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OBJECTIVE: To assess segmental liver stiffness (LS) with MRI before and after endovascular intervention in patients with Budd-Chiari syndrome (BCS). MATERIALS AND METHODS: Twenty-three patients (13 males and 10 females; mean age, 42.6 ± 12.6 years; age range, 31–56 years) with BCS as a primary liver disease were recruited for this study. Two consecutive magnetic resonance elastography (MRE) examinations were performed before the endovascular treatment. Fifteen patients who underwent endovascular intervention treatment also had follow-up MRE scans within three days after the procedure. LS was measured in three liver segments: the right posterior, right anterior, and left medial segments. Inter-reader and inter-exam repeatability were analyzed with intraclass correlation coefficients (ICCs) and Bland-Altman analysis. Segmental LS and clinical characteristics before and after the intervention were also compared. RESULTS: Within three days of the endovascular intervention, all three segmental LS values decreased: LS of the right posterior segment = 7.23 ± 0.88 kPa (before) vs. 4.94 ± 0.84 kPa (after), LS of the right anterior segment = 7.30 ± 1.06 kPa (before) vs. 4.77 ± 0.85 kPa (after), and LS of the left medial segment = 7.22 ± 0.87 kPa (before) vs. 4.87 ± 0.72 kPa (after) (all p = 0.001). There was a significant correlation between LS changes and venous pressure gradient changes before and after treatments (r = 0.651, p = 0.009). The clinical manifestations of all 15 patients significantly improved after therapy. The MRE repeatability was excellent, with insignificant variations (inter-reader, ICC = 0.839–0.943: inter-examination, ICC = 0.765–0.869). Bland-Altman analysis confirmed excellent agreement (limits of agreement, 13.4–19.4%). CONCLUSION: Segmental LS measured by MRE is a promising repeatable quantitative biomarker for monitoring the treatment response to minimally invasive endovascular intervention in patients with BCS.
Subject(s)
Female , Humans , Male , Budd-Chiari Syndrome , Elasticity Imaging Techniques , Follow-Up Studies , Liver Diseases , Liver , Magnetic Resonance Imaging , Venous PressureABSTRACT
Objectives: To determine the frequency of early molecular response in patients of chronic myeloid leukemia treated with Imatinib and its association with baseline white blood cell [WBC] count and spleen size
Study Design: Cross sectional study
Place and Duration of Study: Combined Military Hospital, Rawalpindi Pakistan, from May to Nov 2017
Material and Methods: Seventy eight patients of Chronic Myeloid Leukemia [CML] in chronic phase [CP] were included in the study. Inclusion criteria were: 18 years or older, diagnosed with CML in CP with positive BCR ABL1. Patients who were in accelerated/blast phase, or already taking any Tyrosine Kinase Inhibitors or chemotherapy were excluded from the study. Base line WBC count, spleen size and BCR-ABL1 is values were recorded. All the enrolled patients were placed on Imatinib therapy [400 mg/day] and RT-PCR for BCR ABL1 transcript was repeated after three months
Results: In our study, 60.15 percent of patients achieved EMR at 3 months after Imatanib therapy [p-value <0.001]. In univariate analysis, there was significant association of spleen size, baseline WBC count and percentages of blasts in bone marrow with BCR ABL1 [IS] at 3 months [p-value <0.001], while on multivariate regression model, significant association was found only in spleen size [p-value <0.001] with EMR
Conclusion: A significant number of patients achieved EMR with Imatinib therapy. Spleen size at diagnosis was the only significant factor associated with achieving EMR. It is imperative to identify patients at an early stage who are unlikely to achieve EMR and therefore have poor over-all survival
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The present study was aimed at preparation of transdermal patches of tizanidine HCl, evaluation of the effect of polymers on in vitro release pattern of the drug, and the effect of permeation enhancers on the penetration of the drug through the rabbit skin. Various proportions of hydrophilic (HPMC) and hydrophobic (Eudragit L-100) polymers were used with PEG 400 as film-forming agent, and Span 20 or DMSO as permeation enhancer. The formulations were assessed for physicochemical characteristics and in vitro drug release studies using USP paddle over disc method in phosphate buffered saline (pH 7.4) at 32.0±1°C. On the basis of in vitro studies and physicochemical evaluations, S03-A and S04-A were selected at Eudragit : HPMC ratios of 8 : 2 and 7 : 3, respectively, for further ex vivo analysis. The effects of different concentrations of Span 20 and DMSO were evaluated on excised rabbit skin using Franz diffusion cell. Cumulative drug permeation, flux, permeability coefficient, target flux, and enhancement ratio were calculated and compared with the control formulations. Kinetic models and Tukey's multiple comparison test were applied to evaluate the drug release patterns. Formulation SB03-PE containing Eudragit L-100:HPMC (7:3) with Span 20 (15% w/w) produced the highest enhancement in drug permeation, and followed zero order kinetic model with super case-II drug release mechanism.
Subject(s)
Animals , Rabbits , Transdermal Patch/classification , Transdermal Patch/supply & distribution , In Vitro Techniques , Pharmaceutical Preparations/analysis , Hydrophobic and Hydrophilic Interactions , Drug Liberation/drug effectsABSTRACT
Objective: To evaluate side effects of Imatinib by patients of chronic myeloid leukemia and their influence on quality of life. Study Design: Descriptive and analytic study. Place and Duration of Study: The study was carried out at department of oncology CMH Rawalpindi, from Jan 2015 to Dec 2015
Material and Methods: The study was carried out at department of oncology CMH Rawalpindi from Jan 2015 to Dec 2015. Patients who had been using Imatinib orally for at least 6 months participated in the study. Patients under 18 years of age were excluded from the study. A questionnaire was developed to record adverse effects. This questionnaire included demographic details and quality of life issues like effects on their mood, daily life activities, work, walking and relationships
Results: Ninety two patients participated in the study. Mean age of the participants was 42.05 years [range 22 to 68 years], 52% were males. Among the study population eighty-seven percent had suffered from at least one adverse reaction. The most commonly complained adverse events were muscle cramps [67 out of 92, 72.8%]; fatigue [58 out of 92 63.04%], gastro intestinal upset [44 out of 92 47.82%] and skin rashes [30 out of 92 32.60%]. More than half of the patients felt that the adverse effect had a negative influence on their daily quality of life
Conclusion: Adverse drug effects were common among CML patients receiving Imatinib therapy. These adverse drug reactions had negative impact on patients' daily life
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Background: Congenital heart disease [CHD] are one of condition with significant morbidity and mortality among neonates
Objective: To determine the frequency of congenital heart diseases in neonatal nursery of tertiary care hospital, Rahim Yar Khan
Methodology: Study design: Cross sectional study. Place and duration of study: Neonatal unit, department of Paediatrics, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan from 1[st] January 2015 to 31[st] December 2016. In this study all the neonates admitted in neonatal unit and have some suspicion of cardiac defect [cyanosis, murmur etc] were investigated [CXR, ECG, Echocardiography]. The frequency of CHD was measured and presented as percentage
Results: We found that 0.44 % of congenital heart disease including both cyanotic and acyanotic were admitted in neonatal unit
ABSTRACT
Upper respiratory tract infections [URTI] are the most common acute illnesses that are often of viral origin. Cough and chest congestion are the common symptoms of this disease. Children are prescribed with drugs that are considered to relive the symptoms of this disease. The topical medications contain vegetable camphor for more than a century that relieve chest congestion and cough caused by URTI. The use of camphor in such products remains questionable especially in children who are more sensitive to its side effects. Herbion "Chest Rub" for children is a camphor-free formulation that contains eucalyptus oil mixture, menthol, turpentine and clove oils and is used to relieve symptoms of URTI. The objective of the present investigation was to determine the effectiveness of the chest rub in children suffering with congestion and cough caused by URTI. The study compared the results of the chest rub applied to a group of infected children with a placebo group. Patients were selected randomly on the basis of the criteria set for the study. The results indicated that the chest rub was quite effective in majority of the cases in relieving the symptoms of URTI as compared to the placebo group
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A poor understanding of Ebola Virus Disease (EVD) among Health Care Professionals (HCPs) may put our lives at risk. We aimed to assess the awareness, knowledge, attitudes, perceptions, beliefs of HCPs towards Ebola at Gondar University Hospital (GUH) in Northwest Ethiopia. We conducted a hospital based, cross-sectional survey among 245 randomly selected HCPs working at GUH from August-October, 2015. A validated, self-administered questionnaire was used to collect the data. We calculated descriptive statistics with P0.05 being statistically significant. Of the 245 participants, 211 (86.1%) completed the study. The majority had heard about EVD and used news media (62%) as a source of information. Still, many were afraid of getting EVD (56.4%; P=0.001). A significant number of HCPs thought EVD can cause paralysis like polio (45%) and can be treated with antibiotics (28.4%). In addition, 46.4% of the HCPs felt anger or fear towards Ebola infected patients (P=0.006). We identified poor knowledge and negative incorrect beliefs among doctors and allied health professionals. There is a need for intensive training for all HCPs reduce EVD risk
Subject(s)
Awareness , Ethiopia , Health Knowledge, Attitudes, Practice , Health Personnel , Hemorrhagic Fever, Ebola , Hospitals, UniversityABSTRACT
PURPOSE: In Pakistan, courses in pharmacy practice, which are an essential component of the PharmD curriculum, were launched with the aim of strengthening pharmacy practice overall and enabling pharmacy students to cope with the challenges involved in meeting real-world healthcare needs. Since very little research has assessed the efficacy of such courses, we aimed to evaluate students' perceptions of pharmacy practice courses and their opinions about whether their current knowledge of the topics covered in pharmacy practice courses is adequate for future practice. METHODS: A cross-sectional study was conducted over two months among the senior pharmacy students of two pharmacy colleges. A content- and face-validated questionnaire was used to collect data, which were then analysed using SPSS version 20. Descriptive analysis and logistic regression were performed. RESULTS: Research in pharmacy practice (30.2%), applied drug information (34.4%), health policy (38.1%), public health and epidemiology (39.5%), pharmacovigilance (45.6%), and pharmacoeconomics (47.9%) were the major courses that were covered to the least extent in the PharmD curriculum. However, hospital pharmacy practice (94.4%), pharmacotherapeutics (88.8%), and community pharmacy practice (82.8%) were covered well. Although 94% of students considered these courses important, only 37.2% considered themselves to be competent in the corresponding topics. Of the participants, 87.9% agreed that the pharmacy courses in the present curriculum should be redesigned. CONCLUSION: Our results showed that the pharmacy practice courses in the current PharmD curriculum do not encompass some important core subjects. A nationwide study is warranted to further establish the necessity for remodelling pharmacy practice courses in Pakistan.
Subject(s)
Humans , Cross-Sectional Studies , Curriculum , Delivery of Health Care , Economics, Pharmaceutical , Education, Pharmacy , Epidemiology , Health Policy , Logistic Models , Pakistan , Pharmacies , Pharmacovigilance , Pharmacy , Public Health , Students, PharmacyABSTRACT
PURPOSE: The goal of this study was to compare the knowledge and attitudes of pharmacy and medical students regarding adverse drug reactions (ADRs), as well as their perceptions of barriers to ADR reporting, in a Higher Education Commission-recognised Pakistani university. METHODS: A cross-sectional study was conducted among final-year pharmacy (n=91) and medical (n=108) students in Pakistan from June 1 to July 31, 2014. A self-administered questionnaire was used to collect the data. The responses of pharmacy students were compared to those of medical students. RESULTS: Pharmacy students had a significantly better knowledge of ADRs than medical students (mean+/-SD, 5.61+/-1.78 vs. 3.23+/-1.60; P<0.001). Gender showed a significant relationship to knowledge about ADRs, and male participants were apparently more knowledgeable than their female counterparts (P<0.001). The attitudes of pharmacy students regarding their capability to handle and report ADRs were significantly more positive than those of medical students (P<0.05). In comparison to pharmacy students, a lack of knowledge of where and how to report ADRs was the main barrier that medical students perceived to ADR reporting (P=0.001). CONCLUSION: Final-year pharmacy students exhibited more knowledge about ADRs and showed more positive attitudes regarding their capacity to handle and report ADRs than final-year medical students.
Subject(s)
Female , Humans , Male , Cross-Sectional Studies , Drug-Related Side Effects and Adverse Reactions , Education , Pakistan , Pharmacovigilance , Pharmacy , Students, Medical , Students, PharmacyABSTRACT
Objective: To compare the laparoscopic inguinal hernia repair with Lichtenstein repair in terms of hospital stay and postoperative pain
Study design: Randomized clinical trial
Place and Duration of study: Department of Surgery Services Hospital Lahore, from September 2013 to May 2014
Methodology: Inguinal hernia patients were admitted electively. They were randomly assigned into groups A and B. The group A patients were treated with laparoscopic total extraperitoneal repair [TEP] and group B patients underwent Lichtenstein's repair. Patients were evaluated for 24 hours discharge rate and postoperative pain
Results: A total of 100 patients were included with 50 patients in each group. Group A patients had short hospital stay [discharged within 24 hours - 68.08%] as compared to group B [31.91% -p <0.001]. From 2[nd] to 6[th] postoperative week group A patients had significantly less postoperative pain as compared to group B [p <0.05]
Conclusion: Laparoscopic TEP repair was safe with early hospital discharge and less postoperative pain
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The purpose of this study was to determine the Recurrence rate of odontogenic keratocysts [OKC] and association of recurrence with various surgical modalities. It was cohort analytical study. Eighty-two odontogenic keratocysts cases treated at Oral and Max illofac ial department Armed Forces Institute of Dentistry, Rawalpindi farmed the study subject, and were followed for a period of 9 years from 2004 to 2013. Recurrence ofOKCs were evaluated from 1-9 years after surgical treatment by clinical and ra-diographic means and correlated with various treatment modalities. The most frequent site affected by OKCs was the posterior mandible including body, angle and ramus. Patients were followed for recurrence. 16 patients were lost to follow up and this journal was 14 cases of recurrence out of 66 were treated with varying modalities [21.2%]. Patients treated conservatively with marsupialization or enucleation alone demonstrated higher recurrence rates [100% and 50% respectively]. Odontogenic keratocyst is an aggressive cyst associated with high recurrence. Surgeons should decide on various modalities as per requirement of the case. Although resection carries least risk of recurrence, it should be limited to recurrent and aggressive OKCs. The outcomes of enucleation combined with peripheral ostectomy and chemical cauterization is reasonably acceptable
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Background: Osteoarthritis knee causes disablity among middle aged people
Objective: To find out the frequency of osteoarthritis among patients of knee and its association with gender and obesity
Methodology: This cross sectional study was conducted at Department of Orthopedics, Bahawal Victoria Hospital, Bahawalpur from 1[st] January to 31[st] May 2014. Patients of both sexes with knee pain, age from 40 to 70 years were included in this study. Physical examination of all the patients was done and x-ray of knee joint were also taken from every patients to assess the knee osteoarthritis. The data was entered and analysed by using SPSS version 15
Results: Total 100 patients were included in this study. Mean age of the patients was 52.64 +/- 8.8 years. Osteoarthritis was found in 72 [72%] patients. 20 [55.6%] among male and 52 [81.25%] among female were having osteoarthritis. Out of 60 [60%] obese patients osteoarthritis was found in 56 [93.33%] patients
Conclusion: Obesity is found to be significant important risk factor for Osteoarthritis Knee [KOA]. KOA is also found more in females and obese
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To determine the efficacy of low pressure vs high vacuum suction drains after modified radical mastectomy in terms of earlier removal and its impact on duration of hospital stay. A randomized clinical trial. The study was conducted at Military Hospital Rawalpindi and CMH Peshawar over a period of 12 months from March 2010 to March 2011. Sixty trucut/biopsy proven, early invasive breast cancer patients undergoing modified radical mastectomy were randomized into groups A [n=30] and B [n=30] to receive high vacuum [400 mm Hg] suction drains or low vacuum suction drains [200 mm Hg] at completion of operation. Drains were recharged to the specified pressure daily and drain output was recorded. Drains were removed when the daily drainage reduced to 30 ml. 28 patients in group A and 27 patients in group B were finally included in the study. Mean hospital stay in low vacuum suction group was 4.96 +/- 0.898 days which was 32.9% shorter than 7.39 +/- 1.397 days for high pressure suction group [p< 0.005]. The use of low vacuum vs high vacuum drains after modified radical mastectomy reduces the hospital stay significantly
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To explore the nurses' expectations and experience about pharmacists in private sector hospitals of Karachi, Pakistan. A cross-sectional study was conducted from June to September 2012 in five private sector hospitals of Karachi, Pakistan. A convenient sample of nurses [n=377] were enrolled in this study. Data was obtained through a previously validated questionnaire. Responses were statistically analyzed using SPSSv.17. Questionnaires were returned giving a response rate of 63.6% of which 20 were unusable [n=240]. Out of the remaining 220, 24.1% [n=53] responded that they never or rarely interacted with a pharmacist. Respondents who expect pharmacists to collaborate with nurses to solve drug related problems were 45% [n=99]. Nurses' experience of pharmacists was not substantial as only 44.5% [n=98] respondents consider pharmacists as a reliable source of clinical drug information. The role of pharmacists is not well appreciated among nurses in Pakistan. Hence, pharmacists must bridge the observed gap and use a more strategic and consistent approach to build a more positive image in line with other healthcare professionals and in providing patient-centred pharmaceutical care. This research would impress upon the pharmacists the need to redefine their role in the healthcare settings
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To assess the quality of postgraduate fellowship training and to determine the differences in the quality of postgraduate fellowship training in public and private teaching hospitals of Karachi. It was a cross sectional survey conducted in four public and private sector hospitals of Karachi from January to March 2012. A total of 246 postgraduate fellowship trainees were interviewed. A standardized questionnaire adopted from CPSP guidelines on postgraduate training standards was developed. Postgraduate fellowship trainees [PG's] were selected on the basis of convenient non-probability sampling technique. Fisher's exact test and chi-square test were used to find differences in quality of postgraduate training. The mean duty hours per week was highest in private sector hospitals i.e., 72.1 as compared to government sector hospital which was 58.3 [P-value <0.01]. Of the respondents, 66.0% of PG's in private hospitals agreed that they have a structured study program as compare to 46.5% in public hospitals [P-value <0.001]. Only 38.1% of PG's in public hospitals agreed that they spent appropriate amount of time with their family and friends as compare to 1.8% of PG's in private hospitals [P-value <0.001]. No significant difference was found in quality of supervision in both public sector and private sector hospitals. The attributes of different aspects of training were different in public and private sector hospitals. So significant room exists for improvement in the quality of postgraduate medical training as indicated by the less than desirable proportion of trainees being satisfied with different aspects of training
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To translate and validate the Pittsburgh Sleep Quality Index [PSQI], a standardized self-administered questionnaire for the assessment of subjective sleep quality into the Urdu language. Validation study. Mayo Hospital, Lahore, from March to April 2012. The PSQI was translated into Urdu following standard guidelines. The final Urdu version [PSQI-U] was administered to 200 healthy volunteers comprising medical students, nursing staff and doctors. Inter-item correlation was assessed by calculating Cronbach alpha. Correlation of component scores with global score was assessed by calculating Spearman correlation coefficient. Correlation between global PSQI-U scores at baseline with global scores for each PSQI-U and PSQI-E at 4-week interval was evaluated by calculating Spearman correlation coefficient. Moreover, scores on individual items of the scale at baseline were compared with respective scores after 4-week by t-test. One hundred and eighty five [185] participants completed the PSQI-U at baseline. The Cronbach alpha for PSQI-U was 0.56. Scores on individual components of the PSQI-U and composite scores were all highly correlated with each other [all p-values < 0.01]. Composite scores for PSQI-U at baseline and PSQI-E at 4-week interval were also highly correlated with each other [Spearman correlation coefficient 0.74, p-value < 0.01] indicating good linguistic interchangeability. Composite scores for PSQI-U at baseline and at 4-week interval were positively correlated with each other [Spearman correlation coefficient 0.70, p < 0.01] indicating good test-retest reliability. The PSQI-U is a valid and reliable instrument for the assessment of sleep quality. It shows good linguistic interchangeability and test-retest reliability in comparison to the original English version when applied to individuals who speak the Urdu language. The PSQI-U can be a tool either for clinical management or research
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<p><b>OBJECTIVE</b>Terrorism-related bomb attacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to improvised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan University Hospital, Pakistan (AKUH). Further, a few pertinent management guidelines have also been discussed.</p><p><b>METHODS</b>The hospital database and clinical coding during a 5-year period were examined for head injuries secondary to terrorism-associated blasts. In addition to patient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, management (conservative or operative) to associated complications, and discharge neurological status.</p><p><b>RESULTS</b>A total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients (mean follow-up: 7.8 months), with most patients having no active complaints.</p><p><b>CONCLUSION</b>The results of this series show that civilian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.</p>
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Blast Injuries , Diagnostic Imaging , Epidemiology , Therapeutics , Bombs , Craniocerebral Trauma , Diagnostic Imaging , Epidemiology , Debridement , Decompressive Craniectomy , Glasgow Coma Scale , Pakistan , Epidemiology , Skull Fractures , Epidemiology , Suicide , Terrorism , Tomography, X-Ray Computed , Urban Population , Wounds, Penetrating , EpidemiologyABSTRACT
Background: Central serous retinopathy [CSR] is an idiopathic disorder of the macula characterized by serous elevation of the neurosensory retina at the posterior pole caused primarily by leaky choriocapillaries. On fundus fluorescein angiography [FFA], two typical patterns of this leakage are defined as inkblot and smoke stalk appearance. But atypical and unusual patterns also occur that can produce difficulty in diagnosis
Objective: To determine the spectrum of atypical presentations of CSR on FFA
Patients and Methods: All patients presenting with a clinical diagnosis of CSR and referred for FFA were included in this descriptive study. After taking consent, FFA was performed and the results were analyzed for atypical features of this disorder. Where FFA features were not conclusive an optical coherence tomography [OCT] was also performed to aid further evaluation
Result: 12 out of 23 patients had atypical FFA features. These include multiple inkblots in one eye, multiple inkblots in both eyes, ink blot and smoke stalk in the same eye, CSR with pigment epithelial detachment in which only the pigment epithelial detachment shows up on FFA, CSR with choroidal eovascularisation in which the CNV only shows on FFA and CSR with no leakage on FFA
Conclusion: Atypical presentations of CSR can cause diagnostic problems. The ophthalmologist must be aware of these features. Furthermore, these cases should be worked up for associated systemic / ocular disease
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The aim of this cross-sectional study was to assess the complications associated with tooth supported fixed dental prosthesis amongst patients reporting at University College of Dentistry Lahore, Pakistan. An interview based questionnaire was used on 112 patients followed by clinical oral examination by two calibrated dentists. Approximately 95% participants were using porcelain fused to metal prosthesis with 60% of prosthesis being used in posterior segments of mouth. Complications like dental caries, coronal abutment fracture, radicular abutment fracture, occlusal interferences, root canal failures and decementations were more significantly associated with crowns than bridges [p=0.000]. On the other hand esthetic issues, periapical lesions, periodontal problems, porcelain fractures and metal damage were more commonly associated with bridges [p=0.000]. All cases of dental caries reported were associated with acrylic crown and bridges, whereas all coronal abutment fractures were associated with metal prosthesis [p=0.000]. A significantly higher number of participants who got their fixed dental prosthesis from other sources i.e. Paramedics, technicians, dental assistants or unqualified dentists had periapical lesions, decementations, esthetic issues and periodontal diseases. This association was found to be statistically significant [p=0.000]. Complications associated with fixed dental prosthesis like root canal failures, decementations, periapical lesions and periodontal disease were more significantly associated with prosthesis fabricated by other sources over the period of 5 to 10 years