Preoperative work up: are the requirements different in a developing country?

In developing countries there is a tendency to advocate routine testing in asymptomatic healthy patients to identify undocumented significant medical conditions. A retrospective review of pre- operative laboratory investigations undertaken in patients attending the General Surgical department was performed. Three hundred and twenty patients case notes were reviewed, patients were selected on the basis of common general surgical procedures. Two hundred and sixteen patients (67.5%) did not have any associated medical illness on history and physical examination. Analysis of laboratory results showed that 42/216 (19.4%) had low hemoglobin. An abnormal chest X-ray was the next common abnormality 11/103 (10.6%). Mild hypokalemia (\u3e 3 mEq/L) was seen in 6/123 (4.8%) and a raised blood sugar level was seen in 1/113 (0.88%) patients. Only one patient with hemoglobin of 4.8 gm/dL needed preoperative intervention, the rest of the abnormalities did not effect the treatment plan or outcome. The results were in general agreement with other studies except for the high proportion of low hemoglobin seen in the female population. It is suggested that a thorough history and physical examination is a reliable and inexpensive preoperative screening tool. Guidelines for pre-operative investigations in American Society of Anesthesiologists Grade I (ASA I) patients are suggested

Lafora Disease Masquerading as Hepatic Dysfunction

Lafora disease is fatal intractable progressive myoclonic epilepsy. It is frequently characterized by epileptic seizures, difficulty walking, muscle spasms, and dementia in late childhood or adolescence. We chronicle here an unusual case of an asymptomatic young male soccer player who presented with elevated liver enzymes. Neurological examination was unremarkable. The diagnostic workup for hepatitis, infectious etiologies, autoimmune disorders, hemochromatosis, Wilson\u27s disease, alpha-1 antitrypsin deficiency, and other related diseases was inconclusive. He subsequently underwent an uneventful percutaneous liver biopsy. Based on the pathognomonic histopathological findings, Lafora disease was considered the likely etiology. The present study is a unique illustration of this rare disorder initially manifesting with abnormal liver enzymes. It underscores the importance of clinical suspicion of Lafora disease in cases with unexplained hepatic dysfunction. Prompt liver biopsy and genetic testing should be performed to antedate the onset of symptoms in these patients

Estimating Output Gap for Pakistan Economy:Structural and Statistical Approaches

The objective of this study is to estimate potential output vis-à-vis output gap for Pakistan’s economy. This paper reviews six commonly used techniques to estimate potential output and from that the output gap. The results suggest that while measures of output gap are not identical they nonetheless do show some degree of association among each other. Therefore, a composite output gap is calculated for 1950 to 2007. The composite output gap depicts that Pakistan economy has been observing a cyclical episode of periods of excess supply followed by excess demand in the period of analysis. Furthermore, evidence suggests that Pakistan economy is currently experiencing rising demand pressures since FY05. These demand pressures show a high degree of correlation with the rising inflation as shown in the temporal correlation between inflation and composite of output gap measures

Assessment of ethnopharmacological potential of Cyperus difformis L. in terms of its’ phytochemistry, antibacterial, antioxidant and anticancer attributes

The present research was carried out on Cyperus difformis L., commonly found sedge weed in rice field to evaluate its’ ethnopharmacological potential in terms of phytochemical constituents, antibacterial, antioxidant and anticancer activities. FTIR spectroscopy of powdered material of plant parts, rhizome (with roots), leaves and flowers showed the presence of three main chemical groups, i.e. -OH (alcohol), -C=O (carbonyl) and -CO-O-CO (anhydride). The phytochemical composition of n-Hexane, chloroform and ethanol crude extracts of same parts analysed by GC-MS and n-Hexane extract of various parts indicated 14 compounds with highest (10) in flowers extract followed by six compounds in chloroform and five in ethanol extracts of plant parts. The antibacterial activity was assessed against Salmonella enterica, E. coli and Staphylococcus aureus by using well diffusion method and similar resistance was shown by n-Hexane and ethanol extracts while noticeable inhibition by chloroform extract, especially by leaves showing zone of inhibition, 16.17±0.52mm, comparable with Gentamycin 18±0.11mm. The antioxidant activity in terms of DPPH Scavenging activity was found higher in n-Hexane and chloroform extracts, especially leaves i.e., 54.6±0.43 & 43.45±0.53 as compared to that of ethanol extracts. The percentage activity was increased with an increase of concentration of extracts. Antiproliferative activity checked by SRB proliferative assay and the crude extracts of plant parts of C. difformis showed good activity against A2780 and HCT116 cancer cells in three days. C. difformis having therapeutic action as well as its’ ethnopharmacological history, being used as fodder, it may be recommended good herbal fodder for the dairy animals

Effect of Lubricant on Wear Debris Color Diagnosis

Color feature of debris is quite often used for source diagnosis in machine component while performing wear debris analysis (WDA). This feature is commonly observed and analyzed with different offline debris imaging setups. In these setups, its attributes remain consistent in their values as just a colorless medium i.e. air is in between the imaging setup and the observed debris. But in the case of an online debris analysis, the measurements of these attributes can be affected as the imaging has to perform in the presence of a machine lubricant. The lubricant color can affect the measurement of debris original color attributes and further can cause a wrong source diagnosis. In this paper, the effects of lubricant color on debris color measurements are discussed. A debris imaging setup is used for experimentation. Micro size steel debris are analyzed with three different lubricants. The debris color measurements are initially performed in an offline mode when the debris are placed on a glass slide. Later the mentioned measurements are taken in the presence of lubricants when the debris are flowing with the lubricant medium via a flow cell. Finally a comparison is made which concludes that the darker the lubricant the lesser will be chances to deduce the material (color and attributes). Whereas brighter lubricants do not hinder the analysis and identification of material and hence are considered suitable for qualitative wear debris analysis

Childhood tuberculosis deskguide and monitoring: An intervention to improve case management in Pakistan

Background: Childhood tuberculosis (TB) has been a neglected area in national TB control programme (NTCP) in high burden countries. The NTP Pakistan adapted the global approaches by developing and piloting its policy guideline on childhood TB in ten districts of the country. We developed an intervention package including a deskguide and a monitoring tool and tested with the ongoing childhood TB care in a district. The objective of our study was to measure effectiveness of intervention package with deskguide and monitoring tool by comparing TB case finding and treatment outcomes among districts in 2008, and performance assessment in intervention district. Method: An intervention study with cohort design within a routine TB control programme comparing case findings and treatment outcomes before and after the intervention, and in districts with and without intervention. We enrolled all children below 15 years registered at all nine public sector hospitals in three districts of Pakistan. The data was collected from hospital TB records. Results: In eight months during 2007 there were 164 childhood TB cases notified, and after intervention in 2008 a total of 194 cases were notified. In intervention district case finding doubled (110% increase) and correct treatment practice significantly increased in eight months. Successful outcomes were significantly higher in intervention district (37,100%) compared to control district A (18, 18%, p < 0.05) and control district B (41, 72%, p < 0.05). Conclusion: Childhood TB deskguide and structured monitoring was associated with improved case management and it augmented NTP policy. More development and implementation in all health services of the district are indicated.publishedVersio

Third-Party Verification Immunization Coverage Survey (TPVICS) - 2021

• Background• Survey Design and Methodology• Implementation of Survey• Survey Results• Referenceshttps://ecommons.aku.edu/pakistan_coe-wch_survey_report/1000/thumbnail.jp

The inclusion of diagnostics in national health insurance schemes in Cambodia, India, Indonesia, Nepal, Pakistan, Philippines and Viet Nam

The Lancet Commission on Diagnostics highlighted a huge gap in access to diagnostic testing even for basic tests, particularly at the primary care level, and emphasised the need for countries to include diagnostics as part of their universal health coverage benefits packages. Despite the poor state of diagnostic-related services in low-income and middle-income countries (LMICs), little is known about the extent to which diagnostics are included in the health benefit packages. We conducted an analysis of seven Asian LMICs - Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, Viet Nam - to understand this issue. We conducted a targeted review of relevant literature and applied a health financing framework to analyse the benefit packages available in each government-sponsored scheme. We found considerable heterogeneity in country approaches to diagnostics. Of the seven countries, only India has developed a national essential diagnostics list. No country presented a clear policy rationale on the inclusion of diagnostics in their scheme and the level of detail on the specific diagnostics which are covered under the schemes was also generally lacking. Government-sponsored insurance expansion in the eligible populations has reduced the out-of-pocket health payment burden in many of the countries but overall, there is a lack of access, availability and affordability for diagnostic-related services

Are children with tuberculosis in Pakistan managed according to National programme policy guidelines? A study from 3 districts in Punjab

<p>Abstract</p> <p>Background</p> <p>The adherence to policies of National TB Control Programme (NTP) to manage a case of tuberculosis (TB) is a fundamental step to have a successful programme in any country. Childhood TB services faces an unmet challenge of case management due to difficulty with diagnosis and relatively new policies. For control of childhood TB in Pakistan, NTP developed and piloted its guidelines in 2006-2007. The objective of this study was to compare the documented case management practices of pediatricians and its impact on the outcome before and after introducing NTP policy guidelines.</p> <p>Findings</p> <p>An audit of case management practices of a historical cohort study was done in children below 15 years who were put on anti-tuberculosis treatment at all nine public hospitals in three districts in province of Punjab. The study period was two years pre-intervention (2004-05) and two years post-intervention (2006-07) after implementation of new NTP policy guidelines for childhood TB. There were 920 childhood TB cases registered during four years, 189 in pre-intervention period and 731 in post-intervention period. The practices changed significantly in post-intervention period for use of tuberculin skin test (63% of pulmonary cases, 19% of extrapulmonary cases and 67% for site unknown), and for the use of chest x-ray (69% of pulmonary cases, 16% of extrapulmonary cases and 74% for site unknown). Diagnostic scores were recorded for only a minority of cases (18%). The proportion of correct drugs pre- and post-intervention remained same. There were unknown treatment outcomes in 38 out of 141 cases (27%) in pre-intervention and in 483 out of 551 cases (87%) post-intervention, all among the 692 cases without documented treatment supporter.</p> <p>Conclusions</p> <p>The study has shown that pediatricians have started following parts of the national policy guidelines for management of childhood TB. The documented use of diagnostic tools is increased but record keeping of case management practices remained inadequate. This seems to increase case finding substantially but the treatment outcomes were poor mainly due to unknown outcomes. Development and implementation of standardized operational tools and regular monitoring system may improve the services.</p