The women of reproductive age and children under-5 are most vulnerable and easily affected by malnutrition. Particularly, those belonging to lower socioeconomic classes commonly suffer from ...malnutrition because of an unbalanced diet and a lack of food diversity. It has been further noticed that malnutrition problems are generally severe among pregnant mothers. In this cross sectional study data was collected about the socioeconomic conditions, maternal and child health feeding habits, current nutritional status of married women and children under five and awareness level of respondents in the target area of selected village. The information collected in this household survey was used to determine a linkage between the effect of the availability and diversity of foods, dietary habits, Breast feeding, complementary feeding practices and living conditions and hygiene on the prevalence of malnutrition among mothers and children. The results illustrated that most of the respondents belonged to lower socioeconomic status. The data showed that (38.1%) women have no formal education; only (31%) women possess primary education followed by (24.4%) have secondary education. A substantial proportion of household (39.1%) had monthly income less than Rs 20000 whereas 60.9% of households had monthly income ranging from Rs. 20000 to 50000. The data further showed that 14.7% of the sample households owned cultivable land and a smaller percentage were growing their own vegetables. This baseline survey noted that 19.8% households are rearing animal and poultry at their homes. The joint family structure prevails in majority of the respondents as 65 % of sample households lives jointly whereas 34.5% are living as nuclear families.
The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a ...randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan.
This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition to usual care, received reminder SMS for 2 months that contained a) Personalized, prescription tailored daily medication reminder(s) b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle.
Two hundred participants were enrolled. 38 participants were lost to follow-up. After 2 months, the mean medication score was 7.4 (95 % CI: 7.2-7.6) in the intervention group while 6.7 (95 % CI: 6.4-7.02) in the control group. The adjusted mean difference (Δ) was 0.54 (95 % CI: 0.22-0.85). The mean diastolic blood pressure in the intervention group was 2.6 mmHg (95 % CI; -5.5 to 0.15) lower compared to the usual care group.
A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure in stroke survivors with complex medication regimens living in resource poor areas.
Clinicaltrials.gov NCT01986023 last accessed at https://clinicaltrials.gov/ct2/show/NCT01986023.
Stroke is a major cause of morbidity and mortality, especially in low and middle income countries. Medical management is the mainstay of therapy to prevent recurrence of stroke. Current estimates are ...that only 1 in 6 patients have perfect adherence to medication schedules. Using SMS (Short Messaging Service) as reminders to take medicines have been used previously for diseases such as diabetes and HIV with moderate success. We aim to explore the effectiveness and acceptability of SMS in increasing adherence to medications in patients with stroke.
This will be a randomized, controlled, assessor blinded single center superiority trial. Adult participants with access to a cell phone and a history of stroke longer than 1 month on multiple risk modifying medications will be selected from Neurology and Stroke Clinic. They will be randomized into two parallel groups in a 1:1 ratio via block technique with one group receiving the standard of care as per institutional guidelines while the parallel group receiving SMS reminders for each dose of medicine in addition to the standard of care. In addition intervention group will receive messages for lifestyle changes, medication information, risk factors and motivation for medication adherence. These will bemodeled on Social Cognitive Theory and Health Belief Model and will be categorized by Michies Taxonomy of Behavioral Change Communication. Patient compliance to medicines will be measured at baseline and then after 2 months in each group by using the Morisky Medication Adherence Scale. The change in compliance to medication regimen after the intervention and the difference between the two groups will be used to determine the effectiveness of SMS reminders as a tool to increase medication compliance. The acceptability of the SMS will be determined by a tool designed for this study whose attributes are based Rogers Diffusion of innovation theory. A sample size of 86 participants in each arm will be sufficient to detect a difference of 1 point on the MMAS with a power of 90 % and significance level of 5 % between the two groups; using an attrition rate of 15 %, 200 participants in all will be randomized.
The SMS for Stroke Study will provide evidence for feasibility and effectiveness of SMS in improving post stroke medication adherence in an LMIC setting.
https://clinicaltrials.gov/ct2/show/NCT01986023 11 /11/2013.
Aim
We report here, a case series of patients with acute kidney injury (AKI) after ingestion of paraphenylene diamine (PPD) a derivative of analine. It is used as a colouring agent to dye hair, fur ...and plastic and in photographic films.
Methods
Subjects for the study reported here comprised a cohort of 100 patients coming to this institution with AKI following PPD poisoning. AKI was defined according to RIFLE criteria and PPD poisoning on the basis of history and presenting features. All patients had normal sized kidneys on ultrasonography and no previous co‐ morbidity.
Results
One hundred patients with AKI after PPD exposure were brought to this institute between May 2010 and February 2015. Among these, 56 were females, with mean age of 23.11 ± 7.94 years. Cause of AKI was toxic rhabdomyolysis as indicated by marked rise in muscle enzymes with mean lactate dehydrogenase and creatinine phosphokinase levels of 6665.22 ± 6272.04 and 194 486.66 ± 301 905.80, respectively. Hepatotoxicity with raised aspartate aminotransferase and alanine aminotransferase was a main feature of the studied population. Renal replacement was required in 97% of patients. Complete renal recovery was observed in 77 patients, while 16 died during the acute phase of illness. Respiratory failure and recurrent hyperkalaemia were the main causes of mortality.
Conclusion
Easy availability and low cost of PPD has lead to a remarkable increase in the use of this substance, especially for suicidal purposes. Awareness of its effects among health professionals, as well as at a societal and government level, is needed at this time.
Summary at a Glance
This manuscript describes the continued high prevalence of acute kidney injury among the poor in Pakistan due to easy availability of toxic paraphenylene diamine used as hair dye.
Objective: In this study we evaluated the two most commonly used methods for pain relief in acute pancreatitis i.e. epidural analgesia and I/V analgesia and compared the results. Study Design: ...Randomized Controlled Clinical Trial. Setting: Surgical Unit-1 of Holy Family Hospital, Rawalpindi. Period: June 2019 to June 2020. Material & Methods: Patients presenting with acute pancreatitis with moderate severity were divided into groups A and B. In group A patients, epidural catheter was passed at T9-T10 level epidural space and they received 0.125% Bupivacaine injection every 4 hours, while group B patients received combination analgesia in the form of IV tramadol 100mg TDS and IV Toradol 30mg BD. Pain was assessed by using visual analog scale (VAS) at 12 hour intervals. Rescue analgesia, in the form of IV paracetamol 1g given in the case of >7 VAS score was also recorded. Results: Total 100 patients were included according to the inclusion criteria of the study. Patients were randomly divided into two groups; Group A (Epidural) and group B (intravenous). Mean age (years) in the study was 42.39+11.21 whereas there were 37 male and 63 female patients who were included in the study. In our study, mean pain score in group A was 3.16+1.23 which was significantly lower than group B (5.42+1.01), p-value < 0.0001. There was a single mortality in the study. 6 patient’s required ventilatory support due to respiratory complications, 5 in group B and 1 in group A. Conclusion: Epidural analgesia is superior to I/V analgesics in pain management of moderately severe pancreatitis and it also reduces respiratory morbidity in these patients.
To ascertain the hard event rate in local population with normal myocardial perfusion.
The study, which was conducted from August 2006 to January 2007, included 300 patients with normal exercise ...myocardial perfusion scan (MPS). Patients were categorized according to their pre-test probabilities for CAD. Patients with low pre-test probability for CAD were 136 and ranked in group A, while group B constituted 164 patients who had intermediate to high pre-test probability.
During a follow-up of mean duration of 27 +/- 3 months, an overall hard cardiac event rate of 1.02% was noted. However, a statistically non-significant difference between the survival rates of low and high pre-test probability groups was also observed.
The study demonstrated good prognosis for patients with normal exercise myocardial perfusion scan.
To assess the significance of attenuation correction on sensitivity, specificity and diagnostic accuracy of myocardial perfusion SPECT.
102 patients referred for myocardial perfusion imaging (MPI) ...were divided into two groups: 42 patients (mean age: 54.6±12.6) were enrolled in the group A, who had undergone coronary artery angiography, within six months of the scan. 60 patients (mean age: 49.79±11.3) were placed in the group B who had a <15% pretest likelihood of CAD. Both non-corrected (NC) and attenuation corrected (AC) images were visually analyzed according to 17-segment model of the left ventricular cavity. Visual assessment derived sensitivity, specificity, diagnostic accuracy and normalcy rate of NC and AC sets of images were compared using McNemar test.
Sensitivity, specificity and diagnostic accuracy for detection of coronary artery disease were found to be 100%, 11% and 79% respectively for NC images and 66%, 78% and 68% for AC images. The p value was found to be significant in only the RCA territory. Normalcy rates in the group B population were 19% for NC image set and 74% for the AC image set. No significant difference on basis of BMI was observed in attenuation corrected scans. The technique appears to be more valuable in men.
This study demonstrates that CT based attenuation corrected Tc-99mm sestamibi SPECT myocardial perfusion imaging significantly improved the specificity of the RCA territory compared with non-attenuation corrected Tc-99mm sestamibi SPECT myocardial perfusion imaging in both genders irrespective of BMI.
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