Right-sided diaphragmatic hernia in an elderly male

Diaphragmatic hernia is rarely reported in elderly. Here we present a 90-year-old male patient suffering from respiratory symptoms with no prior history of trauma. Investigations showed diaphragmatic hernia on the right-side. Defect was anteromedial in position. The contents of the hernia were small and large gut. Considering multiple co-morbid it was decided not to operate on this patient

Utilization pattern of health delivery system at primary and secondary level and problems encountered by users in mirpur khas division

To know the current utilization status of the health facilities at primary and secondary level in Mirpur Khas Division. Information was collected on a specially designed questionnaire which was also translated in local language for easiness of the patients. Data were collected from 47.7% [84] out of 176 primary health care facilities and 81.8% [09] out of 11 secondary level health care facilities. The users and doctor's incharges were interviewed. The data were collected from the field were compiled, entered and analyzed at PMRC Research Centre, LMC Jamshoro, The questionnaire covered basic information of the health facilities. Staff strength, provision of medicines and consumable supplies from DHO, officers, operation and maintenance of equipments provided and other general problems highlighted. The project was conducted during 1998-99 under the HSR Grant received from PMRC Islamabad. The population of Mirpur Khas Division was 45, 56, 570. The total health care facilities were 176 [165 + 11] primary and secondary respectively. Data were collected from PHC facilities 47.7% and 81.8% secondary level. The study showed 23.7 users visited primary health care facilities while 251.33 visited secondary level. The primary and secondary care health facilities are under utilized due to shortage of staff, particularly WMOs in this division. Tharparkar desert is 22,000 km area and there are no ambulance services to transport serious patients and pregnant ladies to some tertiary care hospital for urgent surgeries or neonatal care. Most of the deaths are observed while transporting pregnant mothers on the back of the camel which is frequent traditional mode of transport in desert