To determine patients' perceptions and attitudes for blood transfusion

Background: Blood transfusion is a risky procedure due to transmission of various infections and reactions of unmatched blood transfusion. Many blood transfusion related problems can be prevented to some extent if patients and their family members are involved in transfusion related procedure

Objectives: To determine patients' perceptions for the recall of consent process, risks, benefits and attitude for blood transfusion

Study design, settings and duration: Hospital based cross-sectional study done on adult patients admitted in Orthopedic and Surgical wards of Civil Hospital, Karachi from November 2014 to January 2015

Patients and Methods: Using convenient sampling, a total of 350 patients who were admitted and received blood transfusion were included in the study. Variables included age, gender, educational status, language spoken, recall of consent for blood transfusion, risks, benefits and attitudes for blood transfusion. Questionnaire based instrument was used for data collection. SPSS version16 was used for descriptive frequencies

Results: Of the total 98% patients were neither asked nor recalled for the consent of blood transfusion. Only 19 [5%] patients were informed about the risks and 77 [22%] about the benefits of blood transfusion. About 236 [67%] patients were of the opinion that blood of family members, if transfused, carries fewer chances of risk/reactions and 213 [61%] patients stated that they will prefer to receive blood transfusion from their family members. Only, 16 [5%] said that would refuse blood transfusion even if it was needed and will prefer blood alternatives. Overall 326 [93%] patients had poor perception and 262 [75%] good perception for blood transfusion

Conclusion: The consent for blood transfusion was missing in majority of the cases and risks and benefits were not explained to the patients

Policy statement: Institutional Bioethics Committees should take notice of these shortcomings

Case-control study for measles outbreak in a tertiary care hospital

Objectives: To compare the profile of measles patients [cases] with non-measles [controls] admitted in Pediatric units of Civil Hospital, Karachi during the measles epidemic

Study type, settings and duration: Retrospective, case control, hospital record analysis of children admitted in pediatric units of Civil Hospital, Karachi from October 2012-March 2013

Subjects and Methods: From the list provided by the ward authorities, case records of children [cases] admitted in pediatric units of Civil Hospital, Karachi with the clinical diagnosis of measles were selected using convenient sampling. From the same wards, age and gender matched non-measles cases [controls] were also selected. The signs, symptoms, mortality and hospital stay of cases and controls were taken from the hospital record, while some information like socio-economic status, vaccination status, symptoms, number of days ill before presenting to health facility, health status of the child, history of similar illness in the family, neighbors, relatives and history of calamity in the area in recent past was taken from the parents or care givers telephonically. Sample size of 300 children [150 cases, 150 controls] was calculated

Results: Out of 150 children having measles, 84 [56%] were females. Most cases reported to health facility after a median of 8 days of onset of symptoms. Almost 98 [65%] children were vaccinated for measles and 52 [35%] were not vaccinated Median age of cases, vaccinated for measles was 30 months while median age of cases not vaccinated for measles was 21 months. All cases had history of fever and maculo-papular rash. Death occurred in 10 [7%] cases due to pneumonia. There was history of measles in their family in 90 [60%] cases, 54 [36%] had measles in neighbors and 30 [20%] in relatives. Out of 150 controls, 76 [51%] were vaccinated for measles and 74 [49%] were not vaccinated. The main reason for admission was pneumonia in 78 [52%] and bronchial asthma in 45 [30%]. The risk of measles was 0.83 times higher for cases who were vaccinated for measles as compared to controls who were vaccinated for measles. Using univariate analysis, symptoms of breathlessness and lower respiratory tract infection at the time of admission were significantly associated with measles disease. Using multivariate analysis, children between 9 to 60 months of age, presenting with breathlessness and lower respiratory tract infection had a significantly high chance of suffering from measles disease

Conclusion: Almost 65% who had received measles vaccination as per their mothers statement suffered from measles

Policy message: Measles outbreak occurring in many children despite getting measles vaccine needs further workup both for the timing of vaccination, actual verification of vaccination and its efficacy

Pneumococcal infections in children under 5 in karachi: a retrospective analysis

To analyze the hospital case records of children under five years of age for Pneumococcal pneumonia. Retrospective case record analysis of children admitted in pediatric units of Civil Hospital, Karachi, from 2011 to 2012. This case record analysis was conducted on children under 5 years of age who were admitted and diagnosed to have pneumonia. The clinical criteria used for the diagnosis of pneumonia were taken from WHO [IMCI]. Variables studied included age, gender, birth and feeding history, vaccination status, symptoms/signs on admission and diagnosis. Information was collected on a questionnaire. SPSS version 15 was used for analysis. Out of 820 case records retrieved, diagnosis of pneumonia was written on the files in 637 [78%]. Fifty two percent [333] children were age appropriately vaccinated. Majority [62%] of children were up to 11 months of age and male to female ratio was 1.4:1. Commonest symptoms were fever, cough and respiratory distress. Pneumonia was severe in 124 [19%] children and out of these 96 children were less than 12 months of age and they had a respiratory rate of more than 50 per minute with more than two danger signs. Pneumonia was more severe among un-vaccinated [schedule EPI immunization] group. Blood culture reports were available in only 14 children and none were positive for Streptococcalpneumoniae. Majority of the children with pneumonia were less than 12 months of age and severity of pneumonia was more in un-vaccinated children. This study can be used as a baseline for pneumonia or pneumococcal disease in children under 5 years and compared with the drop in the pneumonia cases after the introduction of Pneumococcal Conjugate Vaccine in schedule EPI programme

Prescription pattern of antimicrobial agents in a teaching hospital of South India.

Background: Use of irrational and unnecessary antimicrobials remains common in the developing countries. The present study was conducted to evaluate the use of antimicrobial agents in the tribal district hospital of Andhra Pradesh India. Methods: In this retrospective study, 200 hospitalized cases from medicine, surgery, obstetrics and gynaecology and paediatrics departments were randomly selected. Results: Most common diagnosis was febrile illness (15%) followed by gastroenteritis (10%) and malaria (8%). Antimicrobials were used in 57% cases. All the cases were managed by empirical treatment. Cefixime (40%) was the most common antimicrobial followed by ampicillin (32.50%), metronidazole (30%) and ciprofloxacin (26.50%). Use of antimicrobial monotherapy (41.67%) and 2 drug therapy (36.46%) was common. Conclusion: Empirical use of higher antimicrobial agents is routine and cheap antimicrobials like ampicillin are still most useful drugs in the region. There is a need of specific essential drug list for the region.

Comparative study of bone mineral density in high and low income school children

To compare the bone mineral density [BMD] and associated dietary and physical activity factors in low and high socio economic status [SES] groups of children. This is a cross sectional, prospective, descriptive study. This study was conducted at two different socio-economic level schools. The low socio-economic school was Major Sultan Shaheed Primary School in North Nazimabad, Karachi, while the high socioeconomic school was Horizon School in Gulshan-e-Iqbal Karachi. This study was conducted in September 2007. The perfomas were filled and the tests were done during one week. One hundred children of age 10-12 years of both sexes were selected randomly from two schools of Karachi representing the two different socioeconomic classes. Fifty children each were recruited from either school. Each group included 25 from either sex. A questionnaire was designed to include basic demographic features, weight, height, BMI, dietary habits and physical activities. BMD was measured at the heel using a portable quantitative ultrasound [QUS] densitometry machine. The results were expressed as T-score. The data was analyzed on SPSS version 11.5. For data comparison and calculation of significance ANNOVA and ETA were used. The mean T-scores in high SES group were significantly lower at-2.82 than the low SES group which was-2.36 [p-value < 0.05]. This is despite the fact that the high SES group had a significantly higher BMI and better overall dietary calcium and other minerals consumption. However, the high SES group children also consumed significantly higher quantities of carbonated soft drinks and chocolates. The high intensity activities were comparable in both groups [p-value 0.83]. However, the moderate intensity activities were observed 2.5 folds more frequently in low SES than in high SES group. Lower BMD values were noted in high SES group of children despite having higher BMI and better overall mineral consumption. This could be because of concomitantly higher consumption of carbonated soft drinks and other junk food that may hinder calcium and minerals absorptions and sedentary lifestyle observed in high SES group children

Patients' satisfaction with the nurse-led aural care clinic

The necessity of decreasing costs while maintaining a high standard of clinical care has led to the expansion of the role of nurses in recent years. To this end, nurse-led clinics are becoming increasingly common in otolaryngology. The aims of this cross sectional survey were to assess patients' satisfaction with this nurse-led aural care clinic. Patients attending this clinic were requested to fill in an anonymous questionnaire. Data was collected for 12 weeks between January and April, 2007. Forty-four questionnaires were completed satisfactorily [44/50=88%]. In response to the presenting complaint, the nurse gave verbal advice [25], discussed with a doctor [10] or arranged a doctor review [9]. Forty patients were very satisfied and 4 patients were satisfied with the overall care in the clinic. Combining medical and nursing efforts can provide efficient use of limited time resource in NHS. Nurse-led clinics are cost effective and help reduce the waiting time for outpatient clinics

Heavy metal exposure; jewelers and automobile workers

There are various metals that concern us because of occupational of residential exposure. Majority of these are heavy metals. Small amount of these elements are common in environment and diet that are actually necessary for good health but large amount of any of them may cause acute or chronic toxicity. Historical association and provocative findings of blood Cu and Cd levels at short and long term Cu and Cd exposure shows Cu and Cd pollution. A study was carried out to determine the blood metals levels. In this study 44 samples were analyzed using flame atomic absorption spectrometer A 1800 Hitachi Japan. Whole blood cadmium levels found in jewelers, automobile workers were 398 +/- 183pg/100ml, 768 +/- 180pg/100ml respectively. Whole blood copper levels in jewelers, automobile workers were 710 +/- 139mcg/100ml, 746 +/- 89mcg/100ml. The control subjects were not occupationally exposed and healthy appearances have Cu and Cd levels 641 +/- 45mcg/100ml, 353 +/- 190mcg/100ml respectively. Copper levels were significantly raised [P < 0.05] in automobile workers compared with control. On the other hand Cd levels although raised but not significant. Results show that our control subjects have raised Cu and Cd levels when compared with WHO criteria 160-270mcg/100ml and 160-220mcg/100ml respectively

Conservation of wild animals by assisted reproduction and molecular marker technology.

Wild animals are an integral component of the ecosystem. Their decimation due to abrupt natural calamities or due to gradual human intervention would be disastrous to the ecosystem and would alter the balance in nature between various biotic components. Such an imbalance could have an adverse effect on the ecosystem. Therefore, there is an urgent need to put an end to the ever increasing list of endangered species by undertaking both in situ and ex situ conservation using tools of modern biology, to ascertain the degree of genetic variation and reproductive competence in these animals. This review highlights the development and use of molecular markers such as microsatellites, minisatellites, mitochondrial control region, cytochrome b and MHC loci to assess the genetic variation in various Indian wild animals such as the lion, tiger, leopard and deer. The review also presents data on the semen profile of the big cats of India. Reproductive technologies such as cryopreservation of semen and artificial insemination in big cats are also highlighted.