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@#Introduction: Vaccination is a biological process that improves immunity level of an individual towards certain diseases. Vaccination is generally given to all newborn and kids. Most countries oblige their citizens to be vaccinated as early as new-born age. The aim of this research is to study the perception on vaccination intake and the associated factors that lead to its refusal among parents in east coast and west coast peninsular Malaysia. Methods: Primary data were collected using self-administered questionnaire and were distributed to assess the study objectives. Total 240 questionnaires were distributed equally in west coast and east coast study area. Questionnaire consists of demographic data, perception aspects and factors that may lead to the negative perceptions. Results: There is significant association between perception and religion, education level and side effect factor in east coast with majority of the respondents are Muslims (40.83%) while there is no significant association between education level and side effect factor (p>0.1) in west coast with majority of respondents are Muslims (51.67%) too. This study found that perception regarding vaccination is influenced by the religion restrictions in east coast of peninsular Malaysia and not in west coast region. The other factors associated with vaccination refusal varies according to education level, and regional basis. Conclusion: Most of the respondents who have negative perception regarding vaccination are from East Coast region as they are more prone into Islamic teachings. All the possible factors of vaccination refusal are accepted by the respondents but varies in its prevalence as the leading factor determined that caused the vaccination refusal are religion restriction and the least percentage for the factor is time restriction.
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Introduction. Transverse cerebellar diameter (TCD) measurement is very accurate in assessment of gestational age especially in cases where the LMPs are not exactly known. Normally value of the transverse cerebellar diameter in mm is considered roughly equivalent to the gestational age in week (particularly between the 14-20 weeks of gestation). It is of utmost importance to identify the fetal growth restriction during the antenatal period because it involves perinatal mortality and morbidity. TCD is a useful parameter for assessing fetal growth retardation. The purpose of my study is to evaluate the accurate measurement of transverse cerebellar diameter as against the conventional parameters in assessment of gestational age in normal pregnant women between 16 to 38 weeks. Material and Methods:It was a prospective cross-sectional study and All data were collected from 100 antenatal women of gestational age 16-40 weeks referred to Department of Radio diagnosis, Father Muller Medical College and Hospital for routine antenatal scans from May 2018 to October 2018 based on inclusion and exclusion criteria. Results: In this study 100 cases were studied. Age distribution of normal pregnancies was ranged from: 18 to 35 years. 63 cases were multigravida and 37 were primigravida. In 95 cases the estimated gestational age predicted by measuring BPD, HC, AC and FL was also closely correlated with gestational age estimated from transverse cerebellar diameter measurements with a p value of 0.001. In 5 cases it was poorly correlating. We found good curvilinear relationship between the TCD and gestational age (R2=0.956) and (P=0.00012). Conclusion: So our study shows that the TCD in the estimation of gestational age is consistently correlating with gestational age.
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Chronic myeloid leukemia [CML] is categorized as one of the myeloproliferative neoplasms, according to the World Health Organization [WHO] myeloid neoplasms and acute leukemia classification. The hallmark of this disease is the presence of a reciprocal translocation between the long arms of chromosomes 9 and 22 [t[9;22][q34;q11]] which leads to the formation of the Philadelphia chromosome [Ph] and is present in 90%-95% of CML patients. In 5%-10% of CML cases, there are variants where one or more different chromosomes are involved in addition to chromosome 9 and 22. We present a patient with newly diagnosed CML with a rare variant translocation involving chromosomes 9, 19 and 22. To the best of our knowledge, this is the first case study to describe a variant Ph chromosome translocation in chronic phase CML in Bahrain
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Objective: the aim of present study was to evaluate hematological changes in malaria in Mardan, Pakistan
Methods: this prospective observational study was conducted at O.P.D of Mardan MedicalComplex Mardan from July to September 2015. A total of 115 patients were divided to age groupsof< 15 and > 15 years old. Malaria parasite was examined using thick and thin smears stained with Giemsa stain and also cross-checked by ICT. Those patients with a confirmed diagnosis of malaria were investigated for platelets, hemoglobin and total leukocyte count on Automatic hematology analyzer [Mindray] and studied by hematologist. Data was tabulated, descriptive statistics analyzed; the chi-square test was applied to evaluate statistical significance of the studied variable between groups on SPSS version 20. A p-value of 0.05 or less was used for statistical significance
Results: a total of 115 patients were included in the study. Male were 56[48.7%] and females 59[51.3%], the mean age of study group was 10.62[3.89]. According to age group, patients were divided into two groups; those <15 years comprised of 102[88.7%], while> 15 years were found 13[11.3%]. P. vivax was seen in 108[93.9%] and P. falciparum 7[6.1%] patients. Out of total population 70[60.9%] were found anemic, 79[68.7%] had mild thrombocytopenia and 4[3.5%] with moderate thrombocytopenia and sever leucopenia were found 2[1.7%], mild leucopenia 24[20.9%], mid leucocytosis 1[0.9%]. Patients with P.vivax aged <15 years had found anemia 59[62.1 %] with p=0.56, moderate thrombocytopenia 4[4.2%] [p=0.05], sever leucopenia 2[2.11 %], mild leucopenia 13[13.7%] and mild leukocytosis 1 [1.1 %] with p=0.001
Conclusions: the present study concludes that thrombocytopenia and anemia are common hematological findings in patient with Plasmodium infection particularly vivax species infection in Mardan region. Therefore, malaria should be a consideration in febrile patients with low platelets and haemoglobin
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To determine the association of the pro-brain natriuretic peptide [NT-proBNP] plasma levels with two dimensional echocardiographic determination of left ventricular dimensions and ejection fraction [EF] in acute dyspneic patients. An observational cross-sectional study. Tabba Heart Institute, Karachi, from January to June 2010. One hundred patients were selected by consecutive purposive non-probability sampling who had presented with acute dyspnoea. NT-proBNP levels were assessed by commercial tests [Roche Diagnostics]. The clinical diagnosis of congestive heart failure [CHF], echocardiographic assessment of left ventricular dimensions and function were compared with NT-proBNP levels. Receiver operating characteristic [ROC] curve was estimated for NT-proBNP and compared. The chi-square test was applied for categorical and student's t-test for numerical data at 0.05 levels of significance were used to compare patients with and without heart failure. Further comparative analysis between groups on the basis of ejection fraction was done by one way ANOVA test. Seventy-nine patients [79%] had CHF as a cause of their dyspnoea. Patients with CHF were older [61.9 +/- 14 years vs. 58.6 +/- 14 years, p=0.368], had a lower EF [36.9% vs. 61%, p < 0.0001], had a higher LV dimensions, left ventricular end diastolic dimension - LVEDD [49.94 +/- 5.6 vs. 42 +/- 7.9 mm, p < 0.0001], left ventricular end systolic dimension - LVESD [37.31 +/- 6 vs. 29.21 +/- 10.9 mm, p < 0.0001] and a higher NT-proBNP [10918 +/- 1228 vs. 461 +/- 100 pg/mL, p < 0.0001] than patients without CHF. NT-proBNP values increased with the severity of ventricular impairment. Significant differences were found between patients with LVEF < 25% and patients with moderate ventricular impairment [LVEF = 26 - 40%] and mild ventricular impairment [LVEF = 41-60%, p < 0.001]. The group of patients with LV dilation, had significantly higher BNP levels than those with normal LVEDD [12416 +/- 1060 pg/ml vs. 6113 +/- 960, p = 0.009] and LVESD [10416 +/- 1160 vs. 4513 +/- 960 pg/ml, p = 0.008]. Area under ROC curve for the diagnosis of CHF was significantly higher for NT-proBNP [AUC 0.99, p < 0.003]. The sensitivity of NT-proBNP value of > 300 pg/mL for the diagnosis of CHF was 100% and specificity was 42%. A cut-point of 300 pg/mL NT-proBNP had 100% negative predictive value to exclude acute CHF. NT-proBNP is strongly associated with two-dimensional echocardiographic determination of left ventricular dimensions and EF in identifying CHF in patients with acute dyspnoea
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To determine the diagnostic significance of plasma NT-proBNP estimation in patients presenting with acute dyspnea in Emergency Department. An observational, cross sectional study. From January to June 2008 at Liaquat National Hospital, Karachi. In this study, 100 patients were selected with purposive non-probability sampling who had presented to the emergency department with acute dyspnea. Plasma NT-proBNP levels, chest X-ray and transthoracic echocardiography were performed at the time of admission. NT-proBNP levels were assessed by commercial tests. The clinical diagnosis of congestive heart failure, patient's hospital course and discharge diagnosis were cross-tabulated with NT-proBNP levels. The chi-square test for categorical data and Student's t-test for numerical data was applied at 0.05 level of significance to compare patients with and without heart failure [HF]. Further comparative analysis between age groups was done by one way ANOVA test. The mean NT-proBNP level among the 79 subjects with a final diagnosis of heart failure was 10918 compared with 461 pg/ml in those without heart failure [p=0.001]. The diagnostic accuracy of NT-proBNP at a cutoff of 300 pg/milliliter [ml] was 100 percent. An optimal strategy to identify acute HF was to use age-related cut-points of 450 and 900 pg/ml for ages < 50 and > 50 years, which yielded 100% sensitivity and 86% specificity for acute HF. An age-independent cut-point of 300 pg/ml had 100% negative predictive value to exclude acute HF. NT-proBNP is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea
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To identify the extent of ossicular chain damage in chronic suppurative otitis media [CSOM]. Prospective study. This study was conducted at department of Otolaryngology-Head and Neck Surgery, Dow Medical College and Civil Hospital, Karachi. March 2003 to March 2004. 100 cases presenting with CSOM under going mastoid exploration. The age of presenting of CSOM undergoing mastoid exploration ranged from 5 yrs to 55 yrs. The most commonly affected group was between 11 yrs to 20 yrs [50%]. Females were affected more than male [60%]. All patients presented with chronic discharging ears having conductive deafness, 60% presenting with moderate degree of hearing impairment [31 to 50 dB] while 30% had less than 30 dB loss and only 10% had greater than 50 dB loss. Granulation tissue was found in 47 cases, cholesteatoma in only 30 cases, inflamed mucosa in 24 cases, polyps in 7 cases and tympanosclerosis in 3 cases. Handle of malleus was necrosed in 30 cases, while in 20 cases all the three ossicles were necrosed except the foot plate of stapes. Long process of incus and handle of malleus were missing in 10 cases and the long process of incus alone was necrosed in 5 cases while malleus and incus were missing in 5 cases. In 30 cases all the ossicles were intact and mobile. Multi ossicular chain damage is more frequent than single ossicle damage in cases of chronic discharging ears. It is also observed that cholesteatoma is less frequent than the granulation tissue and inflamed mucosa in our setup