A Descriptive Study on Patterns of Traumatic Spinal Injuries in a Tertiary Care Hospital Rawalpindi

Introduction: Spinal injuries are one of the most debilitating injuries if not fatal and affect every dimension of patients' lives i.e. early mortality and late complications. Lifelong disability due to spinal cord injury is very common even if the patient survives early death. The current study was aimed to investigate the frequency, management, mortality, the pattern of spinal injuries and to recommend plans for better patient management based on assessment.Material and Methods: The study was descriptive, cross-sectional, and was conducted at the Neurosurgery Department of Rawalpindi Medical University and Allied Hospitals for the duration of October 2018 to January 2019. All cases of traumatic spinal injuries were included and variables noted were gender, age, mode of Injury, presenting motor power in limbs, ASIA score, diagnosis, management, outcome, and deaths.Results: In the sample size of 84 patients, the mean age was 37.1 years, the mechanism of injury due to falls was most common at 73%, the lumbar region was found to be the most common area involved. Male patients outnumbered females in the study. 14% of the patients could not survive due to the injury, 15% received cervical traction, 4% received cervical traction and anterior cervical plating, and 43% of patients underwent Transpedicular Screw Fixation, the total number of patients who expired was 25%.Conclusion: Patterns of traumatic spinal injuries are changing, shifting from road traffic accidents to falls being the primary cause nowadays, with prolonged hospital stay periods, disability for life, and high-cost treatments putting a huge burden on our already exhausted health resources. Efforts should be made to make a national registry for traumatic spinal injuries presented to the emergency department and guidelines should be established regarding occupational hazards. Awareness should be given to the general population regarding hazards at home regarding falls

Comparison of microcoils and polyvinyl alcohol particles in selective microcatheter angioembolization of non variceal acute gastrointestinal hemorrhage

Objectives: To compare the efficacy of polyvinyl alcohol (PVA) particles with microcoils in angiembolisation of non variceal acute gastrointestinal haemorrhage.Methods: This is a retrospective cross-sectional study of patients who underwent transcatheter angioembolization from January, 1995 to December, 2013 at Aga Khan University Hospital, Karachi. Patients were divided into two groups on basis of use of either microcoils or PVA particles and compared in terms of technical success, clinical success, re-bleeding and ischemic complication rates. Chi (chi(2)) square and Fisher\u27s exact tests were applied and a P-value of less than 0.05 was considered statistically significant.Results: Fifty seven patients underwent angioembolization. Microcoil and PVA particles embolization was performed in 63% (36/57) and 35% (20/57) cases respectively. Technical success was achieved in all cases (100%). Clinical success rate was higher in microcoils group (92%) than PVA particles group (75%) with statistically significant P value (p=0.048). Ischemic complication was seen in one case (3%) in the microcoil group, while no such complications were seen in the PVA particles group.CONCLUSION: In angioembolization of non variceal acute gastrointestinal haemorrhage microcoils are better than Polyvinyl alcohol particles with higher clinical success and lower re-bleed rates

Out-of-Pocket Expenditure on Delivery Care in Public and Private Health Sectors – A Study in a Rural District of Pakistan

Pakistan witnessed a significant improvement in maternal health outcomes during the past two decades. However, persistent urban-rural and socio-economic inequalities exist in access to maternal healthcare services across the country. The objective of this study was to estimate out-of-pocket expenditure (OOPE) on delivery care by women in the public and private health sectors in RajanPur district. This was a cross-sectional study conducted, among 368 randomly selected mothers who had childbirths from 1st October to 31st December 2020. The study applied multi-stage random sampling technique to select the study participants. The results showed that about two-thirds of mothers preferred public hospitals for most recent delivery. The percentage of cesarean deliveries conducted in private hospitals (43.8%) was 4.7 times higher than in public hospitals (9.3%). About 99% of mothers incurred OOPE during delivery care, and the mean OOPE incurred during delivery care was PKR 2840 (US$17.75) in public hospitals and PKR 25596 (US$159.9) in private hospitals. OOPE on cesarean delivery in private hospitals (PKR 39654.7, US$247.8) was 2.5 times higher than the public hospitals (PKR16111.9, US$100.69), whereas OOPE incurred on normal delivery care in private hospitals (PKR14339, US$89.62) was 9.5 times higher than OOPE in public hospitals(PKR 1501.4, US$9.38).To conclude, the findings and recommendations drawn from the research would provide some insights to health policymakers and planners in developing an integrated and viable maternal healthcare program in Pakistan

An alkali catalyzed trans-esterification of rice bran, cottonseed and waste cooking oil

In this research work, biodiesel production by trans-esterification of three raw materials including virgin and used edible oil and non edible oil has been presented. A two step method following acidic and alkali catalyst was used for non edible oil due to the unsuitability of using the straight alkaline-catalyzed trans-esterification of high FFA present in rice bran oil. The acid value after processing for rice bran, cottonseed and waste cooking oil was found to be 0.95, 0.12 and 0.87 respectively. The influence of three variables on percentage yield i.e., methanol to oil molar ratio, reaction temperature and reaction time were studied at this stage. Cottonseed oil, waste cooking oil and rice bran oil showed a maximum yield of 91.7%, 84.1% and 87.1% under optimum conditions. Fuel properties of the three biodiesel satisfied standard biodiesel fuel results

(Review article*) Permaculture: Smart Growth Strategies and Management for Juniper Forest

Permaculture creates an integrated system by incorporating those parameters which are often viewed as separate entities such as smart growth, low-impact development, habitat protection, complete streets, and other initiatives. Its gives better planning options and give policies a line of coherence and directions which provides basis for the real concept of sustainability. Presently in Pakistan, forest management policies suffer from a number of drawbacks and especially the Juniper forests in Pakistan are under constant pressure due to natural as well as anthropogenic pressures. To conserve the Juniper Forest Ecosystem a proposed Smart Growth Strategies based on Permaculture’s principles are designed to protect the Ziarat Juniper Forest that offers an unequivocal vision and strategy to gain valid sustainability in forest management

Evaluating the Relationship between Work-Family Conflict & Organizational commitment (A Survey of Nursing Staff in Public Sector Hospitals of District Bhakkar, Pakistan)

Organizational commitment of workers has captured the attention of social-researchers. Many organizations are facing the problem of less commitment among employees. Little importance has been given to work–family conflict as one of the many causes of decreasing commitment towards the job. This research was undertaken to check the impact of three forms of work-family conflict (WFC): Time, Behavior and Strain-based, on organizational commitment of nurses in public sectors hospitals of District Bhakkar, Pakistan. Data was collected through survey approach by administering the questionnaires among 110 nurses. Tests of Correlation and regression showed that, WFC-Time was the most significant predictors of less organizational commitment. These findings suggests to the nurses to manage their work and family commitments responsibly. Key Words: Work family conflict, time, strain, behavior, Organizational commitment, affective, normative, continuance

Comparison of Polyetheretherketone (PEEK) Cage versus Iliac Bone Graft undergoing Anterior Cervical Discectomy and Fusion (ACDF): A multicenter experience

Background:In anterior cervical discectomy and fusion (ACDF), the two most frequently used materials are allografts and polyetheretherketone (PEEK) cages. The aim of the study was to compare the functional and radiological outcomes of polyetheretherketone (PEEK) cages with iliac crest allografts in anterior cervical decompression and fusion (ACDF) in patients of symptomatic Cervical spondylotic myelopathy (CSM).Methods:In this cohort study, we included 70 (35 in each group) patients of symptomatic CSM having degenerative cervical disc disease who were planned for ACDF from Jan-2017 to Jan-2021 in Rawalpindi Medical University. All procedures were performed under general anesthesia in supine position, standard ACDF technique was used in all patients. Anterior cervical locked plates were used for fixation of PEEK cages or the iliac allografts in the inter-vertebral space. Radiologic and functional outcomes were determined till 6 months after surgery. Results:The baseline study characteristics were similar between the groups. Mean Modified Japanese Orthopaedic Association (MJOA) score at 06 months’ follow-up was same between the groups; 14.16±4.30 in group A and 13.54±3.24 in group B (p-value 0.49). Disc space height at 06 months’ follow-up was also similar between the groups; 10.01±0.67 mm in group A versus 10.11±0.70 mm in group B (p-value 0.54). Fusion rate at final follow-up was 31 (88.6%) in group A versus 30 (85.7%) in group B (p-value 0.72).Conclusion:PEEK cages have similar functional and radiologic outcomes in comparison to ileal crest allografts. So, PEEK cages can be used as a successful alternative to ileal crest allografts this will help to reduce donor site morbidity and will reduce longer surgical times associated with graft harvesting

Predictors and outcome of tetanus in newborns in slum areas of Karachi city: A case control study

Background: Tetanus in newborns, is an under-reported public health problem and a major cause of mortality in developing countries. This study aimed to determine the predictors and outcome of tetanus in newborn infants in the slums of Bin-Qasim town, Karachi, Pakistan.Methods: We conducted a case-control study at primary health care centers of slums of Bin-Qasim town, area located adjacent to Bin Qasim seaport in Karachi, from January 2003 to December 2013. Cases were infants aged ≤30 days with tetanus, as defined by the World Health Organization. Controls were newborn infants aged ≤30 days without Tetanus, who were referred for a checkup or minor illnesses. The case to control ratio was 1:2.Results: We analyzed 26 cases and 52 controls. The case fatality was 70.8%. We identified four independent predictors of Tetanus in newborns: maternal education (only religious education with no formal education OR 51.95; 95% CI 3.69-731), maternal non-vaccination (OR 24.55; 95% CI 1.01-131.77), lack of a skilled birth attendant (OR 44.00; 95% CI 2.30-840.99), and delivery at home (OR 11.54; 95% CI 1.01-131.77).Conclusions: We identified several potentially modifiable socio-demographic risk factors for Tetanus in newborns, including maternal education and immunization status, birth site, and lack of a skilled birth attendant. Prioritization of these risk factors could be useful for planning preventive and cost-effective measures