Shaikh Zayed Hospital Research Articles

KELL BLOOD GROUP ANTIGENS IN THE BLOOD DONORS ATTENDING BLOOD BANKS OF TERTIARY CARE HOSPITALS OF LAHORE, PAKISTAN.

Introduction: Among the complications of blood transfusion, Hemolytic transfusion reactions (HTRs) and Hemolytic disease of the newborn (HDN) are particularly important. Literature reports frequency of HTRs and related mortality up to 1/76,000 and 1/1.8 million units transfused respectively. These hemolytic reactions are caused by incompatibility between the donor and recipient blood and in cases of HDN, due to feto-maternal incompatibility due to maternal antibodies attacking the fetal red cells. Anti-K antibody is the most common antibody encountered in blood banks after the ABO and Rh antibodies. So routine screening and matching of these blood antigens along with ABO and Rh can further reduce the risk of HTRs and HDN. Existing literature on Kell blood system reports varying frequency of K and k antigens among various populations. Objectives: The objectives of this study were to determine the prevalence of Kell blood group antigens in the blood donor population at Shaikh Zayed and Jinnah Hospitals Lahore and the association of Kell blood group antigens with different ABO blood groups of Lahore population. Study Design: It is a descriptive cross-sectional study. Setting: Research was conducted at the Blood banks of Sheikh Zayed Hospital, Lahore and Jinnah Hospital, Lahore. Period: 6 months after the approval of synopsis from 15/06/2015 to 15/12/2015. Material and Methods: This study included 192 donors; 96 from Sheikh Zayed Hospital, Lahore and 96 from Jinnah Hospital, Lahore. A written informed consent was taken from every donor. Kell blood group antigens K and k were determined. Results: There were 192 donors, 96 each from Shaikh Zayed Hospital, Lahore and Jinnah Hospital, Lahore. Out of these donors 186 (96.9%) were males and 6 (3.1%) were females. The most frequent ABO blood group antigen observed was B, which was seen in 82 (42.7%) donors, followed by O in 68 (35.4%), A in 36 (18.8%) and AB in 06 (3.1%) donors. Kell antigen k was found in 185 (96.3%) donors while K was found in 07 (3.6%) donors. When stratified, there was no statistically significant difference in the frequency of Kell antigens between genders (p=0.08) and ABO blood groups (0.09). The frequency of k antigen was higher among those with blood group B (43.2% vs. 17.8%) as compared to A, and the frequency of K antigen was higher among those with blood group A (42.8% vs. 28.5%) as compared to B, however, this was statistically insignificant. Conclusion: The frequency of k was observed to be 96.3%. It was higher in donors with antigen B while the frequency of K was found to be 3.6% and it was higher in donors with antigen A.

COMPARISON OF ONDANSETRON AND METOCLOPRAMIDE IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANESTHESIA.

Background: Laparoscopic cholecystectomy is a standard treatment for cholelithiasis. It is a safe and effective treatment in many cases. General anesthesia has a high incidence for PONV. But anti-emetic drugs can help in preventing PONV. Objectives: To compare the efficacy of ondansetron and metoclopramide in patients undergoing laparoscopic cholecystectomy under general anesthesia. Study Design: Randomized controlled trial. Setting: Department of Anaesthesia, Sheikh Zayed Hospital, Lahore. Period: 6 months i.e. from 15-2-2017 to 15-8-2017. Material & Methods: The patients were divided into two groups. Ondansetron was given to group A patients within 15 minutes of induction, and metoclopramide to group B patients within 15 minutes of induction. Then patients were shifted to the ward after surgery and followed-up for 24 hours for assessment of PONV. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients in group A was 38.40±12.07 years and in group B was 42.63±11.77 years. The efficacy achieved in 53 were from group A and 39 were from group B Statistically significant difference was found between the study groups i.e. p-value=0.003. Conclusion: Ondansetron showed significantly better efficacy than metoclopramide in preventing PONV after laparoscopic cholecystectomy under general anesthesia.

HYPOSPADIAS REPAIR IN CHILDREN: 10-YEARS EXPERIENCE AT SHAIKH ZAYED HOSPITAL LAHORE.

Introduction: Hypospadias is one of the common urogenital condition affecting male children. Multiple factors have been reported by different studies that contribute towards hypospadias, including in utero growth retardation, higher maternal age and endocrine disruptors. Usually multiple surgical procedures are required for correction of hypospadias especially in cases of proximal hypospadias associated with chordee. Objectives: The purpose of study was to report the early outcomes after single stage repair for distal hypospadias and staged repair for proximal hypospadias over the last 10 years in our department. Study Design: Descriptive Study. Setting: Department of Paediatric Surgery, Shaikh Zayed Hospital Lahore. Period: January 2006 to December 2016. Materials & Methods: This study was conducted in Department of Pediatric Surgery, Shaikh Zayed Hospital Lahore. All the patients who were operated between January 2006 to December 2016 for hypospadias or their complications in our unit were included. Data was collected from chart review and outpatient follow up. Data for age at presentation, type of anomaly, congenital curvature, testosterone stimulation, surgical procedure and complications with their management were collected. Patients were divided in two groups depending upon whether single stage procedure was performed or two stage surgery was undertaken. All patients with glandular hypospadias had meatal advancement but glanuloplasty was done in selected cases. Patients with distal hypospadias without chordee underwent tubularized incised plate urethroplasty (TIP) repair. Patients with proximal hypospadias had two stage surgery with correction of chordee with grafting and tubularization of graft after 6 months. Data was analyzed by SPSS v 22. Results: During the study period 134 patients with hypospadias or its complication were managed. Out of these 90 patients met our inclusion criteria. The mean age of patients was 5.0 years. Sixty three (70 %) had distal hypospadias. MAGPAI was performed in 12 (13.3%), TIP repair in 51 (56.7%), Bracka I in 25 (27.8%), Bracka II in 18 (20.0%) and Mathieu repair in 2 (2.2%) patients. Both the patients with Mathieu repair had dehiscence. The most common complication in distal cases was meatal stenosis. In patients with distal hypospadias 10.8% developed fistula while 44.5% of patients with proximal hypospadias developed fistula. Conclusion: Repair of proximal hypospadias with chordee is associated with more complications. Outcomes may be improved by specialized training with adequate workload.

HEMODIALYSIS;

Objective: To evaluate the treatment success rate of percutaneous transluminal angioplasty (balloon angioplasty) for peripheral and central venous stenosis in hemodialysis patients. Study Design: Retrospective/observational study. Place and Duration of Study: Department of Cardiology, Shaikh Zayed Hospital Lahore from 1st January 2018 to 30th June 2018. Methods: Thirteen patients of both genders presenting during from two years of hemodialysis failure and ipsilateral arm and neck swelling followed by peripheral and central venous stenosis were included in this study. Patients ages were ranging from 25 to 70 years. Patient’s detailed history including hemodialysis treatment, age, sex, socio-economic status was examined after taking informed consent from the patients. Percutaneous transluminal angioplasty (PTA) was performed at all the patients. Procedural success rate was examined. Results: There were 9 (69.23%) patients were men and rest (13.77%) were women. 5 (38.46%) patients were ages between 25 to 45 years, 6 (46.15%) patients had an ages 46 to 65 years and 2 (15.38%) patients were ages greater than 65 years. 10 (76.92%) had rural residency. 40 % patients had income >30000 PKR. Location and severity of lesions was examined as brachiocephalic vein, subclavian vein, Axillary vein, basilica, cephalic and median cubtal vein in 1,3,2,3,3 and 1 patients respectively. We determine priority patency rate in central lesion PTA was 82.7%, 62% and 38% at 3, 6 and 12 months and priority patency rate in peripheral lesions PTA was 87%, 79.5% and 67.8% at 3, 6 and 12 months. Conclusion: It is concluded that percutaneous transluminal angioplasty (balloon angioplasty) procedure for treatment of central and peripheral venous stenosis in hemodialysis patients was safe and effective with no procedural complications.

Post Cataract Surgery Refractive Error in Myopic Patients Using SRK/T Versus Holladay 1 Formula for IOL Power Calculation

Purpose: To compare post-operative mean refractive error with SandersRetzlaff-Kraff/theoretical (SRK-T) and Holladay 1 formulae for intraocular lens (IOL) power calculation in cataract patients with longer axial lengths. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Ophthalmology, Shaikh Zayed Hospital Lahore from 01 January 2017 01 January, 2018. Material and Methods: A total of 80 patients were selected from Ophthalmology Outdoor of Shaikh Zayed Hospital Lahore. The patients were randomly divided into two groups of 40 each by lottery method. IOL power calculation was done in group A using SRK-T formula and in group B using Holladay1 formula after keratomery and A-scan. All patients underwent phacoemulsification with foldable lens implantation. Post-operative refractive error was measured after one month and mean error was calculated and compared between the two groups. Results: Eighty cases were included in the study with a mean age of 55.8 ± 6.2 years. The mean axial length was 25.63 ± 0.78mm, and the mean keratometric power was 43.68 ± 1.1 D. The mean post-operative refractive error in group A (SRK/T) was +0.36D ± 0.33D and in group B (Holladay 1) it was +0.68 ± 0.43. The Mean Error in group A was +0.37D ± 0.31D as compared to +0.69D ± 0.44D in group B. Conclusion: SRK/T formula is superior to Holladay 1 formula for cases having longer axial lengths. Key words: Phacoemulsification, intraocular lens power, longer axial length, biometry.

FREQUENCY OF STAPHYLOCOCCUS AUREUS IN BLOOD STREAM INFECTIONS AND THEIR DRUG SUSCEPTIBILITY PATTERN

Background: Staphylococcus aureus is important cause of blood stream infections. The objectives of this study were to determine the frequency of Staphylococcus aureus in blood stream infections and their antimicrobial drug susceptibility pattern. Materials & Methods: This cross-sectional study was conducted at the Department of Pathology, Shaikh Zayed Hospital, Lahore from April 2018 to March 2019. The sample size was 1527 positive blood cultures for bacteria selected through consecutive sampling technique. Research variables were; presence of positive blood cultures, presence of staphylococci in positive blood cultures, types of staphylococci and types of staphylococcus aereus. Frequency and percentage of blood stream infection caused by Staphylococcus aureus and susceptibility of Staphylococcus aureus to various antimicrobial drugs was detected by disc diffusion and e-strip method. Results: Out of 12744 blood cultures, 1527(11.98%) were positive for bacteria. Out of these 1527, 339(22.20%) were positive for staphylococci. Out of these 339, 87 (5.69%) were staphylococcus aureus. Out of these 87, 48 (3.14%) were methicillin resistant (MRSA). Susceptibility of S. aureus isolates to various commonly used drugs was also detected. Conclusion: Staphylococcus aureus is a significant cause of blood stream infection and can exhibit multi-drug resistance. Therefore drug susceptibility profile of pathogens prevalent in hospital should be monitored and kept in mind when prescribing antimicrobial drugs before getting results of antimicrobial drug susceptibility tests.

COMPLICATED INGUINAL HERNIAS;

Background: Herniorrhaphy and hernioplasty are the two most common modalities used with different degree of success and complication rates in the treatment of inguinal hernia. Several studies show that use of mesh is superior to the non-mesh operations in inguinal hernia surgery.It is generally believed that the use of biomaterials should be limited to non-infected surgical fields.Now the concept regarding use of mesh in complicated hernias is changing as shown by many studies. Current study is being planned to observe the outcomes of the mesh hernioplasty in treatment of complicated inguinal hernias in emergency so that in future appropriate and safe technique may be suggested for repair of complicated hernias in emergency setting. Objectives: To compare the outcome of hernioplasty and herniorrhaphy in emergency for the treatment of complicated (Irreducible/obstructed) inguinal hernias regarding wound infection and hospital stay. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical ward, Sheikh Zayed Hospital, Rahim yar khan. Period:09 months from 01-01-2016 to 30-09-2016. Sample Size: A total of 64 patients with 32 patients were included in each group, with confidence level of 95% and power of 80% and anticipated mean level of hospital stay in group 1 of 5±3.4 days versus 3±2.1 days in group 2. Sampling Technique: Non-probability, consecutive sampling. Results: In this study there were total 64 cases with 32 in each group. The mean age was 41.69±11.06 years and the mean duration of hernia obstruction was 12.83±4.97 hours. There was no significant difference in terms of age, duration of hernia and hernial obstruction between both groups. Seroma was seen in 5 (7.81%) out of 64 cases while wound infection was seen in 8 (12.50%) of cases. Seroma was seen in 2 (6.25%) out of 30 cases in herniorrhaphy as compared to 3 (9.38%) out of 32 cases with hernioplasty with p value of 0.64. Wound infection was seen in equally 4 (12.50%) out of 32 cases in both groups with p value of 1.0. Duration of hospital stay was 4.66±1.36 in patients with herniorrhaphy as compared to 4.53±1.37 days with hernioplasty with p value= 0.82. There was no significant difference in terms of age groups, duration of hernia and its obstruction between both groups regarding seroma. There was also no significant association among any of the confounding factors regarding the wound infection and length of the hospital stay between the both groups. Conclusion: We can perform hernioplasty as compared to herniorrhaphy for complicated inguinal hernia with similar complications and better success rates in the same emergency setting.

HYPERLIPIDEMIC PATIENTS;

Objectives: Role of niacin in decreasing cardiovascular accidents by lowering the levels of Apo-B in hyperlipidemic patients. Background: In hyperlipidemia, there are high levels of atherogenic lipoproteins leading to higher risk of atherosclerotic cardiovascular events. Patients with dyslipidemia use statins as a mainstay of therapy over last many decades. Recent studies show that apolipoproteins play a major role in formation of atheromatous plaque, thus there is an urgent need to study the effects of lipid lowering medication on apolipoprotiens levels. Study Design: Cross sectional analytical study. Setting: Sheikh Zayed Hospital Lahore (Department of Biochemistry and Chemical Pathology). Period: 12 weeks from July to Sep 2014. Materials and Methods: Recently diagnosed hyperlipidemic patients (n=44) were selected for the study purpose and divided into two equal groups; A and B. Each group was given different medication. Group A took only statin while group B took a combination of statin and niacin. Blood samples were taken at the start of medication and then after completion of 12 week time period. Results: At the start of the treatment there was no significant difference in the Apo B cholesterol level between the two groups (p value 0.972). However, after the end of 12 week duration, there was a significant reduction in the Apo level of group B taking statin and niacin as compared to group A taking statin alone (p value 0.003). Conclusions: Niacin has cardio-protective role when used in combination with niacin.

PROSTATIC HYPERPLASIA (BPH);

Objectives: To determine the efficacy of tamsulosin with and without tolterodine in patients having benign prostatic hyperplasia (BPH) with irritative (overactive bladder) symptoms. Study Design: Randomized clinical trial. Setting: Department of Urology and Kidney Transplantation, Sheikh Zayed Hospital Lahore. Period: Six months from July to Dec 2017. Patients and Methods: Sixty patients of BPH had irritative (overactive bladder) & obstructive presentation were recruited. Patients were categorized in two groups and were compared for efficacy according to international prostatic symptom scoring while the data analyzed in SPSS 16. Results: Patients with BPH having irritative (overactive bladder) symptoms, after receiving Tamsulosin with Tolterodine, 76.60% (23/30) of patients reported symptomatic improvement whereas only 40.00 % (12/30) of subjects improved with tamsulosine only. Rate of improvement was observed to be higher in individuals with tamsulosine with tolterodine (Group B) than group A (includes tamsulosin only) with statistical significance) chi-square = 8.297; p=0.004). Conclusion: Efficacy of tamsulosin with tolterodine is higher than tamsulosin alone in subjects with BPH had irritative (overactive bladder) & obstructive symptoms.

IL-22 in hepatocyte's survival of Pakistani patients with end stage liver disease: an insight into IL 22 mediated hepato-regenerative pathway.

Hepatitis is the principal cause of hepatocellular carcinoma (HCC) and decompensated cirrhosis. HCC is amongst the leading causes of deaths worldwide. Current therapeutic options have proven to be unsuccessful in treating this disease due to multifactorial nature of the disease. The present study was designed to investigate the role of IL-22 mediated survival of hepatocytes during cirrhosis and HCC. Resected/explanted liver tissue samples of patients with End Stage Liver Disease were obtained from Hepato-Pancreato-Biliary Liver Transplant Unit of Sheikh Zayed Hospital, Lahore, Pakistan. Qualitative expression of IL-22, SOCS3, and IL-22 induced anti-apoptotic protein, B-cell lymphoma extra-large (Bcl-xL), were evaluated by Immunohistochemical analysis (IHC). The IHC analysis revealed significantly high expression of IL-22, SOCS3, and Bcl-xL within explanted livers of HCC patients. Overall, the expression of SOCS3 was higher than any other protein, and the expression of all proteins showed significant variation in different group of patients based on clincopathological features. The results of the current study indicated that IL-22 mediated JAK-STAT pathway i.e. liver regeneration and healing is dependent on the disease progression and type of agent responsible for causing the infection in the first place. However, quantitative analysis of these factors in future can provide further evidence of the role of this pathway in HCC for development of anti-HCC therapies.

Alkaline phosphatase is a predictor of Bone Mineral Density in postmenopausal females.

Objectives:The study was planned to determine whether serum calcium, phosphate and alkaline phosphatase (ALP) are predictors of bone mineral density (BMD) in postmenopausal non-osteoporotic, osteopenic, and osteoporotic females.Methods:In this cross sectional study, conducted at Shaikh Zayed Hospital, Lahore in the year 2014-2015, postmenopausal females between 50-70 years of age were taken and divided into three groups non-osteoporotic (n=52), osteopenic (n=69) and osteoporotic (n=47). Serum ALP, phosphate and calcium were used in a stepwise multiple regression analysis to predict T-score in these groups.Results:In normal postmenopausal females, the prediction model was statistically significant, F(2, 41) = 6.041, p < 0.05 and showed a T-score variance of 22%. T-score was primarily predicted by higher levels of phosphate and calcium. In postmenopausal osteopenic females, T-score was only predicted by lower levels of ALP. The model was statistically significant, F(1, 59) = 4.995, p < 0.05, and accounted for approximately 7% of the variance of T-score. In postmenopausal osteoporotic females, the prediction model contained no predictors.Conclusion:Our study suggested that calcium and phosphate are the strongest predictors of T-score in postmenopausal normal females, while in postmenopausal osteopenic females ALP was the strongest predictor of T-score. Elevated serum ALP levels may help in determining loss of BMD in postmenopausal females.

Adrenergic receptor beta-3 rs4994 (T>C) and liver X receptor alpha rs12221497 (G>A) polymorphism in Pakistanis with metabolic syndrome.

The present study aimed to determine the association of adrenergic receptor beta-3 (ADRB3) rs4994 T>C and liver X receptor alpha (LXR-α) rs12221497 G>A polymorphism with metabolic syndrome (Met S) and the related traits in Pakistanis. Patients of Met S were recruited from the Endocrinology and Diabetic Clinic of Sheikh Zayed Hospital Lahore, over the time span of 6 months from July to December 2016. Single-nucleotide polymorphism (SNP) of ADRB3 was determined by restriction fragment length polymorphism and of LXR-α by amplification refractory mutation system polymerase chain reaction. The frequency of TT variant of ADRB3 T>C in Met S was 69 (34.5%) and in controls 89 (44.5%), frequency of TC 103 (51.5%) and 96 (48%), and of CC 28 (14%) and 15 (7.5%), respectively. In the recessive model (CC: TT + TC), CC genotype was found to be associated with the increased risk of Met S (P = 0.027; odds ratio [OR] = 2.09; confidence interval [CI] =1.08-4.03) and the association remained significant after controlling for the confounders such as age and sex. The frequency of GG variant of LXR-α G>A in Met S was 35 (17.5%) and in controls 15 (7.5%), GA 129 (64.5%) and 137 (68.5%), and AA 36 (18%) and 48 (24%), respectively. In the recessive model (GG: GA + AA), GG genotype was found to be associated with the increased risk of Met S (P = 0.004; OR = 2.52; CI = 1.33-4.80) and the association remained significant after controlling for the confounders such as age and sex. It was concluded that SNP of ADRB3 (190 T>C) and LXR-α (-115 G>A) were associated with the risk of Met S and might increase the susceptibility to the obesity-related traits.

Comparison of rheumatoid factor of IgM, IgG and IgA isotypes with disease activity score 28 in patients of rheumatoid arthritis

Introduction/background: Rheumatoid factor (RF) is a widely used serological marker for the diagnosis of rheumatoid arthriris (RA). RF can be detected in up to 70 to 80% of RA patients and it is associated with disease activity, bone erosion, and disease outcome. RF is an autoantibody targeting the 'fraction crystallizable' (Fc) region of IgG antibodies and exists as IgA, IgG and IgM isotypes. The objective of this study was to compare the RF isotypes IgM, IgG and IgA with disease activity score 28 in rheumatoid arthritis patients. Materials and Methods: This was a descriptive study, which included 83 RA patients. Blood samples of the patients were collected from the Department of Rheumatology, Sheikh Zayed Hospital Lahore. The levels of different isotypes of RF i.e. IgM, IgG and IgA were determined by ELISA technique. Data was analysed by SPSS 20.0. Results: RF, IgM, IgG, and IgA isotype, was detected in 83%, 10%, and 40% of RA patients respectively. RF istoypes were compared with DAS28. There was no significant association between DAS 28 and RF IgM [Odd ratio (CI)] [0.5(0.07-3.18)], RF IgG [3.0(0.27-32.20)] and RF IgA [0.4(0.43-0.13)]. Disease duration was also compared with RF isotypes but no significant association found. There was no significant association between disease duration and RF IgM [Odd ratio (CI)] [1.4(0.46-4.86)], RF IgG [1.6(0.50-5.0)] and RF IgA [1.1(0.53-2.7)]. Conclusion: All the isotypes of RF were detected in RA patients. As a screening method for rheumatoid arthritis the IgM-RF is superior to other RF isotypes. RF titer may be valueable in estimation of disease activity and other inflammatory parameters in RA patients.

VITAMIN D DEFICIENCY AND PCOS;

BackgroundPolycystic ovary syndrome (PCOS) is mainstream gynaecological problems in adult women. Vitamin D has been linked to propensity of developing PCO. As this hormones has certain effects on insulin sensitivity and restoration of reproductive capacity in women with PCOs. So, a study was planned to establish correlation of deficiency of vitamin D and PCOs.ObjectiveTo determine the correlation of deficiency of vitamin D with PCOs in patients reporting to a teaching hospital.Material &amp; MethodsCase control study carried out at institute of Shaikh Zayed Hospital, Lahore, Gynae-Obst Department for six months. If serum level of vitamin D is &lt; 25nmol/L then deficiency was labeled. Odds ratio was calculated between PCOs and vitamin D deficiency, ResultsThe mean age of the patients was 26.91±6.09 years. In this study, 70% females were married. The mean BMI of patients was 22.59±2.48kg/m2, and 76(76%) patients had normal BMI and 24(24%) patients were overweight. Vitamin D deficiency was observed in 47 cases in which 31 were from case group and 16 were from control group with significant association i.e. OR=3.47. ConclusionOur study results concluded that there is more risk of vitamin D deficiency in females with PCOS as compared to females without PCOS.

ASTHMA

Introduction: The prevalence of childhood asthma is increasing globally. Asthma is one of the main causes of hospitalization and frequent emergency department visits of children. The parents having awareness about asthma can comply with the treatment, avoidance from triggers and subsequently, they can control asthma symptoms in their children. Study Design: Cross- sectional analytical study. Setting: The Children’s Hospital and the Institute of Child Health, Lahore and Shaikh Zayed Hospital, Lahore in collaboration with University of Health Sciences Lahore. The Shaikh Zayed Hospital, Lahore is a tertiary care and an academic hospital as it is attached with Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College (Shaikh Zayed Hospital updates). The Children’s Hospital and Institute of Child Health, Lahore provides services of tertiary health care as well as allied facilities. Period: 12 months from 01-08-2013 to 01-07-2014. Methods: To assess the knowledge of parents of asthmatic children about the disease and to determine any association between asthma knowledge and the level of asthma control in their children. Subjects were parents with their asthmatic children ages between 4 to 12 years attending two exclusive pediatric hospitals at Lahore. A tool was constructed to assessparent’s knowledge about asthma, and a pre-validated asthma control tool was administered to determine asthma symptoms control in children. Data was represented in the form of figures, tables and chi square test was used to determine the association of knowledge about asthma,demographic information, and environmental information with different group of asthma control. Results: One hundred and ninety-six parents with their asthmatic children participated in this study. There was no association between asthma knowledge and the level of asthma control.There were 108 parents who had adequate knowledge about asthma, out of them only 45 (41.7%) children had asthma control. There were 88 parents who had inadequate knowledge about asthma. Out of them 36 (40.9%) children were with asthma control (p=.915). Conclusions:The findings of the study concluded that more than 50% (108/ 196) of the parents/ guardians have adequate knowledge about asthma and there was no association found between asthma knowledge and the level of asthma control. However, we need to empower Pakistani communityvia a national asthma awareness program, smoking cessation campaign and also empower the health care team with up-to-date knowledge about asthma management.

RISK FACTORS FOR HEPATITIS;

Background: Infections with Hepatitis B Virus (HBV) and Hepatitis C virus (HCV) are worldwide public health problem. Thisis related to the continued occurrence of new infections and the presence of a large reservoir of chronically infected persons. Objective:To determine the frequency of risk factors (causes of transmission) for HBV and HCV infections in hospitalized patients of CMH, Lahoreand Sheikh Zayed hospital, Lahore. Design: Descriptive (cross sectional). Setting: The study was carried out in CMH, Lahore and SheikhZayed hospital, Lahore from January, 2012 to July, 2012. Methods: The patients were selected by consecutive (non-probability)sampling technique. The data was collected through questionnaire. Informed written consent was obtained SPSS version 16.0 was usedto calculate the descriptive statistics. Results: Out of total of 100 subjects, 50 were cases and 50 were controls. Out of 50 cases, 26%were HBV positive and 74% were HCV positive with female preponderance. The history of injections was very high in both the groups,making a total of 64% (14% HBV; 16% HCV) the important contributors for different types of hepatitis were blood transfusion (HBV =10%; HCV = 28%; controls = 14%). Surgical procedures (4% HBV, 28% HCV; 8% controls). History of piercing in the last six months(HBV = 6%; HCV = 22% and control = 8%). History of dental procedures in the last six months was higher in HCV patients (18% HCV and4% HBV). History of HBV or HCV positive patients or relatives at home. (HBV 18%; HCV 36%; control 30%). Conclusions: In Pakistan thereis an urgent need to raise the public awareness about importance of properly screened blood transfusion, use of disposable needles andusing new blades for shaving and haircuts especially at barber shops. In our study, the important contributors for different types ofhepatitis were blood transfusion, surgical procedures and history piercing in the last 6months.

CARDIOTOCOGRAPHY

Introduction: The cardiotocography (CTG) is more commonly knows aselectronic fetal monitoring (EFM). A cardiotocography measures the fetal heart and the frequencyof uterine contractions. Using two separate disc shaped transducers. Objectives: The objectiveof this study is to co-relate the intrapartum cardiotocography monitoring with fetomaternaloutcome. Study Design: Cross sectional analytical study. Setting: Department of Obstetricsand Gynaecology, Shaikh Zayed Hospital, Lahore, Pakistan. Period: From September 2012 toMarch 2013 (Six Months). Patient &amp; Method: Total 60 patients (pregnant females) fulfilling theinclusion criteria were selected for this study, who were admitted in labour room in early andactive labour. In group A normal CTG monitoring and in Group B women with abnormal CTGmonitoring. Maternal outcomes in terms of mode of delivery and fetal outcome (APGAR Score,neonatal seizures, admission to nursery and time of neonatal discharge were seen). Result: Themean age in group A was 26.13+3.90 years and in group B was 26.53+4.17 years. The meangestational age in group A was 38.40+1.50 weeks and in group B was 36.60+1.59 weeks. Ingroup A, 25 (83.3%) woman were delivered through spontaneous vaginal birth and 4(13.4%)women, who were delivered by caesarean section (for all indication except fetal distress), 1(3.3%) woman by assisted vaginal birth (for all other indications). In group B there were 7(23.8%)women who delivered through spontaneous vaginal birth. 3(10%) women by assisted vaginalbirth (for abnormal CTG monitoring) and 20(66.7%) women by caesarean section (for abnormalCTG). In group A, there were 7(23.3%) neonates who were admitted in nursery, while in groupB, there were 19(63.3%) neonates, who were admitted in nursery. Conclusion: Intrapartumexternal fetal cardiotocography is not a single indicator of fetal distress. An increased caesareansection rate in babies with a pathological cardiotocography stresses on the need for additionaltests to differentiate hypoxic fetuses from non-hypoxic.

Outcome Of Endoscopic Management Of Post Living Donor Liver Transplant Anastomotic Strictures

To evaluate the therapeutic efficacy of endoscopic dilatation of anastomotic stricture (AS). An observational study. Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital, Lahore, Pakistan from November 2016 to November 2017. Patients presenting with anastomotic biliary stricture following living donor liver transplant (LDLT) underwent endoscopic retrograde cholangio-pancreaticography (ERCP) and treatment of their strictures with dilatation with or without stenting. The patients were then followed up to see adequate resolution of stricture and repeat therapeutic ERCP was performed, if required. The patients were labelled as cured if stricture resolution persisted for a period of up to six months following ERCP. Forty-three patients (32 males and 11 females), with post-LDLT AS, who met the inclusion and exclusion criteria were enrolled in the study. Thirty-six (83.7%) patients had a single biliary anastomosis while seven (16.3%) patients had two anastomoses. Ductoplasty was done in 15 (34.9%) of the enrolled patients. Patients with post-LDLT AS required 3.65 +1.15 sessions of ERCP. Plastic type biliary stent was used in seven (16.3%) patients, balloon dilatation alone was done in five (11.6%) patients and combined balloon dilatation and stent placement was performed in 29 (67.4%) patients, and combined graduated dilator and stent placement was performed in two (4.7%) patients. Five (11.6%) patients required rendezvous procedure (whereby a radiologist placed a guidewire percutaneously into the biliary system) as guidewire placement across stricture site was endoscopically unsuccessful. The overall success rate was 88.4%. Mean stent free follow-up was 7.18 +1.38 months. Recurrence of AS was noted in one (2.3%) patient. Endoscopic management of post-LDLT AS has an efficacious long-term outcome.

Clinical Efficacy Comparison of Saccharomyces Boulardii and Lactic Acid as Probiotics in Acute Pediatric Diarrhea.

To compare the efficacy of Saccharomyces boulardii and lactic acid producing probiotics in addition to usual treatment regimen to cure diarrhea among children (6 months to 5 years of age). Randomized controlled trial. Department of Pediatrics, Sheikh Zayed Hospital, Lahore, from February to July 2015. Children suffering from acute diarrhea were orally administered Saccharomyces boulardii and lactic acid producing probiotics for 5 days. The efficacy of administered probiotics was monitored. Patients were given Saccharomyces boulardii and lactic acid producing probiotics randomly to remove the bias. Two hundred patients randomly selected for trials; out of which, 100 were treated with Saccharomyces boulardii while the other 100 were supplemented with lactic acid concomitantly along with conventional diarrhea treatment. Results indicated that Saccharomyces boulardii treatment group has significantly higher efficacy rate (45%) compared to lactic acid producing probiotics (26%). This study concluded that Saccharomyces boulardii has a better efficacy compared to lactic acid and may be adopted as a probiotic of choice.

Socio-economic factors affecting quality of life of Hemodialysis patients and its effects on mortality.

Objective:Many factors affect quality of life (QOL) of dialysis patients. This study was conducted to determine the effect of socio-economic factors effecting QOL of hemodialysis patients.Methods:This descriptive multi-centric, follow up study was conducted at Department of Nephrology, Mayo Hospital, Lahore, from February 2015 to August 2017. All patients who were on regular maintenance hemodialysis (MHD) for more than three months and able to read and understand Urdu version of Kidney Disease Quality Of Life (KDQOL) tool were included in the study. Patients were included from hemodialysis units of Mayo Hospital (MH), Shalamar Hospital (SH), and Shaikh Zayed hospital (SZH), Lahore. Patients with less than three-month duration on dialysis, with cognitive impairment, dementia, active psychosis, non-Urdu readers/speakers were excluded. Demographic data and lab data was collected on predesigned pro forma. Patients were divided into different groups on the basis of education, monthly income, source of funding for treatment and employment. Patients were followed up for two years to determine the effect of QOL on mortality.Results:One hundred and thirty-five patients were included in the study. Socio-economic factors like education, employment, income, funding was compared with KDQOL sub scales and were found statistically significant (p-value (<0.05). We found that patients with higher income had better work status (p=0.039) but social (0.04) and sexual function (p=0.029) were relatively better in patients with low income. Employed patients had better work status (p=0.01), ability to do social function (p=0.027) but they had more pain (0.049), symptoms/problems of disease (p=0.05) and effect of kidney disease (p=0.015). Those patients whose dialysis were funded by their family could socially interact (p=0.012) better and deal more efficiently with effect of kidney disease (p=0.007). Higher education was associated with better emotional well being (p=0.045), patient satisfaction (p=0.046) and staff encouragement (p=0.045) then patient with lower level of education. QOL had no effect on mortality.Conclusion:The socio-economic factors consisting of education, employment, income and funding are important parameters affecting QOL of kidney patients. QOL does not affect mortality of the dialysis patients.