La relación entre plaquetas y linfocitos predice resultados adversos en pacientes con síndrome coronario agudo / The platelet to lymphocyte ratio predicts adverse outcomes in patients with acute coronary syndrome

Resumen Objetivo: Examinar la correspondencia entre la relación plaquetas-linfocitos (RPL) y los puntajes GRACE y TIMI en pacientes con síndrome coronario agudo. Materiales y método: Se incluyeron 1.000 pacientes con síndrome coronario agudo que fueron asignados al Departamento de Cardiología del Dustira Army Hospital. El examen del paciente y el registro médico se realizaron entre enero del 2019 y junio del 2020. Resultados: El puntaje de riesgo GRACE fue sustancialmente mayor en el grupo de RPL alta en comparación con los grupos de RPL moderada y baja [158 (144-174), 130 (114.5-149) y 124 (104-147.75)], respectivamente (p < 0.000). De manera similar, el grupo de RPL alta tuvo puntajes TIMI significativamente más altos para angina inestable, infarto de miocardio sin elevación del segmento ST (IAMSEST) e infarto agudo de miocardio con elevación del segmento ST (IAMCEST) que los grupos de RPL moderada y baja [3 (3-4), 3 (3-4), 3 (3-3), p = 0.001; 5 (4-5), 4 (4-5), 4.5 (4-5), p < 0.000 y 6 (5-7), 6 (5-6), 6 (5.5-6), p = 0.003]. Además, los puntajes de riesgo GRACE (r = 0,314, p < 0,000), TIMI para AI (r = 0.365, p < 0.000), TIMI para IAMSEST (r = 0.314, p = 0.001) y TIMI para IAMCEST (r = 0.227, p = 0.001) también tenían un vínculo favorable con la RPL. Conclusión: La RPL es un marcador de laboratorio económico, conveniente y reproducible en la práctica clínica habitual, que podría predecir el pronóstico en pacientes con síndrome coronario agudo.

Abstract Objective: To examine the relationship between PLR with GRACE and TIMI score in ACS patients. Materials and method: This study included 1,000 ACS patients who were assigned to the Cardiology Department at Dustira Army Hospital. Patient examination and medical record were completed from January 2019 to June 2020. Results: The GRACE risk score was substantially greater in the high PLR group compared to the moderate and low PLR groups [158 (144-174), 130 (114.5-149) and 124 (104-147.75)], respectively (p < 0.000). Similarly, the high PLR group had significantly higher TIMI scores for unstable angina pectoris (UAP), non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI) than the moderate and low PLR groups [3 (3-4), 3 (3-4), 3 (3-3), p = 0.001; 5 (4-5), 4 (4-5), 4.5 (4-5), p < 0.000, and 6 (5-7), 6 (5-6), 6 (5.5-6), p = 0.003]. In addition, GRACE risk score (r = 0.314, p < 0.000), TIMI risk score for UAP (r = 0.365, p < 0.000), TIMI risk score for NSTEMI (r = 0.314, p = 0.001), and TIMI risk score for STEMI (r = 0.227, p = 0.001) also had a favorable link with PLR. Conclusion: PLR is an inexpensive, convenient and reproducible laboratory marker in routine clinical practice that could predict the prognosis in patients with ACS.

Prevalence and Correlates of Vitamin D Deficiency Among Children and Adolescents From a Nationally Representative Survey in India

Objective: To evaluate the prevalence of vitamin D deficiency (VDD) and its correlates among apparently healthy children and adolescents. Methods: We carried out a secondary analysis of data of Comprehensive National Nutrition Survey 2016-18 to analyze the pre-valence and predictors of VDD among Indian children and adolescents. Results: The over-all prevalence of VDD in preschool children (1-4 years), school age (5-9 years) children, and adolescents (10-19 years) was 13.7%, 18.2%, and 23.9%, respectively. Age, living in urban area, and winter season were significantly associated with VDD. Vegetarian diet and high-income households were the main risk factors observed in 5-19 years age category. Female sex and less than three hour of physical activity/week were independent risk factors among adolescents. Conclusion: The prevalence and determinants of VDD across different age-groups are reported, and these should be interpreted and addressed to decrease the burden of VDD in India.

Preschool Children Feeding Patterns And Early Childhood Oral Health Impact In Tanah Merah, Kelantan, Malaysia

@#Introduction: Poor feeding patterns increase risk of Early Childhood Caries (ECC), which can cause negative impacts on oral health-related quality of life (OHQoL) of preschool children and parents. This study aims to assess feeding patterns of preschool children and OHQoL of the children and their parents in Tanah Merah. Methods: A cross-sectional study was conducted involving 134 preschool children aged 5-6 years old from eight private preschools, chosen by multi-staged stratified cluster sampling. Parents answered adopted self-administered questionnaire on feeding patterns and oral health-related impacts. Mann-Whitney U test and Kruskal-Wallis test were used to compare the median between groups of feeding patterns. Results: A total of 122 parents responded. Majority of the children had history of bottle-feeding (97.5%) and being given solid food during infancy (61.2%). Many children were still using bottle to drink (38.5%). Majority were still given formula milk at least three times daily (51.1%) and were feed with bottle to put to sleep (97.9%). The Child Impact Section (CIS), Family Impact Section (FIS) and Overall ECOHIS mean scores were 2.39 (SD=3.41), 0.71 (SD=1.45) and 3.10 (SD=4.41), respectively. Most common impact reported in CIS was ‘oral pain’ (26.2%) whereas in FIS, ‘parents felt guilty’ (7.4%). None of feeding patterns were found significantly different in terms of ECOHIS score median (p-value>0.05). Children OHQoL reporting by proxy should be treated as complementary. Conclusion: Many preschool children were involved in prolonged, frequent and nocturnal bottle-feeding. No significant difference in median ECOHIS scores found according to feeding patterns.

National guidelines for data quality in surveys: An overview

Good quality health, nutrition and demographic survey data are vital for evidence-based decision-making. Existing literature indicates system specific, data collection and reporting gaps that affect quality of health, nutrition and demographic survey data, thereby affecting its usability and relevance. To mitigate these, the National Data Quality Forum (NDQF), under the Indian Council of Medical Research (ICMR) - National Institute of Medical Statistics (NIMS) developed the National Guidelines for Data Quality in Surveys delineating assurance mechanisms to generate standard quality data in surveys. The present article highlights the principles from the guidelines for informing survey researchers/organizations in generating good quality survey data. It describes the process of development of the national guidelines, principles for each of the survey phases listed in the document and applicability of them to data user for ensuring data quality. The guidelines may be useful to a broad-spectrum of audience such as data producers from government and non-government organizations, policy makers, research institutions, as well as individual researchers, thereby playing a vital role in improving quality of health, nutrition and demographic data ecosystem.

Assessment of urinary interleukin-18 in the early post-burn period to predict acute kidney injury of various degrees of burn patients

Background:Early detection of acute kidney injury (AKI) in burn-injured patients can help modify the treatment to prevent progression of acute renal failure and reduce the need for renal replacement therapy. The aim of the study was to evaluateurinary interleukin-18 in the early post-burn period to predict the AKIfor the various degrees of burn patients. Methods:This prospective observational study was conducted in the department of nephrology, Dhaka medical college in collaboration with burn and plastic surgery unit of the same medical college hospital, from July 2017 to June 2018 for a period of one year. The 48 burn patients (Age>18 years) who attended in the burn unit of Dhaka medical college, Dhaka of both sexes were enrolled in this study. Data were analyzedby using SPSS 22.0. A value of p<0.05 was considered statistically significant for all tests. Results:In this study, mean age of the burn patients was 32.41�.59 years. Male female ratio was 3.36:1. Urinary IL-18 in diagnosis of AKI showed accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 93.8%, 91.7%, 94.4%, 84.6% and 97.1% respectively. AUC for urinary IL-18 at admission was 0.968 (CI, 0.921-1.000) and AUC for serum creatinine at admission was0.937 (CI, 0.871-1.000).Conclusions:According to Kappa value, AUC and sensitivity and specificity urinary IL-18 is a good biomarker in predicting of early AKI in burn patients

Isolated Gastrointestinal Symptoms as Initial Presentation in Systemic Lupus Erythematosus and Its Differential Diagnosis

@#Initial clinical presentation of Systemic Lupus Erythematosus (SLE) is varied as it affects various organs in the body. While the typical presentation of SLE is mucocutaneous, musculoskeletal and haematological manifestation, gastrointestinal (GI) manifestation is a rare initial presentation of SLE. We discuss the case of a 13-year-old girl who was diagnosed with SLE after she presented with isolated gastrointestinal symptoms. She presented with vomiting, diarrhoea, mild colicky abdominal pain and bilateral ankle oedema; and was treated as acute gastroenteritis. She returned after one week with worsening symptoms. Her full blood count showed bicytopenia; urinalysis had proteinuria and haematuria, and renal profile revealed acute on chronic kidney injury which triggered suspicions of a more serious disease rather than simple viral gastroenteritis. Further investigations of positive anti-nuclear antibody, low complements and positive Coombs’s test supported the diagnosis of SLE. The diagnosis of SLE was confirmed when her renal biopsy reported crescentic lupus nephritis ISN/RPS Class IV. Additional investigation to investigate the cause of her gastrointestinal symptoms included an ultrasound abdomen which showed minimal ascites and bilateral renal parenchymal disease. She was planned for colonoscopy but due to the unavailability of paediatric endoscopy, colonoscopy was postponed. However, her symptoms markedly improved with intravenous Cyclophosphamide which supported the diagnosis of GI SLE. This case report is to highlight that a patient with symptoms of simple viral gastroenteritis might have a more serious underlying disease. Even though rare, SLE can present with gastroenteritis symptoms and is one of the differential diagnoses that should be considered.

Screen time and Sleep Quality among College and University Students of Karachi / Tempo de tela e qualidade do sono entre estudantes universitários de Karachi

Objectives: To assess the relationship between screen times and sleep quality of the age group 17-24. Methodology: This is a cross-sectional study. The study was conducted on students of Colleges and universities in Gulshan-e-Iqbal Town Karachi. A total of 600 undergraduate students were approached in colleges and universities of Gulshan Town, Karachi. The sampling technique was Multi Staged sampling. The research instrument comprised of 3 parts i) Demographic profile, ii) Sleep quality measures and iii) Screen time usage measures. Results: The mean total hour of sleep was 6.7 ± 1.5. The Mean Cumulative score of the components of the questionnaire was 7.47 ± 3.56, while 174 (29%) have Normal Sleep quality and 426 (71%) have poor sleep according to the questionnaire. The odds ratio suggests there were 4.23 times higher chances of poor sleep quality in students whose screen time was more than 2 hours on weekdays as compared to other students. (OR: 4.23, 95% CI: 2.66-6.72). The odds ratio suggests there were 24.15 times higher chances of poor sleep quality in students whose screen time was more than 2 hours on weekends as compared to other students (OR: 24.15, 95% CI: 11.192-52.11). Conclusion: As, negative impacts were determined within sleep quality, and increased screen watching of multiple versions of the devices (screen time), influencing the commended level of screen watching among university and college students (age 17-24) is an affair of public health.

Objetivos: Avaliar a relação entre o tempo de tela e a qualidade do sono de estudantes universitarios na faixa etária de 17 a 24 anos. Metodologia: Este é um estudo transversal. O estudo foi realizado em estudantes de faculdades e universidades em Gulshan-e-Iqbal Town Karachi. Um total de 600 alunos de graduação foram abordados nessas instituicoes. A técnica de amostragem foi a amostragem Multi Staged. O instrumento de pesquisa compreendeu 3 partes i) Perfil demográfico, ii) Medidas de qualidade do sono e iii) Medidas de uso do tempo de tela. Resultados: A média de horas totais de sono foi de 6,7 ± 1,5. A pontuação média cumulativa dos componentes do questionário foi de 7,47 ± 3,56, sendo 174 (29%) com qualidade de sono normal e 426 (71%) com sono ruim, de acordo com o questionário. O odds ratio sugere que houve 4,23 vezes mais chances de má qualidade do sono em alunos cujo tempo de tela era superior a 2 horas durante a semana, em comparação com outros alunos (OR: 4,23, IC 95%: 2,66-6,72). O odds ratio sugere que houve 24,15 vezes mais chances de má qualidade do sono em alunos cujo tempo de tela era superior a 2 horas nos finais de semana em comparação com outros alunos (OR: 24,15, IC 95%: 11,192-52,11). Conclusão: Como os impactos negativos foram determinados na qualidade do sono e aumento da visualização da tela de várias versões dos dispositivos (tempo de tela), influenciar o nível recomendado de visualização da tela entre universitários e estudantes universitários (idade 17-24) é uma questão de saúde pública.

Detection methods of avian influenza - current and novel approaches

@# Avian influenza (AI), caused by the avian strain of influenza A virus (AIV) is one of the significant health concerns globally. Human infections with AI viruses were reported sporadically and often exhibited high mortality and morbidity rate. AI outbreaks also influenced the safety of the food supply and caused significant economic losses. Immediate control measures are required during AI outbreaks in poultry to prevent further viruses spreading. Hence, accurate, sensitive, and rapid detection methods are pivotal for decision making. Traditional methods of detection, such as virus isolation in embryonated chicken eggs, immuno-based methods, and nucleic acid amplification method, pose different limitations. These always grab the attention of researchers to improve existing methods or invent novel diagnostic approaches to compensate for the shortcoming of current methods applied. However, the method of choice is highly dependent on the availability of facilities and resources. Among the detection methods, reverse transcription-polymerase chain reaction (RT-PCR) is the most favourable method used for detecting AIV. However, a constant review of the virus genome is crucial to maintain the assay’s sensitivity. More comprehensive research and evaluation study are needed for new diagnostic approaches.

The role of polysaccharide peptide of Ganoderma lucidum as a potent antioxidant against atherosclerosis in high risk and stable angina patients

Objectives Antioxidants can reduce oxidative radicals that affect the early phase of atherogenesis, that is endothelial dysfunction. Polysaccharide Peptide (PsP) derived from Ganoderma lucidum has an active substance in the form of β-glucan. Previous studies have proven the PsP of Ganoderma lucidum as an effective antioxidant in atherosclerotic rats and shows no toxicity in animal model. This study aims to prove the effect of PsP as potent antioxidant in high risk and stable angina patients. Method This is a clinical trial conducted to 37 high risk and 34 stable angina patients, which were determined based on ESC Stable CAD Guidelines and Framingham risk score, with pre and post test design without control group. The parameters are superoxide dimustase (SOD) and malondialdehyde (MDA) concentration, circulating endothelial cell (CEC) and endothelial progenitor cell (EPC) counts. The patients were given PsP 750 mg/day in 3 divided dose for 90 days. Paired t-test was performed for normally distributed data, and Wilcoxon test for not normally distributed data, and significant level of p ≤ 0,05. Results SOD level in high risk patients slightly increased but not statistically significant with p = 0,22. Level of SOD in stable angina group significantly increased with p = 0,001. MDA concentration significantly reduced in high risk and stable angina patients with p = 0.000. CEC significantly reduced both in high risk and stable angina patients, with p = 0.000 in both groups. EPC count significantly reduced in high risk and stable angina with p = 0.000. Conclusion PsP of Ganoderma lucidum is a potent antioxidant against pathogenesis of atherosclerosis in stable angina and high risk patients

Adenoid cystic carcinoma of breast: clinicopathologic study of seven cases

Adenoid cystic carcinoma [ACC] of the breast is a rare type of tumor. Our objective was to determine the clinicopathologic features of breast ACC. We reviewed slides of breast ACC reported during 12 years. Seven cases were identified. Age ranged from 38 to 59 years [mean = 47 years]. Mean tumor size was 2.3 cm [range 1.2 to 4 cm]. Histologically, dominant cribriform pattern was seen in 4 cases, solid in 2 and tubular in one case. Mitotic figures ranged from 2 to 22/10 HPFs. Grades I and II were seen in 3 cases each while 1 was grade III. Post-surgical tamoxifen given in 3 cases, chemotherapy and radiotherapy in 2 and 1 case, respectively. Follow-up ranged from 12.5 - 138.5 months [mean = 61. 25 months]. One patient developed vertebral metastasis. Consistent with published data, this series indicated that ACC-breast has a good prognosis

Frequency of anemia in rheumatoid arthritis patients presenting in various hospitals of Peshawar, Khyber Pakhtunkhwa

Objective: Anemia is a chronic complication of rheumatoid arthritis that is produced by a number of causes. Very little interest in research is shown in this field by researchers both nationally and internationally. The main objective of the study was to determine the frequency of anemia in rheumatoid arthritis patients

Study Design: Descriptive, cross sectional study

Place and Duration of study: This study was conducted at the Hayatabad Medical Complex [HMC], Rehman Medical Institute [RMI] and Khushal Medical Center, Peshawar, from April 2015 to March 2016

Materials and Methods: Two hundred and thirty patients with rheumatoid arthritis visiting medical outdoor clinics in different hospitals of Peshawar were enrolled from April 2015 to March 2016. Detailed history was taken and clinical examination was performed. After taking consent, diagnosis of anemia was made by performing peripheral smear tests using digital sysmex XT-4000i hematology analyzer. The identity of patients was kept confidential. The demographic informations such as name, age and gender were recorded

Results: Among 230 patients, with mean age of 50 years, male-female ratio was 30%[n=70] and70%[n=160] respectively. Anemia was diagnosed in 26%[n=60] patients, while 74%[n=170] patients had no anemia among the study group. Out of 60 patients with anemia, 30%[ n=18] patients were male and 70%[n=42] patients were female. Anemia association with the duration of rheumatoid arthritis was analyzed, which shows that anemia increases as duration of rheumatoid arthritis increases

Conclusion: It is concluded from the study that rheumatoid arthritis is a chronic disorder affecting multiple organs of the body and anemia is a well-known significant complication of rheumatoid arthritis as shown by the results of this study

prevalence of iron deficiency anemia in female medical students of different medical colleges of Khyber Pakhtoonkhwa, Pakistan

Objective: Iron deficiency anemia [IDA] is very common in adolescent and adults, especially female. In medical students, it is caused by a number of causes, "including overwork, decrease appetite due to stress and unnecessary dieting". Very little data is available at national level about these health conscious medical students. This "descriptive, cross sectional study, was conducted in public and private Medical colleges of KPK". The main objective of the study was "to determine the Prevalence of IDA in female medical students of KPK"

Study Design: Observational / descriptive study

Place and Duration of Study: This study was conducted at the department of Pharmacology, Khyber Girls' Medical College, Peshawar From December-2015 to May-2016

Materials and Methods 390-female medical students aged 19 to 24 years have participated in this study'. After formal consent and recording of their demographic information, "Hemoglobin [Hb] and Mean Corpuscular Volume [MCV] was done using digital Sysmex XT-4000i hematology analyzer". Serum ferritin [S-Ferritin] was done using Architect I-2000 analyzer. The identity of all students was kept confidential. All students with, "Hb<12g/dl, MCV<76um [3] and S-Ferritin <11ng/ml were labeled as having IDA and students having Hb>12g/dl, MCV>76um [3] but S-Ferritin<11ng/ml were labeled as having Iron deficiency [ID], but not IDA"

Results: Complete data of all "390 students were available for further analysis". The mean age of the students was 21 +/- 1 years. IDA was present in 6.66% [n=26/390] students, while ID was present in 41.54% [n=162/390] students. Normal iron status was found in 51.80% [n=202/390] students

Conclusion: It is concluded that "ID and IDA are very common in female medical students of KPK. All female medical students should be encouraged to take extra iron to replenish their iron store"

Role of Topical Acetic Acid in Comparison to Gentamicin for the Management of Chronic Suppurative Otitis Media

Introduction: Chronic Suppurative Otitis Media (CSOM) is one of the diseases resistant to current antibiotics; persisting for more than two week; and capable of causing severe discharge, tympanic membrane perforation and deafness. This may cause distress and affect their quality of life and productivity. Aims: To assess the role of topical Acetic Acid in comparison to Gentamycin for management of CSOM. Methods: It was a Randomized, open label study. Patients diagnosed as CSOM (safe type) were randomly divided into two groups, group I - topical 1.5% Acetic acid and group II - topical 0.3% Gentamicin sulphate in a dose of three otic drops thrice daily. Follow up was done every week for two weeks and was compared on the basis of otological symptoms score. Results: The mean difference of otological symptom score at day 7 and day 14 from baseline in Group I was 1.90±1.01 and 3.40±1.08; and in Group II 1.96±0.57 and 3.12±0.74; p<0.05. Among the study groups, reduction of otological symptom scores at day 7 (Group I =3.22±1, Group II=2.66±1.76; p=0.14) and at day 14 (Group I = 1.72±1.76, Group II= 1.50±1.79; p=0.56) respectively. Also, “Treatment success” seen in 46 (92%) patients in the Acetic acid group and 44 (88%) patients in Gentamicin sulphate group. Moreover, cost of the treatment for Acetic acid was 102.94 and for Gentamicin sulphate was Rs.160.25 per person. Conclusion: Topical Acetic acid was found to be equally effective to Gentamicin sulphate for the treatment of CSOM.

Assessment of hearing loss in multi-drug resistant tuberculosis (MDR-TB) patients undergoing Aminoglycoside treatment.

Background: Incomplete treatments and treatment failures has led to Multi-drug resistant tuberculosis, which has emerged as a significant problem in treating tuberculosis and thus the second line drugs are used with the concomitant increase in the incidence of adverse effects. Methods: This prospective study was carried out from June 2009 to May 2014 in the department of ENT in collaboration with TB & Chest at Teerthanker Mahaveer Medical College & Research Centre. Out of 104, only 84 patients were included in our study. Patients were divided into three groups: group I (n=27) patients using Amikacin, group II (n=40) patients using kanamycin and group III (n=17) patients using streptomycin. Baseline pre-treatment pure tone audiometry was performed on all the patients and repeated every three months until completion of therapy. Results: Patients included were 15 to 55 years age with higher number of males (65%, n=55) than females (35%, n =29). Only 22.7% (n=19) of patients were found to be suffered from Hearing Loss. At the end of the study (at 12 month), Overall incidence of HFL was 58.0% (n=11) while incidence of Dead ear was 31.5% (n=6) and LFL was 10.5% (n=2). Amikacin was found to be more Ototoxic than Kanamycin and streptomycin. Conclusion: Aminoglycosides in MDR-TB patients may cause irreversible hearing loss involving higher frequencies and can become a hearing handicap as speech frequencies are too implied in more or less of the patients, thus underlining the need for regular audiologic evaluation in patients of MDR-TB during the treatment.

Radiological indicators to serve the purpose of juvenile justice system ordinance, 2000

OBJECTIVES: To document radiological age indicator for differentiating Juvenile from adult offender for the purpose of Juvenile Justice System Ordinance, 2000 of Pakistan

STUDY DESIGN: Perspective descriptive study

SETTING: Department of Radiology and Imaging, Liaquat University Hospital Jamshoro/ Hyderabad, Sindh, Pakistan

STUDY PERIOD: June 2007 to December 2008

METHOD: Radiological study of adolescents both males and females [Total 394 comprising of 145 females and 249 males] subjects studying in various academic institutions of Hyderabad, representing the heterogeneous population was conducted with an object to observe the union of various bones that can provide an age indicator of 18 years for both genders

RESULTS: X - Ray pelvis showing fusion of iliac crest with the rest of the bone and X- Ray medial end of clavicle showing appearance, represents age 18 years + 2 months in females, whereas in males X- Ray shoulder joint showing complete Epiphyso- Diphyseal union and their X- Ray pelvis still showing no fusion of iliac crest, represents same age group of 18 years+ 2 months

Radiologically female subjects are one year ahead of their counterparts, so for the skeletal maturity findings are concerned

CONCLUSION: This study concludes that for females, if appropriate radiographs [X- ray pelvis and X- ray chest] showing fusion of iliac crest and appearance of epiphysis at medial end of clavicle the age is 18 years. In male population when radiograph of proximal end of humerus bone gives impression of union, it is concluded that the person has attained the age of 18 years

A prospective study on prevalence of adverse drug reactions due to antibiotics usage in otolaryngology department of a tertiary care hospital in North India.

Background: Polypharmacy, advancing age and longer duration of hospital stay are the factors responsible for adverse drug reactions (ADRs). This study has attempted to analyze the pattern of antimicrobial prescription in OPD & IPD of the Otolaryngology department and to detect, document, assess and report the suspected ADRs due to antibiotic use and preparation of guidelines to minimize the incidence of ADRs. Methods: A prospective study conducted at the TMMC&RC on patients aged >40 years, who visited the Otolaryngology department over a period of 5 months. Suspected ADRs were assessed for causality and severity using Naranjo’s probability scale and modified Hartwig’s criteria, respectively. Results: Out of 1200, 925 prescriptions were analyzed. Most patients were from 41-60 age (59.45%) followed by 61-80 age (37.29%) and least from >80 yr (3.24%). But the incidence of ADRs were found to be higher in patients of >80 yr age group n=8 (26.66%). The most commonly prescribed antibacterials were β-Lactams (64.61%). Out of 925 prescriptions studied, only 94 were found to have 154 ADRs. The most commonly identified ADRs were Gastrointestinal 47.40%, followed by Neurotoxicity 24.67%, cutaneous reactions 20.12%, Hepatic 4.54% and Kidney 3.24%. 74.67% of the ADRs were probable and 20.77% were possible type and only 4.54% were definite. 74.67% ADRs were found to be type A, and 25.32% type B. Conclusions: Our study showed that prevalence of ADRs was highest in elder age group and diarrhea was the most common ADR found. Therefore elderly patients should be given special attention when prescribing medications to avoid clinically significant harmful consequences. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients.

Identifying Factors Associated with Maternal Deaths in Jharkhand, India: A Verbal Autopsy Study.

Maternal mortality has been identified as a priority issue in health policy and research in India. The country, with an annual decrease of maternal mortality rate by 4.9% since 1990, now records 63,000 maternal deaths a year. India tops the list of countries with high maternal mortality. Based on a verbal autopsy study of 403 maternal deaths, conducted in 2008, this paper explores the missed opportunities to save maternal lives, besides probing into the socioeconomic factors contributing to maternal deaths in Jharkhand, India. This cross-sectional study was carried out in two phases, and a multistage sampling design was used in selecting deaths for verbal autopsy. Informed consent was taken into consideration before verbal autopsy. The analytical approach includes bivariate analysis using SPSS 15, besides triangulation of qualitative and quantitative findings. Most of the deceased were poor (89%), non-literates (85%), and housewives (74%). Again, 80% died in the community/at home, 28% died during pregnancy while another 26% died during delivery. Any antenatal care was received by merely 28% women, and only 20% of the deliveries were conducted by skilled birth attendants (doctors and midwives). Delays in decision-making, travel, and treatment compounded by ignorance of obstetric complications, inadequate use of maternal healthcare services, poor healthcare infrastructure, and harmful rituals are the major contributing factors of maternal deaths in India.

Causes of uveitis in a tertiary center in Western Saudi Arabia

Objectives: To analyze the causes of uveitis and compare our results with national and international published studies

Methods: This is a retrospective review of medical records of patients who attend the uveitic clinic of Magrabi Eye and Ear Hospital in Jeddah, Kingdom of Saudi Arabia from January 1999 to December 2011

Results: We encountered 823 eyes of 587 uveitis patients [male: 319 [54%] and female: 268 [46%]]. Native Saudi patients constituted 52% of our total population, expatriate Arabs 23%, and Afro-Asians 23%. Average age at presentation was 34.8+/-12.83 [range 5-70] years. Unilateral presentation was noted in 351 [60%] and bilateral in 236 [40%] patients. Idiopathic anterior uveitis was the most common diagnosis [n=268, 45.7%]. Anterior uveitis was the most common anatomical diagnosis [n=335, 57.1%] followed by panuveitis [n=151, 25.7%], posterior uveitis [n=51, 8.7%] and intermediate uveitis [n=50, 8.5%]. There were 50 patients [8.5%] of Behcet's disease, 48 patients [8.2%] of Vogt-Koyanagi-Harada disease [VKH] and 35 cases [6%] of toxoplasmosis

Conclusion: The most common cause of anatomic diagnosis was anterior uveitis. Behcet's disease was the most common identifiable cause of uveitis followed by VKH. The most common cause of infectious uveitis was toxoplasmosis. Idiopathic anterior uveitis was the most common uveitic entity

Radiological indicators for determination of age of consent and criminal responsibility

Objectives: to establish radiological markers, by ossification form of appearances and fusion for determination of Medico legal important ages for consent and criminal responsibility, for our population

Study design: perspective observational study

Setting: Department of Radiology and Imaging, Liaquat University Hospital Jamshoro / Hyderabad Sindh

Study period: June 2006 to December 2008

Method: Total 1381 Subjects comprising of 617 female and 764 male, free from any musculoskeletal, nutritional and endocrinal disorder and confirmed dates of births were selected, representing the population of Hyderabad city and adjoining areas. The Subjects were divided into 9 groups on the basis of their age and purpose of study. Radiographs of wrist, elbow, shoulder and hip were taken in accordance to the age group and anticipated findings and radiological changes were observed and recorded

Results: Radiograph of wrist showing ossification of trapezoid at the age of 7 years and pisiform at 12 years in both sexes in 100% of cases proved to be a good indicator of the required age groups. fusion of Epiphysis distal Radius and ulna, proximal Hummers and iliuc crest can be relied upon as age indicator in Females and Males from 16 to 18 years

Conclusion: The outcome of this study provides more accuracy with a margin of error of +/-2 months and can be utilized for our population with confidence in medico legal disputes

[In] vivo bioavailability studies of sumatriptan succinate buccal tablets

Sumatriptan succinate is a Serotonin 5- HT1 receptor agonist, used in treatment of migraine. It is absorbed rapidly but incompletely when given orally and undergoes first - pass metabolism, resulting in a low absolute bioavailability of about 15%. The aim of this work was to design mucoadhesive bilayered buccal tablets of sumatriptan succinate to improve its bioavailability. Mucoadhesive polymers carbopol 934 [Carbopol], HPMC K4M, HPMC K15M along with ethyl cellulose as an impermeable backing layer were used for the preparation of mucoadhesive bilayered tablets. In vivo bioavailability studies was also conducted in rabbits for optimized formulation using oral solution of sumatriptan succinate as standard. Bilayered buccal tablets [BBT] containing the mixture of Carbopol and HPMC K4M in the ratio 1:1 [T1] had the maximum percentage of in vitro drug release within 6 hrs. The optimized formulation [T1] followed non-Fickian release mechanism. The percentage relative bioavailability of sumatriptan succinate from selected bilayered buccal tablets [T1] was found to be 140.78%. Bilayered buccal tablets of sumatriptan succinate was successfully prepared with improved bioavailability