Spectrum of Spinal Dysraphism in Pediatric Patients in a Tertiary Care Hospital

Objectives:  To report the spectrum of spinal dysraphism presenting in pediatric patients admitted to the Department of Neurosurgery Lady reading hospital Peshawar. Material & Methods:  A descriptive case series was conducted and total of 89 patients (age between 2 months to 12 years) were included who underwent the surgical treatment. All patients were examined for clinical and radiological diagnosis of spinal dysraphism. Results:  The average age at treatment was 23 ± 39.77 months. The most recurring (52.8%) presenting symptom was the swelling on the back followed by lower limb weakness. Meningocele was reported in 11.2%, myelomeningocele in 47.2%, myelomeningocele & hydrocephalus in 12.4%, tethered cord syndrome in 25.8%, and diastematomyelia 3.4% of patients. Excision combined with the repair was done in 58.4%, release & repair done in 29.2% and endoscopic third ventriculostomy/ventriculoperitoneal shunts with the repair were done in 12.4% patients. Cerebrospinal fluid leak was reported in 3.7%, wound infection in 4.5% and mortality was reported in 3.4% patients. Conclusion:  Overall, a good outcome was reported in the majority of our patients. Surgical procedures like myelomeningocele’s excision & repair, tethered cord’s release & repair, and ETV/VP shunt in patients with hydrocephalus can lead to satisfactory clinical outcomes

Income Inequality, Redistribution of Income and Trade Openness

Literature on nexus between trade openness and government spending is impressive [Atif, et al. (2012), Rudra (2004), Dani (1997) and McGuire (1999)]. The literature is growing rapidly. Analysts have documented the positive effects of government social spending [see for example Mesa-Lago (1994); Huber (1996); Weyland (1996); McGuire (1999)]. Unfortunately, Pakistan lacks empirical evidences on the impact of government social spending. Although Government of Pakistan has taken number of initiatives to have some form of redistribution policies, however, inequality in Pakistan is higher as compared to other Least Developed Countries that are open to trade. This situation is alarming. This paper therefore tries to identify the nexus between trade openness and social spending for the period 1975–2012. International evidence suggests that government social spending influences poverty and distribution of income. Pakistan‘s low level achievement in terms of reducing inequality, given the likely adverse economic impact of trade openness, point towards the fact that government has to design the policy in such a way that it affects the distribution of income. Thus, exploring the effect of social spending on income inequality is necessary for the concerned policy makers

Assessment of Dengue Fever Severity Through Liver Function Test

Objective: To assess the utility of liver function tests (LFTs) for early recognition and prediction of severity of dengue fever in hospitalized patients. Study Design: An analytical study. Place and duration of study: Services Institute of Medical Science and Fatima Memorial Hospital, Lahore, from September to December 2010. Methodology: Admitted cases of dengue fever were divided into three groups: mild, moderate, and severe increases in aminotransferases. Elevation in LFTs was co-related with good or bad outcome i.e. (survival or complication free stay) or (death or complications). Results were analyzed in SPSS version 18. Results: Out of the 353 patients with mean age of 37.12 ± 15.45 years, 245 (69.4%) were males and 108 (30.6%) were females. Seventy five patients (21.2%) had mild elevation of aminotransferases (twofold increases), 265 patients (75.1%) had moderate increases (three to fourfold), and 13 (3.7%) had severe (>4 fold increase). Alanine transaminase (ALT) was statistically higher in patients with septicemia, hepatic, and renal failure (p-value ≤0.05). Aspartate transaminase (AST) was higher in almost all complications. Prolonged hospital stay was associated with raised LFTs and greater complications and mortality. AST was found to be twice as much raised as ALT. Conclusion: AST and ALT were statistically higher in patients with worse outcome thus can lead to early recognition of high risk cases

Determination of risk factors for hepatitis B and C in male patients suffering from chronic hepatitis

<p>Abstract</p> <p>Background</p> <p>Hepatitis B and C is common in Pakistan and various risk factors are attributable to its spread.</p> <p>One thousand and fifty consecutive male cases suffering from chronic liver disease (327 HBV and 723 HCV) were selected from the OPD of public sector hospital and a private clinic dealing exclusively with the liver patients. To compare the results 723 age and gender matched controls were selected from the blood transfusion services of the public sector hospital. A standard questionnaire was filled for all patients and controls which included the information on possible risk factors.</p> <p>Findings</p> <p>Family history of liver disease was significantly higher (43% and 34%) in HBV and HCV positive cases as compared to 5% in controls [odds ratio 15.6; 95% Confidence Interval CI: 10.1 -- 24.1, 10.9; 95% Confidence Interval CI: 7.3 -- 16.4] and same trend was seen for death due to liver disease in the family. Majority 74% hepatitis B positive cases had their shaves done at communal barbers but this practice was equally prevalent amongst controls (68%), thus negating it as a possible risk factor, but there is a significant risk with p < 0.05 associated with HCV in male that get their shave in barber. Very strong association of the disease was found with history of dental treatment (38% HCV 36% HBV and 21% controls) [Odd ratio 2.3; 95% CI: 1.8-3.0, Odd ratio 2.1; 95% CI: 1.5-2.8], surgery (23% HCV cases,14% HBV cases and 12% controls), history of blood transfusion was significantly higher in HCV (6%) as compared to controls (2.1%) [Odd ratio 2.9; 95% CI: 1.5-5.5]. History of taking injections for various ailments by the general practitioners (over 90% patients in both hepatitis B and C cases) was significantly higher as compared to 75% in controls [Odds ratio 3.8, 6.9; 95% CI: 2.4-6.1, 4.5-10.4] but hospitalization was not significant in HBV and HCV cases.</p> <p>Conclusion</p> <p>Injections, surgery and dental treatment appear as major risk factors for the transmission of hepatitis B and C in the community. Massive health care awareness drives need to be done for both health care providers and the public to reduce this menace.</p

Unusual Presentations of Wegener\u27s granulomatosis: Pitfalls in Early Diagnosis

Wegener\u27s Granulomatosis (WG) is a disorder characterized by necrotizing granulomatous vasculitis that primarily affects the upper and lower respiratory tracts and the kidneys. Although the cause is unknown, there is strong evidence that this is an autoimmune disease and immunosuppressive therapy with cyclophosphamide and corticosteroids efficiently relieves the symptoms and, prevents relapses. We report on four cases of WG that presented with unusual features. The first patient presented with vague joint pain, blackish discoloration of the skin and leg ulcers. The second patient presented as fever of unknown origin and gingival hyperplasia. The third patient presented with hearing loss while the fourth presented with arthritis, conjunctivitis and painful swelling of the ear. It is emphasized that WG is a complex disease and can involve multiple organ systems. Early recognition and institution of proper treatment are crucial for optimal outcome

Urdu version of the neck disability index: a reliability and validity study

Abstract Background Despite the wide use of the neck disability index (NDI) for assessing disability in patients with neck pain, the NDI has not yet been translated and validated in Urdu. The first purpose of the present study was to translate and cross-culturally adapt the NDI into the Urdu language (NDI-U). The second purpose was to investigate the reliability, validity and responsiveness of the NDI-U in Urdu-speaking patients experiencing chronic mechanical neck pain (CMNP). Methods Translation and cross-cultural adaptation of the original version of the NDI were carried out using previously described procedures. Seventy-six patients with CMNP and thirty healthy participants were recruited for the study. NDI-U and visual analogue scales for pain intensity (VASpain) and disability (VASdisability) were administered to all the participants at baseline and to the patients 3 weeks after receiving physiotherapy intervention. The global rating of change scale (GROC) was also administered at this time. Test-retest reliability and internal consistency were carried out on forty-six randomly selected patients two days after they completed the NDI-U. The NDI-U was evaluated for factor analysis, content validity, construct validity (discriminative and convergent validity) and responsiveness. Results An intra-class correlation coefficient (ICC2,1) revealed excellent test-retest reliability for all items (ICC2,1 = 0.86–0.98) and total scores (ICC2,1 = 0.99) of the NDI-U. The NDI-U was found internally consistent with a Cronbach’s alpha of 0.90 and a fair to good correlation between single items and the NDI-U total scores (r = 0.34 to 0.89). Factor analysis of the NDI-U produced two factors explaining 66.71% of the variance. Content validity was good, as no floor or ceiling effects were detected for the NDI-U total score. To determine discriminative validity, an independent t-test revealed a significant difference in the NDI-U total scores between the patients and healthy controls (P < 0.001). For convergent validity, Pearson’s correlation coefficient showed a strong correlation between NDI-U and VASdisability (r = 0.83, P < 0.001) and a moderate correlation between NDI-U and VASpain (r = 0.62, P < 0.001). To measure responsiveness, an independent t-test showed a significant difference in the NDI-U change scores between the stable and the improved groups (P < 0.001). Furthermore, moderate correlations were found between the NDI-U change scores and the GROC (r = 0.50, P < 0.001), VASdisability change scores (r = 0.58, P < 0.001) and VASpain change scores (r = 0.55, P < 0.001). Conclusion The results showed that the NDI-U is a reliable, valid and responsive questionnaire to measure disability in Urdu-speaking patients with CMNP

Nitrofurantoin and Fosfomycin, effective oral empirical treatment options against multidrug resistant Escherichia coli

ObjectiveThe present study is designed to monitor antibiotic susceptibility pattern of Escherichia coli to assist in forecasting empirical therapy of urinary tract infection.MethodologyIt is a retrospective cross sectional study. It was carried out at Dow Diagnostic Research and Reference Laboratory for a period of 3 months from February 2017 to April 2017. A data of total 5000 urine culture and sensitivity test reports was taken from the medical record. The data was analyzed by SPSS version 16.ResultsOut of 5000 urine samples processed, 1565 showed significant bacterial growth. Escherichia coli was the most common pathogen isolated. Meropenem, Amikacin, Fosfomycin and Nitrofurantoin respectively were found to be the most sensitive antibiotics against Escherichia coli.Conclusion Fosfomycin and Nitrofurantoin are effective oral antibiotics against Escherichia coli causing urinary tract infection. The present study may help clinicians in making rational choice of empirical treatment of the patients