Health Risk Assessment of PM10 exposure among Malaysian Adult Population based on Physical Activity Pattern

Most health advisories related to outdoor physical activity during haze are general in nature. The advisories normally advise everyone to reduce or limit prolonged exertion or heavy exertion without mentioning the acceptable duration for performing outdoor physical activity causing difficulty for public to decide to stop or cancel a particular outdoor or sport event. The aim of this paper is to determine the acceptable duration for performing outdoor physical activity pattern based on API level. Health risk assessment approach that comprises of hazard identification, exposure assessment, dose-response, and risk characterization steps were used to determine the potential inhaled dose and risk associated with performing the physical activity during haze. We have considered many factors that include time spent for physical activity patterns for Malaysian adult, age, physical intensity-specific inhalation rate (m3/min), and the indoor/outdoor ratio of PM10. A hypothetical exposure scenario of PM10 was created using the breakpoints of PM10 concentration for the calculation of respective API levels. The association between physical activity pattern, API level and risk quotient were presented in the form of risk radar diagram. In general, based on the average estimate, everyone should avoid high intensity physical activity and moderate exertion when API reach > 175 and > 200 respectively. Whereas, based on the high estimate, everyone should avoid high intensity physical activity and moderate exertion when API reach > 135 and > 150 respectively. Below the said API, the duration for performing prolonged exertion and heavy exertion should be adjusted according to the API level as stated in the recommended maximum duration for performing physical activity. Reducing the physical activity is an effective strategy to lower the dose of inhaled pollutants and reduce the health risk during poor air quality. Based on the assessment, the recommended maximum duration for performing the physical activity based on API level was established as a guide for the authority or public to plan their activity during poor air quality.​

Importance of Appropriate Counselling in Reducing Early Discontinuation of Norplant in a Northern District of Bangladesh.

Bangladesh has achieved a considerable decline in fertility level in the past four decades through a strong family planning programme in spite of its poor social and economic growth. However, discontinuation of contraceptive methods and decline in the use of long-acting and permanent methods (LAPMs) are still the major concerns of the family planning programmes. This paper describes various factors that lead to the acceptance of the long-term method—Norplant and those that lead to early discontinuation. This descriptive, cross-sectional study was conducted in the Family Planning Association of Bangladesh (FPAB), Dinajpur, during March–June 2005 among 73 women who visited the clinic to remove their Norplant before its usual duration (5 years). The women were in the 25-31 years age-group—around two-thirds of them (57.5%) without formal education, and three-fourths of them (75.3%) were housewives. Most of them had been married for nine years, on average, and had two and/or more children. Sixty-seven percent of the women experienced regular menstruation, and 95% had used other contraceptive methods prior to using Norplant. Past users of Norplant were the single-most important source of information for about threefourths of the women (74%); half of the women (51%) had discussed the method with their husbands, and majority (96%) of the husbands were informed about the women’s decision on accepting the method before its implantation. All women were aware about the usual length of the effectiveness of Norplant. The most common reason for early removal of Norplant was menstrual disorder (59%), followed by desire for children (16%), husband’s death, for abandonment or residing abroad (8%), anorexia, nausea, vomiting (7%), weight gain (4%), husband’s objection (3%), and religious beliefs (3%). Service providers should properly counsel the couple before providing any contraceptive method, informing them about method-related side-effects and clearing any religious misconceptions. They should also explore the perception of women as well as their partners’ desire for children; couples who would like to have a baby within a year or two can be encouraged to use a short-term method that can be more easily discontinued.

Feto-maternal outcome; trial of labour a study at tertiary care hospital

Trial of labour is a clinical test to assess the adequacy of pelvis and ability of fetus and mother to withstand labour. If progressive changes in dilation and station do not occur, a cesarean delivery is performed. Feto-maternal outcome after trial of labour in women with gestational age b/w 37 to 42 weeks. Cross sectional study. Department of Obs/ Gyn unit-I Liaquat University Hospital Hyderabad. One year from 01-02-2009 to 31-01-2010. 100 pregnant women, with gestational age between 37-42 weeks, who underwent trial of labour at labour ward, Obs/Gyn Unit-1 Liaquat University Hospital, after fulfilling the inclusion criteria were included in the study. Detailed history and examination including abdominal and pelvic examination as well as Ultrasound for fetal well being was performed. Fetal monitoring was done by auscultation and CTG. Partogram was maintained to observe the progress of labour. Those who progressed with trial either delivered normally or with the help of instruments and those who did not progress were delivered by C-section. After delivery, mothers were watched for any postpartum complication and condition of neonates was assessed by APGAR score. Out of 100 women included in this study 58% delivered vaginally, 31% delivered by cesarean section and 11% had instrumental deliveries. Labour was induced in 34%, augmented in 34% and 32% had spontaneous labour. 77.0% babies had apgar score > 5[7.1 +/- 0.72], 16% < 5[3.68 +/- 2.18] and 6% were still birth. 81% mothers had no complication during or after delivery, whereas 19 developed complications and these were 12 Genital tract traumas, 5 postpartum haemorrhage, one uterine rupture and one retained placenta. There was no statistically significant difference [P=0.42] when mode of delivery was compared with the trial of labour. However augmentation of labour was associated with increased rate of maternal complications when maternal outcome was compared with the type of labour [P=0.03]. Trial of labour in carefully selected women with high probability to deliver their babies vaginally decreases the rate of LSCS, thereby reducing the maternal morbidity and mortality associated with it. However augmentation of labour is associated with increased rate of maternal complications as compared to spontaneous or induced labour

Singing magnets ingestion: a rare cause of intestinal obstruction in children

Foreign body ingestion is a common problem in children. Ingested foreign bodies include coins, needles, pins and button batteries. Ingestion of multiple magnets is very rare and poses a unique hazard of intestinal obstruction in children. The ingested magnets may reside in different loops of intestine and attract each other causing necrosis of the intervening wall of intestine. We present the case of a 7-year old child who presented with acute intestinal obstruction due to ingestion of multiple magnets. Patient underwent laparotomy. The loops of small intestine with necrotic walls were found to contain three oblong shaped magnets. Removal of magnets along with resection and anastomosis of affected segment of intestine was performed

Double Meckel's diverticulum in a boy

Meckel's diverticulum is the remnant of vitello-intestinal duct and the most common congenital anomaly of gastrointestinal tract. Usually it is a single diverticulum. Finding a duplication of Meckel's diverticulum is an extremely rare incident. We report a ten year old boy who presented with abdominal pain in whom, at exploration double Meckel's diverticulum was found

Intestinal obstruction in children

To identify various causes and the outcome of intestinal obstruction in children older than one month of age. Descriptive case series. Department of Paediatric Surgery Chandka Medical College Hospital Larkana, from January 2010 to December 2011. Patients above one month of age who presented with signs and symptoms of intestinal obstruction were included. Patients with history of chronic constipation, trauma, post diarroheal distention, obstruction resulting from compression by tumors. Those with free gas on x-ray abdomen and where management done conservatively were excluded from the study. During the study period a total of 55 cases, 41[74.5%] males and 14 [25.5%] females were operated. The age of patients ranged from 1 month to 14 year. The main presenting features were not passing stools [100%], pain abdomen [89.09%], vomiting [85.45%], abdominal distension [81.81%], fever [21.81%], bleeding per rectum [18.18%] and mass abdomen [16.36%]. The causes of intestinal obstruction found were intussusception [27.3%], Meckel's diverticulum with band causing obstruction [16.4%], obstructed inguinal hernia [14.5%], post operative adhesions [9.1%], congenital peritoneal bands [7.3%], Hirschsprung's disease [7.3%], abdominal tuberculosis [5.5%], typhoid ileal perforation [5.5%], malrotation [3.6%] and umbilical hernia [3.6%]. Fifty-four [98.18%] patients recovered and discharged while one [1.81%] patient died. Intussusception and Meckel's diverticulum with a band were the most frequent causes of intestinal obstruction. One patient in this series died.

Common complaints associated with caesarean section during spinal anaesthesia

To identify common complaints associated with caesarean section under spinal anaesthesia and manage them, in order to decrease the anxiety and distress level of the patients. Cross sectional observational study was conducted at Department of Anaesthesia, Liaquat National Hospital and Medical College from October 2011 to December 2012. Hundred patients aged from 20-36 years underwent elective caesarean section under spinal anaesthesia. Patients received nothing per oral for 6 hours. Metoclopramide and Ranitidine IV were given half hour before surgery Colloid 10ml/kg was given IV before induction of spinal anaesthesia. All patients were placed in sitting position and under aseptic conditions lumbar puncture was done at L3-L4 or L4-L5 interspaces with 25 gauge pencil point needle lo administer local anaesthetic over 20 seconds slowly. Oxygen 4 Iiters/minute as administered via a Hudson mask. All the patients were asked for any complaint during caesarean section under spinal anaesthesia. More than five common complaints were considered and similar complaints which are less than five were not included in the study. Out of 100 patients, 67% patients had no complaints and 33% patients presented common complaints. Visceral pain or abdominal discomfort was 19%, shivering 11%, nausea and vomiting 10%, epigastric pain 6%, backache 5% and headache 5%. Spinal anaesthesia is an excellent technique for caesarean section in majority of patients. Patients have various complaints during spinal anaesthesia which may increase anxiety and distress levels in patients

The 2008 Cholera Epidemic in Zimbabwe: Experience of the icddr,b Team in the Field.

During August 2008–June 2009, an estimated 95,531 suspected cases of cholera and 4,282 deaths due to cholera were reported during the 2008 cholera outbreak in Zimbabwe. Despite the efforts by local and international organizations supported by the Zimbabwean Ministry of Health and Child Welfare in the establishment of cholera treatment centres throughout the country, the case-fatality rate (CFR) was much higher than expected. Over two-thirds of the deaths occurred in areas without access to treatment facilities, with the highest CFRs (>5%) reported from Masvingo, Manicaland, Mashonaland West, Mashonaland East, Midland, and Matabeleland North provinces. Some factors attributing to this high CFR included inappropriate cholera case management with inadequate use of oral rehydration therapy, inappropriate use of antibiotics, and a shortage of experienced healthcare professionals. The breakdown of both potable water and sanitation systems and the widespread contamination of available drinking-water sources were also considered responsible for the rapid and widespread distribution of the epidemic throughout the country. Training of healthcare professionals on appropriate cholera case management and implementation of recommended strategies to reduce the environmental contamination of drinking-water sources could have contributed to the progressive reduction in number of cases and deaths as observed at the end of February 2009.

Epidemiology of Rotavirus and Cholera in Children Aged Less Than Five Years in Rural Bangladesh.

Despite the known presence of rotavirus-associated diarrhoea in Bangladesh, its prevalence, including records of hospitalization in rural health facilities, is largely unknown. In a systematic surveillance undertaken in two government-run rural health facilities, 457 children, aged less than five years, having acute watery diarrhoea, were studied between August 2005 and July 2007 to determine the prevalence of rotavirus. Due to limited financial support, the surveillance of rotavirus was included as an addendum to an ongoing study for cholera in the same area. Rotavirus infection was detected in 114 (25%) and Vibrio cholerae in 63 (14%) children. Neither rotavirus nor V. cholerae was detected in 280 (61%) samples; these were termed ‘non-rotavirus and non-cholera’ diarrhoea. Both rotavirus and cholera were detected in all groups of patients (<5 years). The highest proportion (41%; 47/114) of rotavirus was in the age-group of 6-11 months. In children aged less than 18 months, the proportion (67%; 76/114) of rotavirus was significantly (p<0.001) higher than that of cholera (16%; 10/63). By contrast, the proportion (84%; 53/63) of cholera was significantly (p<0.001) higher than that of rotavirus (33%; 38/114) in the age-group of 18-59 months. During the study period, 528 children were hospitalized for various illnesses. Thirty-eight percent (202/528) of the hospitalizations were due to acute watery diarrhoea, and 62% were due to non-diarrhoeal illnesses. Rotavirus accounted for 34% of hospitalizations due to diarrhoea. Severe dehydration was detected in 16% (74/457) of the children. The proportion (51%; 32/63) of severe dehydration among V. cholerae-infected children was significantly higher (p<0.001) compared to the proportion (16%; 18/114) of rotavirus-infected children. The study revealed that 12-14% of the hospitalizations in rural Bangladesh in this age-group were due to rotavirus infection, which has not been previously documented.

Causes for Hospitalizations at Upazila Health Complexes in Bangladesh.

Morbidity and mortality data are important for planning and implementing healthcare strategies of a country. To understand the major causes for hospitalizations in rural Bangladesh, demographic and clinical data were collected from the hospital-records of five government-run rural health facilities (upazila health complexes) situated at different geographical regions of the country from January 1997 to December 2001. During this period, 75,598 hospital admissions in total were recorded, of which 54% were for male, and 46% were for female. Of all the admissions, diarrhoeal disease was the leading cause for hospitalization (25.1%), followed by injuries (17.7%), respiratory tract diseases (12.6%), diseases of the gastrointestinal tract (10.5%), obstetric and gynaecological causes (8.5%), and febrile illnesses (6.7%). A considerable proportion (8.3%) of the hospitalized patients remained undiagnosed. Despite the limitations of hospitalbased data, this paper gives a reasonable insight of the important causes for hospitalizations in upazila health complexes that may guide the policy-makers in strengthening and prioritizing the healthcare needs at the upazila level in Bangladesh.

Perineal ectopic testis - a rare encounter in paediatric surgical practice

Perineal ectopic testis is a rare form of testicular maldescent. We report 2 patients with perineal ectopic testes, in one of them, the condition was bilateral [only the 6th case of this variety]. Surgery was performed in both cases and testicles were mobilized and fixed in the scrotum. Gubernaculum testis was found to be fixed in the perineum. Examination of patient with empty scrotum [maldescent testes] should include examination of sites like perineum to look for ectopic testis

Childhood mortality due to drowning in rural Matlab of Bangladesh: magnitude of the problem and proposed solutions.

Drowning is an important cause of mortality among children in rural Bangladesh. Children aged 1-4 year(s) are at a high risk of death from drowning. Although deaths of children due to drowning in Bangladesh are acknowledged as an important cause of death, little effort has been made to address the issue of preventing deaths from this cause. This study has attempted to describe the problem and suggests possible prevention strategies, which may contribute to reducing childhood mortality from drowning. Data presented in this study were collected from Matlab where ICDDR,B has been maintaining a demographic surveillance since 1966. During the study period from 1985 to 2000, 989 deaths from drowning were reported, of which 796 (80.5%) were children in the age-group of 1-4 year(s), 48 (4.8%) were in the age-group of less than one year, and 145 (14.7%) in the age-group of 5-19 years. During 1985-2000, death rate per 1,000 children due to all causes among children of 1-4-year age-group decreased appreciably from 20.7% to 5.2%, while drowning-related deaths did not. Forty-five percent (n = 359) of drowning-related deaths occurred in ponds, 16.8% (n = 134) in ditches, 8.1% (n = 64) in canals, and 4.4% (n = 35) in rivers. The sites of more than 25% of drowning-associated deaths were not recorded. Analysis of seasonal variation revealed that most deaths due to drowning occurred during April-October, i.e. mostly during the monsoon months. It was also observed that the majority (67%) of mothers of victims had no formal education. Deaths due to drowning were mostly associated with children aged 1-4 year(s) and were 20% more common among boys than among girls (odds ratio = 1.2, 95% confidence interval 1.04-1.38, p < 0.012). The paper recommends some interventions to reduce the number of deaths due to drowning in rural Bangladesh, which include: (a) increasing awareness among mothers and close family members about the risk of drowning, (b) door-fencing, and (c) filling of unused ditches and water holes around households.

Fibrous hamartoma of infancy

Fibrous hamartoma of infancy [FHI] is one of the rare tumor-like malformation. This benign tumor can cause much concern and confusion about being malignancy. We report a case of 10 months old infant who presented with a mass at posteriomedial surface of left upper arm. The mass was excised completely and histopathology confirmed the lesion as FHI

Malaria in children: study of 160 cases at a private clinic in mansehra

This Study was conducted in a private clinic to report frequency, presentation and management of malaria in children presenting with fever. 160 Children of age varying from 42 days to 15 years were included in this study, during a period of 1999-2004. Malaria was confirmed in 154 cases, including 114 male and 46 female children. In 6 cases malarial parasite was not seen on microscopic examination of their blood films. 142 cases were found to be suffering from vivax and 12 were suffering from falciparum malaria. Most of the cases were treated with amodiaquine and some of them were treated with other antimalarial drugs

Effectiveness of routine urine analysis of patient attending rural health centers in Abbottabad

Renal diseases may be discovered accidentally during routine urinalysis. This study was done to see the significance of urinalysis and study the magnitude of abnormal urinalysis in patients with no symptoms of renal disease. From 15th February to 16th March 2005, a total of 1000 samples of urine were collected from the patients attending three rural health centers of Abbottabad. Dipstick Method was used for urinalysis. there were 600 males and 400 female patients. The age ranged from 1 to 55 years. Proteinuria was present in 2.3%, hematuria in 4.8% patients, pyuria in 10.2% and glycosuria in 2% patients. In our setup routine urine analysis should be performed in all patients to identify the presence of unrecognized renal diseases which may benefit from simple therapeutic measures

Immature embryo: a useful tool for oil palm (Elaeis guineensis Jacq. ) genetic transformation studies

Oil palm (Elaeis guineensis Jacq.) is the highest yielding oil-bearing crop. However, being a perennial crop, genetic improvement of oil palm is extremely slow. Indeed, compared to other annual oil crops such as soybean and rapeseed, genetic manipulations remained less important. Therefore, to remain competitive, oil palm growers and breeders need new and novel approaches. In this report, the potential of immature embryos (IE) as a useful tool for oil palm genetic transformation studies was evaluated. It was evident that IEs were amenable to both direct and Agrobacterium-mediated gene transfer. Due to the abundant supply of IE, optimization of biolistic and Agrobacterium-mediated gene transfer into IEs were easily carried out. Transient transformation frequencies were comparable to other plant systems reported, with as high as 97.4 percent recorded for biolistic and 64.4 percent for Agrobacterium-mediated gene transfer. Like most moncots, oil palm tissues were less sensitive to kanamycin, geneticin and chloramphenicol. Instead, both hygromycin and phosphinotrycin were toxic 20 mg/l, making both suitable candidates for selecting putative transformants. IEs were also more responsive to in vitro manipulations as compared to other explants such as leaf and root tissues. Rapid in vitro response to callusing and embryogenesis or rapid and highly efficient direct germination resulted in a shorter culture period. This would minimize the production of abnormal clonal palms, which has been associated to chromosomal aberration due to prolonged time in culture. In addition, IEs also allows rapid and direct introduction of elite genes into breeding programs and in biclonal seed production.

HbsAg and HCV: Increasing test requests and decreasing frequency of positive tests at clinical laboratory of Ayub teaching hospital, Abbottabad

This audit was carried out to assess the frequency of positive results out of the total test requests made for HBsAg and HCV at our laboratory. The frequencies for three years were compared for significance. We have reported monthly total test requests and frequency of positive tests for each of these years in this article. This study is an audit of all HBsAg and HCV test requests received at clinical laboratory of Ayub Teaching Hospital, Abbottabad during a three year period from 2002-2004. Both the tests were made using Rapid device [immunochromatographic kits] method. Frequencies of positive results were calculated from the total test requests for each month of these three years. Cumulative frequencies were compared for statistical significance of difference. Total HBsAg tests requested for years 2002, 2003 and 2004 were 2058, 2563 and 5207 respectively. The frequencies of HBsAg positive cases out of these were 5.53%, 4.36% and 2.68% respectively. The number of test requests for HBsAg increased significantly from 2002 to 2003 and 2004, while the frequency of positive tests decreased significantly [p<.001] during this period. Total HCV requests for years 2002, 2003 and 2004 were 1261, 1671 and 4638 respectively. The frequencies of HCV positive cases out of these were 14.19%, 8.79% and 5.84% respectively. Just like HBsAg, number of test requests for HCV increased significantly from 2002 to 2003 and 2004, while the frequency of positive tests decreased significantly [p<.001] during this period. Conclusions: The test requests have considerably increased in the last few years, probably as a result of increasing awareness of clinicians and public. However most of these tests are negative. In view of high prevalence of both HBsAg and HCV in Pakistan, this overcautious attitude of clinicians is understandable although this is a burden on the pocket of patients and hospital resources

Ischiopagus tripus conjoined twins: a case report

Conjoined twins are one of the rarest congenital anomalies. We present a case of Ischiopagus tripus conjoined twins. The twins were fused at abdomen and pelvis, having two well formed lower limbs and one abnormal lower limb. There was only a single fused pelvis and only one set of well formed male external genitalia and absent anal opening. Anoplasty was done for imperforate anus and later on surgical separation attempted

Hypospadias: experience with Mathieu's repair

To determine the effectiveness of Mathieu's urethroplasty for anterior hypospadias. Design: Descriptive Study. Place and Duration: Department of Paediatric Surgery, Chandka medical College Hospital, Larkana, from January 2003 to December 2003. Patients And A Total of 30 boys who presented with sub coronal and distal penile hypospadias without chordee were included in the study. The neourethra was constructed by utilizing the flap of skin proximal to the meatus. Urethral catheter was used as stent and for diversion of urine. The age at presentation ranged between 1 and 12 years with a mean of 4.86 years. Twenty Three [76.66%] patients presented with distal penile hypospadias while the meatus was subcoronal in 7[23%] patients. The only complication encountered was minute urethrocutanems fistula in 2[6.66%] cases. The cosmetic results were satisfactory. The well established Mathieu's urethroplasty provides excellent result in terms of having minimal complication rate and excellent cosmetic and functional result