What is the effect of riskshaw noise on its driver?

OBJECTIVE: Occupational hearing loss is common in the industrialized world. Road noise is a major contributor to perceived environmental noise. The objective of this study was to assess hearing loss in rickshaw drivers due to rickshaw noise. METHODS: Hearing loss in rickshaw drivers and taxi drivers of Karachi who were 50 years of age or younger was estimated, with a Smith Hearing Screening (SHS) questionnaire that was modified, translated into the national language, Urdu and field tested prior to administration. RESULTS: Interviews for 91 rickshaw drivers and 94 taxi drivers were completed. All subjects were male; mean ages were 34 and 33 years for rickshaw and taxi drivers respectively. None of the rickshaws were fitted with silencers. Rickshaw drivers were about thrice as likely to be screened as hearing impaired by the SHS questionnaire (RR 2.9, 95% confidence interval 1.6, 5.0), twice as likely to report tinnitus (RR 2.2, 95% confidence interval, 1.1, 3.3) and two and a half times as likely to have difficulty in following telephonic conversations (RR 2.4, 95% confidence interval 1.2, 4.8). CONCLUSION: There is loss of hearing and tinnitus among rickshaw drivers that could be attributed to their trade. Use of silencers by rickshaw drivers could result in less hearing loss among rickshaw drivers and less noise in the environment for the other 11 million residents in the city.

Uterine atony at a tertiary care hospital in Pakistan: a risk factor analysis.

OBJECTIVES: To identify risk factors for uterine atony following assisted or unassisted vaginal delivery. DESIGN: This hospital based case control study was done at The Aga Khan University Karachi, Pakistan. Cases were defined as all women with uterine atony within 24 hours of an assisted or unassisted vaginal delivery. Controls were based on women with normal assisted or unassisted vaginal delivery without uterine atony. Data abstracted form the medical records; adjusted odds ratios were estimated by multiple logistic regression. RESULTS: Factors having a significant association with uterine atony were gestational diabetes mellitus (odds ratio 7.6, 95% CI 6.9-9.0, p = 0.003) and a prolonged second stage of labour in multiparas (odds ratio 4.0, 95% CI 3.1-5.0, p = 0.002). No associations were found with high parity, age, preeclampsia, augmentation of labour, antenatal anemia and a history of poor maternal or perinatal outcomes. CONCLUSIONS: Among previously documented risk factors for uterine atony, only a prolonged second stage of labour in multiparas was found to be significant in this study. Gestational diabetes mellitus, a previously undocumented factor, has also been identified as an independent risk factor. Multiparity and age were not found to be significant risk factors. The study underlines the importance of confirming these findings for better prevention and management of uterine atony.

Clinical scoring system: a valuable tool for decision making in cases of acute appendicitis.

OBJECTIVE: Decision making in cases of acute appendicitis poses a clinical challenge specially in developing countries where advanced radiological investigations do not appear cost effective and so clinical parameters remain the mainstay of diagnosis. The aim of our study was to devise a scoring system from our local database and test its accuracy in the preoperative diagnosis of acute appendicitis. METHODS: Clinical data from 401 patients having undergone appendectomy were collected to identify predictive factors that distinguished those with appendicitis from those who had a negative appendectomy. Ten such factors were identified and using Bayesian probability a weight was assigned to each and the results summated to get an overall score. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was then retrospectively applied to a second population of 99 patients in order to compare suggested actions (derived from the scoring system) to those actually taken by surgeons. The sensitivity, specificity and accuracy for the level of decision was then calculated. RESULTS: Of the 99 patients, the method suggested immediate surgery for 65 patients, 63 of whom had acute appendicitis (3.1% diagnostic error rate). Of the 33 patients in whom the score suggested active observation, 18 had appendicitis. The accuracy of our scoring system was 82%. The method had a sensitivity of 78%, specificity 89% and a positive predictive value of 97%. The negative appendectomy rate determined by our study was 7% and the perforation rate 13%. CONCLUSION: Scoring system developed from a local database can work effectively in routine practice as an adjunct to surgical decision making in questionable cases of appendicitis.