Review-Vitamin D and the prevention of preeclampsia: A systematic review.

To identify the effect of Vitamin D in reducing the risk of preeclampsia in pregnant women. The review was conducted from December 2011 to March 2012 at the University of Sheffield. Studies were included from the Medline data base, Web of Science (Web of Knowledge), Ovid database and Google Scholar. Studies were limited to published literature only; published between January 1992 to March 2012. A total of seven studies were selected for this review based on the inclusion criteria. One was non-randomized clinical trial, three were cohort studies and three were nested case-control studies. The clinical trial showed a positive association between Vitamin D supplements and the reduction of preeclampsia risk in pregnant women. In addition, one large cohort and two nested case-control studies also showed a protective effect of vitamin D in preventing the risk of preeclampsia. However, the other two cohort studies and a nested case-control study could not find any association between vitamin D levels and the risk of preeclampsia in pregnant women. The studies included in this review show conflicting results about the association of vitamin D levels and the risk of preeclampsia. However, in this review more than half of the studies showed a positive link between Vitamin D deficiencies and Preeclampsia. There is a clear need for further trials and other robust studies to identify the effect of Vitamin D on preeclampsia.

Situation analysis of child labour in Karachi, Pakistan: a qualitative study.

In Karachi, large employment opportunities, burgeoning population and the availability of cheap labour might be the contributing factors for the increasing prevalence of child labour. A literature review was conducted in 2007 that included published and unpublished literature since 2000. Various organizations working in the field were also covered, while the perception of the child labourers was covered through three focus group discussions. Common health issues among the child labourers in Karachi included respiratory illnesses, fever and generalised pains, as well as drug and sexual abuse. Organisations working for child labour could be broadly categorised into those working for legal advice and advocacy; those generating statistics; and those that are providing interventions. Discussion with children showed that irrespective of the immediate cause, the underlying determinant for child labour was poverty. The best practices identified included evening schools and drop-in centers for working children with provision for skill-based education and basic health facilities. There is need to have more such centres.

Needle stick injuries among health care workers of public sector tertiary care hospitals of Karachi.

OBJECTIVE: To estimate the frequency of needle stick injuries (NSI) among health care workers (nurses, student nurses and paramedical staff) in public hospitals of Karachi. STUDY DESIGN: Cross sectional, observational. PLACE AND DURATION OF STUDY: This study was conducted in three public tertiary care hospitals of Karachi, from November 2007 to January 2008. METHODOLOGY: Data was collected by structured interview-based questionnaires in Urdu and English language. Questionnaire was designed to obtain information regarding demography, work experience, hepatitis vaccination status, and occurrence of needle stick injuries with associated factors. Needle stick injury that occurred in the previous month was the defined outcome. Data was entered in Epi Data and analyzed in SPSS version 15. RESULTS: A total of 417 health care workers participated in the study. Mean age of the participants was 24+/-11 years. Estimated proportion of participants with history of at least one time NSI was found in 66%. Around 13% (n=54) had one or more NSI in the previous one month at work and half of them were affected by non-sterile needle. None of them sought medical care. Almost 90% of them were not wearing gloves or taking any other protective measures at the time of injury. CONCLUSION: There can be serious consequences of needle stick injuries in public hospitals as large proportion of injuries involve non-sterile used needles and health care workers do not take appropriate measures of protection.

Birth weight estimation--a sonographic model for Pakistani population.

OBJECTIVE: To develop a sonographic birth weight estimation model for Pakistani population and to validate the published models in the same population. METHODS: Data was collected for pregnant women who presented to Radiology Department of Aga Khan University Hospital Karachi from January 2007 to July 2008 and had undergone ultrasound estimation of foetal weight within 4 days prior to a term delivery (37-42 weeks gestation). The neonate's actual birth weight was used to validate the published foetal weight estimation models and modified sonographic birth weight estimation model was derived for our population by using linear regression. RESULTS: Modified sonographic birth weight estimation model for our population was derived by using foetal parameters. No significant difference (p-value > 0.05) of actual and predicted birth weight derived from Our regression model, Campbell and Woo models was noted, however least difference (p = 0.7) was identified between our predicted model (Mean difference 14 +/- 37.7 g). CONCLUSION: Our sonographic modified regression model of foetal weight estimation gave the least difference with actual neonatal birth weight and can be reliably used in our population. Hadlock1, Hadlock2 and Woo2 models are not appropriate in our setting or should be used carefully while predicting foetal weight in our population.

Carotid artery disease in patients undergoing elective coronary artery bypass surgery.

OBJECTIVE: To determine frequency of carotid artery disease in patients undergoing elective coronary artery bypass grafting (CABG) using Doppler sonography. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Radiology Department, The Aga Khan University Hospital, Karachi, from January 2005 to September 2008. METHODOLOGY: Patients with known cardiovascular disease waiting for CABG surgery were enrolled for carotid artery Doppler sonography. A predefined data entry form was used for data collection. Coronary angiography findings, carotid artery findings and other associated factors were noted from medical and radiological records. Frequency and pattern of carotid artery disease along with associated risk factors were evaluated. Data was entered and analyzed in SPSS version 15. Pearson chi-square for categorical and independent "t" test was applied for continuous variables at 95% confidence level. P-value of less than 0.05 were considered significant. RESULTS: A total of 176 patients (85% male, mean age=65 years) undergoing elective coronary artery bypass grafting were evaluated preoperatively for carotid artery disease by neck color Doppler sonography. Twenty percent of patients were found to have advanced carotid artery disease (> 50% stenosis), 6% had critical stenosis (> 75% stenosis) and 3% had complete stenosis. Frequency of atherosclerotic plaques was 50%, more common on right side and more prevalent in common carotid artery. Family background of carotid or coronary artery disease and history of smoking were significantly associated with presence of carotid artery disease (p < 0.05). CONCLUSION: A sizeable proportion of patients undergoing elective coronary artery bypass grafting surgery for coronary artery disease were found to have coexistant carotid artery disease.

Clinical radiology research in Pakistan: from evidence to practice.

OBJECTIVE: To assess the clinical radiology research productivity in Pakistan by type of publication, sources of funding and name of journals. METHODS: A systematic search strategy using key words related to techniques and type of clinical radiology was carried out to identify various studies published in Indexed (Medline) and non-indexed (Pakmedinet) medical journals. RESULTS: Total of 397 studies were identified out of which 173(43%) from Medline (indexed database) and 220 (57%) from pakmedinet (Indexed and non- indexed database of Pakistan Medical journals). Original articles were 294 (74%) but most of them (68%) were published in non-indexed journals and significantly different from other articles types (case reports, short reports, review articles and letter to editors) (p-value < 0.001). No Randomized Controlled Trial was identified. No research was funded by any formal financial agency. As high as 78% of indexed studies were published by radiology centers of Sind province. Private hospitals having radiology department contributed significantly in indexed journals compared to government hospitals (p-value < 0.001). Majority (74%) of the studies were done by radiologists as compared to other non-radiology clinical colleagues (p-value < 0.001). The most preferred journal for publication was the Journal of Pakistan Medical Association (JPMA; N = 43) followed by Annals of King Edward medical college (Ann KEMC; N = 20). Australasian journal of radiology was the most preferred international journal for publication (Australas Radiol N = 3). No significant difference was found in radiology research production in terms of number of publication from and before the year 2000 (p-value 0.51). CONCLUSION: Clinical radiology research production from Pakistan is low in terms of quality and number. Only few studies reach the standard of publication in international medical journals. There is an urgent need of building the foundation of research programmes in radiology and strengthen research capacity building at facility and health policy level.

Psychiatry as a career: a survey of factors affecting students' interest in psychiatry as a career.

The objectives of this study were to determine the characteristics of medical students and graduates interested in choosing psychiatry as a career and the obstacles in choosing this field of medicine. Two private and two public medical institutes were surveyed from June 2007 to August 2007. A self-administered questionnaire was distributed to third, fourth and final year students and to medical graduates doing their internship in these four medical institutes. A total of 909 medical students and graduates participated in the study. Seventeen percent of participants responded positively regarding their interest in psychiatry as a career. Significantly higher proportion belonged to private medical institutes (14% vs. 24%, P-value =0.001). There was no significant difference in reporting interest for psychiatry in regard to age, sex, year in medical school and whether or not the participant had done a psychiatry ward rotation. However significantly higher proportion of participants (22%, n=43) were reporting their interest in the field of psychiatry who had done more than a month long psychiatry ward rotation as compared to those participants (14%, n=54) with less than a month or no psychiatry rotation (P-value=0.01). More students were reporting their interest in psychiatry with a family history of psychiatric illness as compared to without family history (24% vs 16%, P-value=0.03). In conclusion, students and graduates with more than a month long rotation in psychiatry, studying in private medical colleges and with a family history of psychiatric illness were more interested in choosing psychiatry as a career.

Non-fatal limb injuries in motorbike accidents.

OBJECTIVE: To determine frequency and pattern of non-fatal limb injuries in motorbike accidents victims. STUDY DESIGN: Cross-sectional observational study. PLACE AND DURATION OF STUDY: Study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi, from October 2006 to March 2007. METHODOLOGY: Trained data collectors prospectively collected data from the emergency department of JPMC, Karachi using structured pre-tested questionnaires. All motorbike accident victims presented to Emergency department with single or multiple bone injury in body extremities were included. Head injury patients who had first presented to neuro-surgery department were excluded. Motorbike accident victims with soft tissue injuries were also excluded from this study. Chisquare test was applied to find out statistical significance at 95% confidence level. P-value < 0.05 was considered as significant. RESULTS: A total of 137 (39%) patients presented with tibial injury among the study sample of 348 patients, which was significantly higher than the bone injuries of the body part (p<0.001). Out of those, in 26% of patients, fibula was also involved along with tibia fracture. Other bone injuries included femur (16%), radius (9.2%), humerus (8.3%) and others. Radius was the commonest injured bone and in highest proportion among upper limb injuries (p<0.001). Overall, 66% of the injuries in motorbike involved lower limb fractures. The highest proportion of motorbike accidents were observed on Saturdays (31%). Majority of the accident victims were in the age group between 16 and 30 years (41% accident cases), 27% in age group 30 to 45 years, 15% in 45 to 60 years and 5% in >60 years. Those with less than 15 years accounted for 12% of cases. CONCLUSION: Tibial bone is at the greatest risk in motorbike accidents probably due to its superficiality and exposed position while riding motorbike. Protective measures need to be taken for the prevention of disability associated with lower limb involvement in motorbike accidents.

Film retakes in digital and conventional radiography.

OBJECTIVE: To determine the film-retake rates and causes in digital radiography comparison to conventional X-rays method. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Radiology Department, Aga Khan University Hospital, Karachi, from January 2004 to December 2006. PATIENTS AND METHODS: X-rays of different body parts, conducted during the year 2004, with conventional radiography (n=170300), and in 2006 with digital radiography (n=174550), were included in this study. Measurements were done for number of X-rays re-take due to different quality control reasons for both the conventional and digital radiography. Quality control reasons included underexposure, overexposure, positioning errors, patient movements, portable X-rays, grid cutoff, and others (i.e. equipment related) due to which X-ray quality was questionable. Results were expressed in percentages. RESULTS: A total of 9423 X-rays (5.5%) were repeated in conventional radiography (n=170300) due to underexposure (38%), overexposure (28.5%), positioning errors (25%), portable procedures (4%), patient movement (2%), grid cut-off (0.5%), and others (2%). Underexposure was the most frequently responsible factor for the X-ray repetition as compared to other factors (p<0.001). In digital radiography (n=174550), 1464 X-rays (1%) needed to be repeated, which was significantly less in comparison to X-ray repetition in conventional method of radiography (5.5%) [p<0.001]. In digital radiography, the most frequent factor for X-ray re-take was positioning error (435, 30%). CONCLUSION: Digital radiography is associated with significantly lesser number of re-take X-rays as compared to conventional radiography, hence minimizes the exposure of the patients to unnecessary radiations due to re-take X-rays. Positioning error remains a problem even in digital radiography, emphasizing training need for technologists.

Cleaning methods for ultrasound probes.

OBJECTIVE: To determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Radiology Department, the Aga Khan University Hospital, Karachi and Microbiology Department, JPMC, Karachi, from December 2006 to April 2007. PATIENTS AND METHODS: A total of 75 culture swabs from ultrasound probes used for sonographic examinations of different body parts of patients were included in the study. Probes were prospectively randomized into three equal groups with 25 probes in each group. Culture was sent before and after using three different techniques of cleaning ultrasound probe, which included sterilized paper towel, 0.9% saline and swipe over with standard bath soap applied on group A (n=25), group B (n=25) and group C (n=25) respectively. Number of Colony Forming Unit (CFU) of bacteria were calculated on standard agar plate to find out the effectiveness of cleaning methods in reducing bacterial count from the ultrasound probe after the procedures. All samples were tested in single microbiology lab by using same bacterial growth media provided by same manufacturer. Kruskall Wallis, Jonchkheere-Terpstra and Wilcoxon sign rank tests were applied to find out statistical significance. RESULTS: There was a significant reduction in bacterial count after applying either of all three cleaning methods for ultrasound probe compared to count on the probes before cleaning (p<0.001), however, soap cleaning method was the most effective in decreasing bacterial count to the minimum level in comparison to other two methods (p<0.001). The overall reduction in pathogenic bacterial count after performing each cleaning method was 45%, 76% and 98% for paper cleaning, normal saline and soap cleaning method respectively. CONCLUSION: Cleaning ultrasound probe after performing each procedure is a cost-effective practice with potential of reducing nosocomial infections. Soap cleaning technique is the most effective method for reducing bacterial count acquired due to patients' body contact with the ultrasound probes.

CT Pelvis in Children; Should We Routinely Scan Pelvis for Wilms Tumor and Hepatoblastoma? Implications for Imaging Protocol Development.

Wilms tumor and hepatoblastoma are the most common intra-abdominal solid organ childhood tumors. CT examination is one of the routinely performed procedures in hospitals for children with these tumors inspite of high radiation exposure associated with CT scans. Sixty patients (Wilms tumor = 45, hepatoblastoma = 16) were evaluated retrospectively. Higher proportion (44.4%) of metastatic disease was identified at presentation in the Wilms tumor subset as compared to hepatoblastoma (6.3%) [p=0.006]. Metastatic disease was noted in 6 patients having Wilms tumor on follow-up while it was also low in hepatoblastoma which was noted in only 2 patients (p > 0.05). No significant difference was identified in pelvic extension of disease at presentation in both studied population (p > 0.05). Pelvic metastasis was noted in 1 patient only with Wilms tumor on follow-up while no pelvic metastasis was seen in the hepatoblastoma patients (p-value > 0.05).