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Objective: To determine the Diagnostic accuracy of Kramer's visual assessment of jaundice in term neonates by taking total serum bilirubin levels as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Neonatology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, Mar to Sep 2019. Methodology: The study was based on examining and investigating 300 neonates. Kramer scale was used to examine jaundice in all neonates, and results were compared to total serum bilirubin levels. Results: A total of 300 patients were included in this study. The mean bilirubin level was 229.1±74.5mol/L. The sensitivity and specificity of visual assessment of jaundice using the Kramer visual scale were 83.84% and 73.53%, respectively, for neonates who were not jaundiced below the abdomen and thighs included in Kramer zones 1 to 3. Conclusion: Kramer visual assessment can be used as a noninvasive screening method in neonates jaundiced up to the abdomen and thighs, which is included in Kramer zones 1 to 3 but for markedly jaundiced neonates Kramer scale is not a reliable noninvasive method of bilirubin estimation. [ABSTRACT FROM AUTHOR]

Objective: To determine the Diagnostic accuracy of Kramer's visual assessment of jaundice in term neonates by taking total serum bilirubin levels as a gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Neonatology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, Mar to Sep 2019. Methodology: The study was based on examining and investigating 300 neonates. Kramer scale was used to examine jaundice in all neonates, and results were compared to total serum bilirubin levels. Results: A total of 300 patients were included in this study. The mean bilirubin level was 229.1±74.5mol/L. The sensitivity and specificity of visual assessment of jaundice using the Kramer visual scale were 83.84% and 73.53%, respectively, for neonates who were not jaundiced below the abdomen and thighs included in Kramer zones 1 to 3. Conclusion: Kramer visual assessment can be used as a noninvasive screening method in neonates jaundiced up to the abdomen and thighs, which is included in Kramer zones 1 to 3 but for markedly jaundiced neonates Kramer scale is not a reliable noninvasive method of bilirubin estimation. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To look for the associative factors in avoidance of exclusive and nonexclusive breastfeeding among mothers after lower segment Caesarean section. Study Design: Cross-sectional study. Place and Duration of Study: Paediatrics department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Oct to Mar 2020. Methodology: Mothers bringing their infants for vaccination at six weeks of age with babies born with lower segment caesarean section were included in the study. They were asked simple questions regarding exclusive or nonexclusive breastfeeding. Relevant sociodemographic factors were also recorded and compared among mothers breastfeeding their babies and those avoiding it. Results: A total of 500 mothers were included in the study. The mean age of the study participants was 33.576±9.174 years. 336(67.2%) women were primiparous, while 164(32.8%) were multiparous. 208(41.6%) women were actively breastfeeding their child, while 292(58.4%) avoided breastfeeding their babies. 150(72.1%) women were nonexclusively breastfeeding, while 58(27.9%) showed an exclusive breastfeeding pattern. Pearson chi-square test revealed that low education and working outside the home had a statistically significant association with the avoidance of breastfeeding the babies among our target population (p-value <0.05). Conclusion: Avoidance of breastfeeding was a common finding after six weeks of birth among women who delivered the babies via lower segment caesarean section. Mothers with low education and duties to work outside the home were more at risk of avoiding this highly beneficial practice for the baby. [ABSTRACT FROM AUTHOR]

Objective: To compare mean platelet volume in neonates with and without sepsis. Study Design: Cross-sectional study. Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Jan 2018. Methodology: A total of 140 neonates of either gender with ages between 0-28 days, suspected of neonatal sepsis presenting with any two of the signs: a core body temperature of >38.5°C or <36°C at time of presentation, pulse rate beyond the range of 100-200 beats/minute, leukocyte count beyond the range of 4000 to 30,000/mm3 or >10% immature neutrophils on peripheral smear, tachypnea (>60 breaths/minute) and oxygen saturation (<90%) on the pulse oximeter, were included. Three ml of blood was drawn and sent for culture, while another 3ml of blood was sent for peripheral smear and mean platelet volume. Conclusion: Neonates having sepsis were found to have significantly raised mean platelet volume. As a result, mean platelet volume is available in complete blood counts without additional cost to prove cost-effective. [ABSTRACT FROM AUTHOR]

Objective: To determine the pattern of proton pump inhibitors (PPIs) use in medical wards. Study Design: Prospective observational study. Place and Duration of Study: Department of medical post graduate medical institute, study for 24 weeks, from 01 Nov 2014. Material and Methods: One thousand eight hundred consecutive patients admitted in medical wards and emergency department were enrolled and followed during hospital stay and their discharge slips were analyzed without intervention in the management protocol of different primary consultants. Results: Results were analyzed on SPSS version 20. Out of 1800 patients, 53.3% (n=960) were males and 46.7% (n=840) females, 72.6% (n=1306) had been prescribed PPIs. Major indications for the use of PPI were stress ulcer prophylaxis (32.5%), upper G.I bleeding (20.0%), acid peptic disease (12.5%), patients of GERD (8.1%) and NSAID use (7.5%). In 19.3% patients, indication of PPI use was not mentioned. Out of the admitted patients 57.7% patients were prescribed inject-able and 42.3% were given oral PPIs. There were 77.9% (n=1018) patients prescribed PPIs on discharge slips while duration of treatment and indication for their use were not mentioned on discharge slips for 66.3% (n=866) and 72.3% (n=944) patients, respectively. Conclusion: PPIs are over used without clear indications in hospitalized and discharged patients. [ABSTRACT FROM AUTHOR]

Primary central nervous system lymphoma (PCNSL) is a rare variety of extra nodal non-Hodgkin lymphoma that reportedly involves leptomeninges, the brain, spinal cord, eyes, or may involve other organs systemically. We present a case of 46-yearold woman with complaints of headache and fever for three weeks, associated with right-sided weakness & altered state of consciousness for one week. The most common presentation of primary central nervous lymphoma is diffuse or multifocal supratentorial masses causing cognitive deterioration and involvement of vitreous, retina, and optic nerve. Most cases of PCNSL are left undiagnosed due to uncommon. [ABSTRACT FROM AUTHOR]

Objective: To compare mean platelet volume in neonates with and without sepsis. Study Design: Cross-sectional study. Place and Duration of Study: Neonatal Intensive Care Unit, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2017 to Jan 2018. Methodology: A total of 140 neonates of either gender with ages between 0-28 days, suspected of neonatal sepsis presenting with any two of the signs: a core body temperature of >38.5°C or <36°C at time of presentation, pulse rate beyond the range of 100-200 beats/minute, leukocyte count beyond the range of 4000 to 30,000/mm3 or >10% immature neutrophils on peripheral smear, tachypnea (>60 breaths/minute) and oxygen saturation (<90%) on the pulse oximeter, were included. Three ml of blood was drawn and sent for culture, while another 3ml of blood was sent for peripheral smear and mean platelet volume. Results: There were 31 (22.14%) neonates who were culture positive for neonatal sepsis. The age distribution of the neonates showed that 43 (30.71%) were between 0-7 days, whereas 97 (69.29%) were between 8-28 days. The mean gestational age was noted to be 37.04±1.76 weeks. The mean neonatal birth weight was 2344.28±.49 grams. The mean platelet volume (fl) was 7.31±0.92 (fl). Mean platelet volume was 8.52±0.51 (fl) in septic neonates and 6.97±0.70 (fl) in neonates without sepsis (p<0.001). Conclusion: Neonates having sepsis were found to have significantly raised mean platelet volume. As a result, mean platelet volume is available in complete blood counts without additional cost to prove cost-effective. [ABSTRACT FROM AUTHOR]