Frequency of Hypertension in Ischemic and Hemorrhagic Strokes: A Cross-sectional Study at a Tertiary Care Hospital of Multan, South-Punjab Pakistan

Background: Stroke is a global health problem. Stroke is responsible for major disabilities in adult population, and is 2nd leading cause of deaths all over the world. Estimated 15 million people all over the world become victim of stroke every year all over the world, of which 5 million die and other 5 million are left permanently disabled and thus major burden on the sufferer and families as well. Different studies have reported hypertension as major cause of stroke in different populations. Objective: To determine the frequency of hypertension among ischemic stroke and hemorrhagic stroke at a tertiary care hospital. Subjects and Methods: Our study included 246 stroke patients which were recruited from Department of Medicine Nishtar Medical University Hospital Multan. Specific history concerning hypertension was inquired from all patients. Blood pressure of all the patients was measured. Blood pressure levels were measured by researcher using random-zero sphygmomanometers with the subject seated quietly. Two readings of blood pressure were taken and average   of the two readings was noted in the proforma. ECG of all the patients was done and checked for the fulfillness of criteria of left ventricular hypertrophy i.e. Sokolow-Lyon Index, Cornell Voltage Criteria. Results: Our  study included 246 stroke patients, 160 (65%) were male patients and 86 (35%) were female patients. Mean age of our study cases was 59.63 + 11.24 years. Ischemic stroke was observed in 133 (54.1%) of our study cases, while hemorrhagic stroke was noted in 113 (45.9%) of our study cases and 13 (5.3%) had previous history of stroke as well. Smoking was observed in 110 (44.7%) of our study cases and all the smokers were male patients. Alcohol consumption and family history of stroke was zero in our study cases. Of these  246  stroke patients, 148 (60.2%) were known hypertensive and all of them were taking anti-hypertensive medication. Frequency of hypertension in our study was 168 (68.3%) at presentation. Conclusion: Higher frequencies of modifiable risk factors was seen with Hypertension was the leading risk factor of stroke in our study. These findings point towards well directed efforts regarding conventional interventions in our population. Hemorrhagic stroke was significantly associated with elevated blood pressure. Hypertension was significantly associated with increasing age, diabetes, previous history of stroke, hemorrhagic stroke and smoking in stroke patients. Keywords: Stroke, Hypertension, Ischemic, hemorrhagic

Effect of Social Support on Health Related Quality of Life in Pregnant Women- A Cross-sectional Study at a Tertiary Care Hospital Multan, South-Punjab Pakistan

Objective: To explore the relationship between social support and health-related quality of life among pregnant women. Method: This cross-sectional study was conducted at Nishtar Medical University Hospital Multan, Pakistan. The duration of study was from January to March2017. Pregnant women presenting to our hospital were approached for data collection. The chronological age range of the sample was 15-35 years and ages of pregnancy in months were included. Social support of pregnant women was measured through multidimensional scale of perceived social support and health-related quality of life was measured through medical outcomes study questionnaire. Results: Of the 120 participants, 66(55%) were from rural areas, and 54(45%) from the urban areas. Subjects who were in their first trimester of pregnancy were 72(60%), while 25(20.8%) were in their second trimester and 23 (19.2%) in the third. Of the total, 80(66.66%) were educated women and 40 (33.34%) were illiterate. Subjects with a history of physical illness were 76 (63.30%) while 60 (50%) suffered from psychological illness too. There was a significantly positive relationship between social support and health-related quality of life among the pregnant subjects (p<0.05). Conclusion: More social support can increase the health-related quality of life of pregnant women. Keywords: Social support, Health related quality of life, pregnant women

Role of Human Resources Management in the Effectiveness of Business Process Reengineering

The main idea of the paper to presents a model with the discussion of Human resources management role with line extent of Management competency, team working, effective communication, IT and Organizational structure and there impact on the effectiveness of Business Process Reengineering. The article suggest that the use of HRM with the implementation of the BPR find the better results and support the organizational better performance Keywords: human Resources Management, business process Reengineering, Organizational performanc

The role of TQM and BPR in executing quality improvement: a comparative study

In order to sustain a competitive edge in this global manufacturing era, enterprises need to adopt appropriate improvement schemes. This article examines a detailed study of quality improvement tools mostly used in the organizations. As this is the conceptual paper, the paper focuses on two important quality improvement techniques, BPR (Business Process Reengineering) and TQM (Total quality management). Both the approaches clinch the same thoughts and objectives for organizational enhancement but the difference lies in terms of means used by each technique, the risk, time frame and the magnitude of change expected from each of these programs. In order to attain this comparison, the article first defines and explains each of the approaches for the in depth understanding of the difference as well as similarities between these two. The articles (related to the comparison of these two improvement tools) of almost last 15 years are gathered and studied in detail and then conclusion is drawn based on the findings of different previous articles. The methodology used primarily is literature review as well as the case study method also helps in gathering the data. The study concludes that even though both the approaches intend to enhance organizational competence, they are relatively different both theoretically as well as practically and each of the approach is suitable for different situation depending upon the needs and requirements of the organization. Keywords: Competitive edge, TQM, BP

Vascular Surprises in Calot’s Triangle during Laproscopic Choleystectomy

Background: To identify the vascular anomalies,variations of Calot’s triangle during laparoscopic cholecystectomy  Methods:  In this prospective observational study one thousand patients with a diagnosis of cholithiasis were included. Exclusion criteria were patients younger than 12 years and older than 80 year.  Calot’s triangle dissection was done meticulously.Cystic artery and hepatic artery anomalies and variations were observed and analyzed on SPSS 21.   Results: The age varied from 12 to 80 years. On the basis of distributional variation the cystic artery was single in 90% cases, branched in 7% cases and absent in 3% cases. On positional variations the cystic artery was superomedial to the cystic duct in 85% cases, anterior in 7% cases, and posterior in 3% cases and low lying in 5% of the cases. On the basis of length variation results showed that 80% cases had a normal cystic artery .A short cystic artery was found in 5% cases and a long cystic artery was present in 5%. Other arterial variations are of hepatic artery i.eMoynihan’s Hump (3%) and right hepatic artery present in Calots triangle in 5% Conclusions:  For the safety of laparoscopic cholecystectomy one should be well aware of the anatomical variations of the cystic and hepatic arter

Parametric analysis of wax printing technique for fabricating microfluidic paper-based analytic devices (µPAD) for milk adulteration analysis

Accurate prediction of hydrophobic–hydrophilic channel barriers is essential in the fabrication of paper-based microfluidic devices. This research presents a detailed parametric analysis of wax printing technique for fabricating µPADs. Utilizing commonly used Grade 1 filter paper, experimental results show that the wax spreading in the paper porous structure depends on the initially deposited wax line thickness, a threshold melting temperature and melting time. Initial width of the printed line has a linear relationship with the final width of the barrier; however, a less pronounced effect of temperature was observed. Based on the spreading behavior of the molten wax at different parameters, a generalized regression model has been developed and validated experimentally. The developed model accurately predicts wax spreading in Whatman filter paper: a non-uniform distribution of pores and fibers. Finally, tests were carried out for calorimetric detection of commonly used adulterants present in milk samples

Comorbidities Associated With Attention-Deficit/Hyperactivity Disorder in Children and Adolescents at a Tertiary Care Setting

Studies have revealed high rates of neurodevelopmental and psychiatric comorbid conditions among individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD). However, research on this topic in the Arab world has been limited. This study evaluates the medical, neurodevelopmental, and psychiatric comorbidities in children and adolescents diagnosed with ADHD in Dubai, United Arab Emirates (UAE). A total of 428 pediatric patients diagnosed with ADHD were included. Children and adolescents with ADHD had high rates of comorbid disorders. Twenty comorbid conditions were identified. More than 3 quarters of the study sample had at least 1 comorbid disorder. The most common comorbidity among children was autism spectrum disorder, and among adolescents was anxiety disorders. Comprehensive assessments are highly warranted to identify and manage associated comorbid conditions. Further research is needed in exploring the biopsychosocial factors contributing to the elevated rate of comorbidity in children and adolescents with ADHD