Common Associated Risk Factor Research Articles

Myocardial Bridging in Patients Undergoing Coronary Angiography for Coronary Artery Disease.

Introduction Myocardial bridge is a rare, benign, normal anatomical variant of the coronary artery that puts the patient at risk for significant cardiac symptoms, resulting in myocardial ischemia, arrhythmia, and sudden cardiac death. The aim of the study was to assess the prevalence and characteristics of myocardial bridging (MB) in patients with chest pain undergoing coronary angiography. Methodology A total of 1301 patients presenting with chest pain suggestive of acute coronary syndrome with associated non-invasive supportive cardiac evaluation were subjected to coronary angiography by Philips Allura Xper FD10 Cath Lab (Philips Healthcare, Andover, MA)and evaluated. Results Out of 1301 patients, the mean age was 54.70 ± 11.41 years with a male-to-female ratio of 1.9:1. Tobacco use and diabetes mellitus were the most common associated risk factors (49% and 44%, respectively). MBwas seen in 51 patients, making the prevalence 3.9%, with male predominance over females in the ratio of 3.9:1. The most common clinical presentation was unstable angina (UA) (n = 22, 43.1%), followed by stable angina (SA) (n = 11, 21.6%), non-ST-elevation myocardial infarction (NSTEMI) (n = 10, 19.6%), and ST-elevation myocardial infarction (STEMI) (n = 8, 15.7%). Myocardial bridgeswere more common among patients with stable coronary artery disease. The left anterior descending artery (n = 51, 3.9%) was involved in all the cases and the middle segment was affected in all patients with MB.Among patients with myocardial bridge, 26 patients (51%) had atherosclerosis and 25 patients had a normal artery. Among patients with myocardial bridge with atherosclerosis, 17 patients (65%) had atherosclerosis in the same artery in which the myocardial bridge was present. Among patients with myocardial bridge with atherosclerosis, nine patients (52%) had atherosclerosis proximal to the bridge, three patients (17%) had atherosclerosis distal to the bridge, and five patients (31%) had atherosclerosis both proximal and distal to the bridge. Conclusion The prevalence of MB in the Indian population is significantly lower than in the Western populations, and it is significantly higher in the male population with patients diagnosed as normal coronaries on coronary angiography.

Primary otomycosis: Assessment of risk factors and identification of fungal agents – A tertiary care hospital experience

Background: Primary otomycosis is one of the common conditions seen in general clinical practices. Although non-fatal, inappropriate management of this condition may lead to serious complications. Aims and Objectives: A cross-sectional study was conducted in our tertiary care hospital to determine the fungal agents in primary otomycosis and its associated risk factors. Materials and Methods: A total of 62 consecutive patients of more than 18 years of age with clinical diagnosis of otomycosis were included in this study. Samples were collected and processed and the fungal isolate was identified. The predisposing factors, fungal isolate, and demographical profile of the patients were analyzed. Results: About 61.29% were males and 38.71% were females. Majority of the patients were in the age group of 18–30 years (62.90%). The most common associated risk factor was habitual self-cleaning (50%), followed by oil instillation (30.65%). Itching (75.81%) was the most common symptom followed by ear discharge (45.16%). About 79.03% of our fungal isolates were Aspergillus species, Aspergillus niger being the most common (58.06 %). About 12.90% of our isolates were Candida species. About 63.27% of Aspergillus isolates was associated with habitual self-cleaning and 62.50% of Candida isolates was isolated with the instillation of oil. About 66.67% of Penicillium species and 100% of Rhizopus species are associated with inappropriate use of topical antibiotics. Conclusion: Health education of the community along with knowledge of common fungal agents causing otomycosis and its associated risk factor will help in reducing the incidence of otomycosis, which along with proper management will prevent further complications.

A CLINICAL PROFILE AND RISK FACTORS IN VENTRAL HERNIA PATIENTS: A RETROSPECTIVE STUDY

Introduction: About 4% of all hernia patients admitted to the ward had ventral hernias. Obesity, wound infections, malnutrition, immunosuppression, and inappropriate suture materials or incorrect suture placement were important causative factors for ventral hernia. Methods: This retrospective study was carried out among 50 patients of ventral hernias. Data were compiled in a pre-designed proforma using information from clinical notes, discharge summaries, and operation notes. This study excluded patients under the age of 18, those with femoral, inguinal, or posterior abdominal wall hernias. Results: The most common subtype of ventral hernia was incisional hernia (54.0%). The most common presenting symptom was swelling only (60.0%). The most common associated risk factor was obesity (36.0%) and constipation (26.0%). About 48.0% hernia occurred following gynecological procedures (hysterectomy - 22.0%, lower segment cesarean section - 8.0%, and tubectomy - 8.0%). Conclusion: The most common ventral hernia is the incisional hernia, which often occurs after obstetric and gynecological surgeries. Surgical site infection, obesity, and constipation increase the risk of ventral hernias.

Risk Factors for Adenoid Hypertrophy in Patients Twelve Year and Older

Background: The adenoids are part of Waldeyer’s ring of lymphoid tissue and when hypertrophied they cause many symptoms, e.g., snoring. They hypertrophy physiologically in children between the ages of 6 and 10 years, and then atrophy by the age of 16 years.
 Objectives: The aim of this study was to reveal the risk factors and clinical patterns associated with adenoid hypertrophy in patients aged over 12 years.
 Methods: We studied 130 patients aged over 12 who had undergone an adenoidectomy between January 2016 to January 2021. Patients were evaluated in the Department of Otorhinolaryngology and Head and Neck Surgery at Jordan University Hospital, Amman, Jordan. Some patients were accessed using medical records and their data were collected by telephone.
 Results: Of the 130 patients, 81 were male and 49 were female, with a mean age of 19.68 years. Snoring was the most common presenting symptom (81.5%), followed by nasal obstruction (75.4%) and mouth breathing (71.5%). The most common associated risk factor was septal deviation (44.6%), and then passive smoking (40.8 %), allergic rhinitis (38.5%), and pollution (38.5%).
 Conclusion: There are multiple suspected risk factors for adenoid hypertrophy in patients aged over 12 years. In our study, septal deviation was the most common associated factor, followed by passive smoking, allergic rhinitis and pollution. Snoring was the most common presenting symptom, followed by nasal obstruction.

Work-related musculoskeletal symptoms among Saudi radiologists: a cross-sectional multi-centre study

BackgroundMusculoskeletal disorders are common health problems worldwide. Several factors cause these symptoms, including ergonomics and other individual considerations. Computer users are prone to repetitive strain injuries that increase the risk of developing musculoskeletal symptoms (MSS). Radiologists are susceptible to developing MSS because they work long hours analysing medical images on computers in an increasingly digitalised field. This study aimed to identify the prevalence of MSS among Saudi radiologists and the associated risk factors.MethodsThis study was a cross-sectional, non-interventional, self-administered online survey. The study was conducted on 814 Saudi radiologists from various regions in Saudi Arabia. The study's outcome was the presence of MSS in any body region that limited participation in routine activities over the previous 12 months. The results were descriptively examined using binary logistic regression analysis to estimate the odds ratio (OR) of participants who had disabling MSS in the previous 12 months. All university, public, and private radiologists received an online survey containing questions about work surroundings, workload (e.g., spent at a computer workstation), and demographic characteristics.ResultsThe prevalence of MSS among the radiologists was 87.7%. Most of the participants (82%) were younger than 40 years of age. Radiography and computed tomography were the most common imaging modalities that caused MSS (53.4% and 26.8%, respectively). The most common symptoms were neck pain (59.3%) and lower back pain (57.1%). After adjustment, age, years of experience, and part-time employment were significantly associated with increased MSS (OR = .219, 95% CI = .057–.836; OR = .235, 95% CI = 087–.634; and OR = 2.673, 95% CI = 1.434–4.981, respectively). Women were more likely to report MSS than males (OR = 2.12, 95% CI = 1.327–3.377).ConclusionsMSS are common among Saudi radiologists, with neck pain and lower back pain being the most frequently reported symptoms. Gender, age, years of experience, type of imaging modality, and employment status were the most common associated risk factors for developing MSS. These findings are vital for the development of interventional plans to reduce the prevalence of musculoskeletal complaints in clinical radiologists.

Study on posterior circulatory stroke characteristics and clinico-radiological imaging

Background: Stroke research and clinical trials have focused mainly on anterior circulation stroke (ACS). Since clinical characteristics, mechanisms, and risk factors of posterior circulation stroke (PCS) have been reported different from ACS, more PCS studies are required. Methods: A Prospective, observational, Clinical study. All patients presenting to the department of general medicine and neurology of saveetha medical college from august 2021 to January 2023 with new onset neuro-deficit. Inclusion criteria is patients age 18 years or older and Clinical profile, radiological finding which is suggestive of acute PCS. Radiological imaging was done in detail to assess the artery involved and area affected. Results: Most common associated risk factors were hypertension (61%), alcoholism (33%) and smoking (32%). Most common presenting clinical symptoms of cases with PCS are giddiness (59%), left/ right sided weakness (48%). Posterior cerebral artery was involved in 45% of the patients. The next common involvement was that of the posterior inferior cerebellar artery (38%). Most common area involved was brainstem, cerebellum. Conclusions: This study describes the pattern of risk factors and clinical characteristics of PCS. Males were affected more than females. Age group commonly involved was above sixty years. Hypertension, alcoholism, diabetes and smoking contributed the major risk factors. Giddiness was commonest symptom at the onset. Most of the patients had clinical signs of cerebellum and brainstem lesions. The territory commonly involved was mid-brain, cerebellum, thalamus, occipital and temporal lobes.

Sexually Transmitted Diseases and Associated Risk Factors Among Transgenders in Peshawar

Background: Transgenders, male to female, are exceptionally predominant in India-Pakistan, dreaded to be alarming for sexually transmitted diseases. The objective of this study was to determine the frequency of sexually transmitted diseases and their associated risk factors among transgenders.
 Methodology: This cross-sectional study was conducted amongst transgenders at Institute of Paramedical Sciences (IPMS), Khyber Medical University Peshawar from January to July,2021. About two ml of venous blood was collected in a gel tube under aseptic conditions among 100 individuals to check for HBsAg, anti-HCV, HIV and syphilis by ICT rapid strip method. Positive samples of HBsAg and anti-HCV were confirmed by Polymerase Chain Reaction (PCR), while positive cases of syphilis were confirmed by Treponema Pallidum Hemagglutination (TPHA). Chi-square test was applied to determine the association between sexually transmitted disease and associated risk factors.
 Results: Out of 100, seven (7%) samples were positive for HBsAg, five (5%) for anti-HCV and nine (9%) were positive for syphilis while there were no positive cases of HIV. HBV infection was significantly associated with blood transfusion, a drug injection history and some surgical procedure (p<0.05). For syphilis, the data were significantly associated with a history of blood transfusion and drug injection (p<0.05).
 Conclusion: Frequency of HBV, HCV and syphilis infections are high in transgenders with common associated risk factors to be sexual activities, drug injection, unsafe blood transfusion and surgical procedures.
 Keywords: Chromatography, Hepatitis B surface antigen, Hepatitis C Antibodies, HIV, Syphilis, Transgenders

Contributors and associated risk factors of neonatal mortality in a tertiary care hospital in the sub-Himalayan region of West Bengal

Background: Lack of revision of knowledge on the magnitude of problem, cause and factors associated with neonatal mortality hampering early interventions and thus preventing reduction of neonatal mortality rate in India. Neonatal mortality statistics are sensitive indicators of the utility, convenience and effectiveness of maternal child health service in the community. This study was done to see the mortality pattern of neonates and contributing factors at the special newborn care unit (SNCU) and neonatal intensive care unit (NICU) of a rural tertiary care hospital so that special attention to those cause and factors can lead to favourable outcomes.Methods: This was a cross sectional retrospective study done in the SNCU and NICU of rural tertiary care centre of West Bengal for a period of three years with neonates admitted before 28 days of life. Data were collected in pre-designed proforma by analysing the case sheets from the records section of the hospital. Results were analysed by descriptive analytical method.Results: Total 13738 babies were admitted in the study period (7143 inborn and 6595 outborn). Majority of the inborns (86.8%) and outborns (68.4%) were discharged during that period while 9.4% inborns and 19.5% outborns were expired and only those expired cases were included in this study. HIE/moderate-severe birth asphyxia (41.2%) was the major contributor of death in inborns but in outborns the most common contributor of death was sepsis/pneumonia/meningitis (34.8%). Prematurity and low birth weight were the most common associated risk factors in both the groups.Conclusions: This study delineating the mortality patterns and associated risk factors of neonates in a rural tertiary care hospital of West Bengal which is unique in its kind. Outcome analysis showed that neonatal mortality rate for outborn babies was higher than in relevant recent studies.

Clinical characteristics, diagnosis, and management outcome of surfactant deficiency respiratory distress syndrome in term and near-term neonates. A retrospective observational study.

This study aims to describe the clinical characteristics of SRDS in term and late preterm neonates. This is an observation retrospective chart review of full-term and late preterm neonates born older than 35 to 41 weeks gestation age diagnosed with SRDS. The diagnosis was based on clinical & radiological manifestations of SRDS. 1547 neonates were admitted during this period to NICU with a diagnosis of increased work of breathing for further management. 117 cases of term and near-term neonates (mean GA = 36.8 wks) had a confirmed diagnosis of Surfactant deficiency SRDS. Who compared 60 preterm neonates with SRDS less than 35 weeks gestation (mean GA 27.5 wks) as a control. The mean birth weight was 2.8 kg vs 1.1 kg in the preterm group. SRDS occurs more among the male gender (58%), with CS in 78.6 % of all diagnosed cases. No apparent cause was found in 28.2 %, while 37.6% of all cases were born to mothers with diabetes mellitus, and 27% were born to mothers with either GBs infection, maternal chorioamnionitis, or prolonged rupture of the membrane. SRDS is not uncommon among full-term and near-term neonates (10/1000 live birth). By far, the most common associated risk factors are maternal diabetes mellitus and cesarean section. It affects males more than females. Most cases will run a mild-to-moderate course that responds to non-invasive ventilation.

Coexistence of Urinary Incontinence and Osteoporosis in Females – A Systematic Review

Background: Urinary incontinence (UI) is described as the involuntary leakage of urine and is a global problem. The younger age groups have the lowest prevalence (12.0%), while the oldest have the greatest (40.0%); however, there is a surge around the middle age. Osteoporosis (OP) is a medical and socioeconomic hazard characterized by the decrease of bone mass, strength throughout the body resulting in lower bone density and a higher risk of fractures. Females become more vulnerable to these conditions as they grow older. The aim of the study: To assess the available research and find links between coexistence of decreased bone health and urinary incontinence in females. Materials and methods: Electronic databases like, CINAHL, Embase, Trip Medical Database, Cochrane Library and Pub Med were the ones searched for relevant articles from January 2011 to January 2022. The PRISMA Statement for Systematic Reviews and Meta-Analysis was used to conduct this systematic review. Results: There were 416 results found in the databases after eliminating the duplicates and studies that were unrelated to the topic. The review included total of five studies and quality assessment was done by four reviewers. Most studies found a strongly significant link between osteoporosis and urinary incontinence, whereas one study found no association. Conclusion: In this study, the five most common associated risk factors were revealed to be menopause, obesity, smoking, physical inactivity, and hyperlipidemia. Based on recent studies a strong significant link was found between the two health conditions (OP and UI) and coexistence of both conditions was seen in females.

Prevalence of Serum Cobalamin and Serum Folate Deficiency with Associated Risk Factors among Children Aged 0 to 19 Years in India – A Review

Anemia is broadly caused by nutritional and non-nutritional factors. Deficiency of cobalamin and folate are one of the causes of anemia and hence are of public health significance among 0 to 19 years old children in India. These deficiencies either alone or together may cause megaloblastic anemia, poor cognitive and motor development and stunting amongst children. To estimate the prevalence of serum cobalamin and serum folate with associated risk factors among children aged 0 to 19 years in India through various published studies. This review literature search was carried out using internet search engine namely PubMed, Google Scholar, Cochrane, Research gate using the term of cobalamin, vitamin B12, folate, children, deficiency and India from January 1st 2011 to June 30th 2021. Of the 252 research articles identified, 13 articles meeting the inclusion criteria (community based, cross sectional studies) were included and 5 articles among 0 to 5 years, 8 articles among 6 to 19 years reported the prevalence of cobalamin and folate deficiency. The prevalence of cobalamin deficiency ranged from 7 to 74% and prevalence of folate deficiency ranged from 1.5 to 40.2% among children aged 0 to 19 years. Most common associated risk factor identified was inadequacy of the diet and consumption of only vegetarian diet. Cobalamin and folate deficiency are of significant public health importance in age group 0 to 19 years in India. The deficiency varied across region and by contributing factors. Dietary diversification and promoting animal source of foods amongst children should be promoted to address cobalamin and folate deficiency.

Self-Reported Prevalence of Recurrent Aphthous Stomatitis among UiTM Dental Students

Recurrent aphthous stomatitis (RAS) is a common mucosal disease characterized by multiple recurrent, small, round, or oval ulcers with circumscribed margins, erythematous haloes, and yellow grey base. Although the exact etiology is unknown, various factors can trigger RAS development. Objectives: This study aims to determine the prevalence of self-reported RAS and to evaluate the associated risk factors of RAS among dental students. Material and methods: A set of validated questionnaires was distributed among the dental students in the Faculty of Dentistry, UiTM. The questionnaire comprises socio-demographic characteristics, nature of ulcers, risk factors, and treatment modalities. Data obtained from the questionnaire were analyzed using Chi-square statistical test SPSS version 27. Results: A total of 299 dental students participated in the questionnaire survey. The prevalence of RAS among dental students was 90.3 %. There was no significant relationship between the socio-demographic background of participants with self-reported RAS. The most common site affected was the buccal mucosa 64.1%, followed by the lips 55.2%. Risk factors frequently associated with RAS are injury (trauma) and stress 47.8% and 28.1%, respectively. Most dental students (69.3%) do not get any treatment to treat their ulcers, and only 1.5% seek treatment from the dentist. Conclusions: This study highlights the high prevalence of self-reported RAS among dental students and common risk factors reported associated with the occurrence of RAS. Therefore, this data assists the clinician in identifying common associated risk factors of RAS and subsequently improve management and efficient therapeutics.

“STUDY OF PRETERM DELIVERY AT TERTIARY CARE HOSPITAL”

Background: Preterm delivery is a major obstetric complication and a leading cause of neonatal mortality and morbidity. In India, the reported incidence of preterm labour is 10-15%. Premature babies are at risk of many immediate and long-term complications. Objectives: With this background, the present study was aimed to analyse the clinical conditions based on maternal, fetal and placental etiology associated with preterm birth. This prospective observational study was conducted in 250 consecutive women who presented with preterm labour between 28 toMethod: <37 weeks in the Department of Obstetrics and Gynaecology at tertiary care hospital during a period from April 2019 to September 2020. Mode of delivery, various maternal risk factors and neonatal outcome were noted. The incidence of preterm births was found to be 16.15%.Results: Maximum number of patients belonged to third gravida group (40.4%). Most common presentation on admission was pain in abdomen (74.8%) and most common associated risk factor was infection (50.8%%) followed by preterm premature rupture of membrane (PPROM) (24.8%). All patients received steroid (betamethasone) before delivery. 90% of patients delivered vaginally and 31.2% of babies required NICU admission. The mean baby weight, mean APGAR Score (5min) and mean NICU stay was 2.41±0.36 kgs, 8.94±0.33 and 9.08±5 days respectively. Conclusion: Preterm labour and birth continue to be a common occurrence, resulting in signicant newborn death and morbidity, as well as nancial burden on families and hospitals. This incidence can be lowered by early identication of proven risk factors with the assistance of universal and appropriate prenatal care. Strengthening the referral system so that high risk patients are managed in tertiary obstetric units with level III NICU facilities will improve the neonatal outcome of these babies.

A study on clinical profile of invasive fungal infection in neutropenic children in a tertiary care teaching hospital

Background: Febrile neutropenia is a common complication of anti-cancer chemotherapy. Invasive fungal infections are found mostly after prolonged neutropenia. Early diagnosis and treatment of these infections are of crucial importance. Hence, there is a need to identify the common causative organisms of fungal sepsis in children and our primary objective was to diagnose invasive fungal infections in children of febrile neutropenia and identify the common fungal etiological agents with clinical profile.Methods: This study was done as observational, cross-sectional study for 18 months at the department of microbiology, Lady Hardinge Medical College and department of pediatrics, Kalawati Saran Children’s Hospital. All children less than 18 years of age clinically suspected to have invasive fungal infection with absolute neutrophil count <500 /ml, with fever not responding to antibiotics for more than 3-4 days were included in the study.Results: Hospitalization ≥7 days (100%) was the most common associated risk factor, followed by neutropenia (100%), immunodeficiency (100%), cytotoxic drugs (87.27%) and malignancies (87.27%). Other less commonly associated risk factors were hyperalimentation (23.64%), residence near a construction site (23.64%), presence of urinary catheters (10.91%) and HIV positivity (9.09%). Around 54.54% of sputum samples were positive for fungal culture. A lower positivity was seen in blood culture (14.54%).Conclusions: Candida spp., Aspergillus spp. and Pneumocystis remain the primary fungal pathogens in this patient population. Early clinical suspicion followed by prompt sampling and evaluation for fungal infections may aid in timely diagnosis and reduction of mortality of these patients.

Depression Among Patients With Type 2 Diabetes Mellitus at King Abdulaziz University Hospital (KAUH): A Cross-Sectional Study.

Background: Depression can increase the risk of diabetes-related complications, healthcare expenditures, and morbidity in patients with type 2 diabetes mellitus (T2DM). There have been increasing cases of diabetes in Saudi Arabia; however, research correlating depression with diabetes is lacking. The aim of this study was to find out how common depression is among T2DM patients at King Abdulaziz University Hospital (KAUH), Jeddah, and assess any additional risk factors for depression in these patients.Methodology: A cross-sectional study using computer-assisted telephone interviews was conducted among patients with T2DM from June to August 2021. A total of 215 participants completed the survey. Symptoms and signs of depression were assessed using the Patient Health Questionnaire (PHQ-9). Univariate, bivariate, and multivariate statistical analyses were used to determine the prevalence and risk factors associated with depression.Results: Depression was shown to be prevalent in 54% of type 2 diabetes patients, with the most common associated risk factors being not exercising (p=0.00) and having at least one diabetes-related complication (p=0.001). There was no evidence of a significant relationship between depression and gender or age, although females were, in general, more depressed than males.Conclusion: Diabetic patients have a significantly high prevalence of depression; therefore, it is vital to conduct regular screening for depression in patients diagnosed with T2DM.

Diabetes Mellitus and Related Admission Factors Among Hospitalized Patients in King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia.

BackgroundDiabetes mellitus (DM) is a rapidly increasing serious health problem that affects the population all over the world. The increasing prevalence of DM in Saudi Arabia is reflected in our hospital admissions as well. This study aimed to assess the proportion of DM (including type 1 and type 2 diabetes) among hospitalized patients and the reasons for admissions to the medical unit at King Abdul-Aziz University Hospital (KAUH) in Jeddah, Saudi Arabia.MethodsWe conducted a hospital record-based cross-sectional study at KAUH from January to April 2021. The study included all adult patients admitted to the internal medicine wards and isolation unit but excluded patients in the coronary care unit and those with gestational diabetes. We reviewed the medical records to collect demographic data, causes of admission, laboratory results, and outcomes.ResultsAmong the hospitalized patients, 49.9% had DM. The most common associated risk factors and causes of admission among patients with DM were hypertension (HTN; 73.2%) and dyslipidemia (43.1%). Other less common reasons for admission were heart failure (20.6%), coronavirus disease-2019 (COVID-19; 17.8%), chronic kidney disease (CKD; 14.5%), pneumonia (12.3%), and stroke (10%). Dyslipidemia, HTN, CKD, diabetic ketoacidosis, heart failure, and need for intensive care unit (ICU) admission were significantly higher in diabetic patients as compared to patients without diabetes. HTN, dyslipidemia, CKD, heart failure, stroke, acute abdomen, and malignancy were significantly higher in patients with type 2 diabetes. Among diabetic patients, those with non-Saudi nationality, low hemoglobin level, dyslipidemia, pneumonia, sepsis, and requiring ICU admission had a greater risk of death.ConclusionsThe high burden of DM on the secondary healthcare level in Saudi Arabia highlights the need for effective diabetes prevention and treatment strategies in primary care and hospital outpatient settings. Such measures would help reduce the hospitalization rate and ease the healthcare system’s burden.

Paediatric Thrombosis: A Five-Year Experience From A Tertiary Care Center Of Pakistan.

Advances in imaging techniques and longer survival of chronic medical conditions contribute to the increase in paediatric thrombosis. We aim to determine the incidence, underlying risk factors, management and clinical outcome of paediatric thrombosis at a multidisciplinary facility of Pakistan. A retrospectively analysis of the medical records of patients in the paediatric age group admitted at the Aga Khan University hospital from January 2013-September 2018 was performed. Site of thrombosis, associated risks factors, management options and outcome of thrombotic event were evaluated. Of the 22,320 paediatric hospitalization, 35 paediatric patients were diagnosed with thrombosis (15 cases per 10,000 admissions). The median age of the study group was 15 years and twenty patients (57%) were male. The commonest site of thrombosis was in lower limb venous 11 (31%), followed by upper limb venous thrombosis 6 (17%), abdominal vein thrombosis 7 (20%), cerebral venous thrombosis 5 (14%), pulmonary embolism and arterial thrombosis 3(9% each). Eighty three percent had underlying clinical condition including central venous catheter [CVC] (26%), malignancy and infection (14% each), antiphospholipid antibody syndrome (9%), inherited thrombophilia (9%), congenital heart disease (6%), while thrombotic thrombocytopenic purpura and autoimmune disorder (3% each). Twelve (34%) patients were treated with heparin only, 8 (23%) received heparin followed by warfarin while warfarin as a single agent was given in 2 (5.7%) patients. One patient died of pulmonary embolism while 9 (25%) had persistence or recurrence of thrombosis. Incidence of paediatric thrombosis was 0.15%. CVC placement was the most common associated risk factor. Warfarin and heparin both were found to be safe anticoagulation option. Recurrence rate was found to be high.

Epidemiology and management of ventral hernia in a tertiary health care centre- a prospective observational study

Background: Ventral hernias are a common problem confronting surgeons. Data about standards of their surgical management have failed to keep pace with rapid advances in surgical techniques, and materials. Older techniques have often been discarded simply because of availability of newer ones without due consideration to availability, feasibility, training, local conditions and constraints. Therefore, a balanced, practical and pragmatic opinion regarding surgical management at individual, institutional and regional levels is needed. We studied clinical aspects and best treatment modalities of ventral hernias in our set-up.Methods: This is a prospective observational study of various types of ventral hernias, surgically managed at a tertiary care hospital between January 2018 and September 2019.Results: Mean age of presentation among 71 patients (27 males, 44 females) was 48.11±5.71 years. Incisional hernias (30.98%) were the commonest type. Painless swelling (49.29%) was the most common clinical presentation. Obesity (40.84%) and multiparity (30.98%) were the most common associated risk factors. Incisional hernias are probably better managed by open approach.Conclusions: Ventral hernias are more prevalent in the elderly and females. Incisional, umbilical, epigastric hernias are the more common types. Laparoscopy is being preferred over open procedure due to some advantages that it offers, but incisional hernias can often be better managed by open approach depending upon local set up. In addition, laparoscopic approach is not universally applicable and also has certain drawbacks.

Intrauterine Foetal Death: A Hospital Based Study

Introduction: Foetal death at any stage of pregnancy is not just a tragic event but also a more traumatic for the mental well-being of a mother. It is one of the most wrenching events in the field of obstetrics.
 Aims: The study was done to determine the probable risk factors of intrauterine foetal death and role of antenatal care in its prevention.
 Methods: The study was conducted in Obstetrics and Gynecology department at Nepalgunj Medical college from July 2018 to July 2020 .Inclusion criteria were intrauterine fetal death of >28 weeks of gestation and baby weighing 1000 grams or more . An exclusion criterion was molar pregnancy.
 Results: There were 115(3.52%) intrauterine fetal death during the study period, making it 35 per 1000 cases. In 17(14.78%) the cause of intrauterine fetal death was not known. The other common associated risk factors were prematurity in 14(12.17%) and hypertension in 13(11.30%). Similarly anemia and antepartum hemorrhage were seen in 13(11.30%) each. 11(9.56%) patients had oligohydramnios. Mal presentation was found in 8(6.95%) patients while polyhydromnios in 6(5.21%).The commonest age range in whom intrauterine fetal death was seen was 20-30 (73.90%). 28 (24.34%) patients were at preterm pregnancy ranging between 28-30 weeks whereas 17(14.78) intrauterine fetal death occured at 32-34 weeks. 77 foetuses were preterm and their birth weight was between 1 - 1.5 kg with the mean wt of 1175.73 gms.
 Conclusion: Intrauterine fetal death is still common inspite of the improving awareness in importance of regular antenatal care. In majority, the cause of intrauterine fetal death is still unknown. However, where the cause was known prematurity was the commonest.

Night-Time Non-dipping Blood Pressure and Heart Rate: An Association With the Risk of Silent Small Vessel Disease in Patients Presenting With Acute Ischemic Stroke.

Background and Purpose: Nocturnal non-dipping blood pressure and heart rate are associated with an increased risk of cardiovascular disease. The effects of such variance on cerebrovascular disease have not been well studied.Methods: The 24-h ambulatory blood pressure (ABPM) and heart rate were monitored with B-pro in patients with acute stroke within the initial week of hospital admission. The risk factor profiles, clinical presentation, imaging, and short-term prognosis were compared in nocturnal dippers and non-dippers (more than 10% nocturnal decrease) of blood pressure and heart rate.Results: We enrolled 234 patients in whom ABPM and MRI data were available. Heart rate data were available in 180 patients. Lacunar sub-cortical stroke was the most common acute lesion (58.9%), while hypertension (74%) and diabetes (41.5%) were the most common associated risk factors. ABPM revealed non-dipping in 69% of patients. On univariate analysis, Small Vessel Disease (SVD) was significantly more frequent in non-dippers vs. dippers (BP: 56.8 vs. 40.3% p = 0.02; heart rate: 57.9 vs. 40.7% p = 0.03). Silent strokes were also more frequent in non-dippers vs. dippers (BP: 40.7 vs. 26.4% p = 0.35; heart rate: 44.6 vs. 25.4% p = 0.01). Multivariate analysis revealed SVD to be significantly related to age, hypertension, blood pressure non-dipping, and severity of symptoms at index event.Conclusions: The presence of nocturnal non-dipping of blood pressure and heart rate are associated with an increased risk of silent stroke and SVD. Increased use of ABPM may allow for improved diagnosis of non-dippers.