National Journal of Health Sciences
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Efficacy of Hematological Indices for ? Thalassemia Trait Screening in Pregnant Women
No full textBackground: ß thalassemia is one of commonest inherited disorder in Pakistan having a carrier rate of 5%. Pregnant women having ß thalassemia trait can have offspring having ß thalassemia major which is lifelong blood transfusion dependent state. Different screening programmes are being carried out in various parts of the world so that the birth of children having ß thalassemia major can be effectively reduced.Objective: To determine the diagnostic accuracy of hematological parameters in identifying ? thalassemia trait in pregnant women keeping measurement of HgbA2 as gold standard.Methods: 108 pregnant women were enrolled during one year of the study period. Blood sample was taken and blood complete picture was obtained. By using variables of CP card Green & King index, Shine & Lal index and RDWI were calculated keeping hemoglobin electrophoresis as gold standard.Results: The age of patients ranged from 17 to 37 years with mean age of 24.65. Out of 108 pregnant women enrolled in study 40 were found to have ß thalassemia trait based on results of hemoglobin electrophoresis. Shine & Lal index showed 100% sensitivity, 0% specificity, 35% PPV and 0% NPV. Green & Kings index had sensitivity of 32%, specificity 100%, PPV of 100% and NPV of 71% while RDWI showed 50% sensitivity, 100% specificity, PPV of 100% and NPV of 77% in diagnosing ß thalassemia trait in pregnant women.Conclusion: Automated cell counters based formula including Green & King index, Shine &Lal index and RDWI provide rapid, reliable and cost effective method for screening of ß thalassemia trait especially in third world countries like Pakistan. However none of them have 100% sensitivity and specificity. So they should be collectively looked at in screening programmes
Adjunct Use of Low Dose Risperidone Verses Adjunct Use of Clonazepam with an SSRI in Treatment of Moderate to Severe Anxiety States; A Comparative Study
No full textBackground: The unprecedented and unaccounted use of benzodiazepines is running havoc in many countries in terms of substance abuse problems and is exponentially increasing. The prescription of benzodiazepines should be minimized and the search for and use of better alternatives be incorporated into clinical practice of Psychiatry.Aim: The aim of this study is to compare the efficacy of low dose risperidone and relatively higher dosage of clonazepam in moderate to severe anxiety states when used in combination with an SSRI.Method: A group of 60 patients having moderate to severe anxiety level, as measured by Hamilton Anxiety Rating Scale (HARS) were randomly divided into two groups. First group was given 1 mg risperidone with 50 mg Sertraline and the second group was given 3 mg of clonazepam with 50 mg Sertraline. The anxiety levels of patients in both groups were again calculated on the 10th post treatment day and compared to each other. Moreover, the Side Effect profiling of Risperidone was also done in all the Patients by using the Glasgow Anti-psychotic Side-effect Scale (GASS)’.Result: The first group had a decrease in the HARS scores having a value of 19.56 between day 0 and day 10. The second group also showed a decrease in the anxiety levels with a mean HARS score of 31.12 on day 0 to 12.36 on day 10. The mean value of decrease in HARS score was comparable.Conclusion: The efficacy of low dose risperidone is comparable to that of relatively high dose of clonazepam in treating moderate to severe anxiety states. Use of risperidone for symptomatic relief from anxiety is a viable alternative to benzodiazepines
Endoscopic Evaluation and Helicobacter Pylori Prevalence in Dyspeptic Patients with Chronic Kidney Disease
No full textAbstract: Objective: Dyspepsia is a common symptom in chronic kidney disease (CKD) as well as in the normal population and may develop due to functional or organic causes. In the literature, there are different results about dyspepsia symptoms, upper gastrointestinal tract lesions and Hp prevalence in CKD. In this study, endoscopic findings and the prevalence of Helicobacter Pylori (Hp) in dyspeptic chronic kidney patients were investigated and compared with the normal population.Materials & Methods: 67 patients with dyspeptic CKD (52 hemodialysis, 6 continuous ambulatory peritoneal dialysis, 9 predialysis) and 63 age and gender-matched control groups were included in our study. Gastrointestinal symptom scoring, upper endoscopic examination, histopathological examination of gastric antrum and corpus biopsies taken during this period, and rapid urease test (RUT) for Hp were performed on all cases included in the study.
Results: Gastrointestinal symptom scores were not different between the CKD and control groups (6.2±2.5 vs 7.7±3.6) (p>0.05). Although the prevalence of Hp in the CKD group (44.8%) was lower than the control group (54%) according to gastric biopsy findings, there was no difference between them (p>0.05). In the endoscopic examination, duodenal ulcer was more common in the control group and duodenitis in the CKD group, and the difference between them was significant (p<0.05). When compared with histopathological evaluation, the sensitivity (78% vs. 79%) and specificity (95% vs. 93%) of the urease test were similar in the CKD and control groups in both groups.
Conclusion: Gastrointestinal symptom score and Hp prevalence in chronic kidney disease were similar to the control group. No correlation was found between Hp and gastrointestinal symptom score. In the endoscopic examination, duodenal ulcer was more common in the control group and duodenitis was more common in the CKD group
Magnitude of Hydrocephalus in Neonates: Its Surgical Management and Complications
No full textAbstract: Objective: : To determine magnitude of congenital or acquired hydrocephalus and its possible management and complications.Materials and Methods: This Hospital based Retrospective observational study was conducted in department of pediatric surgery King Edward medical university / Mayo hospital Lahore from January 2021 to March 2022.All patients presented from neonatal life till 3 months of age with hydrocephalus due to congenital or acquired reasons were included in this study. There were 55 male and 28 female patients with male to female ratio of 1.9:1. A detailed Proforma was made giving patients information, associated congenital or acquired anomaly and surgical management of hydrocephalus. All patients were operated on elective operation theatre list. Post-operative complications were noticed on admission files and addressed.Results: During the study period, 83(n=1) patients with hydrocephalus were admitted in department of pediatric surgery Mayo hospital Lahore. Among these patients, 56(67.5%) patients have hydrocephalus associated with myelomeningocele while 10(12%) patients with encephalocele. 11(13.3%) patients showed hydrocephalus due to post tuberculosis meningitis while 3(3.6%) patients with Arnold chiari 2 malformation. 1(1.2%) patients presented with hydrocephalus due to Congenital obstruction of cerebral aqueduct while 2(2.4%) with Intracranial hemorrhage.ventriculoperitoneal shunting was done in 55(66.3%) patients to treat hydrocephalus. Conservative management of hydrocephalus was done in 24(28.9%) patients while in 4(4.8%) patients ventricular taping was done. Wound infection was major post-operative complication and was noted in in 13 (15.7%) patients.Conclusion: Ventriculo peritoneal shunting is main treatment modality for obstructed hydrocephalus. Major complication of ventriculo pertoneal shunting is infection which can be addressed by proper prophylactic antibiotics as well as sterile environment of operation theatre
Clinical Overview of Chronic Obstructive Pulmonary Disease Patients with Myocardial Perfusion Defect
No full textAbstract: Background: Increased hospitalization and death rates up to 2-3 times greater due to cardiovascular diseases have been reported in
Chronic Obstructive Pulmonary Disease (COPD) cases. Inflammation, neurohumoral activation, and increased oxidative stress are involved in
the etiopathogenesis of both disease groups.
Objective: The study aimed to retrospectively evaluate the patients with COPD with perfusion defects (ischemia/infarct) in myocardial
perfusion scintigraphy and investigate the clinical features of these patients.
Materials and Methods: Patients with COPD were included in the study by examining the files of 196 patients who had perfusion defects by
performing myocardial perfusion scintigraphy (MPS) in the Nuclear Medicine Clinic of our hospital between January 2019-2021.
Demographic data, comorbidities, areas of involvement in myocardial perfusion scintigraphy, pulmonary function test (PFT), smoking history,
modified Medical Research Council (mMRC) score, pulse oxygen saturation, and echocardiography (ECHO) data were recorded.
Results: COPD was detected in 6 (3%) of 196 patients. All of these cases were male and the age range was 67.2 ± 7.4 years. All 6 cases were
male, and the mean age was 67.2 ± 7.4 years. They all had a history of heavy smoking (52.5 ± 30.9 packs/year). The mean forced expiratory
volume in 1 second (FEV1) was 49.6 ± 8.9%, and pulse oxygen saturation was 93.2 ± 3.3%. In ECHO, systolic pulmonary artery pressure
(PAPs) was higher than normal in 2 patients; one had advanced mitral insufficiency and heart failure. In the MPS of 4 patients, an infarct was
observed in the area supplied by the right coronary artery (RCA). While there was no comorbid disease in 2 patients, comorbid diseases were
present in 4. There was no significant difference between the non-COPD group and the COPD group in terms of age and gender. In the
non-COPD group, the most common LAD localized defect (35.3%) and RCA localized defect (23.2%) were detected, while the most common
RCA defect (50%) was found in the COPD group. However, it was not statistically significant due to the small sample size.
Conclusion: In COPD cases, it was determined that infarct developed in the male gender, advanced age and advanced stage, and especially in
the area fed with RCA if exposed to heavy smoking. It is considered that the ischemic changes observed in RCA in COPD may have a role in
the development of right heart failure
Frequency of ß-Thalassemia Trait among Pregnant Women Presenting at Pakistan Institute of Medical Sciences
No full textAbstract: Introduction: Thalassemia is a common inherited disorder in Pakistan with around 5000 new cases diagnosed every year. Despite various preventive measures taken at the national level, the disease burden is still not declining. In this study the incidence of ß Thalassemia trait among pregnant females presenting to a tertiary care hospital is measured.Methods: This study was conducted at Pakistan Institute of Medical sciences. 102 Pregnant females who were referred to us for hemoglobin electrophoresis from July 2017-June 2018 were included. Complete blood count, peripheral film, reticulocyte count and hemoglobin electrophoresis was performed for each patient.Results: The mean age was 25 years and the mean period of gestation was 30.30 weeks. Out of 102 patients, 5 (4.9%) were diagnosed as ß Thalassemia trait. Of these, 2 (40%) did not have a positive family history of Thalassemia. We compared the results of our study with those done at different regions of Pakistan and found variable incidence of carrier state in different regions of the country.Conclusion: Antenatal screening is a forward step towards minimizing incidence of Thalassemia in Pakistan however clinicians should be directed to refer these patients in early pregnancy. 
Secondhand Water-Pipe Smoking and its Association with Systemic Inflammation among Cafés Employees in Karachi, Pakistan
No full textObjective: The study was designed to determine the correlation of exposure to secondhand smoking (SHS) of Water pipe (WP) with Neutrophils to Lymphocytes ratio and Platelets to Lymphocytes ratio.Material & Methods: A cross sectional survey was conducted among employees at cafes and restaurants of Karachi, where WPs were offered to customers. A total of 200 participants were selected through convenience sampling, out of which 181 consented to participate. Participants were divided into exposed (to SHS) and unexposed groups. Data were collected by using structured questionnaire, and blood samples were drawn to measure systemic inflammatory markers (Neutrophil to Lymphocyte ratio NLR, Platelet to Lymphocyte ratio PLR). Data was analyzed by using SPSS software.Results: Among the included 181 participants, 48.1% (n = 87) were unexposed to SHS, 31.5% (n = 57) were exposed to SHS of WP and 20.4% (n = 37) were exposed to SHS of cigarette & WP. Mean NLR (P = 0.779) and mean PLR (P = 0.205) did not vary significantly according to exposure to SHS among participants. After adjusting for socio-demographic covariates, associated of NLR and PLR with exposure to SHS was also not found to have a statistical significance.Conclusion: The study found no correlation between exposure to SHS of WP and systemic inflammation using different markers. However, the cross-sectional nature of data and uncontrolled confounding and relatively lower level of exposure in the study sites may potentially explain the overall findings of the study
Knowledge, Attitudes and Practices of Nurses, Regarding Hepatitis B Prevention at Public Hospital Lahore
No full textBackground: Occupational exposure occurs frequently among Health Care Workers (HCWs). The most serious occupational healthhazard faced by HCWs worldwide is exposure to Hepatitis B Virus (HBV). Having enough knowledge and proper attitudes toward this infection is crucial in prevention of occupational hepatitis infection.Methods: This cross sectional descriptive study conducted to assess knowledge, attitude and practice of nurses regarding Hepatitis B prevention and control at Services hospital Lahore. In this study well-structured close ended questionnaire adopted from a study, knowledge, attitudes and practices of healthcare workers at the princess Marina hospital in Botswana regarding Hepatitis B prevention and control will be used (Machiya, 2011). The study was conducted in Services hospital among 200 nurses to assess knowledge, attitudes and practices of Nurses, regarding Hepatitis B prevention and control at a tertiary care hospital Lahore.Results: It was found that most of the nurses were enough knowledge, positive attitude and better practice among nurses. Mostly, nurses response are positively very rare participant response are negative. The knowledge of Hepatitis B infection prevention, 81% of the participants knew that Hepatitis B infection can be transmitted by carriers. Majority 89.5% knew that Hepatitis B infection cannot be spread through casual contact. Majority knew that open wound, contaminated blood and body fluids, unsterilized syringes, needles and surgical instruments could easily transmit the Hepatitis B infection. Among the participants 86.5% had knowledge that vaccines can prevent Hepatitis B. 23% of the participants had negative attitude towards Hepatitis B. The attitude was positive among 55.6% participants and 54.2% participants were performing safe preventive practices
Central Pleomorphic Adenoma of Mandible – Report of the First Case in a Pediatric Patient
No full textPleomorphic adenomas (PA) are the commonest salivary gland tumors of parotid gland. Central pleomorphic adenomas areextremely rare and so far only 7 cases have been reported in the literature; 2 in maxilla and 5 in mandible. The mean age of occurrence of central PA is 58.8, none of the case of central PA in children has been reported in the literature; hence this is the first report of central PA in a child. An 11 year old Indian boy presented with the jaw swelling from 1 year. Radiographic examination revealed a multilocular osteolytic lesion of mandible. A complete surgical removal of the lesion was performed and the defect was restored with reconsctruction plates. Histopathological features were consistent with central PA. Till now this is the first description of central PA in a child