Socioeconomic status and impact of treatment on families of children with congenital heart disease

To assess the socioeconomic status, treatment being offered and the impact of congenital heart disease treatment on families. Observational study. The Children's Hospital / Institute of Child Health, Lahore, from 1st March to 31[st] August 2010. All patients undergoing a cardiac surgical or angiographic intervention were enrolled. Socioeconomic status was assessed by Kuppuswamy socioeconomic status scale with income group modification. The impact was measured by the source of financing, effect on family financing source and schooling and health of siblings. Of 211 patients undergoing treatment in the study period, surgery was the definitive treatment in 164 [77.7%] and angiographic intervention in 47 [22.3%] patients. Male to female ratio was 1.5:1. The mean age of the patient was 39.1 +/- 3.2 months [range 01 day to 15 years]. Majority of families belonged to middle [66.4%, n=140] and lower [27%, n=57] socioeconomic class. The mean cost of medicines and disposables was PKR 78378.2 +/- 8845.9 [US$ 933.1 +/- 105.3] in open heart surgery, PKR 12581 +/- 7010.8 [US$ 149.8 +/- 83.5] in closed heart surgery and PKR 69091 +/- 60906 in angiographic interventions. In 63.1% patients, families contributed towards these costs either completely [12.3%] or partly [50.8%] with significant contribution from the hospital. Adverse effect on families ranged from leave without pay to losing jobs or business [46%], and selling their assets [11.3%]. It also affected schooling and health of siblings [22.7% and 26.1% respectively]. Majority of children with congenital heart disease belonged to middle and lower socioeconomic status in this study. Main definitive treatment was surgery. The cost of health care facilities posed a marked socioeconomic burden on those families

HIV/AIDS knowledge, attitudes and beliefs among a group of Iraqis

This study aimed to build a baseline profile of knowledge, attitudes and beliefs of Iraqis toward HIV/AIDS. Questionnaire interviews were conducted in 2006 with 335 people attending HIV testing centres in Baghdad. Most respondents [82.7%] had heard about AIDS, mainly from the mass media [71.0%], and 91.9% knew that AIDS is an infectious disease, most commonly via sexual relationships [74.9%]. There was no association between knowledge level and acceptance of caring for an HIV-positive relative or marrying an HIV-positive partner, but there was a significant association between low knowledge level and negative attitudes towards sharing food, sitting on the bus and working at the same place with an HIV-positive individual

Periodontal conditions in rheumatoid arthritis: clinical and radiographic investigations

Periodontal conditions in 100 dentate adults with rheumatoid arthritis [RA] were compared with those of age and gender matched individuals without rheumatoid arthritis. The clinical parameters for periodontitis included probing pocket depths, attachment loss, gingival inflammation scores, plaque scores, and radiographic bone loss scores. The rheumatoid arthritis group had more missing teeth than the control group and a higher percentage of them had deeper pocketing and loss of periodontal attachment. There were no significant differences between the two groups for gingival inflammation and bleeding. There was a tendency to adverse periodontal conditions amongst the rheumatoid arthritis patients with severe periodontal bone loss occurring more frequently than in the controls. The rheumatoid arthritis patients had more dental plaque deposits than the control group, a finding which could indicate a difference in periodontal care. It is suggested that this study provides evidence of a significant association between periodontitis and rheumatoid arthritis

Clinical efficacy of 0.2% glyceryl trinitrate ointment for anal fissures

To validate the clinical efficacy of 0.2% glyceryl trinitrate ointment, a nitric oxide donor, in the management of anal fissures. A prospective clinical study conducted on consecutive patients with anal fissures presented to the surgical clinic of Jinnah Hospital and Allama Iqbal Medical College Complex Lahore. These patients were treated with topical 0.2% glyceryl trinitrate paste in soft white paraffin three times a day. Patients were examined at regular intervals to evaluate the fissure status, adverse reactions, symptomatic control and recurrence. All subjects were followed-up until they were pronounced cured or treatment terminated. 121 patients comprised this study group. 6 cases were lost to follow-up and 109 [94.7%] of the remaining 115 subjects were cured. Of those cured, 13 [11.3%] presented with acute and 102 [88.7%] chronic fissures. There were 98 male and 17 female patients with median age of 41 years [range, 14-70 years]. Complete symptomatic relief w as achieved in all patients within one month of therapy. Treatment had to be terminated in 6 [5.2%] patients: 5 [4.3%] experienced intolerable adverse effects and 1 [0.8%] patient failed to respond. All these cases were successfully treated with lateral internal sphincterotomy. There was no change of continence in this series. Glyceryl trinitrate ointment produces healing of the anal fissures and adequate symptomatic relief and should be considered as the first line treatment for anal fissures

diagnostic value of fine needle aspiration cytology in thyroid swellings in a University Hospital, Yemen

To evaluate the correlation between the fine needle aspiration [FNA] cytology and the histopathological findings in cases of the thyroid swellings and to assess the accuracy of cytological examination of thyroid nodules. This study was carried out at Kuwait University Hospital, Sana'a, Yemen. There were 243 thyroid FNAs of which 199 had subsequent excisional histopathological examination in the period 1997 to 2001. All the records of cytology and histology were reviewed. Cases were classified into 6 subsets: benign follicular lesion, thyroiditis, follicular neoplasm, suspicious for papillary carcinoma, malignant, and non-diagnostic aspirate. For statistical analysis, we excluded cases, which had not had subsequent histopathological examination [n=44], and cases with non-diagnostic aspirate [n=3], so only the histology and medical records of 196 cases were reviewed and correlated with the cytology results. There were 156 [78.4%] cases of benign aspirate, 31 [15.6%] cases of follicular neoplasm, 4 [2%] cases that were suspicious for papillary carcinoma, 4 [2%] cases of papillary carcinoma, and 3 [1.5%] cases of non-diagnostic aspirates. The 196 cases, which underwent cytological and histopathological examinations, were classified as non-neoplastic and neoplastic [including follicular neoplasm and malignancy] according to postoperative histopathology and correlation which, was carried out with preoperative cytology. There were 115 true negatives, 26 true positives, 42 false negatives, and 13 false positives. This gives a sensitivity of 38%, specificity of 89.9%, positive predictive value of 66.7%, negative predictive value of 73.2%, and accuracy of 72%. The sensitivity of FNA cytology in this study is very low compared to published studies, which had adversely affected the surgical decision making as well as the outcome. We should realise that negative FNA cytology does not exclude malignancy and we have to seriously evaluate the situation and to rethink on how to raise the scale of sensitivity in FNA cytology in the diagnosis of thyroid nodules, and to improve the level of expertise in cytology