Immunoglobulin E (IgE)-Mediated Multiple Myeloma Presenting as Pleural Effusion.

Multiple myeloma (MM) is a disease characterized by the abnormal production of plasma cells. These plasma cells have the property to produce immunoglobulins (Ig), on the basis of which MM can be classified. Immunoglobulin G is responsible for most of the cases, while IgE mediates the rarest form of MM. Since the first case was reported in 1967, knowledge regarding IgE-mediated MM is based on individual case reports. Based on the information available, it is thought that IgE-mediated MM presents clinically with the involvement of renal, bone, and hematological symptoms, which are the same as any other myeloma. However, the MM rarely involves the pleura, leading to malignant pleural effusion. We present a case of IgE-mediated MM with a unique feature of pleural effusion. The patient presented with constitutional symptoms of MM, which were followed by lab investigations revealing low hemoglobin, hypercalcemia, and high creatinine levels. An incidental computed tomography angiography (CTA) revealed lytic lesions in the spine. This was followed by skull and chest X-rays as part of the workup to determine the extent of the disease. It revealed further lytic lesions in the skull, humerus, and scapula, along with pleural effusion. This led to the suspicion of MM, which was ultimately confirmed by serum protein electrophoresis and a bone marrow biopsy. The patient was started on a triple regimen of bortezomib, thalidomide, and dexamethasone, which led to substantial improvement in his symptoms.

Over-the-counter use of short-acting beta-2 agonists: a systematic review.

BACKGROUND: The widespread use of short-acting beta-2 agonists (SABA) as an as-needed treatment for asthma is well-established. However, excessive use of SABA has been linked to undesirable outcomes such as increased risk of asthma attacks, exacerbations, and even death. The availability of SABA as an over-the-counter (OTC) medication has contributed to their overuse, leading to undertreated asthma and reduced access to asthma education. OBJECTIVE: This systematic review aimed to summarize the prevalence, characteristic features of, and factors contributing to over-the-counter SABA purchase or overuse. METHODS: The databases searched included PubMed, Scopus, Springer Link, Google Scholar, CINAHL, and APA PsycArticles. Original research articles reporting the prevalence, characteristics features, and factors regarding over-the-counter SABA use, available as full text, published in English language between the year 2000 and April 2023 were included in this review. Commentaries, letters to editor, review articles, qualitative studies, clinical trials, and conference proceedings were excluded. Data extraction was followed by a review of the quality of studies included and data were then synthesized for meaningful findings. This systematic review had been registered in the PROSPERO with registration number CRD42023421007. RESULTS: A total of 18 articles were included. The prevalence range of OTC SABA users in populations were 1.4% to 39.6% and SABA over-users among OTC users were 14% to 66.4%. Factors mostly associated with this behavior were moderate-severe asthma, and less use of preventers. On top of that, not understanding the risk of SABA overuse was clear in many studies that explored this factor. CONCLUSION: Over-the-counter purchase and overuse of SABA medication is a common problem, leading to adverse consequences such as uncontrolled asthma and increased healthcare utilization. Addressing these issues requires improved patient education about their conditions and adequate information regarding the potential long-term effects of SABA use by the healthcare providers. Management and education of asthma patients, including regular monitoring and follow-up, can help reduce overuse of SABA medication and prevent negative consequences.

Evaluation of Willingness to Accept COVID-19 Vaccine and Willingness to Pay among Pakistani Parents for Their Children Aged 5 to 11 Years: Findings and Implications.

Vaccines are the most efficient and cost-effective tool to halt the transmission and prevention of COVID-19. The current study examined the willingness of parents to vaccinate their children against COVID-19. This was a cross-sectional study that used a questionnaire based on the Health Belief Model, previous history of COVID-19, willingness to accept, and willingness to pay for the COVID-19 vaccine. The questionnaire was administered among parents of children aged 5 to 11 years. Descriptive statistics, χ2 tests, and regression analysis were carried out for data analysis. A total of 474 respondents participated in this survey with a response rate of 67.7%. In our study, a majority of the respondents exhibited a willingness to accept the COVID-19 vaccine for their children (Definitely yes/Probably yes = 252, 53.2%); nevertheless, 229 (48.3%) respondents were unwilling to pay for it. More than three-quarters of the respondents were worried about the probability of COVID-19 infection in their children (n = 361, 76.2%) and were afraid of COVID-19-associated complications (n = 391, 82.5%). Likewise, most respondents showed their concerns regarding the effectiveness of the vaccine (n = 351, 74.1%), vaccine safety (n = 351, 74.1%), and the halal nature of the vaccine (n = 309, 65.2%). Respondents who were aged 40 to 50 years (odds ratio [OR]: 0.101, 95% CI: 0.38-0.268; P < 0.001), family income > 50,000 PKR (OR: 0.680, 95% CI: 0.321-1.442; P = 0.012), and location (OR: 0.324, 95% CI: 0.167-0.628; P = 0.001) were the factors that were likely to impact vaccine acceptance among parents. Education-based interventions are urgently required to improve COVID-19 vaccination acceptance among parents for their children.

Effects of long-term Ailanthus altissima extract supplementation on fear, cognition and brain antioxidant levels.

Introduction: Ailanthus altissima is an indigenous plant known for various remedial properties. The present study aimed to evaluate the neuroprotective potential of methanolic extract Ailanthus altissima (AA) bark as current scientific trend is searching plant for neurodegenerative diseases, worldwide. Methodology: In in-vitro experiments, the AA was analyzed for phenols, flavonoids, antioxidative and cholinesterase inhibitory properties with subsequent detailed characterization for secondary metabolites. The in-vivo neurological effects were evaluated in rats through behavioral assessment for anxiety and memory after chronic administration (28 days) of 50-200 mg/kg of AA. At the end of behavior studies, isolated brains were biochemically tested to determine antioxidant enzyme activity. Results: AA was found rich in phenols/flavonoids and active in radical scavenging with the presence of 13 secondary metabolites in UHPLC-MS analysis. The AA yielded anxiolytic effects dose-dependently in the open field, light/dark and elevated-plus maze tests as animals significantly (P < 0.05 vs control group) preferred open arena, illuminated zone and exposed arms of maze. Similarly, the animals treated with AA showed significant (P < 0.05 vs amnesic group) increase in spontaneous alternation, discrimination index in y-maze, novel object recognition tests. Further, AA.Cr treated rats showed noticeably shorter escape latencies in Morris water maze tests.In biochemical analysis, the dissected brains AA treated rats showed reduced levels of AChE and malondialdehyde with increased levels of first-line antioxidant enzymes i.e. glutathione peroxidase and superoxide dismutase. These observed biological effects might be attributed to phenols and flavonoids constituents owned by AA. -The in-silico studies showed thatconessine and lophirone J phytocompounds have good blood-brain barrier permeability and interaction with AChE. Conclusion: The outcomes of this study validate that bark of Ailanthus altissima might work as a source of bioactive phytochemicals of neuroprotective potential.

Clinical Pharmacokinetics of Metoprolol: A Systematic Review.

BACKGROUND: Metoprolol is recommended for therapeutic use in multiple cardiovascular conditions, thyroid crisis, and circumscribed choroidal hemangioma. A detailed systematic review on the metoprolol literature would be beneficial to assess all pharmacokinetic parameters in humans and their respective effects on patients with hepatic, renal, and cardiovascular diseases. This review combines all the pharmacokinetic data on metoprolol from various accessible studies, which may assist in clinical decision making. METHODOLOGY: The Google Scholar and PubMed databases were searched to screen articles associated with the clinical pharmacokinetics of metoprolol. The comprehensive literature search retrieved 41 articles including data on plasma concentration-time profiles after intravenous and oral (immediate-release, controlled-release, slow-release, or extended-release) routes of administration, and at least one pharmacokinetic parameter was reported in all studies included. RESULTS: Out of 41 retrieved articles, six were after intravenous and 12 were after oral administration in healthy individuals. The oral studies depict a dose-dependent increase in maximum plasma concentration (Cmax), time to reach maximum plasma concentration (Tmax), and area under the concentration-time curve (AUC). Two studies were conducted in R- and S-enantiomers, in which one study reported the gender differences, depicting greater Cmax and AUC among women, whereas in another study S-metoprolol was found to have higher values of Cmax, Tmax, and AUC in comparison with R-metoprolol. Results in different diseases depicted that after IV administration of 20 mg, patients with renal impairment showed an increase in clearance (CL) (60 L/h vs 48 L/h) compared with healthy subjects, whereas a decrease in CL (36.6 ± 7.8 L/h vs 48 ± 6.6 L/h) was seen in patients with hepatic cirrhosis at a similar dose. In comparison with a single oral dose following administration of 15 mg IV in three divided doses, patients having an acute myocardial infarction (AMI) showed an increase in Cmax (823 nmol/L vs 248 nmol/L) at a steady state. Twenty different studies have reported significant changes in CL, Cmax, and AUC of metoprolol when it is co-administered with other drugs. One study has reported a drug-food interaction for metoprolol but no significant changes were seen in the Cmax and AUC. CONCLUSION: This review summarizes all the pharmacokinetic parameters of metoprolol after pooling up-to-date data from all the studies available. The summarized pharmacokinetic data presented in this review can assist in developing and evaluating pharmacokinetic models of metoprolol. Moreover, this data can provide practitioners with an insight into dosage adjustments among the diseased populations and can assist in preventing potential adverse drug reactions. This review can also help avoid side effects and drug-drug interactions.

Healthcare Professionals' Compliance with the Standard Management Guidelines towards the Use of Biological Disease-Modifying Anti-Rheumatic Drugs in Rheumatoid Arthritis Patients.

Treatment of rheumatoid arthritis (RA) is complicated, with numerous aspects influencing decision-making, including disease severity, comorbidities, and patient preferences. The present study aimed to evaluate healthcare professionals' (HCPs) knowledge of biological disease-modifying anti-rheumatic drugs (bDMARDs) and their compliance with the standard management guidelines for assuring optimal RA therapy. The cross-sectional, survey-based study was performed in various healthcare and academic settings in Karachi, Pakistan to probe HCPs' knowledge of bDMARDs and their compliance with the European League against Rheumatism (EULAR) recommendations for the management of RA patients. Overall, n = 413 questionnaires were included in our study (response rate: 82.6%). The physicians were further well-informed about the indications (n = 276, 91.3%, p = 0.001) and monitoring requirements (n = 258, 85.4%, p = 0.004). The pharmacists were more knowledgeable about the drug targets (n = 96, 86.4%, p = 0.029) and their mechanisms of action (n = 80, 72.0%, p = 0.013). Male respondents as compared with females (41.3% vs. 35.6%, p = 0.04), and physicians as compared with pharmacists (40.7% vs. 37.8%, p = 0.012), were more confident in using bDMARDs than conventional treatment in RA patients. Our findings show that the respondents were familiar with the attributes of bDMARDs and the standard management guidelines for RA care. Our results may be relevant in creating new methods, guidelines, and treatments to enhance RA treatment adherence, satisfaction, and health outcomes.

A national survey to assess breast cancer awareness among the female university students of Pakistan.

The incidence of breast cancer is increasing in Pakistan as well as globally. Awareness of women about breast cancer plays a cornerstone role in its early detection, better management, and prevention. Keeping this in mind, a cross-sectional study was carried out to assess the awareness of female university students about breast cancer's risk factors, signs and symptoms, and breast cancer examination. The data was collected from female university students studying in Pakistan. A total of 774 participants completed the survey and recorded their responses on an online pre-tested self-administered questionnaire. Only 29.8% of the participants have identified breast cancer history in their first-degree relatives as a risk factor. Moreover, 14.1% of the participant considered that the use of oral contraceptives for more than 5 years can increase the risk of developing breast cancer. In addition, inward pulled nipple, wounds around the nipple, and abrupt changes in the breast size were considered as the sign and symptoms of breast cancer by 25.2%, 25.7%, and 31.7% of the participants, respectively. Moreover, only 20.9% of the participants identified the correct year for starting breast cancer examination and 44.4% of the respondents marked that mammography should be initiated after 40 years. Overall, the university female students of Pakistan were poorly aware of breast cancer's risk factors, signs and symptoms, and breast examination. This study has highlighted the need for initiation of aggressive strategies regarding breast cancer awareness in both the literate and illiterate female population of Pakistan.

Concept generation of cognitive enhancement: healthcare professionals' approach towards the impact and utilization of cognitive enhancers in academic context.

Cognitive enhancers (CEs) encompass a wide range of drugs, including prescription medications for attention deficit disorders and pharmacological compounds for cognitive enhancement. It is well-documented that the students are the leading cohort of CEs users. Exploring how healthcare professionals perceive the use of CEs for academic accomplishments is significant to understand their encouragement of CE use. Hence, the purpose of the current study was to look at healthcare professionals' attitudes and perceived understanding about the usage of CEs in academic contexts. The study was a quantitative cross-sectional research design conducted in different healthcare and academic settings of Karachi. The respondents were approached either through social media platforms or the official email addresses of their working organizations. Data were collected through a web link of an online questionnaire that included four sections; inquiring about the respondents' demographics characteristics, their knowledge about CEs, their attitudes towards the use and impact of CEs, and their inclination to use a hypothetical prescription-only CE. The response rate of the study was 73.3%. The majority of the respondents negated to permit university students to using CEs for cognitive boost (n = 360, 67.1%), to concentrate (n = 406, 75.7%), to increase vigilance (n = 394, 73.5%) or to mitigate the effects of other medicines (n = 312, 58.2%). The pharmacists were more likely to refute that using CEs by the students is safe (pharmacists 10.8% vs. physicians 8.3%, p=<0.001), beneficial (pharmacists 12.7% vs. physicians 5.3%, p=<0.001), or necessary (pharmacists 17.6% vs. physicians 12.8%, p=<0.001). The major reasons for not encouraging the use of CEs were fear of misuse (n = 510, 95.1%), safety concerns (n = 495, 92.3%), and their consideration for CE as unnecessary medical intervention (n = 441, 82.2%). The findings indicated that overall, respondents have a clear consensus of not letting university students use CEs for cognitive improvement or any other purpose implying that cognitive enhancement is not yet a common or approved medical practice by the healthcare professionals in Pakistan.

Optimizing sowing date for peanut genotypes in arid and semi-arid subtropical regions.

Peanut (Arachis hypogea L.) is an important nut crop extensively grown in rainfed regions of Pakistan. The crop requires low inputs; thus, could grow successfully under diverse environmental conditions. Due to pegging ability, peanut grows aggressively in sandy and sandy-loam soils. However, it has not introduced to Thal region of southern Punjab, Pakistan. A two-year field experiment was conducted to optimize sowing dates for two peanut genotypes ('BARI-2016' and 'NO-334') in Thal region (Layyah). Similarly, a yield trial was conducted at Chakwal where both genotypes are extensively grown. Five sowing dates (10th April, 1st May, 20th May, 10th June and 30th June) were included in the study. The highest seed yield was obtained with early sown crop (10th April) during both years. Pod formation reduced with increasing atmospheric temperature and no pods were formed on the plants sown on 30th June. Decreased pod formation seemed a major reason for low yield in late-sown crop. The highest yield was observed for the crop sown on 10th April, which was decreased by 40% for the crop sown on 1st May. Genotype 'BARI-2016' performed better for seed yield at both locations compared with 'NO-334'. The results suggested that genotype 'BARI-2016' is more adaptive to arid and semi-arid condition under rainfed or irrigated conditions. Sowing peanut at optimum time would increase seed yield in arid and semi-arid regions. Nonetheless, 'BARI-2016' can be grown under rainfed and irrigated conditions successfully.

Economic Burden of Chronic Obstructive Pulmonary Disease Patients in Malaysia: A Longitudinal Study.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) requires long-term pharmacological and non-pharmacological management that encompasses continuous economic burden on patients and society, and also results in productivity losses due to compromised quality of life. Among working-age patients, COPD is the 11th leading cause of work productivity loss. OBJECTIVE: The aim of this study was to assess the economic burden of COPD in Malaysia, including direct costs for the management of COPD and indirect costs due to productivity losses for COPD patients. METHODOLOGY: Overall, 150 patients with an established diagnosis of COPD were followed-up for a period of 1 year from August 2018 to August 2019. An activity-based costing, 'bottom-up' approach was used to calculate direct costs, while indirect costs of patients were assessed using the Work Productivity and Activity Impairment Questionnaire. RESULTS: The mean annual per-patient direct cost for the management of COPD was calculated as US$506.92. The mean annual costs per patient in the management phase, emergency department visits, and hospital admissions were reported as US$395.65, US$86.4, and US$297.79, respectively; 31.66% of COPD patients visited the emergency department and 42.47% of COPD patients were admitted to the hospital due to exacerbation. The annual mean indirect cost per patient was calculated as US$1699.76. Productivity losses at the workplace were reported as 31.87% and activity limitations were reported as 17.42%. CONCLUSION: Drugs and consumables costs were the main cost-driving factors in the management of COPD. The higher ratio of indirect cost to direct medical costs shows that therapeutic interventions aimed to prevent work productivity losses may reduce the economic burden of COPD.

Translation and validation of the Test of Adherence to Inhalers (TAI) questionnaire among adult patients with asthma in Malaysia.

OBJECTIVE: The Test of Adherence to Inhalers (TAI) is a validated self-reported questionnaire that can reliably assess adherence to inhalers through patient self-report. However, it was not available in Bahasa Melayu (BM) language, nor has it been validated for use in the Malaysian population. The study aimed, therefore, to translate the 10-item TAI questionnaire into BM and evaluate its psychometric properties. METHODS: The translation of the English version of the valid 10-item TAI questionnaire into BM was followed by subjecting it to a series of tests establishing factorial, concurrent and known group validities. Concurrent validity was assessed through Spearman's rank correlation coefficient against pharmacy refill-based adherence scores. Known group validity was assessed by cross-tabulation against asthma symptom control and using chi-square test. The internal consistency of the test scale was determined by a test-retest method using Cronbach's alpha (α) value and intraclass correlation coefficients. RESULTS: A total of 120 adult asthma patients participated in the study. A 2-factor structure was obtained and confirmed with acceptable fit indices; CFI, NFI, IFI, TLI >0.9 and, RMSEA was 0.08. The reliability of the scale was 0.871. The test-retest reliability coefficient for the total sum score was 0.832 (p < 0.01), which indicated good reliability. The 10-item TAI-BM established concurrent and known group validities. The sensitivity and specificity of the tool were >85%. CONCLUSIONS: The scale successfully translated into BM and validated. The 10-item TAI-BM appears fit for use in testing inhaler adherence of Malaysian patients with asthma.

Vaccine Prices: A Systematic Review of Literature.

Vaccines are among the most vital interventions to control and reduce the morbidity and mortality worldwide. In accessing vaccines, pricing is usually the single most important deciding element. However, there is a scarcity of the literature on the vaccines pricing. The current study aims to review vaccine prices from the published literature and to evaluate factors that impact the pricing of vaccines. The literature (from 2015-2020) was reviewed to identify the original research articles. Systematic searches were conducted across the five databases including, Google Scholar, PubMed, Science Direct, Scopus and Springer Link. Literature search yielded 23,626 articles, of which 7351 were screened and 7310 articles were excluded based on title and abstracts relevance. The 41 studies were selected for full text review and 4 studies were found to meet the inclusion criteria. The included studies discussed vaccine prices for childhood vaccines, for Human Papilloma Virus (HPV) in US, China and in Europe. One study detailed the various scenarios of the HPV vaccines pricing. It was found that recently introduced vaccines have higher prices owing to the involvement of technology and research for their manufacture. However, prices tended to decrease over some maturation in price and by the involvement of Global Alliance for Vaccine Initiative (GAVI) and other allies. The prices of vaccines in China were much lower than the other high-income countries and the prices offered through United Nations Children's Fund (UNICEF), mainly due to the large scale of demand in China. The affordable prices of vaccines were related to delicate procedures involving multiple stakeholders and a shorter duration of contract. This review systematically evaluated the literature and identified key factors that could impact vaccines pricing. The prices were higher for the newly introduced vaccines into the market. However, with the price maturation, there was a decline in the pricing and affordable prices could be achieved through tender pricing and involvement of GAVI and other allies.

A Qualitative Evaluation of Adverse Drug Reaction Reporting System in Pakistan: Findings from the Nurses' Perspective.

The contribution of all key healthcare professionals is vital to promote an efficient adverse drug reaction (ADR) reporting system. In this context, nurses are important as they are in a better position to observe a patient's response regarding the drug therapy and to report an ADR. The aim of the study was to explore the perspectives of nurses about ADR reporting system in Lahore, Pakistan. A total of 21 nurses were interviewed. The thematic content analysis of the qualitative interviews yielded six major themes and eight subthemes. Major themes included: (1) Knowledge about the concept of the medication safety & the ADR; (2) Knowledge regarding pharmacovigilance activities; (3) Willingness to report; (4) Practices related to the ADR reporting; (5) Barriers to the ADR reporting; (6) Facilitators to the ADR reporting. The majority of the nurses were aware of medicine safety and ADRs, but in many cases, they were unable to report these ADRs. The study pointed out considerable concerns regarding the knowledge and practices of nurses about pharmacovigilance activities in their workplace, mainly due to increased workload, due to the absence of a reporting system and legal liability. The main challenges turned out to be the lack of knowledge and training, as well as the implementation of guidelines. Based on the findings, it is suggested that outcome of this study can serve as a guide to design policies that support ADR reporting by nurses in Pakistan.

Physicians' Understanding and Practices of Pharmacovigilance: Qualitative Experience from A Lower Middle-Income Country.

Developed countries have established pharmacovigilance systems to monitor the safety of medicines. However, in the developing world, drug monitoring and reporting are facing enormous challenges. The current study was designed to explore the challenges related to the understanding and practices of physicians in reporting adverse drug reactions in Lahore, Pakistan. Through the purposive sampling technique, 13 physicians were interviewed. All interviews were audio-recorded, transcribed verbatim, and analyzed for a thematic content analysis. The thematic content analysis yielded six major themes: (1) Familiarity with medication safety and adverse drug reaction (ADR) concept, (2) Knowledge about pharmacovigilance activities, (3) Practices related to ADR reporting, (4) Barriers impeding ADR reporting, (5) Acknowledgement of the pharmacist's role, and (6) System change needs. The majority of the physicians were unaware of the ADR reporting system; however, they were ready to accept practice changes if provided with the required skills and training. A lack of knowledge, time, and interest, a fear of legal liability, poor training, inadequate physicians' and other healthcare professionals' communication, and most importantly lack of a proper reporting system were reported as barriers. The findings based on emerging themes can be used to establish an effective pharmacovigilance system in Pakistan. Overall, physicians reported a positive attitude towards practice changes, provided the concerned authorities support and take interest in this poorly acknowledged but most needed component of the healthcare system.

Causative bacteria and antibiotic resistance in neonatal sepsis.

BACKGROUND: Neonatal sepsis is characterised by bacteraemia and clinical symptoms caused by microorganisms and their toxic products. Gram negative bacteria are the commonest causes of neonatal Sepsis. The resistance to the commonly used antibiotics is alarmingly high. The major reason for emerging resistance against antibiotics is that doctors often do not take blood cultures before starting antibiotics. We have carried out this study to find out various bacteria causing neonatal sepsis and their susceptibility to antibiotics for better management of neonatal sepsis. METHODS: A total of 130 neonates with sepsis who were found to be blood culture positive were taken in this study. Culture/sensitivity was done, isolated organisms identified and their sensitivity/resistance was noted against different antibiotics. Data were arranged in terms of frequencies and percentage. RESULTS: Out of 130 culture proven cases of neonatal sepsis, gram negative bacteria were found in 71 (54.6%) cases and gram positive bacteria in 59 (45.4%) cases. Staphylococcus aureus was the most common bacteria found in 35 (26.9%) cases followed by Escherichia coli in 30 (23.1%) cases. Acinetobacter species, Staphylococcus epidermidis, Klebseila, Streptococci, Enterobacter cloacae and Morexella species were found in 17 (13.1%), 17 (13.1%), 13 (10%), 7 (5.4%), 6 (4.6%), and 5 (3.8%) cases respectively. In most of the cases causative organisms were found to be resistant to commonly used antibiotics like ampicillin, amoxicillin, cefotaxime, and ceftriaxone (77.7%, 81.5%, 63.1%, and 66.9% respectively). There was comparatively less (56.9%) resistance to ceftazidime. Gentamicin had resistance in 55.1% cases, while amikacin and tobramycin had relatively less resistance (17.4% and 34.8% cases respectively). Quinolones and imipenem had relatively less resistance. Vancomycin was found to be effective in 100% cases of Staphylococcus group. CONCLUSION: Staphylococcus aureus are the most common gram positive bacteria and Escherichia coli are the most common gram negative bacteria causing neonatal sepsis. Resistance to commonly used antibiotics is alarmingly increasing. Continued surveillance is mandatory to assess the resistance pattern at a certain level.

Hypoxic ischemic encephalopathy in neonates.

BACKGROUND: Birth anoxia remains an important cause of mortality and morbidity in neonates. Hypoxia/ischemia can lead to permanent brain damage and also affects other tissues of the body. It results from lack of oxygen before, during or after birth. The study was designed to assess the risk factors of birth asphyxia, common presentations and association of Apgar score with grades of hypoxic-ischemic encephalopathy. METHODS: The study is descriptive, prospective and carried out in the Paediatric Department of Ayub Teaching Hospital, Abbottabad from September 2007 till September 2008. A total number of 181 neonates (144 males and 37 females) who showed the neurological signs of hypoxic-ischemic encephalopathy were included in the study. Maternal history was taken, Apgar scoring was done and neurological grading was done for the assessment of brain damage. RESULTS: Out of 181 neonates 77.9% were full term, 8.8% were premature, 5.2% were having intra uterine growth retardation and 6.1% were post mature. 38.7% were diagnosed as having grade-3, 38.7% as grade-2 and 22.6% as grade-1 encephalopathy. Mortality due to hypoxic ischemic encephalopathy in our unit was 16%. 52.5% of the mothers were primigravida, 50% of the multigravid mothers had history of perinatal deaths, and 6.1% had ante-natal examination. Antenatal factors like lack of antenatal examinations, toxaemia of pregnancy and prolonged labour were major contributors to the mortality of neonates. CONCLUSION: Primigravid mothers, maternal anaemia, lack of antenatal examination, toxaemia of pregnancy and prolonged labour were the major contributors to the hypoxic ischemic encephalopathy. Early recognition of the risk factors and public health awareness needs to be addressed. Improvements in maternal health and regular antenatal checkups should be emphasised.