Frequency of Ocular Diseases in Infants at a Tertiary Care Hospital

PURPOSE: To determine the frequency of ocular diseases in infants visiting the ophthalmology department of a tertiary care hospital. METHODS: This was a cross-sectional descriptive study conducted in the department of ophthalmology, Abbasi Shaheed Hospital, from January 2015 to May 2016. The study included 377 infants ranging in age from 1 day to less than 1 year who were, selected by a nonprobability consecutive sampling technique. A detailed history was taken, and a complete ocular examination was performed. Descriptive statistics were used to calculate the mean and standard deviation for age. Frequencies were calculated for ocular diseases along with the percentages. Outcome variables included various congenital and acquired diseases such as conjunctivitis, congenital cataract, glaucoma, nasolacrimal duct blockage, squint, trauma, and fundus abnormalities. RESULTS: The mean age of infants was 5.0 ± 3.7 months. There were 196 (52%) males and 181 (48%) females. The sample included 330 (87.5%) full term infants. Acquired ocular diseases occurred in 230 (61%) infants; and congenital diseases, in 147 (39%). The most common ocular disease was conjunctivitis, which occurred in 173 (46%) infants, followed by congenital blocked nasolacrimal duct, which occurred in 57 (15 %) infants. Conjunctivitis was more common among neonates than infants. CONCLUSIONS: Acquired ocular diseases were more common than congenital ocular diseases. The most common ocular pathology was conjunctivitis, followed by congenital nasolacrimal duct obstruction, in infants. Conjunctivitis was more common in neonates than infants.

Toxic metals in maternal blood, cord blood and meconium of newborn infants in Pakistan

Toxic metals and deficiency/excess of trace elements can have adverse effects on health. The aim of this study was to quantify toxic metals lead, cadmium and trace elements zinc, copper, aluminium [Al] and Iron [Fe] levels in pregnant women, cord blood and meconium of new-born infants from industrial zones of Karachi, Pakistan. Analytical research was performed from 2011–2012 in low socio-economic pregnant mothers and newborn infants from 20 towns near Sindh Industrial Trading Estates, Federal B industrial area and Korangi industrial areas, Karachi, where environmental pollution was anticipated. Blood samples of pregnant women [n = 416], cord blood [n = 309] and meconium [n = 309] were analyzed quantitatively for metals and trace elements. Results indicated that mothers residing in steel towns were found to have the highest levels of lead. Meconium contained high levels of toxic heavy metals and trace elements compared to cord blood and maternal blood. Maternal blood toxic metals were present in high quantities. Therefore, safety measures should be taken when industrial waste is disposed of in order to prevent population contamination

Bullous impetigo case series: an updated review

Impetigo also known as pyoderma is a common paediatric skin infection presenting to clinics and hospitals in summer season. The illness is acquired from close skin contact with the victim and is highly contagious. The lesions are fluid filled vesicles that leave crust after rupture and usually heal without treatment. The infection is classified as bullous and non-bullous impetigo, the latter one having the least occurrence and is most commonly associated with complications, therefore prompt treatment is necessary. The case series holds a brief literature review of bullous impetigo, its clinical course, treatment options and complications. The author reports two cases presenting with bullous impetigo in the month of June. A five-year old boy and fifteen months old girl; both presenting with similar rashes involving limbs, trunk and neck with slight differences in the clinical symptoms. Both were treated with fluids, oral and topical antibiotics. The climatic conditions of Karachi favours the incidence of impetigo. Also, poor sanitation and overcrowded areas have further more increased the incidence of the disease. Families are unaware of these types of skin infections and hence do not isolate the victim which, in case of highly contagious illnesses like impetigo, is of great importance. Furthermore, not getting prompt treatment is another factor that cannot be ignored and results in complications in case of bullous impetigo. The most important conclusions which can be drawn from our case series are the lack of paediatric centres that treat dermatological conditions promptly and effectively. Lack of proper guidance convinces families to switch to self-medication and sometimes neglect. The role of a paediatrician is vital when creating understanding with the patient's attendant by explaining them the clinical features and course of treatment of bullous impetigo to avoid self-medication while dealing with skin diseases in children

Transportation difficulties faced by female students of karachi medical and dental college [KMDC] and university of Karachi [UOK]

Objective: To determine the frequency of different modes of transportation used by female students of KMDC and UoK, and to study the difficulties faced by them while commuting to their universities and the subsequent effect on their studies

Methods: An institutional and questionnaire-based study was conducted among the female students of KMDC and UoK aged 17-25 years from May to December 2016. The study was approved by the Ethical Review Board of Karachi Medical and Dental College. A total of 600 students were included in the study by probability [simple, random] sampling method. Students responded to a series of questions regarding mode, convenience and difficulties related to transportation and the impact transportation difficulties had on their education. The data was analysed by using SPSS Version 20.0. Written consent was obtained from the students prior to filling the questionnaire

Results: Out of 600 students, 50.8% used transport provided by the university/college, 53.8% did not consider any means of transportation safe, 54.5% students reported that their studies were affected due to indirect factors such as stress, trauma, fatigue, pollutants, congestion and the consequences were fewer study hours and delayed arrival in class. The frequency of physical along with verbal harassment faced by the students while commuting was reported as 31.3%

Conclusion: Majority of participants complained that their studies were affected by stressful travelling and other transport issues but those travelling by the transport provided by the institute had fewer problems. Efforts should be made to overcome these problems affecting female education

Seckel syndrome: in a two and a half months old male presenting at tertiary care hospital in Karachi

Seckel syndrome is a rare disease, with autosomal recessive mode of inheritance. Clinically manifests as intrauterine and postnatal growth retardation along with microcephaly, receded forehead, micrognathia, hypoplastic ears and mental retardation. Here we present a case of two and a half months old boy with four days history of loose stools and fever with facial dysmorphism and growth retardation of prenatal onset. This case is notable as detailed physical examination in patients leads to early diagnosis of the disease

Viral myocarditis - a case report

Viral myocarditis is an inflammatory disorder of the myocardium, which occurs following a viral infection. The most common agent of infection is Coxsackievirus B2 followed by adenovirus. Here, we present a case of a three and a half year old male child brought to the Emergency Room of Paediatric Unit II at the Abbasi Shaheed Hospital, with complaint of cough and fever since three days, associated with difficulty in breathing and irritability. The patient was managed with antibiotics initially; however, soon he had severe tachycardia, tachypnea, and hepatomegaly. His elevated cardiac enzymes and symptoms confirmed the diagnosis of viral myocarditis. He was managed with ACE inhibitor and ionotropic agent, and echocardiography done later revealing a clear report confirmed resolution of the infection and healed myocarditis. This case is notable as its complications are a threat to life, thus an emphasis on early and correct diagnostic tools is necessary to proper management

Hereditary tyrosinemia Type I, presentation in a two month old

Tyrosinemia is a metabolic disorder which manifests as increased levels of tyrosine in the blood

Hereditary Tyrosinemia Type I is one of the many causes of Tyrosinemia. It is due to the deficiency of the enzyme fumaryl acetoacetate hydrolase which leads to the rise in the serum levels of fumaryl acetoacetate and presents with a variety of different signs and symptoms such as neurological disorders, Hepatic and renal insufficiency and corneal depositions. It can be managed by the timely use of medication and dietary plan and fatality can be avoided if the disease is picked up in its earlier stages. We report a case of a 2-month-old baby with signs, symptoms and lab diagnosis suggestive of hereditary tyrosinemia

The case is discussed along with the drawbacks in our setup such as genetic testing and special tests required for a timely diagnosis for most metabolic disorders including neonatal liver disease such as hereditary tyrosinemia

Zika virus - an international public health emergency

Zika Virus is a member of the virus family flaviviridae and the genus flavivirus. It is spread by day time active Aedes mosquitoes, such as A. aegypti and A. albopictus. This is the same mosquito that spread and causes dengue, chikungunya and yellow fever

The first known case of Zika fever was reported in a sentinel rhesus monkey stationed on a tree platform in the Zika Forest in Uganda in 1947. Sexual transmission of Zika virus from men to women has been witnessed in at least 4 cases

Zika virus has also been isolated from semen samples. Cases of vertical perinatal transmission, from mother to the baby during pregnancy have been reported. WHO declared the couple of microcephaly and Guillain-Barré syndrome [GBS] cases reported in Brazil are strongly suspected to be associated with the Zika virus outburst. Thus, World Health Organisation [WHO] declared that a coordinated and an organized international response is required to improve surveillance, identification of infections, congenital malformations, and neurological complications, to heighten the control of mosquito populations at risk, and to execute the development of diagnostic tests and vaccines to secure people from this international public health emergency

English grammar problems seen in the original articles submitted for publication in annals of Abbasi Shaheed hospital and Karachi medical and dental college

Objective: to find out the frequency and type of English Grammar problems in original articles, submitted for publication in Annals of Abbasi Shaheed Hospital, Karachi

Study Design: a cross-sectional study

Place and Duration of Study: department of Annals of Abbasi Shaheed Hospital and Karachi Medical and Dental College in January 2015

Methodology: the study evaluated 28 original research articles, published in Annals of Abbasi Shaheed Hospital and Karachi Medical and Dental College during January 2013 to December 2014, for the English language mistakes in the manuscripts. The researchers evaluated English grammar problems in the manuscripts and recorded the details on a predesigned proforma. The data was analysed on SPSS version 19.0. The categorical variables were computed as percentage

Results: it has been observed that all the manuscripts evaluated for English grammar mistakes, demonstrated language mistakes. The mean of mistakes in June 2014 was 14.6 +/-2.26, while for December 2014 is 20.5 +/-4.76. The mean for the year 2013 issues was 1 +/-6.18 for June issue and 13.3 +/-3.0 for December issue, respectively. The number of mistakes identified in the manuscripts in descending order included punctuation marks, use of inappropriate tense and voice, use of articles [a, an, the], use of prepositions, wordiness [excessive words], long sentences, spelling mistakes, flow of thought process, incomplete sentences, and frequent use of abbreviations

Conclusion: a large number of manuscripts revealed inappropriate use of punctuation marks followed by tenses, active and passive voices

Frequency and risk factors of cognizable physical violence by intimate partner against women seeking medical care at a tertiary care centre, Karachi

Objective: To determine the cognizable frequency of physical violence by intimate partners against women seeking medical care at a tertiary care center, Karachi

Methods: A hospital based cross sectional survey was conducted at a medical care emergency of a tertiary care center, Karachi. The sample size was 345. A non-probability purposive sampling technique was used for selecting the study subject. A Performa was used to collect the information directly through recorded data and interviews. Written informed consent was obtained from each participant. Data was entered and analyzed by using SPSS software version 15. Means with standard deviation for numerical variables and proportions for categorical variables are presented. Chi square test was performed for association of education level and occupation with frequency of physical violence by intimate partners

Results: There were 345 cases reported during August 2014 to February 2015. Mean age +/- SD was 33.50 +/- 8.41 years and family income 1,855 +/- 962 rupees per month. Cognizable physical violence was observed in 286 [77.7%] by intimate partners against women seeking medical care at a tertiary care center Karachi. Housewives were 271 [78.6%] seeking care for physical violence injury. Fractures were found in 226 [65.5%] women. There was no education in 46 [13.3%] and 5 year education was 191 [55.4%]. The percentage of cognizable physical violence was 77.7%. Non-cognizable physical violence found higher among younger age group 24-36 years as compare to older women

Conclusion: The frequency of cognizable physical violence was two third by intimate partners against women seeking medical care in metropolis megacity, Karachi. Major risk factors found were age more than 36 years, housewives, low family income and only five years education

Student's perspective: should interactive or non-interactive lectures be given to medical and dental students?

In the complex setting of a medical/dental school it becomes essential to utilize an approach to teaching and learning that is best suited to the needs of the students. For productive learning, teaching should facilitate development of logical approaches to a problem and to highlight especially those points which appear critical for students to understand. A cross-sectional pilot study was carried out at Karachi Medical and Dental College to understand the perception of medical students about the current methods of teaching, interactive sessions in lecture and also to identify the techniques, best suited in delivering the knowledge to students. Study participants included third year, fourth year and fifth year M.B.B.S students. A semi-structured questionnaire was used to collect the information. SPSS version 16 was used for analysis of data. A total of 93 students participated in the study. 92.5% students believed lectures given to them are relevant and informative. About 87.1% students felt, lectures are beneficial before reading the topic from book. Approximately 86.0% of students preferred lectures to be interactive. The most preferred modality of teaching aid was found to be chalk-board, preferred by 73.1% students. The findings of pilot study suggested that a combination of conventional teaching methods with other methods such as, Animations, which is a 3D photographic model, PBL [Problem Based Learning] in which students learn about a subject through the experience of solving an open-ended problem. Students learn both thinking strategies and domain knowledge, Post-test in which students are evaluated for knowledge, they grasp after completion of lecture, often used in conjunction with a pretest to measure their achievement and the effectiveness of the lecture, and Doctor-Patient counseling sessions could be an effective way of teaching theory and clinical skills

Increased frequency of pleural effusion with pneumonia in children presenting at a tertiary care hospital of Karachi

We report nine cases of children under the age of ten years with increased incidence of pleural effusion with pneumonia in two months i.e. March and April 2015 at the paediatric unit II, Abbasi Shaheed Hospital, Karachi All children were admitted in our hospital with a history of fever, with or without rigors and chills, cough and dyspnoea. In younger children nasal flaring was observed. Initial chest Xray done showed pneumonia with pleural effusion. This was followed by Chest ultra sound which revealed pleural effusion on either left or right side of the chest, depending upon the patient. Four of the patients required a thoracotomy tube for drainage of the pleural fluid. All patients were treated with intravenous antibiotics and showed improved results. Four of the nine patients required paediatric intensive care admission. We have reported these cases due to our concern in the upsurge of pleural effusion with pneumonia which was previously not seen in the paediatrics department of a tertiary care hospital of Karachi

community based knowledge and practices survey on passive tobacco smoking and its impact on fetal outcome

To determine the proportion of passive tobacco smoking during pregnancy and estimate the level of knowledge and practices regarding Passive tobacco smoking and its adverse fetal outcome. A community based cross sectional survey was conducted in four union councils of Malir Town. This is a small semi urban community of 77216 population. Currently pregnant women were interviewed regarding passive tobacco smoking consumption and their knowledge about its adverse fetal outcome. A semi structured questionnaire was used during June to August 2011. Pregnant women either exposed or not exposed to passive tobacco smoking were interviewed for their knowledge and practices regarding its impact as adverse fetal outcome. A total of 190 mothers were interviewed. In the study 133 [70%] women were found subjected to passive tobacco smoking. About [85.5%] exposed to passive tobacco smoking were knowledgeable about adverse effect of maternal passive tobacco smoking on fetus. The fetal adverse effects comprehend by mothers included stillbirth 35 [63.6%], small size baby 65 [100%], fetal congenital abnormality 33 [86.6%]. The proportion of passive smoking exposure during pregnancy was 70% and 85.5% mothers were knowledgeable regarding Passive Smoking exposures and adverse fetal outcome including stillbirth 63.6%, small size baby 100%, fetal congenital abnormality 86.8%

Effects of counseling and education to patients presenting with hepatitis at a tertiary care hospital

Hepatitis is an escalating problem in Pakistan due to lack of awareness about its risk factors. To create awareness about risk factors for hepatitis in patients coming for its treatment at a tertiary care hospital using a counseling intervention. The study was conducted at civil hospital, Karachi. Patients having hepatitis B or C were enrolled. Each patient filled a pre and post counseling questionnaire [after 6 months]. A total of 153 hepatitis positive patients were counseled. There were 108 females and 45 males. Majority [83] had hepatitis C virus, 56 had hepatitis B virus, 08 had co-infection of hepatitis B virus and hepatitis D virus and 06 had hepatitis B virus with hepatitis C virus. Counseling was done on multiple parameters. Pre counseling figures for using brand new syringes were 32% which improved to 81% after counseling, for using screened blood these changed from 22% to 81%, for sterilized dental instruments they improved from 21% to 65% and for avoiding road side barbers they improved from 58% to 78%. The figures for hepatitis B virus vaccination in hepatitis C virus patients rose from 3% to 36.6% and for families rose from 2.6% to 43.1%. Great improvements were seen in the awareness and health seeking behavior of hepatitis cases following behavior change communication. More stress should be given on preventive strategies through mass awareness and counseling programs to control disease spread

Ultrasound based evaluation of hepatic steatosis and fibrosis in hepatitis c non-responders

To determine the accuracy of ultrasound in the diagnosis and grading of steatosis and fibrosis in Hepatitis C [HCV] patients not responding to ribavarin-interferon therapy. A cross-sectional, analytical study. Radiology Department, Civil Hospital, Karachi, from March 2008 to August 2010. Patients with positive HCV RNA despite 24 weeks ribavarin-interferon therapy [non-responders] were subjected to ultrasound and biopsy prior to institution of pegylated interferon therapy for detection and grading of steatosis and fibrosis. Using histopathology as the gold standard, sensitivity, specificity, negative and positive predictive values for ultrasound were determined. The sensitivity of ultrasound for hepatic steatosis was 90.9% for no steatosis [NS], 100% for moderate and gross steatosis and 84.4% for mild steatosis with 100% specificity. The senitivity for fibrosis was 25% for no fibrosis, 100% for mild fibrosis, 89.74% for moderate fibrosis and 100% for gross fibrosis. The overall accuracy for detection of steatosis was 95.39% and that for fibrosis was 98.02%. Hepatic vein showed increased dampening of flow with advancing grades of steatosis and fibrosis. Ultrasound has a high accuracy in the diagnosis and grading of steatosis and fibrosis in HCV non-responders. Mild fibrosis may confound the diagnosis of mild steatosis

Cutis laxa: a rare entity

Cutis laxa is a heterogeneous group of connective tissue disorders related to abnormalities in elastic tissue. It may be autosomal recessive [Type I and Type II], autosomal dominant, X-linked recessive or acquired. Inborn errors of elastin synthesis and structural defects of extracellular matrix proteins lead to decreased elasticity and redundant, sagging skin in affected patients. It involves skin, lungs, endocrine system, gastrointestinal tracts, cardiovascular system and genitourinary tracts. Clinical manifestations of cutis laxa depend on the type of disease, whether X-linked, autosomal dominant, recessive or acquired. Clinical features of these different types may overlap in a patient. We report a case of cutis laxa in an infant, solely diagnosed on the basis of history and physical examination of the case reported. The clinical features and complications of the case and review of the literature are discussed

Insulin resistance and inflammatory markers in obesity

To estimate the insulin resistance and its correlation to gender and inflammatory cytokines IL6 and TNFalpha in obese Pakistani patients. In one fifty obese patients of both sex, weight, height and Waist circumference was noted and BMI was calculated. Fasting blood was drawn to check for blood sugar and insulin levels. IL6 and TNFalpha were checked via ELISA. Insulin resistance was calculated by HOMA IR. Mean BMI in males was 29.566 +/- 4.4322 kg/m2and 33.96 +/- 5.5609 kg/m2 in females. Sixty one [40.7%] had normal insulin resistance [1.704 +/- 0.647] and 89 [59.3%] had increased insulin resistance [9.678 +/- 10.143]. Mean TNFalpha and Mean IL6 were not statistically different in both the groups [p value 0.891 and 0.386 respectively]. Mean HOMA IR was 5.649 +/- 6.03 in males and 6.8005 +/- 9.76 in females. Mean IL6 was 46.166 +/- 117.67pg/ml and mean TNF was 22.492 +/- 89.99pg/ ml. IL6 and TNF was more in males as compared to females [p-value 0.001]. TNFalpha and IL6 significantly correlated to each other [p value 0.001]. Insulin resistance was increased in sixty percent of obese subjects but showed no difference in mean inflammatory cytokine levels from those with normal HOMA IR. TNF and IL6 levels were more in males. These markers significantly correlated to each other but not to obesity parameters

Interferon- alpha treatment of children and young adults with chronic hepatitis delta virus [HDV] infection

To determine the response of one-year interferon-alpha therapy in hepatitis delta virus [HDV] infection in children and young adults at a tertiary care hospital, Karachi, Pakistan. An observational study. Sarwar Zuberi Liver Centre [SZLC], Medical Unit IV, Civil Hospital, Karachi / Dow University of Health Sciences [DUHS], from June 2009 to July 2010. Paediatric patients [< 18 years age] and young adults [18-35 years] presenting were screened for hepatitis B virus [HBV] and HDV sero-markers. HDV anti-body positive by ELISA were further screened for hepatitis D ribonucleic acid [HDV-RNA] by real time PCR. HDV RNA PCR positive patients were treated with INF- alpha [children 6 MIU/m2/day and adults 5 MIU/day] for a period of one year. Patients were assessed monthly. Haematological parameters and ALT were monitored during treatment. Clinical progress [side effects] and negative HDV RNA were used as response criteria. Overall 49 patients were HDV RNA positive [children: n=15, mean age 15 +/- 2.92 years adults: n=34, mean age 27 +/- 4 years]. Eighty percent were male. Treatment was given to 25 patients [children: n=11, adults: n=14]. HBV genotype D was the predominant in all HDV RNA positive patients [73%]. Eighty percent [20/25] were HDV-RNA negative after one year of treatment, and remaining patients are still under treatment. Side effects were tolerated well and children continued regular activity. Haematological parameters were unremarkable. Children maintained their pre-treatment centile for height and weight [growth parameters]. ALT levels were significantly decreased post-treatment. Conventional INF- was safe in children with HDV infection in terms of side effects and growth parameters. Eighty percent were HDV-RNA negative one year after treatment. Further follow-up 2 years post-treatment will give conclusive results