Journal of General Practice

The Resuscitation Council (UK) explains the pathophysiology of acute perinatal hypoxia. They explain that “If subjected to sufficient hypoxia in utero, or during passage through the birth canal, the fetus will attempt to breathe. If the hypoxic insult is continued the fetus will eventually lose consciousness. Shortly after this the neural centers in the brainstem which control these breathing efforts will cease to function because of lack of oxygen. Thus the fetus born after significant and prolonged intrapartum hypoxia will be unconscious and if the neural center of the brainstem is affected the neonate will make no respiratory efforts”. Therefore, the neonate is floppy and unresponsive from unconsciousness, and will make no respiratory efforts in response to the hypoxia as a result of depression of the respiratory center. This neonate requires ventilation to rescue it from increasing hypoxia. Previous researches described a simple scoring system to the neonate in the first minute after birth so that the healthy neonate requiring no attention could be differentiated from the neonate that required ventilatory assistance. The Apgar score measures muscle tone and responsiveness and the effectiveness of the cardiac output, circulation and respiration. 

Background: To observe the survival of preterm infants with respiratory distress syndrome treated with bubble CPAP in a tertiary care hospital. Methods: This prospective observational study was conducted in the NICU of Civil hospital Sukkur from 1st July 2013 to 18th August 2015. All consecutively born preterm neonates with gestational age between 27 weeks to 36 weeks of gestation, admitted to the neonatal intensive care unit with respiratory distress are included in the study. These neonates were managed by Bubble continuous positive airway pressure (bCPAP) in combination with surfactant (bovine derivative) via intubation, Surfactant replacement, extubation (INSURE) protocol Success was considered when neonates were clinically stable and required <0.3 FiO2 to maintain oxygen Saturation >90% and PaCO2 <40-45 mmHg. Results: Mean age of enrolled infants was 1.35 ± 0.60 days, 70 (57.9%) were males and 51 (42.1%) were female, mean weight was 1.76 ± 0.37 kg and mean gestational age was 33 ± 2.3 weeks. Overall 77 (63.6%) preterm infants were successfully weaned off from CPAP. Multivariable analysis showed weight of infant less than 1.5 kg or 8.63 (95% CI: 1.71-43.57), respiratory rate of more than 70 breaths per minute, or 9.59 (95% CI: 2.59-35.52), nasal flaring or 3.35 (95% CI: 1.08-10.31) and typical findings of RDS on chest X-rays 12.04 (95% CI: 1.89-76.52) are independent risk factors for failure of bCPAP. However, gestational age 0.70 (95% CI: 0.54-0.89) is protective against failure. Conclusion: bCPAP has a high proportion of success in the management of respiratory distress syndrome in preterm. It could be most useful in resource-constrained settings.

Background: Inter family cousin marriages carries a risk of increased birth defects. The exact contribution of interfamily to birth defects risk is controversial. The aims of this study were to determine the frequency of birth defects in in relation to interfamily or outside family marriages. Methods: This cross sectional study was conducted in the Civil hospital Sukkur from 9th November 2013 to 13th December 2015. Mothers giving birth to babies married in interfamily or outside family with their consent obtained were included in the study. Mothers not giving consent for study and having any known major illnesses were excluded from this study. Data was analyzed using SPSS version 21.0. Results: The mean age of enrolled participants is 26.72 ± 7.07 years, the mean years of marriage was 5.95 ± 6 years and 49.4% were residents of urban area. Overall 89.9% were Muslims, 8.4% Christians and 2.8% Hindus, 60.7% infant had gestational age of <37 weeks. Overall 11.4% of newborns have congenital malformations. Frequency of congenital malformations among interfamily marriages was 15.6% compared to outside family marriages accounted for 3.7% cases (p=0.021). Conclusion: It was concluded from this study that congenital malformations are common among participants of interfamily marriages.

Marijuana has been used for centuries as therapy for very diverse health issues which displayed various pathologies, from anorexia to cancer including almost all kinds of inflammatory diseases. However, the use of cannabis as therapy generates much controversy as there is conclusive evidence of its beneficial properties. Also it entails unwanted effects due to psychoactive power of some of its main components. Hence, this ongoing work focuses on finding ways to administer cannabinoids, specifically, cannabidiol (CBD), without the presence of any of the psychoactive compounds. Extensive study in this field could be used amicably and we may also find ways to evaluate the effectiveness of this kind of treatment.

Isolated left ventricular apical hypoplasia (LVAH) is a newly recognized, rare cardiomyopathy which was first described in 2004. Until now, only 20 English-language literatures in relationship with Isolated LVAH were collected from PubMed by the author of this article. We report a case of 50-year-old man by health-examination without any symptom as this patient was first diagnosed in our hospital. This article includes two parts: case report and literature review.