Assessment of particulate matter (PM) in ambient air of different settings and its associated health risk in Haripur city, Pakistan / Avaliação de material particulado (MP) no ar ambiente de diferentes configurações e sua associação com o risco à saúde na cidade de Haripur, Paquistão

Particulate matter (PM) is a major air pollutant causing serious health problems. The aim of the present study was to find out concentration of PM in ambient air and its associated health risk in Haripur city, Pakistan. Twenty-three samples were taken at various educational institutes, hospitals, recreational areas and industries in Haripur city. Concentration of PM2.5 (µg/m3) and PM10 (µg/m3) was measured with Youngteng YT-HPC 3000A portable PM counter. The results revealed that values of both PM2.5 and PM10 were above the permissible limits (35 µg/m3 for PM2.5 and 150 µg/m3 for PM10) set by Environmental Protection Agency Pakistan (Pak-EPA) in all the educational institutes, hospitals, recreational areas and industries investigated. Furthermore, significant (p<0.05) variation was found in the concentration of both PM2.5 and PM10 in all the educational institutes, hospitals, recreational areas, and industries studied. The concentration of PM2.5 was positively correlated with the concentration of PM10 in all the sampling sites. Therefore, from 1-14 scale standard of health index, the values of PM2.5 and PM10 exhibited that the ambient air quality of Haripur city Pakistan is under high risk. If the regulatory authorities such as Environmental Protection Agency, Health Department and Local Government monitor PM pollution in different settings of Haripur city, then a decrease can be possible in the pollution level. The remedies that can be taken to overcome the problem of ambient air pollution such as PM are plantation of trees at the sites where there are higher levels of air pollutants and use of masks on personal protection basis along with implementation of pollution control system in industries of Hattar Industrial Estate Haripur city, Pakistan.

O material particulado (MP) é um importante poluente do ar que causa sérios problemas de saúde. O objetivo do presente estudo foi descobrir a concentração de MP no ar ambiente e sua associação com o risco à saúde na cidade de Haripur, Paquistão. Vinte e três amostras foram coletadas em várias instituições de ensino, hospitais, áreas recreativas e indústrias na cidade de Haripur. A concentração de MP2,5 (µg/m3) e MP10 (µg/m3) foi medida por meio do contador de MP portátil Youngteng YT-HPC 3000A. Os resultados revelaram que os valores de MP2,5 e MP10 estavam acima dos limites permitidos (35 µg/m3 para MP2,5 e 150 µg/m3 para MP10) estabelecidos pela Agência de Proteção Ambiental do Paquistão (Pak-EPA) em todas as instituições de ensino, hospitais, áreas recreativas e indústrias investigadas. Além disso, foi encontrada variação significativa (p < 0,05) na concentração de MP2,5 e MP10 em todos os locais estudados. A concentração de MP2,5 correlacionou-se positivamente com a concentração de MP10 em todos os locais de amostragem. Portanto, a partir da escala padrão 1-14 do índice de saúde, os valores de MP2,5 e MP10 mostraram que a qualidade do ar ambiente na cidade de Haripur, Paquistão, está sob alto risco. Se as autoridades reguladoras, como a Pak-EPA, o Departamento de Saúde e o governo local, monitorarem a poluição por MP em diferentes configurações da cidade de Haripur, pode ser que haja uma diminuição no nível de poluição. As medidas que podem ser tomadas para superar o problema da poluição do ar ambiente, como o MP, são o plantio de árvores nos locais onde há maiores níveis de poluentes atmosféricos, o uso de máscaras e a implantação de sistema de controle de poluição nas propriedades industriais de Hattar, na cidade Haripur, Paquistão.

Episode of Hepatitis C viral infection in the people of Swat, Pakistan / Episódio de infecção viral por Hepatite C no povo de Swat, Paquistão

Infectious agents cause serious diseases in humans worldwide and are responsible for the high rate of morbidity and mortality. The prevalence and epidemiology of infectious disease (HCV) in the hospital visited patients referred by the physicians through the initial findings and their associated risk factors were studied in Swat. The data of 174 infected patients were collected during the period of 2015 to 2017 from two clinical laboratories of Tehsil Matta Swat. Inform consent form was taken before blood collection. After taking informed consent blood samples were collected and ICT test was performed and then ICT positive cases were conform through PCR. A total of 174 ICT positive samples [106 male and 68 females] were included in this study. Age was considered from 10 to 72 years. Of the 174 ICT strip positive, 99 [63 males, 36 females] were confirmed through PCR. The prevalence rate was recorded 56.89%. I.V/I.M injection was recorded in 100% of the individuals. Visits to the barber shop was reported in (58%) of the individuals, married individuals were (81.0), surgical operation was reported in (44.8%), sharing toothbrush was observed in (29.9%), piercing was reported in (39.7%), family history was reported in (26.4%), dental treatment was observed in (21.8%), jaundice were (13.2%) and tattooing was (1.7%). Blood transfusion, surgical operations, Jaundice, family history and dental treatment were found significant risk factors for acquiring HCV infection. It was concluded that proper implementation of precautionary measures should be needed to control the spread of HCV in far near future.

Agentes infecciosos causam doenças graves em humanos em todo o mundo, e são responsáveis pelo alto índice de morbimortalidade. A prevalência e a epidemiologia das doenças infecciosas no hospital que atendeu pacientes encaminhados pelos médicos por meio dos achados iniciais e seus fatores de risco associados foram estudadas em Peshawar. Os dados de 174 pacientes infectados foram coletados durante o período de 2015 a 2017 oriundos de dois laboratórios clínicos de Tehsil Matta Swat. O formulário de consentimento informado foi obtido antes da coleta de sangue. Após a obtenção do consentimento informado, foram coletadas amostras de sangue e foi realizado o teste ICT e, em seguida, os casos ICT positivos foram confirmados por PCR. Um total de 174 amostras ICT positivas [106 homens e 68 mulheres] foi incluído neste estudo. A idade considerada foi de 10 a 72 anos. Das 174 tiras de ICT positivas, 99 casos [63 homens, 36 mulheres] foram confirmados por PCR. A taxa de prevalência foi de 56,89%. A injeção IV / IM foi registrada em 100% dos indivíduos. A visita à barbearia foi relatada em (58%) dos indivíduos, os números de casados foram (81,0%), e a operação cirúrgica foi relatada em (44,8%), o compartilhamento de escova de dente foi observado em (29,9%), o piercing foi relatado em (39,7%), antecedentes familiares foram relatados em (26,4%), tratamento odontológico em (21,8%), icterícia (13,2%) e tatuagem em (1,7%). Transfusão de sangue, operações cirúrgicas, icterícia, histórico familiar e tratamento odontológico foram fatores de risco significativos para adquirir infecção por Vírus da Hepatite C (VHC). Concluiu-se que a implementação adequada de medidas de precaução deve ser necessária para controlar a propagação do VHC em um futuro próximo.

El priapismo en la Leucemia Mieloide Crónica Hallazgos radiológicos en casos de Leucemia Mieloide Crónica que se presentaron con priapismo / 7 PRIAPISM IN CHRONIC MYELOID LEUKEMIA : IMAGING FINDINGS IN CASES OF CHRONIC MYELOID LEUKEMIA WHO PRESENTED WITH PRIAPISM

El priapismo es una emergencia urológica que debe ser diagnosticada y tratada apropiadamente. Específicamente en casos conocidos de leucemia el pene turgente doloroso debe hacer surgir la sospecha de priapismo de primera movida y el Doppler peneano debe ser la mera línea de modalidad de imágenes. Esta información debe ser transmitida al paciente y al departamento clínico emergentológico

Priapism is an urological emergency and must be diagnosed and treated appropriately. Specifically in known cases of leukemia painful turgid penis should raise suspicion of priapism in first hand and penile Doppler should be the first line of imaging modality. This information should be forwarded to patient and emergency department clinician

Acute computed tomography findings in patients with acute confusion of non-traumatic aetiology / Hallazgos agudos con tomografía computarizada en pacientes con confusión aguda de etiología no traumática

BACKGROUND: A retrospective review was undertaken of all patients referred for computed tomography (CT) scans of the head for acute onset of confusion, not consequent on head trauma, during the period June 1, 2004 to May 31, 2007. METHOD: Data were obtained by Microsoft Word search of the reports of the Radiology Department of the University Hospital of the West Indies, Kingston, Jamaica. Two hundred and twenty-one patients were reviewed: 103 men and 118 women. The mean age of the sample was 64 years; 168 patients (76%) were 50 years old or older. RESULT: Computed tomography scans were reported normal in 170 (76.9%) patients; 45 patients (20.4%) had definite acute intracranial CT findings. Findings were equivocal in three patients (1.4%) and unavailable for three (1.4%); 23.2% and 15.6% of patients above and below the age of 50 years respectively showed acute abnormalities on CT. The most common acute finding on CT scan was an ischaemic infarct (68%). Other abnormalities included intracerebral haemorrhage and metastases 6.2% each, toxoplasmosis and primary brain tumour 4.2% each and subdural haematoma and meningitis 2.1% each. The diagnoses of toxoplas-mosis were made based on appearances typical of toxoplasmosis on CT scans in patients whose request stated that they were HIV positive. CONCLUSION: In the sample reviewed, most patients who presented with acute confusion were above the age of 50 years. Overall, 20.4% of patients from all age groups had acute abnormalities on CT with a relative higher proportion, 23.2% versus 15.6% of those over 50 years, having acute pathology. The most common abnormality was an ischaemic infarct. This finding is similar to that in developed countries and unlike that seen in other developing countries where infectious aetiologies predominate.

ANTECEDENTES: Durante el período de junio, 2004 a mayo 31, 2007, se llevó a cabo una revisión retrospectiva de todos los pacientes remitidos para escaneos mediante tomografía computarizada (TC escáner) de la cabeza, en casos de ataques de confusión aguda, no originados por traumas en la cabeza. MÉTODO: Los datos fueron obtenidos mediante búsqueda con Microsoft Word de los informes del Departamento de Radiología del Hospital Universitario de West Indies, Kingston, Jamaica. Se revisaron doscientos veintiún pacientes: 103 hombres y 118 mujeres. La edad promedio de la muestra fue 64 años; 168 pacientes (76%) tenían 50 años de edad o más. RESULTADO: Los escaneos mediante tomografía computarizada fueron reportados como un procedimiento normal en 170 (76.9%) pacientes; 45 pacientes (20.4%) tuvieron hallazgos agudos intracraneales definidos por TC. Los hallazgos fueron equívocos en tres pacientes (1.4%) y no disponibles en tres (1.4%); 23.2% y 15.6% de los pacientes por encima y por debajo de la edad de 50 años respectivamente, mostraron anormalidades agudas en la TC. El hallazgo agudo más común con el escaneo de TC fue el infarto isquémico (68%). Otras anormalidades incluyeron hemorragias intracerebrales y metástasis, 6.2% respectivamente; toxoplasmosis y tumor primario del cerebro, 4.2% respectivamente, y hematoma subdural y meningitis, 2.1% respectivamente. CONCLUSIÓN: En la muestra revisada, la mayoría de los pacientes que presentaron confusión aguda se hallaban por encima de 50 años de edad. En general, 20.4% de los pacientes de todos los grupos etarios presentaban anormalidades agudas en la TC en una proporción relativamente más alta, siendo el caso que el 23.2% frente al 15.6% de aquéllos por encima de 50 años, presentaban patologías agudas. La anormalidad más común fue el infarto isquémico. Este hallazgo es similar al de los países desarrollados, y diferente al que se observa en otros países en vías de desarrollo, dónde predominan las etiologías infecciosas.

Obstructive lung disease in acute medical patients / Enfermedad pulmonar obstructiva en pacientes clínicos agudos

OBJECTIVES: To determine the proportion of adult medical patients who have chronic obstructive pulmonary disease (COPD), using the Global initiative for Chronic Obstructive Lung Disease guide-lines (GOLD), and its relation to vascular disease. METHODS: This is a prospective cross-sectional study of adult patients admitted to acute medical wards. Interviewer administered questionnaire, anthropometric and spirometric measurements were done. RESULTS: Spirometry was performed in 720 acute admissions [Mean (SD) age 50.0 (18.9) years, FEV1: 1.98L (0.83), FEV1/FVC %: 75.1 (11.9)%; males 332 (46.1%), smokers 318 (44%); 43.2% had vascular disease]. Sixty-seven per cent of patients (480) had no airway disease including 35 (4.5%) with chronic cough and sputum with normal spirometry; 89 (12.4%) had asthma and 151 (20.9%) had COPD. Patients with COPD were significantly older [60.3 (16.6) years] than non-COPD patients [47.3 (18.5) years], p < 0.001 and had a greater number of pack years of smoking. A greater percentage of patients with COPD had vascular disease (52%) than the non-COPD patients (40.1%), p = 0.017). Multivariate analysis with vascular disease as outcome variable revealed relationships with older age (p < 0.001) and Indo-Trinidadian ethnicity (p = 0.015), but not with gender (p = 0.321) and smoking (p = 0.442). FEV1% as well as FEV1 showed a significant inverse relationship with vascular disease (p < 0.05). CONCLUSIONS: The prevalence of COPD using GOLD guidelines in acute hospital admissions is 20.9%; 11.7% of admissions have chronic sputum or cough with normal spirometry. Vascular disease is more prevalent in those with COPD. Patients admitted to acute medical care with vascular disease may also have COPD.

OBJETIVOS: Determinar la proporción de pacientes clínicos adultos con EPOC, mediante la guía clínica de la Iniciativa Global para la Enfermedad Pulmonar Obstructiva Crónica (GOLD, en inglés), y su relación con la enfermedad vascular. MÉTODOS: Este es un estudio transversal prospectivo de pacientes adultos ingresados en salas para la atención de enfermedades agudas. El entrevistador aplicó cuestionarios, y se realizaron mediciones antropométricas y espirométricas. RESULTADOS: La espirometría se realizó en 270 casos de ingresos con enfermedades agudas (edad promedio (SD) 50.0 (18.9) años, FEV1: 1.98 L (0.83), FEV1/FVC %: 75.1 (11.9) %; varones 332 (46.1%), fumadores 318 (44%); 43.2% padecían de enfermedad vascular). El sesenta y siete por ciento de los pacientes (480) no presentaban enfermedades de las vías respiratorias, incluyendo 35 (4.5%) con tos crónica y esputo con espirometría normal; 89 (12.4%) padecían de asma y 151 (20.9%) tenían EPOC. Los pacientes con EPOC eran significativamente mayores [60.3 (16.6) años] que los pacientes sin EPOC [47.3 (18.5) años], p < 0.001 y llevaban un número mayor de paquete-años fumando. Un mayor porcentaje de pacientes con EPOC presentaban enfermedades vasculares (52%) en comparación con los pacientes sin EPOC [(40.1%), p = 0.017)]. El análisis multivariante con la enfermedad vascular como variable dependiente o variable respuesta reveló relaciones con el incremento de los años de edad (p < 0.001) y la etnicidad indo-trinitense (p = 0.015), pero no con el género (p = 0.321) y el hábito de fumar (p = 0.442). FEV1% así como FEV1 mostraron una relación significativa inversa con la enfermedad vascular (p < 0.05). CONCLUSIONES: La prevalencia de EPOC usando la guía clínica GOLD en los ingresos a hospitales debido a enfermedades agudas es de 20.9%; 11.7% de los ingresos presentan esputo crónico y tos con espirometría normal. La enfermedad vascular es más prevalente en pacientes con EPOC. Los pacientes ingresados para atención médica por enfermedad aguda, pueden también presentar EPOC.

Funny turns in an elderly man

A 74-year old man presented with recurrent attacks of altered sensorium, sometimes with abrupt falls, against the background of a long history of chronic obstructive airways disease and ischaemic heart disease. Investigations revealed evidence of significant cardiac conduction abnormalities and this led to the insertion of a permanent pacemaker. However, he continued to have recurrent 'syncopal'attacks. He was hospitalized to clarify the nature and aetiology of these attacks. Multiple stereotyped events were observed by different medical personnel, lasting up to two hours in duration. An attack was terminated by the administration of intravenous diazepam. Subsequent initiation of anti-epileptic drugs led to the complete abolition of these episodes. He has remained event-free since then ie two years. Because of multiple co-morbidities, the elderly present a greater diagnostic challenge in the evaluation of paroxysmal alterations in sensorium. It is essential that epilepsy, particularly with non-convulsive seizures, be included in the differential diagnosis whenever evaluating these patients.