Study of Exchange Transfusion by Reconstituted Blood in Hemolytic Disease of Fetus & New Born

Introduction: In newborns with hemolytic disease of fetusand newborn, exchange transfusion is one of the treatments.The main objective of this study was to review and establishthe practice of exchange transfusion with reconstituted bloodin neonates and to observe fall of bilirubin and also rise inhemoglobin and its comparison with related studies.Material and methods: Total 31 neonates with hemolyticdisease of fetus and newborn were included in thisstudy and exchange transfusion was carried out to treathyperbilirubinemia. Exchange transfusion with O Rh negativecells suspended in AB plasma were done for neonates havingRh hemolytic disease of fetus and newborn and O Rh positivecells suspended in AB plasma were used for exchangetransfusion to ABO hemolytic disease of fetus and newborn.The pre and post exchange transfusion blood samples weretested for serum bilirubin and hemoglobin.Result: Out of the 31 cases, 20 were of Rhesus (Rh) hemolyticdisease of fetus and newborn, while ABO and other bloodgroups constituted 08 and 03 hemolytic disease of fetus andnewborn cases respectively. The average post-exchange fallin serum indirect bilirubin was (53.47%) and average rise inhemoglobin level was 3.06 gm/dl in all 31 cases.Conclusion: The reconstituted blood is immunologically muchsafer and better than whole blood for purpose of exchangetransfusion in hemolytic disease of fetus and newborn becauseof its superiority in minimizing transfusion reactions and inachieving all the therapeutic effects of exchange transfusionin better way

Porokeratosis ptychotropica: a rare case report with unusual presentation

Porokeratosis is a rare disorder of epidermal keratinization characterized clinically by annular plaque with thread like hyperkeratotic border with a central groove that expand centrifugally and this border corresponds to coronoid lamellae histologically which are the columns of parakeratosis that overlie an epidermal invagination with loss of granular layer and dyskeratosis of upper spinous keratinocytes. The disorder was erroneously named porokeratosis because the coronoid lamella was initially described as being present over a sweat pore, which is a fixed structure that cannot expand peripherally. Five primary clinical variants have been described: classic porokeratosis of mibelli, disseminated superficial actinic porokeratosis, linear porokeratosis, punctate porokeratosis and porokeratosis palmaris et plantaris disseminate. Porokeratosis ptychotropica one of the rare variants of porokeratosis described by lucker et al which has been added recently in the classification. It is characterized clinically by symmetrical verrucous papules and plaques resembling psoriasis plaque in the gluteal cleft, buttocks and rarely extends to genitalia and histologically by multiple coronoid lamella. We report a case of 43year old female, presented with 10years duration of pruritic raised skin lesion over the left gluteal region. Dermatological examination revealed single well defined erythematous scaly plaque with central atrophy, hyperpigmentation and peripheral thread like elevated border. Histopathological examination revealed multiple coronoid lamella which is the hallmark for porokeratosis ptychotropica, confirmed the diagnosis. The patient was treated with 5-fluorouracil cream. we report this case due to its rarity and the unusual presentation of single plaque of porokeratosis ptychotropica.

Immature reticulocyte fraction is an early predictor of bone marrow recovery post chemotherapy in patients with acute leukemia

To establish the benefits of immature reticulocyte fraction [IRF] measurement using an automated hematology cells analyzer over absolute neutrophil count [ANC] in predicting bone marrow recovery post induction chemotherapy. A prospective observational study was carried out in the Departments of Pathology, Medicine, and Pediatrics, Universiti Kebangsaan Malaysia, Medical Center [UKMMC], Kuala Lumpur, Malaysia during a period of 19 months from April 2009 to December 2010 to assess the bone marrow recovery in patients with acute leukemia. A total of 22 patients in remission induction phases were enrolled in this study. The blood specimens were collected from day zero after chemotherapy, and every 3 days until patients recovered hematologically. All blood samples were measured for ANC and IRF using an automated hematology analyzer [Beckman-Coulter LH750]. The percentage of patients showing IRF recovery earlier than ANC recovery was 63.6% [14 out of 22 patients]. There was a significant difference in the mean number of days for IRF recovery as compared with ANC recovery [14.05 and 17.18 days], p=0.005. This study proved that IRF was more useful in predicting bone marrow recovery in a patient with acute leukemia post induction chemotherapy compared with ANC. The IRF is not affected by infection, is easily measured, and inexpensive; thus, it is a reliable parameter to evaluate bone marrow reconstitution

Costs associated with tuberculosis diagnosis and treatment in Yemen for patients and public health services

This study determined the costs associated with tuberculosis [TB] diagnosis and treatment for the public health services and patients in Sana'a, Yemen. Data were collected prospectively from 320 pulmonary and extrapulmonary TB patients [160 each] who were followed until completion of treatment. Direct medical and nonmedical costs and indirect costs were calculated. The proportionate cost to the patients for pulmonary TB and extrapulmonary TB was 76.1% and 89.4% respectively of the total for treatment. The mean cost to patients for pulmonary and extrapulmonary TB treatment was US$ 108.4 and US$ 328.0 respectively. The mean cost per patient to the health services for pulmonary and extrapulmonary TB treatment was US$ 34.0 and US$ 38.8 respectively. For pulmonary and extrapulmonary TB, drug treatment represented 59.3% and 77.9% respectively of the total cost to the health services. The greatest proportionate cost to patients for pulmonary TB treatment was time away from work [67.5% of the total cost], and for extrapulmonary TB was laboratory and X-ray costs [55.5%] followed by transportation [28.6%]

Efficacy of endoscopic third ventriculostomy in noncommunicating hydrocephalus

Hydrocephalus is common problem requiring either extra-cranial [shunts] or intracranial [ventriculostomy] diversion of cerebrospinal fluid. Endoscopic third ventriculostomy obviates all the complications of shunts and has been accepted as the procedure of choice for the treatment of obstructed hydrocephalus in adults and children because of the minimally invasive nature. This study was conducted to determine the efficacy of endoscopic third ventriculostomy in the treatment of noncommunicating hydrocephalus. This cross sectional descriptive study was done in neurosurgery department of Hayatabad Medical Complex, Peshawar, from 2[nd] February 2011 to 1[st] march 2012. A total of 171 patients with non-communicating hydrocephalous, irrespective of gender discrimination and Glasgow coma scale score of 10 and above were included in this study. Patients below one year of age, with lesion in the floor of the third ventricle or near basilar artery, and hydrocephalus with infected CSF or haemorrhage were excluded. Hydrocephalous was diagnosed on CT-scan brain. All the patients were followed up till 72 hours post-operatively for the determination of effectiveness in terms of improvement in Glasgow coma scale by at least 2 points. All the above mentioned information including name, age, gender and address were recorded in a predesigned proforma. The data was analysed using SPSS-17. Frequency and percentage was calculated for categorical variables. Mean +/- SD was calculated for age. A total of 171 patients with noncommunicating hydrocephalous were included in the study. Out of 171 patients, there were 104 [60.8%] males and 67 [39.2%] females. Age ranged from 1-70 years with majority of the patients was below 10 years of age. Majority of the patients had hydrocephalus due to tuberculous meningitis 39.2% of the whole. In 134 [78.4%] patients the procedure was effective. Procedure was more effective in hydrocephalus due to space occupying lesion. Endoscopic third ventriculostomy is a very effective procedure for the treatment of non-communicating hydrocephalus.

Craniosynostosis: early recognition prevents fatal complications

Background: Craniosynostosis is the premature fusion of cranial vault sutures. The overall incidence is 3–5/10, 000 live births. With multiple craniosynostoses, brain growth may be impeded by the unyielding skull. Most cases of single suture involvement can be treated with linear excision of suture. Involvement of multiple sutures or skull has usually required combined efforts of neurosurgeons and craniofacial surgeons. Methods: On the basis of visible skull deformity all patients were admitted in the Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Pakistan. Patients were examined for signs of raised ICP and other congenital deformities. The records of patients were maintained till follow up. Results: Twenty-seven children were included in this study from 2002 to 2009. Age range was 1–6 years, boys were 18 [66.6%], and girls were 9 [33.3%]. The common suture affected was coronal 12 [44.4%]. Two children with craniostenosis belonged to same family, and all presented with suture involvement. Three [11.1%] deaths occurred due to hypothermia [1], and blood loss [2]. Conclusion: Early diagnosis, expert surgical techniques and per- and postoperative care for bleeding and temperature regulation prevent mortality and morbidity. Keywords: Craniosynostosis, children, skull defects, suture

Pharmacognostical studies on Acalypha indica L.

In the present study, Acalypha indica L. plants were collected and their physicochemical, phytochemical and antimicrobial properties were screened. The, plant extracts containing carbohydrates, alkaloids, saponins, fixed oil and fats, gum, mucilage and flavonoids were qualitatively screened. Among the physicochemical properties such as loss on drying was 72.4 and total ash was 6.03. Its solubility percentage was higher in ethanol than water. Behaviour of plant powder in exposure in different colours with different chemical compounds to determine, fluorescent behaviour was entirely different in normal light than in UV light. Four amino acids such as alanine, threonine, valine and tryptophan were identified. Antibacterial potentiality of aqueous extract exhibited against Klebsiella pneumoniae and Serratia marcescens only. Methanol extract inhibit the growth of Citrobacter diversus and Klebsiella pneumoniae. Antifungal activity was screened only for Candida albicans and Saccharomyces cerevisiae

Management of thoracolumbar spine injuries at a tertiary care hospital

The purpose of descriptive case series study was to see the conservative and surgical outcome in respect of neurological improvement, sphincter functions and early ambulation in cases of traumatic thoracolumbar injuries in a tertiary care hospital. This was a hospital based prospective study comprised of 50 thoracolumbar injury cases registered during the period of 1 year from September 2005 to September 2006. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using Frankle grades. Operative and postoperative record with x-rays and MRI were maintained. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. A total of 50 cases were registered, 43 [86%] were males and 7 [14%] were females. Fall was the most common cause of injury [92%]. The most common level involved was L[1] [46%]. The 2[nd] common site of injury was T[12] [12%]. The treatment given was conservative in 42.55%, and surgery was performed on 57.44%. Three [6.38%] patients were left against medical advice. Thoracolumbar injuries occur in young population and creates socio-economic burden to the society. Patients with partial neurological deficit benefit from surgery

Efficacy of Bacillus thuringiensis var. Kurstaki in the control of two mosquito species (Anopheles stephensi and Culex quinquefasciatus).

Bioinsecticide Bacillus thuringiensis var. kurstaki (Btk) was used for controlling the mosquito species (Anopheles stephensi and Culex quinquefasciatus) which gave a significant (p<0.05) mortality in both species. The higher concentration of Btk was highly effective compared to the control ones. The controlling effect was dose and time dependent. Among the studied mosquitoes the C. quinquefasciatus (LC50 0.154%) was more susceptible than A. stephensi (LC50 0.372%) towards the bioinsecticide Btk.

Quality of management for acute respiratory tract infections and diarrhoeal diseases in rural Yemen

To evaluate the performance of health workers with respect to diagnosis and treatment of acute respiratory infection [ARI] and acute diarrhoea [AD] in children < 5 years in 11 rural heath facilities in Yemen, we carried out a cross-sectional study on 219 cases of ARI and 93 cases of AD. Mean score for performance was 30.04 [range 21-39]. The quality of care provided was fair in 89.4% and poor in 4.5% of cases. A "well done" performance of 6.3% was achieved by medical doctors but only 3.6% of medical assistants and 25% of medical assistants scored "poor" for performance, but only 2.5% of medical doctors. Health workers who had received training courses in ARI and AD performed slightly better than those who had not

Profile of paediatric emergency cases in Yemen: the need for evidence-based guidelines

This study describes the status and characteristics of children presenting to emergency services in hospitals and health centres in Yemen in order to inform the development of guidelines for paediatric emergency services. Information was collected from 7 hospitals and 2 health centres in 5 governorates about 3454 cases, mostly aged < 2 years old. The majority of paediatric emergency cases were due to respiratory system problems [28.6%] and gastrointestinal problems [25.5%]; 36.4% of children presented with a duration of complaint exceeding 4 days. One-third of cases [33.2%] were treated with 3rd generation cephalosporins alone or in combination with other antibiotics. The mortality rate was 1.9%. The most important causes of death were cardiac and respiratory failure

Pattern of encephaloceles: a case series

Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism. The exact world wide frequency is not known. A substantial proportion of children especially those born with a large encephaloceles are physically and intellectually disabled. Our objective of this descriptive case series was to determine the patterns and surgical outcomes in various types of encephalocele in our setting. The study was carried at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh, Pakistan during year 2005 to 2007. Patients with encephalocele [occipital, Scincipital, parietal] admitted during year 2005 to 2007 were evaluated for their clinical features. Complete base line investigations were performed including ultrasound, CT scan and MRI of brain. Other congenital anomalies were also noted in record. Written consent was taken. Operative and postoperative records were maintained. Statistical analysis was done by SPSS method. 25 children with encephalocele were selected during the years 2005-2007. Out of these 19 [76%] were male and 6 [24%] female. Age range was 06 days to 2 years. Most common type of encephalocele was occipital 20 [80%]. All patients underwent surgery. Out of 25 only one patient was died. Postoperative follow up showed uneventful results. Most common type of encephalocele is occipital in our set up. Contents of the sac of encephaloceles are dysplastic brain tissue and there is no harm to sacrifice it

Anterior decompression, fusion and plating in cervical spine injury: our early experience

To evaluate the efficacy of anterior cervical decompression, fusion and titanium plate fixation in sub axial cervical spine injuries in respect of neurological outcome, postoperative stability and early rehabilitation. The Descriptive case series study was conducted at Department of Neurosurgery, Liaquat University Hospital, Jamshoro, Sindh Pakistan during year 2005 to 2007. Patients with cervical spine injuries were admitted during study period were included in this study. All cases were evaluated for their clinical features. During initial phase, level and degree of neurological injury was assessed using ASIA impairment scale. Cervical traction was applied to all patients. Operative and post operative record with x-rays and MRI were maintained. Patients with Injury to C3-6 underwent decompression, fusion and local titanium plate implant fixation by anterior approach. The follow-up ranged from 6 to 12 months with clinical and radiological assessment. 37 cases of sub axial cervical spine injuries included in this study during year 2005 to 2007. Out of these, 28 [75.67%] were males and 9 [24.32%] females. Age range was 8-60 years mean [32-40%]. Common mode of injury was fall. Post operative follow up showed good clinical and radiological outcome, bony fusion and favour early rehabilitation. No immediate complication found except temporary dysphagia. Anterior decompression, fusion and titanium plate fixation is an effective method with good neurological and radiological outcome

Effect of breastfeeding on growth in Ifemeni infants

To estimate the prevalence of effective breastfeeding [EBF] practice and its association with weight of young infants, mothers education, employment status, and parity. The study is a cross-sectional, conducted in Dula Health Center in Sanaa city, the capital of Yemen during the year 2003. Six hundred and twenty-one mothers and their exclusively breastfed apparently healthy infants attended to the health center for immunization were enrolled in the study. Effective breastfeeding was evaluated according to the World Health Organization integrated management of childhood illnesses literature. Weight was measured using Seca scale. We conducted interview to investigate the age of the child, parity, employment status, and education of the mother. The mean age of infants was 49.7 +/- 16.8 days. The prevalence of EBF was 16.9% [n = 105]. Good positioning was observed in 26.7% [n=l66], followed by good suckling in 23.7% [n=l47] and finally by good attachment in 20.3% [n=126]. The mean weight of EBF infants was 3.9 +/- 0.5 kg, whereas that of the ineffectively breastfed gtoutp was 3.5 +/- 0.5 kg [P<0.000l]. The 2 groups were compared with gender and age matched. The mean weight of well-attached infants was 3.8 +/- 0.55 kg and for those with good suckling was 3.8 +/- 0.55 kg and for those with good positioning was 3.7 +/- 0.59 kg. No association was found between EBF with mother's education and employment status while parity was positively related to EBF rate. Prevalence of EBF is low. Infants with EBF are heavier than the ineffectively breast-fed infants

Malaria signs and infection rate among asymptomatic schoolchildren in Hajr valley, Yemen

This study recorded malaria signs and the rate of parasitaemia among asymptomatic schoolchildren in Hajr valley, Hadhramout governorate, Yemen. Tests were made for malaria parasites and anaemia in 469 randomly selected primary-school children aged 6-11 years, together with clinical examination to determine spleen size, and interviews to study sociodemographic factors. Of the children, 12.8% had positive malaria blood films and 11.3% had spleen enlargement. There were significant associations between malaria infection, anaemia and splenomegaly and fever. Children with malaria parasitaemia were more often absent from school

Etiology of hearing in loss in children attended al thawra teaching hospital in sana'a, yemen

To determine the etiology of hearing loss among children presenting at Al-Thawra teaching Hospital in Sana'a, Yemen A total of 580 children with hearing loss attended the ENT out-patient clinic in Al-Thawra Teaching Hospital during the period from January 2003 to December 2004. Patients were examined clinically and investigated by pure tone audiometry, tympanometry and auditory brain stem response [ABR] when indicated. A proportion of 68.3% of children with hearing loss were aged between 5-15 years at presentation. Males were 337 [58.1%] and females were 243 [41.9%]. Of the 385 [66.4%] children who were subjected to pure tone audiometry 282 [73.2%] had profound hearing loss, 71 [18.4%] had severe hearing loss and 32 [8.3%] had moderately severe hearing loss. Causes of hearing loss were: unknown in 238 [41.0%], meningitis in 122 [21.0%], hereditary in 76 [13.1%], ototoxicity in 47 [8.1%] and febrile convulsion in 3.5 [6.0%]. Consanguinity was recorded in the parents of 309 [53.3%] children. Of them 192 [62.1%] married to their first cousins and 117 [37.9%] to their relatives. The highest range of presentation of children with hearing loss was between 5-15 years old. The most common causes were unknown, meningitis, hereditary and ototoxicity. Consanguinity was reported by more than half of the parents. Majority of the children were with profound type of hearing loss

Rapid assessment of trachoma in 9 governorates and Socotra Island in Yemen

This study described the pattern of trichiasis, active trachoma and trachoma risk factors in 9 governorates of Yemen plus Socotra Island, using a rapid assessment during October and February 2004. A total of 3169 children aged 1- 9 years were examined in a central meeting point or at home. Active trachoma was found in a high percentage of children in Al-Jawf, Mareb and Shabwah governorates and the SAFE strategy [Surgery, Antibiotic treatment, Facial cleanliness, Environmental improvement] should be directed toward these governorates. Trichiasis cases were also found in Hadramout and Taiz, suggesting that eyelid surgery should be provided in these governorates

Profile of breast lesions among women with positive biopsy findings in Yemen

This study described the profile of breast pathology based on records from a reference histopathology laboratory in Yemen of 773 women with positive biopsy or mastectomy findings. Cancers were classified according to the International classification of diseases for oncology. Benign lesions were found in 79.9% of cases. Fibroadenoma was the most prevalent lesion [30.0%] with a mean age at presentation of 22.2 years, followed by fibrocystic disease [27.4%] and breast inflammation [13.1%]. Invasive carcinoma was found in 155 cases [20.1%], at a mean age of 44.7 years

Intestinal parasitosis and nutritional status in schoolchildren of Sahar district, Yemen

The prevalence and intensity of schistosomiasis and soil-transmitted parasites was estimated among third-year schoolchildren of Sahar district, Sa'dah governorate, Yemen, after 4 schistosomiasis control campaigns. Anthropometric measurements were used to assess nutritional status in relation to infection rates. The prevalence of schistosomiasis infection was low at 5.6%: 3.3% for Schistosoma haematobium [geometric mean 0.16 eggs/10 mL urine] and 2.3% for S. mansoni [0.18 eggs/g faeces]. Ascaris lumbricoides was found in 0.4% of the children while other soil-transmitted helminths were not found. Stunting was found in 50.9%, wasting in 4.5% and underweight in 48.7% of the children examined; however, no positive association was found between infection and nutritional status indicators