Predictive Factors of Outcomes in Acute Subdural Hematoma Evacuation.

OBJECTIVE: This comparative cross-sectional study was conducted in the Departments of Trauma and Neurosurgery, Ayub Teaching Hospital, Abbottabad, Pakistan from September 2021 to February 2022 to study predictive factors of outcomes in acute subdural hematoma evacuation. METHODOLOGY: A total of 101 patients with confirmed diagnosis of acute subdural hematoma (ASDH) who underwent surgical evacuation by consultant neurosurgeon were included in the study. A detailed clinical proforma was designed to document all the clinical and demographic details of these patients at the time of admission. Glasgow Coma Scale outcome score (GOS) was used to assess the outcome of patients after the surgery. Sociodemographic and clinical parameters were associated with outcome of surgery in our study participants. RESULTS: Out of 101 patients, 55 (54.5%) were males and 46 (45.5%) were females. Mean age was 43.66±19.66 years with 7.39 as mean Glasgow Coma Scale (GCS) at presentation. Road traffic accident (RTA) 62 (61.4%) was most frequent mechanism of injury followed by fall from height (19.8%) and history of assault (13.9%). In our study, 59 patients had poor outcomes while 42 had good outcomes. Elder age, low GCS at presentation, and use of oral anticoagulant were associated with poor outcomes while pupillary reaction had no effect on the outcome after application of test of significance. CONCLUSION: More than half of the patients managed with surgical evacuation for acute subdural hematoma as per guidelines at our neurosurgical unit had poor outcomes according to Glasgow Coma Scale. In this study, advancing age (>60 years), low GCS score at presentation, and use of oral anticoagulation therapy emerged as significant risk factors for poor outcomes in participants. Pupillary reaction had no effect on outcomes as per this study but this needs further evaluation in future studies.

Measurement of sound levels in a neonatal intensive care unit of a tertiary care hospital, Karachi, Pakistan.

BACKGROUND: High sound levels in the neonatal intensive care unit (NICU) can alter preterm newborn hemodynamics and cause long-term neuro-developmental delays and hearing loss. The study aims to collate data on sound levels in a level IV NICU of a tertiary care hospital, identify the factors associated with them, and compare them with the international standards set by the World Health Organization (WHO), Environmental Protection Agency (EPA), and American Academy of Pediatrics (AAP). METHODS: We carried out a cross-sectional study in NICU from 8th April 2019 to 30th June 2019. Sound levels were recorded for 480 h, using a portable sound meter, the Larson Davis 824. We captured sound levels on alternate days, during different shifts and shift changes and in open pods and single isolation rooms within the NICU. Additionally, we documented the total census, acuity of care, number of staff, number of procedures, and number of items of equipment used. The data was analyzed using t-test, ANOVA, and logistic regression. RESULTS: The average sound level (Leq) and the maximum level (Lmax) recorded were 60.66 ± 2.99 dBA and 80.19 ± 2.63 dBA, respectively, which exceeds international recommendations. The sound level gradually decreased from morning to night hours. The major increase in sound was observed during nursing shift change. Similarly, a significant increase in sound was observed in open bays compared to isolation rooms. However, no difference in sound levels was recorded during weekdays and weekends. The number of healthcare professionals and the number of procedures performed were strongly associated with an increased noise level. CONCLUSION: Sound levels in NICU were beyond the safety range and international recommendations. We observed a significant sound increment during morning hours and at the time of nursing shift change. High sound levels were associated with increased number of healthcare workers and bedside procedures in NICU.

Comparison Between Uses Of Contraceptive Methods In LHW Covered And LHW Uncovered Areas.

BACKGROUND: Family planning is of great importance in population dynamics as unregulated fertility negatively affects the economic stabilization of the country. Family planning is considered an effective way for the improvement of child and maternal health and reduces the maternal and perinatal morality. Total contraceptive prevalence rate (CPR) in Pakistan is 29% even of the fact that 97% Pakistani women know only one method of contraception. This study compares the contraceptive usage among LHW covered and LHW uncovered areas. METHODS: This was a comparative cross-sectional study, which was conducted in LHW covered, and un covered areas in tehsil Takht Bai of district Mardan from August to December 2016. Samples of 102 families were selected randomly. All those females who were married, in reproductive ages (15-49 years) and were not pregnant were included in the study. RESULTS: Out of total 102 females 44 (43.1%) were from LHW covered areas while 58 (56.9%) were from LHW uncovered areas. Overall knowledge about various birth control methods was more in uncovered areas, i.e., 71.4% than the covered ones which was 28.6%, p=0.67 and most ladies knew only about the contraceptive pills as compared to other methods. No statistical difference p=0.86 was found in usage of contraceptive methods among couples living in LHW covered and uncovered areas. CONCLUSIONS: This study highlights contraceptive usage and role of national program for family planning and primary health care in promotion of contraception. A lot more has to be done for the improvement of family planning services in the community.

Awareness, use and perceptions about E-cigarettes among adult smokers in Karachi, Pakistan.

OBJECTIVE: To estimate the prevalence of awareness, current use and intention to use of e-cigarettes among adult smokers. METHODS: This cross-sectional survey was carried out at the Aga Khan University Hospital, Karachi, from July to August 2016, and comprised people aged above 18 years who had smoked more than 100 cigarettes in their lifetime. Convenience sampling method was used. A self-administered questionnaire was used to collect data. SPSS 22 was used for data analysis.. RESULTS: Of the 387 participants, 359(92.8%) were male. The overall mean age was 32.4±12.6 years. Moreover, 215(55.5%) respondents belonged to the middle socio-economic class. Besides, 249(64.3%) respondents were aware of e-cigarettes while 39(10.1%) used them, and 81(20.9%) wanted to use them. Socio-economic status was the best predictor for awareness about e-cigarettes (p<0.001), while gender (p=0.001), occupation

Comparison Between Uses Of Contraceptive Methods In LHW Covered And LHW Uncovered Areasxxx.

BACKGROUND: Family planning is of great importance in population dynamics as unregulated fertility negatively affects the economic stabilization of the country. Family planning is considered an effective way for the improvement of child and maternal health and reduces the maternal and perinatal morality. Total contraceptive prevalence rate (CPR) in Pakistan is 29% even of the fact that 97% Pakistani women know only one method of contraception. This study compares the contraceptive usage among LHW covered and LHW uncovered areas. METHODS: This was a comparative cross-sectional study which was conducted in LHW covered and un covered areas in tehsil Takht Bai of district Mardan from August to December 2016. A sample of 102 families were selected randomly. All those females who were married, in reproductive ages (15-49 years) and were not pregnant were included in the study. RESULTS: Out of total 102 females 44 (43.1%) were from LHW covered areas while 58 (56.9%) were from LHW uncovered areas. Overall knowledge about various birth control methods was more in uncovered areas, i.e., 71.4% than the covered ones which was 28.6%, p=0.67 and most ladies knew only about the contraceptive pills as compared to other methods. No statistical difference p=0.86 was found in usage of contraceptive methods among couples living in LHW covered and uncovered areas. CONCLUSIONS: This study highlights contraceptive usage and role of national program for family planning and primary health care in promotion of contraception. A lot more has to be done for the improvement of family planning services in the community.

The role of G protein coupled receptor-mediated signaling in the biological properties of Acanthamoeba castellanii of the T4 genotype.

Despite advances in antimicrobial chemotherapy and supportive care, the prognosis of Acanthamoeba infections remains poor, suggesting that new targets are needed that can affect parasite survival and host-pathogen interactions. G proteins and their coupled receptors are well known regulators of a variety of cellular functions. The overall aim of the present study was to study the role of G-protein coupled receptor, ß adrenergic receptor on the biology and pathogenesis of keratitis isolate of Acanthamoeba castellanii of the T4 genotype. Inhibition of ß adrenergic receptor using antagonist, propranolol had detrimental effects on the extracellular proteolytic activities A. castellanii as determined using zymographic assays. Conversely, ß adrenergic receptor agonist, isoprenaline showed increased proteases. Interestingly, ß adrenergic receptor inhibition affected A. castellanii growth (using amoebistatic assays), viability (using amoebicidal assays by measuring uptake of Trypan blue) and encystation as determined by trophozoite transformation into the cyst form. Pre-treatment of parasites with propranolol hampered A. castellanii-mediated human brain microvascular endothelial cell cytotoxicity, as measured by the lacatate dehydrogenase release. The aforementioned findings suggest that G-protein coupled receptor, ß adrenergic receptor-mediated signaling in A. castellanii biology and pathogenesis may offer new pharmacological targets.

Expectations of a medical student: the deficit between 'what is' and 'what should be'.

BACKGROUND: Over past few decades, the expectations of medical students about their academics, extracurricular support from college and about their social life at campus have all been changed greatly. The relative scarcity of data about the expectations of Pakistani medical students has merited this study. METHOD: A cross-sectional survey was undertaken at Ayub Medical College, Abbottabad at the in December, 2012 based on random sampling technique. Expectation questionnaire of University of Northumbria for Survey of Student Attitudes, Experiences and Expectations was used. RESULTS: One hundred and sixty-two students responded to the questionnaire with 93 (58.1%) males. Students had a fairly realistic picture of academic demands and college environment. There was major difference in the opinions of male and female students about physical environment of college with female having prior misconception about it. Forty-eight percent student found medical education challenging. About 63.3% students had realistic picture about study habits needed in the college. About 77.9% and 73.8% students had reasonable picture of academic staff and teaching methods at the college respectively. Students had a fair picture of the thorough help from teachers. About 63.5% students seemed well-prepared for the extent to which they would need to be independent learners at medical college. However expectations of 55.6% students about non-academic support were higher than provided. Also only 20.3% students found social adjustments easier than expected. About 39.5% students had fairly accurate expectations regarding the physical environment of the college; however in gender based comparison, about 55% female students felt being mistaken about the environment. CONCLUSION: Academic demands are fairly in accordance with the expectations of students. However there is a need to make course content interesting and more understandable. Also the extracurricular support in form of various facilities should be bolstered. Most importantly, the physical environment needs to be made more amicable especially for female students.