Platelet Distribution Width: A Severity Marker Of Pre Eclampsia, Experience At Tertiary Care Hospital

Objectives: To determine mean platelet distribution width in patients with pre-eclampsia. Study design: This is a cross-sectional, descriptive study performed in the Department of Obstetrics and Gynecology, Benazir Bhutto Hospital, Rawalpindi, retrospectively from 01 May 2017 to 01 November 2017 by non-probability consecutive sampling technique. Materials & Methods: A total of 150 pregnant females with mild and severe pre-eclampsia with gestational age > 20 weeks, and an age limit of 18-40 years were included in the study. Patients having deranged coagulation or multiorgan involvement were excluded. Blood and urine samples were collected at the time of presentation. All the blood pressure readings were confirmed by two readings 4-6 hours apart. Mean ± SD was used to express data values. The mean PDW value was calculated for pregnant females with mild and severe preeclampsia. Results: In our study Mean PDW in patients with preeclampsia was 15.86± 0.34. The mean PDW for mild preeclampsia was 15.8± 0.35 and for severe preeclampsia 15.98±0.28.. Conclusion: PDW is a useful marker for the prediction of the severity of preeclampsia before the disease progresses to severe preeclampsia and HELLP. Raised values can help the obstetrician to actively manage the patients in time to reduce maternal and fetal mortality

Role of Tuition Centers in the Performance and Achievement of Students: A Case of Hyderabad District, Sindh, Pakistan

This research is designed to explore the importance of tuition centers in the perception of students. It tries to find out the role, supporting methods, environment and good characteristics of tuition centers, their owners and management to support the student to learn effectively and bring good grades in their board examinations. A qualitative research method employed to collect data from the 30 participating students who receive tuition at different centers of Hyderabad district. Semi-structured interview protocol was design; discussed with five experts of field; improved as per suggestions of field experts; piloted on three students; and then implemented and conducted on the recruited sample of students of class Higher Secondary Certificate -II (XII) in order to collect data. The results revealed that the students who receive tuition at different centers bring good grades in their examination and have suitable knowledge about their subjects taught at centers. Their previous grades were found good and attractive such as A-1 and A with more than 80% and 70% marks respectively, due to coaching received at tuition centers that time, reveled from experiences shared by students

Mental health challenges and psycho-social interventions amid COVID-19 pandemic: A call to action for Pakistan

The increase in death and spread-related coronavirus (COVID-19) has shifted the world focus to the containment of the disease by emphasising measures to prevent spread in the general population. Such a complex, threatening, and unprecedented situation has left the psycho-social wellbeing needs of general public unaddressed. This paper aims to review the current COVID-19 scenario and its effects on the psycho-social wellbeing of people; and an attempt to shed some light on the aforementioned questions. Furthermore, the review will propose some recommendations for overcoming the mental illness issues, during and after the COVID-19 outbreak. We extracted information from reliable published international and national literature and reviewed anecdotes from media content from January to June 2020. The mental health implications of this outbreak will be long-lasting; however, by prioritising, investing diligently, and taking a collective approach, this challenge can be dealt with in a promising manner

Need of physical and chemical restraints: Experiences at inpatient psychiatric ward in a tertiary care hospital in Karachi, Pakistan

In psychiatry, agitated / aggressive patients are often treated with de-escalation techniques. If this does not work, physical or chemical restrains are required; but in the event of resistance, seclusion is applied. We report the findings of baseline study of experiences of physical and chemical restraints in a tertiary care hospital in Karachi, where 104 files were evaluated retrospectively. The mean age of patients was 32.5 ±14.3 years with 54.8% men, while the average length of stay was 11.5 ±9.3 days. Agitation, violent behaviour, and aggression were the most common indications for restraints. In total, 94.5% of patients had both physical and chemical restraints with the latter being used as the first choice in 70 patients; whereas, 67.1% of patients\u27 families were not informed before application of restraints. The seclusion need assessment was conducted in 4.1% of patients

Purification and Characterization of a Nonspecific Lipid Transfer Protein 1 (nsLTP1) from Ajwain (\u3cem\u3eTrachyspermum ammi\u3c/em\u3e) Seeds

Ajwain (Trachyspermum ammi) belongs to the family Umbelliferae, is commonly used in traditional, and folk medicine due to its carminative, stimulant, antiseptic, diuretic, antihypertensive, and hepatoprotective activities. Non-specific lipid transfer proteins (nsLTPs) reported from various plants are known to be involved in transferring lipids between membranes and in plants defense response. Here, we describe the complete primary structure of a monomeric non-specific lipid transfer protein 1 (nsLTP1), with molecular weight of 9.66 kDa, from ajwain seeds. The nsLTP1 has been purified by combination of chromatographic techniques, and further characterized by mass spectrometry, and Edman degradation. The ajwain nsLTP1 is comprised of 91 amino acids, with eight conserved cysteine residues. The amino acid sequence based predicted three dimensional (3D) structure is composed of four α-helices stabilized by four disulfide bonds, and a long C-terminal tail. The predicted model was verified by using different computational tools; i.e. ERRAT, verify 3D web server, and PROCHECK. The docking of ajwain nsLTP1 with ligands; myristic acid (MYR), and oleic acid (OLE) was performed, and molecular dynamics (MD) simulation was used to validate the docking results. The findings suggested that amino acids; Leu11, Leu12, Ala55, Ala56, Val15, Tyr59, and Leu62 are pivotal for the binding of lipid molecules with ajwain nsLTP1

Evaluation of nephrotoxic potential of iyengaria stellata

ABSTRACT The development of renal injury by use of xenobiotics is very prevalent. Iyengaria stellata (Børgesen) is a brown sea weed belongs to the class Phaeophyceae and family Scytosiphonaceae and its effects on renal function has been determined after 30 days once daily dosing to rabbits and the level of urea and creatinine was measured which showed increased level of urea after prolonged administration of Iyengaria stellata however this increase is insignificant and decrease in creatinine level after 30day ingestion of Iyengaria stellata, lead to the conclusion that Iyengaria stellata has nephroprotective effect

A multidisciplinary approach to triage patients with breast disease during the COVID-19 pandemic: Experience from a tertiary care center in the developing world

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.Methods and results: The breast disease management guidelines were developed and approved with the expertise of the Multidisciplinary Breast Program Leadership Committee (BPLC) of the Aga Khan University, Karachi, Pakistan. These guidelines were inspired, adapted, and modified keeping in view the needs of our resource-limited healthcare system. These recommendations are also congruent with the ethical guidelines developed by the Center of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Our institutional recommendations outline a framework to triage patients based on the urgency of care, scheduling conflicts, and tumor board recommendations, optimizing healthcare workers\u27 schedules, operating room reallocation, and protocols. We also describe the Virtual Blended Clinics , a resource-friendly means of conducting virtual clinics and a comprehensive plan for transitioning back into the post-COVID routine.Conclusion: Our institutional experience may be considered as a guide during the COVID-19 pandemic, particularly for triaging care in a resource-limited setting; however, these are not meant to be universally applicable, and individual cases must be tailored based on physicians\u27 clinical judgment to provide the best quality care

Liaison psychiatry in low & middle income countries: Experiences at the Aga Khan University Hospital (AKUH), Karachi, Pakistan

Aims and methods: Our study investigated the pattern of referrals made to psychiatric services from the general wards of Aga Khan University Hospital (AKUH). Data on all cases referred between years 2015 to 2016 was collected retrospectively from the medical records. Information included socio-demographic details, reason for referral, past psychiatric history, treatment, management suggested and outcome of referral. SPSS version 19.0 was used for data entry and analyzing.Results: During the study period 1166 cases were referred for psychiatric consultations of which 995 were analyzed. The results show an almost equal distribution of females and males. Most referrals were from Internal Medicine. The most common reason for referral was behavioral problem and the most common psychiatric diagnosis made was delirium.Clinical Implications: Review of the service has identified areas that need improvement such as late referrals, problems with documentation, and issues in following through with the recommended management and will help us improve the existing services

To assess the compliance of monitoring metabolic symptoms associated with antipsychotics in an inpatient setting in a tertiary care hospital in Karachi, Pakistan

Mental health problems like schizophrenia, bipolar affective disorder and use of second generation antipsychotics (SGA) are linked to the risk of developing metabolic syndrome. The purpose of our study was to determine the level of compliance to monitoring metabolic symptoms associated with second generation antipsychotics according to the standards of NICE guidelines. Secondly, we aim to develop a workable standardized protocol. A total of 385 patients admitted to psychiatric ward from February 2015-January 2016 were included in the study. Case files were reviewed to obtain relevant clinical information. Assessment of height, weight, pulse, blood pressure, movement disorders, level of physical activity and nutritional status were measured in all patients. Fasting blood glucose was measured in 99 (26.5%), glycosylated hemoglobin (HbA1c) in 39 (10.4%), blood lipid profile in 44 (11.8%) and prolactin in 3 (0.8%) patients. Less than half of the patients (118, 31.6%) underwent ECG investigation. Slow titration of medication (331, 88.5%) and a trial at optimum dosage (343, 81.7%) were routinely seen. Overall physical health and patient well-being was recorded in the majority of subjects (310, 82. 9%). A significant number of physical and biochemical parameters were not routinely monitored. Our study reports findings consistent with previous literature. With this we hope to highlight important concerns and make recommendations, especially in country like Pakistan where these monitoring systems are non-existing. This will not only reduce the risk of a number of complications secondary to antipsychotic medications, but will also improve patient adherence and compliance to the pharmacological treatment