Infectious diseases in the aftermath of monsoon flooding in Pakistan

Pakistan is ranked 9th in terms of flood-affected countries worldwide. In the summer of 2010, the northern province of Khyber-Pakhtunkhwa received more than 312 mm of rain in a 56 hour period. This resulted in over 1 600 deaths across the region. In addition, over 14 million people were directly affected by this record-breaking deluge. Flood affected regions serve as ideal breeding grounds for pathogens, leading to the spread of diseases. The poor standards of hygiene in camps set up for individuals displaced by the floods also contribute to this. It is essential that those involved in relief efforts are aware of the epidemiology of diseases that have historically seen a sudden upsurge after natural disasters. Keeping this in mind, we conducted a simple review of literature. An extensive literature search was conducted using the PubMed data base and online search engines. Articles published in the last 20 years were considered along with some historical articles where a background was required. Seven major diseases were identified to increase substantially in the aftermath of natural disasters. They were then classified into acute and sub-acute settings. Diarrhea, skin & eye infections and leptospirosis were identified in the acute setting while malaria, leishmaniasis, respiratory infections and hepatitis were identified in the sub-acute setting.

A case of cellulitis of the hands caused by a predatory bird attack

Many species have been drastically affected by rapid urbanization. Harris's hawks from their natural habitat of open spaces and a supply of rodents, lizards and other small prey have been forced to change their natural environment adapting to living in open spaces in sub- and peri-urban areas. Specific areas include playgrounds, parks and school courtyards. The migration of this predatory species into these areas poses a risk to individuals, and especially the children are often attacked by claws, talons and beaks intentionally or as collateral damage while attacking rodent prey. In addition, the diverse micro-organisms harbored in the beaks and talons can result in wound infections, presenting a challenge to clinical management. Here we would like to present a case of an 80-year-old man with cellulitis of both hands after sustaining minor injuries from the talons of a Harris's hawk and review the management options. We would also like to draw attention to the matter that, even though previously a rarity, more cases of injuries caused by birds of prey may be seen in hospital settings.

Knowledge, attitude and practices regarding sleep and sleep hygiene among patients presenting to out-patient and emergency room services at a teaching hospital in Karachi

To study the knowledge, attitude and practices with regards to sleep and sleep hygiene among patients visiting the Out-Patient and Emergency Room services at a teaching hospital in Karachi, Pakistan. A questionnaire-based cross-sectional survey was conducted at the Out-Patient and Emergency Room services of Aga Khan University Hospital, Karachi, Pakistan. The questionnaire included demographic profile of the participant and questions based on the study objective. The details of the study were explained to the participants, a written Informed Consent was taken and confidentiality was assured. Those who could not read or write or understand english were assisted accordingly. Three hundred seventy six respondents were interviewed, the majority being women [57.7%] and married [62.2%]. A majority 212 [56.4%] respondents were between 25 and 49 years of age. The majority of the respondents had acquired above grade X [Matriculation] education, and were either students or housewives or in private service. The mean number of hours of sleep per day was 7.03 hours. About 60.4% of the respondents sleep 6-8 hours and 23.7% of the respondents believe sedatives should be used in case of insomnia while 9.0% of the respondents actually take sleeping pills. Only 33.8% of the respondents always feel fresh on waking up in the morning. Disruptions and snoring during sleep have been reported. About 27.1% of the respondents have rated their sleep quality as five or less, based on the rating scale 1-10 with 10 being highest quality. Sleep and sleep hygiene is a neglected area of clinical care requiring further research and intervention in terms of educational programs for patients