Combined application of bio-organic phosphate and phosphorus solubilizing bacteria (Bacillus strain MWT 14) improve the performance of bread wheat with low fertilizer input under an arid climate

Abstract This study was aimed to investigate the effect of bio-organic phosphate either alone or in combination with phosphorus solubilizing bacteria strain (Bacillus MWT-14) on the growth and productivity of two wheat cultivars (Galaxy-2013 and Punjab-2011) along with recommended (150-100 NP kg ha−1) and half dose (75-50 NP kg ha−1) of fertilizers. The combined application of bio-organic phosphate and the phosphorous solubilizing bacteria strain at either fertilizer level significantly improved the growth, yield parameters and productivity of both wheat cultivars compared to non-inoculated control treatments. The cultivar Punjab-2011 produced the higher chlorophyll contents, crop growth rate, and the straw yield at half dose of NP fertilizer; while Galaxy-2013, with the combined application of bio-organic phosphate and phosphorous solubilizing bacteria under recommended NP fertilizer dose. Combined over both NP fertilizer levels, the combined use of bio-organic phosphate and phosphorous solubilizing bacteria enhanced the grain yield of cultivar Galaxy-2013 by 54.3% and that of cultivar Punjab-2011 by 83.3%. The combined application of bio-organic phosphate and phosphorous solubilizing bacteria also increased the population of phosphorous solubilizing bacteria, the soil organic matter and phosphorous contents in the soil. In conclusion, the combined application of bio-organic phosphate and phosphorous solubilizing bacteria offers an eco-friendly option to harvest the better wheat yield with low fertilizer input under arid climate.

Combined application of bio-organic phosphate and phosphorus solubilizing bacteria (Bacillus strain MWT 14) improve the performance of bread wheat with low fertilizer input under an arid climate

Abstract This study was aimed to investigate the effect of bio-organic phosphate either alone or in combination with phosphorus solubilizing bacteria strain (Bacillus MWT-14) on the growth and productivity of two wheat cultivars (Galaxy-2013 and Punjab-2011) along with recommended (150100 NP kg ha1) and half dose (7550 NP kg ha1) of fertilizers. The combined application of bio-organic phosphate and the phosphorous solubilizing bacteria strain at either fertilizer level significantly improved the growth, yield parameters and productivity of both wheat cultivars compared to non-inoculated control treatments. The cultivar Punjab-2011 produced the higher chlorophyll contents, crop growth rate, and the straw yield at half dose of NP fertilizer; while Galaxy-2013, with the combined application of bio-organic phosphate and phosphorous solubilizing bacteria under recommended NP fertilizer dose. Combined over both NP fertilizer levels, the combined use of bio-organic phosphate and phosphorous solubilizing bacteria enhanced the grain yield of cultivar Galaxy-2013 by 54.3% and that of cultivar Punjab-2011 by 83.3%. The combined application of bio-organic phosphate and phosphorous solubilizing bacteria also increased the population of phosphorous solubilizing bacteria, the soil organic matter and phosphorous contents in the soil. In conclusion, the combined application of bio-organic phosphate and phosphorous solubilizing bacteria offers an eco-friendly option to harvest the better wheat yield with low fertilizer input under arid climate.

Risk factors of acute myocardial infarction among patients admitted in cardiology unit of a tertiary care hospital

Background: Acute myocardial Infarction is one of the most common causes of death in developed countries

Objective: To determine the risk factors of acute myocardial infarction and time of attack among patients admitted in cardiology unit

Methodology: Study site: Sheikh Zayed Medical college/ Hospital, Rahim Yar Khan. Study Subjects: 112 cases of acute myocardial infarction admitted in coroary care unti and 162 controls selected from attendants of cases. Study Design: Case Control Study. Study Duration: 1st October 2014 to 30th April 2015. Sample Size: A total of 324 subjects were included in this study,162 cases, having acute myocardial infarction and 162 controls, selected from attendants of patients of the same age group. Patients of acute myocardial infarction of either sex admitted in coronary care unit of Sheikh Zayed Medical College/ Hospital, Rahim Yar Khan. Patients having Liver disease, Renal diseases, Thyroid disease, Valvular Heart Disease, Cardiomyopathies, COPD and neurological disease. Variables included was age, Sex, Socioeconomic status, Education, BMI, Residence [Rural/Urban], Hypertension , Diabetes mellitus, Ischemic heart disease, Hyperlipidemia, Smoking, Time of onset of chest pain and obesity. Data analysis was done by using SPSS version 20. Numerical variables like Age, BMI, Height and Weight were presented as Mean and Standard deviation whereas categorical variables like Sex, Hypertension, Diabetes mellitus, Smoking were presented as percentages. Chi Square test was applied to determine the association of different risk factors with Acute Myocardial Infarction. Ethical approval was sought from Institutional Review Board of the hospital. Informed verbal consent was sought from every study subject before data collection

Results: The risk factors association assessed was; rural residence 78 [58%], [P value=0.01], Retired persons 16 [80%], [P value=0.000], Businessman 22 [69%], [P value=0.000], Hypertension 67 [64%],[P value=0.000] Smoking 70 [64%],[P value=0.000], Family history, Hypercholestrolemia 11 [91%], [P=0.003] and Sedentary life style103 [60%],[P value=0.000]

Conclusion: Our study showed that; rural residence, retired person, businessman, smoking, hypertension, family history hypercholesterolemia, sedentary lifestyle, were significantly associated with acute myocardial infarction. It was noted that 12am-8am was most frequent time of acute Myocardial Infarction episode

Comparison of maternal outcome in booked and unbooked mothers delivered in sheikh zayed hospital, rahim yar khan

Background: All pregnant women, by virtue of their pregnancy status, face some level of maternal risk. There are certain complications related to some pregnancies which are mainly associated with the health of mother

Objective: To enlist the risk factors and maternal outcome among booked and unbooked cases

Methodology: This was a cross sectional study done from 1st January to 31st March 2017. Randomly selected 300 study subjects participants were included in this study, from Obstetrics and Gynecology departments of Sheikh Zayed Hospital, Rahim Yar Khan. All the patients admitted through emergency and outpatient department, who had delivered in labour room were included. Ethical approval was sought from Institutional Review Board and took consent from individual patients. Booked patients were those who has atleast three antenatal care visits while unbooked patients included the ones who couldn't have any antenatal care during whole period of pregnancy. A predesigned performa was used for data collection. The performa included booking status, age of both partners, education of both partners, occupation of both partners, monthly income, residence, ethnicity, mode of delivery, number of antenatal visits, health provider at the time of antenatal visits gravida, parity, abortion, mode of delivery, gestational age, history of any disease during pregnancy and maternal consequences. The data was analyzed using SPSS version 16

Results: The mean age of patients was 26+/- 7.5 years, mean age of husbands was 30+/-6years, parity was 1.6+/-2.2, gravida was 3+/-2.4, abortion was 0.4+/-0.7, gestational age was 37.9+/-2.2, number of antenatal visits were 4+/-2.6, monthly family income [PKR] [Median] was 12000. 146 [48.7%] patients were illiterate. Out of total, 98 [32.7%] were booked patients and 202 [6.3%] were unbooked patients. Among booked cases, 84 [85.7%] were healthy, 7 [7.1%] has PPH, 2 [2%] were in ICU, 2 [2%] has ARF, 3 [3.1%] has hysterectomy. Among unbooked cases, 158 [78.2%] were healthy, 14 [6.9%] has PPH, 27 [13.4%] were admitted in ICU and 2 [1%] has hysterectomy. [p=0.00]

Conclusion: Our studyshowed that PPH and ICU admissions were significantly more among unbooked cases at tertiary care hospital. Overall ICU admissions followed by PPH and hysterectomy were more common maternal outcome noted in this study

Role of tsh only strategy for the diagnosis of thyroid disease

Background: Serum thyroid stimulating hormone [TSH] is advised to assess thyroid function and can be used to replace TFTs

Objective: To evaluate the role of TSH only for diagnosis of thyroid dysfunction in tertiary care hospital

Methodology: Study design: Cross sectional study. Study setting: Endocrinology, section of Pathology Department and Surgery Department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, Pakistan

Study Subjects: Patients referred for routine thyroid disease from surgical ward were selected for study. Their history was taken and detailed clinical examination was carried out

Data Collection: Data of all the patients in whom TSH, fT[4] and fT[3] tests or TSH and fT[4] were ordered by clinicians during the period of study was collected. ffT[3] , fT[4] and TSH were analyzed by fourth generation of ECLIA. Samples were assayed in batches, and sometimes 3 4 assays were performed in duplicate when necessary

Results: This study shows that TSH only strategy has 100% sensitivity in both hyperthyroid and hypothyroid cases when TSH plus fT was taken as golden standard, whereas in hypothyroid cases 4 specificity was 86% and in hyperthyroid cases was 90%

Conclusion:This study shows that TSH only strategy can be used as first line test for the diagnosis of thyroid disease and it has good sensitivity and specificity, as many patients with hypothyroidism or hyperthyroidism are diagnosed primarily on the basis of TSH measurement only

Structural and functional annotation of citrate synthase from Aspergillus niger ANJ-120

Citrate synthase [CS] is involved in citric acid biosynthesis which is a well-established metabolic pathway. The condensation of acetyl-CoA with oxaloacetate is catalyzed by CS. Citric acid [CA] has a number of applications in pharmaceutical industry. CA in combination with bicarbonates is used as an effervescent in the preparations of tablets and powders. It has also been used as an anticoagulant and acidulant to form mild astringent. In current study, detailed structural and functional analyses of CS protein were carried out using various bioinformatics tools. Structural modeling was also done by building 3D model of CS from Aspergillus niger ANJ-120 using Modeller 9.16 software. The 3D Model was then evaluated using different online approaches. Furthermore, superimposition of query and template structures, Root Mean Squared Deviation and visualization of generated model were done through UCSF Chimera 1.5.3. Even though various roles of CS protein were already known and verified experimentally, here we presented a structural analysis of CS protein. The structural investigation of CS protein will be helpful for protein engineering strategies and understanding the interactions among proteins. Due to large number of applications, the production of citric acid by A. niger and its bioinformatics studies will offer substantial improvement in commercial scale intensification of this useful product

Incidence and economic burden of acute otitis media in children aged up to 5 years in three Middle Eastern countries and Pakistan: a multinational, retrospective, observational study

Epidemiological data on acute otitis media [AOM], an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children 5 years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children [Saudi Arabia = 1023, Oman = 998, Pakistan = 1022, Turkey = 1000] were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars [USD]]. The overall incidence of AOM episodes per 1000 person-years was: Saudi Arabia, 207 [95% confidence interval [CI]: 178-238]; Oman, 105 [95% CI: 85-127]; Pakistan, 138 [95% CI: 116-163]; and Turkey, 99 [95% CI: 79-123]. The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation [SD] = 93.0], Oman USD16.1 [SD = 16.4], Pakistan USD22.1 [SD = 20.5], and Turkey USD33.6 [SD = 44.9]. The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies

Health seeking behavior among psychiatric patients attending psychiatry outdoor of a tertiary care hospital

Background: Psychiatric illness is mental disorder or mental illness that can be explained as mental or behavior pattern that causes either suffering or poor ability to function in ordinary life. In our country psychiatric problems are increasing day by day. Very little has been done in South Punjab in this regard

Objective: To assess the health seeking behavior among psychiatric patients attending Psychiatric OPD of Sheikh Zayed Hospital, Rahim Yar Khan

Methodology: Study Design: Cross-sectional study. Setting: Psychiatry Outdoor, Sheikh Zayed Hospital, Rahim Yar Khan. Duration: From 15 February to 15 May 2016. Sample Size:116 patients were interviewed. Apredesigned and pre-tested questionnaire was used for the data collection. Subjects of study were all the patients who were suffering from Psychiatric illness between 18-65 years of age and of either sex. Atotal of 116 consecutive patients were included in the study. The questionnaire was prepared and presented. It included variables on age, sex, socioeconomic status, family history, occupation, marital status and education and questions on health seeking behavior, like Health care provider, 1 contact, 2 contact, 3 contact and 4 contact, distance travelled for health care. All data was collected after getting informed verbal consent from patients. Data was entered and analyzed by using SPSS 16. The frequencies and percentages were calculated on categorical variables. Means and Standard Deviation were calculated on numerical variables. The data was entered and analyzed by using SPSS version 16

Results: There were total of 116 subjects included in study. 64% patients were males and 36% were females. 32.8% were illiterate while 36.2% had primary level education. 81% mothers and46.6% fathers of patients were illiterate. 63.8% patients were married and 67.2% were living in urban areas. Among 116 patients, 41.4% has depression, 19% epilepsy, 17.2% anxiety, 12.1 % schizophrenia and 10.3 % insomnia. Out of those, 56.9% of the patients went to Spiritual healer, 20.7% to Psychiatrist, 13.8% to Physician and 8.8% to Hakim overall in the study for the treatment of their psychiatric problems

Conclusion: This study showed that more than half of the patients with psychiatric problems went to Spiritual healers as first contact for health care. There is a dire need of health education programme to launch for the sensitization of people regarding to improve quality of life of psychiatric patients and improve health seeking behaviour

Evaluation of serum ferritin as predictor of HbA1c in patients with type-2 diabetes mellitus

Background: Serum Ferritin is an acute phase protein and it is a marker of iron stores in the body. The HbA1c fraction is abnormally elevated in chronic hyperglycemic diabetic patients

Objective: To determine the association between serum ferritin and long term glycemic control by HbAIc in patients with diabetes mellitus type 2

Methodology: This was a case control study which was carried out in the chemical pathology department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from 1[ST] July 2016 to 31[ST] January 2017. A total of 290 study subjects were included in this study. 110[38%] were the cases [diabetics with high HbA1c]. Ferritin, hemoglobin, HbA1c, and fasting blood sugar were measured in blood samples. Exclusion criteria included anemia, or any other disease or drug that could affect ferritin levels. Results were analyzed statistically by t-test and Pearson correlation test. The data was entered and analyzed by SPSS version 17

Results: A total of 290 study subjects were included in this study.110 were the cases [diabetics with high HbA1c], and 180 normal subjects were included. The mean serum ferritin among cases was significantly higher than control group [137+/-64 vs. 94+/-61ng/ml]. [P<0.00]

Compliance to discharge treatment among acute coronary syndrome patients in a tertiary care hospital

Background: Medicine compliance is a matter of concern for clinicians and policy makers

Objective: To assess the compliance to drug treatment after discharge from hospital among acute coronary syndrome patients in a tertiary care hospital

Methodology: This was a cross sectional study conducted over a period of six months from 1st January to 30th June 2015 at Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Out of 126 patients of acute coronary syndrome, discharged from CCU of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, we were able to contact 80 patients on phone, 47 were alive and have given information regarding medicine use, 3 were reported died during study period while 30 has given inadequate information so were excluded from study. The patients also having other diseases like; Diabetes Mellitus, Renal failure, Hepatitis, Endocrinal diseases were excluded. Informed verbal consent was taken from each patient before inclusion in study. Baseline data regarding medicines prescribed was noted in a questionnaire including demographic variables, number and types of medicines prescribed on discharge. Patients were contacted on phone, after six months of discharge from hospital, with the purpose to get information on compliance of drug intake. Variables included were number of medicines prescribed; grouped as three drugs, four drugs, five drugs and six drugs. Compliance was noted from; no drug to five drugs. The data was entered and analyzed by using SPSS version 20

Results: The mean age of patients was 54 +/- 12 years with 37[78.7%] males. Our study showed that 24[51%] were prescribed three drugs at time of discharge. 18[38%] were prescribed 4 drugs, 4[8.5%] were prescribed 5 drugs and 1 [2%] was prescribed 6 drugs on discharge. This study showed that 11[23%] of patients did not use a single drug after six months of discharge from hospital, 6 [12.7%] only two drugs compliance, 18[38%] showed three drugs compliance and 10[21%] showed compliance to four drugs where as 2[4%] showed compliance to five drugs after 6 months of discharged from CCU. Our results showed that 3[6%] patient died after discharge from CCU

Conclusion: Our study showed that compliance to the recommended treatment for acute coronary syndrome patients at discharge was poor within six months after discharge from hospital and resulting even in death to many of the patients. We suggest that appropriate interventions for secondary care may be planned to improve compliance among acute coronary syndrome patients

Medical school dermatology curriculum - are our graduates adequately prepared and aligned to community needs?

Background: There is paucity of research based information regarding the dermatology learning needs and their fulfilment in primary care physicians

Objective: To determine skin diseases burden in the community AND adequacy of preparedness of Primary Care Physicians to deal with skin diseases

Methodology: This was a cross sectional study conducted from 1[st] January 2015 to 31[st] December 2016 at Dermatology Outpatient Department of Sheikh Zayed Medical College/Hospital [SZMC/H], Rahim Yar Khan, for burden of skin diseases and feedback from Primary Care Physicians of both SZMC/H and Primary Health Care setups [BHUs and RHCs] of District Rahim Yar Khan regarding adequacy of their preparedness to deal with skin disease patients. Records from a tertiary care teaching hospital was sought from OPD to assess skin disease burden and Primary Care Physicians from tertiary care hospital and BHU and RHC of district were surveyed regarding content AND teaching adequacy of undergraduates through their dermatology curriculum. Data was entered and analyzed by using SPSS version 20

Results: A total of 356 doctors participated in this study. Of these 233 [65.4%] were males. It was found that 10% of patients attending OPD in Sheikh Zayed Hospital [A tertiary care teaching hospital] suffered from skin disease. Frequencies of "Common skin diseases" in the community were; eczema 12.9%, scabies 10.8%, fungal infection 9%, bacterial infection 8% and acne 7%. Of all participants, 274 [77%] reported that <10% of their patients suffered from skin disease and only 30 [8.4%] of them were fully confident while treating skin disease patients and only 36 [10.1%] reported that most of their patients were cured. It was noted that 145 [40.7%] participants could name only 1-3 of the common skin diseases in the community, 182 [51.1%] named 4-6 while only 12[3.4%] could name 7 or more and 17[4.8%] had no knowledge of even a single common skin disease in the community. Only 92[25.8%] participants rated that their undergraduate training was adequate while 264[74.2%] rated it to be inadequate

Conclusion: This study concluded that primary care physician were not adequately prepared for managing common skin diseases during their undergraduate training. Appropriate exposure and adequate teaching in dermatology throughout undergraduate medical curriculum is essential because skin presentations manifest throughout all aspects of medicine, and most often dermatological problems are dealt with exclusively by non-dermatologists

Frequency of tinea incognito among ring worm infections and health seeking behavior of these patients

Background: Ring worm infections are common in community and may be maltreated with steroids resulting in delay in proper diagnosis and treatment

Objective: To determine the frequency of tinea incognito among the ring worm infections of skin AND health seeking behavior of these patients

Methodology: This cross sectional study was conducted at Dermatology Outdoor of Sheikh Zayed Medical College Hospital Rahim Yar Khan from 1[st] March to 30[th] April 2017. A total of 170 patients of ring worm infections of skin were included in this study through convenient sampling. These patients were asked about the use of topical steroids through a pre-designed performa containing information about patients, diagnosis, type and duration of treatment and its prescriber. The data was entered and analyzed by using SPSS version 20

Results: Out of total 170 patients, 68[40%] has tinea incognito. Among these 26[15.29%] were treated by general practitioner, 30[17.6%] by relatives/friends, 3[1.8%] by Pharmacist and 9[5.3%] did self-medication

Conclusion: Use of topical steroids is quite common in ringworm infections of skin with poor health seeking behavior of these patients resulting in misdiagnosis and delay in proper treatment. Community should be educated in health seeking behavior for skin disease

Anti-avian influenza virus H[9]N[2] activity of aqueous extracts of Zingiber officinalis [Ginger] and Allium sativum [Garlic] in chick embryos

In the present study, anti-Avian influenza virus H9N2 activity of aqueous extracts [5, 10, 15, 20, 25%] of Zingiber officinalis and Allium sativum was evaluated. Embryo-toxicity was evaluated by histopathological scoring of Chorio-allantoic membrane of chick embryos. Cytotoxicity of extracts was determined by MTT assay on Vero cells. Aqueous extract of ginger had antiviral activity at 10, 15, 20 and 25% while garlic had activity at 15, 20 and 25%. Histopathological scoring of chorio-allantoic membrane for aqueous extracts [5, 10, 15, 20, 25%] of ginger [0.66+/-0.57, 1.33+/-0.57, 1.66+/-0.57, 2.66+/-0.57, 3.66+/-0.57, respectively] and garlic [1.00+/-0.00, 1.33+/-0.57, 2.00+/-0.00, 2.33+/-0.57, 3.66+/-0.57, respectively] was concentration dependant. MTT assay revealed cytotoxicity of both plants was also concentration dependent. Extracts of ginger [5, 10, 15, 20, 25%] had lower cytotoxicity [71, 59, 28, 22, 0 % cell survival, respectively] as compared to garlic [61, 36. 20, 11, 3% cell survival, respectively]. Overall results revealed that concentration of aqueous extract of ginger [10%], showing antiviral activity against H[9]N2, was less toxic to vero cells [> 50% cell survival]. It is insinuated that ginger may have anti- Avian influenza virus H9N2 potential and its active compounds needs further investigations

Intralesional versus oral chloroquine in cutaneous leishmaniasis: comparison of outcome, duration of treatment and total dose of drug

Objective: to compare intralesional versus oral chloroquine in cutaneous leishmaniasis and determine the cure rate, duration of treatment, and total dose of drug

Study Design: Randomized controlled study

Place and Duration of Study: department of Dermatology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2013 to June 2014

Methodology: consecutive 86 patients of cutaneous leishmaniasis, with single to multiple lesions of various sizes were enrolled and divided randomly into group A and B for the purpose of intralesional and oral chloroquine administration, respectively to compare the effect of the two routes on duration of treatment and total dose of the drug. SPSS version 16 was used for data analysis after data entry into it. Quantitative variables like, duration, cost and total dose of treatment were calculated as mean and standard deviation and compared by using T-test. P-value of less than 0.05 was taken as significant

Results: cure rate was 100% in both groups towards the end of treatment. Mean duration of treatment was 9.17 +/- 3 weeks in intralesional [A] group as against 11.37 +/- 3 weeks in oral [B] group [p = 0.0028]. Mean total dose of the drug given to each patient in group A was 5.8 +/- 0.5 gm and in group B, it was 19.2 +/- 1.5 gm, which is significantly higher [p < 0.001]. The total cost of treatment in group A was Rs. 90 +/- 8 and in group B it was Rs. 91 +/- 1 [p=0.446]

Conclusion: duration of treatment is significantly shorter and total dose is lesser with intralesional compared to oral chloroquine in treatment of cutaneous leishmaniasis

Effects of vitamin D supplementation on physical activity of patients with heart failure

Objective: To see the role of Vitamin D supplementation on physical status of patients suffering from Congestive Heart Failure [dilated cardiomyopathy]

Methods: In this nonrandomized clinical trial, Forty three Patients with dilated cardiomyopathy who were not showing any significant improvements in physical performance on optimal treatment of heart failure were included. Vitamin D [200,000 IU] supplementation on weekly basis for a period of 12 weeks was added to heart failure treatment. And its effect was seen on 6 minutes' walk distance and Pro-BNP levels. SPSS version 19 was used for data analysis. Dependent sample t-test was used to see the significant effect of vitamin D supplementation on pre-intervention vitamin D levels, 6MWD and Pro-BNP. Taking p-value <0.05 as significant

Results: On clinical assessment most of the patients were in NYHA class II [65%], the percentages of NYHA Class I, III and IV was 19%, 9% and 7% respectively. The baseline mean vitamin D level of the study group was 16.59 +/- 3.54ng/ml and it raised to 31.97 +/- 3.64ng/ml after 12 weeks of supplementation with vitamin D, p value <0.0005. The mean distance travelled by the study group before the intervention was 806 +/- 380ft while it increased to 945 +/- 393ft after the intervention, p value of 0.008. The mean of pro-BNP level of the study group before the intervention was 1024 +/- 635 while it improved to 159 +/- 80 after the intervention with a significant p value <0.0005

Conclusion: Vitamin D supplementation decreases the severity of HF as reflected by reduction in serum pro-BNP levels and significant increase in six minutes' walk distance

Knowledge and practices of rural mothers about diarrhea among infants

Background: Diarrhea is one of the most common cause of morbidity and mortality in children

Objective: To assess knowledge and practices of rural mothers about diarrhea among infants

Methodology: Study design Cross-sectional sutdy. Place and Duration: This study was conducted at EPI center of OPD and diarrheal unit of children ward Sheikh Zayed Hospital Rahim Yar Khan, from 15th March to 15 May 2016. A total of 224 rural mothers of infants were included in the study by non probability consecutive sampling technique. Before commencing with the data collection, informed consent was taken. The performa was designed and pretested and it contained variables like age, mother's education, mothers occupation, family income per month, knowledge about definition of diarrhea, causes of diarrhea, signs of dehydration, consequences of diarrhea, prepration of market available ORS sachet, continuation of breast feeding during diarrhea, consultation with doctor during diarrhea, time of consultation with the doctor, diet preferences during diarrhea and preventive measures applied by mothers during diarrhea. All the data collected was recorded on the performa, entered and analyzed by using SPSS version 16

Results: Mean age of mothers was 27 +/- 5 years. In our study [49.10%] months were illiterate. Regarding mothers occupation 74.11% were housewives. Regarding Knowledge of the mothers on definition of diarrhea 46.43% told loose watery stool, 3.57% told increased frequency and 36.61% told both loose watery stool and increased frequency. As regards causes of diarrhea, [24.11%] pointed out contaminated water, [9.82%] eating mud and [26.78%] told both contaminated water and eating mud. Regarding signs of dehydration [9.82%] sunken eyes, [6.25%] dry skin and [25%] considered both Sunken eyes and Dry skin. Regarding practices during diarrhea, 68.76% continued breast feeding during diarrhea, 92.86% consulted doctor but before consulting the doctor, 21.88% did self medication and 65.62% consulted the doctor when condition of child was not improving. 33%] gave diet preferences to both ORS and khichree, 26.79% ORS and 6.69% khichree only. 40.89% applied boiling the water, covering the food and keeping child and environment clean as preventive measure during diarrhea whereas 22.32% did boiling the water and covering the food only, whereas, 3.57% boiling the water only and 2.67% covering the foods only

Conclusion: Majority of the mothers has good knowledge and practices about diarrhea but still many of them do not have clear idea about prevention and ideal practices to be adopted during diarrhea and they should be focused. There is a need of health education program to be started in the rural areas of Rahim Yar Khan

Pattern of bony injuries among civilian gunshot victims at tertiary care hospital in Karachi, Pakistan / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>Firearm injuries impose a continuous economic burden on society and hospital resources. The aim of this study was to assess the pattern of bony injuries among victims of gunshots.</p><p><b>METHODS</b>A retrospective study was conducted in the Department of Orthopedics, Dow University of Health Sciences and Civil Hospital Karachi from January 2011 to December 2012. Patients with isolated bony injuries were included while patients with other systemic injuries were excluded.</p><p><b>RESULTS</b>There were 90 cases and the majority of them were male (84.4%). Mean age was (32.52 ± 10.27) years. Most of the patients (72.2%) belong to the younger age group. A low velocity weapon was used in 61 (67.8%) cases and a high velocity weapon was used in 29 (32.2%) cases. Armed robbery (64.4%) was the cause of conflict in more than half of the cases. Lower limb was involved in 72.2%. Fifty eight (64.4%) patients remained hospitalized for 15-20 days and others for more than 20 days. Internal fixation with intramedullary nailing was done in 35 patients while K-wire was used in 5 patients. Fifty patients were managed with external fixation, either uniplanar or multiplanar ilizarov. Deep wound infection and nonunion were observed more often in high velocity injuries.</p><p><b>CONCLUSION</b>Armed robbery was the leading cause of gunshot bony injuries in our hospital. Young males were victimized in a majority of cases. High velocity injuries were associated with more complications.</p>

Analysis of physiological [PAO[2], pulse and blood pressure] changes during modified ECT under general anaesthesia

To study the changes in physiological parameters ie PAO[2], pulse and blood pressure changes during ECT under GA. Quasi-experimental study. Department of Psychiatry and Department of Anaesthesiology, Combined Military Hospital Abbottabad from Sep 2009 to Feb 2010. A total of 50 patients with depression were given four separate ECT sessions each. All patients were anaesthetized using propofol 180-200 mg I/V and suxamethonium 50 mg ie 0.75-1 mg per kg I/V without atropine. They were stratified according to physiological changes including PAO[2], pulse and blood pressure at 1, 2 and 5 min after ECT. Oxygen saturation was measured using a pulse oximeter, which measures saturations in the range of 65-100%. Age range was 19-65 years; mean 46 years [SD +/- 13]. Mean diastolic BP before ECT was 84.72 that decreased post ECT ie 78.02 and 77.46 and 74.44 at interval of 1, 2 and 5 minute respectively. Post-ECT pulse and PAO[2] behaved similarly. Post ECT systolic BP decreased at land 5 minutes. Pulse rate decreased after ECT. ECT under propofol is one of the most effective and safe modality of treatment for psychiatric patients under the supervision of qualified psychiatrists and anaesthesiologists and it gives more stable hemodynamic changes

Intra-articular distal radius fractures; functional outcome of percutaneous kirschner wire fixation and short arm cast in patients of 20-70 years

To determine functional outcome of percutaneous Kirschner wire fixation and short arm cast in intra-articular distal radius fractures in patients of 20-70 years. Descriptive case series. Department of Orthopedic Surgery, Dow University of Health Sciences / Civil Hospital Karachi. 1[st] April, 2013 to 30[th] September, 2013. A total of 62 patients with closed type III distal fractures according to Frykman classification were included in this study. Patient lying in supine position and after general anesthesia, closed reduction was done with the forearm in prone position, aiming to restore normal anatomical position. Two Kirschner wires were inserted from radial styloid process in parallel and oblique fashion to the medial cortex of the radius and one transversely from lateral to medial for intra-articular fragments. Final functional outcome was assessed after 12 weeks of surgery and recorded on pre-designed Proforma. Acceptable functional outcome of percutaneous Kirschner wire fixation and short arm cast in intra-articular distal radius fractures was observed in 80.65% [50/62] cases. It is concluded that functional outcome of percutaneous Kirschner wire fixation and short arm cast procedure is satisfactory in intra-articular distal radius fractures and it appears to be an easy, technically less demanding and effective method for stabilization, so this procedure can be applied for patients with these fractures

Pediatric forearm fractures; functional outcome managed with intramedullary rush nails - experience in a tertiary care hospital

Unstable forearm both bones fracture in children more than 10 years of age are difficult to manage with cast and surgical intervention is required. To determine the functional outcome of patients with unstable forearm fractures managed with intramedullary rush nail. This study was conducted at Department of Orthopedics, Civil Hospital Karachi from July 2011 to August 2013. All the patients with age in between 10 to 15 years, with close radius ulna unstable fracture presenting within 7 days of trauma or fall were included in the study. All the fractures were stabilized with intramedullary rush nails. Functional outcome was assessed at 12 weeks. There were 79 patients included in the study. Mean age was 13.17+/-2 years. There were 52 male patients [65.8%] and 27 females [34.2%]. There were 24 patients with history of road traffic accident, 29 patients with fall and 26 patients with blunt injury. Acceptable outcome was found in 64 [81%] patients and observed more in male children [p=0.001] and children above 13 years of age [p=0.027]. Union was achieved in all the patients. Six patients had pin site irritation and 2 had superficial infection. Intramedullary fixation with rush nail in unstable forearm fractures in the children appeared to be an effective method of fixation and provided acceptable outcome in 64 [81%] patients