Double outlet right ventricle, atrioventricular canal defect with severe pulmonary artery stenosis: a rare cyanotic congenital heart disease.

Double outlet right ventricle (DORV) is characterised by arousal of the aorta and the pulmonary vessel from the right ventricle, and is always accompanied by a ventricular septal defect (VSD). Our patient, a twenty days-old female child, presented to the Paediatrics Unit I of Civil Hospital, Karachi, with complaints of generalised cyanosis and reluctance to feed since birth. Apart from the fact that the neonate was cyanosed with increased respiration, the physical examination was unremarkable. Two-dimensional echocardiography revealed two atrial septal defects (ASD), a ventricular septal defect (VSD) in the membranous area, continuous with primum ASD, resulting in an atrioventricular canal defect. The aorta was dilated with the pulmonary artery stenosis. The left ventricle was rudimentary, and both of the great vessels were arising from the dominant right ventricle. Despite the rarity, DORV with complex anatomy should be considered among the probable differential diagnoses for infants presenting with generalised cyanosis since birth.

A cross-sectional study to investigate pneumococcal vaccination in the elderly in a low income county: patient knowledge, awareness, and attitudes of vaccination and prevalence rates by socioeconomic status.

BACKGROUND: Pneumonia represents the leading cause of infection-related death and the fifth cause of overall mortality, in the elderly. With increasing age, the human immune system undergoes characteristic changes which lead to increased incidence and severity of infectious diseases and to insufficient protection following vaccination as antibody response of elderly vaccines are weaker and decline faster. OBJECTIVE: Knowledge and Attitude toward Pneumonia and its Vaccination in elderly patients. RESULT: Among low SES, 54.9% (549/1000) while from high SES, 91.8% (918) responded that they had heard about pneumonia before (P<0.05). 79.5% (795/1000) patients of high SES had heard about pneumococcal vaccination while only 28.8% (288/1000) patients from low SES had heard about pneumococcal vaccine. Only 2.3% of low SES patients were immunized for pneumococcal vaccine while 16.5% high SES patients were vaccinated. Reported reason for not being immunized were; did not hear, no body advised, vaccine is too expensive, and ignored thinking it is not necessary. METHOD: We conducted a cross-sectional study on 2000 elderly patients who were admitted in medicine and surgery wards of Civil Hospital Karachi and Aga Khan University Hospital Karachi from the period of October to December 2012 to determine their knowledge and attitude toward pneumonia and its vaccination in elderly. Study group was divided into low and high socio-economic status on the basis of patients coming to government Hospital i.e., civil hospital and private hospital i.e., Aga khan hospital. Data was collected through convenient sampling technique. Exclusion criteria were patients below 60 years and those who didn't give consent to be part of study. CONCLUSION: Aside from introducing public awareness program about elderly vaccination at state level, free of cost vaccination of elderly individuals should be done.

Reasons behind the increase in research activities among medical students of Karachi, Pakistan, a low-income country.

CONTEXT: Previously, in a low-income country with limited resources like Pakistan, biomedical research was conducted mostly by individuals working in private organizations. Recently, there has been an upsurge in the number of medical students conducting research in both private and public medical colleges of Karachi, Pakistan. We investigated student perceptions of the reasons behind the increase in biomedical research among medical students of private and public medical colleges in Karachi, Pakistan. METHODS: This cross-sectional study was conducted at four medical universities of Karachi, using structured data collection tool. Participants included medical students who stated that they were interested in medical research. We assessed how many had been involved in research or stated that they intended to be, and tallied students' stated reasons why they were involved in research. Chi-square analyses were used to assess if year of training, institution, and other factors were associated with the likelihood of past or current actual research involvement. RESULTS: Out of the 398 students with research interest who participated in the study, 349 (88%) stated that they intended to do research projects in their undergraduate years. At the time of the study, only 202 (51%) reported that they had actually conducted research. The reasons given for engaging in research for a minority included personal interest (n = 136; 34%), while majority stated that their motivation was to improve their curriculum vitae (75%) and/or to be more competitive for a residency in the United States (43%). The reasons students gave for involvement in research were related to whether their schools were public versus private and to their year of study. DISCUSSION: According to students' reports, improving one's curriculum vitae to get a strong residency in the USA appeared to be a principal reason for the increase in biomedical research in Karachi. The challenges of research, such as lack of good mentors and increased work-load were reported to affect few students' ability to engage in research.

Preterm birth and its associated risk factors. A study at tertiary care hospitals of Karachi, Pakistan.

OBJECTIVE: To study the factors associated with the risk of preterm birth among local population of Karachi, Pakistan. METHODS: This case control study was carried out on all those patients who were admitted in the post-partum wards of Civil Hospital and Abbasi Shaheed Hospital Karachi, during the period of January to May 2011. A total of 600 patients were part of this study. All those women who had preterm delivery (delivery at <37 weeks of gestation) were grouped together as case-group (n=300), while women who had term delivery (delivery ?37 and <42 weeks of gestation) were grouped as control-group (n=300). Data was collected by the help of a questionnaire which included questions related to the previous and current gestational history of the mothers, their nutritional status, drug addictions, urogenital, dental or systemic diseases they suffered, along with any physical or emotional stress they experienced during pregnancy. Last menstrual period and ultrasound reports were brought into use to calculate the precise gestational age of the baby. Data collected from the two groups were then compared to find out the possible risk factors of preterm delivery. RESULTS: A total of 600 subjects were divided into two equal groups of cases (n=300) and controls (n=300). There were 30 (10%) patients in the case-group and 33 (11%) patients in the control-group who were above 35 years of age (p<0.05). At the time of delivery, 111 (37%) cases and 51 (17%) controls weighed <50 kg (p <0.01). There were 264 (88%) cases and 117 (39%) controls with a haemoglobin level <10 gm/dL (p <0.01). In the case-group, 15 (5%) patients had a history of previous multiple preterm deliveries, 24 (8%) had one previous preterm delivery, and 261 (87%) had no previous preterm delivery. In the control-group, no patient had a history of multiple preterm deliveries, 15 (5%) had one previous preterm delivery, and 285 (95%) had no previous preterm deliveries (p<0.05). Common symptoms experienced in the gestational period in the case-group were dizziness/weakness (228; 76%), pain/malaise (213; 71%) and emotional stress such as anger (207; 69%). In the control-group the distribution was as follows: dizziness/weakness (168; 56%), emotional stress such as anger (165; 55%) and pain/malaise (141; 47%) (p<0.01). In the case-group, 69 (23%) women consumed fish, milk and pulses on a weekly basis, 177 (59%) on a monthly basis, and 54 (18%) did not take them at all. In the control-group, 174 (58%) patients consumed fish, milk and pulses on weekly basis, 90 (30%) on a monthly basis, and 36 (12%) did not take them at all (p<0.01). About 66 (22%) patients from the case-group and 21 (7%) in the control-group had evidence of periodontal disease on physical examination (p<0.05). CONCLUSION: Low maternal weight, multiple previous preterm deliveries, periodontal diseases, maternal anaemia, physical and emotional stress are among the factors associated with the risk of preterm birth among the local population delivering in tertiary care, governmental hospitals of Karachi, Pakistan.