Diagnosis and outcome of birth asphyxia in resource constrained health care set up

Objective: To determine morbidity and mortality of neonates with low APGAR score in a resource constrained health care set up

Study Design: Prospective descriptive study

Place and Duration of Study: The study was carried out in combined military hospital Attock, from Jan 2013 to Jan 2015

Material and Methods: All term neonates with 37 completed weeks of gestation and APGAR score less than 7 were included in the study. APGAR score was calculated by an attending pediatrician, gynecologist or trained female nurse at 0 and 5 minutes. In Neonatal Intensive Care Unit [NICU] the babies were daily examined by pediatrician. Outcome was documented in term of morbidity i.e. fits and mortality i.e. death of babies

Results: Total number of neonates included in the study were 85 of which 55 [65%] were males and 30 [35%] were females. Of the total neonates 65 [76%] were discharged in satisfactory conditions and 20 [24%] expired during stay in the hospital. The mean APGAR score of newborns was 4.98 +/- 0.98 at 5 minutes. During stay in hospital 46 [54%] were diagnosed to have hypoxic ischemic encephalopathy 2 [HIE2], those diagnosed with HIE3 were 5 [6%] and the rest 14 [16%] with HIE1

Conclusion: Low APGAR score is an important cause of admission to NICU. Low APGAR score was found associated with increased risk of fits in neonates and one of the most important cause of mortality in our set up

Dental restorations - reasons for placement and replacement

The objective of the present study was to determine the clinical reasons leading to the decision of dental restoration placement and replacement. It was a descriptive case series study and was carried out from October 2010 to July, 2011. non-probability convenience sampling. From the city of Lahore, 30 dental clinics were selected randomly, after dividing the metropolis into six administrative zones with 5 dentists from each zone. All the thirty dentists from six zones were asked to register 100 consecutive direct restorations. The standard criteria proposed by Wilson et al [8] was used to record the reasons for placement and replacement of the restorations. The response from the private practitioners for data collection was 70%. The remaining data was collected from the department of Operative Dentistry, Lahore Medical and Dental College, Lahore. The results of the present study revealed that the primary caries was the major reason [84.3%] for the placement of the initial restoration and secondary caries accounted for the majority [7.1%] of the replacement restoration in the Lahore city. It was concluded that the major reason for restoration placement and replacement was caries therefore there is an need for finding the factors that are responsible for high caries incidence in Lahore and efforts should be made to prevent the caries

Urethral catheterization

[1] To assess the theoretical and practical knowledge of young doctors about urethral catheterization. [2] To evaluate the experience and level of confidence of young doctors regarding the urethral catheterization in various tertiary care centers of Rawalpindi and Islamabad. Sep 2009 to Feb 2010. Tertiary Care Centre, Fauji Foundation Hospital, Rawalpindi. A questionnaire was distributed among 400 young doctors working as interns in various tertiary care teaching hospitals of Rawalpindi and Islamabad. We obtained the information about observation, assistance, performance and knowledge of young doctors about urethral catheterization. Questionnaire was distributed to about 400 young doctors working as interns in different teaching hospitals of Rawalpindi and Islamabad. Among the 400 doctors, 20 [5%] doctors never observed the male urethral catheterization and 35 [8.75%] doctors never observed female urethral catheterization. While among these 400 doctors 159 [38.75%] doctors never assisted male urethral catheterization and 175 [43.75%] doctors never assisted female urethral catheterization. Moreover 205 [51.25%] doctors never performed the male urethral catheterization and 185 [46.25%] doctors never performed female urethral catheterization. Training of young doctors about UC is not adequate. There is a need to train the young interns properly on this aspect. A senior resident or registrar of department should demonstrate the procedure in front of young interns before they are allowed to practice and first few catheterizations should be supervised by senior residents. Other alternate is the use of manikens for training of house officers

Management and outcome of chronic subdural haematoma

To analyze overall outcome in chronic subdural haematoma and study the results of different surgical methods employed to treat this condition. This prospective, descriptive observational study was carried in the Department of Neurosurgery, Nishtar Medical College and Hospital, Multan from October 2007 to April 2008. A total of 60 patients were included in the study. Out of 60 patients, 44 [73%] were male and 16 [27%] were female. 60% patients presented with history of minor trauma to he head in road traffic accidents, falls and slips in bath rooms of different durations, usually more than 2 weeks. The chronic subdural haematoma is a surgical lesion. The burr-holes aspiration under local anesthesia is the perfect surgical method in most of the cases

Psychosocial determinants of preferring home births

Despite the tremendous advancement in Reproductive Health Services in Pakistan, Child birth at home is still preferred by a part of Pakistani population. This study was planned to find out the psychosocial determinants associated with preferring home deliveries. It is a case controlled study. The study was conducted in Gawalmandi, an urban community of central Lahore from August-December 2007. Our study population consisted of 100 mothers. The criteria for selection of cases were that they were married females between the age of 15 and 49 years and a mother of at least one child and preferred home birth. Fifty controls were also selected in the same socioeconomic class that did not prefer home births. After informed consent a pre tested questionnaire was distributed among the study population. They were interrogated. Information was compiled and analysed on the basis of SPSS version 13 and Epi info 2000. Chisquare test was applied. In a study population of 100 females we found that cheaper and trained midwives, privacy and comfort at home, fear of surgery, babies being kidnapped in hospitals, transport problem, negligence of doctors and family influence are significantly associated with the trend of preferring home deliveries [p < 0.05]. It was concluded that factors leading to preference of home births in our community so that adequate measurements should be taken by the inter-sectoral collaboration, participation of civil society, private sector, government and non-government organizations to decrease MMR and IMR due to home births

Neurological and neuropsychiatric spectrum of wilson's disease in local population

This prospective observational study was conducted in the department of Neurology, King Edward Medical University/ Mayo Hospital, Lahore over a period of six months from July to December 2007. The objective was to study the clinical and laboratory features of Wilson Disease in local population and compare the results with national and International data. All consecutive patients who presented with Wilson's disease during this period were included in the study. Their clinical and laboratory features were recorded and compared with the available National and International data. We collected a total of 10 patients from 5 different families. Eight were confirmed cases examined and investigated by the authors. Two cases were probable and dead siblings of these families in whom clinical features strongly supported the diagnosis of Wilson's disease. Clinical and laboratory data of only confirmed cases was tabulated and compared. Of the eight patients six were males and two females with a male to female ratio of 3:1. Mean age at presentation was 12.6 years with a range of 6 to 19 years. Presenting features were as follows: dysarthria in 6 [75%]; dystonia 5 [63%]; extrapyramidal rigidity and bradykinesia 4 [50%]; emotional lability 6 [75%]; cognitive decline 2 [25%] and signs of chronic liver disease in 1 [13%]. Hepatic functions were abnormal in 1 [13%] while 4 [50%] patients had coarse echo texture of liver on abdominal ultrasound. Serum copper levels were within normal range in 8 [100%] patients. Serum ceruloplasmin was low in 8 [100%] patients. Twenty four hour urinary copper excretion was elevated in 5 [63%], KF ring on slit lamp examination was positive in 8 [100%] patients. CT scan of brain was done in 6 [75%] and showed hypodensity of basal ganglia mainly affecting the putamen and globus pallidus along with subcortical white matter disease in frontoparietal region in 4 [50%] patients. MRI was done in 5 [63%] patients and showed evidence of cortical atrophy with hyperintense signals in thalamif brain stem and basal ganglia in all five patients [100%]. Six confirmed cases belonged to three families and no family history was available in two cases [25%]. History of consanguineous marriage was positive in all [100%] cases. We conclude that Wilson's disease is not an uncommon problem in our population with patients presenting at an early age but with advanced stage of the disease. However, poor recognition is the possible cause of it's under and delayed diagnosis. Wilson's disease in children and young adults can present with neuropsychiatric features alone without any hepatic manifestations. Neuropsychiatric features along with KF ring and a low Serum Ceruloplasmin level are sufficient to establish a diagnosis of Wilson's disease

Awareness among barbers about health hazards associated with their profession

Barbers are important professionals of the community which are still owned, cared and financed by the community especially the rural one. Barbers besides performing duties in social events like marriage, circumcision etc is also responsible for hair and nail cutting. In urban settings they have developed their profession by incorporating facial massage and make-up. It is the need of their profession to utilize instruments like knife, blades etc. The objective of the study was to assess awareness among barbers regarding health hazards related to their profession and to identify professional practices linked with infection transmission. This descriptive cross sectional study was conducted in Kharian city of district Gujrat, located almost mid-way between Lahore and Islamabad, from June 2003 to September 2003. Sample of 50 barbers were selected by simple random sampling technique. Data was collected by using a semi-structured questionnaire and a checklist. Data was analyzed using SPSS 10. The mean age of barbers interviewed was 33.3 years with SD +/- 8.3. It was found that 29 [58%] barbers denied about any health hazards associated with their profession whereas 21 [42%] had knew about hepatitis, AIDS; they also described the role of contaminated blades, clips, towels, apron, and combs in causing skin problems. It was observed that 90% of barbers did not wash hands, 80% did not change the apron, 66% did not change towel during barbering services to different customers. Besides 7 [14%] barbers were also performing minor surgeries like circumcision, in growing toe nail excision and abscess drainage. There was significant difference in level of awareness among barbers in respect of age; educational status and duration of working. Age group [15-25] had better knowledge about the health hazards than barbers in age group [26-50]. There is a significant difference [p<0.05] in the awareness of those who got formal education. As for the effect of media on the knowledge of these workers, it was observed that 78% of them had the access to TV and out of these 69% had significant knowledge about health hazards related to barbering profession. The level of knowledge among barbers about health hazards associated with their profession is very poor. Majority of them do not have any perception of unhealthy working practices in barbering. Awareness about threat of receiving hazardous infection from their customers is also unsatisfactory

Determinants of depression in female adolescents and youth

Adolescents and youth are the main human resource for a nation. Depression is a grave yard for hopes and prosperity making the generation sad, inactive, and having suicidal thoughts. Thus every effort should be made to create awareness and eliminate depression from our youth. To find out the psycho-social determinants of depression in female adolescent and youth. Case control study. Lahore cant urban area, from March, 2007 to July, 2007. It was a community based case control study. Total 400 young females were selected. 200 cases of depression and 200 in the control group. An interview schedule including a structured, pre-tested and bilingual questionnaire was used after taking consent. SPSS and Epi info were used for data analysis. Chi square test was applied. In this study the depression in adolescent and young females had statistically significant relationship with unemployment, underage marriage, early child bearing, infertility, violence, sexual harassment [p<0.05]. The family history of psychiatric ill ness in first degree relatives had no statistically significant association with depression in these females [p>0.05]. The statistically significant psychosocial determinants of depression in young and adolescent females should be rectified by creating awareness in the society

Tubularized incised plate urethroplasty for various types of hypospadias

To report out short term results of hypospadias repair using Tubularised Incised Plate [TIP] Urethroplasty as described by Snodgrass for various types of hypospadias. A cohort of 62 patients comprising various types of hypospadias [62% distal penile, 30% mid penile and 8% proximal penile] underwent Snodgrass repair by one surgeon [F.A.] from June 2001 to November 2005. Age of the patients ranged from 1 to 20 years, the modal age being 3.2 years. There was no chordee in 90% of the cases whereas mild to moderate chordee was present in the remaining 10%. Urethroplasty was done by tubularization of the incised urethral plate as described by Snodgrass with coverage of the suture line by vasclarized dartos layer for water proofing. Chordee, if persisted after degloving of the penis, was corrected by dorsal placation. Patients were followed postoperatively on day 5, one month and subsequently on three monthly basis for a year. On the mean follow up of six months 46 patients [74%] achieved good functional and cosmetic results, with normal looking penis and ability to void urine with good forwardly directed stream. Complications were observed in 16 patients [26%]. The most common complication was urethrocutaneous fistula in 14 [22%]. Out of these 8 patients had minor leak which closed without requiring any further surgical intervention by regular urethral dilatation. The remaining 6 patients required re-operation for closure of the fistula. 2 patients had glans dehiscence which required re-operation 6 months later. Another 2 patients developed meatal stenosis which settled with regular post-op dilatation. So, the complications requiring surgical intervention was seen in 8 patients only. TIP Urethroplasty is a simple single stage procedure applicable for the majority of the hypospadias including mid and proximal hypospadias and redo cases where urethral plate is intact. It provides excellent functional neo-urethra, cosmetically normal looking glans and vertically oriented slit like meatus with lesser complication as compared to other single stage procedures

Bilateral emphysematous pyelonephritis

A 63 year old male, known diabetic for 10 years and a known case of Ischemic Heart Disease for almost same duration, on regular treatment presented in a peripheral hospital with 4 days history of jerky movement of left half of body, fever, cough and urinary incontinence. Examination revealed bibasal crackles in chest; tenderness in right lumber region and upper motor neuron type weakness in left half of body. Investigations revealed Hb 15.1, TLC 17.8, platelet count of 28,000, numerous RBCs and Pus cells in urine. LFTs were normal. There was no ketonuria and DIC screen was negative. Serum urea and creatinine done on alternate days showed a rising trend with max serum urea 34.8 mmol/L and serum creatinine 1138 umol/L five days following admission. Hepatitis serology was negative. Culture of urine showed growth of Escherichia coli as well as candida species. CT scan Brain revealed right Parietal lobe infarct. USG Abdomen revealed air lucencies in subcapsular and cortical region of both kidneys suggesting bilateral emphysematous pyelonephritis. CT scan abdomen confirmed bilateral emphysematous pyelonephritis [R>L] with extension of air lucencies in perinephric spaces and prominence of gerota's fascia bilaterally. Right kidney was at the verge of bursting. Case was discussed with Urologist and Anesthetist but patient was unfit for surgery because of existing comorbid conditions. Aggressive conservative management was started including antibiotics [intravenous Tazocin] based on urine c/s and intravenous Fluconazole alongwith alternate

Significance of D-dimers in newborns to pre-eclamptic mothers

The objective of the study was to compare the concentration of D-dimer in cord blood of neonates born to pre-eclamptic mothers with the cord blood of full term neonates born to healthy mothers. The concentration of D-dimer was assayed by using latex agglutination and semi-quantitative determination of D-dimer in plasma by kit of Stago Diagnostics France. Lady Wallingdon Hospital Lahore. Duration of study: January 2003 to September 2003. The concentration of D-dimer was significantly raised in both pre-term and full term index group as compaxed to the control group However, the concentration of D-dimer was higher in gestational age group 28[th] to 31[st] weeks due to the prematurity. The increased concentration of D-dimer indicates the activation of fibrinolytic system and make it mandatory to observe the neonates up to forty-eight hours so that the hemorrhagic disease of the neonate can be predicted and managed accordingly

Relationship between total cystic area of ovaries and acanthosis nigricans in polycystic ovarian syndrome

To correlate the total area of Acanthosis Nigricans with total cystic area of ovaries in women with polycystic ovaries. Thirty young females with polycystic ovaries were selected and in them total cystic area and total area of Acanthosis Nigricans was measured. Mean total cystic area was 92.0 [SD 35.12] and mean total area of Acanthosis Nigricans was 224.46 [SD 234.90]. The relationship between total cystic area [TCA] and total area of Acanthosis Nigricans [TAAN] was statistically significant with p of 0.007. There is a significant correlation between total cystic area and total area of Acanthosis Nigricans in subjects with PCOS. So Acanthosis Nigricans could be a useful cutaneous marker for PCOS and the extensiveness of the cysts presents

study of gynaecological emergencies presenting as Acute Appendicitis

To assess the frequency of gynaecological emergencies presenting as acute appendicitis among females of child bearing age. Descriptive analytical study. The study was conducted at the surgical unit-II of Sheikh Zayed hospital and postgraduate medical institute Lahore from January 2000 to December 2000. The study included 105 female patients aged 15-45 presented in accident and emergency department with right iliac fossa pain. Diagnosis was clinical in all cases .Investigations for leukocyte count, pregnancy test and lower abdominal ultrasound scan were used to improve diagnostic accuracy. All diagnosed patients underwent appendectomy and intra-operative findings were recorded. Patients with gynaecological disorder were dealt accordingly. Final diagnosis of acute appendicitis was made on Intra-operative findings and histopathology report. There was high frequency of gynaecological disorders simulating acute appendicitis in the age group ranging 15-25 years with mean age 23.1 and standard deviation + 0.74. Duration of pain ranges from 12 hours to 4 days. Pain and tenderness in right iliac fossa was found in all patients where as shifting of pain was present in 61% of cases. Total leukocyte count more than 11000 per cubic millimeter was present in 60% cases. Peroperatively acutely inflamed appendix was found in 71.4% ruptured ovarian cyst in 11.4%, right tubal abortion in 0.9% and pelvic inflammatory disease in 4.7% of patients. Histopathological report revealed that in 77.1% of cases appendix was acutely inflamed. Thus out of 105 study subjects who underwent appendectomy, 18[17%] were having gynaecological problems. In 3[2.8%] mesenteric lymph node biopsy was done, which turned out to be chronic nonspecific inflammation. In 9[8.5%] no positive finding could be found preoperatively. The rate of negative appendectomy in our study was 22.9%. There is considerable number of young females with gynaecological disorders presen ting in emergency as acute appendicitis. Good clinical judgment and routine use of ultrasonography is desirable to reduce the negative rate

Pneumatic lithotripsy for the treatment of ureteric calculi

Transureteral lithotripsy has emerged as a popular and standard treatment modality for the management of ureteric calculi. It can be used very effectively to treat ureteric calculi at all locations. In this study, fifty consecutive cases of ureteric calculi treated by ureteroscopy and pneumatic intracorporeal [Lithoclast] lithotripsy have been reviewed. The overall success rate was 92%. With the advent of and continuous refinements in minimally invasive techniques, open surgery is becoming a story of past in the management of ureteric calculi. The success rate for ureteroscopic stone retrieval depends upon the stone size, location and experience of the ureteroscopist. In our experience, ureteroscopic lithotripsy has been found to be a safe, effective and expeditious means of clearing ureteric calculi at all levels. It is tolerated well by the patient, associated with very low morbidity and recommended as a procedure of choice for all ureteric calculi