A Clinical Study of Newborns with Tachypnea: Frequency, Aetiologies and their Outcome

Aims & Objectives: To estimate the frequency, aetiologies and outcome of neonates admitted with Tachypnea in Neonatal Intensive Care Unit (NICU) FGPC PGMI Islamabad.To identify the causes of Tachypnea in newborns, analyze outcome at present, and to plan better outcome in futureMaterials & Methods: A prospective study was conducted at Neonatal Intensive Care Unit of Federal Government Polyclinic Hospital PGMI from 1st June 2016 till 31st July 2017.Data were collected from all patients enrolled in the study during this period. Aim of our study is to identify the causes of Tachypnea in newborns, analyze outcome at present, and to plan better outcome in future.Results: Total 826 neonates were admitted, of which 248 were enrolled in the study. The frequency of tacyopnea was found to be 29.9%.The commonest causes of Tachypnea in our study were Respiratory distress syndrome 82 cases (33.1%), Transient Tachypnea of newborn 71 cases (28.6%) , Meconium Aspiration syndrome 31 cases (12.5%), Congenital heart disease 17 cases (6.8%).Cesearean section was the most common predisposing factor associated with development of  RDS & TTN( the two most common causes of respiratory distress in our study) 146 (58.9%) cases. The mortality rate of tacyopnea in our study was 103 cases (41.5%).Conclusion: Tachypnea is one of the most common problems encountered in neonatal ICUs of which RDS, TTN, MAS and CHD are the common ones. Prematurity, low birth weight neonates and neonates born via Cesearean section show a poorer outcome, needing advanced respiratory support and longer duration of hospital stay. Thus, timely decisions regarding the mode of delivery, prevention of preterm deliveries, and appropriate management of Tacyopnea may reduce neonatal mortality

QUANTITATIVE FUNDAMENTALS VALUE INVESTING AND SYSTEMATIC FACTOR INSULATION INNOVATIONS

Passive indexation through the use of Exchange Traded Funds (ETF) is a highly popular strategy world-wide which helps investment managers diversify their risk profiles and long the market for certain segments of their portfolio while maintaining little tracking error. We want to introduce the advantages of rules based investing which can be implemented and packaged as ETFs and provide managers with returns that are easier to explain, such as indexation, but offer greater return upside and control associated risks. Alternative investment strategies are often overlooked and we will show the advantages of rules based strategies in this paper. By combining Piotroski’s fundamental indicators defining ‘Quality’ and using screeners/rankers of relative valuation, we intend to define a strategy that provides excess return while maintaining similar risk. In addition, we aim to lower volatility through risk management techniques, which will insulate the strategy from systematic factors by shorting a calculated percentage of the market. Through this exercise we show the significant advantages to investing in alternative and ‘smart beta’ strategies compared to indexation in our sample period of 2002 to 2014

Effect of Addition of Nebulized Magnesium Sulphate to Standard Therapy in Children with Severe Asthma

  Objective: To compare the outcome of addition of nebulized magnesium sulphate to the standard treatment in children with acute severe asthma. Methodology: The trial was undertaken at the emergency of Paediatrics Department, Federal Government Polyclinic (Post Graduate Medical Institute), Islamabad from 1st April to 30th September 2019.Children between 1 to 12 years of age with acute severe asthma were initially nebulized with salbutamol thrice and ipratropium once.All the patients were also given intravenous steroid.Those not responding to this treatment and still classified as acute severe asthma were randomly divided into two groups each having 38 patients.Each patient in Group A received 2.5 ml (150 mg) of isotonic magnesium sulphate via nebulizer, thrice20 minutes apart, while group B received 2.5 ml of isotonic saline via nebulizer, thrice20 minutes apart.Each nebulization also contained salbutamol. Yung Asthma Severity Score (ASS) was determined at the start of treatment, at30 minutes and at 60 minutes of treatment. Results: After 60 minutes, the mean Asthma Severity Score of children in group A was 6.95 ± 1.29 and 7.63 ± 1.03 in group B (p < 0.05). In group A, 18 (47.4%) children were discharged and 20 (52.6%) were admitted in the hospital. In group B, 7 (18.4%) children were discharged while 31 (81.6%) were admitted in the hospital (p < 0.05). Conclusion: It is concluded that nebulized magnesium sulphate along with salbutamol can give a better outcome than salbutamol alone in children with acute severe asthma

Takayasu’s Disease: A Rear Case of Occlusive Vascular Disorder of Brain

Takayasu’s Disease is a type of inflammatory disease which involve the vessels at different levels. This disease is important for remission and relapse. It usually affects the younger age group resulting in morbidity of the most valuable group of society. Its symptoms are non specific but it may present with the involvement of different organs of the body like heart, renal impairment, fibrosis of retroperitoneal area. Diagnostic tool is Ultrasonography but definitive diagnosis is achieved with the help of CT angiography at the level of aortic arch, neck and brain. Treatment includes both medical and surgical options. Most of the time relapse occurred but with various treatment we can prolong the remission span and improve the quality of life of the patient

Blended Learning, Learning Motivation, and Academic Performance in Undergraduate Science Students

Amid the Covid-19 pandemic blended learning (BL) has seen an exponential rise across the globe. Data on the effectiveness of BL have mostly come from developed Western countries which are essentially different from developing countries like Pakistan. This study aims to indigenously explore the relationship between students’ views regarding blended learning (BL) and its effect on their academic achievement, possibly mediated by their learning motivation, in undergraduate science students of Pakistan. The participants included 239 (46.4%) male and 276 (53.4%) female students, aged 19 through 24 (Mage = 20, SD = 3.42), taken from GC University, Lahore, and Punjab University, Lahore.  All the participants reported having a rich experience of BL during the Covid-19 pandemic. Learners’ Views on Blended Learning (BL), and Motivated Strategies for Learning Questionnaire (MLSQ) were used to take data from the participants, and their GPAs were taken as their academic achievement. The results indicated that positive views of students’ regarding BL are likely to enhance their learning motivation, whereas BL and learning motivation are likely to enhance their academic achievement. Further, learning motivation is also likely to mediate the relationship between BL and academic achievement. The results are consistent with most studies conducted in the West and support the generalizability and implementation of the Western BL models in the socio-cultural context of Pakistan. However, there is a need for further in-depth Indigenous studies on other aspects of BL before policy making and implementation.

Rural-Urban Income Inequality under Financial Development and Trade Openness in Pakistan: The Econometric Evidence

Pakistan is a developing economy, which has adopted Structural Adjustment Programme (SAP) in the form of economic reforms initiated in early 1990s. Economic reforms related to privatisation of state-owned assets, deregulation, confiscation of price controls, trade liberalisation generally and financial reforms (especially to improve quality of financial institutions) particularly. The objective of such reforms was to improve the welfare of society but these reforms never fruited to every livelihood in the country. Perhaps, fruits of economic reforms are eaten up by poor governance, lack of transparency in economic policies, high level of corruption, high burden of internal and external debts and interest rate payments on these debts, weak situation of law and order, and improper implementation of economic policies

Occurrence of possible drug related interactions in medical patients in out-patient departments of Pakistan

Background: Data regarding occurrence of drug-drug interactions in Pakistan is rare. In the current study, we have tried to find out the clinical adversity and frequency witnessed in prescriptions of a medical outpatient department.Methods: Patient prescriptions were analyzed for potential drug-drug interactions.  A sample of 364 patients, visited outpatient department who were being prescribed at least two drugs simultaneously using a drug interaction program website.Results: The 364 patients (72.8% male, mean age 57.9±15.2 years) were prescribed a median of six drugs (range 2-13) at OPD visit. Three hundred forty nine patients (95.8%) had at least one potentially interacting drug combination. 2636 potential interactions were seen in the visiting patients. Out of these 124 (4.7%) were of major severity, 1730 (65.6%) moderate and 515 (19.5%). Out of 124 patients with a potential DDI with major severity, no patient was re-hospitalized within 2 months after discharge due to a probable drug-related problem associated with the potential DDI.Conclusions: A large percentage of patients were detected having one or more potential drug-drug interactions, using drug interaction detection program. However, the percentage of patients having clinically adverse consequences due to drug-drug interactions appears to be very low

Effect of Addition of Probiotics to Standard Treatment on Neonatal Jaundice

Objective: To compare the mean change in the bilirubin levels with addition of probiotics to standard treatment for the management of neonatal jaundice. Methodology: The randomized controlled trial was undertaken at the Neonatal Intensive Care Unit of the Paediatrics Department, Federal Government Polyclinic (Post Graduate Medical Institute), Islamabad from 1st April to 30th September 2019.  Neonates with hyperbilirubinemia requiring phototherapy were randomly divided into two groups, each having 30 patients. Group A received probiotics along with phototherapy while group B received phototherapy alone. Primary outcome was serum total bilirubin, which was calculated on 0, 1 and 3 days of treatment. Duration of phototherapy and patient's outcome was also recorded. Data was analyzed statistically using SPSS v. 23. Results: The mean serum bilirubin level after 24 hours was 14.27 ± 4.35 mg/dl in combination group while 16.43 ± 4.36 mg/dl in phototherapy group (p > 0.05). After 48 hours, the mean serum bilirubin level was 12.37 ± 3.33 mg/dl in combination group while 14.09 ± 3.60 mg/dl in phototherapy group (p > 0.05). After 72 hours, the mean serum bilirubin level was 11.09 ± 2.87 mg/dl in combination group while 11.72 ± 2.96 mg/dl in phototherapy group (p > 0.05). The mean time required of blue light phototherapy was 43.47 ± 20.71 hours in combination group while 61.53 ±28.27 hours in phototherapy group (p < 0.05). All neonates were discharged. Conclusion: Addition of probiotics to standard treatment decreased the time required for the phototherapy in neonatal jaundice. However no statistically significant difference was seen in the bilirubin levels between the two groups