Albendazole in the treatment of hymenolepiasis in school children

Hymenolepiasis is a helminthic and occasionally fatal disease of human imposing heavy economic losses to human society. Present study was aimed to diagnose the school children for the prevalence and control of Hymenolepiasis. A school based cross-sectional analysis of stool samples collected from 188 children aged 06-15 years was carried out [February to June 2016]. Two stool samples were collected from each student before diagnosing and after treatment. The samples were fixed in 10% formalin and observed under the light microscope using the methods of direct smear in Lugol's solution, normal saline and flotation techniques. On the basis of drugs accessibility all the H. nana infected children were divided in to 2- groups. Children in group A were treated with albendazole [bendazol] 400mg once orally, group B was treated with albendazole [zentel] 200mg orally. Eggs per gram of faeces were counted in each group before and after treatment. Of the 188 children, current study reveals only 6.08% [n=18/296] infection with H.nana and 10.5% [n=16/151] were diagnosed with co infections. The % efficacy of albendazole [Zentel] and albendazole [bendazol] against Hymenolepis nana infection was reported as 83% and 75% respectively. Present study was concluded that albendazole [zentel] is the drug of choice for the treatment of hymenolepiasis in children

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh / 예방의학회지

OBJECTIVES: As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. METHODS: A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. RESULTS: The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. CONCLUSIONS: The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Carbon Dioxide versus Air Insufflation in Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) with air insufflation is commonly used for the staging and treatment of early gastric carcinoma. However, carbon dioxide (CO2) use has been shown to cause less post-procedural pain and fewer adverse events. The objective of this study was to compare the post-procedural pain and adverse events associated with CO₂ and air insufflation in ESD. METHODS: A systematic search was conducted for randomized control trials (RCTs) comparing the two approaches in ESD. The Mantel-Haenszel method was used to analyze the data. The mean difference (MD) and odds ratio (OR) were used for continuous and categorical variables, respectively. RESULTS: Four RCTs with a total of 391 patients who underwent ESD were included in our meta-analysis. The difference in maximal post-procedural pain between the two groups was statistically significant (MD, -7.41; 95% confidence interval [CI], -13.6 – -1.21; p=0.020). However, no significant differences were found in the length of procedure, end-tidal CO2, rate of perforation, and postprocedural hemorrhage between the two groups. The incidence of overall adverse events was significantly lower in the CO2 group (OR, 0.51; CI, 0.32–0.84; p=0.007). CONCLUSIONS:: CO2 insufflation in gastric ESD is associated with less post-operative pain and discomfort, and a lower risk of overall adverse events compared with air insufflation.

In vitro antioxidant and hepatoprotective activities of Paeonia emodi [Wall] rhizome methanol extract and its phenolic compounds rich fractions

The present study aimed to quantify the total phenolic content in Paeonia emodi rhizome methanol extract and its fractions and then evaluate the in vitro antioxidant and hepatoprotective activities of fractions rich in phenolic compounds. Maximum quantity of total phenolic content was observed in butanol [112.08 +/- 5.5 mg GAE/g dw] and chloroform fraction [107.0 +/- 3.5 mg GAE/g dw] followed by methanol extract [94.2 +/- 4.4 mg GAE/g dw], aqueous fraction [92.9 +/- 2.5 mg GAE/g dw], ethyl acetate [62.3 +/- 8.3 mg GAE/g dw] and n-hexane fraction [51.6 +/- 7.2 mg GAE/g dw]. The fractions rich in total phenolic content were evaluated for in vitro antioxidant activity based on 2, 2-diphenyl-1-picrylhydrazyl [DPPH] scavenging assay. The butanol and chloroform fraction showed significantly [P<0.05] higher radical scavenging activity with IC50 values of 6.5 and 7.05 +/- 2.5 ppm respectively. Positive correlation [R square=0.95] was observed between total phenolic content and in vitro antioxidant activity. The fractions rich in phenolic compounds were also evaluated for their hepatoprotective activity in paracetamol intoxicated mice. Five days oral administration of these fractions at a dose of 300 mg/kg body weight restored the serum ALT, AST and ALP levels of paracetamol intoxicated mice to normal level. From the results of the present research it was concluded that the butanol and chloroform fractions of P. emodi rhizome methanol extract are rich in phenolic compounds and strong antioxidant and effective in attenuation of hepatotoxicity

Role of ERCP; in acute biliary pancreatitis: a local experience

Objective: To determine the efficacy of ERCP in acute severe biliary pancreatitis in relation to rate of complications and hospital stay

Patients and Methods: 30 patents were included in the study, divided into ERCP group and Non ERCP group. The study was conducted at Surgical Unit-I, Holy Family Hospital Rawalpindi from July 2009 to April 2011. ERCP Group comprised of 11 patients and non ERCP Group 19 patients. All patients having severe acute biliary pancreatitis raised alkaline phosphatase and common bile duct diameter >8mm were included in the study

Results: In ERCP Group, there were 3 males and 4 females with mean age 42.77 +/- 14 years. In non ERCP group there were 17 males and 2 females with mean age 46.76 +/- 13 years. ERCP was done within 3 day in 8 patients and within 7 day in 5 patients in ERCP group. The rate of complications in both groups was insignificant [P= .92]. The length of hospital stay also does not differ significantly between two groups [P=.874]

Conclusions: In our set up there was no significant difference in outcome in ERCP and non-ERCP group of severe acute pancreatitis. However, in ERCP group intervention was mostly performed after 72hrs

Mild to moderate acute biliary pancreatitis; frequency of conversion from laparoscopic to open cholecystectomy in early versus delayed surgery

Introduction: Acute biliary pancreatitis is a serious complication of biliary calculous disease and is associated with significant morbidity and mortality. Incidence is more often in females and cause is the gall stones in majority of the cases. Definitive treatment is cholecystectomy and with the advancement of minimal invasive surgery, laparoscopic cholecystectomy has been considered as a gold standard for the management of acute Biliary Pancreatitis. The optimal timing when to perform laparoscopic cholecystectomy is still under debate. Many surgeons recommend early surgery whereas others are in favor of delayed surgery. This study is carried out to compare the timing of laparoscopic cholecystectomy in cases of acute biliary pancreatitis

Objective: To compare the frequency of conversion from laparoscopic to open cholecystectomy in early versus delayed laparoscopic cholecystectomy in mild to moderate acute biliary pancreatitis. Study design: Randomised Control trial [RCT]. Setting: Department of surgery, Holy Family Hospital, Rawalpindi. Duration: Six months, from January 2010 to June 2012

Material and Methods: 306 patients, diagnosed as mild to moderate acute Biliary Pancreatitis were randomly allocated into two groups for laparoscopic cholecystectomy. Those who were operated within two weeks of index hospital admission were labeled as Early laparoscopic cholecystectomy [EC] group whereas those undergoing surgery after 02 weeks of index hospital admission were considered as Delayed laparoscopic cholecystectomy group[DC]. Conversion rate from laparoscopic to open cholecystectomy was compared in two groups

Results: Out of 153 patients enrolled as EC group, 138 were female and 15 were male patients. Mean age was 39.19 +/- 11.25years where as in DC group, there were 134 female and 19 male patients in a total of 153 patients, and the mean age was 39.54 +/-10.37 years. Conversion from laparoscopic surgery to open cholecystectomy was 8.5%[13 patients] and 13.1%[20 patients] in EC and DC groups respectively. The overall conversion rate was 10.8%. There was no statistical significance between conversion rate of the two groups. [p = 0.197]

Conclusions: Acute Biliary Pancreatitis should be managed by laparoscopic cholecystectomy regardless of the time elapsed since the start of symptoms. There is no statistical significance of conversion rate from laparoscopic to open cholecystectomy associated with the timing of surgical intervention in the case of acute Biliary Pancreatitis

Estimation of heavy metals in the seeds of blue and white Capitulum's of Silybum marianum grown in various districts of Pakistan

About 70-80% of the world population relies on herbal products, especially in the developing countries. Herbal products are available in various dosage forms for different types of ailment. Contamination of medicinal plants with heavy metal is of great concern. Heavy metals are known to affect the normal physiological function when the level of heavy metals exceeds in plants or animals. It can cause various acute and chronic effects in living organisms. Silybum marianum commonly known as milk thistle is used for varieties of liver diseases. Concentration of Fe 375 mg/kg is found high in the blue capitulum's seeds and concentration of Cr 49.80 mg/kg is present high in the white capitulum's seeds from district Sawabi. Less concentration of Zn 32.00 mg/kg is determined in the blue capitulum's seeds from Karak, while high concentration 30.00 mg/kg of Mn is noted in blue capitulum's seeds from Charsadda. Copper concentration 27.15 mg/kg is recorded in blue capitulum's seeds from Charsadda. High concentration of Cd 1.00 mg/kg is present in white capitulum's seeds from Khyber agency, while concentration of Pb is not detected in white capitulum's seeds collected from Karak district

Frequency of dyslipidaemia in type 2 diabetes mellitus in patients of Hazara division

Diabetes mellitus increases the risk of atherosclerotic vascular disease because of associated dyslipidaemia. Many studies advocate aggressive management of lipid disorders in Type 2 Diabetes to decrease these complications. This study was carried out to know the frequency of dyslipidaemia in our patients and also to determine that whether patients with good glycaemic control [HbA1c /= 8%] emphasizing the importance of good glycaemic control. However none of our patients had a low HDL-Cholesterol as found in some other studies. Hypertriglyceridaemia along with impaired LDL-Cholesterol is present in majority of our patients. Good glycaemic control does affect the lipid profile in Type 2 Diabetes mellitus. However to provide the benefits of lipid lowering therapy to our patients, as confirmed in many studies, we need more awareness and placebo controlled double blind studies

Pendred 's syndrome

This report describes pendred's syndrome in three siblings of a consanguineous marriage, belonging to Rahim Yar Khan. The children presented with deafmutism and goiters. The investigations included scintigram, perchlorate discharge test and audiometery. The perchlorate discharge was positive in index case. Bilateral sensorineural hearing defect was detected on Pure Tone Average [PTA] audiometry. Meticulous clinical and laboratory evaluation is mandatory for the detection of rare disorders like Pendred's syndrome

Patient and non-patient related public health indicators in Pakistan

It is a fair assumption that individuals and communities would rather prefer to stay healthy than be sick. On this premise a person or society would strive to maintain health when not sick and try to regain health when struck by sickness or injury. Public health departments all over the world have been assigned various functions of maintaining health, and providing care at individual and public level whenever health status is compromised. Traditionally public health departments have focused on health maintenance of the general population in addition to providing direct-care to the sick or injured poor of society. The health maintenance functions of public health can be either patient related, [immunizations, nutrition, maternal and child health etc.] or non-patient related [sanitation, drinking water safety and air pollution prevention etc.]. Periodic assessment of these patient related and non-patient related needs of the general population, gives an indirect measure of the health status of the population and the performance of public health departments. The assessment includes surveying and data collection on several public health indicators such as infant mortality rate [patient related] and lead levels in air and drinking water [non-patient related]. This paper explores the information available on such public health indicators in Pakistan and comments on the health status of the population. A comparison is made with other countries of the South Asian region. Deficiencies of some of the programs and departments that function to improve the patient related and non-patients related public health indicators in Pakistan, are discussed in this paper. Recommendations have been made in this article to help improve the current standing of these public health indicators in Pakistan

Bacteriological study of drinking water in district Abbottabad

Seventy samples were collected from various sources of drinking water in Abbottabad Disrtict, to study the quality of such water. Out of all samples, faecal contamination was found in 57.2% of samples, while 18.6% of the samples were found sterile having less than 10 bacilli per 100 ml. It was noted that water from 76.2% spring, 100% streams, 44.0% taps and 50% shallow wells and faecal contamination. The common organism isolated were echerichia coli 57.2%, klebsiella 14.3% pseudomonas 1%, preoteus 1.4% and micrococci 1.4