MATERNAL ANEMIA AS A PREDICTOR OF LOW BIRTH WEIGHT BABIES IN UNDERDEVELOPED RURAL AREA OF SOUTHERN PUNJAB

Objective; To determine the frequency of low birth weight babies born to anemic pregnant ladies of underdeveloped area of Southern Punjab. Subjects and methods; A total 216 pregnant women aged 20 – 40 years, with anemia were included in our study. Anemic pregnant women with gestational age more than 24 weeks having singleton fetus were taken. Five ml of venous blood sample was drawn and sent to the laboratory for estimation hemoglobin levels to diagnose anemia among pregnant women and only anemic women were taken and followed till delivery to diagnose low birth weight. All the data was entered and analyzed by using SPSS version 20.0. Results; A total of 216 pregnant women with anemia were included in this study. Mean age of our study cases was 26.67 ± 4.26 years ranging from 21 – 35 years and 161 (74.5%) were aged up to 30 years. One hundred sixty three (75.5%) were from poor socioeconomic background while 53 (24.5%) were from middle income families. Only 36 (16.7%) were literate and 180 (83.3%) were illiterate. One hundred forty four (66.7%) belonged to joint family system and only 36 (16.7%) had history of using iron supplementation during course of pregnancy. Mean parity was 3.12 ± .93 and 117 (54.2%) had parity up to 3. Mean maternal hemoglobin level was 8.91 ± 1.28 g/dl ranging from 6.5 to 10.8 g/dl. Mean birth weight of our study cases was 2300.97 ± 228.94 grams and low birth weight babies were 120 (55.6%). Conclusion; Very high frequency of low birth weight newborn babies was noted among anemic mothers in our study. Low birth weight was significantly associated with increasing age, illiteracy, lack of use of iron supplementation and increasing parity. Anemic mothers should be counseled for proper dietary uptake during pregnancy so as to avoid adverse pregnancy outcomes. Keywords; Maternal anemia, low birth weight, hemoglobin levels

Diagnostic Validity Of Low Dose CT KUB In Demonstration Of Genitourinary Tract Calculi Compared To Normal Dose Ct Kub: A Provisional Study

Objective: Renal colic is a common clinical condition. Our objective is to evaluate the diagnostic accuracy of low dose CT KUB for detection of urinary stones, to minimize radiation dose to the patients, and to analyze diagnostic accuracy of LDCT KUB in comparison to standard dose CT KUB. We speculate the LDCT KUB may reduce patient radiation dose while maintaining diagnostic value. Materials and Methods: This comparative cross sectional validation study was conducted at Department of Radiology in Benazir Bhutto Hospital, Rawalpindi June 2021 to Feb 2022. After approval of hospital ethical committee, a sample of 49 kidneys of 31 patients was collected by non-probability consecutive sampling technique. Included were the patients diagnosed with renal calculi referred from other departments. All the included patients were scanned by Toshiba Aquilion 16 slices, using automated tube current modulation, without any oral or IV contrast. CT scan started from diaphragm down to pubic symphysis with standard dose CT (SDCT) followed by low dose CT (LDCT). After the data was recorded, statistical package for social sciences, version 20.0 (SPSS Inc., Chicago, Illinois, USA) was used to analyse the data and generate results. Mean + standard deviation was calculated for qualitative data while frequency and percentage for qualitative variables. The means were compared by independent sample t test while the agreement between standard and low dose was depicted by kappa value. Results: A total of 49 kidneys of 31 patients with renal stones was included in this study. The mean age of the patients ranged from 27 years to 48 years with a mean of 36.42 + 9.97 year. In gender distribution, 75.5 % (37) were male while 24.5 % (12) were females. More than half 59 % (29) were right while 41 % (20) were left kidneys. Conclusion: This study demonstrated that LDCT was a productive and effective technique in the detection of urothelial stones despite considerable reduction in radiation dose and exposure as seen in SDCT

Prevalence of MRSA in Rawal Institute of Health Sciences Islamabad & its Antibiotic Susceptibility Pattern

Objective: To determine the prevalence of MRSA infection and its antibiotic susceptibility pattern in patients undergoing abdominal and vaginal surgeries. Material and Method: A retrospective observational study was conducted at Rawal General & Dental Hospital, Islamabad from September 2017 to September 2018 and data of approximately 300 patients were retrieved which included culture and sensitivity reports of wound and vaginal swabs of patients undergoing abdominal and vaginal surgeries to see prevalence of MRSA and antibiotics to which it is susceptible .Obesity was a risk factor and patients with immune-compromised status were not included. Result: Female patients were most affected 87%. Of the total cases, patients between ages 21 to 30 years were more frequent. The rate of MRSA was 37.0% in this study. There were 63% patients who showed methecilline resistance. Linezolid was more effective in MRSA and was sensitive in 81%. &nbsp

Manual loop in laparoscopic appendectomy: A retrospective cohort study and literature review

Objectives: To determine the incidence of complications [Surgical site infection (SSI), intra-abdominal abscess (IAA), stump leak] related to stump ligation with manual loop of sliding extracorporeal suture knot in laparoscopic appendectomy. Methods: This cohort study was conducted on patients who underwent laparoscopic appendectomy from June 2014 to November 2020 performed by the same surgeon with almost similar technique. Stump was ligated with manual loops, applied by the surgeon or trainee or both (one by surgeon and other by trainee). SSI and IAA were classified according to Centers for Disease Control and Prevention (CDC) criteria. Results: Total 120 patients were included with median (Interquartile range, IQR) age of 24 (19-35) years and male predominance i.e. 81 (67.5%). Median (IQR) for the duration of symptoms, time from presentation to surgery and duration of surgery was 2(1-4) days, 10 (4-15) hours and 60 (44-70) minutes, respectively. SSI was documented in 9(7.5%) patients, managed by wound hygiene and antibiotics. IAA was observed in one(0.8%) patient who required readmission for antibiotics and radiology guided drain placement. No stump leak was observed.Conclusions: Manual endo-loop is a safe, reliable and cost effective technique for stump ligation in LA, and can safely be incorporated into teaching of surgical trainees

Frequency of raised red cell distribution width in acute exacerbation of COPD patients

Objective: objective of our study is to investigate and establish the frequency of raised red cell distribution width in acute exacerbation of COPD patients. Study design: Cross sectional study Place and Duration of study: This study was conducted in pulmonology department of Nishtar Hospital Multan from January 2016 to December 2017. Methods: Total 384 patients were selected by non-probability consecutive sampling and approval of study was taken from ethical committee of the institution. Written permission of study was signed by every patient enrolled in study. Numerical variables like age, weight, white blood cells, platelets, MCV, hemoglobin (Hb) and duration of COPD were analyzed statically by taking their mean and standard deviation and t-test was applied to test their significance. Non numerical variables like gender, anemia, thrombocytopenia, income and area of living were statistically analyzed by taking their frequency and chi square test was applied to test their significance. While the outcome variable red cell distribution width was assessed by 3-part hematology chamber. Results: Overall, there were 100% (n=384) patients were included, in this study, both genders. There were 60.7% (n=233) males and 39.3% (n=151) females. 72.1% (n=277) patients belonged to urban areas while 27.9% (n=107) belonged to rural areas. 69% (n=265) had good income and 31% (n=119) had low income. The mean age and BMI of the patients was 65.22±6.45 years and 26.21±2.18 kg/m2 respectively. There were 26% (n=100) patients between 40-60 years while majority of the patients i.e. 74% (n=284) between 61-80 years of age. The distribution of BMI of the patients observed as; 39.3% (n=151) patients between 18-25 kg/m2 and 60.7% (n=233) patients between 26-32 kg/m2. The main outcome variable of this study was red cell distribution width. The Mean±S.D of red cell distribution width was 14.03±1.62%. While, red cell distribution width noted as normal and raised; 54.9% (n=211) and 45.1% (n=173) respectively. Conclusion: Study concluded that there was significant prevalence of raised red cell distribution width (RDW) in acute exacerbation of COPD patients. This easy, inexpensive and quick parameter should be investigated further. So it can be used as prognostic marker and predictor of mortality in acute exacerbation of COPD patients. Key words: Acute exacerbation of COPD (AECOPD), red cell distribution width (RDW), COPD, Inflammation

COVID-19 and Pregnancy Outcome: An Experience in ‘COVID-19 Management Designated’ Tertiary Care Hospital, Rawalpindi, Pakistan

Background: The current COVID-19 pandemic has affected almost 17.3 million victims worldwide with mortality of almost 674K. Pregnancy is one of the most susceptible conditions for COVID-19 infection, but limited data is currently available about the clinical characteristics of pregnant women with the disease. Objective; to describe the clinical characteristics, co-morbidities, management, feto-maternal, and neonatal outcome in COVID-19 positive pregnant women. Methodology: A descriptive case series study was conducted in Obs/Gynae dept of Benazir Bhutto Tertiary Care Hospital, Rawalpindi, including all asymptomatic/symptomatic COVID-19 positive pregnant women and clinical suspects (COVID-19 PCR negative women) delivered in our hospital from 01st April 2020 to 31st July 2020. Their medical records were reviewed for clinical characteristics, management, feto-maternal and neonatal outcomes. Continuous variables were expressed in Mean & Range and Categorical variables as number & Percentage. Results: During the study period a total of 17 cases were reviewed. The mean maternal age was 28.94 yrs. Primigravida (07), Multipara (10). Mean gestational age was 37 wks (range; 30-41wks). Presenting symptomatology was varied. Asymptomatic; (29%), COVID-19 specific symptoms; fever & flu (12%), fever&cough (6%), shortness of breath(SOB) alone (6%), fever & SOB(6%) and pregnancy-related manifestations were labour pains (17%), eclampsia(6%), hydrocephalous fetus (6%) and hepatic encephalopathy(6%). The commonest co-morbidity was Hypertensive disorders of pregnancy (24%). Five women (29%) required ICU care. Lower segment caesarean sections(LSCS) (59%), vaginal delivery (41%). Eleven babies delivered with good Apgar score and birth weight. Two were early neonatal deaths (ENND) and 04 were received intra-uterine fetal deaths (IUDs). Fetal demise was associated with strong obstetric risk factors. Out of 13 live-born babies, RT-PCR Covid-19 testing was done in 10 (77%) cases and was negative. One mother was expired due to complications of hepatic encephalopathy, sepsis, and burst abdomen. Conclusion; The clinical course of COVID-19 disease in pregnancy seems to be no different from non-pregnant women. Clinical manifestations are diverse and infection contracted in the third trimester of pregnancy is associated with good feto-maternal and neonatal outcomes

Comparison Of ALT In Type 2 Diabetics with And Without Fatty Liver Disease

Objective: To determine the association of alanine aminotransferase in type 2 diabetic patients with and without fatty liver disease. Materials and Methods: A cross-sectional study was done for six months at Sheikh Khalifa Bin Zaid Al-Nahyan Hospital Rawalakot. In our study, we included all the patients who presented to the outpatient department (OPD) having type 2 diabetes mellitus. Their age, gender, height, weight, and duration of diabetes mellitus were noted. Their liver function test (LFTS), fasting blood sugar and HBA1c, and fasting lipid profile were also done at the time of their OPD visit and results were noted. They were given an appointment for an ultrasound abdomen from the radiology department for detection of fatty liver disease and the results were noted on the next OPD visit. Results: Total study population was 90 patients and out of which 35 (38.8%) were male and 55 (61.1%) were female. 58 years was the mean age of our study population. Fatty liver was present in 50% of patients. ALT was raised from a baseline value of 36 in 61% of patients while fasting blood sugar was raised in 83% of patients. The mean fasting blood sugar was 208 mg/dl. ALT was not significantly different in patients with and without fatty liver disease. However, it was found that patients with uncontrolled blood glucose levels have significantly raised ALT which was also statistically proven as the P value was less than 0.05. Also, patients with high blood glucose have a higher incidence of fatty liver disease as compared with normal blood glucose level patients but the difference was not statistically significant as shown by a P value more than 0.05. Conclusion: Fatty liver disease is more common in Type 2 diabetic patients with uncontrolled blood sugar. There is a high rate of raised ALT in diabetic patients whose blood sugar control is not optimum

Self-Concept and Self-Esteem among Adults

Despite an ample study and analysis of Self concept and Self esteem, not a solitary deconstructive work has been done on the Effect of Self concept on Self esteem. So, this study aimed at the disclosure of all the ways through which self concept affects the self esteem among university students. The research method applied on the paper was quantitative. The study adopted a Multiple Self Concept Scale byBruce A. Bracken and Rosenberg’s Self- esteems scale (Rosenberg, 1965). The collected data analysis was accomplished statistically using the t-test and coefficient of correlation techniques. A sample of 250 students comprised of 75 males and 175 females was taken from BZU Multan. The inferences of the study conceded that Self Concept has a significant effect on Self esteem among university adults. Besides, the research inquiry brought the fact to light that there is, no doubt, a significant disparity of influences of self concept on self esteem between male and female