Perinatal Outcome According to Gestational Age- A study of 50 Cases

Background: Gestational age supports predicting a potential due date, informing obstetrical care and testing, and assessing the baby’s health at birth. It is vital to obtain a gestational age in all pregnancies to offer regular care and medical management for both mother and fetus. The ultimate suitable techniques for calculating gestational age are ultrasonography. The study aims to investigate the perinatal outcome according to gestational age. Material & Methods: A Prospective cross-sectional study was carried out in the Department of Obstetrics & Gynecology, Bangabandhu Sheikh Mujib Medical University, Hospital, from January 2008 to June 2008. A total of 50 patients were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. Results: Among the study population (N=50), one-fifth of the mothers’ (10,20.0%) age was under twenty. The majority of mothers were (34,68.0%) between 20-30 years old with a mean age of 25.4 ± 4.32 years. Twenty-three patients (23,46.0%) came at 40+ weeks of pregnancy, eighteen patients came at (18,36,0%) on 41 weeks of pregnancy and nine patients (9,18.0%) came at41+ weeks of pregnancy. There was no perineal tear and two patients (2,4.0%) had cervical tears which were repaired. In two patients (2,4.0%) there was postpartum haemorrhage, among them two patients (2,4.0%) needed a blood transfusion. Among the healthy babies, the majority of the babies (20,40.0%) were born at 40 completed weeks of gestation, eighteen babies (18,36.0%) at 41 completed weeks and two babies (2,4.0%) were born at 42 completed weeks of gestation. Conclusion: Many childhood and adult diseases are linked with size at birth and are mostly inclined by early postnatal growth is widely accepted. The evolving fetus formulates itself for post-partum life by reporting to metabolic signals in its uterine environment.

Predominant peripheral lesions in patients with diabetic retinopathy and its association with systemic comorbidities

Purpose: To determine the associations of predominant peripheral lesions (PPLs) with systemic comorbidities in individuals with diabetic retinopathy. Methods: This is a multicenter cross-sectional observational study conducted across three tertiary eye care centers in south India between January 2019 and July 2021. Ultra-widefield fundus images of consecutive patients with varying severity of diabetic retinopathy with data on systemic comorbidities were classified based on the presence or absence of PPL. Systemic comorbidities (hypertension, diabetic kidney disease, coronary artery disease, dyslipidemia, and anemia) were compared between the two groups. Results: A total of 879 participants (70.1% males) were included in the study, of which 443 (50.4%) patients had PPL. The mean age of the study participants was 56 ± 10 years, mean age of onset of diabetes was 41.24 ± 11.6 years, and mean duration of diabetes was 15.39 ± 7.6 years. The number of PPL increased with increasing severity of DR. Of all the systemic comorbidities analyzed, we found that coronary artery disease (CAD) had a significant association with PPL (Odds ratio [OR]-1.69; 95% confidence interval [CI], 1.12–2.55; P = 0.013) after adjusting for diabetic retinopathy severity, duration of diabetes, and age of onset of diabetes. Conclusion: The presence of PPL is a marker for coronary artery disease and early referral to cardiology is warranted.

Nutrient Consumption among the Bangladeshi Children with Autism

Background: The prevalence of Autism in South Asia is 1 in 93 children, where, prevalence is much higher, 3% in Dhaka city of Bangladesh. Consumption of daily required nutrient is essential for these children like normal ones but sometimes may be neglected. Objectives: This study was undertaken to assess the macro and micronutrient consumption among the children with autism in Dhaka city and compared to the requirement.Material & Methods:In this cross-sectional study, 100 subjects where male-female ratio was 3:2, were studied from urban autism centers Dhaka, Bangladesh. Anthropometric parameters height, weight, BMI and 24-hour dietary recall (individual 3days) were collected following predesigned questionnaire. Data was collected from face to face interview from both parents and center抯 teacher as appropriate. Nutritive value of food was calculated using Food Composition Table for Bangladesh, 2014 using a food software. For statistical analysis, SPSS 20 was used.Results:The average age and BMI of subjects were 11 yrs and 21 kg/m2 respectively. The mean 盨Dvalues (g/day) of protein, fat and carbohydrate intake were 38�, 47� and 116� respectively. The average intake of (mg/day) thiamine, riboflavin, vitamin C, calcium, magnesium, iron, niacin, and zinc was 0.68�32, 0.46�23, 33�, 144�, 137�, 6.5� 11�and 5.2�respectively. About 94% children consumed only 33% of the required calcium. Nearly 42% children took 67% of the required magnesium. Similarly, half of the children failed to consume 33% thiamine and zinc of the requirement. Conclusions:Consumption of calcium, thiamine, folic acid, and zinc are seemed to be lower than their requirement.

External Apical Root Resorption and IL-1A, IL-1RN Gene Polymorphisms: A Systematic Review and Meta-Analysis of Prospective Studies

ABSTRACT Objective: To reconnoiter the IL-1A (-889) and IL-1RN (+2018) gene polymorphisms and their association with EARR. Material and Methods: The Science Direct, PubMed and Scopus databases were comprehensively searched by two independent reviewers. In addition, the bibliographies of all relevant publications and textbooks were searched manually. A meta-analysis was performed using data available up to May 9, 2020. Results: A total of 13 and 9 publications were selected for the systematic review and meta-analysis, respectively for both IL-1A and IL-1RN genes. Odds ratio (OR) was used to evaluate the association of the gene polymorphism and the risk of EARR. The risk of EARR was estimated using the overall OR from the published studies. No association was found for IL-1A gene for the risk of EARR. However, the dominant and co-dominant models of IL-1RN gene polymorphism were associated with the risk of EARR. Conclusion: More studies are warranted to determine the relationship between IL-1A and IL-1RN gene polymorphisms and EARR for a clearer understanding of their interactions.

Immunomodulator use in paediatric severe sepsis and septic shock

INTRODUCTION@#The use of drugs that modulate the immune system during paediatric severe sepsis and septic shock may alter the course of disease and is poorly studied. This study aims to characterise these children who received immunomodulators and describe their clinical outcomes.@*METHODS@#This is a retrospective chart review of patients with severe sepsis and septic shock admitted into the paediatric intensive care unit (PICU). Clinical, haematological and outcome characteristics of patients with or without exposure to immune-modulating drugs were compared. Primary outcome was PICU mortality; secondary outcomes were 28-day ventilator-free days (VFD) and intensive care unit-free days (IFD). Univariate and multivariable analyses were performed for these outcomes.@*RESULTS@#A total of 109 patients with paediatric severe sepsis or septic shock were identified. Of this number, 47 (43.1%), 16 (14.7%) and 3 (2.8%) patients received systemic corticosteroids, intravenous immunoglobulins and granulocyte colony stimulating factor, respectively. Patients who received immune-modulating drugs were more likely to require invasive ventilation (38/54 [70.4%] versus 26/55 [47.3%], @*CONCLUSION@#Immune-modulating drugs were frequently used in paediatric severe sepsis and septic shock. Patients who received these drugs seemed to require more PICU support. Further studies are required to examine this association thoroughly.

Evaluation of the incidence, risk factors, severity, and outcome of hydrocephalic fetuses in a tertiary healthcare center located in Northern India: a prospective observational study

Background: Hydrocephalus is a heterogeneous disease marked by abnormal dilatation of the cerebral ventricles secondary to varying etiologies. This study was aimed to determine the incidence, risk factors, severity, and outcome of hydrocephalic fetuses presenting to a tertiary healthcare hospital located in northern India.Methods: In this prospective observational study, pregnant women visiting the obstetrics outpatient department of our hospital from 01 July 2017 to 31 June 2018 were screened for hydrocephalic fetuses via ultrasonography along with a detailed history, and a comprehensive battery of diagnostic investigations. They were followed up for a minimum period of two months after delivery/termination of pregnancy.Results: A total of 3627 pregnant women were screened, of which 10 had hydrocephalic fetuses in the observed time period. The incidence of hydrocephalus was determined to be 2.75 per 1000 live births. Low socio-economic status was identified as a major risk factor. 50% of the hydrocephalic fetuses were severely afflicted and were discontinued. The remaining 50% were successfully delivered and were managed via a ventriculo-peritoneal shunt or are under close observation in the postnatal period without any adverse outcome.Conclusions: The burden of hydrocephalus is considerably high in India, as compared to western countries. In rural settings, low socioeconomic status and lack of folic acid supplementation have a major influence in the etiopathogenesis of hydrocephalus. Management of hydrocephalus requires a multidisciplinary approach and is tailored according to the severity of the presentation. Severe cases of hydrocephalus and cases with associated anomalies have a poor prognosis.

Utilization pattern of drugs among patients attending geriatric outpatient department in a tertiary care hospital in Kashmir

Background: Quality and safety of prescribing in older people remains a global healthcare concern and inappropriate prescribing is a major public health issue because of its direct association with morbidity, mortality and wastage of health resources in this age group. Very limited data is available on the drug utilization pattern in geriatric population and the present study was carried out to see the prescription pattern in geriatric population in this part of the world.Methods: The present study was conducted by the department of pharmacology in outpatient department of geriatrics in a tertiary care centre to look into the prescription pattern among geriatric age group.Results: A total of 237 prescriptions were collected, out of which 108 (45.56%) were males and 129 (54.44%) were females. The majority of the patients were in the age group of 60-69 years (n=141, 59.5%). The most commonly found comorbidity was hypertension (63.29%) and antihypertensive agents (74.68%) were the most frequently prescribed class of drugs. Calcium (37.57%), budesonide (32.91%), thyroxine (27.84%) and pantoprazole (25.31%) were the most common individual drugs prescribed.Conclusions: Like other studies on geriatric population polypharmacy was also observed in the present study and periodic therapeutic audit is essential to ensure rational medicine use.

Soft Tissue Cephalometric Measurements Among Malaysian Malays and Chinese

Abstract Objective: To obtain the standardized values of individuals of Malaysian Malay and Chinese for further relevant research, such as treatment planning and aesthetical considerations. Material and Methods: In this retrospective study, 440 (305 were Malays and 135 were Chinese) standardized lateral cephalometric radiographs of orthodontic patients selected through simple random sampling are profiled using Holdaway's analysis. The independent t-test was used to assess the disparities in race and gender. The significant level was p<0.05. Results: Significant differences were found between the Malays and Chinese in their skeletal profile convexity, superior sulcus depth, inferior sulcus to the H line and nose prominence. Between Malay females and males, there are significant differences in superior sulcus depth, soft tissue subnasale to H line, basic upper lip thickness, upper lip thickness and nose prominence. Between Chinese males and females, there were differences in their skeletal profile convexity, upper lip to H line, basic upper lip thickness and upper lip thickness. Conclusion: The findings demonstrated the difference between standardized norms and the unique profiles of Malaysian Malays and Chinese. There are significant gender disparities in the soft tissue cephalometric measurements among Malaysian Malay and Chinese subjects.

Rational prescribing practice assessment among resident doctors in a tertiary care teaching hospital: a questionnaire based observational study

Background: One of the important factors in health policy is recognised to be rational use of medicines (RUM). Physicians can influence the health and well-being of patients by prescribing appropriate drug in right doses and they should be taught to prescribe rationally at the earliest of their professional carrier.Methods: This cross-sectional, questionnaire-based study was carried out in SMHS hospital which is a tertiary-care teaching hospital associated with Government Medical College, Srinagar, Jammu and Kashmir, India.Results: Out of 106 resident doctors enrolled in the study, 96.2% respondents were aware about the term essential medicines of India, and 47.6% had National List of Essential Medicines of India available at their work place. When the participants were questioned about the term RUM only 17% of them responded positively, but majority of the resident doctors (88.67%) were aware about the ingredients of the drugs they use to prescribe. Though only 3.7% of our participating doctors always use essential medicines during their prescription writing but majority of them (96.22%) would always use to inform the patient regarding disease, drug therapy and monitoring of drug therapy.Conclusions: Considering the fact that respondents are future prescribers they should be aware of all aspects about RUM and improper knowledge in certain areas of RUM is a matter of concern that needs to be addressed.

Prescribing pattern in outpatient department of neurosurgery in a tertiary care hospital of North India

Background: The neurosurgical disorders are amongst the leading cause of global mortality and morbidity. Though surgical intervention is thought to be the main management protocol in the neurosurgical setup but drugs are being equally used especially in the outpatient setting. The present study was carried out in view of the sparse data available on prescribing pattern in neurosurgery.Methods: The present study was conducted by the department of pharmacology in outpatient department of neurosurgery in a tertiary care centre to look into the prescription pattern among these patients.Results: In 268 patients analyzed, mean age was 43.02±15.93 years and 52.23% were females. Majority of our participants (44%) were found to be of young to middle age group (21-40 years). The diagnosis among the study population was spread over large number of diseases. Lumbar Disc Prolapse (LDP) was found to be the leading cause of neurosurgical morbidity, amounting to 32%. As far as the prescription of various drugs in the outpatient of neurosurgery is concerned, Analgesics were the most common drugs prescribed constituting about 48% of the total drugs prescribed followed by GABA analogues and multivitamins which equally formed 41% of the total prescribed drugs.Conclusions: Although the prescription pattern studies among the outpatient neurosurgery patients are very scant, the analysis of prescription studies will be helpful to encourage the rational drug prescribing pattern.

Role of Serum Prolactin Levels in Diagnosis of Epileptic and Pseudoepileptic Events in Children, A Tertiary Care Experience

Introduction: Transient elevation of serum prolactin levels occurs in immediate postictal period in true epileptic events only. Current study was aimed to investigate the role of postictal serum prolactin levels in differentiation of true seizures from pseudo epileptic events. Material and methods: A total of 110 patients of either sex between ages of 6 months to 12 years out of 676 cases admitted for seizure evaluation were enrolled in our study and divided into four groups. Group 1 included 30 children having frank seizures, group 2 included 30 children with typical febrile seizures, group 3 included 25 children with seizure mimics and group 4 included 25 children without seizures.The serum prolactin levels were quantitatively determined by using CoatA-Count Prolactin Immuno-radiometric assay (IRMA). All data was analyzed by standard statistical methods. Results: There were 64(58.2%) males and 46(41.8%) females with mean age of 60.8 and 61.3 months. The serum prolactin level was highest in group I with mean level of 25.5ng/ml ±10 SD(p value =0.00).The serum prolactin levels were raised in 30.3% (20/66) of patients in group I,II,and III when serum sample was obtained within 20 minutes and in none 0/19 (0.00%) when sample was taken after 20 minutes (p value =0.006).All patients with generalized tonic clonic seizures with abnormal EEG had abnormal prolactin levels while as only 83.3% with complex partial seizures and 20% with simple partial seizures had raised prolactin levels (p value =0.002). Conclusion: There was a significant rise in serum prolactin level in children with epileptic seizures as compared to febrile seizures and seizure like events.

A Perquisite for Atonic Post-Partum Hemorrhage - Uterovaginal Packing: A Clinical Study

Aim: To study maternal outcome in terms of morbidity andmortality following intrauterine packing in postpartum atonichemorrhage (PPH).Methods: The study was conducted over a period of 24months in our institution over post-partum patients withintractable PPH before resorting to invasive surgicalmanagement after vaginal delivery & caesarean section.Results: 92% success rate was observed among the patientswith uterovaginal packing.Conclusion: Timely management of patients with intractablepostpartum hemorrhage which is unresponsive to conventionalmedical treatment can be safely managed by uterine packingwith minimal maternal mortality and morbidity. Maternal deathrates and hysterectomies could be minimized using thisconservative method.

Class III Malocclusion: Missense Mutations in DUSP6 Gene

Objective: To determine the DUSP6 gene mutation in three generations of Malaysian Malay subjects having Class III malocclusion. Material and Methods: Genetic analyses of DUSP6 gene were carried out in 30 subjects by selecting three individuals representing three generations, respectively, from ten Malaysian Malay families having Class III malocclusion and 30 healthy controls. They were submitted Clinical Evaluation to clinical examination, lateral cephalometric radiographs, dental casts, and/ or facial and intra-oral photographs. Buccal cell was taken from each participant of Class III malocclusion and control groups. DNA extractions from buccal cell were carried out using Gentra puregene buccal cell kit. Bio Edit Sequence Alignment Editor software was used to see the sequencing result. Results: A heterozygous missense mutation c.1094C>T (p. Thr 365 Ile) was identified in DUSP6 gene in three members of one family with Class III malocclusion, whereas no mutation was found in the control group. Conclusion: Current study successfully identified a missense mutation in DUSP6 gene among one Malaysian Malay family affected by Class III malocclusion. The outcome of this study broadened the mutation spectrum of Class III malocclusion and the importance of DUSP6 gene in skeletal functions.

role of inflammatory markers following Ramadan Fasting

Objectives: The aim of present study was to investigate the effect of fasting during Ramadan on plasma adiponectin and TNF-alpha levels

Methods: This is a cross sectional study, conducted at Federal Urdu University of Arts, Science and Technology [FUUAST], Karachi, comprising a total of 55 [50%] females and 55 [50%] males whose ages ranged between 20 and 40 years, and fasted during Ramadan [June-July 2014] were enrolled in the study. Subjects were separated into normal weight, overweight and obese males and females. Anthropometric measurements and Fasting venous blood samples were taken at first and last [29th] day of Ramadan. Plasma adiponectin and TNF-alpha levels were assayed with ELISA kits. All values were calculated and presented as mean ± standard error of the mean [SEM] and by using analysis of variance [ANOVA] for repeated measures. P values < 0.05 were accepted as significant

Results: Body mass index [BMI] [Kg/m2] in over-weight and obese male subjects exhibited considerable reduction [P<0.05; P<0.05], post Ramadan when compared to their respective pre Ramadan fasting weights. Noticeable and significant reduction was also observed in BMI of obese females [P<0.05]. Post Ramadan Overweight Males [P<0.05] and Post Ramadan Obese Males [P<0.001] exhibited significantly elevated plasma adiponectin [?g/mL] values. While plasma adiponectin mean concentration of only obese females were significantly improved at last week of Ramadan [P<0.01]. Fasting in Ramadan significantly decreased TNF-alpha [pg/mL] levels of post obese males and females than Pre-Ramadan-groups [P<0.05; P<0.01] respectively

Conclusion: The study reports of noticeable changes with Ramadan fasting resulting increase of plasma adiponectin and decrease of TNF-alpha levels as well as body weight. The study strongly suggests further investigations on larger sample sizes with possible association of dietary restrictions and weight loss on mechanism of enhanced adiponectin and reduced TNF-alpha in obese and overweight persons who fast on Ramadan pattern

Fibreoptic intubation in airway management: a review article

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.

A Clinical Study on Labour Analgesia in Full Term Primigravida Patients

Background: Labour is defined as the progressive dilatation of cervix with co-ordinate uterine contractions that effect in and expulsion of the products of conception. Experience has shown that providing pain relief to the mother allays fear, anxiety and provides a more favourable environment for improved obstetric outcome. Aims and Objectives: To compare the effects of programmed labour protocol with epidural analgesia and traditional method of labour. Materials & Methods: This study is a prospective, randomized controlled study conducted in the department of Obstetrics & Gynaecology at Teerthanker Mahaveer Medical College & Research Centre Moradabad. 90 pregnant women in active labour were enrolled in the study. They were  allocated to three groups after randomization . Group-A- 30 pregnant women received epidural analgesia. Group-B - 30 pregnant women received programmed labour protocol. Group-C- 30 pregnant women with traditional labour management. Results: There was excellent relief of pain in group A patient compared to other methods with shortening of duration of labour. Conclusion: Labour analgesia is a simple, effective method for painless and safe delivery and thus can reduce the number of caesarean section

Role of leptin and dyslipidemia in chronic kidney disease

Chronic kidney disease [CKD] patients are at an increased risk of cardiovascular complications and plasma leptin level is elevated in cardio renal syndrome. We wanted to explore leptin levels in patients with different stages of CKD and find its association with risk of cardiovascular disease. This cross-sectional study was conducted in Nephrology Department of Jinnah Post Graduate Medical Centre [JPMC] from January 2014 to September 2014. Group I comprised of controls [GFR=116+/-8.3, n = 44] acquired from general population, CKD patients were grouped as II, III and IV respectively with GFR; 85.77+/-9.9 [n = 42], 53.84+/-9.9 [n=42] and 20.22+/-8.4 [n = 42].CKD patients with any inflammatory disease, Diabetes Mellitus and on steroid therapy were excluded. Serum leptin, lipid profile and C reactive proteins [CRP] were measured. Leptin and CRP levels increased significantly with progression of CKD. High density lipoproteins [HDL] to low density lipoproteins [LDL] ratio was significantly high in control as compared to CKD groups [p<0.001]. A positive correlation of leptin was observed with CRP and HDL/LDL ratio [r= 0.994,p<0.001 and r=-0.403 p<0.001] respectively. Hyperleptinemia observed with progression of CKD contributed to pathogenesis of cardiovascular disease by decreasing HDL/LDL ratio

Frequency of awareness and practice of stethoscope hygiene with regards to guide line among medical students, residents and doctors In Karachi

Objective: The objective of the study was to identify "implications" of guidelines provided to participants at the end of a survey for improvement in stethoscope hygiene

Methodology: A cross sectional survey was conducted from January to March 2016 in which a questionnaire was designed to know the awareness of stethoscope hygiene among health care practitioners. The questionnaire was distributed to 150 consented participants, out of which 138 complete [92%] responses [49, [32%] attending physicians, 50[33%] residents and 39[26%] medical students]; comprising of 84 [61%] females and 54 [39%] males was acquired. The responses included following consulting clinics [n=30, 22%], wards [n=41, 30%], intensive care units [n=41, 30%] and acute care units [n=26, 18%]. At the end of the survey practicing guidelines were discussed and hard copy given to respondents. They were then asked to tell about to the impact of these guide lines on their measures to maintain stethoscope hygiene

Results: It was observed that health care practioners consented to start stethoscope cleaning at the start of every clinic, 33.3% showed their intentions for educating others by verbal instructions, and 66.7% were said they will recommend alcohol swab for cleaning of stethoscope

Conclusion: The survey on stethoscope hygiene with practicing guidelines reflects the awareness generated in the respondents. It is further expected that they will disseminate the information and educate others to consider importance of stethoscope sanitation and practice its hygiene

Ameliorating role of methanolic leaves extract of Fraxinus xanthoxyloides against CCl4-challanged nephrotoxicity in rats

Roots, bark, stem/twigs, and leaves of Fraxinus xanthoxyloides are being used regionally for the cure of malaria, jaundice, internal injuries, pneumonia, pain, rheumatism and also in fracture of bones. Our objective was to assess the methanolic leaves extract of F. xanthoxyloides for its antioxidant capability against oxidative stress induced by carbon tetrachloride [CCl[4]] in the kidney of Sprague-Dawley rats. Duration of this experiment was 30 days and doses were given on alternative days. Urine of rats was assessed for kidney function and renal tissues for antioxidant enzymes activity, biochemical markers, comet assay and histopathology. Enhanced urinary creatinine, urobilinogen levels and decreased creatinine clearance, protein contents, and albumin levels were observed by CCl[4] administration when matched to controls. CCl[4] injection also decreased the level of reduced glutathione, catalase, super oxide dismutase, peroxidase, glutathione s-transferase, glutathione reductase, and tissue protein while elevated the levels of thiobarbituric acid reactive substances, DNA damages and H[2]O[2] in renal tissues of experimental animals. Co-treatment of FXM and silymarin, lead to the restoration of all the above tested parameters of kidney. Through this study we affirmed the ameliorating role of F. xanthoxyloides in oxidative stress affiliated disorders of kidney