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

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

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