Extensively Drug-Resistant Salmonella Typhi: A National Disaster.

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Analgesic Effect Of Direct Breastfeeding During BCG Vaccination In Healthy Neonates.

BACKGROUND: Pain during painful procedures in neonates has far reaching consequences. In developed countries many non-pharmacological interventions are used for neonatal pain reduction. Breast feeding has been proved to be an effective analgesic during mild to moderate painful procedures in neonates. METHODS: The study, randomized controlled trial was conducted in CMH, Quetta. The study period extended from June to November 2015. Neonates included in the experimental group were breastfeed during BCG vaccination and neonates in the control group were provided with routine care. Duration of cry with needle insertion was recorded with a digital stopwatch till the baby is silent for more than 5 seconds. RESULTS: The mean crying duration in experimental group was significantly less than control group. In experimental group mean crying duration was 16.48s (12.76) whereas in control group mean crying duration was 34.93 s(45.26). Statistically significant difference was observed between the mean crying times of the two groups (p<0.05). CONCLUSIONS: Mean duration of crying with breastfeeding is shorter than without breast feeding during BCG immunization. Breast feeding reduces pain during minor painful procedures in neonates.

Neonatal Pain And Preventive Strategies: An Experience In A Tertiary Care Unit.

BACKGROUND: Little is known about neonatal pain in Pakistan. So, to know about neonatal pain, its scoring and the effectiveness of oral dextrose in neonatal pain management we carried this study in neonatal intensive care unit (NICU) of military hospital (MH) Rawalpindi. METHODS: This randomized control trial was carried out in NICU of MH, Rawalpindi from Jan to Dec 2013. Total of 252 babies were enrolled in the study. We assessed neonatal pain by using Modified Behavioural Pain Scale (MBPS). Babies were given 10% dextrose and sterile water two minutes before a painful procedure and pain assessment was done after the procedure. The different painful procedures included, heel prick, nasogastric (NG) tube insertion, cannulation, catheterization and venepuncture for blood sampling. RESULTS: A total of 252 babies were enrolled in the study. Of these 139 (55%) were male and 113 (45%) were female babies. Painful procedures included heel lancing 120 (48%), I/V cannulations 60 (24%), venepuncture 40 (16%), NG insertion 26 (10%) and Foley catheterization 6 (2%). Mean MBPS score with 10% dextrose and sterile water were 4.31 and 6.26 respectively and the difference between two was significant statically. CONCLUSIONS: Oral dextrose is a cheap and easily available solution and can be used in neonatal pain management during various painful procedures.

Risk Factors Associated with Thyroid Carcinoma in North Pakistan.

BACKGROUND: Epidemiological data on thyroid cancer and associated risk factors are scarce in our setting. The present study was therefore designed to gather data which could be helpful in providing insights to thyroid physicians and surgeons for better management of affected patients. PURPOSE: To determine the frequency of carcinoma thyroid among patients presenting with goiter and its association with TSH, Tg/ATg and other demographic factors. MATERIALS AND METHODS: A total of 73 adult patients of either gender with solitary solid cold nodules and/or multi-ndoular goiter (MNG) with predominant solid cold nodules were enrolled. All surgically resected samples were sent for histopathology. The frequency of thyroid cancer and its subtypes was noted and tested for association with gender, age (< or ≥40 years), recent increase in swelling size, TSH, Tg and ATg. RESULTS: Thyroid cancer was diagnosed in 26% (n=19) of the patients, 14 (73.7%) being diagnosed with papillary thyroid cancer and 5 (26.3%) with follicular thyroid cancer. No other subtypes were noted. Presence of thyroid cancer was significantly associated with recent increase in swelling size and higher TSH Values mean TSH values (P<0.05). No significant association was found with gender, age, Tg and ATg values (P>0.05). CONCLUSIONS: Overall percentage of thyroid cancer in our study sample was found to be 26%, with a predominance of papillary over follicular lesions. Rates were significantly higher in patients who had history of recent increase in swelling size and higher and higher pre-surgery TSH values.

CONGENITAL MALARIA.

Neonates with congenital malaria may present with non-specific signs and symptoms which may be mistaken for neonatal sepsis and inborn error of metabolism resulting in delay of diagnosis.and significant mortality and morbidity. Here we present a unique case of 25 days old premature female baby who was diagnosed to have mixed malarial infection. Despite standard treatment the patient was not responding well and was also diagnosed to have congenital adrenal hyperplasia.

Importance of microscopic stool examination in patients with diarrhoea.

BACKGROUND: Loose motion is a common symptom in patients reporting to our hospital. As it is a small set up where only facility for microscopic stool examination is available, we designed this study to know how much microscopic stool examination can help us in management of patients with diarrhoea. METHODS: This cross-sectional descriptive study was conducted from January 2010 to April 2012, at Thall Scout Hospital, Hangoo, Khyber Pukhtoon Khwa, Pakistan. All the patients presenting with acute diarrhoea were included in the study. Patients older than 12 years of age were labelled as adults and those 12 years or younger as child. Stool specimens were collected using proper procedure and were examined microscopically. RESULTS: Of 494 stool specimens examined, 117 (23.68%) were positive for parasites or their ova, 34 (6.88%) had numerous pus and red blood cells and 343 (69.43%) patients had only stool of loose/soft consistency. Of 117 stool specimens positive for parasites, Giardia lamblia was detected in 67 (57.26%) patients, Entamoeba histolytica in 22 (18.80%) patients, H. nana in 10 (8.55%) patients, Tenea saginata in 8(6.84%) patients, hook worm in 6 (5.13%) patients, ascarids in 2 (1.71%) and Trichuris trichura in 2 (1.71%) patients. CONCLUSION: Among the parasitic causes of diarrhoea, giardia is the most common cause in our study with entameoba the second most common cause.