Outcome of Hepatitis-E Virus Infection among Pregnant Women Admitted in a Tertiary Care Hospital

PURPOSE:  To study the effect of post-operative Non-Steroidal Anti-inflammatory (NSAID) eye drops on macular thickness in patients without diabetic retinopathy measured by Optical Coherence Tomography (OCT) STUDY DESIGN: Quasi experimental study PLACE & DURATION OF STUDY:  removed for blind review METHODOLOGY: Diabetic patients without retinopathy who required cataract surgery for visual rehabilitation were included in study. They were than divided into two groups. Group A included patients who received routine steroid+antibiotic post-operative drops while Group B comprised of patients who received nepafenac (0.1%) eye drops eight hourly in addition to routine post-operative eye drops. All patients underwent standard phacoemulsification and intraocular lens implantation followed by use of NSAID eye drops for a month. OCT measurements were done pre-operatively, 7 and 28 days post operatively. RESULTS: Comparison of central macular thickness between groups was significant at (Pre & 7 day post op) and insignificant at (7th day & 28th day post op) and (Pre & 28th day post op) i.e. 0.043, 0.834 and 0.084 respectively. However, difference of mean central macular thickness was significant at all follow-up periods i.e.0.003, 0.006, and 0.000 CONCLUSION: Post-operative NSAID in diabetic patients without retinopathy leads to a significant decrease in macular thickness as compared to controls after cataract surgery. KEY WORDS: Phacoemulsification, Optical Coherence Tomography, Non-steroidal Anti-Inflammatory Agent

Outcome of Hepatitis-E Virus Infection among Pregnant Women Admitted in a Tertiary Care Hospital

PURPOSE:  To study the effect of post-operative Non-Steroidal Anti-inflammatory (NSAID) eye drops on macular thickness in patients without diabetic retinopathy measured by Optical Coherence Tomography (OCT) STUDY DESIGN: Quasi experimental study PLACE & DURATION OF STUDY:  removed for blind review METHODOLOGY: Diabetic patients without retinopathy who required cataract surgery for visual rehabilitation were included in study. They were than divided into two groups. Group A included patients who received routine steroid+antibiotic post-operative drops while Group B comprised of patients who received nepafenac (0.1%) eye drops eight hourly in addition to routine post-operative eye drops. All patients underwent standard phacoemulsification and intraocular lens implantation followed by use of NSAID eye drops for a month. OCT measurements were done pre-operatively, 7 and 28 days post operatively. RESULTS: Comparison of central macular thickness between groups was significant at (Pre & 7 day post op) and insignificant at (7th day & 28th day post op) and (Pre & 28th day post op) i.e. 0.043, 0.834 and 0.084 respectively. However, difference of mean central macular thickness was significant at all follow-up periods i.e.0.003, 0.006, and 0.000 CONCLUSION: Post-operative NSAID in diabetic patients without retinopathy leads to a significant decrease in macular thickness as compared to controls after cataract surgery. KEY WORDS: Phacoemulsification, Optical Coherence Tomography, Non-steroidal Anti-Inflammatory Agent

Clinicopathological Correlation of Leiomyoma undergoing Myomectomy in a Tertiary Care Hospital

AbstractObjective: To evaluate clinic pathological correlation of Leiomyomas undergoing myomectomy intertiary care hospital.Methodology: This cross-sectional study was conducted at Gynaecology and ObstetricsDepartment, Services Institute of Medical Sciences Lahore, from June2019 to September 2022 on asample of 123 eligible patients. After a detailed history investigations and clinical examination, e.g.CBC, blood grouping, fasting blood sugar, ESR, ultrasound scan, laparotomy was performed and thesize of uterus, tubal and ovaries condition and total number and location of fibroids we noted. A tubalpatency test using methylene blue was performed. Histopathological examination was performed toconfirm any endometrial pathology or degenerative process. The data was analysed SPSS 21.0.Categorical variables like demographic profile, clinical characteristics, and location of myoma werepresented as frequency and percentages.Results: Mean age was 25.23±5.623 years. In the study population, 69.1% were nulliparous. Heavymenstrual bleeding was the commonest symptom, constituting 44.7%, mass in abdomen in 30.1%,infertility in 22% and dysmenorrhea in 3.3% cases. Most common site of leiomyoma was Intramural(51.21%), Subseroal 29.26%, and Submucous 19.51%.Conclusion: The study concluded that leiomyoma is one of the most common diseases ofreproductive age.Keywords: Clinicopathological correlation, leiomyomas, fibroids, uterine fibroids

Comparative analysis of developmental profile between normal and severe acute malnourished under-five children in Pakistan: a multicentre cross-sectional study

Objectives: This study aims to compare the developmental profile of severe acute malnourished (SAM) and normal under-five children and to find sociodemographic determinants accountable for their developmental disabilities. Setting: We conducted a multi-centre cross-sectional study in three basic health units and one rural health centre in Pakistan. Participants: 200 children (SAM and healthy) aged 6-59 months. Primary and secondary measures: We screened for nutritional status and clinical complications. Children underwent for developmental assessment by Denver Development Screening Tool II. A pretested structured questionnaire on sociodemographic characteristics and nutrition was used for collecting data about determinants of developmental delay. Results: We observed statistically significant differences in anthropometric measurements among SAM compared with normal nourished in weight, height, mid-upper arm circumference and weight-for-height z-scores. SAM serves as a significant risk factors (p<0.001) for delayed personal or social development (69% vs 11%; OR (95% CI)=18.01 (8.45 to 38.37)), delayed fine motor development (39% vs 8%; OR (95% CI)=7.35 (3.22 to 16.81)), delayed language development (32% vs 8%; OR (95% CI)=5.41 (2.35 to 12.48)), delayed gross motor development (34% vs 10%; OR (95% CI)=4.64 (2.14 to 10.05)) and delayed global development (66% vs 20%; OR (95% CI)=7.77 (4.09 to 14.74)). Applying logistic regression, personal or social development (p<0.001) and language development (p<0.05), under-five siblings was a risk factor, while among gross motor development, mother's educational status (p<0.05) was a significant risk factor for developmental delay. Conclusions Our analysis indicates that children with malnutrition have a high frequency of developmental delays. Missing maternal education and a higher number of under-five siblings are also potential risk factors for developmental delay

Maternal near miss, mortality and their correlates at tertiary care hospital

OBJECTIVE:  To determine the frequency and causes of maternal near miss and mortality among pregnant women. METHODS: This cross-sectional study was conducted Jan 2016 - Dec 2018. All near miss cases, admitted in Gynecology department of Services Hospital Lahore during the study period, were prospectively recruited. WHO criteria was used to identify maternal near miss cases. Primary outcome measures were frequency and causes of near miss and maternal mortality to near miss ratio. Secondary outcome measures were delays, need for massive blood transfusion, ICU admission, obstetric hysterectomy and hospital stay> 7 days. RESULTS: During the study period, there were 10,739 live births, 305 near miss cases and 29 maternal deaths. Frequency of near miss was 28.4/ 1000 live births and maternal mortality to near miss ratio was 1:10.5. There were 215(70.4%) unbooked patients and 23(79.3%) of them died (p<0.001). Hemorrhage accounted for 150 (49.18%), hypertensive disorders 102 (33.44%),cardiac disease 25 (8.28%) and infection for 12 (3.97%) near miss cases respectively. Maternal mortality was significantly low for hemorrhage, hypertension, sepsis and cardiac disease; 6 vs 150, 8 vs102, 3vs 12 and 10 vs 25 respectively (p<0.001). Massive blood transfusion was given to 20.98%patients, 15.74% underwent hysterectomy, 32.13% required ICU admission. First and second delay was seen in 78.6% of patients with 86.2% deaths (p<0.001) CONCLUSION: Hemorrhage and hypertension are major reasons for near miss but timely intervention can prevent mortality. Strengthening care at primary and secondary level can reduce the burden of maternal morbidity.  Continuous...

Effectiveness of Ready-to-Use Therapeutic Food in Improving the Developmental Potential and Weight of Children Aged under Five with Severe Acute Malnourishment in Pakistan: A Pretest-Posttest Study

The objective of this study was to assess whether the standard therapy of ready-to-use therapeutic food in the treatment of uncomplicated severe acute malnutrition (SAM) is effective in improving developmental potential and weight gain in children aged under five years. A multicenter pretest-posttest study was conducted among 91 children aged under five with uncomplicated SAM in Pakistan. Study participants completed their eight weeks’ therapy of ready-to-use therapeutic food according to the World Health Organization’s (WHO) standard guidelines. The study outcome was the proportion of children with improved developmental potential in all domains in comparison with the pretreatment status and children gaining &gt;15% of their baseline weight; mean weight-for-height/length z-score after completing eight weeks’ therapy of ready-to-use therapeutic food. The Denver Development Screening Tool II was used for developmental screening. Significant changes (p &lt; 0.05) were observed for developmental status milestones in terms of gross motor, fine motor, and personal/social milestones, as well as language and global development milestones. There was a strong positive correlation (r = 0.961) between initial weight and weight at the last visit (p &lt; 0.001). Ready-to-use therapeutic food is effective in improving development potential as well as promoting weight gain in children aged under five with uncomplicated SAM if provided according to WHO guidelines

Causal factors influencing quality of treatment and survival in Wilms Tumor: A retrospective investigation

Background: Wilms Tumor (WT) is a highly curable cancer if treatment is appropriate and timely. The outcomes and prognostic factors in a large low- and middle-income country (LMIC) tertiary center were assessed. Materials and methods: Retrospective review of data of all patients, 0–15 years diagnosed between 2010 and 2020 with WT. Kaplan Meier curves were used for survival analysis, and the chi-square test was used for multivariate analysis. Results: Of the 40 patients enrolled (median age: 38 months) in the cohort, 10 had metastatic disease. The most common site of metastasis was lungs (6/10). Nine (22.5%) abandoned treatment. Large tumor (>500 ml) volume was found in half the patients at diagnosis. The majority of patients were treated per the SIOP approach. Out of 34 who went for surgery, 31 received neoadjuvant chemotherapy with tumor shrinkage to less than 500 ml in 26/31 (80%). Maximum tumor shrinkage was observed in the SIOP low-risk group (p < 0.05). Accurate lymph node sampling (≥7) was performed in 7/34 (20%). The SIOP tumor stages were I (n = 14), II (n = 3), III (n = 6), IV (n = 9), and V (n = 5). One of the 31 treated patients vis-à-vis 8 of the patients who abandoned treatment died (p < 0.05). The overall survival and relapse-free survival of all 40 patients were 77.5% and 87.5%, respectively, with a median follow-up period of 25 months. Conclusion: A higher risk histology and abandonment were identified as adverse prognostic factors. The survival could potentially be improved by early referral and initiation of standardized treatment along with adequate lymph node sampling