United Medical Center

IntroductionLateral meningocele is a rare form of spinal dysraphism where meningeal diverticula herniate through the neural foramina. While most meningoceles are dorsal and lumbosacral, lateral meningoceles typically occur in the thoracic region. The

Key Clinical

IntroductionVirtual Communities of Practice (VCoP) offer information and exchange possibilities for people with chronic diseases. This could be especially valuable for self-management in patients with multimorbidity. The first phase of this project is based on building a Patient Journey Map through a co-creation process with professionals and patients.MethodsWe employed a tailored experiential design approach to co-design the VCoP with patients and professionals. Inclusion criteria for patients was to have ≥2 chronic diseases and aged 30–60. Fourteen patients were recruited. Participation consisted of virtual meetings with semi-directed questions that allowed us to collect the necessary information to know the needs of these types of patients and design a Patient Journey Map. Subsequently, they were able to test the pilot of the platform with specific content designed.Results of co-creation processPatients and professionals participated addressing barriers and needs. They built the trajectory of care and designed a Patient Journey Map so their needs could be addressed by the vCoP. The testimonies of patients and professionals were very different:Professionals identified 3 very well-defined phases (Pre-diagnosis and diagnosis, after diagnosis and follow-up). These phases were sequential and did not vary from one individual to another.Patients identified several areas of care, where the deficiencies of the health system and the need for respect and empathy starred in his journey map. They did not clearly identify phases on the trajectory, but rather described a circular map where feelings and thoughts were common at various stages.Discussion and ConclusionA person-centered co-design process of a vCoP may facilitate the empowerment of multimorbid patients. e-EMPODERAT project aims to improve the patients‘ understanding of their chronic diseases and enhance self-care quality.

Objectives: We conducted this survey to evaluate the knowledge of cardiologists, internists, and family physicians regarding influenza and pneumonia vaccination among cardiovascular disease (CVD) patients. Methodology: An online survey was conducted including practicing cardiologist, internists, and family physicians at various positions working in tertiary health care centres of all major hospitals in all over the Pakistan. A structured questionnaire was designed to assess the physicians’ knowledge toward influenza and pneumococcal vaccine and barriers for prescribing it to the recommended CVD patients. Results: A total of 380 physicians participated in this survey, out of which 58.9% (224) were male and majority 96.3% (366) were ≤ 40 years of age. A 82.6% (314) participants indorsed that the pneumococcal vaccine is Class I indication in cardiac patients above 65 years of age, while, 48.2% (183) considered it to be recommended by the ACC/AHA in all age groups of cardiac patients. Pneumococcal vaccine are considered to be live attenuated vaccines by the 41.8% (159) of the participants. The mean knowledge score was found to be 63.09 ± 13.61. The most common stated reasons for not prescribing pneumococcal vaccine was not readily available, 42.9% (42), followed by the perception that it is not indicated, 36.7% (36). Conclusion: Most of the physicians were not thoroughly well-aware about indications of the vaccine in CVD patients. Additionally, scope of the vaccine is under-estimated because of lack of knowledge regarding importance of vaccine and secondly due to unavailability of vaccine in most of the areas of Pakistan.

Objective: frequency of hypocalcemia in jaundiced term neonates undergoing phototherapy. Methodology: A total of 150 term neonates of either gender who develop jaundice requiring phototherapy are included in this study presenting within first week of life whereas those term jaundiced neonates who are at known risk of developing hypocalcemia, infant of diabetic mother, neonates having history of birth asphyxix, septic neonates, those requiring exchange transfusion and those with hemolytic anemias were excluded from study. The patients were examined thoroughly (complete history and physical examination).Informed consent was obtained to include the data in study. Jaundiced neonate is applied phototherapy and after 48 hrs of phototherapy session, 5ml blood sample is drawn and sent to hospital laboratory for estimation of total serum calcium level. Hypocalcemia (i.e. Calcium level < 8 mg/dl after 48 hours application of phototherapy for jaundice neonatorum) was recorded and managed as per hospital protocol. Results: Out of 150 cases, 46%(n=69) were in range of 1-3 days while 54%(n=81) were between the range of 4-7 days of life. The common age was 3.59+1.60 days. There were 53.33%(n=80) male while 46.67%(n=70) were female participants. Hypocalcemia was recorded in 20.67%(n=31). Conclusion: We concluded that the frequency of phototherapy associated hypocalcemia is not very high, however, calcium levels should be monitored as it is a potential but very less studied complication in our clinical settings. Keywords: Term neonates, jaundice, phototherapy, hypocalcemia

Abstract Objective: To determine the effect of maternal colonization with history of PROM on neonatal colonization and early-onset sepsis.Methods: A descriptive cross-sectional study was carried out at a single tertiary care hospital of Karachi from June 1st 2018 to May 31st 2019. A total of 155 patients' full-term new-borns between 37 to 41 weeks of gestation with a history of rupture of membranes more than 18 hours duration was selected by convenience sampling method. A high vaginal swab was collected from all full-term pregnant women with a history of PROM. After delivery of their new-borns, all babies were kept in the nursery under closed observation for 72 hours duration and their blood cultures, CRP (C- Reactive Protein) and CBC (complete blood count) was sent within 24 hours of delivery.Results: In our study, out of 155 PROM cases 58 (37.4) were growth positive and 50 (32.3) neonates had positive blood C/S at delivery. Out of 58 cases with suspected growth positive PROM mothers 51 had gram-negative organisms in HVS while only 7 mothers were gram-positive in HVS. Of all neonates with positive blood C/S at delivery 44 cases were gram-negative organisms in their blood.Conclusion: In our study organisms found in a high vaginal swab of the mother are similar to the organisms found in the blood culture of their new-born with early-onset sepsis.

The Current Procedural Terminology of the American Medical Association has recently introduced coding changes for myelography with the introduction of new bundled codes. The aim of this review was to help neuroradiologists understand these code changes and their unintended consequences and to discuss various scenarios in which permutations of various codes could occur in clinical practice.