Outcomes of cardiopulmonary resuscitation and estimation of healthcare costs in potential 'do not resuscitate' cases

Objectives: Cardiopulmonary resuscitation [CPR] is a life-saving procedure which may fail if applied unselectively. 'Do not resuscitate' [DNR] policies can help avoid futile life-saving attempts among terminally-ill patients. This study aimed to assess CPR outcomes and estimate healthcare costs in potential DNR cases

Methods: This retrospective study was carried out between March and June 2014 and included 50 adult cardiac arrest patients who had undergone CPR at Sultan Qaboos Hospital in Salalah, Oman. Medical records were reviewed and treating teams were consulted to determine DNR eligibility. The outcomes, clinical risk categories and associated healthcare costs of the DNR candidates were assessed

Results: Two-thirds of the potential DNR candidates were >/=60 years old. Eight patients [16%] were in a vegetative state, 39 [78%] had an irreversible terminal illness and 43 [86%] had a low likelihood of successful CPR. Most patients [72%] met multiple criteria for DNR eligibility. According to clinical risk categories, these patients had terminal malignancies [30%], recent massive strokes [16%], end-stage organ failure [30%] or were bed-bound [50%]. Initial CPR was unsuccessful in 30 patients [60%]; the remaining 20 patients [40%] were initially resuscitated but subsequently died, with 70% dying within 24 hours. These patients were ventilated for an average of 5.6 days, with four patients [20%] requiring >15 days of ventilation. The average healthcare cost per patient was USD [dollar sign]1,958.9

Conclusion: With careful assessment, potential DNR patients can be identified and futile CPR efforts avoided. Institutional DNR policies may help to reduce healthcare costs and improve services

Bone in the endometrium: a review

To provide a comprehensive review of the published literature of patients with endo- metrial bone or osseous fragments with a view to critically examine the antecedent clinical presentation, investigations and prognosis after treatment. This systematic review of the literature includes full text articles of published case re- ports and cases series from the following computerized databases: PubMed, Ovid, and Medline between 1928 and 2013. We reviewed a total of 293 patients in 155 case reports and case series. The mean +/- SD age at presentation was 32.7 +/- 8.9. Approximately 88% of patients had at least one prior surgical uterine evacuation relating to pregnancy termina- tion or loss at a median gestational age of 14 weeks [range of 4-41 weeks]. The most common presenting symptom was infertility [56.2%]. One hundred twenty- four [66.0%] of the 188 patients attempting pregnancy after treatment achieved pregnancy prior to article publication and the majority [82.3%] were spontane- ous. Spontaneous miscarriage rate remains high [43%]; however, most pregnancies ended in live-birth [55%]. Bone fragments in the endometrium are most commonly found after pregnancy termina- tion, present with infertility and/or irregular menses, and upon removal, patients rapidly conceive spontaneously

Importance of cadaveric dissection in learning gross anatomy

Background: The trend of dissection training is at the verge of extinction all around the world. With literal mushrooming of private medical colleges, supporting varied degree of medical facilities. There is increasing debate regarding the significance of cadavers in the teaching of gross anatomy. A study was conducted among graduate and postgraduate doctors in order to understand the importance of cadaveric dissection

Objective: To understand the importance of cadaveric dissection and determine the level of supportive rendered by cadaveric dissection at an undergraduate level for choosing the surgical field careers. To assess whether the stress and depression caused by cadaveric dissection at first exposure fades out with further exposures or lingers on

Methods: A cross-sectional multicentre study conducted in Karachi at various hospitals and medical colleges from November 2013 till February 2014. Graduate and postgraduate doctors from basic sciences and clinical sciences involved in teaching as professors and assistant professors were included in the study. A structured questionnaire was administered after taking verbal consent from the participants. The data was tabulated and analyzed using the computer program SPSS Version 15.0 for the production of descriptive statistics

Results: Out of 124 graduate and postgraduate doctors, 51.6% [64] were male, 48.4% [60] were female. The first visit experiences to dissection hall was documented through questionnaire, which was exiting for 71.8% [89], and 38.7% [48] got depressed. Cadaver dissection [CD] was avoided by 25% [31], out of which 18.5% [23] had allergy to formaldehyde, and 12.1% [15] had scared of the dead bodies. In 49.2% [61] helped in developing their professional endeavors, 54% [68] got inclined towards anatomy by CD, 71.8% [89] had clear concepts of gross anatomy. Understanding of in depth knowledge of structural details was found in 58.1% [72], regional anatomical concepts were cleared in 71.8% [89] of doctors

Conclusion: Cadaveric dissection is a good tool in learning the concepts of gross anatomy. It helped doctors to evaluate their interest and trends towards surgical fields, and also build up concepts which were utilized in their professional life

Seroprevalence of pediatric malaria in Quetta, Balochistan, Pakistan

Malaria is one of the most devastating protozoal diseases in under developing countries like Pakistan where health facilities are scarce. It is the second most frequently reported disease with 4.5 million suspected cases in Pakistan. The current study was designed to determine the incidence of pediatric malaria in Quetta, Balochistan. The study was conducted at Children Hospital Quetta [CHQ] during July 2011march 2012. Blood samples were collected from 3418 clinically suspected and were evaluated using thin and thick blood films stained with Giemsa stain. Out of 3418 total of 230 [6.72%] children were found positive for any of the malarial parasitic infestation. Plasmodium vivax was observed to be more common 54.34% [n= 125/230] than P. falciparum 44.78% [n=103/230]. Male children were 65.21% [150/230] i.e. two times more commonly affected than female 34.78% [80/230] children. The prevalence among age groups was 7.41% [n=89/1200] in preschool-aged children aged 1-5 years, 7.11% [n=75/1054] in school-aged children aged 6-10 years while 6.78% [n=46/678] in 11-15 years-old children, and 6.66% [n=20/300] in >15 year-olds children. Peak prevalence was noted in summer and mild in winter. Mixed infection of [0.86%: 2/230] P. vivax and P. falciparum was also observed in two cases although no case of P. malariae or P. ovale infection was seen during entire study. The results reflect the higher prevalence of malaria in Quetta, Pakistan that poses a significant health threat and requires urgent attention of high-ups to launch programme to control the disease in the area.

Total antioxidant status and microalbuminuria in type-2 diabetics attending GMC Hospital Ajman, United Arab Emirates

United Arab Emirates [UAE] has a high prevalence of Diabetes mellitus. While inflammation and oxidative stress are thought to play important roles in the pathogenesis of diabetes mellitus, the role of the antioxidant system still remains unclear. To determine the total antioxidant status in type-2 diabetic patients with and without microalbuminuria. Type-2 diabetics, aged 25-65 years, without history of cardiovascular or renal disease, attending GMC Hospital Ajman, UAE were included in this study. Medical history, height, weight were taken and biochemical investigations performed on venous blood samples. Urine albumin-to-creatinine ratio [ACR] was also measured. Data was entered into SPSS 19 software and analyzed using Pearson's and t-test for correlation and significance respectively. 82 type-2 diabetics included in the study. 76.8% were male and 73.2% were of middle-east ethnicity. Average age was 47 +/- 9.1 years. 79.2% were overweight. 58% had hypertension, 68.3% dyslipidemia and 53.6% family history of diabetes. Microalbuminuria [ACR 30-299 microg/mg], found in 17 diabetics, correlated weakly [r=0.32] but significantly [p < 0.05] with duration of diabetes. Serum total antioxidant status of diabetic patients [1.14 +/- 0.4 mmol/l] was significantly lower [p < 0.05] than in normal volunteers [1.35 +/- 0.08 mmol/l]. No difference was found between males and females. Diabetics with microalbuminuria had a higher total antioxidant status [1.24 +/- 0.62 mmol/l] than those without microalbuminuria [1.1 +/- 0.37 mmol/l]. However this difference was not found significant after adjusting for serum uric acid levels which were significantly higher [p < 0.01] in patients with microalbuminunia [5.98 +/- 1.71 mg/dl] compared to those without microalbuminuria [4.98 +/- 0.94]. Type-2 diabetics had significantly lower total antioxidant status compared to normal adults. Prevalence of microalbuminuria was 20.7% highlighting the need for screening all diabetics. Total antioxidant status in diabetics with microalbuminuria was found to be slightly higher probably due to the higher uric acid levels

Orbital masses CT and MRI of common vascular lesions, benign tumors, and malignancies

A wide variety of space occupying lesions may be encountered in the orbit. CT and MR imaging frequently help confirm the presence of a mass and define its extent. Characteristic imaging features may help distinguish among lesions that have overlapping clinical presentations. This review focuses on some of the common orbital masses. Common vascular lesions that are reviewed include: capillary [infantile] hemangioma, cavernous hemangioma [solitary encapsulated venous-lymphatic malformation], and lym-phangioma [venous-lymphatic malformation]. Benign tumors that are reviewed include: optic nerve sheath meningioma, schwan-noma, and neurofibroma. Malignancies that are reviewed include: lymphoma, metastasis, rhabdomyosarcoma, and optic glioma. Key imaging features that guide radiological diagnosis are discussed and illustrated

Hepatoprotective and therapeutic effect of Muravvaq of Mako on rifampicin-induced hepatotoxicity in rats just after rainy season [August-September]

The efficacy of Muravvaq of Mako [Frothless juice of Aolanum nigrum leaves] to control hepatic damage induces by Rifampicin was studied in Wistar albino rats. Rifampicin was administered orally as suspension to rats with a daily dose of 50 mg/kg body weight till 30 days with Muravvaq of Mako in concurrent group. In the second phase of study the effect of Muravvaq on established hepatotoxicity was studied by giving it for 20 days after withdrawal of Rifampicin. Hepatic dysfunction was assessed by biochemical and histological parameters. A significant increase observed in serum bilirubin, SGOT, SGPT and Alkaline phosphatase levels in negative control groups. However, there was a significant reduction in increased enzymatic levels in concurrent and treated group of rats, which received Muravvaq alongwith Rifampicin for 30 and 50 days, respectively. Histopathological analysis of liver samples also confirmed the hepatoprotective effect of Muravvaq. These results suggest that Muravvaq of Mako shows hepatoprotective effect against Rifampicin-induced hepatic damage in rats. The study was done in two different seasons, just after rainy [August-September] and in autumn season, to assess the efficacy of seasonal variation

Comparison of jeopardy game format versus traditional lecture format as a teaching methodology in medical education

To compare students' performance, satisfaction, and retention of knowledge between a 'jeopardy game format' and a 'didactic lecture format' in teaching viral exanthema to fifth-year medical students. We conducted a parallel-group randomized controlled trial in the Department of Pediatrics, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia from November 2008 to January 2009. We randomized fifth-year medical students into 2 groups. We taught viral exanthema to group one in lecture format, while group 2 received the same instruction in a jeopardy style game format. Both groups underwent a pretest, post-test I, and satisfaction survey. We conducted post-test II after 2 months to assess the retention of knowledge. The satisfaction survey consisted of 5 questions using a 5 point Likert scale. We used the paired sample t-test, and independent sample t-test to compare the results. Eighty-two students participated in the study [41 in each group]. Both groups showed significant improvement in their knowledge on the post-test I compared with the pre-test scores. However, the post-test II conducted after 2 months showed that retention of knowledge was significantly better in the game format. The satisfaction survey showed that the game format was more enjoyable and fun. The game format teaching strategy has an added advantage in retaining knowledge of the subject for a longer time compared with a lecture format

Eruption time of permanent teeth in Pakistani children

To determine the mean eruption time of permanent teeth of Pakistani children and to evaluate the effects of gender, type of schools, height, weight and body mass index on it. This cross sectional study was conducted from September 2007 to April 2008. 4370 children of 'just erupted' teeth were obtained from 102 randomly selected schools from 18 towns of Karachi, using systematic random sampling procedure. The dental examination was carried out for the selected child. Height, weight and date of birth were also obtained. Two sample't' test and paired 't' test were employed to compare the mean time of eruption between gender and type of schools [private/ public], and upper and lower jaws. Pearson and partial correlations were used to determine the significant relationship between eruption time with height, weight and BMI. The right first molars of upper and lower jaws showed the minimum eruption time. Second molars were the last tooth to emerge. Only 3 teeth showed significant difference of eruption time between the genders. None of contralateral teeth showed any statistical significant difference. All the mandible teeth, except the premolars, erupted earlier than maxillary teeth. Private schools children showed early eruption than the public schools children. The Pearson and partial correlation were significant positively correlated with height. Eruption time of all the teeth, except one, showed positive correlation with weight. The eruption time of Pakistani children are different in many aspects with to other nationalities

Plasma homocysteine and other biochemical parameters in gestational Diabetes Mellitus

Gestational Diabetes Mellitus [GDM] is characterized by glucose intolerance that is first diagnosed during pregnancy. Insulin resistance is the hallmark of gestational diabetes, little is known about the other metabolic changes taking place. Plasma homocysteine [Hcy] levels have been reported associated with cardiovascular disease and osteoporosis. Elevated Hcy levels are associated with pregnancy complications and adverse pregnancy outcomes. The objective of the present study was to compare plasma levels of Homocysteine and other biochemical parameters in women diagnosed with GDM attending Gulf Medical College Hospital with that in normal pregnant women. Prospective study of pregnant women GDM [N = 26] was confirmed by the oral glucose tolerance test. Normal pregnant women served as control group [N = 36]. Fasting plasma Glucose [mg/dL] level and Body mass index [kg/m[2]] of the GDM group was significantly higher compared to the control group. serum total cholesterol level was found to be significantly higher [P<0.00] in GDM [230.77 +/- 27.21 mg /dL] compared to contral [181.53 +/- 17.09]. Serum Triacylglycerol, Uric acid and Creatinine were also significantly elevated [P < 0.001] in the GDM group compared to control even though all values lay within the normal reference ranges. Hcy level in GDM was significantly higher [19.073 +/- 3.61 micro mol/L] compared to controls [8.322 +/- 1.94], P<0.001. Homocysteine, Cholesterol, Triacylglycerol, Uric acid and Creatinine levels were significantly elevated in GDM compared to normal pregnant women. Hcy correlated strongly with the fasting glucose levels [Pearson correlation, r = 0.9]

Attitude of teaching faculty towards statistics at a medical university in Karachi, Pakistan

Statistics is mainly used in biological research to verify the clinicians and researchers findings and feelings, and gives scientific validity for their interferences. In Pakistan, the educational curriculum is developed in such a way that the students who are interested in entering in the field of biological sciences do not study mathematics after grade 10. Therefore, due to their fragile background of mathematical skills, the Pakistani medical professional feel that they do not have adequate base to understand the basic concepts of statistical techniques when they try to use it in their research or read a scientific article. The aim of the study was to assess the attitude of medical faculty towards statistics. A questionnaire containing 42 close-ended and 4 open-ended questions, related to the attitude and knowledge of statistics, was distributed among the teaching faculty of Dow University of Health Sciences [DUHS]. One hundred and sixty-seven filled questionnaires were returned from 374 faculty members [response rate 44.7%]. Forty-three percent of the respondents claimed that they had 'introductive' level of statistics courses, 63% of the respondents strongly agreed that a good researcher must have some training in statistics, 82% of the faculty was in favour [strongly agreed or agreed] that statistics was really useful for research. Only 17% correctly stated that statistics is the science of uncertainty. Half of the respondents accepted that they have problem of writing the statistical section of the article. 64% of the subjects indicated that statistical teaching methods were the main reasons for the impression of its difficulties. 53% of the faculty indicated that the co-authorship of the statistician should depend upon his/her contribution in the study. Gender did not show any significant difference among the responses. However, senior faculty showed higher level of the importance for the use of statistics and difficulties of writing result section of articles as compared to junior faculty. The study showed a low level of knowledge, but high level of the awareness for the use of statistical techniques in research and exhibited a good level of motivation for further training

Effect of Muravvaq of Mako, Muravvaq of Kasni and Muravvaqain on hepatotoxicity induced by rifampicin in rats just after rainy season [August-September]

To assess the hepatoprotective activity of Muravvaq of Mako, Muravvaq of Kasni and Muravvaqain frothless juice of Mako [Solanum nigrum] leaves, and Kasni [Cichorium intybus] leaves and collectively leaves of both plants on Rifampicin-induced hepatotoxicity in Wistar albino rats. Hepatotoxicity was induced in rats by Rifampicin given orally as suspension for 30 days. Concurrent group received Muravvaq of Mako, Muravvaq of Kasni and Muravvaqain alongwith Rifampicin. In the second phase of study the effect of Muravvaq of Mako, Muravvaq of Kasni and Muravvaqain on established hepatotoxicity was studied by giving the Muravvaq of Mako, Muravvaq of Kasni and Muravvaqain for 20 days after withdrawal of Rifampicin. Hepatic dysfunction was assessed by biochemical and histological parameters. Muravvaq of Mako, Muravvaq of Kasni and Muravvaqain significantly [p<0.05] prevented changes in the serum levels of bilirubin, SGOT, SGPT and SALP. Similarly it significantly prevented the histological changes as compared to the group receiving Rifampicin. It also significantly reversed the biochemical and histological changes

Hammam an ancient principle of health

The baths or 'hammams' as they are named, are for many, aspects of health not just for external cleanliness. Hammam [bath] is being used as a method of Ilaj-bil-tadbeer [Regimental therapy] advocated in Unani system of medicine since ages. Hammam refers to bath. Hammam refreshes body by dispersing the superfluities and preparing body for assimilation of food. Moreover it guards against discomfort. Unani physicians have mentioned various types of Hammam for different ailments and plays important role in prevention and promotion of health like Wajaul Mafasil [Arthritis], skin diseases, menorrhagia, liver disease etc. This paper is a review of the history, benefits, therapeutic effects and different types of Hammam used and mentioned by old Unani physicians in classical Unani literature. Hammam will also be discussed in the light of modern medicine

Distribution of ABO and Rh D blood groups in the population of Poonch district, Azad Jammu and Kashmir

We evaluated the distribution of ABO and Rhesus [Rh] D blood groups in the population of Poonch district in Azad Jammu and Kashmir. The blood group phenotypes were detected by the classic slide method. The ABO blood group system in the total sample showed the same trend of prevalence as for the general Indian subcontinent [B >/= O > A > AB]. The same trend was found among males, but among females the order of prevalence was different [O B > A > AB]. However, the allelic frequencies in both sexes were in the order of O > B > A. The Rh positive and negative distribution trend in both sexes was also similar

Dracunculiasis an incidental diagnosis in a Saudi female

Dracunculiasis is a disabling, and economically crippling parasitic infestation transmitted by drinking contaminated water. Although the disease has been eradicated from most parts of the world, it is still endemic in some tropical African countries. Here we report a 65-year-old female from the southern region of Saudi Arabia with radiological evidence of heavy load of guinea worms. This case could represent the local reemergence of the disease

Community health and environment

Our community health and environment programme serves to protect the basics: pure food, clean water, fresh air and healthy communities. New issues are always on the rise, so we must stay on the cutting edge to protect our communities, our health and the environment. A EURO symposium in 1966 defined community health as including "all the personal health and environmental services in any human community, irrespective of whether such services were public or private ones". Historical background from ancient India to 20th century will be discussedú in this article which will also enlighten us on the changing concepts in public health, changing global scenario and its effect on community health

Risk factors for stroke: a hospital based study

Stroke is the commonest neurological cause of morbidity and mortality all over the world being the third leading cause of death. The goal of this study was to ascertain the frequency of risk factors for first ever stroke in our patients. This prospective study included all patients of either sex, 20 to 70 years and above admitted in Dr. Ziauddin Medical University Hospital, North Nazimabad Campus, Karachi, with first ever stroke verified by CT scan brain during a period of one year. Data analysis showed that 70.1% had cerebral infarction and 29.9% cerebral hemorrhage. The mean age at presentation was 62 years and male to female ratio 1.05:1.The most frequent risk factors included hypertension 65.8%, smoking 43%, diabetes mellitus 41.3%, underlying cardiac diseases 29.1%, family history of stroke/transient ischemic attack in the first-degree relatives 26.7%, high cholesterol 25.5%, history of past transient ischemic attack 24.9% and significant extracranial carotid atherosclerosis in 18.18%. In-hospital mortality was 11.7%. At 30-day follow up 22.27% of all stroke survivors were functionally independent. This study suggested that diabetes mellitus was more and underlying cardiac diseases less frequent in our patients than in the western reported series. Cerebral hemorrhage was relatively morecommon and the mean age at presentation was lesser compared to those in the developed countries. Stroke patients consume a large part of health resources all over the world so accurate information about the incidence, risk factors, management and outcome is needed for planning medico-social services besides primary and secondary stroke prevention in the community

unusual presentation of postpartum ovarian vein thrombosis

Ovarian vein thrombosis is a rare but potentially serious complication following childbirth. The majority of patients present during the first week postpartum, with fever and right lower quadrant abdominal pain. We report an unusual case of postpartum ovarian vein thrombosis who presented with fever, low backache, and painful thighs. A high index of suspicion is crucial to diagnose and treat this condition in order to avoid serious consequences