Risk Factors and Outcome of Neonatal Thrombocytopenia

Introduction: About 30% of neonates develop thrombocytopenia during hospital admission. Inevitable and irreversible complications can be prevented by determining the risk factors of neonatal thrombocytopenia. The present study was undertaken to determine the risk factors and outcome of neonatal thrombocytopenia in neonates admitted to Neonatal Intensive Care Unit Benazir Bhutto Hospital Rawalpindi. Materials and Methods: A prospective study was conducted to evaluate the risk factors for neonatal thrombocytopenia (NT) in 160 neonates. Neonatal and maternal risk factors were recorded and neonates were categorized into three groups based on the severity of thrombocytopenia. Results: A higher percentage of the neonates 89 (55.6%) were male. The majority (61.9%) had moderate neonatal thrombocytopenia while 21.9% had severe neonatal thrombocytopenia. A highly significant difference was observed for the distribution of gestational age, platelet count, birth weight, and age at admission (for all p-value ≥0.0001) among different groups. Multivariate logistic regression revealed a significant independent association of prematurity, birth asphyxia, and low birth weight with neonatal thrombocytopenia. Conclusion: Prematurity, low birth weight, and birth asphyxia were the significant causes of Neonatal thrombocytopenia. The mortality rate increased significantly with the severity of thrombocytopenia

Why do patients with limb ischaemia present late to a vascular surgeon? A prospective cohort study from the developing world

OBJECTIVE: To look into the factors responsible for delay in presentation of Iimb ischemia patients to a vascular surgeon. METHODS: The prospective cohort study was conducted at the Aga Khan University Hospital, Karachi, from October 01, 2016, to August 10, 2018. Patients coming with delayed presentation of both acute and chronic limb ischemia were included. All the patients were assessed by qualified vascular surgeons. SPSS 23 was used for data analysis. RESULTS: Of the 55 patients, 33(60%) had acute and 22(40%) had chronic limb ischaemia. Mean age of acute cases was 44±23.72 years and it was 60±12.49 years for chronic cases. Overall, the commonest reason behind delay was non-referral by primary physician which was the case with 11(33.3%) patients in the acute group, and 13(59%) in the chronic group. The limb loss in the acute group was 20(60%) and 8(36%) in the chronic group.. CONCLUSION: Delayed presentation of patients with limb ischaemia is mainly due to non-referral. A robust campaign needs to be launched to reduce the rate of limb loss

Massive primary postpartum haemorrhage: Setting up standards of care

Objective: To review practice of massive primary postpartum haemorrhage management and develop a protocol.Methods: Cross-sectional study conducted at the Department of Obstetrics and Gynaecology at Aga Khan University Hospital, Karachi between January 1, 2003 and July 31, 2004. Women with primary postpartum haemorrhage and had blood loss \u3e1000ml were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum haemorrhage, supportive, medical and surgical interventions. Results: Approximately 3% (140/4881) of women had primary postpartum haemorrhage. \u27Near miss\u27 cases with blood loss \u3e1500ml was encountered in 14.37% (20/140) of these cases. Fifty-six percent (18/32) of the women who had massive postpartum haemorrhage delivered vaginally. Uterine-atony was found to be the most common cause, while care in High Dependency Unit (HDU) was required in 87.5% (28/32) of women. In very few cases balloon tamponade (2-cases) and compression sutures (2-cases) were used. Hysterectomy was performed in 4-cases and all of them encountered complications. Blood transfusions were required in 56% of women who had massive postpartum haemorrhage. Conclusion: This study highlights the existence variable practices for the management of postpartum haemorrhage. Interventions to evaluate and control bleeding were relatively aggressive; newer and less invasive options were underutilized. Introduction of an evidence-based management model can potentially reduce the practice variability and improve the quality of car

Review of morphological, optical and structural characteristics of TiO2 thin film prepared by sol gel spin-coating technique

Optical, structural and morphological properties of titanium dioxide (TiO2) deposited by spin coating method have been reviewed in the current work. Sol–gel spin coating is a cost effective and versatile technique due to intellectual properties like simple instruments, easy preparation technique, and less time consuming. In this method, compound in the form of metal oxides is liquefied in a specific liquid in order to bring it back as a solid in a skillful manner. Study of metal oxide thin films have valuable applications in numerous semiconductor devices such as optoelectronics devices and solar energy converters etc. X-ray diffraction (XRD) analysis has been used for studying TiO2 thin films and scanning electron microscopy (SEM) analysis has been applied for morphological investigation and to prove the nanosized structure. Optical and structural properties have been studied as a function of the annealing temperatures. XRD analysis reveals that the films crystallize in orthorhombic brookite phase. Moreover, UV-visible has been used to investigate the optical properties of material. XRD characterization indicates that crystalline structure of TiO2 thin films improves with increasing annealing temperatures which confirms the anatase form of TiO2 thin film. Optical band gap is significantly dependent on the annealing temperatures. The refractive index may increases with increase of crystallite size. The TiO2 film annealed at 400 °C shows high refractive index 2.52 at a wavelength of 335 nm. Moreover, optical band gapes of thin film vary approximately from 3.3 to 3.46 eV which show strong relation with annealing temperature

Changing face of trauma and surgical training in a developing country: A literature review

Trauma continues to be the major cause of disability and death globally and surgeons are often involved in immediate care. However there has been an exponential decrease in the number of the trained trauma surgeons. The purpose of the current review article is to summarize the published literature pertaining to trauma education in postgraduate surgical training programmes internationally and in a developing country as Pakistan. Several electronic databases like MEDLINE, PubMed, Google scholar and PakMediNet were searched using the keywords \u27trauma education\u27 or \u27trauma training\u27 AND \u27postgraduate medical education\u27, \u27surgery residency training\u27, \u27surgery residents\u27 and \u27surgeons\u27. The current training in most surgical residency programmes, locally and globally, is suboptimal. Change in trauma management protocols, and decrease in volume of trauma cases results in variable and/ or inadequate exposure and hands-on experience of the surgical trainees in operative and non-operative management of trauma. This warrants collaborative measures for integration of innovative educational interventions at all levels of the surgical educational programmes