Outcomes of Carotid Endarterectomy with Primary Closure

Background: Cerebrovascular ischemic cases are 3rd leading cause of fatality and neurologic dysfunction in adults. Atherosclerotic lesions outside the carotid cranial circulation are main cause of cerebral ischemia in almost 10-20 percent cases and carotid endarterectomy (CEA) has been proved beneficial for patients with severe carotid artery stenosis to prevent acute cerebrovascular events. Current study is conducted to assess the short-term outcomes of carotid endarterectomy among patients in terms of morbidities and mortalities at our institution during the study period. Material and Methods: This cross-sectional analytical study was carried out at Combined Military Hospital, Rawalpindi during August 2019 to July 2021 to analyze the short-term outcomes of carotid endarterectomy (CEA) with primary closure. All the patients who underwent carotid endarterectomy (CEA) with primary closure during study duration were included in the study. Patients who received selective shunting if Electro Encephalogram (EEG) changes noted were excluded from study. Data was collected after taking verbal consent by using preformed questionnaire. Frequency of morbidities like bleeding, infection, stroke, transient ischemic attacks (TIA), myocardial infarction, repeat operation and revision with stent were noted within postoperative period of one month. Frequency of mortalities in one-month postoperative period among patients undergoing carotid endarterectomy was also calculated. Data was entered and analyzed by using SPSS version 22. Results: Total 198 patients who underwent carotid endarterectomy with primary closure during study duration were included in the study. Age range of the study participants was between 35 to 80 years. Male patients were 107 (54.04%). The comorbidities evaluated in the study participants showed that 172 (86.87%) patients were hypertensive and 73 (36.87%) has diabetes mellitus. The most frequent postoperative morbidities among patients were bleeding and repeat operation. Conclusion: It is concluded that carotid endarterectomy with primary closure is a safe and effective surgical means of stroke prevention.

Helicobacter Pylori Infection with Recurrent Abdominal Pain in Children

Background: Childhood Recurrent Abdominal Pain results in the one of the adulthood complications i.e., irritable bowel syndrome, which is a gastro-intestinal disease. The stomach’s acidic environment is the growth site for Helicobacter Pylori, a pathogenic Gram-negative bacterium with rod shape. It is the main reason for chronic gastritis, gastric adenocarcinoma, peptic ulcers, non-ulcer dyspepsia and mucosa-associated lymphoid tissue (MALT) lymphoma. According to one estimate, 50% of people in world are infected with Helicobacter Pylori. Currently the developing countries are on the hit list of Helicobacter Pylori. The objective of this study was to determine the frequency of Helicobacter pylori infection in the children having recurrent abdominal pain. Materials and Methods: It was a cross-sectional study. This research was carried out during 1.1.2018 to 1.6.2018 in the D.H.Q hospital Mirpur AJK. The sample was consisted of 200 participants among them the proportion of Helicobacter was 8% in patients with Recurrent Abdominal Pain. Results: The mean age of the patients was 12.43 ± 1.23 years. Mostly the age of the sample group was between 8 to16 years. The 4.23 ± 0.47 months was the mean time period of abdominal pain. Helicobacter pylori was found in 47% of patients. Conclusion: In paediatric population, Helicobacter pylori is very common with Recurrent Abdominal Pain. It is a severe problem in children and further study is recommended to explore the risk element associated with this increase trouble of Helicobacter Pylori.

Musculoskeletal Injuries Among Weight Lifters With or Without Supervision ?

Background: People nowadays have developed a new passion of weightlifting. Weightlifting focuses on vigorous muscle development. But injuries are also common in weightlifting. This study aims to compare the injury rates among supervised and non-supervised weightlifters. Methods: A group of 138 weight lifters was divided into two groups i.e. who did training under supervision and the other who did training without any supervision. Injuries related to musculoskeletal system were identified using Nordic musculoskeletal questionnaire. Data was analyzed using SPSS. Chi square test was used to see the association of musculoskeletal pain among weightlifters with or without supervision. Results: Significant association found between musculoskeletal injuries and supervision. Injuries lesser in number among supervised weightlifters as compared to unsupervised weightlifters. Mean age of weight lifters under supervision and without supervision was 21.99 (SD 3.81) and 24.64 (SD 5.01) respectively. Mean workout days /week among weight lifters under supervision was almost same i.e. 5.67 (SD .63) and was 5.62 (SD .81). Out of 51 participants who work-out for 46-60 min, 30 were not under supervision while 31 weightlifters who work-out for 61-90 min were working out under supervision. Injury rate was more in the region of shoulder in both groups supervised and unsupervised groups while hip/thigh region was less involved in both supervised and unsupervised groups. Conclusion: Overall results showed significant association between musculoskeletal injuries and supervision. Injury rate was more among weightlifters who work without supervision as compared to those who work under supervision. Care should be taken and weight lifting and exercises must be performed under expert’s supervision.

Causes of Academic Failure among Nursing Students

Background: Education is the most hopeful discipline which provide pathway for a purposeful and productive life. The progress in any filed is achieved through education. Education is a complex process. Academic failure is the one of the main challenges which students face during academic years. Current study was conducted to identify the causes of academic failure among the nursing students and determine the correlation between these causes. Materials and Methods: A quantitative descriptive cross-sectional study design used to explore the causes of academic failure among the nursing students and correlation between these variables. A convenient sampling technique use to collect the data. Questionnaire distributed in 134 participants. SPSS version 24 was used for data analysis. Results: The mean score of question related to teacher behavior was 2.62 and the overall mean score was 2.62 ± 0.20. Lack of commitment to study was 2.23 and the overall mean score was 2.23 ± 0.22. Problem with learning environment mean 2.61 and the overall mean score 2.61 ± 0.26. The mean score of courses content and examination problem 2.52 and the overall mean score was 2.52 ± 0.32. The unsatisfying relation with family mean score 3.27 and the overall mean score was 3.27 ± 0.30. The future concerns related chosen field mean score was 2.64 and the overall mean score was 2.64 ± 0.20. Conclusion: Causes of student’s failure are the unsatisfied relation with the family and psychological problems of the students. There was positive correlation between all variables except the unsatisfied relation with family and future related concern to the chosen field of study.

Safe Prescription for Junior Doctors in Accordance with All Wales Prescribing Standards

Background: Prescribing errors are quite common and according to one estimate out of 100 patients admitted into UK hospitals 15 will have some form of prescribing error in their records. It is a general understanding that most of the time these errors are made due to lack of awareness. Severity of these errors can range from minor to major mistakes that can lead to fatal results. Materials and Methods: A simplified anonymous approach of identifying these errors and then using a step wise approach to educate the prescribers’ especially junior doctors can be quite fruitful in reducing these errors. Unfortunately there are not many studies or projects available to back our proposal however these seems a logical way forward and is exactly what we have shown in our study. Results: We performed a prospective snapshot study involving 100 inpatients to get baseline measurements. The errors and mistakes were identified and fed back to the junior doctors in an anonymous manner. Clear & legible writing, frequency of use, responsible consultant name, allergy box filled, VTE assessment, oxygen prescribing and labeling of medication discontinuation were the most common negligence identified. At the same time junior doctors were reminded of local prescription standards and guidelines which usually don’t form part of induction. Conclusion: Multiple deficient areas were identified during this audit like legible writing, dosage frequency, VTE prophylaxis and oxygen prescription. It was highlighted to junior doctors how important are these components as they play a key role in patient getting better after medical review. Above mentioned steps did improve prescription errors to an extent, but aim should be to achieve 100% results. Repeated reminders are important in this case as that helps to improve practice and avoid clinical accidents.

Impact of COVID-19 Pandemic and Lockdown Measures on Mental Health

Background: An Uncontrolled Novel COVID-19 started from Wuhan city of China in Late 2019 and spread worldwide has called for unprecedented measures, to prevent it Pakistan government Imposed lockdown on the entire country. Lockdown has a huge impact and affected on mental health of population. The present study aims to assess the effect of COVID-19 on mental health of population and identify the coping strategies to overcome this mental health issues caused by pandemic. Methods: An online survey was administered from 26 May-14 June 2020 to 398 participants. Post Hoc test was performed to examine the associations between general health questionnaire GHQ-12 and socio-economic variables. Results: Losing jobs due to pandemic and lockdown situation and using negative coping strategies were the factors associated with psychological disorders.This study shows high rates of anxiety and stress in younger population specifically in young women with higher odds of endorsing a worst mental health outcome. Outcomes were associated with a number of COVID-19 related risk factors such as challenging family relations, loss of job, no physical activity, financial burden, experiencing stress full events and suicidal ideation. Conclusion: The present situation requires awareness in public media which could be helpful to deal with this and this present article provides details of COVID-19 pandemic situation on mental health of younger population.

Effects of Mosquito coil smoke (D-Transallethrin) on parenchyma of testis of adult Wistar Albino rats

Background: The use of mosquito coils has increased exponentially, especially in the under developed countries. Many researches have been conducted over the past few years to advocate both the possible risks and potential benefits. These coils and the inhalation of their smoke have been proved to cause upper and lower airway tract infections. But still the possible side effects of inhalation of these coil smoke on other organ systems of the body were unclear. Methods: Adult male Wistar rats were divided into two groups each containing eight rats. Group A was control group while group B was allowed to inhale mosquito coil smoke for four week. The experimental group was exposed to MCS for 8 hours / day. Histopathological analysis of testis was carried out. Results: Histopathological studies of rats exposed to MCS revealed changes in parenchyma of testis. Decrease in the height of germinal epithelium and diameter of seminiferous tubules and increase in and vascular congestion was observed. Conclusion: The results of present study suggest that allethrin based mosquito coil smoke has harmful effects on testis

DIAGNOSTIC ACCURACY OF GRAY SCALE ULTRASONOGRAPHY VERSUS COLOR DOPPLER IN SUSPECTED CASES OF ACUTE APPENDICITIS

ABSTRACT: BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease. OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis. MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis. RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%. CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.

COVID-19 Vaccination Challenges in Developing Countries

The pandemic of coronavirus disease 2019 (COVID-19) is challenge of the century for humanity. Pre-pandemic normalcy is assumed to never return until a safe and effective vaccine becomes available and a global vaccination campaign is successfully introduced. To tackle the pandemic of Covid-19 safe and effective vaccines has been developed and pharmaceutical companies Pfizer/BioNTech, Moderna and AstraZeneca started to manufacture the vaccine and make it available in the market. Globally all the countries are in race to secure vaccine access for their populations but it is challenge for developing countries to make vaccine available for the population especially the poor and vulnerable groups. Pakistan is developing country which is facing the double burden of the communicable diseases like malaria, HIV/AIDS, tuberculosis and non-communicable diseases along with financial issues faced by the health system.