Efficacy of memantine on cognitive functions of patients with moderate vascular dementia

Introduction: Vascular dementia is a common condition for which there is no effective approved pharmacological treatment available. Absence of effective treatment creates a difficult situation for those suffering from the disease, their caregivers, and healthcare providers. The objective of this study is todetermine the Efficacy of Memantine on cognitive functions in patients with Moderate vascular dementia. Material and methods: This Case series study was carried out inthe Neurology Section of department of Medicine Ziauddin University and Hospitals North Nazimabad campus, Karachifrom 12th March 2010 to 11th March 2011.90 patients were included, who fulfilled the inclusion criteria after taking an informed consent. The SPSS version 11 was applied to the data. Results: There were 55 (59.1%) males and 38 (40.9%) females. Mean ± standard deviation age 69.7 ± 6.6 years, mean duration of symptoms was 1.76 ± 1.1 years. Baseline minimental examination score was 15.14 ± 3.1. Minimental score after 24 weeks of drug therapy was 17.14 ± 4.1. Efficiency was found in 62 (66.7%) patients. Conclusion: Memantine produced only a small benefit in cognition (of uncertain clinical significance) in patients with moderate vascular dementia. Data is insufficient to support widespread use of this drug in vascular dementia. Individual patient analysis is needed to identify subgroups of patients with vascular dementia who might benefit

Acute myeloid leukaemia in children: experience at a tertiary care facility of Pakistan

Objective: To document the demographics and outcome of children with Acute Myeloid Leukemia (AML) treated at a tertiary care facility of Pakistan. Methods: A retrospective study was conducted at Aga Khan University on children (less than 15 years) diagnosed to have AML between January 2000 to May 2007.Total 40 cases were diagnosed out of which 37 charts were available for review. Results: The average age of presentation was 8.5±4.5 years and 75% were males. The most common presenting feature was fever in 83% followed by bleeding in 41% and pallor in 39%. Initial WBC of \u3e 100,000 was seen in 19% of patients. The most common FAB subtype was M4 39%. Twenty three patients underwent treatment out of which 12 patients are alive and in remission. Majority were followed up around 2 years and 6 months. Out of the 11 patients who died three had resistant disease, four relapsed and rest died due to sepsis mostly during induction. Conclusions: The most common sub type in our study is AML M4 although AML M2 is reported as predominant subtype. About a third of the patients could not start or complete therapy due to financial constraints. The overall survival for our patients who completed therapy was 52%

Vaccination Guidelines for Children With Cancer and Hematopoietic Stem Cell Transplantation Living in Resource-Poor Countries

There is no consensus on the immunization guidelines for immunocompromised children. Some recommendations are, however, available for children living in developed countries. The spectrum of infectious diseases is different in resource-poor countries. Vaccinations against some of these infections are not a part of the immunization schedule for children living in developed countries. We have tried to include vaccinations against diseases, which are still prevalent and a major cause of morbidity and mortality in resource-poor countries. In these guidelines, the focus has been on the vaccine-preventable diseases prevalent in Pakistan but the same can be applied to other resource-poor countries. Pediatr Blood Cancer 2010;54:3-7

Frequency of Caesarean Delivery on maternal request in a private teaching hospital

Introduction: Caesarean section rates are increasing worldwide. There are many reasons for this increasing caesarean section rate one of them is increasing requests by women for caesarean section in the absence of medical indications. Most women think that elective caesarean section is safe both for women and babies. Some clinician also considered caesarean section safe. An increasing rate of caesarean section is alarming in developed as well as underdeveloped countries. Objective: To investigate the frequency of caesarean section on maternal request and factors leading to it in a private teaching hospital. Materials and Methods: This was a cross-sectional descriptive study carried out at Shalamar hospital from 1st May 2018 to 30th April 2019. Women of all ages who were pregnant and were going to have caesarean delivery during the study period at Shalamar hospital. Results: There were 3438 total births during the study period. There were 2380(69%) caesarean section and 1058(31%) were normal vaginal deliveries. Caesarean section rate was 69%. Caesarean sections performed on maternal request were 167(7%) out of 2380 caesarean. Out of these 167 Seventy-two, 43.1% of women were those who already have a previous caesarean section for different non-recurrent indications and now they don’t want the trial of labour and requested for caesarean section. Forty, 24% of women requested for a caesarean section because of fear of labour pains and eighteen, 10.8% were those who had a bad experience of the previous child-birth. Twelve, 7.2% of women had fear of failed vaginal delivery and eight women had fear of trauma to baby and three, 1.8% had fear of perineal trauma during the trial of normal vaginal delivery. Six, 3.6% of women had some social reasons for caesarean section and six, 3.6% had some bad experience of normal delivery of their relatives or friends and two, 1.2% were those who were requesting caesarean section because of their family members preferences. Conclusion: Most of the women requesting for caesarean section were those who had previously trial of labour. We can control the caesarean section rate by proper counselling of pregnant women

Molecular detection of blaOXA-23gene and blaOXA-51 gene in carbapenem resistant strains of Acinetobacterbaumannii in patients with ventilator associated pneumonia at tertiary care hospital

Objective: To evaluate carbapenem resistance and to detect blaOXA-23 and blaOXA-51 genes in carbapenem-resistant acinetobacter baumanii isolates recovered from patients having pneumonia secondry to ventilation. Methods: The cross-sectional study was conducted from July 2017 to June 2018 at the Department of Microbiology, University of Health Sciences, Lahore, Pakistan, and comprised endotracheal aspirates / tracheobroncheal lavage samples from patients irrespective of age and gender who developed pneumonia after being on the ventilator for 48 hrs at the Combined Military Hospital, and Jinnah Hospital, Lahore.  The samples were inoculated on MacConkey and blood agar and aerobically incubated at a temperature of 370C for 18-24 hours. The isolated organisms were further assessed by standard morphological, cultural and biochemical profile. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method. Carbapenem-resistant acinetobacter baumannii were checked for carbapenemase production using Modified Hodge Test. Conventional polymerase chain reaction and agarose gel electrophoreses were performed to detect blaOXA-23 and blaOXA-51 genes. Data was analysed using SPSS 17. Results: Out of 157 samples, 92(58.6%) yielded growth of bacteria, and, among them, 39(42.4%) were identified as acinetobacter baumannii. All (100%) acinetobacter baumannii cases showed resistance to carbapenem, were producing carbapenemase enzyme, and were positive for blaOXA-51 gene. The blaOXA-23 gene was amplified in 38(97.4%) isolates. Conclusion: BlaOXA-23 gene appeared to be the major cause of carbapenem resistance. Continuous..

Assessment of knowledge regarding tracheostomy care and management of early complications among healthcare professionals

Introduction: Tracheostomy is commonly performed surgical procedure in ENT practice. Postoperative care is the most important aspect for achieving good patient outcomes. Unavailability of standard guidelines on tracheostomy management and inadequate training can make this basic practice complex. The nursing staff and doctors play a very important role in bedside management, both in the ward and in the intensive care unit (ICU) setup. Therefore, it is crucial that all healthcare providers directly involved in providing postoperative care to such patients can do this efficiently.Objectives: The objective of this study is to assess the knowledge regarding identification and management of tracheostomy-related emergencies and early complications among healthcare professionals so as to improve practice and further standardization.Methods: Cross-sectional observational study included two hundred and fifty-four doctors and nurses from four large tertiary care hospitals. The questions used were simple and straightforward regarding tracheostomy suctioning, cuff care, cuff management, tube blockage, and feeding management in patients with tracheostomy.Results: Based on evidence from our study, knowledge level regarding tracheostomy care ranges from 48% to 52% with knowledge scores above 50% being considered satisfactory. Significant gaps in knowledge exist in various aspects of tracheostomy care and management among healthcare professionals.Conclusion: Our findings demonstrated an adequate knowledge level among health care professionals ranging from 48% to 52% with knowledge scores above 50% being considered satisfactory and revealed that gaps in knowledge still exist in various aspects of tracheostomy care and management

Successful Treatment of Acute Lymphoblastic Leukemia in a Child with Trisomy 21 and Complex Congenital Heart Disease with Mechanical Prosthetic Valve

A 10-year-old girl with trisomy 21 and complex congenital heart disease presented with acute lymphoblastic leukemia. Her chemotherapy required modifications due to poor baseline cardiac status and a mechanical prosthetic heart valve that was dependent on anticoagulation. We describe our management including the use of low-molecular-weight heparin as anticoagulation for a mechanical heart valve, the safe delivery of intrathecal chemotherapy included bridging with unfractionated heparin, and the use of fluoroscopic guidance to minimize the risk of bleeding. Adjustments were made to avoid anthracyclines. The child tolerated therapy well without complications and remains relapse free five years after diagnosis

An InN/InGaN Quantum Dot Electrochemical Biosensor for Clinical Diagnosis

Low-dimensional InN/InGaN quantum dots (QDs) are demonstrated for realizing highly sensitive and efficient potentiometric biosensors owing to their unique electronic properties. The InN QDs are biochemically functionalized. The fabricated biosensor exhibits high sensitivity of 97 mV/decade with fast output response within two seconds for the detection of cholesterol in the logarithmic concentration range of 1 x 10(-6) M to 1 x 10(-3) M. The selectivity and reusability of the biosensor are excellent and it shows negligible response to common interferents such as uric acid and ascorbic acid. We also compare the biosensing properties of the InN QDs with those of an InN thin film having the same surface properties, i.e., high density of surface donor states, but different morphology and electronic properties. The sensitivity of the InN QDs-based biosensor is twice that of the InN thin film-based biosensor, the EMF is three times larger, and the response time is five times shorter. A bare InGaN layer does not produce a stable response. Hence, the superior biosensing properties of the InN QDs are governed by their unique surface properties together with the zero-dimensional electronic properties. Altogether, the InN QDs-based biosensor reveals great potential for clinical diagnosis applications