relationship of health literacy, perceived health information need and preventive health related behavior in urban Karachi

To determine the relationship of health literacy with perceived need of health information and health related behaviors in urban population of Karachi. Cross sectional survey. Community based study carried out on the students of Institute of Business Management and Ojha Institute of Chest Diseases, Dow University of Health Sciences for four months during February to May 2015. A cross-sectional survey was performed in Karachi using a 33 item validated questionnaire on 100 randomly selected subjects using simple random sampling. Descriptive and analytical data analyses were carried out using SPSS version 20. Linear regression was used to find the association between health literacy and perceived health information needs as well as preventive actions. The information regarding demographics was obtained using dichotomous and multichotomous items, health literacy, perceived health information needs and preventive actions was collected using Likert type scales. The participants had a mean age of 27.8 +/- 8.3 years with at least intermediate level education. The mean health literacy score of respondents was calculated to bell.14 +/- 2.84 on 19 point scale [Range 4-16]. On perceived health information needs, the mean score turned out to be 28.27 +/- 8.52 on a 51 point scale [Range 13-47]. As for preventive health actions on a 48 point scale, the mean score was 21.47 +/- 8.61 [Range 8-44]. Linear regression analysis showed a weak positive [r=0.383] relationship between health literacy and preventive health actions [P=9.25 R2=0.147, p< 0.05], however, a weak negative [r= -0.306] relationship between health literacy and perceived information needs [3 38.58 R2=-0.094, p< 0.05]. Health literacy has an association with preventive actions against different diseases, however it also decreases their feeling of need for more health education and may result in a false sense of security. It is important that proper literacy programs must be initiated to increase preventive measures against common diseases in the society, so that the burden and cost of these diseases can be minimized

Prevalence of impaired glucose tolerance among obese teenagers

Obesity has been accompanied by an increase in the prevalence of type-2 diabetes among adolescents. We determined the prevalence of impaired glucose tolerance in a cohort of 100 obese teenagers. Department of Medicine, BV Hospital, Bahawalpur. From January 2005 to January 2007. All subjects underwent a two-hour oral glucose-tolerance test [1.75 mg of glucose per kilogram of body weight], and glucose levels were measured fasting and during the first 30 minutes after the ingestion of glucose. Impaired glucose tolerance was detected in 21 percent of the 100 obese adolescents [11 to 19 years of age]; silent type-2 diabetes was identified in 4 percent of the obese adolescents. After the body-mass index had been controlled for, insulin resistance was greater in the affected cohort and was the best predictor of impaired glucose tolerance. Impaired glucose tolerance is highly prevalent among adolescents with severe obesity, irrespective of ethnic group. Impaired oral glucose tolerance was probably associated with insulin resistance

Intervention of insulin resistance at two stages in the evolution of type 2 diabetes

The purpose of this study was to compare the impact of treating insulin resistance with a thiazolidinedione drug before versus at the onset of diabetes on as per diagnosed by glucose levels and funduscopy. The study was conducted in Medical OPD, BVH, BWP from January 2001 to January 2007. One hundred twenty six non-diabetic young women who were 18-30 year old, with a history of GDM in the prior 4 year and a total glucose level on a 75-g oral glucose tolerance test [oGTT] above the median for women with gestational diabetes mellitus [GDM]were randomized to troglitazone [early intervention], 400 mg/d, or placebo [later intervention]. Women who developed diabetes were placed on open-label troglitazone. Glucose tolerance, insulin resistance, and funduscopy were measured at randomization, at the diagnosis of diabetes, and 8 months post trial to determine the long-term impact of the two treatments strategies on glucose levels and eye. During a mean follow-up of 4.3 year between baseline and post-trial tests, glucose tolerance [oral glucose tolerance test, P<0.04] and insulin resistance [P< 0.02] worsened more in women randomized to late intervention [n= 69] than to early intervention [n = 57]. Among women in the late intervention group who developed diabetes, retinopathy and cataract deteriorated significantly during development of diabetes on placebo and then did not change significantly [P >0.50] during treatment with troglitazone and post-treatment washout. In high-risk women, amelioration of insulin resistance can stabilize glycemia at the time diabetes develops. These findings highlight the role of insulin resistance in the genesis of progressive evolution of type 2 diabetes and successful treatment of insulin resistance in young, nondiabetic women with recent GDM lowered endogenous insulin requirements and stabilized pancreatic-cell function, thereby preventing type 2 diabetes in later life

Estrogen replacement therapy for depression in perimenopausal women

To determine the effect of a four-week course of oral estrogen therapy on depression in aging women. Quasi experimental. The OPD, Bahawal Victoria Hospital, Bahawalpur, from September 2000 to January 2004. Forty-two depressed women [aged 42-57] who were either perimenopausal [n=20] or postmenopausal [n=22] received open label treatment with oral estrogen tablets[1.25mg/day] for 4 weeks. The Montgomery-Asberg Depression Rating Scale and the Beck Depression Inventory were used to assess depressive symptoms, the Greene Climacteric Scale was used to assess menopause-related symptoms, and the Clinical Global Impression[CGI] was used to assess global clinical improvement in these women at baseline and after treatment. Remission of depression was defined as a score <10 on the Montgomery-Asberg Depression Rating Scale and a score < 2 on the CGI at week 4. The women who completed the study had a median Montgomery-Asberg Depression Rating Scale score of 20 [range= 15-32] at study entry and 11.50 [range= 10-31.0] at week 4 [z = -3.43, p<0.01]. This improvement was consistent with that reported by the women themselves on the Beck Depression Inventory [rs=0.86, n=20, p<0.01]. The improvement measured by CGI scores was also significant [p<0.01]. Remission of depression was noted in 5 of the 40 women [after 1 year] who completed the study. Anti-depressant response was not associated with severity or subtypes of depression at study entry or with concomitant improvement in menopause-related symptoms. Perimenopausal and postmenopausal women benefit from short-term use of estrogen therapy. Antidepressant effect of estrogen therapy is independent of improvement in menopause-related symptoms

Clinical chemical pathology of diabetics at the time of diagnosis at bahawal victoria hospital, bahawalpur

To determine the clinical chemical pathology of diabetes mellitus [DM] in patients at the time of diagnosis at Bahawal Victoria [BV] Hospital Bahawalpur. A hospital -based observational and prospective study. Bahawal Victoria Hospital, Bahawalpur.Jan 2000- Jan 2005. 210 consecutive cases of diabetes mellitus [males=99, females=111, aged 20-80 years] presenting to the out patient department with varying complaints were included. A detailed history with special emphasis on symptoms and signs was conducted and the findings observed were noted on a previously made performa. The diagnosis of diabetes mellitus was made on WHO Criteria as follows: Fasting plasma >=126mg/dl and/or 2hour postglucose load >=200mg/dl. Differentiation between Type 1 and Type 2 was based on age of onset and mode of treatment. Subjects with unequivocal results were further investigated by OGTT. The OGTT and its interpretation was carried out according to the recommendations of WHO Expert Committee on Diabetes. Plasma Lipids were determined all of the study subjects. Only 9.52% of the study population presented with the classical symptoms of diabetes mellitus at BV Hospital Bahawalpur. Most of the diabetics presented to the BV Hospital with symptoms as generalized weakness with aches and pains, numbness of feet, infertility, vulvovaginitus, blindness etc. Although, in total, a high percentage of the patients had complaints of polyuria, polydipsia and decreased body weight but in most of them these were not their presenting complaints.These study subjects did not necessarily have one specific presenting complaint. Different patients had different combinations of complaints. Dyslipidaemia was found in 39% males and 48% females of the study subjects. 33.31% males and 19.82% females had a positive family history for diabetes mellitus 39.29% males and 24.73% females had hypertension, 26.36% males and 26.78% females were obese. On funduscopic examination of the diabetics 1%males and 2% females were found to have retinopathy. Macular edema was noted in one patient. Classical symptoms of Diabetes metlitus may not be present at the time of diagnosis. Dyslipidemia is present in many cases with a high incidence of hypertension and obesity. Due to high morbidity and complications, physicians should be vigilant in making an early diagnosis of diabetes mellitus

Microalbuminuria: incidence in patients of diabetes mellitus at Bahawalpur

To determine the incidence of microalbuminuria in patients of diabetes mellitus.[type 1 and type 2] at Bahawalpur. Comparative, cross-sectional study. Bahawal Victoria Hospital, from September 99 to December. 02. 120 patients [Males=52; Females=68, aged 10-80 years]; with DM [Type 1 or 2] were included in the study. Detection of proteinuria was done by dry chemistry system using Medi-Test [Combi 10-Macherey-Nagel]. Proteinuria was confirmed by repeated testing and by measuring urinary protein excreted in 24 hours. Patients with proteinuria were not screened for microalbuminnuria. Screening for microalbuminuria was done on spot urine samples by dry chemistry systems using Micral -Test [Roche Diagnostic]. If the urine was positive for albumin, the test was repeated on two further occasions, over the next few weeks; if on two of three tests raised, 24- hour collection of urine was done to measured the albumin excretion rate [AER]. If AER was increased monitoring at each review visit was done. Funduscopy of all study subjects was done. Blood pressure was recorded on each visit and if raised, treatment with an ACE inhibitor was started; Baseline GFR was measured. If AER was normal on two of three occasions, AER was re-measured at the next review appointment. Out of 120 diabetics studied, 43.33% were males and 56.67% were females. Fifty percent of the females with DM and 29.1% of the males had microalbuminuria. Twenty [16.7%] of the diabetics had type 1 DM, out of them 50% had microalbuminuria. The duration of diabetes did not affect the incidence of microalbuminuria. Hundred [83.3%] of the studied patients had type 2 DM, 45% of this group was found to have microalbuminuria. Neither the incidence of proteinuria nor that of microalbuminuria was affected by the duration of diabetes. Fifty eight of the diabetics studied were hypertensive. 48.2% of hypertensive diabetics had microalbuminuria and 24.1% proteinuria. Incidence of microalbuminuria [73.9% and 72.72% of patients with type 1 and type 2 diabetes respectively] was common in diabetics with age ranging between 40-69 years. Incidence of microalbuminuria is high on our setup, reflecting poor glycaemic control

Clinical chemistry laboratory testing; Evaluation at Quaid-E-Azam medical college, Bahawalpur after autonomy

To determine the affect of autonomy on clinical chemical testing in pathology department Quaid-i-Azam Medical College and to assess the change in the attitudes of laboratorians and physicians Retrospective and comparative. 1-11-93 to 01-11-03. A retrospective study was carried out from 1-11-93 to 01-1103 in which records from 1-11-93 to 1-11-03 were collected and evaluated. Separate record of each month's revenue from clinical chemistry section was calculated. In order to determine what changes have been brought about after autonomy a universal questionnaire was used to assess the attitudes of physicians and surgeons of hospital inquiring whether they noticed any improvement in the efficiency of clinical chemical test results after autonomy. 620 doctors were interviewed through structured questionnaire. The questionnaire was designed to assess the knowledge, attitude and practices of doctors towards autonomy. In order to determine that who is the most beneficent of autonomy, different records were collected and discussions were made with consultants. Autonomy brought about a healthy change in the staff of clinical chemical section. Quality control has improved the morale of lab staff since technical deviations are more readily identified and corrected within the lab, gross errors are rarely found by the clinicians and so their respect for and confidence in the lab has strengthened Replenishment of chemicals/reagents are timely made. The number of available test has significantly increased which in turn has significantly raised the revenue generated since autonomy is awarded. Pilferage of chemicals has been stopped. Turn around time has been decreased. Clinical Chemical section participates in External Quality Assessment Scheme, NEQAPP [National External Quality Assessment Program Pakistan], which is an essential pad of the routine of a well-run lab. Patient is the most beneficent since autonomy is awarded to QMC/BVH, BWP. A significant improvement in the efficiency of the analytical performance has strengthened the faith of laboratorians and physicians in the test results after autonomy

Effect of pregnancy on diabetic nephropathy and retinopathy

To determine whether pregnancy worsens renal function in women with diabetic nephropathy and the effect of pregnancy on diabetic retinopathy. Design: Cross-sectional analytical study. Place and Duration of Study: The study was conducted in OPD, Bahawal Victoria Hospital, Bahawalpur from September 1997 to June 2003. Subjects and Thirty-five patients [aged 20-36 years] identified with diabetic nephropathy and moderate to severe renal dysfunction[creatinine [Cr] > 1.4 mg/dl] at pregnancy onset by retrospective chart review. Alterations in glomerular filtration rate [GFR] were estimated. An equal number of non-pregnant premenopausal type I diabetic women with similar degrees of renal dysfunction served as controls for non-pregnant rate of decline of renal function and potential contributing factors. Student's t-test and repeated measures analysis of variance were analyzed. Mean serum Cr rose from 1.8 mg/dl prepregnancy to 2.5 mg/dl in the third trimester. Renal function was stable in 27%, showed transient worsening in pregnancy in 27%, and demonstrated a permanent decline in 45%. Proteinuria increased in pregnancy in 79%.Exacerbation of hypertension or pre-eclampsia occurred in 73% and 71% of these showed acceleration of disease during the pregnancy. All the patients had diabetic retinopathy, though proliferative retinopathy was diagnosed and treated in only 54.5.% prepregnancy. The retinopathy progressed, requiring laser therapy, in 45.4%. Macular edema was noted in 6 of the patients. Other diabetic complications included peripheral and autonomic neuropathy in 8 patients. Pregnancy induced progression is seen in the decline of renal functions. Patients with diabetic nephropathy were found to have a > 40% chance of accelerated progression of their disease as a result of pregnancy. Forty-five% of the patients had permanent decline in GFR in association with pregnancy