Outcome of shaft fractures among children treated with elastic stable intramedullary nailing

Background: Long bone fractures are frequent occurrence among children and considered a frequent pediatric orthopedic injury requiring hospitalization. Authors aimed to retrospectively analyze the outcome of fixation of long bone fractures with elastic stable intramedullary nailing (ESIN) among children and adolescents.Methods: From 2010 to 2018, ESIN was performed on 128 children aged 2 to 17 years having single shaft fractures of long bones. The data related to associated injuries, postoperative complications, postoperative treatment, till bony union or removal of rods, mal-union, functional deficit, need for secondary surgical intervention and subjective complaints at follow-up originated from postoperative clinical and radiological consultations carried out regularly. The primary end points were time of complete radiological union or removal of rods.Results: The mean age at the time of accident was 9.5 years. There were 37 (28.9%) femoral fractures, 16 (12.5%) of the lower leg, 51 (39.8%) fractures of radius/ulna and 24 (18.8%) of the humerus. In 2 (2.3%) children, reoperation was necessary due to prominent ends of elastic rods and 6 (4.7%) had early removal of rods due to same reasons. End point of the study, removal of rods noted in 126 (82.8%), radiological evidence of union in 7 (5.5%) and 15 (11.7%) cases were lost at follow-up.Conclusions: ESIN fixation of diaphyseal fractures in children and adolescents is safe. ESIN was found to be minimally invasive method, noted to produce excellent functional as well as cosmetic outcomes

Crimean-Congo hemorrhagic fever in a dengue-endemic region: lessons for the future.

Crimean-Congo hemorrhagic fever and dengue hemorrhagic fever are endemic in Pakistan. However, the overlap of geographic distribution and early clinical features between the two conditions make a reliable diagnosis difficult in the initial stage of illness. A 16-year-old boy presented with a history of hematemesis and high-grade fever. A preliminary diagnosis of dengue hemorrhagic fever was made and supportive treatment was instituted; however, the patient continued to deteriorate clinically. Dengue IgM antibody testing was negative on the third day of admission. Qualitative polymerase chain reaction test for Crimean-Congo hemorrhagic fever viral RNA was sent but the patient expired shortly after the results became available on the sixth day of admission. Considerable resources had to be expended on contact tracing and administration of ribavirin prophylaxis to all the health-care workers who had come in contact with the patient. It is crucial that Crimean-Congo hemorrhagic fever be recognized and treated at an early stage because of longer term financial and health implications for contacts such as health-care workers in the setting of a developing country. Increased surveillance of dengue and Crimean-Congohemorrhagic fever cases is warranted for the derivation of reasonably reliable, cost-effective and prompt predictors of disease diagnosis. These predictors can help guide future decisions in the management of similar cases. Ultimately, such a strategy may translate into better cost containment in resource-poor settings. Institution of ribavirin prophylaxis in selected patients also merits consideration

DETRIMENTAL EFFECTS OF PESTICIDES ON HEALTH AND ENVIRONMENT

Pesticides are toxic chemicals used for controlling of insects and pests which caused harms to plants or animals. Pesticides also effect the environment as well as human health. They play a vital role in securing of food but they require a number of risks and problems. Therefore, present study is designed to know the pesticide usage and its harmful effects on environment and health of cotton growers. There are 19 rural union councils out of which 4 were selected through simple random sampling. From each selected union council, 2 villages were selected at random and from each selected village, 20 cotton growers were selected randomly thus making a sample size of 160 respondents. A well planned pre-tested and validated interview schedule was prepared for the collection of data from the selected respondents. The collected data were examined by using Statistical Package for Social Sciences (SPSS) for illustration conclusions and making recommendations. A vast majority (90%) of the respondents selected the pesticides on better results, (83.1%) on behalf of multinational company and majority (76.3%) selected pesticides of national company and a significant of majority (70%) of respondents used the gloves whereas a huge majority (85.6%) of respondents weared the mask during pesticide application. It was found that a huge majority (81.9%) of respondents had headache effect, 67.1% had fatigue, and majority (68.8%) had dizziness while 68.1% had skin disorders. Govt. should promote the first aid training program for safety measurement regarding pesticide usage and enhance the protection techniques for environment and health of organisms regarding pesticides effect

Bio-methane Production from Sorghum Elite Lines under the Climatic Conditions of Pakistan

Fossil foils are depleting dramatically to meet the ever blooming energy demands. Plant biomass is a best source of renewable energy which can be used for bio-fuel production in order to meet the energy demands. Therefore, this study was conducted for two consecutive years 2016 and 2017 to screen out best lines of sorghum for biomass yield, chemical composition and bio-methane yield. The results revealed that tested lines had differential responses for biomass yield, biomass quality and methane yield. Line 5018, performed remarkably and produced maximum leaf area index (LAI), leaf area duration (LAD) and crop growth rate (CGR) followed by L-6024 whereas the minimum LAI, LAD and CGR were recorded for L-5025. Maximum plant height, leaves per plant and dry matter yield ha-1 was observed in L-5018, whereas the minimum plant height leaves per plant and dry matter yield ha-1 was recorded in L-5025. Likewise, L-5018 also had maximum protein content, acid detergent fiber, neutral detergent fiber, lignin content and ash content whereas the L-1914 had the minimum values for these parameters amongst the tested li- nes. In addition, L-1914 produced maximum specific yield, however, L-5018 produced maximum methane yield ha-1 owing to higher dry matter yield ha-1. The results of this study suggested that L-5018 can be used to develop high biomass cultivars with good methane yield potential

Immune response to Hepatitis B vaccination in hemodialysis patients.

Background: Hemodialysis patients are vulnerable to infections with Hepatitis B Virus and hepatitis C virus (HCV). Patients who are on maintenance hemodialysis are considered as high-risk group for acquiring hepatitis B virus, resulting in high morbidity and mortality. Therefore, to vaccinate them against the virus is mandatory. Compared to a response rate of over 90% in the normal population, only 50 to 60% of those with end-stage renal disease achieve adequate antibody levels following immunization and the objective of this study was to determine the antibody level after Hepatitis B vaccination in chronic hemodialysis patients. Methods: 118 patients, undergoing chronic hemodialysis (HD) at the dialysis unit of Liaquat National Hospital, fulfilling the inclusion and exclusion criteria were enrolled between April 2013 and September 2013, after taking informed consent and approval from ethical review committee. AntiHbs (Hepatitis B surface antibody) titers were measured. Patients were differentiated as Immune and non immune based on antibody titers, with levels of >10IU/l being considered as immune and levels of <10IU/las non immune. AntiHbs titer was measured by ELISA (Enzyme Linked Immunosorbant Assay). Data was analyzed using SPSS version 14.0 for windows. Chi square test were used to ascertain the statistical significance. P value <0.05 was taken as statistically significant. In addition, the effect of age, gender and duration of Hemodialysis on antibody titer was also observed. Results: Out of 118 patients enrolled, 103 (87.3%) had an adequate antibody response and were considered immune while only 15 patients (12.7%) had an inadequate antibody response rendering them non immune. AntiHbs titers showed no significant co-relation with gender and duration of Hemodialysis therapy(p>0.05), while age was found to have significant correlation as younger age group (<60years) had more immune response (p<0.001). Conclusion: Our study showed a very good antibody response to Hepatitis B vaccination among hemodialysis patients that correlated with age with younger age group having a better response but no correlation to gender and duration of dialysis. Key Words: Hepatitis B virus, Anti-HBs antibody, Hemodialysis, Prevalence, Vaccination

Urban-rural inequities in knowledge, attitudes and practices regarding tuberculosis in two districts of Pakistan's Punjab province

<p>Abstract</p> <p>Objective</p> <p>The aim of this study was to explore inequities in knowledge, attitudes and practices regarding tuberculosis (TB) among the urban and rural populations.</p> <p>Design</p> <p>A cross-sectional study was conducted in two districts of Pakistan's Punjab province. The 1080 subjects aged 20 years and above, including 432 urban and 648 rural respondents, were randomly selected using multistage cluster sampling and interviewed after taking verbal informed consent. Logistic regression was used to calculate the crude odds ratio (OR) with 95% confidence interval (CI) for the urban area. The differences in knowledge, attitudes, practices and information sources between the urban and rural respondents were highlighted using Pearson chi-square test and Fisher's exact test.</p> <p>Results</p> <p>The study revealed poor knowledge regarding TB. The deficit was greater in the rural areas in all aspects. The knowledge regarding symptoms (OR 2.03, 95% CI 1.59-2.61), transmission (OR 1.93, 95% CI 1.44-2.59), prevention (OR 2.24, 95% CI 1.70-2.96), duration of standard treatment (OR 1.88, 95% 1.41-2.49) and DOTS (OR 1.84, 95% CI 1.43-2.38) was significantly higher in the urban areas (all P < 0.001). Although a majority of the subjects (urban 83.8%, rural 81.2%) were aware of the correct treatment for TB, less than half (urban 48.1%, rural 49.2%) were aware of the availability of the diagnostic facility and treatment free of cost. The practice of seeking treatment at a health facility (P = 0.030; OR 2.01, 95% CI 1.06-3.82), as soon as they realized that they had TB symptoms (P < 0.001; OR 1.72, 95% CI 1.26-2.35), was significantly higher in the urban areas. People in the urban areas were more likely to feel ashamed and embarrassed being a TB patient (P < 0.001; OR 2.03, 95% CI 1.50-2.76); however, they seem to be supportive in case their family member suffered from TB (P = 0.005; OR 1.53, 95% CI 1.13-2.06). Nearly half of the respondents, irrespective of the area of residence, believed that the community rejects the TB patient (urban 49.8%, rural 46.4%). Television (urban 80.1%, rural 68.1%) and health workers (urban 30.6%, rural 41.4%) were the main sources for people to acquire the TB related information.</p> <p>Conclusion</p> <p>Respondents' knowledge regarding TB was deficient in all aspects, particularly in the rural areas. Intended health seeking behavior was better in the urban areas. Television and health workers were the main sources for TB related information in both the urban as well as the rural areas. Therefore, the area of residence should be considered in tailoring communication strategies and designing future interventions for TB prevention and control.</p