Showing papers in "International journal of health sciences in 2009"

Life in conflict: Characteristics of Depression in Kashmir.

Abstract: Background: Mental, physical and social health, are vital strands of life that are closely interwoven and deeply interdependent. Mental disorders affect people of all countries and societies, individuals at all ages, women and men, the rich and the poor, from urban and rural environments. Depression is more likely following particular classes of experience – those involving conflict, disruption, losses and experiences of humiliation or entrapment. Many people living amidst the rages of conflict suffer from posttraumatic stress disorder. Objective: To determine the characteristics of depression in the population in Kashmir where a low-intensity-conflict has been going on for the last seventeen years. Methods: The non-combatant civilian population was surveyed. The Centre for Epidemiological Studies Depression (CES-D) Scale was used to measure symptoms of depression in community populations. Results: Due to continuing conflict in Kashmir during the last 18 years there has been a phenomenal increase in psychiatric morbidity. The results reveal that the prevalence of depression is 55.72%. The prevalence is highest (66.67%) in the 15 to 25 years age group, followed by 65.33% in the 26 to 35 years age group. The difference in the prevalence of depression among males and females is significant. Depression is much higher in rural areas (84.73%) as compared to urban areas (15.26%). In rural areas the prevalence of depression among females is higher (93.10 %) as compared to males (6.8%). Conclusion: Mental health is an integral part of overall health and quality of life. Effective evidence-based programs and policies are available to promote mental health, enhance resilience, reduce risk factors, increase protective factors, and prevent mental and behavioural disorders. Innovative community-based health programmes which are culturally and gender appropriate and reaches out to all segments of the population need to be developed. Substantial and sustainable improvements can be achieved only when a comprehensive strategy for mental health which incorporates both prevention and care elements is adopted.

Evaluation of problem based learning course at college of medicine, qassim university, saudi arabia.

Abstract: Background The PBL approach to learning in medical education can be considered as the most significant educational innovation in the past four decades. PBL is by now a well established method of learning and instruction. Evaluating the success of PBL as compared to more traditional Lecture Based Learning requires more complex techniques. Objective The objective of this study is to examine the conceptualization, design, implementation and usefulness of the PBL programme, and to determine its effectiveness. Methods This study was conducted at a premier problem-based leaning medical school of Saudi Arabia. The Course Experience Questionnaire [CEQ], designed to measure the quality of learning experience, and the Student Course Experience Questionnaire (SCEQ) have been used in this study. The survey included the four aspects of learning environments known to relate to the quality of student learning. Results The study reveals that the PBL system helps developing student skills particularly problem solving skills and help sharpening analytic skills However, majority of the students are not satisfied with the evaluation system in the college as they think that it is not student-centered as it does not reflect the improvement made by the student with the passage of time. Students are satisfied with many objectives of the Problem Based Learning. The majority of respondents agreed that PBL is better than the traditional system and consider it superior to the traditional Lecture-Based System in Medical Education. Conclusion The growing popularity and increased application of PBL presents significant challenges. Results indicate that after 18 months students become bored with the repetitious routine of working through problems and the problems and the approach used in the tutorial groups cease to be challenging and motivating. The authors conclude that PBL is having an impact on the performance of students, their perspective on learning and teaching methods. Our strategy for evaluating the success of PBL is ongoing and the results represent only an initial stage in analysis as we are still in the process of standardizing the process of collecting the outcome data particularly from those who are pass outs from the college.

Esophageal Cancer in Kashmir (India): An Enigma for Researchers

Abstract: About 90% of esophageal cancers worldwide are Squamous Cell Carcinomas (SCC), mostly occurring in defined high-incidence areas of low and middle-resource countries. Historically, the highest incidences are reported in regions of Central Asia. One such region is Kashmir Valley in Northern India. In this review, we summarize a large body of epidemiological, toxicological and observational information on occurrence, dietary patterns and lifestyles to discuss factors that may be involved in the etiology of SCC in Kashmir Valley. To date, no single factor can be identified as the main cause of the excess incidence of SCC as compared to other regions of India. Three main components emerge as important factors: a societal component with poor, rural lifestyle and general deprivation, status in particular in vitamins and oligoelements; a lifestyle component with the use of copper utensil in cooking, the consumption of spicy, deep fried foodstuffs, and the drinking of hot salty tea; and an environmental component with exposure to high levels of dietary nitrosamines from diverse sources. Overall, these three components are similar to the general pattern of factors that have been involved in causing SCC in other high-incidence area in the so-called “esophageal cancer belt”, namely in central China (Cixian, Lixian) and in Northern Iran (Golestan). Further comparative studies between these regions are needed to identify the contributions of these various components.

Role of stem cells in treatment of neurological disorder.

Abstract: Stem cells or mother or queen of all cells are pleuropotent and have the remarkable potential to develop into many different cell types in the body. Serving as a sort of repair system for the body, they can theoretically divide without limit to replenish other cells as long as the person or animal is alive. When a stem cell divides, each new cell has the potential to either remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell. Stem cells differ from other kinds of cells in the body. All stem cells regardless of their source have three general properties:They are unspecialized; one of the fundamental properties of a stem cell is that it does not have any tissue-specific structures that allow it to perform specialized functions.They can give rise to specialized cell types. These unspecialized stem cells can give rise to specialized cells, including heart muscle cells, blood cells, or nerve cells.They are capable of dividing and renewing themselves for long periods. Unlike muscle cells, blood cells, or nerve cells -- which do not normally replicate themselves - stem cells may replicate many times. A starting population of stem cells that proliferates for many months in the laboratory can yield millions of cells. Today, donated organs and tissues are often used to replace those that are diseased or destroyed. Unfortunately, the number of people needing a transplant far exceeds the number of organs available for transplantation. Pleuropotent stem cells offer the possibility of a renewable source of replacement cells and tissues to treat a myriad of diseases, conditions, and disabilities including Parkinson's and Alzheimer's diseases, spinal cord injury, stroke, Cerebral palsy, Battens disease, Amyotrophic lateral sclerosis, restoration of vision and other neuro degenerative diseases as well.

Prepregnancy obesity and pregnancy outcome.

Abstract: Background: Maternal obesity has long been correlated with an increased risk of chronic hypertension and diabetes prior to pregnancy and adverse pregnancy outcomes including preeclampsia, gestational diabetes, fetal macrosomia, Cesarean deliveries, postpartum endometritis and a prolonged hospital stay Objective: To determine the effect of maternal pre-pregnancy obesity on pregnancy outcomesMethods: One hundred and twenty two women were recruited in the study. The patients were allocated into two groups, group 1 obese patients (68) BMI 30 or more and group 2 non obese patients (54) BMI between 19.8-24.9. Outcomes: About two - third of the study group were having mild obesity, moderate obesity comprised about 28% and about 4% only was morbidly obese. Hypertensive disorders were nine folds more among obese women (R.R 4.74). Obese pregnant women were significantly more prone to have gestational diabetes (R.R 6.35). Even anemia was significantly more amongst Obese women when compared to non obese ones (29/68, R.R 3.84). Ante partum hemorrhage had significantly more in obese women (R.R 3.14). There was no increased risk for PROM (R.R 0.71). Moreover The macrosomic babies were extremely commoner among obese (R.R 9.1). Conclusion: Pre-pregnancy obesity is a risk factor for gestational diabetes, preeclampsia, labor induction, cesarean section for fetal distress, and wound infection. They should be considered as high risk and counseled accordingly. Keywords: BMI, obesity, gestational diabetes postpartum hemorrhage

Prevalence of Metabolic Syndrome Among Qassim University Personnel in Saudi Arabia

Abstract: Objective: to estimate the prevalence of metabolic syndrome among Qassim university personnel in Saudi Arabia using the definition proposed by NCEP ATPIII. Methods: a cross sectional study that included all male university staff of different ages and careers. 560 individuals participated in this study with a response rate of 85%. For all participants, the data collected were sociodemographic characteristics, past history or receiving medication for diabetes or hypertension, smoking habits, physical activity, and measurements necessary to identify metabolic syndrome. Results: Prevalence of metabolic syndrome was 31.4%. The prevalence was found to show a steady increase with increasing age, BMI and serum cholesterol. General obesity measured by BMI was the most common component associated with the syndrome where 75% of participants suffered from overweight and obesity. Participants with high-density lipoprotein below protective level constituted 73.6%, while those with total cholesterol and triglyceride above clinically normal level constituted 60.0% & 46.4% respectively. Elevated fasting plasma glucose and hypertension were the least common. After adjustment, factors found to be associated with metabolic syndrome were being a Saudi national, smoking, not doing regular exercise, being obese, having total serum cholesterol above 180 mg/dl, and age groups above 40 years. Conclusion: Almost a third of the university personnel have metabolic syndrome and therefore they are at higher risk for both cardiovascular diseases and diabetes mellitus. Similar studies are required among a wider range of subjects to assess the scope of the problem in Saudi Arabia.

Extended spectrum B-lactamase mediated resistance in Escherichia coli in a tertiary care hospital.

Abstract: BACKGROUND ESBL occur mostly in Enterobacteriaceae e.g. Escherichia coli. ESBLs are clinically important because they destroy cephalosporin's, work horse hospital antibiotics, given as first line agents to many severely ill patients. Delayed recognition and inappropriate treatment of severe infections caused by ESBL producers with cephalosporin has been associated with increased mortality. ESBL-mediated resistance is not always obvious in vitro to all cephalosporin. Many ESBL producers are multi -resistant to non-B-Lactam antibiotics such as quinolones and amino glycosides, narrowing treatment options. Some producers achieve outbreak status spreading among patients and locals, perhaps owing to particular pathogenicity traits. METHODS A total of 221 Escherichia coli isolates from different clinical specimens during the period of August 2005 to July 2007, were screened for potential ESBL activity. These strains were isolated from different clinical specimens like urine, blood, sputum, pus and other body fluids which were received in the bacteriological division of microbiology. RESULTS Two hundred and twenty one Escherichia coli isolates were isolated from different clinical specimens like urine, blood, sputum, pus and other body fluids submitted for both in and out-patients of the hospital during the period August2005 to July2007. All of them were subjected to screening by using ceftazidime, cefotaxime or ceftriaxone. Two hundred and eleven were positive for potential ESBL producers out of 221. 95.4%of E. coli (211/221) were screen positive which were subjected to confirmatory tests CONCLUSION Maximum number of ESBLs was from in-patients followed by out-patients. The out-patient presence of ESBL is of main concern as it is now come to the alert of the physician that ESBL is spreading fast in the community and responsible for community-acquired ESBLs and maximum number being from urine specimen.

Management of Diarrhea in Under-fives at Home and Health Facilities in Kashmir.

Abstract: Background: Diarrheal disease forms one of the two major killer diseases in children under five years of age in the developing world. There are inherent cultural practices for management of diarrhea at the domestic level. Also, the treatment practices at health centers vary, with inappropriate use of antibiotics, and iv fluids observed commonly, while ORS is less frequently used. Methodology: Cross sectional study was carried out using pretested interview schedule between January and December 2006, in villages of Kashmir Valley. Results: The ORS use rate is low (24.4% and 8.4%) respectively in past and current episode. Cultural practices include harmful ones like starving to overcome the episode. The rate of Antibiotic use is higher with 77.9%. Conclusion: Kashmir valley faces the same problems in effective diarrhea management as in other developing regions of India and the world, viz. less ORS use, high antibiotic use and harmful cultural practices like giving bowel rest.

Impact of obesity on fetomaternal outcome in pregnant saudi females.

Abstract: Worldwide obesity is the most prevalent, chronic medical condition [1]. The rate of obesity in pregnant women is rising, increasing the significance of its impact on obesity-related pregnancy complications. Pregnancy complications associated with maternal obesity can be broadly grouped into those primarily affecting the mother and those primarily affecting the fetus, neonate or older child. Obesity influences not only the chance of conception but also reduces the response to fertility treatment, and increases the risk of miscarriage, congenital anomalies as well as pregnancy complications like gestational diabetes, pregnancy induced hypertension, cesarean delivery, macrosomia and infections in addition to potential adverse effects on long term health of both mother and infant. The aim of this study is to determine frequency of obesity and its adverse effects on fetomaternal outcome in pregnant Saudi females.

Variations in the anterior belly of diagastric.

Abstract: The anterior belly of diagastric is highly variable. Variation in anterior belly is most common amongst the submental region variations. We observed 6 such variations in the anterior belly of diagastric among 15 cadavers dissected (40%). Unilateral and bilateral variations were seen in equal number of cases. Accessory belly frequently cross midline and attached over the mylohyoid muscle. Knowledge of such variations is of significant importance while planning for surgeries in submental region and during staging of tumors.

Evaluation of periodontal status among saudi females with gestational diabetes and its relation to glucose and lipid homeostasis in ohud hospital, Al madina Al-munwarrah.

Abstract: Objectives Due to the lack of pregnant based oral health studies in our country, we conducted this study to evaluate periodontal status among females with gestational diabetes in Ohud Hospital, Al Madinah Al-Munwarrah and to assess its effect on insulin sensitivity and lipid metabolism. Methods This cross-sectional descriptive study was conducted from January 2008 till June 2008. The sample includes 250 Saudi females, 100 were pregnant with gestational diabetes (GDM), and 100 were pregnant without GDM and 50 were normal non pregnant females. The study cases were matched age and body mass index. All the participants were subjected to history taking, physical examination and assessment of their periodontal status. Laboratory tests include fasting blood sugar, insulin levels, Homeostasis Model Assessment Insulin Resistance (HOMA-IR) test and serum lipids. Serum levels of inflammatory markers (CRP, ESR, IL-1β, and TNF-α) also measured. The periodontal health status was assessed using the Community Periodontal Index of Treatment Needs (CPITN). Results Severe periodontal diseases were elicited in 37% of the pregnant females with GDM, 29% of the pregnant females without GDM and 14% of non pregnant normal control group. Females with GDM showed higher systolic and diastolic blood pressure, fasting insulin, HOMA-IR, serum lipids and serum inflammatory markers levels than the other groups. Serum fasting insulin levels, HOMA-IR, triglyceride levels, and serum inflammatory markers were higher in females with severe periodontal diseases. Females with recurrent GDM were found to have higher Body Mass Index (BMI), severe periodontal diseases, as well as higher HOMA-IR, than those presented for first time with GDM. Females with GDM; also shows significant positive correlation between CPITN scoring and patient age, HOMA-IR and inflammatory markers. Conclusions The prevalence of periodontal disease is high among pregnant females especially those with GDM. Periodontal disease had important deleterious effects on carbohydrates and lipids metabolism. Strategies are needed to improve dental health care and to reduce periodontal diseases among pregnant females.

Factors Influencing Outcome of Head Injury Patients at A Tertiary Care Teaching Hospital in India

Abstract: Background: Trauma is the most common cause of morbidity and mortality in people younger than 45 years and head injury is mostly highly weighted predictor of outcome in trauma population, anything than can improve the outcome from severe head injury has the potential of improving the lives of many accident victims. Objective: A study regarding factors influencing outcome of traumatic brain injury patients was conducted at a tertiary care hospital of Srinagar (India). The basic predictors in this study included age, sex, rural/urban, time taken from site of trauma to arrival at hospital, mode of transportation, referral from other hospitals, referral to other hospitals, and Glasgow Coma Scale. Methods: Traumatic Brain Injury (TBI) patients (n 547) were taken prospectively by simple random sampling method for a period of one year (2004) for this study. Results: Majority of patients belonged to age group 0 to 10 years (25.5%) and a maximum death (8) were seen in age group 51 to 60 years. Maximum number of patients were males (75.9%) and (71.1%) TBI patients were from rural areas. (26.7%) reached this hospital within a period of one hour. (66%) were shifted through ambulance service. 6.4% expired after treatment.

Timing of referral to consultation-liaison psychiatry.

Abstract: Objective: The purpose of this study was to examine the factors affecting the timing of psychiatric consultations and the impact of timing on length of hospital stay. It also assessed the relationships between the timing of consultations and some clinical factors. Methods: 264 adult patients consecutively referred to the psychiatric C-L service at King Khaled University Hospital in Riyadh were prospectively included in 2004. The following information was recorded for each consultation: patient demographic characteristics, date of admission, date of consultation, date of discharge, total days of stay, specialty service requesting the consultation, reason for referral given by the referring physician, and DSM-IV diagnosis based on the consultation interview. Results: Earlier consultations significantly predicted shorter lengths of stay. Delayed consultations were seen with female patients, obstetrics/gynecology ward admission, patients perceived by their treating teams as having anxiety disorders or substance abuse, and psychiatric diagnoses of anxiety or bipolar affective disorder. Conclusion: Timing of referral is a crucial variable for the effectiveness of psychiatric intervention in medical settings. Early detection strategies for high-risk patients with whom delayed consultation may occur, and increasing the awareness of nonpsychiatric physicians about the importance of timing of referral are very important for a better and cost-effective patient care. Further studies are also needed in this line of research.

Relation of insulin resistance and liver fibrosis progression in patients with chronic hepatitis C virus infection.

Abstract: Background: Hepatitis C virus (HCV) infection can predispose to the development of insulin resistance before diabetes occurs. Such a potential link is particularly cogent in light of recent data indicate that diabetes may be associated with increased hepatic fibrosis progression in patients with chronic HCV infection. The aim of the study is to determine the prevalence of insulin resistance in non diabetic patients with chronic hepatitis C and its relation to liver fibrosis. Methods: Thirty eight patients with chronic liver diseases. They subdivided into 2 groups; chronic hepatitis C (CHC) with elevated liver enzymes and CHC with normal liver enzymes. Age and sex matched 12 healthy subjects as control group. All subjects were subjected to Careful history and copmlete examination with stress upon symptoms and signs of chronic liver diseases. Investigations include liver function tests; viral markers (Anti HCV antibodies & PCR for HCV). Serum fasting glucose; serum fasting insulin; homeostasis model assessment (HOMA), liver biopsy and abdominal ultrasound. Results: No correlation between viral load and hepatic fibrosis in HCV infected patients. Liver fibrosis is considerably higher among HCV patients with elevated serum transaminase levels. Insulin resistance is present in HCV infected cases compared with control group and it is positively correlated with liver fibrosis. Conclusion: The present data support the hypothesis that insulin resistance may increase the rate of fibrosis progression in non diabetic patients with chronic HCV. Follow up of hyperinsulinemia by serial measurement of HOMA test in non diabetic HCV infected patients may be a biochemical indicator for progression of liver fibrosis.

NASH: The Hepatic injury of Metabolic syndrome: a brief update.

Abstract: Non alcoholic fatty liver disease occurs in those who don't consume alcohol in amounts considered harmful to the liver. It represents a spectrum of conditions characterized histologically by mainly macrovesicular hepatic steatosis. There are two histological patterns of NAFLD: fatty liver alone and steatohepatitis. In this brief review, clinical and histologic spectrum, natural history, diagnosis, and management of this condition are discussed.

Human embryology and the holy quran: an overview.

Abstract: Man’s quest to know about his origin has led him to search his roots and the best source for him has been religious scriptures The greatest miracle is the Holy Quraan There is an elegant description of origin, development and step by step developmental stages of intra-uterine life in Quraan Muslims had this knowledge in 7th century and the Prophet Muhammad’s Ahadeeth (sayings, deeds, approvals narrated by authentic narrators) had explained almost everything about natal and even postnatal events These findings once presented to experts in the field of Anatomy and Embryology surprised them and they believed that the knowledge given to the Prophet Muhammad was indeed divine Who else would provide this knowledge to the Prophet Muhammad (PBUH) except the Creator Himself Modern embryology is a fairly recent development which has its beginning with the invention of microscope in the 17th century However the concept of the human being developing in stages was not recognised until much later But the scientists then and most Muslim and non-Muslim scholars do not even know that the holy Quran and Sunnah [words, deeds, approvals of Prophet Muhammad (PBUH) collected by authentic narrators] had provided a detailed description of the significant events in human development from the stages of gametes and conception until the full term pregnancy and delivery or even post partum Actually information in the Quran and Hadith corrected many superstitious and vague ideas about human development that were prevalent before

Quality Control in Linen and Laundry Service at A Tertiary Care Teaching Hospital in India

Abstract: Introduction: The clean bedding and clean clothes installs psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Being an important Component in the management of the patients, a study was carried out to find out the current quality status and its conformity with the known standards and identify the areas of intervention in order to further increase the patient and staff satisfaction regarding the services provided by linen and laundry department Methods: Quality control practised in the Linen and Laundry Service was studied by conducting a prospective study on the concept of Donabedian model of structure, process and outcome. Study was done by pre-designed Proforma along with observation / Interviews / Questionnaire and study of records. The input studied included physical facilities, manpower, materials, equipments and environmental factors. The various elements of manpower studied consisted of number of staff working, their qualification, training, promotion avenues, motivation and job satisfaction. Process was studied by carrying out observations in linen and laundry service through a predesigned flow chart which was supplemented by interviews with different category of staff. Patient satisfaction, staff satisfaction and microbial count of laundered linen (quality dimensions) were studied in the outcome. Results: The current study found that in spite of certain deficiencies in the equipment, manpower and process, the linen and laundry service is providing a satisfactory service to its users. However the services can be further improved by removing the present deficiencies both at structure and process level.

Comparative study of various forms of urinary diversion after radical cystectomy in muscle invasive carcinoma urinary bladder.

Abstract: Results: 60% of the patient’s preferred Ileal neobladder, 10% preferred Ileal conduit and 10% preferred Mainz pouch II as their 1st choice diversion; 20% left the decision to the operating surgeon. The mean post-operative hospital stay was 15.0 days in Ileal conduit group, 17.8 days in Mainz pouch II group and 19.7 days in Ileal neobladder group. The mean follow up was 27.7 months. Early complications (within 1 month of surgery) were observed in 46.2% of patients in Ileal conduit group, 38.5% in Mainz pouch II group and 50.0% in Ileal neobladder group. Late complications (after 1 month of surgery) were seen in 61.5% of patients in Ileal conduit group, 46.2% in Mainz pouch II group and 50.0% in Ileal neobladder group. In Mainz pouch II group 92.3% of the patients achieved daytime continence and 84.6% achieved night time continence 3 to 6 months after surgery. In Ileal neobladder group, 75.0% patients achieved day time continence and 50.0% achieved night time continence 3 to 6 months after surgery. Patient satisfaction and overall quality of life was described ‘Good’ by majority of patients in Ileal conduit group and ‘Very Good’ by majority of patients in Mainz pouch II group and Ileal neobladder group.

Psychogenic Psychosis Revisited: A Follow up Study.

Abstract: Background: Although brief and acute psychoses are usually dramatic in presentation, they usually have benign course Studies investigating clinical features and changes in diagnosis between psychotic episodes have differed in design However, some consistent findings have emerged This study seeks to clarify and extend these features by describing and comparing clinical diagnostic stability in a group of subjects with first episode psychosis diagnosed as acute psychotic disorder (psychogenic psychosis) followed up for 6 years Methods: The study comprises a retrospective evaluation of case records of 161 patients admitted for the first time with first episode psychosis Among this group a subgroup of 69 psychogenic psychoses were followed up with special reference to stability of diagnosis within a period of 6 years Results: Forty-six patients (676%) were male, 22 (324%) were female and data were missing in one case-record There was no significant statistical difference between gender and diagnosis The mean age was 275 years (13-45 years) There were criteria, which distinguish acute psychotic disorder (psychogenic psychosis) These criteria include acute onset with short duration of untreated psychosis, precipitating factors, adjusted pre-morbid personality, no family history of mental disorder, short duration of admission, full recovery in most of cases, with no further admission Nearly 80% of the patients have never been admitted again in 6 years time Conclusions: Our findings show a high level of agreement with the original concept of psychogenic psychosis; however, these bear little relationship to the DSM-IV (1994) and ICD-10 (WHO, 1993) criteria for brief or acute psychotic disorder

Anaplastic transformation of differentiated thyroid carcinoma.

Abstract: Anaplastic thyroid cancer (ATC) is one of the most aggressive malignancies that arise from transformation of preexisting differentiated thyroid cancer (DTC). However, the carcinogenic mechanism of anaplastic transformation remains unclear. We describe a case for huge goiter diagnosed as papillary thyroid carcinoma, which underwent thyroidectomy. The final histology showed anaplastic transformation. The clinical and possible etiological aspects are discussed. Keywords: anaplastic, thyroid cancer, transformation

Unilateral cleft hand with cleft foot.

Abstract: Congenital anomalies of the hand form an important class of congenital malformations. They have a huge functional importance because of the part played by the hand in the daily activities of a person. The deformities also have significant cosmetic significance and may also be associated with other anomalies. Amongst the congenital anomalies, central deficiency or cleft hand is relatively rare. The association of cleft foot with cleft hand is an even more rare occurance. We present a case report of a 6 year old child, born of a non-consanginous marriage, having congenital central deficiency of ipsilateral hand and foot.

Myringoplasty: A Comparison of Bismuth Iodoform Paraffin Paste Gauze Pack and Plane Gauze (containing Lococotien with Veoform).

Abstract: Objectives To assess difference between two methods of post-operative ear packing: bismuth iodoform paraffin paste (BIPP) versus plane gauze containing steroid and antibiotics (lococotien with veoform) Methods A retrospective study of patients who had undergone myringoplasty at our hospital from January 2005 to January 2007. Data, including age, size of perforation surgical approach, use of post-operative ear dressings, complications were collected from the patient notes and analysed. The overall success rate of the operation (with success being defined as an intact tympanic membrane at 12 months) was noted Results Two hundred eighteen myringoplasties where data were completed are included in this study. Age ranged from 12 to 65 years (mean age 35 years) and the mean follow-up period was 12.61 months. The overall success rate was 83.5 percent. The success rate for BIPP and plane gauze (lococotien with veoform) was 80.9 and 86.4 percent respectively (p = 0.272). In BIPP group (23.5%) developed granulation tissue formation in exteranal canal compare to 11.7 percent of (lococotien with veoform) group (p =0.023). Conclusion We found no significant difference in the success rate of myringoplasty between the BIPP and (lococotien with veoform) groups. However, there was a statistically significant difference between the two groups in in term of granulation development. Packing with (lococotien with veoform) gauze has lower tendency to develop granulation tissue in the external canal following myringoplasty.

Prevalence of Exfoliative Glaucoma among Kashmiri Population: A Hospital Based Study.

Abstract: Background: The Prevalence of exfiolative glaucoma has shown extensive variation all over world ranging from 0 to 50%. Objective: To know the prevalence of exfoliative glaucoma in Kashmir. Methods: A hospital based cross-sectional study was conducted from January 2006 to January 2007 on 300 patients with documented raised intra ocular pressure (IOP), glaucomatous changes in the fundus and open angle of anterior chamber. Results: The study included 236 males and 64 females. Out of 300 patients, 115 had exfiolative glaucoma and among those left eye was involved in 47 patients, right eye in 31 and 37 had bilateral involvement.The patients above 60 years of age were found to have this condition more frequently as compared to those below 60 years of age. Occupation of patients had a strong association with this condition, as the disorder was seen more commonly in patients engaged in outdoor activites.The patients with exfiolative glaucoma were found to be having less Visual acuity; a higher IOP at presentation and a more severe and early optic nerve head involvement as compared to those with open angle glaucoma. Conclusions: The study reveals that prevalence of exfoliative glaucoma as seen in our OPD based cross sectional study was found to be 38.3%. This prevalence was high as compared to prevalence studies conducted in southern parts of the country and low as compared to the studies conducted in the Scandinavian countries. The difference in the prevalence of the condition was probably inpart related to the differences in the climatic conditions, ethnic origin and in part related to genetic factors of the studied population.

Ciliopathy with special emphasis on kartageners syndrome.

Abstract: Cilia are hair-like structures extending from the cell membrane, perform diverse biological functions. Primary defects in the structure and function of sensory and motile cilia result in multiple ciliopathies. The most prominent genetic abnormality involving motile cilia is primary ciliary dyskinesia (PCD) or Kartageners syndrome. PCD is a rare, usually autosomal recessive, genetically heterogeneous disorder characterized by sino-pulmonary disease, laterality defects and male infertility. One of the important components of cilia is the Dynein. Ciliary ultrastructural defects are identified in approximately 90% of PCD patients and involve the outer dynein arms, inner dynein arms, or both. Diagnosing PCD is challenging and requires a compatible clinical phenotype together with tests such as ciliary ultrastructural analysis, immunofluorescent staining, ciliary beat assessment, and/or nasal nitric oxide measurements. Increased understanding of the pathogenesis will aid in better diagnosis and treatment of PCD. The aim of the article is to present the basic defect involved in the etiology of this interesting syndrome.

Is Tertiary care Treatment Affordable to All? - Explore Alternative (s) for Healthcare Financing.

Abstract: Background: Health indicators such as life expectancy at birth, infant mortality rate etc. are some of the tools to measure the social development of that country. Due to advancement in technology, disease profile etc. expenditure on health care, especially tertiary care treatment is increasing day by day, and is beyond the reach of common people. This is one of the hindrances in the social development. India is a developing country and approx. 35% population is below poverty line. Since many people now are below poverty line or in a lower income group, people do not have any feeling to save or cannot save the money for future expenditure on health; therefore the tertiary care facility is inaccessible to a major fraction of the society. Methods: A study was conducted at Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) Lucknow in the month of May-June 2007 with objectives to find out the level of awareness about hospital care financing, analyze the mode and mechanism of Health care financing and to assess the affordability of the tertiary care treatment by the patients undergoing treatment at this centre. A prospective study of 154 patients by floating the structured questionnaire containing 17 questions, covering various issues of HCF was carried out. Results: While observing the HCF pattern of High cost treatment diseases related to ICU, kidney transplant, cardiovascular surgery, Haematology, Surgical Gastroenterology etc. (expenditure limit more than Rupees (Rs) 75000 so far incurred in one patient ), the study revealed that the average size of family is 6 members with an income of approx. Rs. 10185 per month per family. Average expenditure so far incurred by one shows that majority 115 (75%) patients bear the expenses themselves (out of pocket) It was also observed that approx. 50% out of pocket expenditure was met by taking loan from the bank,relatives, selling of assets and mortgaging the assets. approx. 34 (22%) reported that their expenditure will be reimbursed or got advance payment. Only 40 patients out of pocket had received some sort of assistance from some of the of the sources like CM, PM Fund and other types of donation. The study further highlights that average treatment expenditure already incurred in one patient i.e. Rupees 219376/- has exceeded the per capita expenditure on health care of individual (Rs. 1500/-), & total expenditure on whole family (Rs. 9000/-) and even total estimated annual income of one member (Rs.20370/) and whole family (approx. 122220/-). Only 2 (1.2%) respondents had health insurance policy. Conclusion: The present study findings reflect that the tertiary & high cost treatment is beyond the reach of majority and will have great impact on the economy and health profile of society. In view of above, it is the need of the hour to strengthen the mechanism of the HCF by mass awareness with great emphasis is to be given to meet the “out of pocket expenditure” and encourage the “health insurance” mechanism. This may help in providing the tertiary care treatment to many people; otherwise the treatment cost is unaffordable.

Profile of patients admitted in a large teaching hospital as a result of earthquake in kashmir during october 2005.

Abstract: BACKGROUND Among natural calamities Earthquakes are more devastating, as much of the life and property is affected. METHODS The study was carried- out in Accident & Emergency Department of SKIMS, to determine personnel and medical profile of earthquake victims of October 2005, when the state was rattled by a major tremor. Data was obtained from Accident & Emergency Department. Total no of patients Admitted were 166, which were followed from admission to discharge/Death. Each patient was subjected to a pretested questionnaire indicating age, sex, rural/urban distribution, Glasgow coma score, out come of treatment and referral to other care facility. RESULTS The study revealed that children were mostly affected, being the valnerable group. Most of the patients had head and bone injuries. 143 patients out of 166 patients had a Glasgow coma score of 15. Only 9 patients died. The reason for better end result was because of initial first Aid, Rapid transportatation to Hospital and prompt treatment in the Hospital. CONCLUSION As Jammu and Kashmir falls in seismic zone 5, it needs a central trauma centre, having all the specialties and sub specialties under one roof. This will save precious time, as cross referral to other hospitals will not be needed.

Courveilhier Baumgarten Syndrome: A Rare Syndrome Revisited

Abstract: A 25 year old male had presented with history of abdominal distension of 20 days duration and on examination he had prominent abdominal vein and a venous hum with Ascites. He had no history of altered sensorium, melena. The clinical scenario was suggestive of Cruveilhier Baumgarten syndrome.

Missile diaphragmatic injuries: kashmir experience.

Abstract: Background: Importance of repairing a diaphragmatic tear due to a missile injury cannot be overemphasized.Even a small diaphragmatic rent should be repaired because of morbidity and mortality caused by subsequent herniation and strangulation. Methods: Fifty-three cases with diaphragmatic injuries caused by penetrating missiles were studied from January 1997 to January 2007. All the patients were primarily explored either for thoracic or abdominal penetrating trauma; the diaphragmatic injury was an associated incidental intraoperative finding. Thoracotomy was performed in 18 patients, Laprotomy in 33 patients and in two patients combined thorocoabdominal approach was utilised for managing associated visceral injuries. Results: Overall mortality was 37.7%.Mortality was dependent on associated injuries of thoracic and abdominal viscera. Most patients died due to associated injuries and septicaemia. None of the patients had any sequelae of diaphragmatic repair. Conclusion: Immediate repair of diaphragmatic injury is of paramount importance to prevent subsequent complications of herniation and strangulation.

Acral Lentigines, Is it a Paraneoplastic Syndrome?

Abstract: We report a 34 years old gentleman who was referred to us with multiple brown spots on the palms, soles and scalp. He had those three months prior to being diagnosed with non-Hodgkin’s lymphoma. His past history includes both Evan’s syndrome and membranoproilferative glomerulonephritis treated by mycophenolate mofetil (MMF). On examination he had multiple brownish macules over the palms, soles and scalp. Biopsy from one of the lesions on the palms showed pigmentation of the basal cell layer with increased melanocytes. His lentigines are most likely induced by immunosuppression due to Non-Hodgkin’s lymphoma.