Background: Despite the recommendation of zinc in the management of acute diarrhoeal illness, the effect has been seldomly reported in adolescent population. Objective: To evaluate the efficacy of zinc supplementation in acute diarrhoea in adolescent population. Study Design: Randomized Controlled Trial. Settings: Department of Medicine and Paediatrics, Hayatabad Medical Complex. Study duration: This study was conducted from 1st February 2022 till 31st October 2022. Materials and methods: Both male and female patients presenting with acute diarrhoeal illness were enrolled. Patients were equally divided through block randomization into two groups. Elemental zinc at 20mg BD was administered orally to the study group. Control group received mineral and vitamin supplementation except zinc. Efficacy was evaluated in terms of reduction in stool frequency and hospital stay. Results: Age of the patients ranged from 10 to 18 years. Mean age of the patients in study group was 14.83±3.730 years versus 13.90±3.806 years in control group. Mean stool frequency on presentation in study versus control group were 5.904±1.052 versus 6.089±1.472 respectively while on day it was 1.472±0.130 versus 2.937±640 respectively. Recovery was observed in 29 patients (93.5%) in study group as compared to 21 patients (67.7%) in control group.
Objectives: To determine the diagnostic importance of bone marrow aspiration and biopsy in work up of cases presenting with anemias of unknown etiology. Study Design: Cross sectional descriptive study. Setting: Pathology Department, Khyber Teaching Hospital, Peshawar. Period: July 2015 to July 2017 (two year). Material & Methods: All patients presenting with anemia (Hemoglobin less than 12gm/dL for females and 13 gm/d L for males), whose cause cannot be established on clinical history, examination and blood counts, and were thus referred for bone marrow examination for further workup were included in the study. Patients having malignancies, chemotherapy or radiotherapy associated marrow suppression, and those with diluted marrow unfit for comments were excluded from the study. Bone marrow aspiration and biopsy was done, slides were examined, and diagnoses was made and recorded. The results were drawn accordingly. Results: A total of 199 patients were referred for bone marrow aspiration, presenting with unexplained anemia, during the study period. About 12 patients had blast cells on peripheral blood film, giving diagnosis of leukemia. So they were excluded from the study. Remaining 187 cases were included in the study. The age of the study sample ranged 3 years to 63 years (mean age 42 years ±8.1 SD). There were 96 (51%) males and 91 (49%) females. Male to female ratio was 1.05:1. Out of 187 cases presenting with unexplained anemias, about 44(23.5%) cases were of iron deficiency anemia, 39(20.7%) cases were of anemia of chronic disorder, 16 (8.7%) cases as hemolytic anemia, about 19 (10.3%) cases as aplastic anemia, and 52 (27.8%) cases of megaloblastic anemia on bone marrow examination. Conclusion: Bone marrow aspiration and biopsy successfully gives the final diagnosis in cases of anemia where cause cannot be found by routine lab investigations. It helps physician decide further management plan of the patients. So, it should be done in all cases with unexplained anemia.
Objectives: To determine the pattern of clinical presentation, pattern of cytopenias, and haematological parameters of megaloblastic anemia in our setup. Study Design: Cross Sectional Descriptive study. Setting: Pathology Department, Khyber Teaching Hospital, Peshawar. Duration: January 2016 to December 2016 (one year period). Material and Methods: A total of 337 patients underwent bone marrow biopsy during the study period, out of which 46 patients were diagnosed as having megaloblastic anemia on bone marrow aspirate and B12 levels. The clinical features and hematological parameters of these patients were recorded in a proforma and the results were drawn accordingly. All cell counts were done on automated counter machine. Results: Out of 337 patients referred to pathology department for bone marrow aspiration, about 45 cases had megaloblastic anemia. These 45 cases were included in the study. Age of the study sample ranged from 1 year to 90 years (mean 32.2 years ± 12.1 SD). There were 35 (78%) males and 10 (22%) females, with male to female ratio of 3.5:1. Commonest clinical feature was generalized weakness and loose motion, while commonest physical sign was pallor, which were seen in 36 (80%), 36 (80%) and 40 (88%) cases respectively. About 28 (62%) patients had pancytopenia, 9 (20%) patients had bicytopenia (low hemoglobin and platelet count), and 8 (18%) cases had isolated anemia. Low Hb was present in all the 45 (100%) patients. Both the mean hemoglobin level and platelet count were reduced (7.4g/dL and 128x109/L. respectively) while mean white cell count in study sample was normal (mean 5.0x109/L). Conclusion: Megaloblastic anemia may presents as anemia, bicytopenia or pancytopenia. The cytopenias are important feature of megaloblastic anemia. Generalized weakness, and lethargy are the common clinical presentation, while pallor is common physical finding. Patients presenting with a constellation of generalized weakness, pallor and pancytopenia should be suspected of megaloblastic anemia and should be investigated accordingly.
Objective: The aim of our study was to evaluate the reliability of Mentzer index in the differentiation of iron deficiency anemia and beta-Thalassemia trait. Materials & Methods: This cross sectional study was conducted in five different primary schools of district Peshawar. Sample collected were processed in pathology department of Khyber Teaching hospital and Khyber Medical College Peshawar. Duration of the study was six months which was started from june 2017 to December 2017 in which 500 blood samples were analysed. Permission from the parents were obtained through principles of the schools. The samples were obtained keeping full aseptic conditions and collected in EDTA anticoagulant tubes. Hb, MCV, MCH, MCHC and platelet RBC count along with RDW, were assessed on a Sysmex Hematology Analyzer. Peripheral smear of the participants with low Hb(<11gm/dl) and low MCV (<80fl) were examined to look for morphology of RBCs. Serum iron (SI), serum iron binding capacity, serum ferritin was estimated using Cobas of the participants who had hypochromic microcytic blood picture on peripheral smear. Results: The participants in this study were both male (260) and female (240). Minimum age of the participants was 3.5 years and maximum age was 8 years. Minimum Hb was 7.6mg/dl and maximum Hb was 10.8 mg/dl with average Hb of 9.2mg/dl. All the paticipants had MCV below 80fl with minimum MCV of 50fl and maximum MCV of 80fl. RBC count was between 2.2 million and 6.2 million. The participants in this study were both male (260) and female (240). Minimum age of the participants was 3.5 years and maximum age was 8 years. Minimum Hb was 7.6mg/ dl and maximum Hb was 10.8 mg/dl with average Hb of 9.2mg/dl. All the paticipants had MCV below 80fl with minimum MCV of 50fl and maximum MCV of 80fl. RBC count was between 2.2 million and 6.2 million. Conclusion: Mentzer index can be used as initial screening tool in the diagnosis of IDA and beta thalassemia major.
Objectives: The study aimed to assess the students’ perception of the educational environment in the pediatric unit of Khyber teaching hospital using Dundee Ready Educational Environment Measures (DREEM). Material and Methods: This cross-sectional, questionnaire-based study was conducted at the Department of Child Health Khyber Teaching Hospital Peshawar, Pakistan, from May to November 2019. The sample size included 220 students fourth-year students. The study instrument was the DREEM questionnaire, which has 50 items that assess five domains. There are 50 items with 5 subscales and the maximum score is 200. Descriptive statistics were used to calculate the mean and standard deviation of the DREEM and the five domains Results: Of the 220 Students, 100 completed the questionnaire, resulting in a response rate of 45%. The total DREEM score was 113.14/200 (56.57%). The results showed that student’s perception of their learning environment was 27.31/48 (56.89%), the perception of teachers was 25.45/44 (57.84%), self-perception of their academics was 18.97/32 (59.28%), their perception of the atmosphere was 27.7/48 (57.7%), and social self-perception was 13.7/28 (48.96%). Conclusion: The study found that the atmosphere in the pediatric ward of Khyber Teaching Hospital was perceived positively by the students. However, the total DREEM score and points in the subdomains did not fall in the excellent category and remained one step below the highest rank. Therefore, there is room for improvement in the educational climate at the pediatric ward of Khyber Teaching Hospital. Keywords: Dundee Ready Educational Environment Measures (DREEM), educational environment measures.
Objective: To determine the frequency of various hematological disorders by using bone marrow aspirate and biopsy in a tertiary care hospital. Materials & Methods: This is a cross sectional descriptive study, conducted in Pathology Department of Khyber Medical College and Khyber Teaching Hospital, Peshawar. Duration of the study is one year i.e from January 2017 to December 2017. All the patients referred to the pathology department for bone marrow aspiration were included in the study. The diagnoses were noted and results were drawn accordingly. Results: Out of 300 patients, about 105 (35%) cases were diagnosed as having leukemias. This was followed by megaloblastic anemia which was seen in 75 (25%) cases, Idiopathc Thrombocytopenic purpura which was seen in about 51 patients (17%) cases. Metastatic infiltration and leshmeniasis were seen in 3(1%) case each. Conclusion: Leukemia was the commonest malignant hematological disorder in this study , followed by megaloblastic anemia, which was the commonest non malignant disorder.
Malaria continues to be a cause of high mortality and morbidity. It can cause anemia and thrombocytopenia.The mechanism of thrombocytopenia in malaria is probably the consequence of several factors.Experimental data and clinical studies have successively emphasized the role of immune factors and thedestruction or sequestration of platelets. Thrombocytopenia might be a useful indicator of malaria and canalso be used as a marker of response to therapy. This study was conducted to evaluate thrombocytopenia inthe patients suffering from acute plasmodium vivax and plasmodium falciparum malaria separately. OBJECTIVE: To evaluate the effect of malaria on platelet count. MATERIALS AND METHODS: This is an original descriptive case series study and was carried out inpathology department Khyber Teaching Hospital Peshawar over period of six months from 1 st June 2011 to30 December 2011 . Total of 200 malaria parasite positive patients were included in the study. These patientsshowed malaria parasite in their peripheral blood smear (thick and thin) stained with Giemsa stain. P.vivaxand P.falciparum positive cases were grouped separately. Complete blood count was done on automatichematology analyzer and Platelet count was noted. RESULTS: Out of 200 patient, 120 were males and 80 were females. 127 (63.5%) were plasmodium vivaxpositive and 73 (36.5%) were plasmodium falciparum positive. Amongst P. Vivax positive patients 62(48.81%) showed thrombocytopenia while amongst P. falciparum positive patients 40 (54.79%) showedthrombocytopenia. Thus thrombocytopenia is observed to be more common amongst P. falciparum positivepatients. CONCLUSION:Malaria parasite causes thrombocytopenia. KEYWORDS: Platelets, thrombocytopenia, malaria.
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