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Home > Determinants and Outcome of Oesophageal Caustic Stricture Interventions Among Children at French Medical Institute for Mothers and Children, Kabul, Afghanistan

Determinants and Outcome of Oesophageal Caustic Stricture Interventions Among Children at French Medical Institute for Mothers and Children, Kabul, Afghanistan

Thesis Info

Author

Moghul, Dunya

Department

French Medical Institute for Children (FMIC)

Program

Diploma

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2016

Thesis Completion Status

Completed

Subject

Paediatric Surgery

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676727861619

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Background: Caustic Substance Ingestion (CSI) is still one of the significant problems more likely in developing countries, as an incidence of more than 200,000 of caustic exposures has been reported in National Poison Data System at 2008. The incidence of oesophageal caustic stricture is about 10 to 30 % after CSI worldwide. Aim: This study aimed to find out the demographic characteristics of CSI and its outcome. Moreover, this study will determine the outcome of the oesophageal caustic stricture and its interventional procedures among children at FMIC, Kabul, Afghanistan. Methodology: Retrospective case series study design was conducted at French Medical Institute for Mothers and Children, Kabul, Afghanistan. Records of patients admitted at surgical department from 2010-2016 with history of caustic substance ingestion reviewed and total of 63 patients based on inclusion and exclusion criteria enrolled in the study. Chi square test, t-test and co-relation was run to find out the associations. Result: Out of all 63 patients, 36.5% (23 patients) were male and 63.5% (40 patients) were female. The oldest patient was 14 years old and the youngest one was 1-year-old with the mean age of 4.36+ 3.101. About 57.1% were from North West of Afghanistan which the majority of them were from Balkh province. The second highest number of these patients were from Kabul province 25.4%, and 7 % of these patients were from the west of Afghanistan all from Herat and 6.3% were from the south east. CSI in 2 of cases it has been recorded as acid ingestion who was also accompanied with pyloric stenosis and the majority of cases (71.9%) were alkali which is mostly used as whitening liquid (Vitex) for clothes. But families could not describe the type of ingested material in 23.4% of cases so it has been recorded under the name of caustic agent.XV In 15 patients (23%) dilatation was not successful as patients got complicated that 9 was failed, in 6 cases dilatation was done but then in 1 of these patients developed pneumomedistinitis and 5 of them developed pneumothorax during first 24 hours post dilatation which then underwent of gastrostomy or gastrostomy+ oesophagoplasty. After cross tabulation of gender, the P- value of gender and complications stayed 0.006 which is highly significant, showing association, meaning that most of our female patients got complicated. The mean frequency of dilatation of different gender showed P- value = 0.06, which is again highly significant.
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مولانا شاہ وصی اﷲ

مولانا شاہ وصی اﷲ
آہ کیوں کرکہیے کہ۲۵/نومبر کوحج وزیارت حرمین شریفین کوجاتے ہوئے مظفری جہاز میں مولانا شاہ وصی اﷲ صاحب بھی رہ گزائے عالم جادوانی ہوگئے۔ اناﷲ وانا الیہ راجعون۔وفات کے وقت عمر۷۵برس تھی۔علوم دینیہ واسلامیہ کی تکمیل دارالعلوم دیوبند میں کی تھی اورحضرت الاستاذ مولانا محمد انورشاہ الکشمیری کے ارشد تلامذہ میں سے تھے۔جن حضرات نے مولانا کایہ زمانہ دیکھا ہے ان کا بیان ہے کہ طالب علمی کے زمانہ میں ہی رشد وہدایت کے آثارطالع روشن سے ہویدا تھے۔چنانچہ ایک مرتبہ ایک بزرگ نے فرمایا بھی تھا کہ اگر کسی کو مادر زاد ولی دیکھنا ہوتو وصی اﷲ کودیکھے۔طالب علمی کے زمانہ میں ہی حضرت تھانویؒ کی خدمت میں آناجاناشروع کردیا تھا۔آخرکار یہ رنگ اس درجہ غالب ہواکہ برسوں کی ریاضت اورمحنت ومشقت کے بعد اپنے پیرومرشد کے نہایت ممتاز خلیفہ اور جانشین ہوگئے۔شروع میں آپ کامرکز ِارشادوہدایت فتح پور تھا۔پھرالہٰ آباد منتقل ہوگئے اوراب گذشتہ چند برسوں سے بمبئی میں بھی قیام رہنے لگا تھا۔ آپ جس درجہ کے عارف باﷲ اورمحرم اسرارطریقت تھے اُسی درجہ کے عالم اور مبصر علوم دینیہ واسلامیہ بھی تھے۔قرآن مجید سے طبعاً بڑا شغف تھااور تفسیر آپ کا خاص فن تھا، چنانچہ روزمرہ کے معمولات میں درس قرآن بھی شامل تھا جس کی پابندی سے سختی فرماتے تھے اور اوراد و وظائف اورارشاد وہدایت کے دوسرے مشاغل کے ساتھ مطالعہ کتب کاسلسلہ برابر جاری رہتا تھا یہاں تک کہ سفر میں بھی کتابوں کابکس ساتھ چلتا تھا، درس یاگفتگو میں کوئی بات بغیر حوالہ کے نہیں فرماتے تھے۔
شاہ صاحب کومعمولی سے معمولی باتوں میں اتباع سنت نبوی اور تعمیل شریعت کااہتمام رہتا تھا۔درحقیقت آپ کاتصوف بجزاُس احسان کے کچھ اورنہ تھا جس کی تعریف میں زبان وحی ترجمان سے ارشاد ہوا : ان تعبداﷲ کانک تراہ فان لم تکن تراہ فانہ یراک ۔
اسی بنا...

Correlation Between Internal and External Assessment at University Level: Acase Study of I. E. R, University of Peshawar

Abstract: Evaluation is the backbone of our education system. It is one of the important factors of the three pillars of our education system. The three pillars are: educational objectives, teaching learning process and evaluation or assessment. Assessment, scores or grades are one of the factors of the main concern for the students of any academic programme. The present study is aimed to investigate the correlation between the internal and external assessment of Master of Education (M. Ed) examination of the students of Institute of Education & Research (I.E.R), University of Peshawar. In total all 200 students of university of Peshawar who appeared in the M. Ed. Annual examinations were taken as a sample being convenient to the researcher. The data was obtained from the Examination section of the University of Peshawar. The data so obtained was then analyzed through SPSS and it was concluded that both the Internal and External assessments were correlated. The implications were discussed. Key Words:           Correlation, Assessment, Case study, M. Ed, University                              of  Peshawar.  

To Study the Effect of Salts and Complexes of Lead and Arsenic Metals on the Status of Thiols in Blood Components, Pharmacological and Toxicological Perspectives

Heavy and transition metals have been widely known for their toxicities for centuries. Arsenic and Lead are highly valued in terms of toxicity to living systems due to their high affinity for sulfhydryl (-SH) containing residues. The chemical interactions of Arsenic and Lead with thiols (–SH rich molecules) results in numerous ill-health effects. As a part of this PhD thesis, the chemical status of GSH was determined in the presence of inorganic and organic complexes of lead and arsenic employing simple spectrophotometric analysis and 1H NMR methods. The behavior of Ellman’s reagent towards the metal-thiol chemistry was initially investigated to begin with the study of the changed status of thiols resulting from metal-thiol coordination. Chapter 2 describes the use of NMR methods to study the species in solutions. 1H NMR allowed us to identify additional components of the reaction mixture, their relative abundance and consequently the involvement of these additional Ellman’s based species in the spectrophotometric errors associated with the use of Ellman’s reagent. Using 1H NMR methods we are able to show that Ellman’s reagent can exchange with thiolates previously coordinated with lead and arsenic. In the context of this 1H NMR study, some limitations were found to be associated with the use of Ellman’s reagent in our study. Ellman’s reagent was found able to react with the thiols being previously attached with arsenic and lead, leading to an over estimation of the thiols in the solution systems. 4,4′-dithiodipyridine (DTDP) was adapted instead of Ellman’s reagent for the spectrophotometric determination of the mixtures involving metal-thiols complexes in aqueous solution and biological mixtures after establishing limitations associated with the use Ellman’s reagent in this capacity of the study. Chapter 3 describes the 1H NMR carried out to study the conditions and ratios of the complexed thiolates (complexes of both arsenic and lead with some important low molecular weight thiols (Glutathione, N. acetyl cysteine and D-Penicillamine). 1H NMR study presented in this chapter provides detailed information about the changes in the chemical status of GSH that might be the basis of this chemical change observed spectrophotometrically in the form of depletion. 1H NMR methods confirmed metal-thiol adducts (i.e., As-SG3 and Pb-SG2) to be the mechanism behind the GSH depletion in the presence of these metal compounds. After establishing the limitation associated with the use of Ellman’s reagent, 4,4′- dithiodipyridine was used for the spectrophotometric determination of the unbound thiols in the presence of complexed thiolates in aqueous solutions. In the course study presented in XII chapter 4, we have spectrophotometrically investigated the reactions of arsenic and lead with sulfhydryl containing thiols i.e., Glutathione, N-Acetyl cysteine and D-Penicillamine in aqueous solutions. In this chapter, the effects of arsenic (Sodium arsenite and Methylarsonous acid) and lead (Lead acetate and Lead acetyl acetonate) on low molecular weight thiols (Glutathione, N. acetyl cysteine and D-Penicillamine) have been spectrophotometerically quantitated in aqueous solutions. Employing influential variables (i.e., different metal concentrations, incubation times and pH ranges) to the study in aqueous solutions, prominent and regular decrease in the thiol levels were caused by each of the inorganic and organic compounds of arsenic and lead in spectrophotometric analysis. Chapter 5 describes the spectrophotometric estimation of important and most abundant low molecular weight thiol (Glutathione) in the whole blood and blood components (cytosolic Fraction and plasma) of human volunteer. In order to improve our understanding of the coordination chemistry of arsenic and lead in whole blood, cytosolic fraction and Plasma, a systematic study of the changes in glutathione (GSH) levels in these biological samples of healthy human volunteers, has been carried out. The effects of the inorganic and organic compounds of arsenic and lead on glutathione status in these biological samples have been spectrophotometerically evaluated by 4,4′-dithiodipyridine. Chapter 6 describes the spectrophotometric estimation of Glutathione in WBCs (Lymphocytes and Monocytes) isolated from human blood, while the study carried out in chapter 7 describes the estimation of Glutathione in liver isolated from rabbits. Chapter 8 describes the exchange of arsenic (AsIII) and lead (PbII) between Proteins (Albumin) and low molecular weight thiols (Glutathione, N. acetyl cysteine and D- Penicillamine). In addition to thiol disulfide exchange reactions, the exchange of arsenic and lead between Proteins (Albumin) and low molecular weight thiols (Glutathione, N. acetyl cysteine and D-Penicillamine) has also been investigated by Column chromatographic methods using Ellman’s reagent. The exchange behaviour of arsenic and lead between proteins and low molecular weight thiols have been analyzed spectrophotometrically by making use of Ellman’s reagent. Column chromatographic methods have been used to collect complexed proteins. The sulfhydryls present on the pure and complexed proteins have been estimated spectrophotometerically. The study regarding the thiol disulfide exchange reactions resulted that the low molecular weight thiolates (Reduced glutathione and N-acetylcysteine) take off As(III) and Pb(II) species which are attached to proteins. XIII Results from multiple studies presented in this PhD thesis are consistent to conclude and anticipate that lead and arsenic species are dynamic in nature as in the case of using Ellman’s reagent, thiolates could be removed from the coordination sphere of the arsenic and lead in As(SR)3 and Pb(SR)2 respectively and in the case involving albumin, the slow exchange of lead and arsenic species bound to cys-34 is the basis for a mechanism by which toxic species can become widely distributed around the body.