Mental health of doctors: A preliminary online survey during the current pandemic

Background: Corona virus disease 2019 pandemic (COVID-19), has posed significant mental health challenges. Psychological morbidities among Indian doctors has not been extensively examined. In order to plan appropriate interventions, it is imperative to know the details of the mental health condition of our doctors especially so during this period of enormous physical and mental challenges brought by the current pandemic. Methodology: The present findings, are from an online survey done to briefly assess the mental health status of doctors. The survey was done, through a questionnaire, generated by the authors, from items of Mini International Neuropsychiatric Interview (MINI) version 6. Results: A total of 274 responses were received and 242were analysed. Mean age of the participants was 37.21 Years (SD = 10.70). 61.98% of the participants were males. 42.14% were resident doctors, 44.21% were faculty members. Majority of the doctors reported having some psychiatric symptom. Only, 0.83% reported having suicidal ideation. None of the participants were planning to seek a psychiatric consultation, in near future, for the psychiatric problems. There was a positive correlation of psychiatric symptoms, with exposure to COVID-19 duties. Conclusions: Doctors have higher psychological morbidities, but due to various reasons are not willing to address the severity of their symptoms nor are they acknowledging the need for intervention. There is an urgent need, for acceptance and acknowledgement of the psychological problems being faced by this highly demanding, vulnerable population, especially so during the present crisis

Comparison of platelet count by manual and automated method

Background: Since the emergence of dengue fever in the past few years, platelet count has become a routine test in every pathology lab. Common methods are by peripheral blood smears made from blood collected in ethylenediaminetetraacetic acid (EDTA) tubes, by neubaeur chamber, automated method by hematology cell counter.Methods: Blood samples of 460 adult patients and 72 children (<15 years), including indoor and outdoor, between May to August 2019, attending Hind institute of medical sciences, were collected in EDTA tubes. Samples were properly mixed on blood shaker and immediately peripheral blood smears were made and stained with Leishman stain. Platelet count of every sample was done by peripheral blood smear and by Mindray (BC5150) automated cell counter, simultaneously.Results:  Results by manual slide method are slightly higher than automated method but significantly not different from automated method.Conclusions: Traditional slide method can also be used if done carefully comparable to automated method especially useful in small labs which can’t afford automated cell counter.

Clinical and demographic profile of paediatric patients presenting with acute diarrhea

Background: Diarrhea is a public health problem globally, being the 2nd leading cause of death in children under 5 years. Dehydration as well as malnutrition are also serious consequences of diarrhea. This study was carried out with an aim to focus on the clinical and demographic profile of diarrheal patients of pediatric age.Methods: Infants and children aged 6 months to 5 years were analysed for age and gender distribution, chief complaints, feeding practices, nutritional status and assessment of dehydration; from January 2018 to June 2019 in the Department of Pediatrics of a Tertiary Care Teaching Hospital.Results: Total 150 patients were analysed. Almost 50.67% group A and 41.34% group B patients belonged to toddlerhood. Male preponderance was also noted. Along with diarrhea, vomiting was noted in 22 group A and 21 group B and fever in 19 group A and 29 group B patients. Approximately 41-45% patients had no malnutrition and 55-60% had no dehydration in both the study groups.Conclusions: There is lack of awareness regarding dog bite and its management among the rural people fever and vomiting were most frequently associated with diarrhea. A little less than half of the study participants had some-dehydration. Nearly half of the patients belonged to toddler age group. Majority of the patients were exclusively breast-fed for six months.

Anthropometric Profile and Nutritional Status in Children with Generalized Epilepsy

Background: Epilepsy is widespread in developing countriescompared to that in developed countries. The reason ofepilepsy in most cases is unknown. Considering the factthat the nutritional status of children in developing countriesis generally poor, our objective was to determine possiblerelationship between nutritional status and epilepsy.Material and methods: Towards this, we gather a datasetof 34 Cases from the Department of Pediatric and as manyControls from the local populace. The age group (5-8.5 years),sex, and gender data is also augmented with educationaland socioeconomic history along with the results of clinicalexaminations, such as, weight, height and body mass index.Results: Our statistical results unveil insignificantdifference in socioeconomic status and educational levels inbetween the parents of Cases and Controls. Additionally, asignificantly higher value of anthropometric measurementsin Controls is observed compared to that of the Casesi.e.Height (117.38±6.05 vs. 112.21±6.82 cm; p value 0.002),Weight (21.29±2.83 vs. 18.14±2.94 kg; p value <0.001) andBody mass index(15.39±1.03 vs.14.33±1.26 kg/m2; p value<0.001).Conclusion: Our results show that generalized epilepsymay have effect on growth and development of children,reflecting that nutritional programs are required to improvethe nutritional status in children with generalized epilepsy soas to optimize their growth and development.

Evaluation of Ossification of Iliac Crest in Children as Per Risser’s Sign in Gurugram Region of Haryana

Background: Risser’s sign is a good indicator of skeletal maturity in pediatric age group. The observations drawn from this can be well documented for the age verification and in relation to some pathologies. Ossification centers are evaluated with their further fusion. Methods: We carried out the evaluation by this sign in judging the exact skeletal maturity. Twenty one individual group comprising of eight females and thirteen males were included in this study. All children underwent pelvic radiography with antero-posterior view. Their iliac crest ossification and fusion was evaluated. Results: Grading of ossification of ileal cartilage was done as per the percentage extent of the ossification from Grade I to V. Conclusion: It was observed that there is delay of skeletal maturity in females as compared to males of the same age group in Gurugram region of Haryana which is contrary to the earlier studies conducted in general.

A curious case of raised gradient across mitral bioprosthetic valve

High Doppler valve gradient is generally suggestive of valve thrombosis. However, it should be corroborated with the finding of restricted leaflet movement to confirm the diagnosis. In the present case, abnormally high gradient was not associated with limited leaflet movements or any valve thrombus.

Clinicopathological Study Of Oral Cavity Mass Lesions In A Tertiary Care Centre Of North India

Background: Oral mass lesions, especially the potentially malignant and malignant lesions are a major health concern for a developing country like India. They pose a serious health and economic burden.Aims: This study was carried out to analyze the clinical profile and reaffirm the frequency of various causes causing mass lesions in oral cavity in different age-groups in a tertiary care centre of North India.Materials and Methods:All patients who had oral mass lesions and attended Departments of Otorhinolaryngology, General Surgery and the Dentistry of Hind Institute of Medical Sciences, Safedabad, Barabanki and Department of Surgery of School of Medical Sciences and Research, Sharda University, Greater Noida in two years (2015-2016) were included in the study.Statistical Analysis:All the analysis was carried out on SPSS 17.0 version (Chicago, Inc., USA). The results are presented in percentages. The Chi-square test was used to assess the associations between categorical variables. The p-value<0.05 was considered significant.Results:Of 126 cases with oral lesions, we found that 66 (52.4%) were benign, 12 (9.5%) were pre-malignant and 48 (38.1%) were malignant lesions. Squamous papilloma was the most common benign lesion followed by fibroepithelial hyperplasia. The premalignant lesions observed in our study in the decreasing order of frequency were leukoplakia, lichen planus and submucous fibrosis. The malignant lesions comprised of squamous cell carcinoma and verrucous carcinoma. Conclusion:In our study it was found that though the benign oral lesions are commoner that malignant but still these form significant numbers. Hence the origin and the nature of oral cavity lesion should not be decided on clinical assessment alone but should also take into account the histopathological evaluation of the lesion also.

Provincial differences in levels, trends, and determinants of childhood immunization in Pakistan

Background: Efforts to improve immunization rates are urgently needed in Pakistan but national statistics mask important local differences in immunization levels and determinants.

Aim: In this study we aimed to determine how similar or different are recent trends and levels of immunization coverage in Pakistan's 4 main provinces [Punjab, Sindh, Khyber Pakhtunkhwa [KPK] and Balochistan], and what factors are associated with complete childhood immunization in each province.

Method: We analysed data from the 2006–07 and 2012–13 Pakistan Demographic and Health Surveys. Trends in immunization coverage among children aged 12–23 months were calculated for each province. Bivariate and multivariate analyses were conducted to identify factors associated with complete immunization.

Results: The proportion of children completely immunized had risen significantly in Punjab but had fallen significantly in Balochistan. Complete coverage ranged from 16.4% in Balochistan to 65.8% in Punjab [2012–13]. Tetanus toxoid injection during pregnancy was a significant predictor of complete immunization everywhere. Other predictors in specific provinces were: urban residence in Balochistan, wealth in Sindh and KPK, mother's education in Punjab and KPK, and distance to the facility in Punjab.

Conclusions: Although some strategies to increase immunization coverage are relevant nationwide, programme managers need to seek solutions specific to provincial trends and predictors. This analysis demonstrates that viewing childhood immunization in Pakistan through a provincial lens can help achieve a deeper understanding of the challenges and potential strategies to boost coverage

Cardiac Output Assessment by Transthoracic Electrical Bio-impedance in Patients of Acute Myocardial Infarction: Comparative Analysis with Echocardiography.

Objectives: Transthoracic electrical bio-impedance (TEB) has been proposed as a non-invasive and continuous method of cardiac output (CO) measurement, but it still has not found wide usages in clinics. The present study measured CO, using a new instrument NICOMON, and compared it with Echocardiography (ECHO) in acute myocardial infarction (AMI) patients. Methods: In the present study 100 patients of AMI were assessed by both ECHO and NICOMON for cardiac output and ECHO is considered as a reference method for comparison. TEB CO was measured by passing an alternating current and measuring the bio-impedance across the thorax. End diastolic volume (EDV), End systolic volume (ESV) & Left ventricular outflow tract (LVOT) diameter, measured by ECHO were used to calculate CO. Various statistical methods like “t”-test & correlation coefficient (r) were used where found suitable. Results: Mean TEB-CO (4.03±1.11 l/min) was significantly higher (p<0.001) than mean ECHO-CO (3.80±1.28 l/min) with a mean difference of 0.25±1.02 l/min. Conclusions: NICOMON measures CO non-invasively but, it needs more elaborative studies on a larger sample to establish it as an alternative method of ECHO for cardiac output measurement on regular basis.

Efficacy of steroid injection in the treatment of trigger finger

Objective:To assess the efficacy of local steroid injection in trigger finger

Materials and Methods:This prospective study was conducted at department of Orthopaedics,Civil Hospital, Dow University of Health Sciences, Karachi, from March 2012 to 2013. Males and females with complain of trigger finger were included in this study during the specified period. All patients were injected depomedrol with plain xylocaine at the nodule site and functional outcome was assessed with respect to pain relief and finger movement

Results: Study included 43 patients with trigger finger.29 were males and 14 were females. Right hand fingers were involved in 24 patients, remaining had left hand fingers involvement. 10 involved the index finger,7 middle finger, 4 ring finger,10 little finger and 12 thumb. 9 patients had associated rheumatoid arthritis and 15 were known cases of diabetes. Remaining patients were primary with no known co-morbid. All patients had pain relief initially and regained movement of finger. 10 patients required repeated injection after 3 months. Maximum pain relief and regaining of movement after steroid injection was 4 months

Conclusion:Local steroid injection provides excellent symptomatic pain relief and regained movements without any complication in patients with trigger finger

Radial head fracture mason type III and IV treated with K-wire Fixation

Objective: To assess the functional outcome of radial head fracture Mason type III and IV treated with K-wire fixation

Materials and Methods:This prospective study was conducted at Department of Orthopaedics,Civil Hospital,Dow University of Health Sciences Karachi from 2013 to 2015. Patients with Radial head fracture type III and IV were included in the study

Results:A total of 42 patients were included in this study. Out of these 36 were males and 6 were females. Right side was injured in 18 patients and left side in 24 patients. 32 patients were with Mason type III radial head fracture and 10 were Mason type IV fractures. All fractures were fixed with open reduction and internal fixation with K-wire. Lateral approach was used in all fractures. In Type IV elbow was reduced with close technique. Outcome was measured on the basis of Morrey elbow scoring system. 22 patients with type III radial head fracture had excellent results while10 with type III had good result. All patients with radial head fractureType IV had good results

Conclusion:Assessment of functional outcome of radial head fracture Mason type III treated with K-wire fixation showed excellent outcome in majority of patients while Type IV had good outcome.Mason type III radial head fractures should be reduced and fixed with K-wire. It maintains the stability of elbow joint and elbow function

Imaging changes after breast reconstruction with fat grafting - retrospective study of 90 breast cancer

Objective: To evaluate the breast imaging changes after fat grafting and its impact on cancer follow up

Methods: This is a retrospective observational study conducted on patients who underwent fat grafting for breast reconstruction. We reviewed mammographic and ultrasound images of patients. Fisher's exact test was used to analyze results. The level of significance was set at P < 0.05

Results: A total of ninety patients with breast cancer had fat grafting. Fifty eight patients for defects following post mastectomy reconstruction and 32 for wide local excision defects. The mean follow up was 37.4 months. Benign lumps were identified in 23/90 cases [25 percent].Mammograms were reported as BIRADS I in 21/32 cases [72 percent] and BI-RADS II in 8/32 cases [28 percent]. BI-RADs III score was reported in two patients on further follow up imaging, both were re-classified as BI-RADS II after biopsy. A total of eight patients [8.9 percent] required biopsy. No local recurrences or new cancers were observed in any patients

Conclusion: Our study suggests radiological changes after fat grafting are almost always benign with no adverse outcome on cancer follow up

Outcome of four years experience in laparoscopic ventral hernia repair

To find out the short term outcomes of laparoscopic ventral hernia repair [LVHR] during the last four years. It was a descriptive and prospective case series of 53 consecutive patients out of 107 at Department of General Surgery, Jinnah Post Graduate Medical Center, Unit II, Karachi, from January 2009 to December 2012. These patients were admitted through out patient department with complain of lump, pain and discomfort. Most of the patients were obese. All patients were clinically examined and baseline investigations done. Fifty three [49.5%] patients underwent laparoscopic repair with mesh placement and remaining 54 by open surgical repair. Among 53 patients, mean age was 46 years range [30 - 55]. While females were 33[62.2%] and males 20[37.7%]. We observed variety of hernias, in which midline and epigastric hernia were predominant. The commonest symptom was lump and dragging sensation. The duration of symptoms ranged between 6 months to one year. About 53 patients [49.5%] had laparoscopic repair with mesh placement. Average hospital stay was two days. Out of 53 patients, 4 [7.5%] had cellulitis at trocar site, seroma in 2[3.7%], 2[3.7%] patient complained of persistent pain postoperatively, port site minor infection was in 2[3.7%] patients, while conversion to open approach was done in 2 [3.7%], postoperative ileus was observed in one [1.8%] patients. This study provides the evidence that, laparoscopic repair with mesh placement in ventral hernia is safe and effective approach compared to open surgical procedure. It has a low complication rate, less hospital stay and low recurrence

Outcome of nonunion femur with Ilizarov technique

Objective: to find the outcome of Ilizarov technique in nounion femur patients

Study design: descriptive case series

Place and Duration of study: department of Orthopaedic Surgery Dow University of Health Sciences / Civil Hospital Karachi, from 1999 to 2014

Methodology: all patients with nonunion of femur with and without bony defect were included in this study. Bone loss cases because of other reasons like congenital causes and bone tumors, were excluded

Results: forty-eight patients with nonunion femur were included in this study. The number of males was 44 and females 4. The mean age of patients was 27 year [range: 07 year to 59 year]. The mode of injury was road traffic accident in fifteen patients, firearm injury in five, crush injury in earthquake in one, postsurgical implant infection in nineteen and chronic osteomyelitis in seven. Nonunion was in proximal femoral segment in three patients, midshaft in sixteen and distal femur in twenty-nine cases. Segmental bone loss was present in thirty-one patients. Preoperative shortening was in noted in thirty-four patients. Ilizarov external fixator yielded excellent and good outcome in majority of the patients for the gap nonunion of femur. Bone transport was needed in few cases

Conclusions: Ilizarov external fixator yielded excellent and good outcome in majority of the patients for the gap nonunion of femur. Bone transport was needed in 10 cases

Outcome of intraarticular communicated fractures distal radius treatment with orthofix external fixators

Background: Assess the outcome of intraticular comminuted fracture distal radius treated with orthofix external fixator

Methods: Prospective study with inclusion criteria of Comminuted intraarticular fractures distal radius, 20 to 60 years age, close and open fractures and exclusion criteria of patient above 60 years, extraarticular fracture, volar and dorsal barton fractures, more then 10 days old fracture

Results: From Januarry 2012 to sept 2014, 63 patient with intraarticular comminuted fracture distal radius treated with orthofix external fixator included in this study. Functional outcome was assessed on Gartland and Wesley scoring system. 40 [63%]male and 23[37%] female patients, 35[56%] road traffic accident and 28[44%] have fall. AO C1, were 32[51%], C2 ,19[30%], C3, 12[19%] patients. Additional kwire fixation applied in 54 patients.Fixator removed at 6 weeks. Functional result were excellent in 26 patient[41%], good 32[51%], satisfactory in 4 patient[6%], poor in 1[2%]. Complication observed were, minor and major pin track infection 30[65%], tethering of external indicis tendon 3[7%] patient, k wire loosening 10[22%] and sudecks atrophy 3[7%] patients

Conclusion: Orthofix external fixator application in intraarticular comminuted fracture distal radius is recommended because it is minimal invasive technique ,have excellent to good outcome . Most of the times needs additional kwire fixation for the fragment stabilization

Frequency of wound infection in open mesh inguinal hernioplasty

Objective: To analyze the frequency of surgical site infection in mesh open inguinal hernioplasty with single prophylaxis dose antibiotics and to find out organisms and its sensitivity

Study design: A Prospective interventional study

Place and duration: Jacobabad institute of medical sciences [JIMS], previous name of District head quarter hospital Jacobabad Sindh from 1st June 2009 to 30th April 2012

Methodology: The study comprises of 215 cases who underwent open mesh inguinal hernioplasty. Preoperative assessment was done for fitness of anesthesia before mesh repair. A single dose i/v antibiotic used, and early post operative surgical site infection examined. Wound site edema, redness, seroma, and pus discharge data collected. Culture was done to identify common organisms in wound infected cases. The data was collected and analysis done to see frequency of wound infection and sensitivity of infecting organism

Results: The frequency of surgical site wound infection was observed in 3.2%, and in these pus culture report showed that staphylococcus aures was commonest and E-coli organism was second common cause of superficial surgical site infection

Conclusion: The frequency of surgical site wound infection is low in Open inguinal mesh hernioplasty with single dose antibiotic prophylaxis and the Staphylococcus aueres was the common culprit organism

Realty or myth hyponatremia is common in admitted patients in medical wards lumhs Hyderabad

OBJECTIVE: To see the frequency of hyponatremia in hospitalized patients of medical wards at Liaquat university hospital Hyderabad

METHODOLOGY: In this Descriptive Cross-sectional Study we included 200 patients admitted in medical wards of Liaquat University Hospital Hyderabad from 1st July to31 august 2013, Serum sodium level of these patients was sent and results were recorded on a preformed profarma. We included all patients admitted in ward through emergency or out patients department

Inclusion Criteria: In this study patients attending emergency and OPD were included in between age of 12 years to 80 years

Exclusion Criteria: In this study we excluded all patients with acute myocardial infarction ,angina ,and traumatic emergency

RESULTS: Among 200 patients, we found 44%[88] patients having hyponatremia with 36%[72] patients with mild to moderate hyponatremia and 8% [16] patients have moderate to severe hyponatremia

Males have increased frequency of hyponatremia then females. Study concludes that frequency of hyponatremia is more frequent with increasing age

CONCLUSION: Hyponatremia is common problem seen in admitted patients in male wards

Frequency of malnutrition inflammation complex syndrome in patients with end stage kidney disease on maintenance hemodialysis presenting to tertiary care hospital, karachi

OBJECTIVE: To determine the frequency of Malnutrition Inflammation Complex Syndrome [MICS] in patients with End Stage kidney disease on maintenance hemodialysis patients presenting to tertiary care Hospital in Karachi

DESIGN: A cross sectional study

SETTINGS: Department of Nephrology Jinnah Postgraduate Medical Center, Karachi

METHODS: Total of 62 patients was included through non-probability purposive sampling

All patients diagnosed with End stage kidney disease on maintenance hemodialysis [twice week for >3months] were included and patients with acute kidney injury, chronic infections and chronic liver disease were excluded. Malnutrition inflammation score [MIS] was used to determine malnutrition inflammation complex syndrome [MICS]. Mean and standard deviation were calculated for continuous variables, and percentages or proportions for categorical variables

Chi square test was used to determine the proportion of MICS in Maintenance Hemodialysis patients

RESULTS: Mean age was 46 years +/-12.59 SD [range 18-72 years]. 34 [55%] were females and 28 [45%] males. 26 [42%] patients had duration of Maintenance Hemodialysis<1 years and 28[45%] between 1-4 years. Frequency of malnutrition complex syndrome [MICS] in patients with end stage renal failure was noted in 60 [97%] patients, out of these 31[50%] patients had mild MICS and 29 [47%] patients moderate MICS. Mild and Moderate malnutrition complex syndrome [MICS] was more observed in age group of 31-40years [12% in mild and 14% in moderate [MCIS].Moderate MICS was higher in females and mild MICS was higher in male patients

CONCLUSION: Our study concluded that most [97%] of our patients with end stage kidney disease on maintenance hemodialysis has evidence of malnutrition inflammation complex syndrome

Cutaneous changes in chronic kidney disease patients on maintenance hemodialysis visiting at tertiary care hospital, Karachi

Objective: To determine the frequency of cutaneous changes in patients with chronic kidney disease on maintenance hemodialysis

Methods: A cross-sectional study conducted at Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi from 1[st] August 2009 to 31[st] January 2010. A total of 100 patients with chronic kidney disease on maintenance hemodialysis were included. After taking demographic data, cutaneous changes were noted. Mean and standard deviation were computed for quantitative variables [age] and frequency and percentage were computed for categorical variable [sex, cutaneous changes]

Results: Mean age was 52.58+/-13.84 years and out of 100 patients 56% were males. At least one skin change was noted in 91%. Among type of manifestations, xerosis was noted in 96%, generalized xerosis 70%, alopecia 70%, half-and-half nails 36%, scaling 20% and ichthyosis 10%. Pruritus was found in 64%, out of these 93% had mild to moderate intensity and 7% had severe intensity of pruritus

Conclusion: Chronic kidney disease is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. Xerosis and pruritus were most common among patients with CKD, so early recognition of cutaneous signs can relieve suffering and decrease morbidity