Comparison of Local Infiltration of Bupivacaine and Tramadol in Post- Operative Pain Management in Children after Inguinal Herniotomy

Introduction: Adequate pain control is essential in immediate postoperativeperiod. Different methods are being used to provide pain management but none of these is completely effective. Regional blocks are becoming more popular then systemic opioids in all age groups due to efficacy and safety of agents used. The objective of this study was to establish the effectiveness of tramadol and bupivacaine for pain control after inguinal herniotomy in children.Materials and Methods: This randomized controlled trial was conducted at pediatric surgery department, services hospital Lahore over 2 years. Two hundred and eighty four cases randomly divided into two groups B (Bupivacaine) & T (Tramadol). Bupivacaine (dose of 2 mg/kg) in group B or Tramadol (2mg/kg) in group T was infiltrated in the wound. Postoperatively pain score was measured using Wong-Baker Faces pain scale (WBFPS) at 0,1,2,4 and 8 hours. Both groups experienced side effects.Results: Age and gender distribution in both groups were comparable. Pain score in both Groups was equal at 0- hours. However at 1-hour, 2-hour and 4-hour, pain score was slightly more in Group-B, But at 8-hours mean pain score was markedly raised in Group-B as compared to Group-T (3.32 ± 1.42 vs 2.45 ± 1.35). Only complication noted in patients was vomiting which was higher in Group T.Conclusion: Locally infiltrated Tramadol is a better choice than bupivacaine as a local anesthetic for pain management in children after inguinal herniotomy. Further research is needed to elucidate any benefits it may have in other surgeries

Assessment of Environment of Pediatric Surgery Residents of Pakistan using PHEEM

Introduction: Different countries have their own residency programs in order to train new residents in the field of medicine. Some of these programs are very efficient while some have room to improve, especially in developing countries. These residency programs can play an important role in producing great consultants in the future. So it is very important to evaluate the residency program of a country so as to make sure their residents receive quality training.Materials and Methods: A cross-sectional survey was conducted in Pakistan using PHEEM questionnaire; for assessment of educational environment of pediatric surgery post graduate residents (PGR’s) of Pakistan. A questionnaire was sent to all 95 pediatric surgery residents via E-mail in February 2017 and SPSS 20 was used to analyze data.Results: The response rate from pediatric surgery PGR’s was 48.4% (n= 45).The mean age of participants was 29.69 ± 2.71 years. Most of the participants were male (76%) and in 5th year of residency (39.13%). The high scored items (mean >2.5) were only 3: question 9, 17 and 26. The mean PHEEM total score was found to be 63.06 ± 16.77. When categorized into global scales, most of the residents (84.4%) labeled educational environment into level 2. Mean PHEEM score was found significantly higher among female and those residing in province ‘Sindh’.Conclusion: We conclude that although educational environment depends upon and varies with many factors; overall it is not reported to be satisfactory by pediatric surgery PGR’s across our country. Authorities urgently need to look into the matter and take serious actions in order to improve the quality of our future consultants

Molecular study of Apolipoprotein E gene in familial hypercholesterolemic families

AbstractBackground: Familial hypercholesterolemia (FH) is understood to be one in all the foremost common hereditary disease and critically associated with Coronary heart condition worldwide. FH is taken into account to be caused because of mutations and polymorphisms within the apolipoprotein E (Apo E) cistron. Exaggerated level of density compound protein LDL-C is that the hallmark of this malady.Methodology: Seven hypercholesterolemic families were chosen for this study. Case history was taken and pedigree was created in person by visiting every family. Exon3 and exon4 regions of ApoE cistron were amplified using polymerase chain reaction (PCR).After successful amplification, both citrons were sequenced. Single strand conformation polymorphism (SSCP) results were obtained to support the different pattern of single strand polymorphism of studied samples.Results: The sequencing results of probands from all the seven families showed that six out of seven have Apo E three isoform whereas one family showed change within the sequence from T to C at 112 sequence position of processed macromolecule resulted in amino acid that represents it as Apo E4 isoform.Conclusion: Our findings show that Apo E3 is more prevalent than Apo E4 and other isoforms in studied population of Pakistan

Early Outcome of Ventriculoperitoneal (VP) Shunt in Terms of Improvement and Complications

Objective:  To analyze the outcome of ventriculoperitoneal (VP) shunts in terms of improvement and complications. Material and Methods:  This retrospective observational study is done in MTI Mardan medical complex and Prime teaching hospital from September 2017 to March 2020. The hospital record of all patients who underwent ventriculoperitoneal shunts was reviewed for improvement and complications. Patients undergoing ventriculoperitoneal shunt for normal pressure hydrocephalus were excluded from this study. Revision of ventriculoperitoneal shunt was the primary endpoint of the study. Results:  A total of 167 patients were operated on for ventriculoperitoneal shunts with males 106 (63.47%) and females 61 (36.52%). Age ranged from 1 month to 75 years with a mean of 14 years. The most common indication for surgery was congenital hydrocephalus in 102 patients (61.1%) while brain tumors caused hydrocephalus in 25 (15%) patients. Common presenting symptoms were the increase in head size in 75 (44.9%), and headaches in 84 (50.2%) patients. Symptomatic (headache, vomiting, and increase in OFC) improvement occurred in 145 patients (86.82%). Shunt revision was needed in 50.29% (84 patients) in one year. Conclusion:  VP shunt is a life-saving procedure and is an effective treatment of hydrocephalus but is not risk-free. Almost half of the shunted patients will need revision surgery in one year period. Keywords:  Hydrocephalus, Ventriculoperitoneal Shunt, Occipitofrontal Circumference (OFC)

Predictors of obesity among post graduate trainee doctors working in a tertiary care hospital of public sector in Karachi, Pakistan

Objectives: To identify the predictors of obesity among post graduate trainee doctors working in a tertiary care hospital of public sector at Karachi, Pakistan.Methods: A cross sectional analytical study was conducted at one of the tertiary care hospitals of public sector in Karachi. Information was collected from 117 post graduate trainee doctors via pre-tested self administered questionnaire and standard tools were used for height and weight measurement. Obesity was defined as body mass index (BMI) \u3e or =23 by using South Asian cut-off points. SPSS version 16 was used for data analysis, and logistic regression technique was applied to come up with predictors of obesity.Results: Frequency of overweight and obesity among doctors was 31.6% and 28.2% respectively. Nearly, 18% were using tobacco and family history of obesity was present in 44%. Approximately 64% doctors were taking lunch outside home, 76% were taking tea at least once a day, 59% were taking snacks between meals and 50% were physically inactive. Predictors of obesity among doctors include; taking lunch outside home OR = 7.11 (2.28-22.09), snacks between meals OR = 5.36 (1.51-19.03), tea OR = 7.85 (1.63-37.63), physical activity OR = 0.18 (0.05-0.57), increase duration of training OR = 1.7 (1.15-2.49), family history of obesity OR = 3.35 (1.11-10.08) and male gender OR = 3.83 (1.07-13.72).Conclusion: Frequency of overweight and obesity was high among post graduate trainee doctors. Taking lunch outside home, snacks and tea intake between meals, increase duration of training, family history of obesity, male gender and lack of physical activity were found to be predictors of obesity among doctors

Assessment of Mortality and Causes after Re-bleed In Patients Having Endoscopy for Upper Gastrointestinal Bleeding

Introduction: Acute Upper gastrointestinal bleeding (AUGIB), with prevalence of 36 to 172/100,000 natives per year, is a common medical emergency. Mortality rate after UGIB ranges from 4–14% while re-bleeding is evident in 10–30% of these patients. Despite advances in treatment modalities of UGIB, the in-hospital mortality rate remains high and it is commonly due to re-bleeding. However, the causes and frequency of mortality among patients with re-bleeding are not well known in Pakistan. Objective: To determine the frequency and causes of in-hospital mortality after re-bleeding among patients undergoing endoscopy for upper gastrointestinal bleeding. Methodology:  A descriptive cross-sectional study was done in Military hospital Rawalpindi from December 2014 to June 2015. A total 150 patients aged between 18 to 65 years who presented with upper gastrointestinal bleeding (UGIB) and underwent upper GI endoscopy and re-bleed were included through purposive sampling. Structured questionnaire used to record data. The patients were observed for mortality and causes after re-bleeding in the hospital for about 5 days. Patients who died, the cause of the death was assessed by 2 senior consultant physicians. SPSS version 21 was used for data entry and analysis. Variables like mortality were presented as percentage and frequencies. Effect modifiers like age and gender were controlled by stratification. Results:  The mean age of patients (n=150) was 43.97±12.28 years. Among total cases, 97 (64.7%) were males and 53 (35.7%) were females. The in-hospital mortality rate was 20% (n=30), re-bleed was cause in 12 (40%) while in 18 (60%) cause was other than re-bleed (cardiac, multi-organ failure, neurological, pulmonary, and advanced malignancy). Mortality in male patients was higher (n=18, 60.0%) as compared to female patients (n=12, 40.0%). The highest mortality (n=22, 73.3%) was observed in age group ˃43 years. The association of in-hospital mortality was statistically significant (p value = 0.02) by age but not by gender. Conclusion: In-hospital mortality after UGIB is 20 %, frequent cause is other than the re-bleed. Male above aged 43 are more vulnerable. Management of UGIB should also focus on optimization of non-re-bleeding causes and other co-morbid related deaths instead of merely maintaining homeostasis and blood transfusions.   Keywords: Re-bleeding, Mortality, Acute Upper Gastrointestinal Bleeding, Upper GI Endoscopy

Analysis and Forecast of Mining Fatalities in Cherat Coal Field, Pakistan

Mineral exploitation contributes to the economic growth of developing countries. Managing mineral production brought a more disturbing environment linked to workers' causalities due to scarcities in the safety management system. One of the barriers to attaining an adequate safety management system is the unavailability of future information relating to accidents causing fatalities. Policymakers always try to manage the safety system after each accident. Therefore, a precise forecast of the number of workers fatalities can provide significant observation to strengthen the safety management system. This study involves forecasting the number of mining workers fatalities in Cherat coal mines by using Auto-Regressive Integrating Moving Average Method (ARIMA) model. Workers' fatalities information was collected over the period of 1994 to 2018 from Mine Workers Federation, Inspectorate of Mines and Minerals and company records to evaluate the long-term forecast. Various diagnostic tests were used to obtain an optimistic model. The results show that ARIMA (0, 1, 2) was the most appropriate model for workers fatalities. Based on this model, casualties from 2019 to 2025 have been forecasted. The results suggest that policymakers should take systematic consideration by evaluating possible risks associated with an increased number of fatalities and develop a safe and effective working platform

Occurrence of HCV genotypes in different age groups of patients from Lahore, Pakistan

Background: Hepatitis C virus is a small, enveloped single stranded, positive sense RNA virus. Different genotypes are distributed in different geographical areas of the world. Determination of HCV genotype is a powerful tool for the treatment of chronic and acute liver disease.Method: The present study was carried out to find the occurrence of different HCV genotypes in the city of Lahore, a populous city of Pakistan from January 2010 to December 2010. Blood sample of patients positive for anti HCV by ELISA as well as HCV by PCR were collected and plasma was separated. HCV viral RNA load was analyzed in these samples using Real Time PCR. Qiagen HCV mini kit for RNA extraction and Qiagen HCV amplification kit for PCR amplification were used. Amplicons were subjected to HCV genotyping using Third Wave Technology.Results: Among 489 patients, 211 (43.1%) patients were males and 278 (56.9%) were females. Occurrence of HCV in the age group of 36-45 years was 32.5 %. Occurrence of HCV genotype 1 was 9.6% (47), genotype 3a was 80.77% (395), genotype 3h was 1.0% (5) , genotype 4 was 4.9% (24), co-infection of genotypes 1 & 2 was 0.2% (01), co-infection of genotypes 1 & 3 was 0.6% (03) and co-infection genotypes 1 & 4 was 0.4% (02).Conclusion: HCV genotype 3a is most prevalent HCV genotype in subjected population during said duration with most infected people from 26 to 35 years of age. Female population is having more of HCV infection as compared to males