Ultrasound based evaluation of hepatic steatosis and fibrosis in hepatitis C non-responders

Objective: To determine the accuracy of ultrasound in the diagnosis and grading of steatosis and fibrosis in Hepatitis C (HCV) patients not responding to ribavarin-interferon therapy.Study design: A cross-sectional, analytical study.Place and duration of study: Radiology Department, Civil Hospital, Karachi, from March 2008 to August 2010.Methodology: Patients with positive HCV RNA despite 24 weeks ribavarin-interferon therapy (non-responders) were subjected to ultrasound and biopsy prior to institution of pegylated interferon therapy for detection and grading of steatosis and fibrosis. Using histopathology as the gold standard, sensitivity, specificity, negative and positive predictive values for ultrasound were determined.Results: The sensitivity of ultrasound for hepatic steatosis was 90.9% for no steatosis (NS), 100% for moderate and gross steatosis and 84.4% for mild steatosis with 100% specificity. The sensitivity for fibrosis was 25% for no fibrosis, 100% for mild fibrosis, 89.74% for moderate fibrosis and 100% for gross fibrosis. The overall accuracy for detection of steatosis was 95.39% and that for fibrosis was 98.02%. Hepatic vein showed increased dampening of flow with advancing grades of steatosis and fibrosis.Conclusion: Ultrasound has a high accuracy in the diagnosis and grading of steatosis and fibrosis in HCV nonresponders. Mild fibrosis may confound the diagnosis of mild steatosis

Consequences of Drug Abuse among Female and Male Population of Karachi: A Statistical Surveyed Approach

Drugs are chemicals. Different drugs, because of their chemical structures, can affect the body in different ways. The most obvious effects of drug abuse which are manifested in the individuals include ill health, sickness and ultimately, death. The social life is also not spared by the hazardous impacts of the problem. Whereas the load at health department is increased, rise in crime rate is also a perilous effect faced by the society related to the growth of abusers in the country. The following study highlights the different effects that can influence male and female drug abusers to get rid of their drug misuse habits. Abusers age, level of awareness about drugs adverse effects, their encounters to health ailments including the life threatening infection HIV, and involvement in crimes were included in the survey which was carried out in Karachi in order to assess the magnitude of this problem

A Comparative Study of Operation Theatre Disinfection by Fumigation Using Different Compounds

A comparative study of operation theatre disinfection by fumigation using different compounds.Background and Objective: Objective of this study was i) to evaluate the efficacy of formalin and quaternary ammonium compounds (QUAT). ii) To compare the efficacy of both agents/techniques for operation theatre disinfection.Study Design: This was an interventional, Case control study. This study was conducted at Children Hospital & Institute of Child Health Sciences, general operation theatre.Material and Method: A total of 200 samples were collected out of which 80 samples ( plates as well swabs) were collected before and after formalin fumigation and 120 samples prior and after spray fogging using QUAT based compound. The samples were cultured on blood and Mac-Conkey agar. Identification and isolation was performed in microbiology department according to bacteriological standards.Results: During fumigation by formaldehyde 34.3% samples (n = 32) were pre positive while 21.9% samples were post positive on different surfaces. On the other side 47.9% samples (n = 48) were pre positive while only 18.7% samples were post positive on different surfaces. Average bacterial count of air reduced from 744 (21 cfu/m3) to 329 (9 cfu/m3) after formalin vapor and 858 (25 cfu/m3) reduced to 492 (14 cfu/m3) after fogging.Conclusion: This study proves that fogging by less toxic compounds takes less time and has fewer disadvantages if we use automatic equipment having fine particle siz

Clinical evaluation of diaphyseal femoral fractures operated in lateral decubitus position with interlocking nail

Background: The diaphyseal fractures of femur in adults are conventionally treated in supine position on traction table, which carries risk of compartment syndrome, pudendal nerve palsy, whereas in lateral decubitus position these complications can be avoided with additional advantage of easy access to greater trochanter particularly in obese patients. The aim of this study is to evaluate outcomes of femur diaphyseal fractures treated with intramedullary interlocking nail in lateral decubitus position.Methods: In this study 40 patients with femur diaphysea fractures were treated with intramedullary interlocking nail in lateral decubitus position, were studied for a period of 9 months from September 2019 to May 2020.Results: At the end of our study of 40 patients, outcome is graded according Thoresen’s criteria where 22 (55%) patients had excellent results with full, pain-free, function of the extremity and 11 (27.5%) patients had good result; 10 patients had range of motion 1200 and shortening of femur by 1.5 was observed in 1 patient. There were 6 (15%) patients with fair result; with range of motion 900 and 1 poor result (2.5%) had non-union with range of motion <900.Conclusions: Fixation of femur diaphyseal fracture in lateral decubitus position leads to easy access to the proximal femur making it easy to establish an entry point for an intramedullary device and it significantly eliminates the complications caused by other conventionally used methods

Factors responsible for delay in provision of care to suspected COVID-19 patients presenting in surgical emergency and ways to combat it

Introduction: Health care workers are found to be at three times greater risk of getting infected as compared to the general public.  Scientists and doctors all over the world have agreed upon the use of PPE including gloves, masks, head covers, face shields, goggles, and jumpsuits in protection against COVID-19. Materials and Methods: This observational prospective study was conducted in the surgical emergency of Holy Family Hospital, Rawalpindi over a period of 2 months and 21 days. Patients included all those who presented to surgical emergency with suspicion of being positive for COVID-19 and time taken by first-line health care workers in attending them. 157 patients were observed for this purpose and 23 first-line surgeons including general, orthopedic, and neurosurgeons were interviewed regarding their fears and concerns about contracting COVID-19 and infecting their families. Results: It was observed that a surgeon took on an average of 10 minutes (+/-3 minutes) in wearing all the personal protective equipment and a total of 14minutes (+/- 5 minutes) in reaching a patient in the trauma room with symptoms suggestive of COVID-19. This was in contrast to a patient presenting to a trauma room who had no respiratory symptoms or fever, in which case, the patient was seen within 3 minutes (+/- 2 minutes) of presentation to a surgical emergency. Out of 23 surgeons, 15 had reasonably aware of the disease while 7 were knowledgeable up to the mark. 17 surgeons were extremely fearful about contracting the disease and infecting their friends and families. 7 surgeons confessed to avoiding COVID-19 patients and 9 surgeons confessed that they commanded their junior surgeons to see suspected COVID-19 patients in the emergency room. Conclusion: We concluded that delay in attending trauma patients suspected of being positive for COVID-19 was a worrisome problem that needed to be addressed. Numerous local and regional circumstances served as a factor for this delay, most important of which came out to be an inadequate provision of PPE, time consumed in collecting and wearing PPE, fear of the disease, and anxiety provoked due to this fear among surgeons

White Blood Cell to Platelet Ratio as a Marker of Adverse Outcome in Organophosphate Poisoning: A Retrospective Cross-Sectional Survey

Introduction: Organophosphorus compounds are pesticides commonly used for agricultural purposes. However, by nature they are poisonous, and administration either accidental or intentional is a medical emergency requiring prompt evaluation and treatment, and can even lead to death. In addition due to the ease of their availability, they are commonly used for self-harm/suicidal purposes. Many of the patients are initially managed at primary or secondary healthcare setups before being referred to tertiary care hospitals. The purpose of our study is to find a prognostic marker in the initial blood work of these patients. Materials and Methods: A total of 46 patients were included in this retrospective cross-sectional survey conducted at the Department of Emergency Medicine, Holy Family Hospital, Rawalpindi. Data were collected from patient files using specific questionnaires. Outcomes were defined in terms of Emergency Department disposition. Data were analysed using SPSS v25. A univariate analysis, followed by Spearman’s Correlation was used. Results: Patients with a higher WBC to Platelet ratio had worse outcomes. The Spearman’s rho correlation coefficient was calculated and a moderately strong correlation (rho = .458, p < .001) was found. Conclusion: WBC to Platelet ratio is a hematological parameter determined to be most strongly correlated with adverse outcomes in Organophosphate Poisoning. It has a statistically significant stronger correlation than the WBC count alone. However, further extensive and focused studies are needed to corroborate these findings and substantiate them as a definite marker of prognostic significance. Keywords: Organophosphate Poisoning; Emergency Medicine; ED; White Blood Cells; Emergency Care; Patient Outcome Assessment

Compliance on the Use of Different Types of Face Mask by Healthcare Workers and General Public in Tertiary Care Hospital of RMU during COVID-19 Pandemic

Objective: To determine the compliance on the use of different types of facemask among HCWs, patients and the general public in different hospital settings of tertiary care hospital of RMU during COVID-19 pandemic Material and Methods: Cross-sectional descriptive study was done among 397 study subjects of either gender consisting of HCWs, patients, and the general public visiting the tertiary care hospital from 6th April-6th June 2020. Subjects were enrolled through convenience non-probability sampling. Data was gathered by a self-structured proforma. The study consisted of questioning the frequency of washing hands, using hand sanitizers, practicing physical distancing, using eye protection goggles or face shields, the practice of sterilizing or changing of shoes and clothes after coming back to home, frequent use of disposable gloves, use of caps or head covers and water-repellant aprons and gowns. Data were analyzed by SPSS version 25.0. Results: A total of 397 study subjects including 206 (52%) males and 190 (48%) females were enrolled in the study. 118 (29.7%) had an underlying disease, 93 (78.8%) of them showed regular use of masks. The mean age of participants was 34.7 ± 12.2 years. 90.4% of study subjects had good compliance with using face masks in hospital settings, 25.9% study subjects used respirator type of masks while the use of homemade cloth was 4.8%. A total of 57.8% of study subjects had use of single masks, 22.5% used double masks, and 10.4% people used triple masks remaining 9.3% uses no masks at all. Among 189 HCWs 54% were using respirator type of masks and 46% were using surgical masks. The general public preferred to use locally made surgical masks or homemade cloth because they are cheap and easily available. Conclusion: The selection and use of PPE especially facemasks vary among HCWs and non HCWs. Even among HCWs usage varies according to the type of healthcare workers and the working environment. Overall compliance with the use of face masks and other PPE was considerably low among non HCWs. Our study has provided preliminary data about the usage of masks among HCWs and non HCWs. Longitudinal studies must be conducted to collect better evidence about the use of the face mask as PPE and its associated factors