Understanding the Crisis: Prevalence and Key Determinants of Stunting in Children Aged 2 to 5 Years in an Afghan Refugee Camp in Kohat.

BACKGROUND: Stunting, characterized by impaired growth and development due to malnutrition and illness, is a significant public health concern with profound implications for cognitive and physical development. This issue is particularly severe in refugee settings, where food insecurity and limited access to healthcare exacerbate the problem. OBJECTIVE: This study aimed to evaluate the prevalence and determinants of stunting among children aged 2 to 5 years in an Afghan refugee camp in Kohat, Pakistan. METHODS: A cross-sectional observational design was employed, collecting data from children aged 2 to 5 years who had resided in the camp for at least six months. A pre-validated, standardized questionnaire was administered to parents or guardians to gather data on socio-demographic factors, dietary intake, and health history. Stunting was defined as a height-for-age Z-score less than -2 SD from the median of the WHO Child Growth Standards. Anthropometric measurements were taken following WHO guidelines. Bivariate and multivariate logistic regression analyses were conducted to identify predictors of stunting. RESULTS: Out of 384 children, 153 (40%) were found to be stunted. The prevalence was slightly higher among boys (80 out of 153, 52%) compared to girls (73 out of 153, 48%). Significant predictors of stunting included a lack of parental education (adjusted odds ratio (AOR) for fathers 1.8, 95% confidence level (CI) 1.2-2.9; AOR for mothers 2.1, 95% CI 1.3-3.4), a history of infectious diseases (AOR 1.9, 95% CI 1.2-3.0), and low dietary diversity (AOR 2.3, 95% CI 1.4-3.7). CONCLUSION: The study highlights the high prevalence of stunting among children in the refugee camp, underscoring the need for comprehensive interventions targeting healthcare improvement, parental education, economic support, and dietary diversity to reduce stunting rates and improve children's health outcomes.

Effectiveness of Oral Azithromycin in Treating Enteric Fever: A Hospital-Based Study on Pediatric Patients.

Introduction Enteric fever is prevalent in underdeveloped and developing countries. It is caused by Salmonella Typhi, which has developed resistance over the years to commonly used antimicrobials. Meropenem is an effective treatment for all complicated and uncomplicated extensively drug-resistant (XDR) bacteria, but it is administered intravenously, three times daily, by infusion, and it is quite expensive for the patient. Oral azithromycin is shown by some authors to be effective in extensively drug-resistant enteric fever. Material and methods This retrospective cross-sectional study was conducted in the outpatient department of Lady Reading Hospital Medical Teaching Institution, Peshawar. The duration of the study was one year. Data was collected after approval from the hospital's Ethical and Research Committee. All pediatric patients meeting the inclusion criteria for extensively drug-resistant enteric fever were included. Data on patient demographics, blood culture and laboratory results, treatment given, and effectiveness were documented in a specialized proforma. Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, US) was used for data analysis. Results Out of the total 106 patients, 72 (67.9%) were male and 34 (32.1%) were female. The mean age was 7.51 ± 2.75 years, with a range of 1 to 15 years. Among them, 66 (62.3%) had anemia (hemoglobin less than 11 grams per deciliter for under 5 years and 11.5 for 5-15 years old children), with a mean hemoglobin level of 10.6 ± 1.53 grams per deciliter (g/dl), ranging from 7.2 to 13.8 g/dl. Thrombocytopenia was found in 14 (13%) patients. The mean platelet count was 317 x 103 ± 164 cells per microliter, with a range of 61 x 103 to 834 x 103 cells per liter. The mean total leukocyte count was 9.71x 103 ± 4.321 cells per microliter, with a range of 2.01 x 103 to 30.40 x103 cells per microliter. However, leucopenia was seen in only 5 (4.7%) patients. In 98.1% of cases, azithromycin was found to be effective in treating enteric fever caused by extensively drug-resistant Salmonella. Conclusion Azithromycin is effective in treating extensively drug-resistant enteric fever. It can be confidently used in patients with no or mild complications with extensively drug-resistant enteric fever. Good compliance and complete dosage should be followed to avoid resistance to this drug. Blood cultures should always be sent when prescribing antibiotics, especially when suspecting enteric fever.

Frequency and impact of individual symptoms on quality of life in dry eye disease in patients presenting to a tertiary care hospital.

OBJECTIVE: To assess the frequency of symptoms and impact on quality of life in individuals with dry eye disease. METHODS: The cross-sectional, study was conducted from December 2018 to June 2019 at the outpatient clinic of the Department of Ophthalmology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, and comprised dry eye disease patients aged at least 13 years with ocular burning sensation, lacrimation, grittiness, photophobia, redness or itching. Tear Film Breakup time <10 sec and / or positive ocular surface staining >5 corneal spots, >9 conjunctival spots, lid margin staining ≥ 2mm in length were used to diagnose the disease. Data was collected using the Dry Eye Quality of Life Score questionnaire. Data was analysed using SPSS 25. RESULTS: of the 191 patients, 135(71%) were females and 56(29%) were males. The overall mean age was 39.8±16.6 years. Itching 155(81.2%), watering 151(79.1%) and burning 124(64.9%) were the most frequent symptoms, with watering (p<0.001) and photophobia (p=0.012) significantly impacting quality of life. CONCLUSIONS: The most common symptoms among patients of dry eye disease affecting their quality of life were itching, watering, burning, photophobia and low mood.

Surgical Management of Odontoid Fracture in Elderly.

Odontoid type II fractures are associated with high mortality in the elderly. No formal guidelines are present regarding the treatment of such fractures. Their management can be done either conservatively or surgically, however, surgical treatment is technically demanding and relatively new. We report a case of 75 years old man who presented to our clinical setting, following a history of fall. The CT scan and MRI showed odontoid type II fracture. With time, the neurological deficit got marked and he underwent transoral odontoidectomy and occipitocervical fixation using rods and screws via posterior approach. Patient's neurological condition improved dramatically and on the short term follow up, he had no motor deficit. Our experience suggests that occipitocervical fixation via posterior approach is a viable option for the management of odontoid type II fracture in the geriatric population.

Quantification of sparfloxacin in pharmaceutical dosages and biological samples.

A simple and fast method for spectrophotometric determination of sparfloxacin using p-dimethyl-aminobenzaldehyde (DMAB) has been developed. A yellow coloured product formed from reaction between sparfloxacin and DMAB as a result of condensation reaction at room temperature. The maximum absorbance was found at 392 nm with molar absorptivity of 4.9 × 10(3) L mol(-1) cm(-1). All parameters for the reaction, as concentration of DMBA reagent, molarity of sulphuric acid, and reaction temperature were studied. Under the conditions studied, a linear relationship between absorbance of the condensation product and concentration of sparfloxacin in the range of 2.0-80.0 µg mL(-1) was found with good correlation coefficient (0.9997). The limits of detection (LOD) and quantification (LOQ) for the proposed method were found to be 0.22 and 0.75 µg mL(-1) respectively. The repeatability and accuracy (model) of the method was studied at three different concentrations of sparfloxacin and found with value of relative standard deviation less than 2.0%. The method was found selective for determination of sparfloxacin in the presence of commonly used excipients in dosage forms. The developed method was validated statistically and applied successfully to the analysis of the drug in pure form, pharmaceutical preparations, and spiked blood plasma and urine samples with good accuracy (real) and precision. The percentage recovery was found from 99.0-100.0% with relative standard deviation less than 1%. The results of the proposed method were compared statistically with the results of literature HPLC method.

A reappraisal of contributing factors leading to shunt infection.

BACKGROUND: Central nervous shunt infection (CNSI) is a cause of significant morbidity, causing shunt malfunction and chronic ill health. It can also lead to prolong hospital stay. The aim of this study was to look into the factors responsible for neurosurgical shunt infection and measures to prevent them. METHOD: This retrospective case study was done with nonrandomized convenience sampling. We studied 121 patients who underwent neurosurgical shunt operations during year 1994 to 1999. These patients received pre, per and post operative antibiotics to combat shunt infection. Study design was retrospective case study with non randomized convenience sampling. RESULT: Out of 121 patients, 65 patients were females and 56 males. The total number of shunts procedures performed in these patients was 151. Ninety-seven patients operated once for shunt procedure. Eighty-three (83) patients underwent ventriculo-peritoneal shunt, 10 patients underwent lumbo-peritoneal shunt, 3 had ventriculo-pleural shunt and 1 had ventriculo-atrial shunting done. Three patients developed shunt infection, only one had true primary infection. All were adults with male to female ratio of 2 to 1 and in all of them shunt was inserted first time. CONCLUSION: Strict aseptic technique and prophylactic use of antibiotics have critical role in the prevention of shunt infections.

Salvage decompressive craniectomy in malignant MCA infarcts--results of local experience at Shifa International Hospital, Islamabad, Pakistan.

Malignant infarctions of the middle cerebral artery (MCA) have high mortality. Recent studies showed decreased mortality with good functional outcome in young people with decompressive surgery. We report prospective, non-randomized case series of live patients in whom successful life saving decompressive craniectomy was performed. All five were males. Mean age was 59.2 +/- 13 years. Four had right MCA infarction while I had left MCA infarction. Ipsilateral temporoparietal craniectomy with duraplasty was performed in mean time of 76 +/- 27 hours after onset of symptoms. Four (80%) patients were discharged to home in awake, alert, conversant, hemiparetic state. One patient developed status epilepticus, and was transferred to another facility in intubated. sedated state. Three month follow-up on three patients showed moderate improvement in neurological status. Early craniectomy was life saving in all of our patients. Neurosurgical intervention should be considered early in large MCA infarcts, especially in young patients.

Thoracolumbar junction injuries and their management with pedicle screws.

BACKGROUND: To evaluate the use of pedicle screw fixation in earthquake injured thoracolumbar spine. METHODS: Nineteen patients with posttraumatic instability of lower thoracic or upper lumbar spine were included in the study. White and Panjabi criteria was used to assess spinal instability. All patients underwent open reduction and internal fixation by posterior approach. Pedicles were localized using detailed anatomical landmarks and intraoperative imaging. Local bone was used as bone graft. The neurological status of the patients and any other complications were noted up to one year. RESULTS: There were 19 patients with unstable thoracolumbar junction injuries who were managed with pedicle screws and rods. Females were more affected (F:M ratio was 8.5:1). Wedge compression was the commonest. None of the patients deteriorated after surgery. There were 20 Frankel improvements in 18 patients (1.11 Frankel on average) with neurological deficit whereas 1 patient in Frankel E remained in the same grade on subsequent follow-ups. There was one patient with wound infection and one patient developed DVT. None of the patients developed bedsores. CONCLUSION: Pedicle screw fixation is a useful choice for thoracolumbar junction injuries for achieving reduction and stability in both anterior and posterior column injuries, without affecting extra motion segments.