Identification of Helicobacter spp. in gastrointestinal tract, pancreas and hepatobiliary system of stray cats

The aim of the present study was to determine the presence of Helicobacter species in different parts of gastrointestinal tract, hepatobiliary system and pancreas of stray cats. Six different sites at the level of genus, gastric [H. heilmannii and H. felis] and enterohepatic species of Helicobacter were investigated in six cats using species-specific primers by polymerase chain reaction [PCR]. Interestingly, DNA of enterohepatic spp. was detected in 1/6 duodenum, 2/6 colon and 1/6 pancreas specimens. Results of sequencing revealed that all of these four positive samples belong to Helicobacter canis. While cats have not been considered as a potential zoonotic danger for non-pylori Helicobacter infections, the results of current study show prompt re-evaluation of that view. To the best of our knowledge, this is the first study about distribution of Helicobcater spp. in gastrointestinal tract of cats

Validation of the arabic version of the epworth sleepiness scale

The Epworth Sleepiness Scale [ESS] is a questionnaire widely used in developed countries to measure daytime sleepiness and diagnose sleep disorders. This study aimed to develop an ESS questionnaire for the Arabic population [ArESS], to determine ArESS internal consistency, and to measure ArESS test-retest reproducibility. It also investigated whether the normal range of ESS scores of healthy people in different cultures are similar. The original ESS questionnaire was translated from English to Arabic and back-translated to English. In both the English and Arabic translations of the survey, ESS consists of eight different situations. The subject was asked to rate the chance of dozing in each situation on a scale of 0-3 with total scores ranging between 0 [normal sleep] and 24 [very sleepy]. An Arabic translation of the ESS questionnaire was administered to 90 healthy subjects. Item analysis revealed high internal consistency within ArESS questionnaire [Cronbach's alpha = 0.86 in the initial test, and 0.89 in the retest]. The test-retest intra-class correlation coefficient [ICC] shows that the test-retest reliability was substantially high: ICC = 0.86 [95% confidence interval: 0.789-0.909, p-value < 0.001]. The difference in ArESS scores between the initial test and retest was not significantly different from zero [average difference = -0.19, t = -0.51, df = 89, p-value = 0.611]. In this study, the averages of the ESS scores [6.3 +/- 4.7, range 0-20 in the initial test and 6.5 +/- 5.3, range 0-20 in the retest] are considered high in Western cultures. The study shows that the ArESS is a valid and reliable tool that can be used in Arabic-speaking populations to measure daytime sleepiness. The current study has shown that the average ESS score of healthy Arabian subjects is significantly higher than in Western cultures

Aspiration Cytopathology of Peripancreatic Space: A Clinicoradiologic and Cytopathologic Analyses of 42 Cases

BACKGROUND: The pancreas is surrounded by soft tissue known as the peripancreatic space (PPS). Pathologic lesions of the PPS are infrequent and have only rarely been reported in the cytopathology literature. METHODS: A retrospective review of cytopathology files at two large institutions revealed 42 cases of PPS lesions obtained by transabdominal fine needle aspiration (FNA) or endoscopic ultrasound-guided FNA over a 16-year period. Clinicoradiologic findings and follow-up information were also reviewed. RESULTS: Patients ranged in age from 23-83 years (mean, 60 years) with an equal gender distribution. The major clinical presentations included pain, jaundice, nausea/vomiting, and abnormal liver enzymes. Radiographic characteristics included lymphadenopathy and cystic/solid soft tissue masses with a size range of 1.5 to 8 cm. Cytologically, 4 (9.5%) cases were nondiagnostic, 9 (21.5%) were diagnosed as benign, 4 (9.5%) were atypical or suspicious for cancer, and 25 (59.5%) were malignant. Six of 25 (24%) patients had metastasis of a prior known malignancy. CONCLUSIONS: FNA of PPS masses is a rare occurrence. The majority of lesions are metastatic carcinomas from a variety of primary sites. Flow cytometry and immunoperoxidase studies are useful adjuncts to determine the tumor origin. The sensitivity of PPS aspiration for a malignant diagnosis is 90% with a positive predictive value of 100%.

Acinar Cell Carcinoma of the Pancreas: Clinical and Cytomorphologic Characteristics

Acinar cell carcinoma is a rare malignant epithelial neoplasm with predominantly exocrine acinar differentiation and is seen primarily in older men (mean age, 62 years). The presenting symptoms are usually non-specific, and jaundice is often not present. Symptoms relating to the overproduction and release of lipase into the circulation are present in 10-15% of patients. Characteristic cytomorphologic features include a population of cells with minimal pleomorphism, eccentrically placed nuclei with a single prominent nucleoli and moderate hyperchromasia. The cytoplasm is finely granular, and the background may contain granular debris secondary to cytolysis. A significant proportion of the cases also have a minor neuroendocrine component or scattered neuroendocrine cells. Approximately 50% of patients have metastatic disease at presentation, often restricted to the regional lymph nodes and liver. The prognosis is poor, only slightly better than that of pancreatic ductal adenocarcinoma.

Cytotechnologists and On-Site Evaluation of Adequacy

While fine needle aspiration (FNA) is certainly not a new biopsy technique, recent developments in advanced imaging techniques, molecular testing, and targeted therapies have coincided with a rapid increase in the number of FNA procedures being performed. Concurrently, the demand for on-site evaluation of adequacy (OSEA) has also increased, outstripping the capacity of available cytopathologists at some institutions. Among the several alternatives to cytopathologist-performed OSEA, cytotechnologist-attended OSEA stands out because it preserves the representation of the pathology service at the time of the procedure. Herein, we review the current literature about OSEA and the necessity of cytotechnologists to expand access of this useful pathology service to a broader patient population. We also examine how cytotechnologists are likely to fit into the emerging practice of telecytology.

Relationship of self esteem and social anxiety: a comparative study between male and female adolescents

The present study aims to find the relationship differences of social anxiety and self esteem among male and female adolescent students in Pakistan. It was hypothesized that there would be a difference in the relationship of self esteem and social anxiety in males and female adolescents. A Correlational Study. Different Schools and Colleges of Karachi, 2011. A total of 210 adolescents including 86 males and 124 females served as the subjects of the study. To assess the social anxiety Interaction Anxiety Scale, Urdu version1 and for the evaluation of self esteem Rosenberg Self Esteem Scale translated version2 was employed. Descriptive Statistics was computed to analyze sample characteristics; and Pearson correlation coefficient was applied to determine the relationship of social anxiety and self esteem among male and female adolescents. Z correlation was also computed to find out if the gender difference in the relationship of social anxiety and self esteem is significant. The results indicate that there is gender difference between the associations of two variables but it is not significant. 16 Bano, Ahmad and All. Findings of the research do not support the role of gender difference in the relationship of self esteem and social anxiety

Pattern of magnetic resonance imaging and magnetic resonance venography changes in cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis is a common but highly under-recognised condition, which is missed not only by general practitioners but also by neurologists. Computerised tomography [CT] or magnetic resonance imaging [MRI] of brain alone is not sufficient to diagnose this condition. Objective of this study was to explore the pattern of magnetic resonance imaging [MRI] and magnetic resonance venography [MRV] changes in cerebral venous sinus thrombosis [CVST]. This was a descriptive study in which 52 cases of cerebral venous sinus thrombosis with special emphasis on their MRI and MRV findings were included. The study was conducted in Neurology Unit, Lady Reading Hospital, Peshawar, Pakistan, from January 2010 to July 2011. All patients suffering from cerebral venous sinus thrombosis were included in the study. Multi-planar/multi-sequential, Tesla 1.5 MRI/MRV time of flight images were done in all cases where there was suspicion of cerebral venous sinus thrombosis. Out of 52 patients with cerebral venous sinus thrombosis 41 [78.84%] were female and 11 [21.15%] were male. Mean age was 37 +/- 5 years. Definite risk factors were found in 38 [73.076%] patients with pregnancy, use of oral contraceptives or puerperium being the most frequently found risk factor in 20 [73.076%] patients. Most common complaint was headache found in 41 [78.84%] patients, followed by focal neurological deficits, and altered mental status and seizures. Papilloedema was seen in 20 [38.46%] patients. The cerebral venous sinuses most frequently involved were transverse and sigmoid sinuses in 17 patients [32.69%] while superior sagittal sinus alone in 10 [19.23%] patients. Overall CT brain was normal in 30% and MRI brain in 23.07% patients; however, MRV of these patients revealed CVST. Imaging plays a primary role in the diagnosis of cerebral venous sinus thrombosis because the clinical picture of CVST is non-specific and highly variable. Thrombosis of cerebral venous system is readily picked-up on MRV even if it is missed by CT scan or MRI.

Effects of mating sex ratios in Indian peafowl [Pavo cristatus] on production performance at Wildlife Research Institute, Faisalabad [Pakistan]

Effects of mating sex ratios on production performance in Indian peafowl were investigated at Punjab Wildlife Research Institute, Gatwala Faisalabad. Research was conducted from May through August 2007 to explore the most productive mating sex ratio. The sex ratios have a significant effect on egg production

Maximum mean eggs [1.63] were produced by the sex ratio 1:2 while maximum egg fertility [79.63%] and hatchability [61.59%] was noted in the sex ratio 1:3. Sex ratios had a significant effect on egg weight

Sex ratios have shown no effect [except number of mountings] on courtship behavior of peafowl. Statistically less feed was consumed by sex ratio 1:3 and better feed conversion was shown by sex ratio 1:1?

Prevalence of plasmid mediated bla(TEM-1) and bla(CTX-M-15) type extended spectrum beta-lactamases in patients with sepsis

OBJECTIVE@#To characterize the bacterial pathogens in patients having gram negative septicaemia. Further, to evaluate the antimicrobial resistance and underlying molecular mechanisms in these strains.@*METHODS@#A total number of 70 cases of gram negative sepsis were included in this prospective, open labeled, observational study. Standard methods for isolation and identification of bacteria were used. Antimicrobial susceptibility and ESBL testing was performed by the standard disc diffusion method. PCR amplification was performed to identify bla(CTX-M), bla(SHV) and bla(TEM) type ESBLs. Conjugation experiments were performed to show resistant marker transfer.@*RESULTS@#The most prevalent isolates Escherichia coli (E. coli) 58.6%, Klebsiella Spp. 32.9% and Pseudomonas 8.6%, were resistant to most of the antimicrobials including cefazolin, ceftriaxone, cefuroxime, ampicillin and co-trimoxazole but sensitive to imipenem and meropenem. ESBL and MBL production was seen 7.3% and 12.2% of E. coli isolates respectively. Three isoaltes were found to have bla(CTX-M-15) and two of them also showed bla(TEM-1) type enxyme. Whereas, none of them showed bla(SHV). Conjugation experiments using J-53 cells confirmed these resistant markers as plasmid mediated.@*CONCLUSIONS@#This work highlights the molecular epidemiology of escalating antimicrobial resistance and likely switch over of bla(CTX-M-15) type extended spectrum beta-lactamases by bla(TEM) type ESBLs in India. Further, the antimicrobial resistance by horizontal gene transfer was predominant among Enterobacteraceae in the community setting.

Perioperative effects of various anesthetic adjuvants with TIVA guided by bispectral index / 대한마취과학회지

BACKGROUND: This prospective, randomized, double blinded, controlled study was designed to compare effects of intravenous co-administration of clonidine, magnesium, or ketamine on anesthetic consumption, intraoperative hemodynamics, postoperative analgesia and recovery indices during Bispectral Index (BIS) guided total intravenous anesthesia (TIVA). METHODS: After ethical committee approval and written informed consent, 120 adult patients ASA I and II scheduled for open cholecystectomy were randomly assigned to one of 4 equal groups. Group CL received clonidine 3 microg/kg and maintained by 2 microg/kg/h. Group MG received magnesium sulphate 50 mg/kg and maintained by 8 mg/kg/h. Group KET received racemic ketamine 0.4 mg/kg and maintained by 0.2 mg/kg/h. Control group (CT) received the same volume of isotonic saline. Anesthesia was induced and maintained by fentanyl, propofol and rocuronium. Propofol infusion was adjusted to keep the BIS value between 45-55. Intraoperative hemodynamics, induction time, anesthetic consumption, recovery indices, and PACU discharge were recorded. RESULTS: Induction time, propofol requirements for induction and maintenance of anesthesia, intraoperative fentanyl and hemodynamic values were significantly lower with Groups CL and MG compared to Groups KET and CT (P < 0.05). Patients in Group MG showed significantly lower muscle relaxant consumption, delayed recovery and PACU discharge than other groups (P < 0.05). First, analgesic requirement was significantly longer and total postoperative analgesic consumption was significantly lower in the adjuvant groups versus Group CT (P < 0.05). CONCLUSIONS: Clonidine, magnesium, and ketamine can be useful adjuvant agents to BIS-guided TIVA. Pharmacokinetic studies of such drug combinations were recommended to investigate their interaction.

[Health status and activities of daily living in hemodialysis and transplant patients]

The aim of renal transplantation is improvement of general health and well-being in patients with end-stage renal disease. Both hemodialysis and renal transplantation have complications that can adversely affect health and activities of daily living [ADL] in patients. The assessment and comparison of these variables can be helpful in proper management of the patients. This study was conducted to assess and compare activities of daily living and health status among hemodyalisis and renal transplant patients in Kashan, Iran in 2004-2005. This cross-sectional study was conducted on 163 patients undergoing hemodyalisis and renal replacement therapy in Kashan, Iran. They were selected by census and evaluated by Nottingham Standard Activities of Daily Living questionnaire and DUKE health profile. The data were analyzed by descriptive statistics and multiple regression. The mean age was 40.6 in transplant and 55.3 years in hemodialysis patients. Of dialysis group 55.6% were female, while the female patients were 41% in transplant group. The mean duration of current therapy was 64.7 month in transplant and 30.3 months in dialysis patients. The mean score of general health was 59.1 +/- 17.7 in transplant and 49.8 +/- 17.6 in dialysis patients [p

Controlled mechanical ventilation with lmasureme[TM] Versus I-Gel[TM] in anesthetized adult patients

The efficacy, safety and ease of insertion of LMA[TM] Supreme and the i-gel™ in adult cases undergoing elective surgical procedures requiring general anesthesia with controlled mechanical ventilation. This study included 60 ASA physical status I-II adult patients of both sexes scheduled for elective surgical procedures under general anesthesia. Patients were randomly allocated into one of two groups; LMA-S[TM] GI [n=30] and i-gel[TM] Gil [n=30]. A size 4 LMA Supreme[TM] and a size 4 i-gel[TM] were used with standard monitoring. Number of insertion attempts, ease of insertion, presence of gastric insufflation, laryn-geal leak, leak pressure, ease of gastric tube insertion, ventilatory parameters, complications as well as hemodynamic variables was recorded. The results showed no clinically significant changes of heart rate, MAP, Sp0[2] or P[ET] CO[2] in GI and GIL The i-gel[TM] showed higher frequency of ease of insertion[p=0.048] and gastric tube [p< 0.001]. First attempt of insertion was successful in 60% of LMA-S[TM] GI and 73.3% of the i-gel[TM]Gil [p=0.460] without failures in both groups. Leak pressure was significantly higher in the i-gel[TM] [25.5 +/- 4.8 cm H[2]O] compared to the LMA-S[TM] [21.1 +/- 7.6 cm H[2]O] [p=0.010] while both peak and plateau pressures were significantly lower in i-gel[TM] GI [19.35 +/- 2.25 cm H[2]O and 17.75 +/- 2.07 cm H[2]O] compared to LMA-S[TM] Gil [30.05 +/- 3.82 cm H[2]O and 28.80 +/- 3.99cm H[2]O][p<0.001] respectively. There was no significant difference between both groups in the frequency of complications encountered during insertion or recovery

Multisectoral development for improved health outcomes: evaluation of community-based initiatives in the Islamic Republic of Iran

Community-based initiatives [CBI] are based on integrated multisectoral socioeconomic development with community participation and intersectoral support to improve the health and quality of life of the people. During 2005-06 the World Health Organization supported an evaluation of CBI in the Islamic Republic of Iran by collecting information from intervention villages on social capital and other indicators, with validation of the findings. The data showed some positive changes in the intervention areas compared with control villages. The evaluation suggests that the CBI approach is a useful tool for improving health and social indicators and providing mechanisms for community-based participation and intersectoral collaboration for health and development at the local level

Sub-antibiotic doses of erythromycin as a prokinetic in abdominal surgeries: reviving the old

All patients undergoing major abdominal procedures have some degree of gastric atony in the immediate postoperative period, presenting mainly with vomiting. Many prokinetic agents have been used in the past, but none is a universal remedy. Studies showed that subantibiotic doses of erythromycin, a macrolide. antibiotic and motilin agonist, accelerates gastric emptying. This study investigated whether preoperative subantibiotic dose oral erythromycin [250 mg], altered residual gastric volume and postoperative adverse effects in patients scheduled for abdominal surgeries. Erythromycin was compared with the commonly used prokinetic metoclopramide and antiemetic ondansetron, in terms of prokinetic efficacy, cost and adverse effects. In a double-blind study, eighty patients [20 each] were allocated randomly to receive orally, either erythromycin 250 mg [E250] or erythromycin 500 mg [E500], or 10 mg metoclopramide [M], or 4mg ondansetron [Z], an hour pre-induction of anesthesia. Preoperative oral erythromycin in subantibiotic dose 250mg elicited a significantly lower residual gastric volume [P<0.001] and a lower VAS for vomiting, compared with ondansetron. As for metoclopramide and erythromycin 500, residual gastric volume was comparable, but E 250 had a lower VAS for vomiting than both groups. Rescue remedy for vomiting was required for groups E500, M and Z [100, 10 and 10 %] compared to 0% in group E250. Ultimately, subantibiotic oral dose of erythromycin [250 mg], given1 hr preoperatively, is an inexpensive prokinetic alternative with a promising post-operative profile which may be superior to the inexpensive prokinetic metoclopramide with known adverse effects, and the expensive antiemetic ondansetron

Control of emergence hypertension after craniotomy for brain tumor surgery

To compare the anti-hypertensive effects of both remifentanil and esmolol infusion. This prospective comparative study was conducted on 20 patients [10 patients in each group], in the Neurosurgical Theater of Kasr Elaini Hospital, Cairo, Egypt from 2006 to 2008. The patients were divided into 2 equal groups. In group one, remifentanil was used as a bolus of one ug/kg intravenous [iv] in 30-60 seconds, followed by infusion at a rate of 0.25-0.5 ug/kg/min until the systolic blood pressure was <140 mm Hg. In group 2, esmolol was given as a 500 ug/kg iv bolus in 30 seconds followed by continued infusion of 100-300 ug/kg/min until systolic blood pressure was < 140 mm Hg. Infusion was continued until the patients left the post anesthesia care unit [PACU]. The onset time of decreasing blood pressure was shorter in group 2 [40 +/- 0.01 seconds] than group one [52.5 +/- 4.47 seconds]. The PACU and hospital stay were comparable between both groups. Remifentanil can be used to control blood pressure during emergence of anesthesia after craniotomy for brain tumors. It has higher rapid recovery score than esmolol and other narcotics. In addition, it can be used when esmolol is contraindicated such as in cardiac patients, asthmatics, chronic obstructive pulmonary disease, or during pregnancy. Also, it decreases the need for postoperative analgesia and allows sedation if the infusion is continued as surgical patients are admitted to the ICU

Congenital synostosis in a child from Gezira state: a case report

A 13 years old boy presented with inability to fully rotate the arms during eating and writing. No history of trauma or history of similar conditions in the family. The problem began since early childhood. The parents sought help from traditional healer. Physical examination revealed inability to supinate both forearms. No other abnormality was detected. X-ray showed proximal radio-ulnar synostosis

Awake craniotomy versus general anesthesia for managing eloquent cortex low-grade gliomas

To compare awake craniotomy using conscious sedation technique versus conventional general anesthesia [GA] for excision of low-grade glioma encroaching on eloquent brain. This prospective study included 40 patients ASA classification 1 and 2, aged 23-55 years, harboring low-grade glioma encroaching on eloquent brain. The study was carried out in the Neurosurgical Theatre in Kasr El-Aini Hospital, Cairo, Egypt, from January 2007 to November 2008. Twenty patients [group 1] received GA with endotracheal intubation and controlled ventilation. In group 2, awake craniotomy was carried out using local anesthetic infiltration, and intravenous injection of propofol and fentanyl. Forty patients completed the study. In the awake group, none of the patients received GA, 2 patients developed intraoperative agitation, 5 patients were over-sedated, and none of the awake patients developed intraoperative nausea or vomiting. Four patients in the GA group developed post-operative nausea and vomiting compared to one patient in the awake group, and this difference was statistically significant [p=0.039]. The neurological outcome regarding motor power and/or speech was found better or with no fresh deficits, immediately postoperative in 90% of the awake group patients. This is compared to 40% in the GA group. The difference was statistically significant. At 6 months follow up, the results were 90% and 60%, but the difference was not statistically significant. Gross total tumor resection was achieved in 10 cases of the GA group versus 8 in the awake group; however, the difference was not statistically significant. Compared to GA, awake craniotomy is a relatively simple non-expensive procedure that allows tumor removal guided by physiology rather than anatomy

Long- term outcome of orthotopic neoblader reconstruction after radical cystectomy

To assess the long- term outcome of neobladder reconstruction after radical cystectomy. In this retrospective study we evaluated the records of 90 patients [70 males and 20 females] subjected to radical cystectomy and orthotopic neobladder reconstruction at Sohag University Hospital, Sohag, Egypt, between January 1999 and January 2006. The age of the patients ranged from 35 to70 years with a median age of 42 years. All patients had invasive bladder carcinoma: squamous cell carcinoma was found in 55, transitional cell carcinoma in 33 and adenocarcinoma in 2 patients. Thirty-five patients had a W-neobladder with serous-lined extramural ureteral reimplantation, 35 patients had Studer pouch and 20 patients had colonic [sigmoid] neobladder reconstruction. After surgery all patients were followed up for a period of between 6 and 84 months [median 45 months] in order to evaluate the functional and oncological outcome. Thirty [33.3%] patients developed complications within 30 days from surgery, defined as early complications. Chest infection and wound infection which was found in 3 [3.3%] and 5 [5.6%] patients, respectively, was treated with antibiotics. Eight patients developed paralytic ileus which was managed with NGT. Re-operation was required in 8 patients: 3 of them required re-suturing of the abdominal incision, bleeding occurred in 2 cases, while 2 cases developed intestinal obstruction and one patient ureterointestinal leakage. Pouch leakage was observed in 6 patients. Late complications occurred in 18 [20%] patients. Re-operation was necessary in 15 cases: 4 cases with stone formation in the neobladder, 3 cases with incisional hernia, 5 cases with a stricture at the ureterovesical junction, one case with vesicourethral stricture and 2 cases of vesicovaginal fistula. Complete continence during day and night was achieved in 63 [70%] patients, while 24 patients [26.7%] had nocturnal incontinence and 3 patients [3.4%] were fully incontinent. The daytime continence rate was 86.6% [87 patients] with 4 patients [4.4%] using clean self-intermittent catheterization. Twenty-seven [30%] patients developed recurrence of cancer within 4 to 30 months from surgery, among them 3 with urethral recurrence, 20 with local pelvic recurrence and 4 with distant metastases. Orthotopic neobladder reconstruction provides excellent continence rates and has an acceptable early and late complication rate. Therefore we recommend neobladder reconstruction for all patients undergoing cystectomy

Pericardial effusion in acute myocardial infarction: frequency and in-hospital course

To determine the frequency and in-hospital course of pericardial effusion in acute myocardial infarction in our population. Prospective observational study. The study was conducted in the Department of Cardiology and Medicine, Mayo Hospital, Lahore. One hundred consecutive patients presented within first 24 hours of first episode of ST elevation myocardial infarction [STEMI] were studied. Patients with known coronary artery disease [CAD], chronic renal failure, collagen vascular disease, cardiac surgery and metastatic disease were [PE] was considered to be present when separation between two pericardial layers persisted throughout the cardiac cycle. Among 100 patients who were enrolled, 27 developed PE. Frequency of baseline variable like age, gender, and risk factors for coronary artery disease including hypertension, smoking, and diabetes mellitus were same in patients who developed PE when compared to those who did not. Most of the PE was detected on day 5 of the admission. About 82% patients had mild PE [only posteriorly and <10 mm]. Moderate PE was detected on day 5 of the admission. About 82% patients had mild PE [only posteriorly and < 10 mm]. Moderate PE was detected in 18% [present all around and between 10-20 mm]. None of the patients developed large PE [>20 mm]. About 15% patients who were thrombolysed and 40% who could not be thrombolysed developed PE [p <0.01]. Frequency of PE was statistically highly significant [p <0.001] among patients with higher Killip class and lower ejection fraction at the time of presentation. Patients who developed PE had statistically significant longer hospital stay [p <0.001] and higher in-hospital mortality [p<0.05].Thrombolysis decreased the frequency of PE in acute STEMI. Development of PE during the course of acute STEMI has prognostic implications and early invasive strategy may be offered for patients who develop this complication

Health for all in Pakistan: achievements, strategies and challenges

This paper describes Pakistan's progress towards achieving health for all. Strategies and achievements are discussed, with particular reference to political commitment, community participation and programme development. The challenges faced by the country in achieving health for all are described and the future prospects outlined