ABSTRACT
Para pharyngeal space tumors constitutes only 0.5-0.8% of all tumors of which Lipoma is the rarest. Generally, lipoma is found just beneath the subcutaneous tissues. Here we are presenting a case of 9 year old child with lipoma of left parapharyngeal space extending into the neck mimicking cystic Hygroma on presentation
ABSTRACT
Objective: to determine the knowledge of clinicians and their opinion about legalization, obstacles in practicing euthanasia and factors that may compel them to practice euthanasia
Methodology: a questionnaire based descriptive study was conducted at public and private hospitals of Khyber Pakhtunkhwa. A questionnaire was distributed randomly to 540 doctors of different specialties and general practitioners. Questions were related to their knowledge, views about legalization, factors and obstacles in practicing euthanasia. The questionnaire was collected from the doctors who filled the form and consented to participate in the study
Results: the response rate was 55%, among them 79% were males. Only 61% [185] knew the meaning of euthanasia, whereas 36% [109] knew about its guidelines and 2% [6] had no knowledge of euthanasia. Amongst clinicians who knew about euthanasia, 84% did not and 16% agreed with its legalization. Reasons mentioned for disagreement with its legalization were religion 95%, moral 61%, ethical 44%, emotional 41% and social 37%. Of those clinicians who agreed with its legalization, 90% would and 10% would not practice it on their patients. Out of them 40% would adopt no resuscitation method, 40% would administer lethal drugs and 20% would withhold or withdraw the treatment
Conclusion: majority of responding clinicians were not aware of euthanasia and any related guidelines. They disagreed with the practice as well as legalization of euthanasia
ABSTRACT
Discrepancies in blood typing is one of the major reasons in eliciting a transfusion reaction. These discrepancies can be avoided through detailed analysis for the blood typing. Here, we report a subgroup of blood group type-B in the ABO system. Donor's blood was analyzed by employing commercial antisera for blood grouping. The results of forward [known antisera] and reverse [known antigen] reaction were not complimentary. A detailed analysis using the standard protocols by American Association of Blood Banking revealed the blood type as a variant of blood group-B instead of blood group-O. This is suggestive of the fact that blood group typing should be performed with extreme care and any divergence, if identified, should be properly resolved to avoid transfusion reactions. Moreover, a major study to determine the blood group variants in Pakistani population is needed
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To document the effects of secondary prevention on different risk factors in the real world situation. It was a cross sectional comparative study carried out at a referral cardiac clinic in Peshawar from January 2010 to December 2010. Study subjects presenting with at least 6 months follow up were included from different parts of Khyber Pukhtunkhawa. All patients with positive history or objective evidence of CAD were enrolled. Study subjects were divided in two groups based on the fact that either taking or had stopped medication for the duration of the study period. Study variables were levels of lipids, glucose, blood pressure [BP], smoking and obesity. A total of 843 patients were included in the study. Males were 70.4% [593]. Mean age was 58.74 +/- 10.6 years. Patients taking regular medicine were 69.03% while 30.97% had stopped their medicine for at least three months. Diabetics, hypertensive and positive family history for CAD were 33.4%, 50.25% and 24% respectively. When compared to patient who had stopped medicine, mean systolic BP [p= 0.014], diastolic BP [p= 0.05], mean Cholesterol [p=0.000], mean LDL [p=0.000], mean HDL [p=0.000] and HbA1c% [p=0.049], was well controlled in patients who were taking medicine regularly. Mean BMI [p=0.786], triglycerides and smoking [p=0.761] had no significant difference between the two groups. Blood pressure, serum cholesterol, LDL, HDL, as well as HbA1c% were reduced with little effect on serum TGs, BMI and smoking in those who were taking medicine regularly compared to those who had stopped
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To assess the effect of optimal medical therapy on the control of risk factors in coronary artery disease [CAD] patients with or with-out intervention. It was a cross sectional comparative study carried out at Lady Reading Hospital, Peshawar January to December 2010. Subjects were divided into two groups based on percutaneous coronary intervention and optimal medical therapy. Study variables were smoking, physical activity, dyslipidemia, diabetes, hypertension and obesity. Informed written consent was taken from all the study participants. Data was recorded on a preformed Questionnaire and analyzed with SPSS version 16. P-value of 0.05 was taken as significant. A total of 315 patients were studied. Baseline characteristic were similar between groups. Smoking was decreased significantly in [PCI group] as compared to [OMT group] [p=0.027]. Physical activity goal >/= 150 min/ week were achieved more in [PCI group] compared to [OMT group][p=0.019]. Goals set for Serum cholesterol, HbA1c%, serum LDL, Systolic blood pressure and Diastolic blood pressure have significantly achieved in [PCI group] as compared to [OMT group] with p- valves of [0.018,0.027,0.023,0.033 and 0.017] respectively. While goals set for Triglycerides, serum HDL and BMI have no significant difference between the two groups with p-valves of [0.223, 0.089 and 0.164 respectively]. Patients who underwent intervention and remained on optimal medical therapy were more adherent to regular exercise and good compliance which lead to better risk factors control for coronary artery disease as compared to patients who remained on optimal medical therapy alone
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Risk Factors , Angioplasty, Balloon, Coronary , Cross-Sectional Studies , Surveys and Questionnaires , Smoking , Hyperlipidemias , Body Mass IndexABSTRACT
To determine the association of the pro-brain natriuretic peptide [NT-proBNP] plasma levels with two dimensional echocardiographic determination of left ventricular dimensions and ejection fraction [EF] in acute dyspneic patients. An observational cross-sectional study. Tabba Heart Institute, Karachi, from January to June 2010. One hundred patients were selected by consecutive purposive non-probability sampling who had presented with acute dyspnoea. NT-proBNP levels were assessed by commercial tests [Roche Diagnostics]. The clinical diagnosis of congestive heart failure [CHF], echocardiographic assessment of left ventricular dimensions and function were compared with NT-proBNP levels. Receiver operating characteristic [ROC] curve was estimated for NT-proBNP and compared. The chi-square test was applied for categorical and student's t-test for numerical data at 0.05 levels of significance were used to compare patients with and without heart failure. Further comparative analysis between groups on the basis of ejection fraction was done by one way ANOVA test. Seventy-nine patients [79%] had CHF as a cause of their dyspnoea. Patients with CHF were older [61.9 +/- 14 years vs. 58.6 +/- 14 years, p=0.368], had a lower EF [36.9% vs. 61%, p < 0.0001], had a higher LV dimensions, left ventricular end diastolic dimension - LVEDD [49.94 +/- 5.6 vs. 42 +/- 7.9 mm, p < 0.0001], left ventricular end systolic dimension - LVESD [37.31 +/- 6 vs. 29.21 +/- 10.9 mm, p < 0.0001] and a higher NT-proBNP [10918 +/- 1228 vs. 461 +/- 100 pg/mL, p < 0.0001] than patients without CHF. NT-proBNP values increased with the severity of ventricular impairment. Significant differences were found between patients with LVEF < 25% and patients with moderate ventricular impairment [LVEF = 26 - 40%] and mild ventricular impairment [LVEF = 41-60%, p < 0.001]. The group of patients with LV dilation, had significantly higher BNP levels than those with normal LVEDD [12416 +/- 1060 pg/ml vs. 6113 +/- 960, p = 0.009] and LVESD [10416 +/- 1160 vs. 4513 +/- 960 pg/ml, p = 0.008]. Area under ROC curve for the diagnosis of CHF was significantly higher for NT-proBNP [AUC 0.99, p < 0.003]. The sensitivity of NT-proBNP value of > 300 pg/mL for the diagnosis of CHF was 100% and specificity was 42%. A cut-point of 300 pg/mL NT-proBNP had 100% negative predictive value to exclude acute CHF. NT-proBNP is strongly associated with two-dimensional echocardiographic determination of left ventricular dimensions and EF in identifying CHF in patients with acute dyspnoea
ABSTRACT
Introduction: Approximately 30 to 40% of patients with Chronic Hepatitis "C" [CHC] have persistently normal serum alanine aminotransferase [ALT] levels. Historically, these patients have been classified as healthy or asymptomatic and have not received any treatment for CHC infection. However, definition and clinical significance of persistently normal ALT in CHC have been recently revised as new information on liver disease which is now getting available
Aims: To evaluate the histological feature of liver of patients suffering from CHC with persistently normal ALT levels
Methods: In this prospective observational study we recruited consecutive patients infected with CHC with persistently normal ALT since last six months, visited our hepatology clinic from September 2004 to April 2005. The METAVIR scoring system was used for liver histology grading [degree of inflammation] and staging [degree of fibrosis]
Results: A total of 55 patients were recruited from outpatient clinic with normal ALT during a follow up of six months. Mean age of these patients was 36.7+/- 9.78 years; out of these 39 [70.9%] were male. All these patients were diagnosed to have hepatitis C by HCV RNA PCR method. There were 24 [43.6%] patients with stage [fibrosis] equal or greater than 2 and 33 [60%] had biopsy grade equal or greater than 2. Eighteen [32.7%] patients had steatosis on liver biopsy. Twelve patients with stage > 2 had steatosis while 6 patients with stage < 2 had steatosis [p< 0.01]
Conclusion: There was no correlation found between the transaminase level and biopsy scores. Approximately 44 % of the patients have fibrosis equal to or greater than stage 2. The extent of steatosis is directly related to the biopsy score of the patients