Severity of Plasmodium vivax malaria in Karachi: a cross-sectional study

INTRODUCTION: Plasmodium vivax malaria affects billions of people annually. This study aimed to note the presentations and complications and subsequently to identify the determinants of in-patient hospital care of P. vivax malaria patients presenting to a tertiary care hospital in Karachi, Pakistan. Severity of the shock was also assessed using a shock index. METHODOLOGY: This study descriptive cross-sectional study was conducted at the Emergency Department of Aga Khan University Hospital, Karachi. All adult patients with a positive P. vivax peripheral film and/or immunochromatography admitted through the department were studied during 2009. Data was entered and analyzed using SPSS version 16. Keeping the length of stay at a cut-off of 48 hours after admission, the independent Student-t test was applied. Level of significance was taken at 0.05. RESULTS: A total of 97 patients were included in the study. Fever was the most common presentation. A significant number of patients had nonspecific complaints, but tachycardia, altered mental status, and adult respiratory distress syndrome were important findings. Mean shock index was 1 (SD 0.26). Common reasons for admission were thrombocytopenia and dehydration. Some patients were admitted for more than 48 hours. Complications included pneumonia and bleeding requiring platelet transfusion. CONCLUSION: This study highlights that the debilitating impact of P. vivax malaria remains high. Although the effects of severe vivax malaria can be contained through aggressive resuscitation and specific therapy, sensitivity and awareness of this complicated course must be highlighted among caregivers

Graph Theory and Matrix Approach (GTMA) Model for the Selection of the Femoral-Component of Total Knee Joint Replacement

Total Knee Replacement (TKR) is the increasing trend now a day, in revision surgery which is associated with aseptic loosening, which is a challenging research for the TKR component. The selection of optimal material loosening can be controlled at some limits. This paper is going to consider the best material selected among a number of alternative materials for the femoral component (FC) by using Graph Theory. Here GTMA process used for optimization of material and a systematic technique introduced through sensitivity analysis to find out the more reliable result. Obtained ranking suggests the use of optimized material over the other existing material. By following GTMA Co_Cr-alloys (wrought-Co-Ni-CrMo) and Co_Cr-alloys (cast-able-Co-Cr-Mo)are on the 1st and 2nd position respectively

Biliary stones: an atypical cause of abdominal pain in paediatric age group

OBJECTIVE: To identify Paediatric patients with biliary stone disease presenting to a tertiary care hospital in order to determine the etiology, presentation and management. METHODS: Retrospective study of all cases of ultrasonographically proven biliary stones under the age of 15 years from January 1988 to December 2008. Data included their risk factors, complications, management and outcome. RESULTS: Total 32 patients were identified with biliary stones, treated in the hospital. Mean age at presentation was 8.25 +/- 3.33 years. Sixteen patients underwent cholecystectomy. CONCLUSION: Paediatric cholelithiasis is an atypical and under-diagnosed cause of abdominal pain in childhood. True prevalence of the disease may be higher than reported. Appropriate surgical intervention is required in patients with symptomatic and complicated biliary lithiasis

Malignant Psoas abscess or pseudomyxoma extraperitonei

Primary adenocarcinoma of appendix is an uncommon gastrointestinal malignancy. Similarly, Psoas abscess is an entity, which sometimes requires extensive work-up to reach a diagnosis. Combined presentation of these two rare conditions is not only exceptional, but also diagnostically challenging. We present a case of a lady who presented with recurrent UTI secondary to right sided ureteric obstruction, referred right hip joint pain resulting from a Psoas abscess, which eventually turned out to be a consequence of metastatic adenocarcinoma of appendix, causing pseudomyxoma extraperitonei, with simultaneous intraperitoneal deposits

Integrating Latent Load into the Cooling Degree Days Concept for Current and Future Weather Projections

Rising temperatures, increase in population, and dense urban morphology have resulted in increased cooling energy demands. The conventional degree-days method to calculate cooling energy demand considers only the sensible heat load of air and neglects the latent component. This study aims to estimate the cooling degree days based on the heat index (by considering both the sensible and latent loads) for the current and future years (2050 and 2080). Further, the ventilation load index for each of these cities has been established to unlock the impact of ventilation on the building’s total energy consumption for current and future years. The results show that heat index- based degree days have a stronger relationship with the buildings’ cooling energy consumption and, therefore, can predict the cooling energy demand of buildings with 20% higher accuracy than conventional temperature-based degree days. Analysis shows that cooling degree-days and frequency of temperature above the comfort range continue to increase in Pakistan, highlighting increased degree-days in the range from 11.0 to 41.6% by 2050 and from 28.4 to 126.5% by 2080. Prompt actions are essential to enhance the resilience of Pakistan’s national grid to meet these future cooling energy demands

Undergraduate clerkship in emergency medicine: experience from Pakistan.

Although Emergency Medicine (EM) is an integral part of undergraduate medical curriculum in many countries, it has not been included formally in the MBBS curriculum in Pakistan. Medical graduates are supposed to be able to handle common as well as life threatening emergencies but little has been done to ensure the process to achieve this competence. The development of an undergraduate EM curriculum is important but challenging task. Implementation of standard curriculum will ensure that medical graduates have gained competence in assessing and managing acutely ill patients and dealing with common emergencies. This paper shares the features of an undergraduate EM clerkship which can be used as a template by other medical institutions

Differences in risk-adjusted outcome of road traffic injuries in urban tertiary care centers of Pakistan

Objective: To assess the differences in road injury survival in three tertiary care hospitals in an urban setting.Methods: The study was conducted in and comprised all road traffic injury victims presenting to the three state-run tertiary care centres in Karachi from September 2006 to October 2009. Patients\u27 age, gender, mode, and delay in arrival, severity of injury were noted. Data was stratified by hospital of presentation. A logistic regression model was developed and probability of survival was assessed after adjusting for various risk factors, including patient characteristics and injury severity.Results: There were 93,657victims in the study, but complete information was missing in 6,458(6.89%) study subjects, including survival information. Overall, 83,837(89.5%) were males; 64,269(74%) were aged between 16 and 45 years; 84,016(95%) had injury severity score of ?15; and overall survival was 84,141(96.5%).Conclusions: Significant differences existed in risk-adjusted survival of road injury victims presenting to public hospitals of Karachi. These differences pointed to variations in the process of care, and highlighted opportunities for improvement