Clinicobacteriological profile, antibiotic sensitivity patterns and mortality of neonatal sepsis in a tertiary care hospital in Kashmir, Jammu and Kashmir, India

Background: Neonatal sepsis refers to generalized bacterial blood stream infection in first 28 days of life documented by positive blood cultures. It is one of leading causes of neonatal mortality. Objectives was to study clinicobacteriological, antibiotic sensitivity patterns and mortality of neonatal sepsis.Methods: This prospective study was conducted in the Department of Pediatrics of Government Medical College Srinagar in collaboration with Department of Microbiology of same medical college after ethical clearance from ethical committee of Government Medical College Srinagar. One hundred (100) neonates out of 731 neonates admitted between octomber2007 and September 2008 with signs and symptoms of neonatal sepsis were included in our study by random sampling method. After history, examination and laboratory investigation blood culture results were analyzed by standard statistical methods.Results: The blood culture was positive in 40% of neonates. Fifty one (51) neonates were males while as 49 were females. Sixty three (63) neonates had late onset of sepsis while as 37 had early onset sepsis. The positive' blood culture was more common in males, late onset sepsis, babies born in rural areas, home born, vaginal births, preterm and other' low birth weight neonates .The gram negative isolates were most common followed by positive ones .The best sensitivity of gram negative isolates was to ciprofloxacin followed by amikacin and cephalosporins while as gram positive isolates were sensitive to imipenum followed by vancomycin. Pseudomonas was most responsive to pipercillin +tazobactum combination. The neonatal mortality was 35% being higher in early onset sepsis and low birth weights.Conclusions: This study depicts a high rate of neonatal sepsis, mainly caused by gram negative organisms followed by gram positive organisms with rising drug resistance that could bear far reaching implications to the times to come, mandating the implementation of sepsis preventive measures and administration of specific antibiotics.

Role and effectiveness of intraperitoneal bupivacaine in post-operative pain management after laparoscopic cholecystectomy

To study the effectiveness of intraperitoneal bupivacaine in the pain management of patients who had laparoscopic cholecystectomy, and comparison with a control group

Objectives: the purpose of the study is to find out the efficacy of intraperitoneal bupivacaine injection, for post-operative pain management in patients following laparoscopic cholecystectomy

Material and Methods: the method of study is a randomized control trial, Two groups of people were selected at random from a pool of 100 patients, each group had 50 patients each. One group did not receive intraperitoneal bupivacaine, while the other group was injected 20ml of bupivacaine [.25%] intraperitoneally, in the sub diaphragmatic space on the right side along with in the bed of the gall bladder

Results: the post-operative mean abdominal pain score using the VAS scale in both groups was calculated using at different intervals and recorded as 1.34 +/-0.43 cm in the control group and 2.54 +/- 0.26 cm in the bupivacaine group at zero hours,, 2.11 +/- 0.32 cm in control group and 2.98 +/- 0.54 cm in bupivacaine group at two hours, 2.98 +/- 1.05 cm in control group and 3.24 +/- 0.84 cm in bupivacaine group at four hours while 3.13 +/- 1.21 cm in control group and 4.59 +/- 1.32 cm in bupivacaine group at six hours were recorded. The efficacy is recorded as 36.67% in control group and 6.67% in bupivacaine group while 63.33% in control group and 93.33% in bupivacaine group

Conclusion: for postoperative pain relief in laparoscopic cholecystectomy patients, intra peritoneal bupivacaine injection is an effective method

Disaster induced Migration and Social Conflict in Bangladesh: Study on Cyclone Sidr.

Disaster induced migration has the potential to become a phenomenon of a scale and scope not experienced in human memory. Displacement due to disaster is considered to be a socio-economic and political problem, when it gets solved, the issue of displacement is also ignored. Bangladesh was struck by a category-4 cyclone (Sidr) on the evening of 15 November in 2007 which resulted in displacement of 650,000 people. Such migration posed a serious threat towards social stability and leads towards social conflict. Migration is generally considered as a source of social conflict. Over 3 million people live in slums and squatters of Dhaka city with very little utility service. Slums and squatters are the informal settlements of Dhaka city that accommodate the low-income group of people. Conflict (quarrel, clash, fight) in the slums and squatters is a regular phenomenon. The displaced persons are knowingly and unknowingly discriminated on various grounds and suffer as the survivors of various stigmas. The study reveals that, undue influence by the muscleman, discrimination between migrated and poor slum dwellers, and demand for money by the terrorist group, ignorance to the migrated people by the different quarters and sexual harassment to the migrated adolescent girls are responsible for slumping of social conflict. Their voices are ignored, their pleas are neglected and thus they are excluded from the mainstreamed section in the society.

Democratization at Local Government (LG): Revisiting the Lowest Tier of LG in Bangladesh.

Union Parishad (UP), lowest tier of the LG is a major component that plays a crucial role to strengthen democracy and to gain sustainable development of the rural community. UP is considered to be the significant breeding grounds for democracy. But in the developing country like Bangladesh, there are several margins prevailing behind the democratization of local government. In fact, UP in Bangladesh is associated with chronic problems i.e. absence of sensitization and bring about progressive change in communalist mindsets of rural populace; absence of capable elected representatives especially the women; no provision for engagement of professionals and consultants for speedy rural development; practice of party driven elections and absence of unanimous elections in avoiding political interference; lack of a devolved function required for administrative and financial authority; highest scope of the intervention and control of state government; absence of a strong political will for the effectiveness of the democratization within UP; fragile economic condition; absence of visionary leadership; noon cooperation among different stakeholders; gender inequality in mainstreaming political parties; patron-client relationship resulting impediment towards democratization of UP. In consequence, sustainable development is not achieved in rural Bangladesh yet.

Prevalence of viral hepatitis in patients attending medical camp

Objective of this study was to check prevalence of Viral Hepatitis in Patients attending Medical Camp Cross sectional study. This study was conducted in free Medical Camp of Shaheed Mohtarma Benazir Bhutto Medical University Larkana from 01.07.2011 to 31.12.2011. An advertisement was given one week prior via media for awareness of people. The camp was organized by the faculty of Medical unit III on 1[st] July 2011. This camp, apart from necessary medicines, equipped with diagnostic facilities to diagnose hepatitis B and C viruses. Patients willing to participate in this study were enrolled; patients with known hepatitis B and C were excluded. ELISA technique was used to diagnose. This study was approved by Ethical committee of Shaheed Mohtrama Benazir Bhutto Medical University. SPSS version 19 was used for data analysis. Total of 400 peoples were seen at the camp, 96 of them were already known cases of hepatitis B and C and were excluded from analysis. Of 304 patients 246 were males and 154 were females. From 304 patients 32 [10.5%] patients had hepatitis C and 16 [5.3%] had hepatitis B and rest were seronegative. The frequency of HCV and HBV was common in patients with age between 20 to 40 years. This was a small effort to increase awareness in local population regarding the course of viral hepatitis. We also collected data regarding present prevalence of chronic viral hepatitis in rural areas of interior Sindh. Much more is to be done to control this misery of our community

Hypertension as independent risk factors for acute stroke

The stroke is leading cause of death in world and many patients die of an acute stroke. This study was conducted to determine whether the hypertension is independent risk factor for acute stroke. Prospective cross sectional. This study was carried out at AK CMH/SKBZ Muzaffarabad from May 2012 to May 2013. In this study 220 patients having first ever acute stroke. Many clinical variables have been investigated as risks factors for stroke.The hypertension was investigated as a risk factor for stroke. The evaluation of patients included structured questionnaire, clinical, neurological examinations, laboratory tests, and computed tomogram scan [CT] brain. The follow-up at 14 days was done for all patients. Out of 220 cases of acute stroke, 171 [[77.73%] were hypertensive, and 49[22.27] % were normotensive. The statistical significant risk factors for stroke were: hypertension [p=0.04] and Hypercholesterolemia [p=0.05]; for cerebral infarction [CI]: [p=<0.001] and hypertension [p = 0.05] and Hypercholesterolemia [p=0.001]; for intracerebral hemorrhagic [ICH] stroke [p = 0.001]. The low Glasgow coma scale [GCS] score [p=0.05] on admission was associated with high mortality and worst outcome in hypertensive patients. Thus hypertension has statistical significant association for both CI and ICH stroke patients. This study confirms the statistical significant association of hypertension with acute stroke and emphasizes the need in preventing and controlling of hypertension in order to avoid stroke and its mortality

experience of open Anderson-Hynes pyeloplasty

To document the outcome of open Anderson-Hynes pyeloplasty for pelviureteric junction [PUJ] obstruction in terms of renal function and complications. Descriptive study. Department of Urology at Peoples University of Medical and Health Sciences for Women Hospital Shaheed Benazir Abad [Nawabshah] from 2007 to 2009. Thirty consecutive cases of pelviureteric junction obstruction were admitted. All patients underwent Anderson-Hynes open pyeloplasty. Complications and outcome were recorded. Most of our patients were male [n=25]. Majority belonged to age group 1-5 year [n=18]. Left side was affected in most of the cases [n=22]. Low incidence of postoperative accepted complications noted. Post operative outcome was excellent In relation to improved drainage and renal function. Anderson-Hynes pyeloplasty was safe, with low postoperative complication rate and better renal function preservation

Tetanus: still a killer in adults

To determine the socio-demographic characteristics, clinical profile and outcome of the tetanus patients. Case Series SICU of Peoples University of Medical and Health sciences [PUMHS] Nawabshah, from January 2010 to December 2012. The information obtained from the attendants of patients who presented with clinical features of tetanus and classified into generalized and cephalic types and; severity was classified into mild, moderate severe and very severe. Treatment was started immediately with protocol of supportive care; neutralization of circulating toxin and eradication of the source of tetanospasmin. Details of socio-demographic data, clinical features, complications and outcome were recorded and entered in a questionnaire before analysis. Twenty two cases of tetanus were studied included males were 16 and females were 6. Six of 22 [27.3%] patients had prior tetanus immunization while the other sixteen [72.7%] patients were not vaccinated or did not know their tetanus immunization status. Lower limbs were most common of portal of entry 15 [68.2%]. Most of patients [95.5%] have generalized tetanus and 5 [22.7%] patients had very severe disease. Body stiffness/spasm [100%], trismus [100%] and dysphagia [68.2%] were the three commonest presenting complaints. Complications of tetanus were documented in 16 [72.7%] patients. Overall mortality was 68.2%. Tetanus prevalence is still high in interior Sind and is associated with high morbidity and mortality rate

Is photodynamic therapy with adjunctive non-surgical periodontal therapy effective in the treatment of periodontal disease under immunocompromised conditions?

The aim was to assess whether or not photodynamic therapy [PDT] with adjunctive scaling-and-root planning [SRP] is effective in the treatment of periodontitis under immunocompromised conditions. PubMed/Medline and Google-Scholar databases were searched from 1967 to May 2013 using various key words. Six studies [five experimental and one clinical] were included. In the clinical study, SRP with PDT was reported to be ineffective in treating chronic periodontitis in T2DM patients. All experimental studies reported significantly less bone in periodontal defects treated with SRP+PDT than those treated with SRP alone. Efficacy of PDT+SRP in the treatment of periodontal disease under immunocompromised conditions remains unclear

effect of mifepristone antiprogestrogen on the number of progesterone receptors in the rat uterus

Objective: To investigates the effect of mifepristone on the number of progesterone receptors in the rat uterus

Study Design: Laboratory based randomized controlled trials

Place and Duration of the study: Department of Anatomy, Army Medical College Rawalpindi from Jan 2007-March 2007

Method: Sixty adult female rats were divided randomly into two groups, comprising of 30 animals in each group. In control group A one ml of normal saline was given orally daily for three months while in group B mifepristone was given orally in a dose of 1 mg/kg body weight daily for three months. All the animals were sacrificed next day after the last oral dose. Two ml blood was taken directly from the heart for measurement of estrogen and progesterone levels. About ½ cm piece of tissue was taken from the middle of the right uterine horn. Immunohistochemical staining procedure was done for demonstration of progesterone receptors

Results: In the control group Total number of PR stained receptors in all the compartments of the uterus were 40400. In the experimental group the number of progesterone receptors in all uterine compartments of the experimental group was 986 Significantly lower level of progesterone while higher levels of estrogen level were noted in the experimental group as compared to control group

Conclusion: Long term mifepristone administration suppresses the endometrial proliferation The number of progesterone receptors in all uterine compartments of the experimental group were decreased and found statistically significant It also lowered the plasma concentration of progesterone. While the plasma concentration of the estrogen was raised

Frequency of hepatotoxicity caused by ATT in pulmonary tuberculosis

Tuberculosis is common disease caused by Mycobacterium Tuberculosis. Tuberculosis is one of the world's most widespread and deadly illnesses and infects an estimated 20-43% of the world's population and kills about 3 million people each year in the world. The common side effect of antituberculous drugs is hepatotoxicity. This study was carried out to determine the magnitude of hepatotoxicity caused by antituberculous drugs in patients of pulmonary tuberculosis. To determine the frequency of hepatotoxicity caused by ATT in pulmonary tuberculosis. Frequency of hepatotoxicity. Cross sectional study. This study was carried out in collaboration of Department of Medicine and Department of Pulmonology, Chandka Medical College, Civil Hospital Larkana from November 2010 to May 2011. Subjects: All consecutive sputum smears or culture positive patients or radiological evidence of active pulmonary T.B of either sex, older than 15 years of age were included in the study. After approval of ethical committee for medical research of Shaheed Mohtarma Benazir Bhutto University Larkana, informed written consent was taken from newly diagnosed patients of pulmonary tuberculosis for participation in the study. Blood samples were taken, coded and sent for determination of liver function test. Final outcome was measured at the end of 4th week. The data was analyzed using SPSS version 17. A total of 256 patients were enrolled in this study during study period. The mean age of enrolled participants is 41.5 +/- 18.1. Of 256 patients, 132 [51.6%] were male and 124 [48.4%] were female. The male to female ratio was 1.06:1. Mean serum bilirubin was 1.5 +/- 0.7 mg/dl [Range l.l-3.9mg/dl], the mean alanine transferase level was 34.7 +/- 11 IU/L [Range 11- 109 IU/L], aspartate transferase level was 35.4 +/- 19.3 IU/L [Range 11-112 IU/L] and alkaline phosphatase level was 150 +/- 38 IU/L [Range 95-280 IU/L].The frequency of hepatotoxicity was 51 [19.9%]. Hepatotoxicity was observed in 25-35 age group was 21.7% and 56-65 years was 26%. Hepatotoxicity was observed in 23.4% female and 16.7% male. It is concluded from this study that patients taking anti tuberculosis therapy are vulnerable to hepatotoxicity. Screening should be done after starting of ATT in order to avoid liver damage

Induced abortion - a continuing threat to maternal life

In Pakistan, therapeutic induced abortion is a controversial issue and continued to be a significant contributor of maternal mortality and morbidity. The aim of the present study is to assess the magnitude of septic abortion in a tertiary care hospital over a period of 2 years with special emphasis on maternal mortality and morbidity. This prospective study was aimed to determine the frequency of induced abortion, to know the reason for requesting abortion, assess the associated maternal morbidity and mortality in our setup. Descriptive study. This study was conducted at the Department of OBGY, PUMHSW Nawabshah from 1[st] January 2009 to 31[st] December 2010. Hospital record of patients who were admitted with unsafe abortions in 2 years [2009- 2010] were reviewed to evaluate the demographic and clinical profile in relation to age, parity, marital status, indication and method of abortion, qualification of abortion provider and maternal mortality. Unsafe abortion contributes 4.4% of total patients admitted with abortion over 2 years. Mean age of them was found +/- SD 30.14 + 8.56 and mean parity was 6.07 +/- 3.00. 78.6% patients belong to poor community and > 70% patients were married and used it as a method of contraception. Uterine instrumentation was the commonest method [78%] used to induce abortion. Majority of women were admitted with life threatening complications like haemorrhage [75%], sepsis [53.57%], hypovolumic shock [39.28%] and faecal peritonitis in 21.42%. DIC in 10.71%, uterine perforation in 28.57% and mortality in 4 [14.28%]. 5 [17.85%] were managed conservatively, 13 [46.42%] had re-evacuation, 10 patients had exploratory laparotomy, out of them 2 needed peritoneum toilet, while in 5 patients gut resection and anastomosis and in one permanent colostomy was done. Uterine trauma found in 8 patients [28.57%] in whom 3 [10.70%] ended up in hysterectomy. Unsafe abortion contribute 14.28% of death in study group. The present study conclude that unsafe abortion is a major neglected health issue needs attention and high degree of commitment. Its elimination requires advocacy, policies to support woman right and improving access to family planning services

Paraphenylene diamine poisoning: our experience at PMC Hospital Nawabshah

The aim of this descriptive, case series study was to study demographics, clinical features and outcome of paraphenylene diamine [PPD] [commonly known by local people as 'kala pathar'] poisoning admitted to our intensive care unit [ICU] from June 2009 and May 2012. All cases of PPD poisoning admitted to ICU of the Peoples Medical College Hospital, Nawabshah, between June 2009 and May 2012 were included in this study. Demographic features, clinical features and outcome of patients were recorded. A total of 16 poisoning cases were admitted to the ICU. The mean age was 25.87 +/- 5.59 years; a majority of the patients were young females [21-30 years] and belonged to a low socioeconomic class. The main cause was intentional suicidal ingestion. Cervicofacial edema, throat pain, dysphagia, dysphonia, and stridor were the earliest clinical findings. Rhabdomyolysis, hepatitis and acute renal failure dominated the clinical picture during the later course of poisoning. Active pharmacological intervention, elective tracheostomy and assisted ventilation were the therapeutic measures required for survival. A high mortality rate [37.5%] was observed in the study. Paraphenylene diamine [PPD] poisoning is associated with high morbidity and mortality

Association of hepatitis [B, C and D] viral infection to gallstones in cirrhosis of liver

To observe the association between hepatitis viral [B, C and D] infection to gallstones in liver cirrhosis. A cross-sectional and hospital based study. This study was carried out at the Hepatology Clinic of CMC, Larkana during January 2011 to December 2011. 913 patients of cirrhosis of liver presenting at Hepatology Clinic of CMC, Larkana during January 2011 to December 2011 were enrolled for study. After informed written consent, blood samples were drawn for HBsAg, anti -HCV antibodies, and anti-HDV Antibodies by ELISA. Ultrasound of all cases was performed to detect gallstones and study the related radiological features. The data was transferred and analyze using SPSS version 17. Means of numeric response variables and categorical response variables were compared by chi-square test and odd ratios calculated when and where applicable. P value less than 0.05 was taken as statistically significant. HBsAg, Anti-HCV Ab and Anti-HDV Ab were documented in 272 [42.2%], 253 [39.3%] and 178 [27.6%] patients respectively. HCV co infection with HBV and HDV was documented in 56 [8.7%] and 44 [6.8%]. Gallstones were detected in 269 [29.5%] cirrhotic patients, of these 136 [14.9%] were multiple. Statistically significant association was observe between gallstones and HBsAg seropositivity with odd of 2.17 [95% CI: 1.62 - 2.90] and p value less than 0.001. There was no statistically significant association between Anti-HCV Ab and Anti-HDV Ab seropositivity with gallstones in cirrhosis of liver. HBV infection is documented more frequently in cirrhosis with gallstone. Female were more likely to be infected. HBV infection may be one of the risk factor for development of gallstones in cirrhosis of liver

Stapled hemorrhoidectomy in third degree hemorrhoids: a prospective study

To study the outcome of Stapled haemorrhoidectomy in 3rd degree hemorrhoids. 50 patients, who underwent stapled hemorrhoidectomy, were included in this study. The study took place at Surgical Unit-I, Civil Hospital, Karachi, from January 2009 to December 2010. Prospective interventional study. Stapled hemorrhoidectomy [SH] was performed in 3rd degree haemorrhoids in 50 patients. 3 patients had minimum pain and only 1 patient had persistent pain and one patient had post-operative minor bleeding which was managed conservatively. SH is an effective surgical procedure for the treatment of 3rd degree haemorrhoids. There is strong evidence that SH results in less postoperative pain than other procedures as well as earlier mobility. In our experience, SH is the treatment of choice for third degree hemorrhoids in hospitalized patients

Frequency of hepatitis D virus infection in hepatitis B surface antigen-positive liver diseases

To determine the frequency of HDV among hepatitis B surface antigen [HBsAg]-positive liver disorders. An observational cross-sectional study. Medical Unit I, Chandka Medical College Hospital, Larkana, from July 2003 to June 2008. Adult patients with HBs liver related disorders were evaluated for the presence of delta antibodies using commercially available ELISA kits. Descriptive statistcs were used for describing data. Proportions of anti D antibodies between gender and age were compared using chi-square test with significance at p < 0.05. Of the 774 cases, 438 were males [60.4%] and 336 were females [39.6%]. The mean age was 36.5 +/- 14.39 for males and 34.03 +/- 13.16 years for females ranging from 15 to 60 years. Anti-HDV was positive in 183 patients [23.6%].The frequency of HDV was not significantly different between the gender groups [p=0.718]. HDV infection was markedly higher in chronic than acute liver disorders. The HBV/HDV co-infection is frequent in the studied area. Therefore, practitioners and health care managers should be made aware of the risk of dual infection with HBV and HDV

Risk factors in various subtypes of ischemic stroke according to TOAST criteria

To identify the frequency of risk factors in various subtypes of acute ischemic stroke according to TOAST criteria. Cross-sectional, observational study. Ziauddin Hospital, Karachi, from January to December 2007. Ziauddin Hospital, Karachi, from January to December 2007. Patients with acute ischemic stroke were enrolled. Studied variables included demographic profile, history of risk factors, physical and neurological examination, and investigations relevant with the objectives of the study. Findings were described as frequency percentages. Proportions of risk factors against subtypes was compared using chi-square test with significance at p< 0.05. Out of the 100 patients with acute ischemic stroke, mean age at presentation was 63.5 years. Risk factor distribution was hypertension in 85%, Diabetes mellitus in 49%, ischemic heart disease in 30%, dyslipedemia in 22%, smoking in 9%, atrial fibrillation in 5%, and previous history of stroke in 29%. The various subtypes of acute ischemic stroke were lacunar infarct in 43%, large artery atherosclerosis in 31%, acridoembolic type 8%, stroke of other determined etiology in 1% and stroke of undetermined etiology in 18%. Hypertension and Diabetes were the most association was found with ischemic heart disease [p=0.01]. Importance and relevance of risk factors evaluated for subtypes rather than ischemic stroke as a whole should be reflected in preventive efforts against the burden of ischemic stroke

Validity of pneumonia severity index and CURB-65 severity scoring systems in community acquired pneumonia in an indian setting.

Background. Little information is available from India regarding prognostic factors in patients with community acquired pneumonia (CAP). Methods. Hospital-based prospective study to test the validity of pneumonia severity index (PSI) and the confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65) risk scoring systems in patients with CAP (n=150). Results. Although both CURB-65 class ³III and PSI class ³IV were 100% sensitive in predicting death, CURB-65 class ³III had a higher specificity (74.6%) than PSI class ³IV (52.2%) when used to predict death. In both PSI and CURB-65 risk scoring systems, mortality rate, need for intensive care unit (ICU) admission, prolonged need for intravenous (I.V.) antibiotics, prolonged duration of hospital stay and need for admission to ICU increased progressively with increasing scores. The PSI class ³IV was more sensitive in predicting ICU admission than CURB-65. The duration of hospital stay was found to have a weak but significant correlation with PSI and CURB-65 criteria. Defervescence time also had a very weak but significant correlation with PSI and CURB-65 criteria. Duration of I.V. antibiotics had a moderately strong correlation with CURB-65 criteria but a weak correlation with PSI criteria. Conclusions. Both PSI and CURB-65 were found to have equal sensitivity to predict death from CAP. Specificity of CURB- 65 was higher than that of PSI. However, PSI was more sensitive in predicting ICU admission than CURB-65.