which are categorized as class B. Howerever, 280 [15.77%] of drugs had no apparent classification in FDA regimen. Furthermore, a great number of the study population [80.24%] did not use drugs without medical consultation. It can be concluded that most of the surveyed drugs were considered safe in pregnancy. Further qualitative and quantitative studies are needed to assess the safety of prescribed drugs during pregnancy

Carbamazepine and the QTc interval: any association?

Objective: To determine whether carbamazepine monotherapy in epilepsy patients is or is not associated with prolongation of the QTc interval. Methods: This case-control study enrolled 100 consecutive patients with generalized tonic-clonic seizures. Fifty patients were already taking carbamazepine for a variable time, and the rest (n=50) were not on any antiepileptic drug. The QTc interval was calculated after doing a resting 12-lead ECG examination on a single occasion. Results: Of the 50 patients who had received carbamazepine, 11 patients displayed prolongation of their QTc interval, while 8 patients out of the 50 in the control group had QTc interval prolongation after correction for gender; p value =0.49, OR 1.36, 95% CI 0.54-3.29. Conclusion: This study demonstrated no statistically signifi cant association between carbamazepine monotherapy and prolongation of the QTc interval. Carbamazepine does not seem to prolong the QT interval when used as monotherapy for epilepsy. The presence of prolonged QTc interval in such patients should prompt a search for co-factors that prolong this interval, such as multiple medications, electrolytes disturbances, structural heart disease, and congenital long QT interval syndromes.

Detection of some organophosphrous compounds residues in nile fish markets of some villages of Kaliobia governorate

A total sixty samples Nile tilapia [Qreochromis niloticus] and Clarias garpinus [Thirty of each] collected from fish markets of some villages of Kaliobia governorate and subjected to fat extraction and determination of organophosphrous residue by gas chromatography. Organophosphrous residues including diazinon, chlorpyrifos-ethyl, Malathion, Methyl-parathion, ethyl parathyion and Ethion with an incidence from muscles of Tilapia nilotica were [33%, 6.7%, 20%, 12%, 12% and 3% respectively] and from Clarias garpinus were[50%, 6.7%, 16%, 10%, 12% and 3% respectively]. The obtained result revealed that the residues of diazinon came in the first rank followed other organophosphrous residue. Most residues detected within action limit for fish, however, residues of these pesticide were not detected in collected samples may be due to their percent in very trace amount or gave indicter for safety environment from different types of pollution

Role of laparoscopy in the management of chronic unexplained lower abdominal pain

Patients with chronic lower abdominal pain in whom routine investigations fail in accurate diagnosis, continue to pose a challenge to the clinician. In many patients laparotomy is the only alternative. The aim of this study was to evaluate and establish role of laparoscopy in management of unexplained chronic lower abdominal pain. Over a period of 24 months we prospectively managed 52 patients presented with unexplained chronic lower abdominal pain by laparoscope. Laparoscopy yielded positive findings in 39[75%] of these patients. Chronic appendicitis, intrabdominal adhesions and gynecological problems were the major findings. Therapeutic procedures were performed in 40 patients [laparoscopically in 35 patients]. There were no major complications following diagnostic laparoscopy. Laparoscopy is safe and effective in management of undiagnosed chronic lower abdominal pain

Montelukast versus sodium cromoglycate in children with mild persistent asthma: effect on allergic inflammation and bronchial hyperresponsiveness

The effect of montelukast and cromolyn on allergic inflammation and bronchial hyperresponsiveness was compared in 40 children with mild persistent asthma. Twenty children received oral montelukast [Singulair] while twenty children received inhaled cromolyn [Intal-5 MDI] during the study period of 6 weeks. Asthmatic children were evaluated clinically and with pulmonary function tests [forced expiratory volume in one second [FEV[1]] and peak expiratory flow [PEFR], challenge tests [histamine and exercise] and measurement of inflammatory markers [blood eosinophil count, serum immunoglobulin E [IgE], eosinophil cationic protein [ECP], interleukin 4[IL4] and nitric-oxide products in sputum] both. before and after six weeks therapy with either montelukast or cromolyn. Twenty age and sex matched non atopic children served as controls. Asthmatic children, on admission, had significant decrease in mean FEV[1] and PEFR and increase in mean eosinophil count, serum levels of total serum IgE, ECP, IL4 and sputum nitric-oxide products as compared to controls. Both drugs produced significant and equal improvement in pulmonary functions [FEV[1] and PEFR], decrease in the degree of bronchial hyperresponsiveness to histamine and exercise and a significant decrease in blood eosinophil count, serum IgE, ECP and IL4 and sputum nitric-oxide products. However all these parameters were still significantly different as compared to mean control levels. Better asthma symptoms control was observed with montelukast than with cromolyn sodium and there was a greater significant adherence with montelukast than with cromolyn- sodium with both patients and parents preference for montelukast

Role of magnesium sulphate in ischaemic stroke

To evaluate the role of magnesium sulphate in patients presenting with ischaemic stroke. This experimental type of interventional study was carried out at Mayo Hospital, Lahore. Within 24 hours of onset of clinically diagnosed stroke, which was later confirmed by CT scan, patients were randomized to receive either magnesium sulphate [16mmol IV over 15 minutes and 65mmol over 24 hours] or placebo. Their disability was measured by Barthel score at presentation and outcome measured after three months by death and disability and the results were compared between the two groups. Those patients who had a Barthel score of = 12 at three months were considered independent and those with a score of < 12 were considered disabled. The results were analyzed by SPSS. Fifty patients were recruited in the study. 25 patients were randomized to receive MgSO[4] and 25 received placebo. The Barthel score improved from 5.1 +/- 3.3 at presentation to 13.5 +/- 3.4 after three months in all the patients so the re was improvement whether MgSO[4] was given or not. Patients who were randomized to receive MgSO[4] had a lower Barthel score of 4.2 +/- 2.9 as compared to controls 5.9 +/- 3.5, but after three months they improved more than the controls gaining a score of 15.7 +/- 1.9 versus 11.3 +/- 3.2 [p=0.000]. The mortality rate was not statistically different in the two groups. 88% patients had a Barthel score of > 12 at three months in the MgSO[4] and 30% in the control/placebo group. Combined death and disability was 8% in MgSO[4] group and 60% in the control group. Moreover MgSO[4] was well tolerated. Magnesium sulphate therapy was safe in patients presenting with ischaemic stroke irrespective of the site of infarct. It improves prognosis regarding Barthel score at three months as well as the difference in the Barthel score at presentation and at three months. A greater percentage of magnesium treated patients led independent lives after three months

Complications of streptokinase during infusion in acute myocardial infarction

Myocardial infarction is one of the most common causes of death worldwide. The cornerstone of therapy is thrombolytic therapy. Coronary thrombolysis helps restore coronary patency, preserves left ventricular function and improves survival. The most common thrombolytic agent used is streptokinase. But thrombolytic therapy is at times associated with some complications. This comparative study was aimed to find out the complications occurring during streptokinase infusion in patients presenting with acute myocardial infarction in Mayo Hospital, Lahore. Two hundred patients with definite diagnosis of acute myocardial infraction, who presented to East Medical Ward, Mayo Hospital, Lahore, were included in this study. All patients presenting with AMI were considered for SK therapy. Those who were actually given SK constituted the SK group and those who were not fit for SK, but otherwise SK was indicated, constituted the control group. In SK group 100 patients were given standard t reatment of acute myocardial infarction including streptokinase. In control group 100 patients were given standard treatment of acute myocardial infarction except streptokinase due to non-eligibility. Patients with typical chest pain of at least 30 minutes duration, serial ECG changes and serial cardiac enzyme changes were entered in the study. Comparative / interventional Post SK changes in blood pressure were significant [p= 0.011]. There was post SK hypotension in 48 [24%] and post SK hypertension in 20 [10%] patients. Allergic reaction was present in 4 [2%] only [p=0.044]. Arrhythmias were significantly less prominent in SK group [p=0.000]. Post SK bleeding occurred in 3 [1.5%] only [p=0.082]. 37 patients died [18.5%] in total, out of which 5 [2.55] patients died in SK group and 32 in control group [p=0.000]. CVA occurred in 1 SK group patient only, which was found to be hemorrhagic on CT scan [p= 0.31]. Early administration of SK lowers in-hospital mortality [p= 0.00 0]. Major complications during SK therapy are Hypotension [p= 0.011], Arrhythmias [p= 0.000], Allergic reactions [p= 0.044]

Atrial fibrillation in mitral stenosis and its correlation with age, sex and clinical symptoms

The objective of the study was to calculate the frequency of atrial fibrillation of MS and its correlation with age, sex and clinical symptoms. A prospective descriptive study. Mayo Hospital and Punjab Institute of Cardiology, Lahore. 112 patients of mitral stenosis were investigated with an ECG and an echocardiography to confirm mitral stenosis and to measure anteroposterior left atrial dimensions on M-mode. All patients who were suffering from AF due to causes other than mitral stenosis were excluded. The significance of findings were tested through standard "t"test. Atrial fibrillation is more in female patient and has a linear correlation with age. More common symptoms of shortness of breath followed by palpitation

Frequency of atrial fibrillation in mitral stenosis and its correlation with left atrial size

Chronic rheumatic heart disease is much the commonest cause of mitral stenosis. Incidence of rheumatic MS parallels that of acute rheumatic fever. Atrial fibrillation usually develops in the presence of pre-existing ECG evidence of left atrial enlargement and is related to the size of the chamber, the extend of fibrosis of the left atrial myocardium, the duration of the atriomegaly and the age of the patient. Descriptive. Mayo Hospital, Lahore and Punjab Institute of Cardiology, Lahore. Convenient. 129 consecutive cases of predominant mitral stenosis. 112 cases included in the final workup. The frequency of AF in MS in this study was calculated as 25.9%. The correlation between AF and left atrial size was significant [p = 0.000]. This was plotted on the scattergram [Figure No. 1], which shows a steep rise in the frequency of AF beyond a left atrial size of 70 mm. Frequency of AF in patients with MS is 25.9%. The correlation between AF in MS and left atrial size is significant [p = 0.000]

Interpretation of liver chemistry tests

Liver chemistry tests are frequently used to assess patients with symptomatic and asymptomatic liver diseases. However, these tests are neither sensitive nor specific and should, therefore, be interpreted in conjunction with clinical data and other laboratory investigations as well as imaging studies. Nonetheless, certain patterns in liver tests may be helpful in short listing the differential diagnosis of liver dysfunction. This article discusses the utility and limitations of liver tests in establishing the diagnosis and prognosis in patients with various liver disorders. The paper also addresses non-hepatic causes of abnormal liver chemistry tests

Evaluation of drug use in Jordan using WHO prescribing indicators

Patterns of prescribing and use of pharmaceuticals by physicians and patients in Jordan have not previously been studied. We retrospectively evaluated pharmaceutical drug prescribing practices in 21 primary health care facilities in Irbid governorate, northern Jordan using World Health Organization-recommended core indicators.The mean number of drugs prescribed was 2.3 overall, ranging from 1.9 to 3.0. The percentage of drugs prescribed by generic name was very low, as was the percentage of prescriptions involving injections. The percentages of prescriptions involving antibiotics and drugs from the essential drugs list averaged 60.9% and 93% respectively. We conclude that the prescribing and use of drugs in Jordan requires rationalization, particularly the over-prescribing of antibiotics and the under-prescribing of generic drugs