ROLE OF MAGNESIUM SULPHATE IN NEWBORNS WITH BIRTH ASPHYXIA.

Background; Birth asphyxia is a leading cause of mortality and morbidity in neonates in developing countries, with an incidence of 100-250/1000 live births compared to 5-10/1000 live births in the developed world. It remains a significant cause of loss of life and adverse developmental outcome. Objective; To compare magnesium sulphate therapy versus placebo in control of fits among newborns admitted with birth asphyxia along with fits at a tertiary care hospital. Material and Methods; All the study (n=260) participants of either sex who met inclusion of this study were who are admitted with birth asphyxia. Group A was study group and was treated with magnesium sulfate in a dose of 250 mg/kg initially within six hours of birth followed by 250 mg/kg at 24 and 48 h of birth while group B (control group) was not given MgSO4 therapy and were observed for control of fits and was given standard treatment. Results; Of these 260 study cases, 139 (53.5 %) were male patients while 121 (46.5 %) were female patients. Mean age of our study cases was 3.84 ± 1.47 hours. Of these 260 study cases, 177 (68.1%) belonged to rural areas and 83 (31.9 %) belonged to urban areas. Of these 260 study cases, home delivery was noted in 91 (35.0%), 149 (57.3%) in private clinics / hospital and 20 (7.7%) in teaching hospital. Mean gestational age of our study cases was 38.23 ± 2.38 and preterm births were noted in 91 (35.0%) of our study cases. Of these 260 study cases, control of fits were noted in 173 (66.5%) while control of fits in group A were noted in 105 (80.8%) and in group B it was 68 (52.3%) (p = 0.000). Conclusion; Our study results support the use of Magnesium Sulphate in control of fits in children with birth asphyxia. Magnesium sulphate was safe, reliable and having no side effect so it can be used safely in these patients to reduce morbidity and mortality. All clinicians treating such patients can employ this treatment modality having safety and efficacy. Keywords; Birth asphyxia, Control of fits, Magnesium Sulphate. DOI: 10.7176/JMPB/54-20 Publication date: April 30th 201

ELECTROCARDIOGRAPHIC PREDICTORS OF MORTALITY IN ACUTE STROKE

Objectives; The study is aimed at establishing the prognostic importance of various ECG changes as predictors of in-hospital mortality from acute stroke. Study Design; Cross-Sectional. Patients and methods; Two hundred patients of acute stroke who presented within 48-hours of the onset of neurological symptoms, were enrolled in the study, irrespective of the comorbid conditions like hypertension, diabetes mellitus, valvular heart disease, coronary artery disease and cardiomyopathy. A non-contrast computerized tomographic scan (CT Scan) of the brain and a 12-lead ECG were recorded at the time of admission to define the stroke type and to determine the ECG variables. A follow-up of the patients was recorded during their stay in the Medical Department for calculating in hospital mortality. The ECG variables categorized as, disturbances of heart rate and rhythm, ischemic changes and heart rate corrected QT interval (QTc interval), were correlated with the death during the hospital stay, by analyzing the data using SPSS-20 version for statistical analysis. Results; Majority of the patients had ischemic stroke, while mortality was higher with hemorrhagic stroke. ECG changes due to variations in heart rate and rhythm were frequent but less helpful than ischemic changes and QTc alterations, in predicting in hospital deaths due to stroke.  Conclusion; In hospital mortality in sufferers of stroke is mostly of cardiac origin. Electrocardiographic changes resulting from QTc prolongation, ischemic changes, and rhythm disturbances are most helpful in this regard. Keywords; ECG, CT-Scan, QTc interva

Fear of getting Covid-19: A challenge to elective surgical practice and ways to overcome

Background: Covid-19, a global pandemic has a huge impact on surgical practice. There is transmission risk of Covid-19 during the elective surgery and nowadays it is a part of informed consent process. This has an impact on patient decision making as it creates anxiety and fear. Objective: To evaluate patient experience (fear of getting Covid-19) from elective surgery and challenges of elective surgical practice and ways to overcome during this pandemic era. Methods: This study was an observational cross-sectional survey and it has been conducted in General Surgery Department of Dr Akbar Niazi Teaching Hospital, Islamabad, from May to August 2021 after approval of Institutional Review Board (IRB). Participants for elective surgery and their negative report of Covid-19 infection by polymerase chain reaction (PCR) were included in the study. Fear of Covid-19 infection was measured through “fear of Covid-19 scale” by Ahorsu et al and analyzed. All findings were entered in a structured Proforma. Data was entered in SPSS version 26 and analyzed. Effect modifier chi square was used to find out the patient’s dropout due to getting Covid-19 infection from surgery. Results: Total 200 patients were included; 62% patients were male and 38% were females. The mean age of the patients was 38.64±12.08 years. The statistical analysis showed that there was a very significant association between FCV-19 scale and getting Covid-19 infection from elective surgeries (p ≤ 0.05). When stratified FCV-19 scale with education status of all patients there was a very significant association between them (p=0.001). The patient’s observations regarding FCV-19 questionnaire, most of the patients were disagreed (46.3%) to getting Covid-19 infection from their elective surgeries or any fear of Covid-19 infection. The actual dropout of patients from elective surgery due to fear of getting Covid-19 infection during surgery or staying in hospital was 7.5%. Conclusion: Fear of getting Covid-19 is still present in some of the patients who visit hospitals for elective surgeries. Discussing the various steps taken by the institute to improve patient safety and minimize risk of Covid-19, greatly enhanced their confidence in elective surgery and improved satisfaction level. Key words: Covid-19; Fear; Fear of Covid-19 Scale; Elective Surgical Procedures

Fear of getting Covid-19: A challenge to elective surgical practice and ways to overcome

Background: Covid-19, a global pandemic has a huge impact on surgical practice. There is transmission risk of Covid-19 during the elective surgery and nowadays it is a part of informed consent process. This has an impact on patient decision making as it creates anxiety and fear. Objective: To evaluate patient experience (fear of getting Covid-19) from elective surgery and challenges of elective surgical practice and ways to overcome during this pandemic era. Methods: This study was an observational cross-sectional survey and it has been conducted in General Surgery Department of Dr Akbar Niazi Teaching Hospital, Islamabad, from May to August 2021 after approval of Institutional Review Board (IRB). Participants for elective surgery and their negative report of Covid-19 infection by polymerase chain reaction (PCR) were included in the study. Fear of Covid-19 infection was measured through “fear of Covid-19 scale” by Ahorsu et al and analyzed. All findings were entered in a structured Proforma. Data was entered in SPSS version 26 and analyzed. Effect modifier chi square was used to find out the patient’s dropout due to getting Covid-19 infection from surgery. Results: Total 200 patients were included; 62% patients were male and 38% were females. The mean age of the patients was 38.64±12.08 years. The statistical analysis showed that there was a very significant association between FCV-19 scale and getting Covid-19 infection from elective surgeries (p ≤ 0.05). When stratified FCV-19 scale with education status of all patients there was a very significant association between them (p=0.001). The patient’s observations regarding FCV-19 questionnaire, most of the patients were disagreed (46.3%) to getting Covid-19 infection from their elective surgeries or any fear of Covid-19 infection. The actual dropout of patients from elective surgery due to fear of getting Covid-19 infection during surgery or staying in hospital was 7.5%. Conclusion: Fear of getting Covid-19 is still present in some of the patients who visit hospitals for elective surgeries. Discussing the various steps taken by the institute to improve patient safety and minimize risk of Covid-19, greatly enhanced their confidence in elective surgery and improved satisfaction level. Key words: Covid-19; Fear; Fear of Covid-19 Scale; Elective Surgical Procedures

A hydraulic analysis of shock wave generation mechanism on flat spillway chutes through physical modeling

Shock waves are generated downstream of spillways during flood operations, which have adverse effects on spillway operations. This paper presents the physical model study of shock waves at the Mohmand Dam Spillway project, Pakistan. In this study, hydraulic analysis of shock waves was carried out to investigate its generation mechanism. Different experiments were performed to analyze the rooster tail on a flat spillway chute and to examine the factors affecting the characteristics of the rooster tail. The study results show that shock wave height is influenced by spillway chute slope, pier shape, and flow depth. Moreover, the height of the shock wave can be minimized by installing a semi-elliptical pier on the tail part of the main pier. Further modifications in the geometry of the extended tail part of the pier are recommended for the elimination of the shock wave. Based on observed data collected from the model study, an empirical equation was developed to estimate the shock wave height generated on the flat slope spillway chutes (5◦ to 10◦ )

Functional genomics analysis of Leptin-Melanocortin system genes reveals candidate genes associated rapid growth and high carcass yield in sheep

The Leptin-Melanocortin System (LMS) is an important regulatory system involved in appetite and energy balance in many organisms, including sheep. Functional genomics analysis of LMS genes can provide insights into the genetic factors that influence rapid growth and high carcass yield in sheep. However, the genetic potential of sheep growth and reproduction has not been fully exploited. Therefore, identifying genes that regulate growth and reproduction would offer strategies for improving the yield and quality of sheep meat. In this study, to explore the possible molecular mechanisms underlying rapid growth and muscular high-yield carcass in sheep, we screened 14 genes, which were previously claimed to be associated with such traits in humans and rodents. The FST outlier approach implemented in LOSITAN detected the loci under selection. These candidate genes were connected to complicated biological processes, including the regulation of eating behavior, energy balance, and the positive regulation of the cAMP biosynthetic process, according to the gene ontology (GO) study. In addition, the 14 genes' re-sequence data revealed 7,226 SNPs. The MC4R, STAT3, BDNF, and TUB genes were discovered to be an outlier and significantly under positive selection using the fixation index (FST) based technique with the tentative combined allocation of mean heterozygosity and FST. Differentially expressed genes were found, and their functions were assigned using a functional genomics approach. Results showed that these genes are crucial in determining sheep features including size and meat quality. Insights are gained into the molecular mechanisms behind these phenotypic variations, and possible genes for future sheep breeding initiatives are provided. This research proves the value of functional genomics analysis in identifying the heritable components of valuable sheep agriculture traits.The authors extend their appreciation to the Researchers Supporting Project number (RSP2023R27) King Saud University, Riyadh, Saudi Arabia.Peer reviewe

Concurrent dengue and malaria infection in Lahore, Pakistan during the 2012 dengue outbreak

SummaryIntroductionWe conducted this study to determine the frequency of malaria and dengue–malaria co-infection in patients admitted to our hospital as ‘probable’ cases of dengue fever during the 2012 outbreak of dengue, and to ascertain whether dengue–malaria co-infection was more severe than either infection alone.MethodsThis cross-sectional observational study was conducted at Jinnah Hospital Lahore, Pakistan between August and November 2012. Patients with 2–10 days of fever and with two or more of the following: myalgia, arthralgia, retro-orbital pain, headache, skin rash, and hemorrhagic manifestations plus thrombocytopenia and leukopenia, were classified as probable cases of dengue fever and were subjected to reverse transcriptase (RT)-PCR and/or dengue-specific IgM by ELISA. The diagnosis of malaria was established on thick and thin blood film microscopy. Severe disease was defined by the presence of an altered level of consciousness, World Health Organization grade ≥2 bleeding, jaundice, circulatory shock, hemoglobin <50g/l, platelet count <50×109/l, serum creatinine >265μmol/l, or death.ResultsThere were 85 probable cases of dengue fever. Sixty-four (75%) were male and the median age was 22 years (range 12–90 years). Of 52 patients for whom results of diagnostic tests for both dengue and malaria were available, five (10%) had isolated dengue infection, 18 (35%) isolated Plasmodium infection, and 17 (33%) dengue–malaria co-infection. Thirty-five out of 52 (67%) probable cases had malaria and 17 out of 22 (77%) dengue-specific IgM reactive patients had concurrent malaria. Patients with isolated malaria had significantly lower median hemoglobin concentrations (124.5g/l vs. 144.0 g/l, p = 0.04) and median hematocrit (36.0 vs. 41.7, p=0.02) at presentation than cases of isolated dengue. Patients with dengue–malaria co-infection had a significantly lower rate of jaundice than those with isolated dengue (0% vs. 40%, p = 0.04). The frequency of severe disease was comparable amongst the three groups; this was seen in five (100%) cases of isolated dengue, 17 (94%) cases of isolated malaria, and 16 (94%) cases of dengue–malaria co-infection.ConclusionsThe rate of isolated malaria and dengue–malaria co-infection was high in probable cases of dengue fever in our study. Except for jaundice, we could not find any significant between-group differences in the severity of the disease