Impact of Emotion Regulation in Patients Suffering from Chronic Obstructive Pulmonary Disease

Objective: To investigate the impact of self-management intervention on the effectiveness of emotional regulation in patients suffering from chronic obstructive pulmonary disease (COPD). Materials and Methods: This study was conducted in the Pulmonology Department of Jinnah hospital Lahore in Collaboration with community medicine department for Six months duration from March 2018 to August 2018. 86 consecutive chronic COPD patients were diagnosed in the stable phase. 43 patients in each group were divided into a control group and a randomized observation group. In the control group, the continuous feeding mode outside of a conventional hospital and an enhanced guide to self-care programs in the observation group (information about the disease, breathing exercises, emotions, home oxygen therapy, medication technique, healthy life behaviors and deteriorating action plans) were used to compare differences in results. Results: For six-month follow-up visits, personal hygiene behavior, physical education, cognitive symptoms and management of medical care results, and observation groups in both groups were more visible and the differences were statistically significant (p <0.05); Self-regulation of emotions regulation in two groups was increased, including positive effect, deterrence / anguish, anger / irritation and total results. In addition, the extent of growth in the observation group was clearer and the differences were statistically significant (p <0.05). Conclusion: intervention of the self-monitoring program can improve the self-control behavior of patients with COPD and is important for improving the effectiveness of regulation and prediction of emotions.

Evaluation of Subjective and Objective Levels of Drowsiness, it’s Rating and its Relation with Facial Dynamics

Objective: To determine the subjective and observed levels of lethargy and changes in facial dynamics. Materials and Methods: This study was conducted at Department of community medicine, Services Institute of Medical Sciences Lahore for one-year duration from January 2017 to December 2018. The changes in facial dynamics, such as changes in eyes, lips and eyebrows, were tested in KKS (Karolinska Sleepiness Scale) in twenty-five drivers. And ORD (drowsiness observer rating). Repeated ANOVA measurements and repeated MANOVA measurements were used to analyze the data. In addition, a neural network and Viola-Jones were used to detect facial features. PERCLOS (percentage of eye closure), blink frequency and blink time were examined to see eye parameters. The size of the open mouth during sleep was examined for oral parameters. When examining the eyebrows, the number 50 indicates that the eyebrow is in the normal position. For eyebrows above the normal position, a range of 50 to 55 was specified; In addition, 45-50 was found to be a defined range for normal eyebrows. Results: Descriptive statistics of dynamic changes in the mouth and eyes showed increased drowsiness while driving, as well as changes in the eyes and mouth. However, statistical findings made while driving showed that dynamic eyebrow changes had a clear expression with a continuous trend. Similar studies on data obtained from CSR and ORD showed that both parameters increased at the same time and lethargy level. There was also a significant relationship between facial expressions and lethargy. Conclusion: This study will be an effective and efficient tool for alerting and detecting sleep in a timely and accurate manner.

Valuation of Satisfaction Level among Patients Attending the Indoor Clients of First Referral Units in Lahore

Objective: Internal customer satisfaction is a breakthrough parameter for assessing the functioning of the First Command Unit established by the government. Pakistan, as part of the Child Survival and Safe Motherhood (CSSM) Program in 1992. It is currently expected that CSSM, as part of the flagship National Health Mission (NHM), will reduce the burden of high maternal mortality in Pakistan and the extent of further reductions from current levels to ensure safe motherhood and then childhood to achieve the Health for All goal. In this context, some primary and most community health centers have been upgraded to the first referral unit (FRU), which has been specifically prepared to handle obstetric emergencies. Intensive efforts continue to strengthen these FRUs under the National Health Mission Program by addressing the needs of patients particularly staying in rooms participating in the FRU. Methods: Data was collected from outpatient ward of the Jinnah Hospital Lahore for one year from November 2017 to October 2018. Patients / clients using internal services; a sample of 60 customers was selected for the survey. They were asked questions to assess the level of satisfaction with the use of various internal services, and their answers were rated as poor-1, fair-2 and good-3. Results: An evaluation of the functioning of some FRUs showed that the overall level of internal customer satisfaction is around 50%, which can be further improved by improving service delivery. Conclusions: We conclude that in order for FRU to operate smoothly, the health needs of clients should be a priority.

Enteric Fever in Patients of Lahore: Association of Positive Blood Cultures with the Typhidot Immunoassay Tests and Widal Agglutination

Objective: Laboratory study to assess the correlation of existing Salmonella blood culture isolates with Widal agglutinin titers and EIA-based Typhidot immunoassay antibodies as the gold standard. Materials and Methods: This study was conducted at the department of community medicine KEMU Lahore for six months from June 2017 to November 2018. 2704 blood samples were taken for cultural studies and Widal test in a clinical laboratory among people with symptoms of clinical intestinal fever. Of these, 1497 were isolated from Salmonella; The sera of these patients who did not accompany Typhidot requests were also subjected to spot immunoassay with the informed consent required for bleeding. All sera were stored at 40 ° C until selection. Results: Blood of 802 men (53.6%) and 695 women (46.4%) gave 61.85% S. typhi (n = 926), 31.26% S. Para typhi-A (n = 468) and 6, 88% S. Para typhi. n = 103) insulation. Broad agglutinins were detected in 473 (31.5%) of these people. Without detectable "O" antibodies, 1:80 "H" titers (n = 264: 17.6%) were most commonly observed in children's sera (n = 112; 7.4%). Widal H with agglutinin "O" was recorded in 209 (13.9%) corresponding positive blood cultures, and 104 (6.9%) gave a titre of 1: 320 or more. A total of 1,024 sera (58.4%) did not have detectable Widal antibody. Typhidot immunoglobulin spots (57.1%), negative in 856 sera, were detected in 641 samples (42.8%). IgG-free IgM stains without detectable IgM, IgG stains without IgG were also observed in 22 sera (1.47%) and samples producing S. Para typhi-A isolate (n = 8) and S. Para typhi-B. Conclusion: S. Para typhi-A has often grown in the last decade, suggesting incomplete protective coverage, probably with a monovalent vaccine. Antibodies against Widal and Typhidot agglutinins were detected in the serum of patients with Salmonella growing in blood in 31.5% and 42.8%, respectively. Widal may be misinterpreted because of possible "lower" agglutinins that have not been inoculated, and the EIA immunoassay is particularly limited only to S. typhi. An ICT based Salmonella serotype three indicator is desirable.

Impacts of Environmental Changes on Health in the Gulf Region

From the mid-20th century, there has been quite a radical change in environmental and climate patterns regionally as well as globally. The reason behind these changes is primarily linked to deforestation, industrialization, expanded use of fossil fuels, and the extreme production of carbon dioxide (CO2) in the atmosphere. The environment comprises the surrounding conditions such as the complex of biological, physical, and chemical factors that act upon the ecological community and ultimately determine its form and survival. Environmental change encompasses the disturbances caused either by ecological processes or by the human influence which can be in the form of man-made disasters including but not limited to wars, oil spills, pollution, cyclones, etc. Environmental changes are a huge threat to humanity as a whole. These changes can be detrimental to health in a multitude of ways. Most significant ones being exacerbating existing health conditions or causing unforeseen health problems. These environmental changes affect human health by polluting the air we breathe, the water we drink, and the food that we eat. As a result of accelerated progressions in technology, active industrialization, ongoing wars, irrational use of pollutants like petroleum, etc., the whole of our planet is susceptible to environmental changes, but some areas like the Gulf region have been more sensitive to these. The gulf has shown climate deviations that have transmuted into various environmental extremes such as rising sea levels, melting of the arctic ice caps, droughts, and floods. According to the widely cited, "The Stern Review", a temperature rise of 2 degrees Celsius will see a 20-30% decrease in water availability in one of the regions of the globe, and a 4 Celsius rise will result in up to 50% decrease in water availability1. The latest example of this is Kuwait; where due to the environmental changes world's most scorching day was recorded recently in 20192.The Gulf region is the largest producer of oil and gas in the world fulfilling 1/3rd of the world’s needs. According to world bank statistics, UAE, Saudi Arab, and Qatar produce around 22.9, 19.4 & 43.9 metric tons of CO2 per capita against the global average of 5.0 metric tons of CO2 per capita. These materials when processed to make electricity and other products release greenhouse gasses which are highly susceptible to environmental changes that have a direct or indirect effect on the health in the region. The byproducts include particulate matter (PM2.5) that cause chronic respiratory diseases and also aggravate the asthma condition in many. Furthermore, the overall increase in urban smog also has an impact on the psychological health of a human being by making the environment dark and hazy.

A Pilot Study on Thickened Blood Vessels in Endometrial Curettage in Dysfunctional Uterine Bleeding

Background: Dysfunctional uterine bleeding (DUB) is a common disease. About 10% of patients registered with DUB in Gynecology OPD for treatment in developing countries. There has been a change in the rhythmic cyclic menstruation that causes excessive and irregular bleeding. Lack of ovulation or oligo-ovulation leads to permanent estrogenic effects without opposing the progesterone effects. Other causes of the estrogen domain may have similar effects. The relative estrogen domain causes several changes in the uterine vascular system that causes menstrual bleeding. Objective: To determine the frequency and significance of thickened blood vessels in curettage of the endometrium in dysfunctional uterine bleeding. Materials and methods: It was a Retrospective cross-sectional pilot study conducted at Department of Gynecology and Obstetrics, Jinnah Hospital Lahore for one-year duration from January 2017 to December 2017.Hematoxylin and eosin (H&E) stained sections 30 consecutive incident cases of endometrial curettage due to dysfunctional uterine bleeding were examined by an optical microscope, with particular regard to the number of thickened blood vessels. All patients with history of endometrial curettage with dysfunctional uterine bleeding were included while curettage of uterine mucosa in patients with a specific etiology, such as endometritis, atypical hypertrophy, retained products, intrauterine devices (intrauterine device) were excluded. Results: Over 50% of patients were perimenopausal, i.e. 40-55 years of age. All endometrial procedures included thickened blood vessels. On average, there were about 8 blood vessels thickened by curettage of the endometrium. Conclusion: Estrogen-induced vascular lesions result in greater permeability, which can lead to the accumulation of various plasma proteins with increased intramural vascular thickening. These thickened veins may not contract properly, causing excessive bleeding and prolongation.

A Meta–Analysis and Systematic Review to Determine the Pregnancy Outcomes in Mothers with inactive Hepatitis B Carrier

Objective: Our goal was to investigate whether asymptomatic maternal hepatitis B (HB) infection affects early membrane rupture (PROM), fetal death, preeclampsia, eclampsia, gestational hypertension, or bleeding before delivery. Materials and Methods: This study was conducted in the Department of Community Medicine and Obstetrics and Gynecology department, KEMU Lahore for one-year duration from May 2017 to April 2018. The electronic literature surveys were conducted using gray literature studies (e.g. conference papers and final reports). (Technicians) and scanned reference lists of attached studies and systematically related studies. We study statistical heterogeneity using statistical tests I2 and tau square (Tau2). Results: 18 studies included. Early membrane ruptures (PROM), fetal death, preeclampsia, eclampsia, gestational hypertension and prenatal bleeding were obtained in this study. The results showed no significant relationship between inactive HB and these complications during pregnancy. Small amounts of P and chi-square and large amounts of I2 have revealed heterogeneity, which we are trying to modify using statistical methods such as subgroup analysis in this chapter. Conclusion: Inactive HB infection did not increase the risk of adverse effects in this study. In addition, well-designed tests should be performed to confirm the results.

Comparison between clinical estimated fetal weights (CEFW) Versus Ultrasonographic estimated fetal weight (UEFW) for co-relation with actual birth weight (ABW) in 3rd Trimester of Pregnancy

Background: Accurate prenatal estimation of birth weight is useful in the management of labour and delivery. Objective: To determine the correlation between clinical estimated fetal weight with actual birth weight in 3rd trimester of pregnancy and to determine the correlation between Ultrasonographic fetal weight assessment with actual birth weight in 3rd trimester of pregnancy. Material & Methods: This cross sectional study with non-probability purposive sampling technique was conducted in three tertiary care hospitals of Punjab, Department of Obstetrics & Gynaecology, Allied Hospital, Faisalabad, Lady Aitcheson Hospital Lahore and Lady Willington Hospital Lahore. Informed consent was obtained from each female to use their data for research purpose. Demographic details were also noted. Then females undergo CEFW was done by using Johnson’s formula. Then ultrasonography was done on every female by experienced radiologists to get UEFW. FW measurement was done by using Shepard formula. Then females were followed-up till delivery of fetus. Actual birth weight (ABW) was noted on birth. Pearson correlation was used to measure the correlation coefficient for CEFW and UEFW with ABW. P-value≤0.05 was taken as significant. Results: In our study the mean age of the patients was 29.60±6.23 years and the mean gestational age of 33.30±2.31 weeks. The mean BMI value of the patients was 23.08±1.26 Kg/m2, the mean CEFW value 2219.60±556.41 grams while the mean UEFW value of the patients was 2227.77±521.94 grams and the mean value of ABW of the patients was 2284.00±515.29 grams. In our study the positive correlation was found between the CEFW, UEFW with ABW of the baby. Conclusion: Our study results concluded that both the clinical estimation ultrasonography estimation showed the feasible and reliable results. Both showed positive correlation with actual birth weight.

Effect of placental cord blood drainage on duration of third stage of labour

Introduction: Third stage of labour start after delivery of baby and continues till delivery of placental and membranes. Post-partum hemorrhage is most common complication of this stage. Objectives: To compare the mean duration of third stage of labour in patients undergoing spontaneous vaginal delivery with and without placental cord blood drainage. Materials and Methods: This randomized control trial was carried out in three tertiary care hospitals of Punjab, Department of Obstetrics &Gynecology, Allied Hospital, Faisalabad, Lady Aitcheson Hospital Lahore and Lady Willington Hospital Lahore. From 1st July 2018 to 30th December 2018, 188 cases (94 in each group) were selected using non probability consecutive sampling. Total 188 patients were enrolled in the study after taking informed consent and allocated into control and case group by lottery method. In control group cord was clamped from both sides while in case group cord was unclamped from other side and duration of third stage was noted for both groups. Ethical approval was taken from hospital ethical committee. Results: The mean age was 29.06 ± 4.9 years with minimum age of 21 years and maximum age of 45 years. More patients belong to younger age group (20 years to 35 years) i.e. 119 while 69 belonged to elder age group i.e. 36 year to 50 years 63.2 % and 36.7% respectively. Mean duration of third stage of labour in case group was 8.5±2.9 minutes and in control group 10.8±5.4 minutes. More distribution of patients in younger age group 20 -35 years and less in 36 to 50 years i.e. 67% and 33% respectively. Conclusion: This study concluded that unclamping placenta from mother side significantly reduces the third stage of labour