IN-HOSPITAL MORTALITY AMONG PATIENTS OF LIVER CIRRHOSIS WITH VARICAL BLEED

Background; A major cause of cirrhosis-related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Each episode of active variceal bleeding is associated with 30 percent mortality. This study was planned to determine frequency of variceal bleeding in patients with liver cirrhosis and frequency of in-hospital mortality of these patients in our population. Objective; To determine the frequency of variceal bleed in hospitalized patients with cirrhosis of liver and its outcome in terms of in-hospital mortality. Material and Methods; Consecutive 139 Patient diagnosed with cirrhosis of liver were included in this cross-sectional study from department of Medicine, Bahawal Victoria hospital Bahawalpur. Complete history and physical examination was assessed to document duration of duration of liver disease, ascites, Hepatic encephalopathy, Previous GI bleed and systemic coagulopathy. All the patients had undergone diagnostic upper GI endoscopic examination to document varices. Results; Of these 139 study cases, 77 (55.4 %) were male and 62 (44.6 %) were female. Mean age of our study cases was 45.50 ± 10.81 years. Mean duration of disease (liver cirrhosis) was 3.25 ± 2.32 years. Majority of our study cases i.e. 94 (67.6%) were having liver cirrhosis for the duration of less than 5 years. Child-Pugh class C was more prevalent i.e. 77 (55.4%) of our study cases. Variceal bleeding was observed in 100 (71.9 %) of our study cases. Frequency of mortality was 35 (25.2%) in our study cases with liver cirrhosis, while frequency of mortality in patients with variceal bleeding was seen in 31 (31%). Conclusion; Very high frequency of variceal bleeding was observed in patients with liver cirrhosis. In-hospital mortality was significantly more prevalent in patients with variceal bleeding than without bleed. Variceal bleeding was significantly more seen in patients with increasing age, duration of disease and with more severe level of disease (Child Pugh class C). There was no statistically significant difference of bleeding with regards to gender. Keywords; Liver Cirrhosis, Variceal bleeding, Mortality.

ASSOCIATION OF UNSAFE ABORTIONS WITH COMPLICATONS

Background; Unsafe abortion is a persistent, preventable pandemic. WHO defines unsafe abortion as a procedure for terminating an unintended pregnancy either by individuals without the necessary skills or in an environment that does not conform to minimum medical standards, or both. This study was conducted in our local population of southern Punjab to ascertain magnitude of the problem in terms different maternal complications after unsafe abortions. Objective: To determine the frequency of complications of unsafe abortions at a tertiary care hospital. Material and Methods; All the study cases (n=169) who met inclusion criteria of my study were taken from Department of Gynecology and Obstetrics, Bahawal Victoria Hospital, Bahawalpur, Pakistan from June 2015 to June 2016 in this descriptive cross – sectional study . Once registered, these study case had undergone required investigations like blood tests (TLC count to determine sepsis and serum urea and creatinine levels to ascertain ARF). These blood tests were performed by a trained pathologist. These patients were also arranged for X – Ray chest (PA view) to diagnose perforation and complications such sepsis, hemorrhage, ARF and perforations were noted in the proforma by the researcher. Data was analyzed by using SPSS Version 20. Results; Mean age of our study cases was 29.39 ± 4.12 years (with minimum age of our study cases was 24 years while maximum age was 37 years) and majority of our study cases i.e. 93 (55 %) belonged to age group 20 – 30 years of age. Of these 169 study cases, 104 (61.5%) were from rural areas, 113 (66.9%) were poor, 141 (83.4%) were illiterate, 111 (65.7%) spouses were illiterate and most of them i.e. 112 (66.3%) belonged to joint family system. Mean body mass index of our study cases was 24.78 ± 3.24 kg/m2 and obesity was present in 27 (16 %) patients. Hemorrhage was noted in 94 (55.6%), sepsis in 74 (43.8%), acute renal failure in 39 (23.1%) and perforations in 19 (11.2%) of our study cases. Conclusion; Our study results indicate that unsafe abortion is a major cause of maternal morbidity with hemorrhage was commonest complication followed by septicemia, mostly because the procedure was performed by untrained health care providers under unhygienic conditions.  Majority of the patients had multiple complications. There is urgent need to improve quality of services offered by family planning programs and provision of safe abortion services to decrease significant morbidity among targeted population. This will improve their quality of life and also provide relief to health authorities in terms of more investments due to prolonged hospitalizations. Keywords; Unsafe abortion, hemorrhage, sepsis

Sudden Maternal Death from Suspected Amniotic Fluid Embolism and a Dead Baby Delivered with Natal Teeth

Amniotic fluid embolism (AFE) is a rare presentation in obstetric emergencies that carries great risk for the life of both mother and fetus. It is usually characterized by sudden cardiovascular collapse, respiratory distress and disseminated intravascular coagulation. Here we present a case of sudden death of a pregnant woman due to suspected AFE. We also present a rare finding of natal teeth in her deceased baby, which along with reported AFE in the mother, is an unlikely event in the medical literature

PSYCHOSOCIAL CORRELATES OF POST-TRAUMATIC STRESS DISORDER IN PATIENTS WITH FIRE BURNS

OBJECTIVE: to elucidate the psychosocial correlates of post-traumatic stress disorder (PTSD) in the burn victims of Pakistan. METHODOLOGY: A total of 200 burn victims were included in the sample. The standardized measures were used to assess the symptom levels of PTSD. The detailed demographic profile of the patients was also received for gleaning the demographics’ association with PTSD symptoms. The screening of PTSD symptoms for further clinical management had also been catered through this data collection strategy. For analysis SPSS Version 22.0 was employed. RESULT: Mean age of the respondents was 30.56+10.3 years. Most of the respondents were males (n=111, 55.5%), panjabi speaking (n=120; 60%), followers of Islam (n=146; 73%), lower socioeconomic class (n=93; 45.5%), illiterate (n=114; 57%), Unemployed/Housewife (n=155; 77.5%) and were married (n=143; 71.5%). Most of the respondents had high PTSD levels (n=169; 84.5%). Panjabi natives (n=105/120; 87.5%), married persons (n=120/143), urban background (n= 110/118; 93.2%), persons currently living with children (n=102/123; 82.9%), Unemployed/Housewife (n=140/155; 90.3%), illiterate (n=109/114; 95.6%), respondents who experienced domestic violence (n=150/151; 99.3%) and those experienced burn injuries less than one-year duration (n=140/151; 92.7%) had higher PTSD levels than their counterparts. Fifty-one (25.5 %) respondents had suicidal ideation. CONCLUSION: Being male, married, illiterate, urban background, having history of domestic abuse, unemployed/housewives, having lower education level and experienced burn injuries less than one-year duration are significant psychosocial correlates of PTSD in patients with fire burns

A PROSPECTIVE OBSERVATIONAL STUDY ON PREVALENCE AND TREATMENT OF URINARY TRACT INFECTIONS IN A TERTIARY CARE TEACHING HOSPITAL IN TELANGANA STATE

Objective: To study the Prevalence of urinary tract infections and related risk factors and to study the Management of urinary tract infections. Methods: This was a prospective observational study conducted in General Medicine Department, Osmania General Hospital (OGH), a tertiary care teaching hospital in Telangana State, where patients presenting or highly suspicious of having UTIs were included in the study. Pregnant women, Children, Patients who are not willing to participate were excluded from the study. Data was collected in predesigned Data collection forms. Results: Over a period of 6 Mo a total of 75 UTI cases were observed in General Medicine Department of OGH, which included 33 Males, and 42 Females. High prevalence of UTI were observed in Females in the middle age group i.e. 31-45 y, whereas in Males, in senior adult group i.e.,>60 y. The age group 18-30 y have shown the dominance of Uncomplicated UTIs(19%) and Primary UTIs (17%) and the age group>60 y have shown the dominance of Complicated UTIs (25%) and Recurrent UTIs(23%). The most common causative organism was found to be E. coli (69.3%). It was confirmed that the most common risk factor was found to be Diabetes Mellitus, followed by Hypertension and Chronic Kidney Disease. The most common antibiotic prescribed for UTI was Piperacillin+Tazobactum and for fungal UTIs, an antifungal drug i.e., Fluconazole was prescribed. Conclusion: E. coli are the major cause of UTIs among patients It is discovered that UTI is common among females. Hospitalisation, married individuals, Diabetes mellitus, genitourinary tract abnormalities, congestive cardiac failure, hypertension, prostatitis and female gender are the most important risk factors of UTIs. Appropriate measures may help to reduce UTIs due to these associated factors

A PROSPECTIVE OBSERVATIONAL STUDY ON EFFECTS OF HEPATOPROTECTIVE AGENTS IN ALCOHOLIC LIVER DISEASE AT A TERTIARY CARE HOSPITAL

Drug utilization evaluation of hepatoprotective drugs is important in view of the spectrum of effect and associated risks with their therapy. The study was designed to evaluate the effects and adverse effects of hepatoprotective agents. A prospective, observational study was carried out for a period of 6 months at Osmania General Hospital (a tertiary care hospital). 120 patients were evaluated receiving corticosteroids, pentoxifylline, ursodeoxycholic acid for observing a trend in hepatic parameters and its outcomes. Ursodeoxycholic acid (81.66%) was the most commonly prescribed drug in almost all cases of alcoholic liver diseases followed by pentoxifylline (10%) in hepatorenal syndrome and then prednisolone (8.33%) in fatty liver. 67 cases were reported to have the significant drop in liver transaminases and bilirubin levels. Ursodeoxycholic acid resulted in a drop of 25% serum bilirubin and 35% drop in serum ALT (alanine transaminase) and 33% drop in serum AST (aspartate transaminase) in patients in a time gap of 1 week. Among 120 cases 94 were males (78.05%) and 26 females (21.04%) and maximum patients with alcoholic liver disease belonged to age group of 30-40 years (27.6%). Ursodeoxycholic acid (300 mg once daily) is used as an off-label drug for all types of alcoholic liver disease and also for viral hepatitis. Though Ursodeoxycholic acid showed a significant drop in liver transaminases and serum bilirubin levels in cirrhotic patients a better alternative lie in liver transplantation as long as they remain abstinent from alcohol. Keywords: Alcoholic liver diseases, Hepatoprotective agents, Liver transaminases, Bilirubin, Paired t-test

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Analysis of meteorological variations on wheat yield and its estimation using remotely sensed data. A case study of selected districts of Punjab Province, Pakistan (2001-14)

Land management for crop production is an essential human activity that supports life on Earth. The main challenge to be faced by the agriculture sector in coming years is to feed the rapidly growing population while maintaining the key resources such as soil fertility, efficient land use, and water. Climate change is also a critical factor that impacts agricultural production. Among others, a major effect of climate change is the potential alterations in the growth cycle of crops which would likely lead to a decline in the agricultural output. Due to the increasing demand for proper agricultural management, this study explores the effects of meteorological variation on wheat yield in Chakwal and Faisalabad districts of Punjab, Pakistan and used normalised difference vegetation index (NDVI) as a predictor for yield estimates. For NDVI data (2001-14), the NDVI product of Moderate Resolution Imaging spectrometer (MODIS) 16-day composites data has been used. The crop area mapping has been realised by classifying the satellite data into different land use/land covers using iterative self-organising (ISO) data clustering. The land cover for the wheat crop was mapped using a crop calendar. The relation of crop yield with NDVI and the impact of meteorological parameters on wheat growth and its yield has been analysed at various development stages. A strong correlation of rainfall and temperature was found with NDVI data, which determined NDVI as a strong predictor of yield estimation. The wheat yield estimates were obtained by linearly regressing the reported crop yield against the time series of MODIS NDVI profiles. The wheat NDVI profiles have shown a parabolic pattern across the growing season, therefore parabolic least square fit (LSF) has been applied prior to linear regression. The coefficients of determination (R2) between the reported and estimated yield was found to be 0.88 and 0.73, respectively, for Chakwal and Faisalabad. This indicates that the method is capable of providing yield estimates with competitive accuracies prior to crop harvest, which can significantly aid the policy guidance and contributes to better and timely decisions

The Fiscal Insertions with External Debt, Poverty and Economic Presentation: The Nexus Study of Pakistan

Contemporary analysis aims to inspect the bearing of exterior debt and poverty on Pakistan’s economic progression by exhausting almanac time-series statistics from 1981 to 2020. To analyze the results ARDL model is used. The ARDL estimates found that the variables GFCF, and FDI are positively and ominously connected with the economic progress although the regress and regression external debt and poverty are negatively and significantly related with the economic progress in Pakistan. Grounded on the findings it is suggested that domestic sources of revenue should be increased by increasing the tax base while employment opportunities for the poor should also increase to eradicate the level of poverty in Pakistan

Celebrity-Persona and its Effects on Self-Esteem and Life Satisfaction

The study was conducted to examine Celebrity-Persona and its Effects on Self-Esteem and Life Satisfaction among university students. Convenience sampling technique was used to collect the data. The sample consisted of 416 individuals, who were investing more than 5 hours a day on fictional content like novels, movies, dramas, and professional stars (e.g., singers, athletes, actors); 239 male participants and 177 female participants. Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffin, 1985), Celebrity-Persona Parasocial Interaction Scale (CPPI) (Bocarnea & Brown, 2007) and Six-Item State Self Esteem Scale (Heartherton & Polivy, 1991) were used to measure life satisfaction and celebrity persona parasocial interaction and self-esteem respectively. Life satisfaction has significant positive correlation with celebrity persona parasocial interaction and self-esteem. Parasocial interaction has positive correlation with self-esteem. Excessive exposure to fiction content is negatively correlated with life satisfaction. Simple linear regression analysis showed excessive exposure to fiction content as a predictor of life satisfaction and self-esteem among university students. Celebrity persona parasocial interaction worked as a significant mediator in the relationship between excessive exposure to fiction content and satisfaction with life among university students. Independent sample t-test showed that male students have higher life satisfaction than female students