Reliability and validity of floor transfer test in subjects with idiopathic Parkinson’s disease

@#Objective: To determine the validity and reliability of the floor transfer test (FTT) in people with Parkinson’s disease (PD). Methods: The sample was 25 subjects with PD. The concurrent and convergent validity of FTT was determined by correlation with scores of timed up and go test (TUG), movement disorder society- unified Parkinson’s disability rating scale-III [motor component] (MDS-UPDRS), Schwab and England activities of daily living scale (SEADL). The intra rater reliability (ICC 3, 1), SEM, MDC, Bland & Altman limit of agreement (LOA) were determined. Results: FTT scores were positively correlated with TUG (ρ= 0.59, p=0.02), MDS UPDRS III (ρ= 0.69, p=0.001) and negatively correlated with SEADL (ρ= -0.79, p=0.001) showing moderate concurrent and convergent validity. ICC (3,1) was 0.92, SEM and MDC were 1.28 and 3.54 respectively. Conclusion: FTT is a valid and reliable tool to assess functional mobility in people with mild PD.

Serum copper and ceruloplasmin levels in systemic sclerosis and various types of morphea in the Kashmir valley

To find the serum copper and ceruloplasmin levels in patients of systemic sclerosis and morphoea in the Kashmir Valley. This was a cross sectional study conducted in the department of dermatology of SKIMS Medical College over a period of one year involving 12 patients of systemic sclerosis and morphea and equal number of healthy controls. All the individuals were taken up for serum copper and ceruloplasmin levels. In patients with systemic sclerosis, the mean levels of copper and ceruloplasmin were increased. No alterations were found in patients with morphea and healthy controls. The increase in serum copper is probably secondary to increase in ceruloplasmin level, which occurs as a nonspecific response to inflammation

Terrorism, civil war and related violence and substance use disorder morbidity and mortality: a global analysis

The purpose of this study is to examine associations between deaths owing to terrorism, civil war, and one-sided violence from 1994-2000 and substance use disorder disability-adjusted life years [DALYs]. The relationship between terrorism, and related violence and substance use disorder morbidity and mortality among World Health Organization Member States in 2002, controlling for adult per capita alcohol consumption, illicit drug use, and economic variables at baseline in 1994. Deaths as a result of terrorism and related violence were related to substance use disorder DALYs: a 1.0% increase in deaths as a result of terrorism, war and one-sided violence was associated with an increase of between 0.10% and 0.12% in alcohol and drug use disorder DALYs. Associations were greater among males and 15-44 year-old. Terrorism, war and one-sided violence may influence morbidity and mortality attributable to substance use disorders in the longer-term suggests that more attention to be given to rapid assessment and treatment of substance use disorders in conflict-affected populations with due consideration of gender and age differences that may impact treatment outcomes in these settings. Priorities should be established to rebuild substance abuse treatment infrastructures and treat the many physical and mental comorbid disorders

Conflict and diarrheal and related diseases: a global analysis

The purpose of this study was to determine the association between deaths owing to terrorism, civil war and one-sided violence from 1994-2000 and disability-adjusted life years [DALYs] attributable to diarrheal and related diseases, schistosomiasis, trachoma and the nematode infections [DSTN diseases] in 2002 among World Health Organization Member States. Deaths resulting from terrorism, civil war and one-sided violence were significantly related to DSTN DALYs across the majority of sex-age subgroups of the populace, after controlling for baseline levels of improved water/sanitation and a variety of economic measures: overall, a 1.0% increase in deaths owing to terrorism and related violence was associated with an increase of 0.16% in DALYs lost to DSTN diseases. Associations were greatest among O-to-4-year olds. The results of the present study suggest that DSTN disease control efforts should target conflict-affected populations with particular attention to young children who suffer disproportionately from DSTN diseases in these settings. In view of the evidence that terrorism and related violence may influence DSTN DALYs in the longer term, control strategies should move beyond immediate responses to decrease the incidence and severity of DSTN diseases to seek solutions through bolstering health systems infrastructure development among conflict-affected populations

Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia

The purpose of the study was to measure the rate of non-compliance and the factors contributing to non-compliance among the diabetic patients in the Al Hasa region of Saudi Arabia. A cross-sectional survey was conducted in the Al Hasa region during the period of June 2010 to June 2011. Random sampling was carried out for the selection of 535 diabetic patients from three chronic disease centers in different parts of Al Hasa. The data were collected by means of interviewing questionnaires and file records. Any patients who had been prescribed optimum treatment and was properly advised on diet and exercise for his/her diabetes, but did not follow the medical advice, with Hb1AC of more than 7% at the time of interview, participants was 67.9% [n = 318, 95% CI 63.59 - 72.02%]. The non-compliance of males [69.34%] was higher than females [65.45%, P = .003]. The non- compliance among the urban participants was significantly higher than [71.04 vs. 60.15%, P= .023] in the rural participants. There was a statistically significant difference in the prevalence rate of non-compliance among the participants with different levels of education. Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender [OR = 1.90, CI =1.32-4.57], level of education [Illiteracy] [OR = 5.27, CI = 4.63 - 7.19], urban population [OR = 5.22, CI= 3.65 - 8.22], irregularity of the follow-up [OR = 8.41, CI = 4.90 - 11.92], non-adherence to drug prescription [OR = 4.55, CI = 3.54 - 5.56], non-adherence to exercise regimen [OR = 5.55, CI = 4.26 - 6.], insulin [OR = 1.29, CI = .71 - 1.87], and insulin with oral Metformin [OR = 1.20, CI =. 65- 1.75]. The findings indicate that there is a high rate of non-compliance among the diabetes patients in the Al Hasa region of Saudi Arabia and there is a definite need for improvement in the healthcare system, health education, and training of diabetic patients

Health disparities between Muslim and non-Muslim countries

We examined differences in health indicators and associated factors across countries according to the proportion of the population who are Muslim. Of 190 UN countries, 48 were classified as Muslim-majority countries [MMC] and 142 as non-MMC. Data on 41 potential determinants of health were obtained from 10 different data sources, and 4 primary outcome measures [male and female life expectancy, maternal mortality ratio and infant mortality rate] were analysed. Annual per capita expenditure on health in MMC was one-fifth that of non-MMC. Maternal mortality and infant mortality rates were twice as high in MMC as non-MMC. Adult literacy rate was significantly higher for non-MMC. Four significant predictors explained 52%-72% of the differences in health outcomes between the 2 groups: gross national income, literacy rate, access to clean water and level of corruption

Young adult and giant cervical exostosis

Degenerative changes in the spine can result in the formation of osteophytes on the anterior surface of the cervical spine. Depending on their site, osteophytes can bring on clinical manifestations such as dysphagia, hoarseness, and stridor. We discuss an interesting case of a young adult patient who presented with dysphagia along with neck discomfort, and on investigation was found to be suffering from diffuse idiopathic skeletal hyperostosis. Here, we briefly portray the presenting features, radiographic findings, and management options

impact of the disease early warning system in responding to natural disasters and conflict crises in Pakistan

The disease early warning system [DEWS] was introduced in the immediate aftermath of the 2005 earthquake in Pakistan, with the objective to undertake prompt investigation and mitigation of disease outbreaks. The DEWS network was replicated successfully during subsequent flood and earthquake disasters as well as during the2008-09 internally displaced persons'crisis. DEWS-generated alerts, prompt investigations and timely responses had an effective contribution to the control of epidemics. Through DEWS, 1360 reported alerts during 2005-09 averted the risk of disease outbreaks through pre-emptive necessary measures, while the 187 confirmed outbreaks were effectively controlled. In the aftermath of the disasters, DEWS technology also facilitated the development of a disease-surveillance system that became an integral part of the district health system. This study aims to report the DEWS success and substantiate its lead role as a priority emergency health response intervention

Laparoscopic appendectomy for acute appendicitis: is this a feasible option for developing countries?

The role of laparoscopic appendectomy is still not well defined in the literature. This study was conducted to evaluate the feasibility of laparoscopic appendectomy at a university hospital in a developing country. Patients undergoing laparoscopic appendectomy [LA] from August 2002 to August 2006 were identified. For each case, a control was selected from patients undergoing open appendectomy [OA] during the same year by systematic sampling. The groups were compared in terms of duration of surgery, requirement of narcotic analgesia, length of hospital stay, postoperative complications and the overall cost for each patient. A total of 68 patients underwent laparoscopic appendectomy during the study period. Median duration of surgery was 82 minutes in LA group and 70 minutes in OA group [P < 0.001]. Forty-five patients in LA group and 64 in OA group required narcotic analgesia [P < 0.001]. Median length of hospital stay [P = 0.672] and postoperative complications [P = 0.779] were comparable in both groups. Median cost of hospital stay was Pakistani Rupees [PKR] 47121/in LA group and PKR 39318/in OA group, the difference being significant [P = 0.001]. Laparoscopic appendectomy is feasible in developing countries with similar postoperative outcome and less requirement of narcotic analgesia. The duration of surgery and overall cost were significantly higher and efforts should be made to develop expertise and reduce operative time with resultant decrease in cost. Development of standardized protocols for discharge of patients from the hospital after LA may further reduce the cost and benefit patients in developing countries

Bone stress injuries in the army cadets of Pakistan Military Academy

Bone stress injuries are common among army cadets during training period and these injuries give rise to morbidity and loss of training hours. Some cadets with stress fractures re-join their duties while some are kept out of services resulting in attrition and economic loss. A retrospective analysis of bone stress injuries of one hundred and twenty cadets between June 2006 and Dec 2007 was conducted from the case documents available at Institute of Nuclear Medicine, Oncology and Radiotherapy [INOR] Abbottabad. The occurrence of stress fractures among cadets at Pakistan Military Academy, presenting with exercise induced pain was 68.3% amongst these cadets. Seventy fours percent f the fractures were labelled grade-I. High grade fractures were confined to tibia. Tibia was the commonest site of stress fractures in both sexes, accounting for about 73% of all stress fractures. Fifty percent of these patients were labelled as having shin splints and 3% as thigh splints. Most of the stress injuries were confined to the tibia. The referral was considered early as most of the stress injuries were of low grade

Excessive crying and irritability in infants due to drugs

This study was performed to see the extent and magnitude of drug induced excessive crying in infants and to know the causative drugs, from July 2005 to June 2006. It is a prospective and descriptive study. All children under 1 year of age, who presented with excessive crying of recent onset as the main complaint and were receiving some medicines were included in the study. After getting detailed history [particularly drug history], the problem was explained to the parents, the suspected drug was stopped and the patients were called back for follow up after 48-96 hours. If the crying had not stopped, the diagnosis was reconsidered and patient was excluded from study analysis. If the crying had stopped, it was assumed that the drug was the cause of excessive crying. All the included patients were studied for age, diagnosis, month of the year, geographical origin and the causative drugs. A total of 227 patients were included in the analysis; out of this, 44 [19.38%] were less than imonth of age while 183 patients [80.62%] were above 1 month, 143 patients were suffering from upper respiratory infection and 78 from wheezy chest. Majority of the patients presented during winter months. About 3/4th of the patients were from D. I. Khan district but the remaining 1/4th were from nearby and remote districts like Mianwali and Layyah. Most frequent causative drug was Rondec-D drops [Abbot] in 13o patients. Other drugs were various cough preparations, promethazine [Phenergan], brochodilators, anti-emetics, metronidazole, anti-histamines, various herbal preparations, phenolbarbitone and various anti-diarrhoeals in a decreasing order of frequency. This problem can be reduced by avoiding these medicines in below 1-2 years of age. It is therefore recommended that these above drugs should not be promoted for use in infants and Rondec-D drops and other similar preparations may be withdrawn from the market

Assessment of degradation of agricultural soils arising from brick burning in selected soil profiles

The study was conducted with the selected soil profile of burnt [soil around brick kilns] and unburnt [agricultural land] soils in the Dinaj'pur, Rangpur, Rajshahi, Khulna and Patuakhali districts at the western part of Bangladesh to evaluate the effects of brick kilns on soil degradation and environmental pollution. The pH values of the unburnt soils increased as a function of the soil depth for Rangpur, Khulna and Patuakhali, while decreased for the soil profiles in Dinajpur. Burning of soils significantly [p<0.05] decreased the average pH values of soils by 0.4 pH units [7% increased over average content = IOAC], but strikingly increased the average EC values from 0.26 to 1.77 mS/cm [592% IOAC] and the effect was pronounced with the depth function. The average sand content of the soil profiles increased by 330%, while the silt and clay contents decreased by 49 and 40%, respectively. The average losses arising from the burning of agricultural soils were amounted to 63% for organic matter, 56 to 86% and 23 to 88% for available and total N, P, K and S, respectively. This huge loss through the burning of 1 m deep soil profile, i.e. almost 3/4[th] of the deterioration of soil fertility is not only reducing the crop production but also polluting the associated environment and atmosphere. The burning of enormous C, N and S not only degrade the agricultural soils but also contributing to the changes in the global climate

Potentiality of open burnt clay as an adsorbent for the removal of Congo red from aqueous solution

Open burnt clay was studied as a potential adsorbent for the adsorption of Congo red [a reactive dye] from aqueous solution. The effect of contact time, pH, adsorbent dosage and temperature were studied. It was observed that the amount of Congo red retained increase with decreasing pH and increasing initial concentration. Removal percentage at pH 2 and 3 are almost same. The adsorption capacity of regenerated burnt clay was showed more than 98% recovery of the adsorption efficiency of initial virgin adsorbent. The equilibrium data were described well by both Langmuir and Freundlich isotherm model. The adsorption capacity of some natural adsorbents, namely rice husk, wood charcoal, tea waste etc. were also investigated and compared with that of open burnt clay

Colonic injuries: is primary repair a safe option?

This study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of large gut injuries. 80 patients, presenting in emergency between Jan. 2004 and December 2005, were selected out of which 63 were males and 17 were females. Colonic injuries were divided into five categories and were dealt accordingly. All colonic injuries presenting to emergency in study period except. Injuries requiring ileocolic anastomosis, repair and proximal fecal diversion and distal colonic injuries requiring Hartmann's procedure

Comparison between primary repair and exteriorization in cases typhoid perforation

This comparative study was conducted at Mayo Hospital, Lahore from April 2004 to May 2005 to compare the results of primary repair and exteriorization in cases of typhoid perforation 80 patients were selected out of which 48 were males and 32 were females. Consisted of a history of fever abdominal pain, constipation, sharp shooting pain superimposed over the colicky abdominal pain clinical finding included tense tender abdomen and absent bowel sounds, investigations including gas under diaphragm in abdominal x-ray and positive widal test. Consisted of negative Widal test even if there was gas under diaphragm, per op findings suggestive of tuberculosis or histopathology reports suggestive of tuberculosis or any pathology other than typhoid. Primary repair was done in patients who presented within 36 hrs of experiencing sharp shooting pain and per op findings of minimal contamination. Exteriorization in the form of loop or double barrel ileostomy was done in other cases

Amputations in general surgical practice

Amputation is still often viewed as a failure of treatment. The responsibility for performing an amputation may even fall on the most junior member of the surgical team. Whatever the reason for extremity amputation, it should not be viewed as a failure of treatment. Amputation can be the treatment of choice for severe trauma, vascular disease, and tumors. In our setup amputations for vascular and diabetic complications fall under the domain of general surgeons The purpose of study was to determine the age and sex distribution, incidence of diseases that resulted in amputations, and the level of amputations done in them. A descriptive study on one hundred patients undergoing limb amputations in general surgical practice at department of Surgery, Mayo hospital Lahore. All the patients presented to general surgical emergency/OPD with limb pathology Patients with bone tumors and isolated limb trauma [referred to orthopedic unit]. Most amputations in our study were performed in elderly persons for PVD, Diabetes mellitus being the leading cause

Congenital leukaemia

This is a case series of three infants who presented with pallor, bruises, and rashes in first month of their life with non specific symptomatology and were diagnosed to have congenital leukaemia. All were of acute myeloblastic leukaemia [AML] M5-FAB type