A comparative study of the effect of health insurance on women's use of health facility delivery: Evidence from demographic health survey in Benin Republic

Studies in the Benin Republic have identified contextual factors that determine health facility delivery among women of reproductive age. However, it is not certain if the same set of factors predicts facility delivery for women who enrolled in health insurance and those who did not. The study seeks to compare the determinants of health facility delivery for mothers under health insurance and those that are not in the Benin Republic. The study used data for 33,078 women of reproductive age, drawn from the most recent Benin demographic and health survey (2017-18). The characteristics of the women were described using simple proportions and frequency. Binary Logistic regression was used to examine determinants of health facility delivery for both groups of women. The result showed that only 0.7% of the women were under health insurance coverage. The prevalence of health facility delivery was high in the enrolled group but not in the unenrolled group (98.3% vs. 87.8%). The uniform determinants of health facility delivery across the two groups were household wealth, education, employment, land/house ownership, media exposure, a minimum of four antenatal contacts, and place of residence. To improve the coverage of health facility delivery, a multi-pronged approach should be used to improve household socioeconomic status, encourage media use among women, expand education opportunities for women, and specifically target rural women in Benin. (Afr J Reprod Health 2022; 26[6]:104-115).

Spectrum of joint deformities in children with juvenile idiopathic arthritis

Objective: To determine the frequency and types of joint deformities in children with juvenile idiopathic arthritis and their association with clinical parameters and rheumatoid factor

Study Design: Cross-sectional study

Place and Duration of Study: Rheumatology Outpatient Clinic, the Children's Hospital and the Institute of Child Health, Lahore, from September 2014 to February 2015

Methodology: All patients of both genders of less than 16 years of age, who fulfilled the International League of Association for Rheumatology [ILAR] criteria for Juvenile Idiopathic Arthritis [JIA], were enrolled in this study. Their demographic data, duration of disease at the time of presentation, types of JIA, various joint deformities and rheumatoid factor [RF] were documented. Statistical analysis of data was done on SPSS version 16. Chi-square test was applied to determine the association of clinical deformity with age of patients, disease duration at presentation, types of JIA and RF

Results: Out of 70 patients enrolled during the study period, 51.4% were boys with mean age at presentation being 9.44 +/-3.89 years [2-7 years] and median duration of disease being 24 months [interquartile range 42 months]. Forty patients [57.1%] had joint deformities. Most common joints involved were hand [50%], wrist [50%], and knee [35.7%]. The common types of joint deformities were boutonniere deformity [28.6%], ulnar deviation of wrist [28.6%], fixed flexion deformity of wrist [22.9%], and knee [31.4%]. The most common type of JIA was polyarthritis RF negative with or without deformity. There was a strong association of deformities with older age of patients at presentation [p=0.036], longer duration of disease at presentation [p=0.028], polyarthritis [RF seronegative / seropositive] [p=0.013], and seropositivity [p=0.04]

Conclusion: More than 50% patients with JIA have joint deformities. Joint deformities are more likely to be seen in children with long-standing disease, those with polyarthritis JIA and seropositive patients

Psychosocial implications of blindness and low vision in students of a school for children with blindness

Objective: To find out the psychosocial implications of blindness and low vision in students of blind school Bahawalpur

Methods: A cross sectional descriptive study was carried out in Higher Secondary School for blind, Bahawalpur after getting approval from Institutional review board of Quaid-e-Azam Medical College, Bahawalpur and Principal of Blind School, Bahawalpur. Forty willing students filled a customized questionnaire, consisting of questions about logistic variables and questions regarding areas of satisfaction. Statistical analysis was performed using SPSS version 18

Results: Out of 40, 55% [22/40] of them were found depressed [as assessed through DSM-lV], 50% [20/40] were having difficulty in making new contact but 52.5% [21/40] were satisfied with family care

Conclusion: Sixty percent [24/40] of blind school children experienced difficulty in their life. This study showed that blindness or low vision does have psychological implications like feeling of guilt, anxiety, sadness and depression

Incidence of intestinal tuberculosis in patients presenting in emergency with intestinal perforation- a review of 1000 patients

Objective: The present study was undertaken to document the presentation of intestinal tuberculosis in patients with intestinal perforation that present to the emergency department of Nishtar Hospital Multan

Study Densign: Observational / Descriptive / cross sectional study

Place and Duration of Study: This study was conducted at Nishter Hospital, Multan. from 2007-2015

Materials and Methods: A proforma was filled which was approved by hospital ethical committee. 1000 patients who were admitted in in A and E department Nishtar Hospital,Multan with intestinal perforation were included in this study

Histopatology specimen were sent. Results were labeled as either presence or absence of intestinal tuberculosis

Results: 1000 patients, complying with the inclusion criteria were included in the study. The mean age of the patients was 45 +/- 5 years. 289 [ 28.9%] were in the age group of 20-30 years of age.312[31.2%] were in the age group 31-40 years.243 [24.3] were in age group [24.3%]. 156 [15.6%] were from age group 51-60

Regarding age, majority of the patients 532 [53.2%] were females, and 468 [46.8%] were males

Duration of symptoms ranged from 1 day to >3 days. 312 [31.2%] had symptoms for 1-2 days. 432 [43.2%] had symptoms for 2-3 days and 256 patients had symptoms for more than 3 days. All had histological evaluation

Conclusion: 23% patients were found to have tuberculosis

Frequency of positive ct scan findings in minor head trauma based on nice guidelines

To determine the frequency of positive CT scan findings in cases of minor head injury with GCS score of 13-15 at presentation based on NICE guideline. Cross sectional study. Study was conducted in departments of Radiology CMH Rawalpindi and MH Rawalpindi from 10[th] Feb 2010 to 10[th] Aug 2010. One hundred and thirty five indoor and outdoor cases, fulfilling the inclusion criteria, reporting to the radiology department after head trauma, were included in the study after seeking written informed consent. Computerized tomography [CT scan] of the brain was done. Positive CT scan findings i.e. fracture, extradural, subdural and intraparenchymal hemorrhage were noted. Total number of patients studied in this study was 135 and evaluated after taking written consent from them. Out of total 135 patients 104 [77%] were males and 31[23%] were females. Positive CT scan findings were found in 10[7.4%] patients while 125[95.6%] patients had negative CT findings. Among patients having positive CT scan findings epidural hemorrhage was found in 2 [1.5%] intraparenchymal hemorrhage with fracture in 3 [2.2%], skull fracture in 3 [2.2%] and 1 [0.7%] patient had subdural hemorrhage. CT scan is done in minor head trauma although results are often normal. NICE clinical guideline helps in identification and early management of head injury. The goal of implementing such guideline is to do CT scan only in those who are at risk of developing complications, thus minimizing the cost of CT scanning as well as strain on emergency neurology and radiology departments

Salmonella cholecystitis: atypical presentation of a typical condition

Salmonella cholecystitis is a rare but important complication of Salmonella typhi infection. We are reporting an 11 years old female child who presented with complaints of high-grade fever, jaundice and right sided abdominal pain [Charcot's triad]. Her examination showed tender hepatomegaly. Initial blood results revealed high white cell counts with left shift, deranged liver function tests. Abdominal ultrasonography revealed distended gallbladder with minimal layer of sludge seen within its lumen along with streak of pericholecystic fluid. Blood culture grew Salmonella typhi. She was successfully treated with intravenous ceftriaxone.

MR image spectrum of spinal dysraphism in a military hospital

To demonstrate the spectrum of MR imaging findings in patients with suspected spinal dysraphism in a Military Hospital. Descriptive study. Department of Radiology, Military Hospital Rawalpindi from September 2005 to October 2007. Patients were referred from neurology, neurosurgery and general surgery departments of Military Hospital and Combined Military Hospital Rawalpindi who presented with various neurological problems and skin stigmata having suspicion of spinal dysraphism. A total of 74 patients were evaluated over a period of two years. All 74 [100%] patients suspected of spinal dysraphism showed one or multiple abnormalities out of the whole spectrum on plain MRI spine. Mean age was 6.4 years with the youngest patient sixteen days old and the eldest being 37 years old. Majority of the patients were under six years of age. A wide range of abnormalities were seen with Myelomeningocele found in 29 [39.2%] and along with lipomatous component in 9 [12.2%]. Thirty three [44.6%] patients had diastometomyelia, 10 [13.5%] having associated lipoma of filum terminale while syringomyelia was noted in 36 [48.6%] patients. Moreover, in the majority of patients, dysraphism was at the lower lumbar and upper sacral region. It was concluded that plain MRI spine is a single safe, non-invasive and quick method of describing the gamut of findings in patients of spinal dysraphism

Comparison of magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography in hepatobiliary disorders

Purpose of this study is to evaluate the diagnostic value of MRCP in hepatobiliary disorders and compare it with ERCP. Descriptive validation study. Radiology Department Military Hospital, Rawalpindi from 15 August 2006- 15 Feburary 2007. Fifty one consecutive patients included 37 males and 14 females were included. Out of 51 patients, 12 had malignant stricture, 05 had benign stricture, 06 had mass at porta hepatis, 05 had cholelithesis, 8 had choledocholithiasis, 03 had both cholelithesis and choledocholithesis, 3 had chronic pancreatitis, 04 had mass head of pancreas, 1 had sclerosing cholangitis and 4 patients had normal studies. MRCP was sensitive and specific. Positive and negative predictive values for choledocholithiasis were 100%, 95.3%, 100% and 97.9%. For cholelithesis and benign stricture 80%, 100%, 100% and 97.9% respectively. ERCP showed 5 cases of cholelitiasis, in comparison to MRCP, which had missed one case. In detecting malignant strictures MRCP was 91.7% sensitive and 100% specific. In cases of periampullary growths, it was difficult to cannulate the endoscope during ERCP. In these cases MRCP showed the level of obstruction non-invasively. MRCP was better in cases for chronic pancreatitis, in defining anatomy of pancreatic duct than ERCP, which has magnification factor of 1.5. Our findings confirm that MRCP, a noninvasive imaging technique of greater value in the diagnosis of hepatobiliary disorders as compared to ERCP

Diagnostic accuracy of magnetic resonance imaging in meniscal injuries of knee joint and its role in selection of patients for arthroscopy

Magnetic Resonance Imaging [MRI] is frequently advised to evaluate clinically suspected cases of meniscal injuries in our setup. The objective was to determine the diagnostic accuracy of MRI in meniscal injuries of knee joint and its effectiveness in selection of patients for arthroscopy. A Cross-sectional comparative study was conducted at Radiology Department Military Hospital [MH] Rawalpindi in collaboration with Orthopaedic Department Combined Military Hospital [CMH] Rawalpindi from 31 Jan 2007 to 1 Aug 2007. Fifty-seven patients with clinical suspicion of meniscal injuries were subjected to MRI. Arthroscopy was done only in 34 patients while 23 were excluded on the basis of MRI findings. MRI findings were compared with arthroscopic findings. Medial and lateral menisci were considered separately in each case. Among 57 patients only 30 showed significant tear on MRI. Arthroscopy was done in these cases. Arthroscopy was considered on clinical grounds only in 4 patients who did not show significant tear on MRI. MRI showed Medial Meniscus [MM] injury in 23 patients and Lateral Meniscus [LM] injury in 10 patients. Arthroscopy confirmed MM injury in 17 patients and LM injury in 7 patients. MRI missed two MM and one LM injuries. This showed that MRI has sensitivity of 89.4% and specificity of 62% in diagnosing injuries of MM, while sensitivity of 87% and specificity of 88% in diagnosing injuries of LM. Diagnostic accuracy of MRI in MM and LM injuries was 76.4% and 88.2% respectively. MRI is accurate in diagnosing meniscal injuries of knee joint and is effective in selection of patients for arthroscopy

Correlation of doppler waveform abnormalities of hepatic veins with histological findings in chronic liver disease [HCV infection]

To study the relationship of the abnormalities in Doppler waveform of hepatic veins with histologic findings in chronic liver disease [HCV infection]. cross- sectional study. Radiology Department Military Hospital Rawalpindi. The duration of study was one year from February 2004 to February 2005. 50 patients with non de-compensated HCV infection were studied, who were subjected to biopsy by medical specialists. Their Doppler waveforms of hepatic veins were noted. On histopathology, 4 cases [8%] had no evidence of fibrosis, 27 cases [54%] had mild, 15 cases [30%] had moderate and 4 cases [8%] had severe fibrosis. Three patterns of waveform were observed. These waveforms include normal triphasic waveform [type O], decreased amplitude of phasic oscillations without the reversed flow phase [type 1] and completely flat waveform [type 2]. Among 33 cases of type 0 flow, majority [85%] had either mild fibrosis. Twelve cases that had type 1 flow, majority [92%] had mild to moderate fibrosis. Out of 5 cases that were observed ultrasound type 2 flow, all had either moderate or severe fibrosis. The degree of fibrosis was related directly to the hepatic vein waveforms abnormalities [p<0.001]. Ultrasonographic abnormalities of Doppler waveforms of hepatic veins are equivalent to histology in predicting the progression of CLD

Quantitative analysis of stress and cholesterol levels in university teachers and housewives of hyderabad-Pakistan

To evaluate environmental, psychological and physiological stresses in university teachers and housewives and correlate it with serum total cholesterol, HDL cholesterol, LDL cholesterol and triglyceride levels. Eighty females from middle socioeconomic groups [40 university teachers and 40 housewives] aged between 30-45 years were selected for this study. All subjects were selected from Hyderabad and its adjoining areas. Environmental, psychological and physiological stress levels were measured using Likert scale. Total cholesterol, LDL cholesterol and HDL cholesterol were measured by CHOD-PAP method and triglyceride levels were measured by GPO method. Housewives had high levels of total cholesterol, LDL cholesterol and triglyceride but low levels of HDL cholesterol than the university teachers. Environmental, psychological and physiological stresses were also significantly high in housewives as compared to university teachers. High levels of total cholesterol, LDL cholesterol, triglyceride and low levels of HDL cholesterol in housewives correlated to their stressful lifestyle

Management of compromised airway due to unusual presentation of cystic hygroma

The successful management of a unique case of huge cystic hygroma in a fourteen month old child who presented in the emergency room with severe respiratory distress as a result of nearly almost complete upper airway obstruction, is presented

Congenital fetal anomalies antenatal ultrasound detection

A study carried out in two PAF hospitals radiology departments to determine the frequency of different anomalies by ultrasonographic detection. We subjected the pregnant ladies for ultrasonography who had basic screening done in obstetric department and had suspicion of some anomaly and were sent for detailed scanning. Other groups of patients were those who had bad obstetric history and sent from gynecological department for detailed scanning. About 200 patients were scanned, Out of these 134 had different anomalies and the commonest was from central nervous system with relatively more prevalent in cousin marriages. The study concluded in a small section of population showed the preponderance of neural tube defects as detected by ultrasonography but an area which was not subjected to detailed scanning was cardiac anomaly scanning due to non-availability of equipment and expertise in peripheral hospitals and may be possible in dedicated tertiary care hospitals

Clinical, nutritional and radiological features of pneumonia

From December, 1992 to February, 1993,100 consecutively admitted children between 2-24 months of age with pneumonia were studied. They were diagnosed and treated according to the National ARI Control Programme case management guidelines. Of the total, 74 were under one year of age. Seventeen children had very severe pneumonia, 77 severe pneumonia and 6 simple pneumonia. Sixty children had radiological evidence of pneumonia, 89 responded to standard recommended treatment and only 11% required a change of therapy. There were no deaths. Only 6 mothers of these 100 children had practiced exclusive breast feeding. Low socioeconomic status, illiteracy and malnutrition were the other risk factors. In this study all types of pneumonia were more common in children under one year of age and radiology did not appear to be essential for its diagnosis. The National ARI Control guidelines for diagnosis and management of hospitalized children are simple, useful and effective

Reduction in morbidity and mortality in neonatal ventriculitis by intraventricular instillation of antibiotics through a ventricular drain

A prospective study of 15 consecutive babies treated for ventriculitis and followed up for one year is presented. The criteria for diagnosis is discussed. The role of intraventricular antibiotic in improving the overall prognosis is reported. A new technique of insertion of a ventricular drain is described which reduces the trauma of repeated ventricular punctures and helps to drain the thick pus from the ventricles