Department of Community Health Sciences & Research

Sepsis is an important cause of mortality in neonates Umbilicus is a common site for sepsis and requires utmost care in order to prevent probable risks of infection. There lies a difference in the method of cord cutting and caring the remaining stump of cord which varies from region to region based on the socio-cultural background.1 However, proper umbilicus care is very important to prevent chances of risk and infections. Different beliefs in different communities regarding cord care and handling of umbilicus exposes a newly born child to some potential dangerous consequences and risk for developing sepsis.

A neonate presented to the Paediatric Ward of Kuwait Teaching Hospital, Peshawar, KPK with an umbilicus wrapped. The string was tied around his neck (refer to Figure 1) to apparently help in falling off the cord quickly as the baby moves his head. Handling umbilicus in such an unhygienic way is dangerous and can lead to bacterial infection and sepsis2, as was the case in this baby.

It was really interesting to find that a similar practice also exist in Africa where the cord is held with string and then tied around the baby’s neck exclusively of male gender as the perception is that if the cord touches the genitalia then it will later cause sterility.3

It is therefore necessary to educate the parents of neonate to observe a proper protocol for the care of cord and umbilicus. This will not only help in minimizing risk of sepsis but also it will contribute in reducing unnecessary burden on neonatal health care centres and thus reducing yearly economic burden

To assess the satisfaction level of students of Doctor of Physical Therapy (DPT) regarding their field of education. To
identify the causes responsible for dissatisfaction of students with their field of study. Physical Therapy is an emerging
and growing field in Pakistan and currently is passing through its stage of infancy. Five year program of Doctor of
Physical Therapy (DPT) has been now introduced resulting in increased influx of students. Yet unawareness among the
students as well as society still prevailed that resulted in confusing the minds of young undergraduate students of
Physical Therapy. A cross-sectional study was conducted in the Institute of Physical Medicine and Rehabilitation,
Peshawar. Total 100 students of Doctor of Physical Therapy. Were interviewed through structurally designed
questionnaires. Ethical consideration was taken into account. The response rate was 78%. 55.1% students were found
satisfied with the field, 7.6% were dissatisfied while 37.1% were unable to analyze whether satisfied or dissatisfied
majority being basic sciences students. Students highlighted certain factors as responsible for their
dissatisfaction.Majority of the students satisfied from their field of education belonged to clinical sciences which
indicate their well-aware attitude about the significance of this field. Moreover, the students held disrespectful attitude
of society, Limited facilities and job opportunities and Incapable Physical Therapists imparting bad name to this
profession responsible for their dissatisfaction.

Frequency, Causes, Severity and Outcome of burn victims admitted in the tertiary care hospital of Peshawar in the year 2013

Principal Author: Salman Qureshi*
Co Authors: Mahboob Khan*, Hadi Raza*, Najmush Shakireen*, Amir Zaman*, Bakhtawar Qureshi* *

* Peshawar Medical College
** Khyber Medical University, Peshawar

Background: Every year, significant amount of patients suffer from burns injuries resulting both in morbidity and mortality. Burn injuries are of especial important due the fact that these injuries affect people of both genders and of all ages, thus not confined to any specific age group or gender. In medicine, burn care is among one of the few disciplines which is regarded both medically and surgically a challenging task.  The current study was undertaken to find the frequency of burn victims admitted in Lady Reading Hospital, Peshawar and to identify various causes responsible for the burn injuries and to assess the severity of burn injuries reported and finally to evaluate the ultimate outcome of burn victims at the time of discharge.

Methodology: A retrospective study was carried out at Burn & Plastic Surgery Unit of Lady Reading Hospital, Peshawar. The data was collected from the record register and patients files. The sample size was 49. Simple random sampling technique was used. The ethical consideration was taken in account and confidentiality of subjects was secured. The data was analyzed in SPSS Version 19. The entire study duration was about 5 months.

Results: Total 1103 patients were admitted in the year 2013 with burn injuries out of which the record of 49 patients were taken under consideration for data analysis (n=49, M: 26 & F:23). The mean age calculated was 27.63 years while the standard deviation was 17.34 years.  33 patients had not received any first aid before coming to the hospital. Flame injuries were the commonest followed by electrical and chemical burns. The percentage of Total Body Surface Area (TBSA) burn ranged from 2% to 61%. Inhalational injury was present in 3 patients. The mean length of hospital stay calculated was 8.98 days. 5 patients were having previous history of burn. 22.4% patients were sufferer of chronic diseases at the time of admission. In normal patients, the mean length of hospital stay was 7.53 days. Majority of the patients were having facial burns followed by burns involving legs and arms. History of violence was positive in 6 patients. 23 patients were having first degree burns, 12 were having second degree burns while the remaining 12 patients were having third degree burns. 32 patients were completely healthy at the time of discharge, 5 patients got disabled, 6 patients died while rest of the 6 were referred to other hospital.

Conclusion: Flame injuries were commonest while Hot liquid burns and steam burns were least common. Facial burns were most common followed by burns involving upper and lower limbs. Majority of the patients were having first degree burns. Majority of the patients were completely healthy at the time of discharge however morbidity as well as mortality was also reported in few cases.

Keywords: Burn victims, Total Body Surface Area. Disability adjusted life years, Length of Hospital Stay

Author:Muhammad Salman H. Qureshi*
Co-authors: Shahnawaz Yousaf*, Bakhtawar Qureshi**, Akbar Azam*, Bilal Zaigham*

* Peshawar Medical College (PMC)
** Khyber Medical University (KMU)

Introduction:
The trend of quackery is a serious matter of concern especially for underdeveloped and developing countries where uneducated and unaware segment of the society are deceived by the unqualified personnel. It not only ethical but also the moral duty of a person not to undertake a task to which he feels himself incapable and unqualified. However, still there are few people who handle the risk of other’s life to earn their livelihood.

Objectives:
• To investigate major reasons compelling patients to seek medical treatment from quacks.
• To highlight general hurdles in seeking medical treatment from qualified medical practitioners and specialists.

Methodology:
A cross-sectional study was carried out at Kohat Road, Peshawar. Total 50 subjects (M: 38 & F: 12) were interviewed in their regional languages through a semi-structured questionnaire. Total 6 uneducated and 27 under/till matriculate and 17 above matriculate were included. The sampling technique used was “Convenient Sampling”. Ethical consideration was taken in account. The study duration was about 8 weeks.

Results:
Out of 50 subjects, More than 30 subjects were seeking medical aid from quacks for more than two years. 22% of the subjects stated that they have suffered either financial or health loss due to their treatment. Major factors responsible for seeking medical aid from quacks was the presence of their treatment center in near vicinity (n=22), charging low fee (n=9), receiving discount in fee (n=6) and easy access (n=3). While major reasons for avoiding treatment from medical practitioners and specialists stated by the subjects were charging high fee (n=21), prescribing unnecessary and extra laboratory investigations (n=9) and distant clinics (n=5) while other minor reasons identified by the subjects were spending too much time while waiting, doctors not paying proper attention, taking commission, prescribing too many drugs and paying more attention to their clinics and

Conclusion:
The major root cause identified was poverty. Moreover, easy availability and presence of treatment centers at near vicinity were also the contributing factors. Further, the attitude, behavior and concern of the doctor also counts a lot in building or fading the doctor-patient relationship.

Objectives: To document the spectrum of presenting symptoms, diagnostic investigations, treatment and outcome of severe malaria in the hospitalized children of Kuwait teaching hospital. Methodology: This was a descriptive study using patient case records of children admitted from 1st January till 31st December 2013. All children with malaria requiring admission and treatment with parenteral anti-malarial were categorized as severe malaria and included in the study. Data was analyzed using Microsoft office Excel 2007. Results: 32 cases fulfilled the inclusion criteria. Fever was the commenest presenting symptoms present in 100% of cases (n=32). Fifty percent children (n=16) had pallor, 12.5 %( n= 4) cough, 9.3 %( n=3) had dysuria and 6.25 %( n=2) had fits recorded as additional presenting symptoms. 71.8% (n=23) had parasitological confirmation test before commencement of treatment .100% of this parasitological confirmation was done by peripheral blood smear/microscopy test. Out of the 23 who had microscopy done 60.86%(n=14) had negative result and 39.13%(n=9 )were positive for plasmodium of which,88.88%(n=8)were vivax and 11.11%(n=1) was falciparum.93.75 %(n=30) of the parenteral anti-malarial used was intravenous quinine. All except one child 96.8 %( n=31) recovered with the anti-malarial treatment used. Conclusions: Fever and pallor are the two most common presenting symptoms of hospitalized children with severe malaria. Microscopy remained the most common investigation for the diagnosis of malaria. Quinine is the most frequently used drug for severe malaria. The study highlighted the need to further improve the case management of severe malaria in children. Key Words: Severe malaria, Children, WHO guidelines, Clinical manifestation, Management

Steven Johnson Syndrome is relative a rare but yet an acute life-threatening condition. A middle aged lady presented to us in an emergency condition with high grade fever (104 o F), oral mucosal ulcers, purulent discharge from both eyes, photophobia, generalized skin rashes, flank bruises, dyspnea, severe odynophagia along with dysphagia and blisters on both hands and feet. Because of extensive oral thrush, mouth ulcers and purulent discharge from eyes, the patient was initially suspected to be a case of oral candidiasis and bacterial conjunctivitis. However, due to wide spread muco-cutaneous involvement and after obtaining detailed drug history and getting opinion from dermatology and ophthalmology department, a diagnosis of Steven Johnson Syndrome was established. The treatment was started accordingly and the patient responded dramatically to the treatment, got improved and was subsequently discharged.

Background Percutaneous Nephrolithotomy (PCNL) is a surgical procedure used for the removal of renal stones. The technique is minimally invasive and is often used for the removal of renal stones that are located near the pelvis. The topical administration of local anesthetics in the surgical area has been proven effective in minimizing post-operative pain after various surgical procedures. Purpose This study was conducted to compare the mean post-operative pain score in patients with pre-operative Bupivacaine infiltration of nephrostomy tract with placebo in control group of patients undergoing percutaneous Nephrolithotomy. Methods A randomized controlled trial was carried out in Department of General Surgery, Kuwait Teaching Hospital, Peshawar with diagnosis of renal stones. A total of 66 patients (33 males and 33 females) age: 16-50 years were admitted with diagnosis of renal stones. Statistical analysis was performed by using SPSS version 17. Results Patients with renal stones who underwent PCNL were randomly divided into Group A (Bupivacaine) and Group B (Placebo). The overall Average pain score for Group A was 4.15 ± 1.48 range (2 to 7) on visual analogue scale (VAS), while that for Group B was 6.06 ± 1.02 range (4 to 8) p-value < 0.05, which indicates that preoperative infiltration of bupivacaine significantly decreases the postoperative pain in patients undergoing Percutaneous Nephrolithotomy. Conclusion The study concludes that local bupivacaine infiltration along the nephrostomy tract is an effective method of management of postoperative pain after PCNL, regardless of age and gender as shown by results of the study.

Burn injuries are of great matter of concern because of their impact not only on the body but on the soul as well. Burn injuries are also significant because they are not confined to any particular age group or gender. Globally, an appreciable proportion of population suffers from burn injuries resulting in morbidity and mortality. Khyber Pakhtunkhwa (KP) is one of the four major provinces of Pakistan and shares its borders with Afghanistan and China. The current review article has been drafted with an effort to highlight this issue in the context of the province of Khyber Pakhtunkhwa.

Scabies is commonly characterized by the presence of itchy rash but this typical symptom does not necessarily always mean scabies. A female infant presented to the paediatrics department of Kuwait teaching hospital with a characteristic pruritic rash on soles suggestive of scabies. However, failure of the anti-scabies treatment, absence of positive personal and hygienic history and progression towards the deterioration of existing situation lead to the establishment of a history and clinical based diagnosis of Infantile Acropustulosis. The treatment was started accordingly and soon after starting treatment, the patient showed the signs of recovery. No doubt that scabies is comparatively more common as compared to infantile acropustulosis but yet scabies must not be considered as an absolute diagnosis for a patient presenting with an itchy rash particularly on soles.

INTRODUCTION: Each year a number of people become either completely or incompletely paralyzed due to paraplegia and quadriplegia as a result of various accidental cases and neurological disorders. Therefore the current study was conducted to investigate involvement of various spinal cord segments along with their causes and association with age and gender.

INTRODUCTION: Glomus tympanicum tumor is a benign but most common tumour of the middle ear with relatively good prognosis if detected early. These tumours arise from paraganglionic tissue and are innervated by parasympathet-ic autonomic nervous system (PANS). They are more common in females. The spread of these tumours is multidirectional and simultaneous. They may be asymptomatic or present with pulsatile tinnitus. On examination, the eardrum shows a rising sun or setting sun appearance. On CT scan, we can see a soft tissue mass lateral to the cochlear promontory which may fill the middle ear cavity. Surgical resection is the treatment of choice.

After 3-12 days of bite by mosquito infected with Zika virus, symptoms start appearing which are usually mild ABSTRACT Zika virus belongs to the family of Flaviviridae. The Flaviviridae family also includes other human pathogens like West Nile virus (WNV), Yellow fever virus (YFV), mosquito transmitted Dengue virus (DENV), Tick borne encephalitic virus (TBEV) and Japanese encephalitis virus (JEV). Zika virus is a mosquito-borne disease and is transmitted by Aedes aegypti mosquito.

Background: Cervical cancer is a great matter of concern all around the globe due to increase incidence of mortality. Human papilloma virus (HPV) is regarded to be the major causative agent of cervical cancer. Moreover, HPV has been found to cause sexually transmitted disease not only in women but also in men. As prevention is known to be the best and better strategy than cure, cervical cancer has been proven to be prevented by HPV vaccine. The current study was conducted to assess the knowledge, awareness and attitude of senior medical students towards HPV vaccination.