Frequency of stillbirths in a tertiary care hospital of Karachi

Background and Objective: Pakistan accounts for the highest stillbirth rate in the world. Therefore, this observational study was planned to determine the prevalence of stillbirths and its associated demographic characteristics in the given context. Hence our objective included: To determine the frequency of stillbirths with reference to parity and gestational age in a tertiary care public hospital, Karachi. To determine the socio-demographic characteristics of families with stillbirths

Methods: All pregnant mothers who delivered stillbirth babies at Gynaecology and Obstetrics ward of Jinnah Postgraduate Medical Center, Karachi a tertiary care facility were prospectively enrolled from October 2012 to September 2013. Deliveries occurred before 28 weeks of gestational age were excluded. Gestational age was confirmed from hospital record and attending physicians. Data was collected on predesigned proforma and analyzed using descriptive statistics

Results: Among 7708 registered deliveries, 137 were stillbirths. A total of 84 mothers were primiparous and 12% of mothers were below 20 years at the time of delivery. Majority of stillbirths were macerated type [80.3%] and 20% were fresh stillbirth. About 55% of still births occurred between 33-37 weeks and 20% between 28-32 weeks. Almost 80%[109] of stillbirths were low birth weight and only 20%[28] were normal birth weight

Conclusion: This study shows that stillbirths are more common in primiparous mothers in a given context. Conducting awareness sessions with special focus on antenatal and obstetrical care of primiparous may be helpful to reduce still births

Functional and structural abnormalities of the kidney and urinary tract in severely malnourished children - A hospital based study

Objectives: The association of malnutrition and systemic diseases like chronic kidney disease [CKD] is well known. Various urinary tract abnormalities may be associated with malnutrition. So objective of current study was to determine the frequency of functional and structural urinary tract abnormalities in severely malnourished children admitted in Nutritional Rehabilitation Unit [NRU] of a tertiary care facility, Karachi

Methods: This descriptive cases series of 78 children was conducted in NRU from October 2014 - March 2015. All newly admitted children aged 2-60 months, diagnosed as Severe Acute Malnutrition [SAM] were studied and children with known kidney and urinary tract disorders were excluded. Detailed history, examination and investigations like serum creatinine, ultrasound kidney and urinary tract in addition to routine tests for SAM, were done. A proforma was used to collect demographic data, clinical history, physical findings, and radio-imaging and biochemical investigations. Glomerular filtration rate [GFR] was calculated using Schwartz equation. Data was analyzed using descriptive statistics

Results: Among 78 children, male to female ratio was equal. Mean age was 18+/-15.53 months and majority [79.48%] of children were below 24 months. Majority [82%] of children with SAM had marasmus whereas 18% had edematous malnutrition. Out of 78, 57 [73%] children had either functional [80.7%] and or structural [19.3%] abnormalities whereas 21[36.84%] had normal functional and structural status. Most common functional abnormality was subnormal GFR [<90ml/min/1.73 m[2]] found in all 46 children. Functional abnormities were more common in children below 24 months. Other functional disorders were Bartter syndrome, renal tubular acidosis and urinary tract infection [UTI] found in two cases each. Common structural abnormalities were echogenic kidneys [n=4, 36%], hydronephrosis [n=3, 27%], hypoplastic kidneys [n=3, 27%] and calculi [n=1, 9%]. Subnormal GFR was also found in all cases with structural abnormalities. UTI was observed exclusively in two children among 11 with structural abnormalities

Conclusion: A high frequency of functional abnormalities and noticeable proportion of structural abnormalities of urinary tract were detected in children with SAM. Current finding suggest that multicenter study at national level may be undertaken to generate better data about prevalence of renal diseases in SAM

Comparative evaluation of in vitro cytotoxic effects among parent abietyl alcohol and novel fatty acid ester derivatives against MCF7 and hepatocellular carcinoma cell lines

Synthesis of twelve hitherto unreported esters of abietyl alcohol and screening of these esters against four cancer cell lines including one breast cancer line MCF7 and four hepatocellular carcinoma cell lines [HCC] Huh7, Hep3B, Snu449 and Plc has been determined using SRB assay. The Cell cycle progression showed changes in cellular behaviour after 48 and 72 hours in MCF7 and Huh7 cell lines. Abietyl alcohol was obtained from the reduction of abietic acid, a tricyclic diterpene, isolated from oleoresin of Pinus longifolia Roxberghii

Biosafety intervention and follow up assessment in laboratory workers of Karachi, Pakistan

Regular trainings and capacity building are required for all health care workers to ensure that they follow the laid down standard operating procedures and thus avoid any mishap. Delays in such trainings and improper supervision results in their reverting back to their old habits. Post intervention assessment of laboratory workers of public and private sector hospitals of Karachi on adherence to biosafety practices. Quantitative-qualitative cross-sectional survey done from August-November, 2012 using simple random sampling. Study population comprised of 253 laboratory workers of public and private sector hospital laboratories of Karachi. An initial KAP survey on biosafety practices in the laboratories and their workers followed by training and a post intervention evaluation was done in 2008. Four years later these workers were re-evaluated using an anonymous closed ended questionnaire to assess how many are following the training and the standard guidelines. Data was entered and analyzed using SPSS 13.0. Mean and percentages were calculated for quantitative variables and x[2] - test was applied for significance. A total of 253 participants [168 males and 85 females] returned the filled questionnaire Almost all [98.8%] laboratory workers had correct concept on use of personal protective equipment, 85% were neither practicing mouth pipetting for chemical and biological samples, nor using laboratories for eating and drinking purposes while importance of SOP/BOP and laboratory accident record maintenance was acknowledged by over 95%. Knowledge about discarding the used syringe was present in only 68%. A comparison between public and private sector laboratory workers revealed that 37% public sector workers were still discarding syringes in the dustbin as opposed to 3% from private sector. Educational interventions performed almost 4 years ago were still followed by laboratory workers indicating the importance of at least one training every 2-3 years to sensitize them on biosafety

Pattern of diseases, reason of visiting and waiting time at various stages of tertiary hospital

Objectives: To determine the frequency of diseases in children, reasons of visiting out patients department of tertiary care children, hospital and to evaluate the waiting time of patients at different stages of treatment

Study Design: Descriptive observational study

Place And Duration: National Institute of Child Health, Karachi from October 2007 to July 2008

Methodology: Patients up to 13 years of age attending OPD were recruited in to study using simple random sampling procedure. Sample size was 400

Results: Children were selected from three OPDs of NICH, Karachi. Majority of patient were below 5 years of age [69.7% [n=279]]

Mean age was 3.53years + 3.3 with range 155 months [1-156]. The main diseases in medical OPD were respiratory problem 19.43 % [n=34], followed by renal problems 17.7% [n=31], and GIT problem 13.7% [n=24]. In surgical OPD, trauma and fracture 23.2% [n=36], hernia 17.42 % [n=27], and urology 15.5 % [n=24] were important problems in children. Respiratory distress 31.43% [n=22], sepsis 18.61% [n=13], NNJ+ 17.1% [n=12], and constipation 11.43% [n=8], were theicommon disorders in infants attending well baby clinic. Mean number of visits per patient was 2.5 +1.9 [range 1-20]

Conclusion: Most frequent disorders in medical OPD were respiratory problem, trauma and fracture in surgical OPD, and respiratory distress, sepsis and neonatal jaundice at well baby clinic. Availability of free of cost facilities was the main reason for attending the OPD

To evaluate the efficacy and reliability of commonly available tests for the diagnosis of dengue fever in children in Karachi

Diagnosis of dengue fever in financially constraint countries like Pakistan is usually made on immunochromatographic [ICT] based serological tests. To compare the diagnostic accuracy of commercially available dengue rapid immunochromatographic tests [ICT] with dengue ELISA in acute dengue infection in children. This retrospective study was carried out at the National Institute of Child Health, Karachi in the Department of Pathology from October 2010 to January 2011. Hospitalized children who fulfilled the WHO and CDC definition of probable dengue fever i.e. fever of 2 to 7 days with two or more than two of the associated symptoms like headache, retro orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestation, leucopenia, thrombocytopenia and supporting serology were included in the study after taking informed consent from their parents / care givers. Malarial parasite positive cases were excluded from the study. Dengue ICT based IgG, IgM, IgA antibodies were done using rapid devices, dengue NS[1] was done on ICT rapid device and dengue IgM was done using enzyme linked immunosorbent assay [ELISA] by micro titer well plate. Data entered and analyzed on SPSS version 16. Out of 80 suspected cases [being a retrospective study it would be better that we give number of all suspected cases and then delete the numbers that did not have complete tests], 39 fulfilled the criteria of suspected dengue fever patients. Ages of these children ranged from 6 months to 13 years. There were 18 males and 21 females. Mean haemoglobin was 8.7g/dl and mean haematocrit was 26.3%. Elevated haematocrit was seen in 7.5% cases only. Mean WBC count was 6164/cmm, with leucopenia seen in 33.3% and leucocytosis in 5.12% cases. Thrombocytopenia was present in all cases except one. Positivity rate of dengue IgG was 25.64%, IgM 15.4%, IgA 43.59%, rapid antigen by ICT method 20.5% and ELISA IgM [by micro titer well- plate] was 76.9%. Sensitivity / specificity of dengue IgG, IgM, IgA and rapid antigen by ICT were compared with ELISA IgM [gold standard] and these were 33.3/100%, 16.67/88.89%, 50.0/77.78%, 23.3/88.8% respectively. ELISA IgM antibody [by micro titer well-plate] test was most reliable as compared to ICT tests. Among the ICT tests, dengue IgA antibody was superior to other tests

Liquid antacids: a comparative study on palatability and cost effectiveness

To compare the palatability, acid consuming capacity and cost effectiveness of different brands of liquid antacids available in Karachi. Fifty healthy volunteers between the age of 20 to 59 years were recruited in the study. A total of seven antacid brands available in market were physically and chemically tested. The trial design was that of randomized, double blind and cross over study type. All fifty volunteers were individually asked to taste different brands of respectively classified antacids. All antacids were given during a period of 2-hour. Scoring/rating was conducted on the basis of aroma, taste, consistency and after taste using a scheme similar to wine tasting point scale methodology. Acid consuming capacity of antacid were determined according to British Pharmacopeias 2007. A total of 50 volunteers participated in the study after giving informed written consent. The taste rating scores deduced were independent of age and gender. Among all the antacids suspension B [Sodium Bicarbonate and Sodium Alginate] showed maximum palatability; however the overall palatability of the antacids was poor. Antacid containing sodium bicarbonate and sodium alginate was found least palatable. More over the extra strength antacid version showed highest acid consuming capacity entailing small dosage but shows reduced palatability. Antacid brand-B reveals lowest cost effectiveness and least palatability. While, based on the findings of this study G suspension can be one of the suitable antacid for the treatment of gastrointestinal disorders since it showed highest palatability scores and cost effectiveness

Frequency of smoking among employees at a tertiary care children hospital, Karachi

To determine the frequency of smokers among employees at National Institute of Child Health, [NICH] Karachi. Total no. of 150 employees from NICH [including doctors, paramedics, administration staff, security staff, account staff, house keeping staff and others] participated in the study after giving verbal consent. A self-administered pre-coded proforma was used as an instrument to collect the information. A total no. of 150 health care professionals and others participated in the study. There were 111[74%] males, 39[26%] were females. The male to female ratio was 1:2.8. No female was found to be a smoker in our setting. 14.6% of smokers were in between 25-36 years of age. Frequency of smoking was found to be high in both Matric and MDBS categories i.e. 7.3% and 6.7% respectively. The frequency of smoking was found to be much higher [17%] in married males as compared to un-married employees [06%]. More than seventy percent [24] had started smoking in between 12-24 years of age. Around 44% of smokers used more than ten cigarettes per day. More than 97% of the participants were aware of potential health hazards of smoking. In our setting, overall frequency of smoking is still high [22.7%] in health care workers indicated it is that in spite of awareness regarding injurious effects of smoking, the health care professionals do not realize that smoking is one of the major causes of increase in morbidity and mortality due to respiratory and cardiac ailments

Typhoid fever: comparison of tests available for its diagnosis

To determine the most reliable, rapid, easy to perform and cheaper test for the diagnosis of typhoid fever. Two years hospital based comparative and analytical study. Place and Duration of the study: This study was carried out at the National Institute of Child Health, Karachi in collaboration with Department of Microbiology, University of Karachi from April 2003 to March 2005. One hundred and ten patients up to 13 years of age were included in the study after taking verbal informed consent from their parents/caregivers. Patients had fever of more than five days with presumptive diagnosis of typhoid. Patients who did not meet the above mentioned inclusion criteria or suffering with any other/obvious cause of fever were excluded from the study. Total leucocyte count, Widal test, blood/bone marrow cultures and typhi dot tests were performed for comparison. Out of 110 patients 90 [81.82%] were confirmed positive for typhoid fever taking bone marrow cultures as standard. Most of the typhoid fever positive cases had normal or slightly raised total leucocyte count. By blood culture isolation rate of pathogen was only 14% while by bone marrow culture isolation rate was 82%. Widal test correlated in about 65% cases. Typhi dot test was performed on 32 patients only, with the positivtiy of 75% and the sensitivity about 100%. It is concluded that Dot Elisa [Typhi Dot] is specific and sensitive and comparatively rapid test, but bone marrow culture still remains the gold standard as it provides high isolation rate of organism and sensitivity pattern too