Knowledge, attitudes and practices of lady health workers regarding family planning program in tehsil muzaffargarh

Objective: To assess the knowledge, attitudes and practices of lady health workers [LHWs] regarding implementation of family planning program in Tehsil MuzaffarGarh

Study Design: Cross sectional study

Place and Duration of Study: It was carried out from December 2015 to May 2016 involving Lady Health Workers from 10 union councils of Tehsil Muzaffar Garh including both urban and rural areas

Material and Methods: The data were collected by interviewing 307 LHWs using a structured closed ended questionnaire

The data were entered and analyzed through SPSS version 22

Results: Lady health workers [LHWs] demonstrated a good knowledge ranging from 78% to 99% of different aspects of family planning. They were poorly informed regarding pregnancy complications, breast feeding and infertility. Almost all of them 305 [99%] showed positive attitude regarding job, trainings, compatibility of family planning with religion, although were unsatisfied with their salaries and monetary incentives

Conclusions: LHWs have a good knowledge and positive attitude towards family planning except knowledge about infertility, pregnancy complications and breast feeding. Family planning practices are difficult in rural areas because of low literacy rate and dominance of mothers in law, which needs attention

Polio immunization and awareness: a cross sectional study in shangla and swat districts,pakistan

Objective: To assess polio immunization coverage, awareness about polio and its vaccination and to find reasons of polio vaccination refusals in districts Swat and Shangla [the two conflict affected areas in recent past]

Methodology: This Cross-sectional descriptive study was carried out in Swat and Shangla districts, KPK, from January to July 2014. It was a door to door survey of 800 families selected by random sampling from four different localities of these two districts. Information gathered included educational status of both parents, number of children less than 5 years, polio vaccination history [both routine immunization and house to house approach] complete polio vaccination history, polio awareness level of parents and reasons of refusals to polio vaccination. Data collected was analyzed with SPSS version 21. Chi-square test was used to ascertain the association between various categorical variables and p value less than 0.05 was considered significant

Results: There were total 1775 children in age group 0-5 years in the 800 households under study. The children, who got vaccinated against polio, were 1392 [78 %]. Out of rest, 294 [16.5 %] had not been vaccinated against polio and the parents of remaining 89 [5%] children did not remember whether vaccination against polio was done or not. There was a significant association between educational status [minimum matriculate] of parents and polio vaccination [p=0.000]

Conclusion: The present day situation of polio vaccination is encouraging in areas under research. Law and order situation, illiteracy and misperceptions about the vaccine should be addressed along with the capacity building of the health care staff as soon as possible through sincere coordinated efforts for complete eradication of polio by all concerned institutions

Effect of military deployment in operational area on the trend of smoking among troops

To identify effect of military deployment in operational area on trend of smoking cigarettes among troops. Descriptive cross-sectional study. The study was carried out in an Army Brigade deployed in Operation Al-Mizan, Swat, from Jan to March 2014. Whole troops of an army brigade deployed in operation Al-Mizan, Swat were the part of present study. Total strength of brigade comprised of 1850 troops. Out of these 1850, officers constituted 53 [2.86%] and rest 1797 [97.14%] were Junior Commissioned officers [JCOs], noncommissioned officers [NCOs] and soldiers. All ranks other than officers were collectively termed as soldiers. All the individuals were given structured questionnaire to fill. The information was gathered on variables like age, rank, unit, education, duration of deployment in operational area, habit of smoking, intensity of smoking [number of cigarettes smoked daily] and change in the habit and intensity of smoking after being deployed in the operational area. Information was also gathered from the individuals about the reasons for change in the habit [starting or stopping smoking] and intensity of smoking after deployment in operational area. Forty nine individuals with less than 6 months duration in operational area were excluded. All the other officers and soldiers [1801] having served more than 6 months in the operational area were included in the study. There were total 1801 individuals included in the study. Officers constituted 52 [2.88%] of the total and rest 1749 [97.12%] were soldiers. The mean age of officers was 26.34 +/- 4.6 years and mean age of soldiers was 27.92 +/- 4.5 years. The overall frequency of smoking in officers and soldiers in the operational area came out to be 29.6%, however the overall frequency of smoking in these individuals before coming to operational area was 26.8%. There were 3 officers and 47 soldiers who started smoking in the operational area. There was an increased consumption of cigarettes among troops [p < 0.001]. The increased frequency of consumption of cigarettes in operational area was because of stress/increased combat activities, boredom, lack of recreational activities and monotony. It is concluded from the present study that operational activities increase the tendency of smoking in some troops and cause increased consumption of cigarettes by others mainly because of stress and peer pressure, which over the period of time can affect health, medical fitness and operational readiness of military personnel

Comparison of postoperative pain and hemorrhage in children after tonsillectomy with bipolar diathermy technique versus tonsillectomy with cold steel dissection and silk ligature

Objective: To compare post operative pain and hemorrhage in children after tonsillectomy with bipolar diathermy versus tonsillectomy with cold steel dissection and silk ligation to secure hemostasis

Study Design: Randomized controlled trial

Place and Duration of Study: Combined Military Hospital [CMH] Kharian from June 2012 to June 2013

Material and Methods: A total of 126 patients were included in the study through non-probability convenience sampling and randomly divided in two groups of 63 each. In group A patients were treated by tonsillectomy with bipolar diathermy and in group B patients underwent tonsillectomy with cold steel dissection and silk ligation to secure hemostasis. Results in terms of postoperative hemorrhage and pain based on Facial Pain Scale were observed

Results: A total of 126 patients were included in the study and randomly divided in two groups of 63 each. Average age in group A was 6.60 years [SD +/- 2.46] and in group B it was 6.31 years [SD +/- 2.48]. There were 33 males [52.38%] in group A while 37 males [58.73%] in group B. Both the groups are comparable with respect to gender [p=0.473] and age [p=0.522]. In group A, there were 5 [7.93%] cases of mild pain as compared to 15 [23.80%] in group B. Similarly there were 32 [50.79%] cases of moderate pain in group A and 39 [61.90%] in group B. In group A 25 [39.68%] had severe pain as compared to 9 [14.28%] in group B. It indicates that patients who underwent tonsillectomy with bipolar diathermy had significantly high frequency of severe pain than group A [p=0.03]. In both groups there was no incidence of primary hemorrhage. In group A, 3 [4.76%] patients had secondary hemorrhage and in group B, 1 [1.58%] patient had secondary hemorrhage however this was insignificant [p = 0.310]

Conclusion: Cold steel tonsillectomy technique with silk ligation to secure hemostasis is a safe method. It has significantly less postoperative pain as compared to bipolar diathermy technique. However there is no significant difference in post operative hemorrhage between the two methods

To compare efficacy and discomfort in posterior nasal packing with Foley's catheters versus bipp gauze packing in cases of posterior epistaxis

To compare efficacy and discomfort in posterior nasal packing with Foley's catheters versus BIPP gauze packing in cases of posterior epistaxis. Randomized controlled trial. Combined Military Hospital [CMH] Kharian from October 2011 to October 2013. A total of 206 patients of posterior epistaxis were included in the study through nonprobability convenience sampling and randomly divided in two groups of 103 each. In group A patients were treated by posterior nasal packing with Foley's catheter and in group B patients were treated by posterior nasal packing with BIPP gauze and results in terms of control of epistaxis and discomfort during pack insertion, while the packs were in situ and pack removal, based on VAS [Visual Analogue Scale] were observed. Average age in group A was 52.64 years [SD=9.57] and in group B it was 50.27 years [SD +/- 10.13]. There were 71 [68.9%] males in group A while 67 [65%] males in group B. During posterior nasal pack insertion, the mean pain score in Group A was 6.21 [SD +/- I.13] and in Group B was 7.43 [SD +/- 1.19]. The mean pain score with the pack in situ was 4.27 [SD +/- 0.08] in Group A versus 4.76 [SD +/- 0.09] Group B. Similarly pack removal was also more painful in group B than group A [6.14 +/- 0.91 vs 6.89 +/- 1.09] [p =0.000]. In the group A, 31 [30.1%] patients had rebleeding after pack removal, out of which 9 [8.7%] had significant bleeding requiring repacking. In 22 [21.4%] cases there was mild bleeding which settled without repacking. In group B 22 [21.4%] patients had rebleeding after pack removal, out of which 5 [4.7%] had significant bleeding requiring repacking. It is concluded that posterior nasal packing with BIPP gauze pack is effective for controlling posterior epistaxis but causes more discomfort to the patients as compared to Foley's catheter packing

Comparison of BIPP gauze packing versus maxillary antrum packing with Foley's catheter after Caldwell-Luc surgery in terms of re-bleeding and discomfort

Objective: to compare efficacy and discomfort caused by maxillary antrum packing with Foley's catheter versus BIPP gauze packing after Caldwell-Luc surgery

Methodology: this Quasi experimental study was carried out at two centres CMH Kharian and PAF Hospital Faisal, Karachi from June 2012 to June 2014. A total of 46 patients who underwent Caldwell-Luc surgery were included in the study. The cases were divided in two groups of 23 each. In Group A patients, maxillary antrum was packed with Foley's catheter after Caldwell-Luc surgery and in Group B patients, packing was done with BIPP gauze. Results in terms of efficacy and discomfort were observed. Efficacy was assessed by control of bleeding and subjective discomfort was assessed based on VAS [Visual Analogue Scale]

Results: in Group A average age of patients was 36.30[SD+13.52] and in Group B average age of patients was 39.65 [SD+13.84]. There were 56.52% males in Group A and in Group B there were 60.86% males. Whilst the pack was in situ, average pain score in Group A [Foley's catheter pack group] was 4.09 [SD+0.73] and in Group B, average pain score was 4.17[SD+0.83]. On removal of pack, pain caused by BIPP gauze was significantly higher i.e average pain score of Group B was 7.30 [SD+1.10], however that of Group A was 5.13 [SD+1.32] [p<0.001]. There was no case of bleeding after pack removal which showed that both types of packing are equally effective

Conclusion: maxillary antrum/antral packing with Foley's catheter is equally effective as compared to BIPP gauze packing and causes significantly less pain on removal as compared to BIPP gauze pack after Caldwell-Luc surgery

Is declotting a better procedure than Redo MVR for stuck mitral valve?

To evaluate and compare the outcome of declotting versus Redo Mitral Valve replacement for stuck mitral valve in the early postoperative period. Retrospective interventional study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFICNIHD] Rawalpindi from 1[st] Jan, 2010 to 31[st] Oct, 2013. A total of 36 patients were selected. Group A [n = 28] underwent declotting and group B [n = 08] were treated by redo mitral valve replacement [MYR]. Diagnosis of prosthetic valve obstruction was made on the basis of history, clinical examination, echocardiography and fluoroscopy. All patients were operated under general anesthesia and cardiopulmonary bypass [CBP]. Total clamp and CPB time were recorded. Post operatively, patients were evaluated with daily progress parameter. The hemodynamic status, isotropic support, ventilation time, intensive care ward and total hospital stay were also recorded for comparison. Two-dimensional echocardiography was done before extubation and at discharge. Mortality rate was also compared in the two groups. No statistical difference was found on the basis of gender, age, interval between initial mitral valve replacement [MVR] and redo operation or decloting, anticoagulation status, New York Heart Association NYHA] functional class, international normalized ratio [INR] level, trans thoracic echocardiography and luoroscopy. The mean CBP time and cross clamp time was significantly less in group A than group B. Similarly mean ventilation time in group A was significantly less than in group B. The mean ITC stay was and mean hospital stay was not statistically significant. The mortality rate in group A and B was 7.14% and 50% respectively which was statistically significant. Prosthetic valve thrombosis is a life threatening complication after mechanical mitral valve replacement with high mortality without timely and effective surgical intervention. Declotting, being a less aggressive surgical technique is recommended because of better outcome in terms of morbidity and mortality in the early post-operative period

Treatment of acute apical abscess by single visit endodontics - 2 case reports

The purpose to publish these case reports is to show the effectiveness of single visit endodontics in teeth with acute apical abscess. Infected non-vital teeth in two patients were treated with single visit RCT along with incision and drainage of the abscess in the same appointment. Follow up of both the patients showed relief of symptoms to remarkable extent in the evening of treatment day. Radiographs showed significant periapical bone healing after 3 months in both patients