Nutritional assessment of school going children in district Abbottabad, K.P. Pakistan

Background:To assess the nutritional assessment of the primary school children in Abbottabad. Methods:A descriptive cross-sectional study, conducted among children of private and public sectors primary schools of Abbottabad from January -September 2018 by simple random sampling. 200 students from each school (7 and 13 years), present on the day of data collection were included in this study and those who were absent, sick or not willing, were excluded. The data was collected on apre-tested questionnaire.Results:Total 200 students, males 49.5% (n=99) and females 50.5% (n=101) were interviewed and assessed for their nutritional assessment. Their mean age was 11.67±1.66years, height was 144.93±12.34 cms and weight was 37.69±12.96 kgs. Male students (n=67) 67.7% and from private schools (n=67) 65.7% were healthier then female (n=55) 55.4% and government schools (57.1%), P valve 0.085 and 0.026. Most of the students with grade C in last year school performance were underweight (100%). Raven Test for both types of school gave 0.012 P value which indicated more intelligent students resides in private schools. Furthermore, children of well-serviced fathers and qualified mothers were healthy, more intelligent and practiced good hygiene.Also, children of a private school who has better nutritional status scored more than Public school children.Conclusions:Nutritional status of children have a direct effect on their cognitive abilities. Private school children who have scored better in the intelligence test, have better nutritional status. Socioeconomic status and mother qualification have a direct effect on children’s nutrition, health status, school performance and hygiene.

experience with ventriculoperitoneal shunting at keen’s point for hydrocephalus

Objective: This study was conducted to assess outcomes in patients with hydrocephalus who underwent ventriculoperitoneal shunting at Keen's point

Methods: This retrospective study was conducted in Combined Military Hospital [CMH] Peshawar. Time frame was four years from January 2011 to January 2015. The presenting complaints, clinical findings, investigations, treatment plans and surgical outcomes were noted. Ventriculo-Peritoneal [VP] shunting was done at Keen's point. The presence of shunt complications in the first week post-surgery was noted and at a three-month follow up in the outpatient department. General condition of the patient, shunt complications, presence of seizure and worsening of vision were noted

Results: Study included 143 patients, out of whom 46 were females and 95 were male patients. Most common causes of hydrocephalus were congenital [79]. Majority of adults had hydrocephalus due to central nervous system tumors while congenital hydrocephalus in children was most frequently due to aqueductal stenosis. Good clinical improvement was seen in 114 patients after shunt placement, satisfactory in 20 patients, 7 patients died while we observed no change in two patients

Conclusion: Our experience with VP shunting at Keen's point resulted in excellent outcomes. It can be used for the management of hydrocephalus both in pediatric as well as adult population

Radiological and clinical outcomes in patients undergoing anterior cervical discectomy and fusion: comparing titanium and peek [polyetheretherketone] cages

Objectives: To study clinical and radiological outcomes in patients who had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK [polyetheretherketone] cages for cervical disc prolapse

Methods: This is a retrospective/non-randomized study which was conducted at the Combined Military Hospital Peshawar. Study interval was four years from 1st October, 2010 to 31st September, 2014. Total number of included patients were 149. All of the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK [polyetheretherketone] cages. All of the patients had plain MRI cervical spine done for diagnosis of anterior cervical disc prolapse

Results: Most of the patients had stenosis at the C5 / C6 [PEEK cage group 63% and titanium cage group 47.6%] and C6 / C7 [PEEK cage group 15.38% and titanium cage group 19.04%] cervical level. Bi-level involvement was also seen. In the patients who complained of brachialgia, total resolution of symptoms was seen after the operation. Three [2.01%] of the patients in titanium cage group, who presented with axial neck pain, continued to complain of pain after the operation. Four [2.6%] of the patients in PEEK [polyetheretherketone] cage group and 2 [1.3%] in titanium cage group complained of pain at the donor site [iliac crest]. Fusion rate was 100% with both titanium and PEEK [polyetheretherketone] cages at one year

Conclusion: Results with titanium and PEEK [polyetheretherketone] cages are excellent. There was no significant difference in clinical and radiological outcome between two groups of patients [p > 0.05]. Fusion rate was 100% at one year with both cages

Effect of video games on the aggressive behavior of children

Introduction: Video games are considered to be causing deleterious effect on children as they influence their minds regarding aggression. Aggressive behaviour includes fighting, arguing, yelling and bullying others. The promotion of these emotions by video games depends upon various factors like active parental surveillance and minimizing the number and duration of playing sessions, tactfully

Objective: To investigate the relation between over playing of video games and aggressiveness of children

Study design: Descriptive cross-sectional study

Setting: Community and Elementary schools of Faisalabad

Duration of study: Three months from January to March 2018

Sample size: 100 children. Both male and females were included

Data collection procedure: The children were given survey questionnaires and then assessed accordingly

Results: The children who played games with more violent content were found fighting and arguing in more number. This verified the significance of positive relation between video games and aggression

Conclusion: Video games play a prominent role in boosting the aggressive emotions in children

Disaster management in combined military hospital Quetta

Objective: To review the mass casualty management at Combined Military Hospital Quetta [CMH QTA], from 2012 to 2015 and to recommend measures for enhancement of capabilities in order to handle major mass casualty events

Study Design: Descriptive, cross sectional

Place and Duration of Study: Combined military hospital Quetta, from Jan 2012 to Dec 2015

Material and Methods: This study is a review of the patients brought to CMH QTA, in different types of mass casualty events from 2012 to 2015. The type of trauma, the procedure carried out and the patient outcome in each case was recorded. The data were analyzed and based upon the mortality and morbidity of casualties, the evaluation of facilities available and required was carried out as per Joint Commission on Accreditation of Healthcare Organizations [JCAHO] standards

Results: Over a period of four years, out of 3507, the highest number of casualties [42%] were received in year 2013. Civilians represented the commonest victims [79%] followed by army personnel [13%] and frontier corps [8%]. The gunshot wounds and Improved Explosive Device [IED] blasts were on the top [53.5%] as a cause of mass casualty followed by road traffic accidents [37.5%]. The highest number of patients [89%] underwent minor procedures like debridement, stitching and aseptic dressing. Twenty five percent of patients required a team work of various surgical specialists

Conclusion: The existing resources are sufficient for managing minor and moderate mass casualty scenarios but proper planning and enhancement of resources [equipment, infrastructure and personnel] is essential to cope with any probable major mass casualty event. We recommend training of paramedical staff for receiving, triage, resuscitation and definitive management of casualties

Frequency and antibiogram of isolates from surgical units of a tertiary care hospital in Quetta

Objective: To determine the frequency and antibiogram of the isolates from infected patients in surgical units of a tertiary care hospital

Study Design: Cross-sectional, descriptive study

Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Quetta, from March to October 2015

Methodology: Clinical samples from the surgical units received in Department of Microbiology for culture and sensitivity were analyzed by Gram stain, culture and biochemical tests for identification of the isolates; and the antibiotic susceptibility was determined by modified Kirby Bauer disc diffusion method. Data was analyzed by Statistical Package for Social Sciences [SPSS] version 19

Results: The commonest isolate was Acinetobacter baumannii [22%] followed by Escherichia coli [20%], Pseudomonas spp. [15%] and Methicillin-resistant Staphylococcus aureus [MRSA] [11%]. Acinetobacter baumannii showed highest susceptibility to doxycycline [41%], Enterobacteriaceae to meropenem [96%], Pseudomonas spp. to polymyxin-B [100%] and Gram positive bacteria to linezolid [100%]. Seventy-two percent of the isolates were found to be multi-drug resistant

Conclusion: There was a high infection rate in surgical patients with Acinetobacter baumannii, Eschericia coli, Pseudomonas spp. and MRSA being the commonest isolates. Acinetobacter baumannii showed highest susceptibility to doxycycline, Enetrobacteriaceae to meropenem, Pseudomonas spp. to polymyxin-B and Gram positive bacteria to linezolid

Mini titanium plates; hearkening the end of nonrigid cranial bone flap fixation

Background and Objective: Craniotomy bone flaps should be replaced for both cosmetic and protective purposes. Different methods are available commercially. The aim of this study was to assess outcome of bone flap fixation using mini titanium plates and screws

Methods: Between March 2011 and March 2014, 71 patients underwent cranial bone flap fixation with mini titanium plates and screws after craniotomy and excision of supratentorial lesions at Combined Military Hospital, Peshawar. There were 42 males and 30 females with a mean age of 40.07. All patients had supratentorial lesions. Intracranial lesion size ranged from 3 cm by 2 cm to 7 cm by 5 cm. The changes of local incision and general condition were observed

Results: Subcutaneous effusion occurred in two patients. One patient developed a mild postoperative wound infection. CT scan showed good repositioning of the flap and edge to edge apposition at two weeks after operation. All the patients were followed up for 12 months post operatively. Skull had good appearance without any discharge and, local deformity or effusion. Repeat CT/MRl showed no subsidence or displacement of cranial flap or artifacts

Conclusion: Mini titanium plate and screw fixation of cranial flaps is a simple, cost effective and safe option for repositioning and immediate stability as compared to traditional sutures

Reasons for negligence of oral health care

Objective: The purpose of this study is to evaluate factors responsible for negligence of oral health care in our population

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the Jinnah Medical and Dental College, Karachi from August 2015 to September 2015

Materials and Methods: A questionnaire was structured which was based to evaluate, the background, including age, gender, social and educational level, dental habits and the reasons responsible for them. The data was stored in excel worksheet and was analyzed using SPSS

Results: The major factors responsible for people neglecting oral health care was found out to be the high cost prices of dental treatments by 36%, followed by lack of care seeking attitude by 28% and time management by 23% of people. Socio-Economic status and educational background also had a significant relationship. People from lower socio economic and educational background were seen to be never visiting the dentist. No significant relationship was found with relation to age, marital status, availability of dentist, and dental misconceptions

Conclusion: People are neglecting oral health care mainly due to the high cost price of dental treatments. Care seeking attitude is seen to be absent in our population. Dental health comes last in the set of priorities by the majority of people. Time is another area people find difficult to manage. These areas can be worked upon to decrease the prevalence of dental disease in our population

Parasiticidal and brine shrimp cytotoxicity potential of crude methanolic extract of rind of Punica granatum Linn against round worms and tape worms

Rind of Punica granatum is traditionally used for anthelmintic purposes. The current work describes the possible anthelmintic activity of crude methanolic extract of Punica granatum [Pg. Cr] against round worms [Ascaridia galli] and the tape worms [Raillietina spiralis]. Brine shrimp cytotoxicity is also performed. Brine shrimp cytotoxic activity was tested using different concentrations [1000µg/ml, 100µg/ml and 10µg/ml] of Pg.Cr. In vitro anthelmintic activity of Pg. Cr was determined against the parasites using albendazole and piperazine citrate as st and ard anthelmintic drugs in concentration 10 mg/ml. LC50 value for Brine shrimp cytotoxicity was 189.44+/-28µg/ml. In test concentration of 40mg/ml of the Pg. Cr, Raillietina spiralis was paralyzed in 23 minutes. However, for parasiticidal activity [death of the parasite], it took less time [40 minutes] as compared to st and ard Albendazole. Time taken for death of the parasite Raillietina spiralis, in concentration 40 mg /ml, is 40 min. While st and ard drugs took more time to kill the Raillietina spiralis. Pg. Cr took 19 minutes to paralyze the Ascaridia galli at concentration 40 mg/ml whereas; it took 48 minutes for to kill the parasite Ascaridia galli. The current work confirms the traditional use of rind of Punica granatum as anthelmintic against Raillietina spiralis and Ascaridia galli. Results of brine shrimp cytotoxicity assay warrant for the isolation of cytotoxic compounds. List of abbreviation: Pg. Cr = Crude methanolic extract of Punica granatum

Subdural hematomas following intracranial aneurysm rupture: a rare phenomenon

Acute Subdural Hematoma [aSDH] due to aneurysm rupture and no subarachnoid bleeding are very rare with only 29 cases reported in literature. A 56-year female presented with headache and drowsiness and a previous history of loss of consciousness. Clinical examination revealed a GCS of 14 and a right sided hemiparesis. Workup revealed a pure subdural hematoma due to a middle cerebral artery aneurysm rupture with no subarachnoid hemorrhage. Laboratory workup was otherwise normal and she had no history of falls or head trauma consistent with the usual etiology of an aSDH. She underwent evacuation of the hematoma with clipping of the aneurysm. She had an uneventful recovery with good outcome and no residual neurological deficits at one-year follow-up

Can spinal anaesthesia be a routine for single level lumbar discectomy?

To compare the efficacy of spinal anaesthesia with general anaesthesia for lumbar discectomy in terms of theatre time and post-operative effects. Randomized controlled trial. Neurosurgery department Combined Military Hospital Rawalpindi, from November 2013 to April 2014. A total 60 consecutive patients with herniated lumbar discs were enrolled in this study to undergo randomly into assigned spinal anaesthesia group SA [n=30, group A] or General anaesthesia GA [n=30, group B].Variables included age, gender, level of lumbar disc prolapse, type of anaesthesia, operative time, and combined total theatre time, post-operative pain using visual analogue scale [VAS] and hospital stay in days. Mean theatre time in group A was 62.70 and for group B it was 90.73 [p<0.001]. The mean hospital stay after surgery in group A was 2.0 days and in group B was 2.27 days [p< 0.002]. Peak post- operative pain scores according to visual analogue scale and resultant analgesic requirements in group A was 5.10 while for group B it was 6.87 p< 0.001. Spinal anaesthesia is safe and can be routine anaesthesia for most of the patients undergoing lumbar discectomy

Disorders of the musculoskeletal system amongst practicing dentists

The aim of this study is to find out the frequency of musculoskeletal disorders among dentists working in Karachi and to establish factors associated with these disorders. Cross-sectional descriptive and analytical study. This study was conducted at Jinnah Medical and Dental College, Karachi from June 2014 to August 2014. The data was collected from three dental colleges of Karachi. The study was conducted at Jinnah Medical and Dental College. The study included 222 dentists working in different faculty positions from house officers to professors. The data was collected to find out the frequency of musculoskeletal disorders among dentists working in five different dental institutions of Karachi. A 22-item questionnaire was used to collect the data. The questionnaire was validated among a group of five dentists before using it for final survey. The questionnaire consisted of number of questions about age, gender, number of years in profession, pain in the back and neck, working hours per day, number of patients treated per day, any break taken between patients or not, working with assistant or not, working positions used, and medicines taken due to musculoskeletal pain. The data was stored in excel worksheet and was analyzed using SPSS. 222 dentists from five dental institutions of Karachi participated in the study. The study sample comprised of 90 males [40.5%] and 132 females [59.5%]. The study highlighted that dentist who are involved in clinical practice are more prone to musculoskeletal problems accounting for about 79%. Amongst these 52.8% having backache, while 43.9% of the dentists having pain in the neck. The factors that were found to be significantly associated with musculoskeletal pain included; Dentists working without assistance experience more musculoskeletal problem approximately 47.6%. Dentist working more than 7 hours a day experienced more neck pain 40%. In the light of this study it is apparent that musculoskeletal disorders are very common amongst the dentist working in Karachi. It is seen more in those who are working for long hours and those working without trained assistants. Breaks between patients and reducing the number of working hours as well as trained dental assistance can reduce the incidence of these disorders

Acute toxicity and antispasmodic activities of achillea wilhelmsii C. Koch

Since Achillea wilhelmsii is used as antispasmodic in traditional medicine, we conducted our current work to investigate its rationale on scientific grounds. Acute toxicity studies of crude methanol extract of Achillea wilhelmsii [Aw. CMeOH] is also performed. Effect of Aw. CMeOH and its fractions were tested on isolated sections of rabbits' jejunum at test concentrations 0.01, 0.03, 1.0, 3.0, 5.0 and 10mg/ml. The test extracts, in similar concentrations, were also tested on KCl-induced contractions. Calcium chloride curves were constructed for those fractions which relaxed KCl induced contractions in the absence and presence of the test samples to investigate its possible mode of action through calcium channels. Aw. CMeOH tested positive for flavonoids, saponins, tannins, glycosides, terpenoids, sterols, phenols, carbohydrates and proteins. LD[50] for acute toxicity studies is 2707 +/- 12.6 mg/kg. Mean EC[50] values for Aw. CMeOH on spontaneous and KCl-induced contractions are 3.41 +/- 0.18 [2.56-3.8, n=6] and 0.68 +/- 0.05 [0.6-0.85, n=6] mg/ml, respectively. Respective EC[50] values for n-hexane fraction on spontaneous and KCl-induced contractions are 3.06 +/- 0.08 [2.8-3.3, n=6] and 1.68 +/- 0.8 [1.4-1.9, n=6] mg/ml, respectively. Corresponding EC[50] [mg/ml] values for chloroformic, ethylacetate and aqueous fractions of Achillea wilhelmsii on spontaneous rabbits' jejunum preparations are 4.8 +/- 0.2 [4.41-5.63, n=6], 5.07 +/- 0.15 [4.7-5.58, n=6] and 5.2 +/- 0.13 [4.91-5.64, n=4], respectively. Constructing calcium chloride curves, in the presence of 0.1 mg/ml of Aw. CMeOH, mean EC[50] value [log molar [Ca[++]]] is-1.98 +/- 0.03 [-1.89-2.05, n=6] vs. control EC50 [log molar [Ca[++]]]-2.41 +/- 0.02 [-2.32-2.44, n=6]. Mean EC50 value [log molar [Ca[++]]] for 0.3 mg/ml n-hexane fraction is-1.76 +/- 0.05 [-1.70 -1.93, n=6] vs. control EC50 [log molar [Ca[++]]] value-2.18 +/- 0.07 [-2.0-2.46, n=6]. While in the presence of chloroformic fraction [3 mg/ml], mean EC50 [log molar [Ca[++]]] value is -2.4 +/- 0.1 [-2.78 - 2.9, n=6] vs. control EC50 [log molar [Ca[++]]] value-2.70 +/- 0.05 [-2.5-2.8, n=6]. Mean EC50 value [log molar [Ca[++]]] for ethyl acetate fraction [1 mg/ml] is-1.94 +/- 0.07 [-1.75-2.05, n=6] vs. control EC50 [log molar [Ca[++]]] value-2.69 +/- 0.04 [-2.57-2.79, n=6]. Mean EC50 [log molar [Ca[++]]] value for residual aqueous fraction [3 mg/ml] is-1.8 +/- 0.3 [-1.71-1.84, n=6] vs. control EC50 [log molar [Ca++]] -2.6 +/- 0.04 [-2.59-2.76, n=6]. Whereas, the verapamil [0.1 micro M] EC[50] value [log molar [Ca[++]]] is-1.7 +/- 0.1 [-1.6-1.8, n=6] vs. control EC50 value [log molar [Ca[++]]]- 2.4 +/- 0.09 [-2.3-2.47, n=6]. The present research work confirms that the intestinal relaxation effect of Achillea wilhelmsii is supporting its traditional use as antispasmodic. The plant species can be a source for calcium antagonist[s], which can preferably be isolated from n-hexane fraction

Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar

To determine the effects of pre-operative submucosal dexamethasone injection on postoperative swelling and trismus following surgical extraction of mandibular third molar. Randomized controlled trial. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry [AFID], Rawalpindi, from October 2009 to March 2010. A total of 100 patients aged 18 - 40 years with good periodontal health and mesioangular impaction were divided in two treatment groups [50 in each group]. Group-A received prophylactic 4 mg submucosal dexamethasone intraoral injection and Group-B acted as control group. Facial swelling and trismus were assessed at baseline, 2nd and 7th postoperative days. Data was analyzed using SPSS-10. There were 35 [70%] males and 15 [30%] females in group-A and 34 [68%] males and 16 [32%] females in group-B. Surgical time ranged from 30 - 50 minutes [mean = 40.62 +/- 4.886 minutes] for group-A and 33 - 50 minutes [mean = 42.12 +/- 4.543 minutes] for group-B. Administration of dexamethasone had statistically significant effect in reduction of swelling and trismus on second postoperative day [p < 0.05] in group-A. Pre-operative 4 mg submucosal dexamethasone injection was significantly effective in reduction of postoperative swelling and trismus

Prevalence of radiographic classification of impacted mandibular third molars - an overview

The purpose of this study was to evaluate radiographically the position of mandibular third molars. It is a descriptive study carried out at 1 Military dental Centre, Sialkot Cantt from August to March 2011. The patients who came with the complaints of pain or swelling in the lower third molar area were clinically assessed and advised radiograph [peri apical view or orthopantomograph] for their lower third molar. These radiographs were assessed according to the Winter's classification for angulation and Pell and Gregory classification was used to access the space and depth of impaction. A total of 415 patients were examined. 73.7% patients [n=306] were males and 26.3% [n=109] females. Most of the patients were between 20-29 years of age [n=244]. Mesioangular impaction was the most common found in 38.5% [n=160] patients. Position A 66% [n=274] and class II 55% [n=229] were found to be the most common

Maxillofacial trauma and associated brain injuries

The aim of this study is to find out the distribution of brain injuries in patients with craniofacial trauma. Retrospective study. This study was conducted at the Departments of Oral and Maxillofacial Surgery and Neurosurgery of Liaquat National Hospital from Jan. 2010 to Dec. 2010 History form and radiographs of 112 patients who visited the Departments of Oral and Maxillofacial Surgery and Neurosurgery of Liaquat National Hospital were reviewed. Mean age of the sample was 31.7 years [+/- 8.8], minimum 18 years and maximum 65 years. The most common cause of cranio-facial trauma was road traffic accidents accounting for 94.6% followed by gunshot 2.7% fall 1.8% and assault 0.9%. Young adult males were most frequently affected. The most common site of trauma was midface 49.5% followed by mandible 26.8%, orbit 16.1% and panfacial 8%.Brain injury was recorded in 37.8 % of patients. Contusion, concussion and direct trauma to the brain was most common in mid face fractures hemorrhage was most common in Panfacial fracture. Mean GCS score was 14.77 in Mandibular trauma, 13.17 in isolated orbital fractures 12.98 in Midface trauma and 9.18 in Panfacial trauma. There is a strong correlation noticed between the craniofacial trauma and brain injury in this study. Young adult males sustained most craniofacial fractures as a result of road traffic accidents. A clearer understanding of risk factors associated with road traffic accidents and strict implantation of road traffic safety measures should be emphasized to avoid serious complications. Education of oral and maxillofacial surgeons regarding brain injury and its significance in terms of neurological outcomes should be emphasized

Comparison of Improvised Ventilating Nasal Packs with Vaseline Gauze Packs in Nasal Surgery

To study the outcome of using Improvised ventilating nasal packs compared with Vaseline gauze packs in nasal surgery. A comparative study. Department of ENT, Combined Military Hospital Rawalpindi, from July 2011 to December 2012. One hundred and twenty patients undergoing nasal surgery were divided into two groups of sixty each. After surgery, Group A was packed with Improvised Ventilating nasal packs and Group B with Vaseline gauze nasal packs. Effects of nasal packs in both the groups were studied and compared in terms of control of bleeding, comfort level while in place, and discomfort level while packs were being removed. Patient comfort level was significantly better in Group A as compared to Group B, while there was no significant difference in post operative bleeding control among the two groups. Discomfort level while packs were being removed, was also similar among the two groups. Ventilating nasal packs provide a better alternative to conventional nasal packs in terms of patient comfort after nasal surgery, while they are as good in providing bleeding control

Diabetes mellitus prediction; Serum lipids, ALT and fasting blood glucose: using serum lipids and ALT

The rapid change in lifestyles and dietary has led to a pandemic of diabetes mellitus. The diagnosis of diabetes mellitus sometimes requires 2 hr OGTT sampling. Recent evidence has shown that there are lipid related abnormalities associated with diabetes mellitus, so a consideration comes in fortheir utilization as a marker to support diabetes mellitus. [1] To correlate serum total cholesterol, triglycerides and ALT with fasting blood glucose [2]. To predict diagnosis of diabetes mellitus using above serum markers. Cross-sectional analysis, descriptive study. This study was carried out between Mar-2010 to Jan-2011 at the department of pathology, PNS RAHAT in collaboration with PNS SHIFA. A total of 251 subjects were screened for presence of glucose dysregulation. Based upon the results of fasting blood glucose, subjects were grouped as having normal glucose tolerance [NGT], impaired fasting glucose [IFG], and newly diagnosed diabetes mellitus [NDDM]. A comparison of lipids including triglycerides, total cholesterol and alanine aminotransferase [ALT] were made in the above groups to measure the differences between the above mentioned three groups. ALT, triglyceride and total cholesterol were correlated with results of fasting blood glucose through pearson's correlation. Later the performance of different cut-offs of triglycerides, total cholesterol and two mathematical models [[Factor-l=FBG [mmol/L] + triglycerides [mmol/L]] and [Factor-ll=FBG [mmol/L] + triglycerides [mmol/L] + total cholesterol [mmol/L]]] were evaluated for detecting diabetes mellitus against the gold standard 2 hr OGTT in 71 subjects. The results of triglycerides, total cholesterol and serum ALT between the three groups were as: [[Triglycerides: NGT =1.91, IFG =2, 10, NDDM= 2.75, p=0.003] [total cholesterol: NGT=5.03, IFG=5.19, NDDM=5.74, p=0.056] [ALT:NGT=28.47, IFG=27.95, NDDM=25.78, p=0.846]]. Most correlation was found between serum triglycerides and fasting blood glucose [r2=0.235, p<0.001]; while serum total cholesterol and ALT showed lesser correlations [[total cholesterol:r2= 0.172, P=0.007], [ALT:r2= 0.010, p= 0.877]]. While triglycerides demonstrated superiority in terms of sensitivity to total cholesterol for detection of diabetes mellitus, the factors incorporating lipids and glucose had the highest overall diagnostic efficiency. Triglycerides and total cholesterol levels rise from normoglycemic individuals to subjects having impaired fasting glucose and newly diagnosed diabetics. The inclusion of triglycerides and total cholesterol for diagnosis of diabetes mellitus improves the chances of for detection of diabetes mellitus

APACHE II scores as predictors of cardio pulmonary resuscitation outcome: evidence from a tertiary care institute in a low-income country

The aim of this study was to demonstrate that APACHE II scores can be used as a predictor of the cardio-pulmonary resuscitation [CPR] outcome in hospitalized patients. A retrospective chart review of patients admitted, from 2002 to 2007, at the Aga Khan University Hospital, Karachi, was done for this study. Information was collected on 738 patients, constituting all adults admitted in general ward, ICU, CICU and SCU during this time, and who had under-went cardiac arrest and received cardiopulmonary resuscitation during their stay at the hospital. Patient characteristics, intra-arrest variables such as event-witnessed, initial cardiac rhythm, pre arrest need for intubation and vasoactive drugs, duration of CPR and survival details were extracted from patient records. The APACHE II score was calculated for each patient and a descriptive analysis was done for demographic and clinical features. The primary outcome of successful CPR was categorized as survival >24 h after CPR versus survival <24 h after CPR. Multivariable logistic regression was used to assess the association between the explanatory variables and successful CPR. Patients with APACHE II scores less than 20 had 4.6 times higher odds of survival compared to patients with a score of >35 [AOR: 4.6, 95% CI: 2.4-9.0]. Also, shorter duration of CPR [AOR: 2.9, 95% CI: 1.9-4.4], evening shift [AOR: 2.1, 95% CI: 1.3-3.5] and Male patients [AOR: 0.6, 95% CI: [0.4-0.9] compared to females were other significant predictors of CPR outcome. APACHE II score, along with other patient characteristics, should be considered in clinical decisions related to CPR administration