Association between Parental Smoking and Pneumonia among Children Less Than 5 Years of Age

Introduction: Pneumonia continues to be the biggest killerworldwide of children under five years of age. Although theimplementation of safe, effective and affordable interventionshas reduced pneumonia.Objective: The objective of this study was to find associationbetween parental smoking and pneumonia in children under 5years of age presenting to tertiary care hospitals in Peshawarcity, Pakistan.Methodology: It was Unmatched Case Control Study with aratio of 1:1. Cases were children less than five years of agepresenting to four major tertiary care hospitals with Pneumoniainfection. Controls were selected from same hospital withmedical condition other than respiratory infection.Results: Among the total sample of 248 children, 67 (27%) ofthe children’s parents were smokers while 181 (83%) were notsmoking. Pneumonia infections were twice likely to developamong those children who were exposed to parental smokingat home with an odd ratio of 2.02 (95% C: 1.14-3.60)Conclusion: Children exposed to second hand smoking are athigh risk of developing respiratory problems like asthma later inlife. More effective policies and strategies are required to limitthe second hand smoking exposure at homes.

Caesarean-Section Frequency and Indications among Doctors and Non-Doctors

Objective: To find and compare the frequency of caesareansection and its indications among doctors and non-doctorspresented to tertiary-care hospitals of Peshawar city, Pakistan.Methodology: A descriptive cross sectional study wasconducted in four tertiary-care hospital of Peshawar city ofPakistan. Data on Caesarean section frequency and itsindications were collected from the clinical records of 400participants from March to May, 2016.Results: Among the total 400 participants, the frequency ofcaesarean-section was 52.5% (80% in doctors and 25% innon-doctors). A statistically significant difference wereidentified when chi-square test were used to compare thedifference between the two groups (P <0.05). Emergencycaesarean was performed in 120 (57.2%) patients whileElective caesarean was performed in 90 (42.8%). The mostcommon indication for caesarean-section was failedinduction/failed progress of labor (23%).Conclusion: The increased caesarean-section rate observedin doctors community is highly alarming. Our results should betaken into consideration when formulating policies to managethe national trend of increasing caesarean-section rates.

Morphometric study of ketoconazole treated liver in albino rats

To study the effects of Ketoconazole induced liver damage, compare with control group and correlate with previous studies. Forty adult male albino rats were used for this study. Group-A served as control animals, received injection of normal saline in dose of 0.05 ml/100 gm of body weight intraperitoneally daily for 03, 07, 15 and 30 days. Group-B received injection of Ketoconazole 40 mg/kg of body weight intraperitoneally daily for 03, 07, 15 and 30 days of treatment. Animals were sacrificed after completion of treatment under ether anaesthesia. Liver were removed, fixed in 10% and alcoholic formalin for 24-48 hours. They were dehydrated in ascending strength of alcohol and paraffin tissue blocks were made 5 IJm thick section were stained with H and E for general morphology and micrometry and Gomori's reticulin stain for observing reticulin fibres. The results were compared with control. Analyzed statistically with student 't' test and correlate with previous studies. Ketoconazole treated animals showed distortion of hepatic architecture, increase size of hepatocytes, decrease nuclear diameter and necrosis of hepatocytes. Increased amount of reticulin fibres and area of focal fibrosis within hepatic lobule as compared to control group-A animals. It is concluded from this study that Ketoconazole induce injury is dose and duration of therapy dependent and due to its cost effective frequent use needs further research in humans

Thrombo-embolism in patients with myocarditis

Myocarditis and dilated Cardiomyopathy continues to be an important cause of hospital admission in our part of the world. Systemic embolism due to thrombi in left ventricle is a rare but important complication of these patients. Study objectives: To determine the incidence, course and outcome of thrombo-embolism in children with dilated dysfunctioning heart due to acute myocarditis or dilated Cardiomyopathy. Design: A 5 year analysis [December 1999- Nov 04] of all children under 16 years of age admitted and diagnosed as having myocarditis or dilated Cardiomyopathy in a single tertiary care center. Patients and The charts and echocardiography records of all patients with dilated dysfunctioning heart and systemic thrombo-embolism were reviewed. Data was reviewed for mode of presentation, age, hospital course and outcome. Echocardiography data was reviewed with special reference to the size, function and presence of thrombus in LV. Of all admissions to the paediatric cardiology unit over the study period, myocarditis and dilated Cardiomyopathy was the underlying lesion in 405 patients. The mean age of patients was 2.1 +/- 4 years. Systemic embolism was the presenting feature in 28 [6.9%] patients [Group A]; while another 17 [4.2%] developed it during the hospital stay [Group B]. Another 5 patients had thrombus in the LV but did not develop embolism. All 50 patients showed seriously impaired LV function with mean ejection fraction [EF] for those with vs. those without thrombo-embolism was 17.5 +/- 5.5 vs. 20.0 +/- 6.9 [p = 0.08]. The groups were similar with respect to other baseline characteristics, co morbid illnesses, and drug therapies other than anticoagulants. In group A 26/28 patients presented with a stroke. Only 6 had a thrombus in LV at the time of admission. All 28 patients with or without LV thrombus were treated with heparin and then oral anticoagulant warfarin. There were two deaths. In group B, 3/17 patients had thrombus in the LV on echocardiography at presentation. They were started anticoagulation but still went on to develop a stroke. There were 2 deaths in this group as well. Conclusions: Myocarditis and dilated Cardiomyopathy is an important cause of hospital admission in our set up accounting for 15% of all admissions to a paediatric cardiology unit. These patients are at risk of developing thromboembolism, which may well be the presenting feature. The risk is higher in patients with lower ejection fraction of the LV. All patients with EF below 17% should be treated with prophylactic anticoagulation. A peripheral embolic event adds to morbidity and is related to poor long-term survival in this patient group