District Headquarter Hospital Research Articles

Implementation, Patient Satisfaction and Usability of Telemedicine Services for Pediatric Thalassemia Cases in Balochistan During COVID-19 Pandemic and Beyond

<i>Background</i>: Telemedicine health service has revolutionized delivery of health care to the doorsteps of needy and deserving cases especially since the onset of the recent pandemic; COVID-19. Beta thalassemia major children require lifelong medical care, despite any untoward circumstances. Aim of this study is to identify role of telemedicine in diagnosing, treating and following-up of thalassemia cases and assess patient satisfaction. <i>Objective</i>: To assess implementation, patient satisfaction and usability of telemedicine health service for pediatric thalassemia cases in Northern Balochistan. <i>Study place and duration</i>: Study was carried out at District Headquarter Hospital Zhob from April 2021 to September 2021. <i>Material & methods</i>: Telemedicine service was established at Pediatric Department DHQ Hospital Zhob during COVID-19 pandemic. The data of all thalassemia cases that were managed/provided health care via telemedicine was collected and recorded. Patient satisfaction and usability of telemedicine service provided was assessed using a questionnaire prepared after thorough study of literature. The parents and care-givers of thalassemia cases treated via telemedicine were interviewed on mobile cell phones/telephone and the questionnaires were filled. Overall satisfaction was also gauged according to a scale from 1 to 5, where 1 depicted extremely dissatisfaction and 5 showed extreme satisfaction. The data was analyzed with Statistical package for social science (SPSS 21). <i>Results</i>: Total 347 patients of thalassemia received telemedicine health service during the study period. There were 182 (52.4%) males and 165 (47.6%) females with age range of 1 – 15 years (mean age 8.09 + 3.47 years). Total 289 (83.3%) telemedicine service seekers were residing in rural areas and rest 58 (16.7%) resided in urban areas. Ninety seven families (28%) belonged to poor class, 192 (55.35) belonged to lower middle class, 55 (15.9%) belonged to upper middle class and 3 (0.9%) belonged to rich class. Majority of participants (97.4%) were significantly satisfied with telemedicine service (p value 0.001). <i>Conclusion</i>: During current COVID-19 pandemic telemedicine has emerged as an exceptional alternate mode of healthcare delivery. It saves cost and time of travelling for thalassemia cases who require life-long hospital visits and follow-up. People have shown high satisfaction and positive attitude towards telemedicine health service provision.

Assessment of oral health care practices and smokeless tobacco habit among adults in Odisha: A cross-sectional study

Background: Tobacco chewing is an ancient habit dating back to more than 2000 years. Since then, it has spread with remarkable rapidity, seeping into all sections of the society. Aim: The study was carried out to compare the oral health care practices among the tobacco chewers and nonchewers and to record the tobacco chewing habit among the tobacco chewers of Khordha city, Odisha. Materials and Methods: A cross-sectional descriptive study was conducted from March 2015 to August 2015, among 25–64 years old patients attending the dental out-patient department of Gopabandhu Khordha District Headquarter Hospital. The study sample of 512 subjects (256 tobacco chewers and 256 nonchewers), who were age and sex matched, were then interviewed regarding their oral hygiene practices and tobacco chewing habit using a closed-ended questionnaire, derived from the National Youth Tobacco Survey Questionnaire, 2012 and the WHO Oral Health Questionnaire for Adults, 2013. Data obtained were analyzed using Chi-square test. The significance level was set at P ≤ 0.05. Results: All the study subjects had people at home who had the habit of chewing some or the other form of tobacco. Most (73.4%) of the tobacco chewers felt that tobacco chewing probably makes young people look cool or fit in their peer group. Furthermore, 72.2% never saw a warning label on a smokeless tobacco product and 95.3% never had family or friends talk to them about not using any type of tobacco product. However, 87.1% were willing to quit this habit if proper guidance was provided. Conclusion: Tobacco chewing is a socially and culturally acceptable habit in Khordha city, Odisha. Awareness about the harmful effects of tobacco chewing among the users was very low, emphasizing the need to educate and promote awareness about smokeless tobacco products.

Association of maternal age and presence of non-communicable diseases in consanguineous marriage with congenital abnormalities in infants

Consanguineous marriages are most common among communities where most families are of traditional and extended types. It has been seen that females who conceive at a very young age or have any non-communicable disease have higher chances to have off springs with congenital abnormalities. Objective: To find out the association between maternal age and non-communicable diseases with congenital abnormalities in children. Methods: It is a cross-sectional study performed at District Head Quarter Hospital, Okara, including 100 married participants in the age range of 19-55 years after obtaining their informed consent Results: It was observed that 57% of mothers were below 20 at marriage, 42% were above 20 at marriage and 1% of mothers were above 30 at marriage, were having children with congenital abnormalities. 22 out of 100 mothers had obesity, 15 had diabetes and 21 had CVD when pregnant. The infants born to these mothers suffered from brain anomalies, cleft lip and cleft palate, CVD and diabetes. The results were obtained with p less than 0.05. Conclusion: Congenital abnormalities were more common among children with mothers aged below 20 or 25 and suffering from any metabolic or genetic disorder.

Social Stigma and Family Support among HIV/AIDS Patients: A Psychological Analysis

This paper intends to examine social stigma and family support among HIV/AIDS patients in terms of psychological context. As social stigma among patients has created psychological problems and family members have been trying to manage the issue through social support. Hence, these patients have faced depression, stress, and anxiety in their life as they have been socially stigmatized. This study used a quantitative study design to conduct a cross-sectional survey from 200 HIV/AIDS patients sampled through a convenient sampling technique from district headquarters hospital Sargodha. The measurement scales were used including Demographic Sheet, Depression Anxiety Stress Scale (DASS), Perceived Discrimination Devaluation Scale (PDSS), and Perceived Family Support Scale (PFSS). The scale was pretested, and the value of Alpha was ranging from .811 to .915. The study findings asserted that perceived social support has a significant positive relationship with psychological problems among HIV/AIDS patients. The depressive symptoms, anxiety, and stress symptoms were found to be high among the participants reporting an increased level of perceived social stigma. HIV/AIDS-related social stigma increase fear of rejection, loneliness, and other psychological issues. The results also pointed out that perceived social stigma mediated the relationship between the perceived family support and psychological problems, revealing the fact that it is eminent to prevent the HIV/AIDS-related stigma. Keywords: Social Stigma, Family Support, Stress, Depression, Anxiety, Patients

Frequency of dental caries in 1-5 years aged children and its impact on their quality of life

Oral diseases can vastly depreciate the individual’s quality of life. It has also been considered as the most important oral health burden worldwide. It can also have significant implications on the functional, mental, and social well-being of the individual. This has been found as a preventable dental and oral health issue which have also been amongst the most prevalent chronic disease. Objectives: To estimate the frequency of dental caries and its impact on the quality of children’s life in Hafiz- Abad, Pakistan. Methods: It was a cross sectional analytics based study spanning around nine months. Three hundred and seventy children (aged between 1-5 years) were included as subjects, who visited the District Headquarter (DHQ) hospital, Hafiz Abad, Lahore, Pakistan. Dental caries were measured by using decayed missing filled (DMF) index. Data was collected and analyzed by using SPSS version 23.0. Results: A high prevalence frequency of 243 (65.7%) were found suffering from dental caries. High prevalence of dental caries (70%) in children of low literate parents has been found statistically significant (p=0.035). As far as brushing frequency is concerned 93.8% children were not found brushing their teeth prior to breakfast. Theassociation between brushing frequency prior to breakfast and formation of dental caries was found statistically significant (p&lt;0.001). Conclusion:High prevalence of dental caries coupled with high severity level was found associated with the worse dental and oral hygiene awareness levels amongst the preschool children and their parents

Evaluation of Oral Health Related Quality of Life in Patients Diagnosed with Head and Neck Cancer Receiving Radiotherapy

Objective: To evaluate the oral health related quality of life in patients diagnosed with head and neck cancer receiving radiotherapy. Design of the Study: It’s a case control study. Study Settings: The study was conducted at department of Oncology Holy Family Hospital, Rawalpindi and District Headquarters Hospital, Rawalpindi from Feb 2021 to Sep 2021. Material and Methods: Total 300 patients aged 18 years and above diagnosed with head and neck cancer undergoing radiotherapy for a minimum period of 1 month were included in this study. Oral Health Impact Profile (OHIP-14) is a 14 item pre-validated questionnaire graded on five point Likert scale used to assess Oral Health related Quality of Life based on seven dimensions of impacts of oral conditions on people’s OHRQoL. Pearson correlation and Spearman’s correlation were used to find out correlation between oral health status and quality of life. Results of the Study: Among Head and neck cancer group: 45(30.0%) were 35 to 44 years; 44(29.3%) were 45-64 years and 41(27.4%) were 65-74 years age group. Among Head and neck cancer group: 99(66.0%) were males and 51(34.0%) were females. The overall Mean SF-12 scores of head and neck cancer patients was significantly lower as compare to control patients (30.89±4.66 36.14±3.75&lt;0.001). Mean oral health-related quality of life (OHIP-14) was significantly lower in head and cancer group patients as compared to controls (18.35±7.48 vs. 11.14±8.18; &lt;0.001). Conclusion: It is proved that radiotherapy have a serious influence on oral health of the patients. Considering the influence of radiotherapy on oral health of the patient, assessment of the oral cavity should be done in routine assessment by the dentistry consultant. The OHIP-14 questionnaire has evident to be consistent and valid instrument for assessment of quality of life related to oral health in cancer patients. Among cancer patients this questionnaire should be considered in the protocol of the treatment about complications of oral health and for their optimal well-being. Keywords: cancer, quality of life, oral-health, head and neck cancer

Association Of Tinnitus With Depression And Anxiety In Hypertensive Patients

Background: Tinnitus is a condition that can be objective or subjective. The form of tinnitus most often associated with psychosocial co-morbidities is subjective tinnitus.Objective: The aim of our study was to determine the association of tinnitus with depression and anxiety in hypertensive patients.Methodology: It was cross sectional study. A total of 159 (100) % patients with hypertension were screened for presence of tinnitus in medical outpatient department of district headquarter hospital Vehari from July 2020 to March 2021. All of them were asked to complete a standardized Tinnitus handicap inventory questionnaire (THI) to assess severity of tinnitus followed by otoscopy. Depression and anxiety were measured using the Beck depression and anxiety inventories.Results: Tinnitus is strongly linked to anxiety and depression, according to the findings.Conclusions: All tinnitus patients should be screened for mental illness because of the strong connection between tinnitus, depression, and anxiety. These complex disorders should be handled by a multidisciplinary team that includes cognitive behavioral treatment and likely pharmacological therapy.

Study of Guillain-Barre syndrome etiology in Pakistani patients.

To examine clinical features, biochemical markers, demographic features, antecedent infections, frequency and treatment strategies related to Guillain-Barré syndrome. The case-control study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, and the District Headquarters Hospital, Rawalpindi, Pakistan, from 2018 to 2020, and comprised Guillain-Barré syndrome patients in group A and healthy controls in group B. The patients were diagnosed on the basis of clinical presentation, nerve conduction study, electromyography, cerebrospinal fluid analysis and biochemical profile. Data was analysed using SPSS 23. Of the 167 subjects, 90(54%) were in group A and 77(46%) were in group B. The mean age of group A was 40.20±14.90 years, while there were 61(67.7%) males and 29(32.2%) females compared to 50 (64.93%) males and 27 (35.06%) females with mean age 38.40±12.34 years in group B. Acute inflammatory demyelinating polyneuropathy was the most common electrophysiological variant of Guillain-Barré syndrome 41(46%). There was significant difference in mean interleukin-17 levels between group A 23.12±3.41 pg/ml and group B 8.82±2.49 (p<0.05). Gastrointestinal infection was the most common preceding infection 51(56.66%). The mean cerebrospinal fluid protein was 100.83±51.32g/dl and albumiocytologic dissociation was found in all the four variants (p= 0.005). Guillain-Barré syndrome affected patients regardless of age, while males were more affected than females. Majority of the patients had an antecedent infection before disease onset. Increased levels of interleukin-17 showed involvement of autoimmunity. Albuminocytologic dissociation differentiated it from poliomyelitis.

Prospective Study of the HCV-RNA Genotype 3a Diagnosed Patients Treated with Sofosbuvir and Peg Interferon Alpha-3

Background: Hepatitis C Virus (HCV) is a global health emergency. Every year, thousands of individuals suffer from HCV. HCV if not treated, may manifest severe hepatic complications, many of which have fatal outcomes. Various therapeutic strategies are currently used to eradicate the virus from the patient’s body. Treatment of the HCV patient depends largely on the genomic typing. Objectives: The aim of the present study was to assess the comparison between Sofosbuvir and Peg-Interferon alpha in patients diagnosed with HCV RNA genotype 3a. Methodology: A prospective case cohort study had been conducted in District Headquarter Hospital, Sargodha, Pakistan. Patients diagnosed with HCV genotype 3a were enrolled in the study and randomly divided into 2 groups. Group I was assigned Sofosbuvir 400 mg and group II Peg-Interferon alpha 3 million units. Both the groups were also administered ribavirin. The study was conducted for a period of 24 weeks and efficacy was determined by the decline in the viral RNA load. Results: Each group had 50 patients of which majority were males. Compared to males, females had higher viral RNA load. However, the efficacy of both the treatment drugs was similar in both the genders. Comparatively, Sofosbuvir group showed better efficacy than Peg-Interferon group with significant difference in mean HCV RNA at the end of the study (p < 0.05). Conclusion: Although, Sofosbuvir and PEG-Interferon both demonstrated efficacy in reducing the viral RNA load, Sofosbuvir is more efficacious and better tolerated in the management of HCV RNA genotype 3a infection.

IDENTIFYING FACTORS ASSOCIATED WITH THE USE OF A SCALED-UP POSTPARTUM FAMILY PLANNING PROJECT IMPLEMENTED IN PUNJAB, PAKISTAN

Pakistan has one of the highest unmet needs for family planning among low and middle-income countries. Postpartum family planning (PPFP) is considered to have the potential of significantly improving the contraceptive prevalence rate and reducing the unmet need for family planning. Jhpiego (John Hopkins Affiliate) implemented a PPFP pilot project in the district headquarter hospital of Mandi Bahauddin. The key interventions of the Jhpiego pilot were to improve services pertinent to PPFP. Based on the successes of the pilot, the interventions were scaled up to other health facilities. The present study aims to identify the factors associated with the utilization of the postpartum family planning health project implemented in the health facilities once the scale-up activities ended and comparing it with the pilot facility. A cross-sectional survey with a sample of 410 women using postpartum care services in the facilities was conducted using a structured questionnaire. The findings indicated that the complete set of interventions were not present in the facilities. Postpartum family planning method uptake was low (26%) along with the shortage of contraceptives supplies. Multivariate logistic regression was conducted to identify the predictors for the current use of postpartum family planning. The predictors identified that women with the age of 25 years and above with 3 or more children, who attended antenatal care visits and were counselled on PPFP were more likely to adopt/use PPFP in the postpartum period. The findings indicated scale-up was limited and the interventions were not sustained once the donor support ended.

Seroepidemiology and associated risk factors of hepatitis B and C virus infections among pregnant women attending maternity wards at two hospitals in Swabi, Khyber Pakhtunkhwa, Pakistan.

Hepatitis B and C infections are global issues that are associated with a massive financial burden in developing countries where vertical transmission is the major mode and remains high. This cross-sectional study was designed to investigate the seroepidemiology and associated risk factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among 375 pregnant women attending antenatal care health facilities at Bacha Khan Medical Complex (BKMC) Shahmansoor and District Head Quarter (DHQ) Hospital Swabi, Khyber Pakhtunkhwa, Pakistan. From a total of 375 pregnant women selected using systematic random sampling from both hospitals, 10 ml of blood samples were collected and alienated serum was examined for indicators identification through the Immuno-Chromatographic Test (ICT) and 3rd Generation Enzyme-Linked Immunosorbent Assay (ELISA). A pre-structured questionnaire was used to collect the socio-demographic data and possible risk factors. The data was analyzed via SPSS 23.0 statistical software. A chi-square analysis was performed to determine the association between variables. P-value < 0.05 was set statistically significant. The overall frequency of HBV and HCV among 375 pregnant women involved in the study was 3.7% and 2.1% respectively. None of the pregnant women were co-infected with HBV and HCV. Dental extraction (P = 0.001) and blood transfusion (P = 0.0005) were significantly allied with HBV infection while surgical procedure (P = 0.0001) was significantly associated with HCV infection. Moreover the sociodemographic characteristics: residential status (P = 0.017) and educational level (P = 0.048) were found significant risk factors of HBsAg and maternal age (P = 0.033) of anti-HCV, respectively. HBV and HCV infections are intermediary endemic in the study area. A higher prevalence of HBV was detected among pregnant mothers with a history of dental extraction, history of blood transfusion, resident to the urban area and low educational level. The age and surgical procedures were the potential risk factors found significantly associated with HCV positivity among pregnant mothers in our setup. Future negotiations to control vertical transmission should include routine antenatal screening for these infections early in pregnancy and the requirement of efficient preventive tools including the birth dose of the hepatitis B vaccine in combination with hepatitis B immune globulins to the neonate.

Burnout and Empathy: A Cross-Sectional Study among Resident Physicians in Public Sector Hospitals of a Developing Country

The main objective of our study was to determine the prevalence of burnout and to identify various socio-demographic factors which are associated with resident burnout. As a secondary objective, we aimed to assess levels of empathy among the residents. A descriptive cross-sectional study was performed among residents working in Holy Family Hospital, Benazir Bhutto Hospital, and District Headquarter Hospital, all of which are situated in district Rawalpindi of Punjab, Pakistan. Data were collected from January 2019 to April 2019 using a convenient sampling technique. The participants were requested to complete Maslach Burnout Inventory to measure burnout and Jefferson Scale of Physician Empathy to measure empathy from January 2019 to April 2019. For data analysis IBM SPSS © version 25.0 was used. Descriptive statistics were used to summarize the quantitative variables. Chi-square test was used to determine the association between burnout and categorical variables. Then, those independent variables with p-value &lt; 0.05 were subjected to binary logistic regression to identify predictors of burnout. A P-value of &lt; 0.05 was used as the criterion for statistical significance and OR with 95% confidence interval was used to indicate the strength of association. Independent sample t-test was used to assess empathy among the groups. The prevalence of burnout in our sample was 78%. The average burnout score of the sample was 81±13.45. Weekly working hours (p-value &lt; 0.05) and the type of specialty (p-value &lt; 0.05) were significantly associated with resident burnout. Residents working more than 80 hours were more prone to develop burnout [AOR 2.700(1.42-5.120)]. Medical residents were found to be at a higher risk of developing burnout as compared to surgical residents [(AOR 2.097(1.16-3.78)]. Residents working less than 80 hours per week had more empathy scores as compared to residents working more than 80 hours and this result was statistically significant (p-value &lt; 0.05). However, no significant difference in empathy was found for age, gender, marital status, and posts. Therefore, weekly working hours should be reduced to diminish burnout and increase empathy, thereby, promoting the quality of care being delivered to the patient. Moreover, efforts should be made to reduce burnout in medicine residents so that we may promote the doctor-patient relationship.

Ghrelin levels in hypertensive obese and normotensive obese subjects.

Objective: The purpose was to determine the ghrelin level, its effect and relationship with blood pressure levels in obese subjects. Study Design: Comparative Cross Sectional study. Settings: General OPD of Madinah Teaching Hospital (MTH) and District Head Quarter hospital Faisalabad (DHQ). Period: 2019 to 2020. Material &amp; Methods: Blood samples were collected from hypertensive and compared with the normotensive obese (BMI &gt;30). Ghrelin level was measured by Enzyme-linked immunosorbent assay (ELISA). Statistical analysis was done on Statistical Package for the Social Science (SPSS) 20 software. Mean ±SD has been given for quantitative variables. Independent sample t test was used for comparisons. Significance has been chosen as p ≤ 0.05. Results: Total 114 obese patients were selected for this study, of which 57 were hypertensive and 57 were normotensive. Minimum age was 30 years and maximum age was 60 years with mean age 39.35 ± 10.08 years. Mean age of hypertensive obese was 43.42 ± 10.46 years and mean age of normotensive was 35.28 ± 7.87 years. Statistically significant difference of mean fasting ghrelin levels between hypertensive obese and normotensive obese was noted with p value 0.013. Conclusion: Obese persons with elevated circulating concentration of ghrelin may be susceptible to the progression of increasing blood pressure.

Wheat Pill Poisoning: Management and outcome in cases reported in DG Khan District.

Objective: To determine the clinical manifestations and prognosis of victims presenting with wheat pill poisoning. Study Design: Prospective Cohort Study. Setting: Emergency Department in District Headquarter Hospital DG Khan. Period: February 2019 to January 2020. Material &amp; Methods: Patients admitted with history of accidental or suicidal wheat pills poisoning were followed over a period of 3 to 6 months. Symptomatic treatment was initially given for 2-3 hours. The patients were retained in CCU for 24 hours before shifting to ward. Research tool (proforma) was designed for collection and interpretation of data. Acute Physiology and Chronic Health Evaluation Score 2 (APACHE-2) score was used for prognosis and recovery. Result: Out of 96 victims of aluminum phosphide ingestion male/female ratio was 2:1, 64% (n= 64) were females and 36% (n=32) were males. Higher incidence was found in age group (16–25 years (n= 27 victims). Overall mortality was 63 (65.6%). Conclusion: Wheat pill was a poison of choice among teens and adults in Pakistan as it is freely available and cheap. Arrhythmia and metabolic acidosis are the major causes of death after wheat pills ingestion. Coconut oil was found effective in delaying the absorption.

Iron deficiency anemia and associated factors among pregnant women in a tertiary care hospital, in Sargodha District, Pakistan

Purpose: To evaluate iron deficiency anemia and other concomitant risk factors among pregnant women in a tertiary care hospital in Sargodha District of Pakistan.&#x0D; Methods: An observational cross-sectional study on pregnant women over a six-month period from December 2016, was conducted in the gynaecology and obstetrics department of the District Headquarters Hospital, Sargodha, Pakistan. All women with renal failure, heart disease and surgical history were excluded from the study, while all pregnant women visiting the out-patient department (OPD) were included in the investigation. Blood sampling and analysis were performed, following standard laboratory operating procedures to determine the haemoglobin (Hb) levels of the patients.&#x0D; Results: Fifty pregnant women were enrolled in this study. They had a mean age of 27.85 ± 4.99 years with a range of 20 – 46 years. Almost half, i.e., 26 (52 %), were aged 20 – 30 years; 18 (36 %) 31 – 40 years and six (12 %) &gt; 40 years of age. Regarding occupational status, 45 (90 %) of the respondents were housewives. In total, 86 % of the women were anemic, while the remaining 14 % were non-anemic and had an Hb level slightly &gt; 11 g/dL. Among the anemic women, 13 (26 %) had mild anemia, 33 (66 %) moderate anemia, and 4 (8 %) were severely anemic.&#x0D; Conclusion: Iron deficiency and anemia have major health impacts on pregnant women. Steps should be taken during ante-natal care to monitor Hb levels in pregnant women and apply appropriate remedy where necessary. Other biomarkers and related risk factors such as total iron binding capacity (TIBC) and total blood count (TBC) have previously been found to be linked to anemia

Effectiveness of Ponseti Versus Kite Method for the Management of Club Foot- A Quasi Experimental Trial

Objective: To determine the effectiveness of ponseti versus kite method for the management of club foot among children. Methods: A quasi experimental trial was conducted to determine the most effective conservative method for managing idiopathic club foot. This study was carried out in District Head Quarter Hospital, Layyah. A total of 46 children (60 Feet) aged less than six months of both genders were included in this study using convenience sampling technique. The study sample was divided into Group A (Ponseti) and Group B (Kite). Each treatment group comprises of 30 feet. Patients were called for weekly follow up till ten weeks consecutively. At every follow-up visit, patients were assessed to check the improvement of deformity with the help of the Pirani scoring system for the foot. Pirani score difference was measured in both treatment groups from the baseline until the last follow-up interval until the 10th Week. Pirani score difference was measured in both treatment groups from the baseline until the last follow-up interval until the 10th Week. A greater negative value signified better correction. SPSS 23 was used for data entry and analysis. Results: Children's mean age in both treatment groups (A and B) was 10.83±4.59 and 10.20±4.75 weeks. At presentation mean Pirani score in both treatment groups (A and B) was 5.85±0.67 and 5.86±0.45, respectively, while at 10th follow up it was 1.42±0.39 and 2.35±0.54 for group A and group B, respectively. Conclusion: This study demonstrates that the Ponseti technique significantly improved the management of club foot as that of the Kites method. Ponseti's method is more effective in terms of rapid improvement in the involved group. Key words: Non operative Management, Idiopathic Club foot, Kites method, Ponseti method.

Non-fatal firearm injuries, Incidence and Circumstances: Presenting in DHQ Hospital Rawalpindi

Objective: To describe the incidence and manner of nonfatal firearm injuries in Rawalpindi District Study design: Observational retrospective study Place and Duration: District Head Quarters Hospital Rawalpindi. Duration of 6 months, from July 2020 to Dec 2020. Methodology: Total 82 patients with nonfatal firearm injuries were included. After approval from ERC committee of DHQ Hospital Rawalpindi, data was obtained from the duplicate copies of medicoleagal reports kept at the Forensic Medicine department t of IIMCT. These reports were carried out by cross ponding author and the demonstrators of Forensic Medicine department of IIMCT. The data was entered on a pre-designed Performa having variables such as demographics, time &amp; place of death, region of body involved, weapon used &amp; month of the year. Results: A total of 82 nonfatal firearm injuries were reported during these 6 months. 87% of the victims of were males encountering injuries 1 to 11 in number with an average of 3 injuries per person. 3o% of these injuries were received on the upper trunk, 32% on the lower trunk, 16% the lower limbs, 13% the upper limb, 3% the head and neck and 6% on the other regions. 68% of the injuries were lacerations, an exit wound was detected in 19% of cases and in 13% only entry wounds were found. Tattooing and burning of the adjacent skin were common in wounds on the upper and lower trunk while comminuted intra articular and shaft fractures were important varieties in the limbs. 86% of the victims were vitally stable, others being critically unstable with GCS ranging till 6/15. Conclusion: The public health issue of firearm-related injuries continues to be a concern. The necessity for a district-based, nationwide reporting system for fatal and nonfatal firearm-related injuries is critical. In Pakistan, these data could be used in the design, implementation, and assessment of preventative programs. Key words: Non fatal, Firearm injuries, Regional injuries

Investigation of a child malaria death during COVID-19 pandemic in a hamlet of Angul district, Odisha (India)

Background: This study aimed to find out the cause of child death due to Plasmodium falciparum and associate co-morbidities in a hamlet of Garud village of central district of Odisha (India), Angul during the COVID-19 pandemic and to recommend necessary actions to prevent such unwanted death.Methods: A retrospective investigation was conducted bases on the death audit report of a female child belonging to Garud village of Angul district. Death was reported at the district headquarters hospital, Angul. Detailed history from the starting of first symptom till death with laboratory investigations were reviewed using the malaria death audit format of NVBDCP, Odisha. Along with in-depth interview with family members, mass screening using bivalent rapid test and slide test, treatment and malaria preventive measures were undertaken in the community.Results: During the COVID-19 pandemic, one child death was recorded due to falciparum malaria infection. Along with the child, all two family members were infected with falciparum. The family belongs to small hamlet with eight households and 39 population. All 39 populations were screened for malaria and out of these, 11 number people were found positive of falciparum.Conclusions: COVID-19 pandemic resulted the major societal disruption due to lockdown and shutdowns affecting routine health care which may be attributed to the death of a child even in a in a well-resource setting district of Odisha. In such pandemic situation much more attention need to be given on the traditional infectious diseases which may cause unnoticed death.

Prevalence of Typhi DOT IGM positive results in COVID-19 patients at primary and secondary health care hospitals in Punjab, Pakistan.

Objective: To determine prevalence of Typhi dot IgM positive results in COVID-19 patients at primary and secondary health care hospitals in Pakistan. Study Design: Descriptive Cross-sectional study. Setting: Tehsil Head Quarter Hospital of Burewala and District Head Quarter Hospital of Vehari. Period: 1st March 2020 to 30th June 2020. Material &amp; Methods: Study was done among diagnosed cases of COVID-19 after taking ethical approval from ethical review board. Results were assessed by using SPSS version-24. Results: Males were predominant (71.30%) in our study as COVID-19 positives than the females. Most of the patients (51.70%) were from middle aged group, i.e. 31-60 years. Only 7.40% patients were from elder age group (more than 60 years). More than half of the patients (51.90%) were found to be positive with IgM typhi dot test. We repeated the tests and found the same results. We also calculated the prevalence of typhoid positive cases in COVID patients according to different demographic variables. As far as gender is concerned, our result was highly statistically significant when associated with typhoid positive results among COVID patients (P=0.0001). Males were predominantly having high rate of typhi dot IgM positives (71.30%) than females. Middle aged patients were found to be more affected by typhi dot positive results. Conclusion: It is concluded that there is a high and significant ratio of typhi dot positive results for IgM in COVID patients at Vihari district.

Implementation of a telemedicine service during COVID-19 pandemic in Pakistan.

AimIn this feasibility study, we aimed to implement a pilot telemedicine service at our healthcare facility in Faisalabad, Pakistan, and describe our experience.MethodsTelemedicine service was established by Faisalabad Medical University at two of its affiliated locations: (i) a 24‐hour COVID‐19 Telephone Helpline was established at the Director Emergency Office, Allied Hospital, and District Headquarter (DHQ) Hospital. (ii) A Telemedicine Clinic comprising consultants and postgraduate residents from different specialties was established at Chief Office, Allied Hospital. The data related to the number and categories of calls and advice provided were collected from 27th March 2020 to 31st July 2020.ResultsA total of 4582 calls were received, at both locations, during the study period, out of which 2325 callers (51%) were male, and 2257 (49%) were females. At Allied Hospital, 172 patients were advised accordingly for their complaints, whereas, at DHQ Hospital, 320 patients were advised accordingly for their complaints. At the Telemedicine Clinic only, a total of 2436 calls were received during the study period, 1474 (60%) callers were male, and 962 (40%) were female. The majority of the calls were received by medicine (43%), dermatology (21%), and paediatrics (11%) specialties, respectively.ConclusionDespite some limitations, the benefits of telemedicine in this COVID‐19 era are enormous and it is feasible to implement telemedicine services in developing countries. The developing countries must invest in the internet and technology access to facilitate telemedicine and other e‐health services for not only curbing this pandemic but also to promote a more efficient healthcare system after the pandemic.