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Objective: Large number of fetal weight formulae derived using different populations suggest that there is no fetal weight formula which is acceptable worldwide. Ethnicity and gender of the fetus are the well reported and recognized causes of inaccuracies in these fetal weight formulae. The aim of this study was to compare the accuracies of Schild's gender specific formula with Hadlock's, Shepard's and Aoki's formulae in Pakistani population
Study Design: Cross sectional study
Place and Duration of Study: This study was conducted at Ziauddin University Hospital, from May 2014 to May 2015
Material and Methods: This cross sectional study recruited 150 primary gravida with singleton pregnancy. Patients with hypertension, diabetes and smoking were excluded. Sonographic evaluation for fetal parameters was done during 36.39 +/- 0.684 weeks of gestation. Mean fetal weight was estimated from these formulae. Mean error, mean percentage error and the limit of agreement by Bland -Altman plot was determined. Anova was applied to compare the means of estimated fetal weight, error and percentage error. Gender and weight was noted after birth
Results: No significant difference was found between the means of estimated fetal weightobtained by these formulae. Statistically significant difference was found between mean error of these formulae [p -value = 0.012] ranging between -217.24 gram to - 310.93 gram. Insignificant difference in mean percentage errors was noted which was between - 6.74% to - 9.37%. The narrowest and widest limit of agreement was found with Schild's formula and Hadlock's formula respectively
Conclusion:In our population,for pregnancies with in normal range of fetal weight, Hadlock's, Shepard's, Aoki's and Schild's fetal weight formulae, all showed low values of mean errors and mean percentage errors which were within acceptable range
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Background: Chronic Hepatitis C [CHC] is highly prevalent in Pakistan. Current standard treatment is Interferon alpha/ Peginterferon with oral ribavirin. Interferon therapy is associated with development and worsening of depressive symptoms in CHC patients and to determine the frequency of depressive and anxiety symptoms among patients on treatment with interferon/ Pegasus
Methods: This cross sectional study was conducted at OPD of Liaquat University Hospital Hyderabad during a period of 4 months [from July2013 to October2013]. A sample of 120 patients aged 18-60 years, either currently receiving interferon/ Pegasus treatment or had received that treatment during last 12 months was taken. Known cases of anxiety, depression and those suffering from other debilitating co morbid conditions like carcinoma and non-consenting were excluded. Ethical approval was taken from LUH ethical review committee. A Proforma was used to gather the data. The data collected were analyzed using SPSS version 20.0. Mean [+/-SD] were computed for quantitative variables. Categorical variables [such as gender and outcome variables i.e. anxiety and depressive symptoms] were measured in frequencies and percentages. Stratification was done with regard to age group and gender to see the impact of these on the outcome followed by application of chi-square test with P-value <0.05 taken significant
Results: Total 120 patients were included in the study and 119 completed the questionnaire. Male patients were 55.5%. Mean age of patients was 32.59 +/- 8.56 years [Range: 16-56 years]. Primary outcome i-e; frequency of depression and anxiety in patients on interferon were 77.3% and 70.6% respectively. [n=92] had depression. Frequency of depression of almost similar in both genders [77.3% in males and 77.4% in females; p value= 0.584], while anxiety was more in females than males [75% vs 68.2%; p value= 0.273]. Both psychiatric symptoms increased with increasing age from 16-26 years to 47-56 years of age [p values = 0.432 and 0.736 respectively]. Vast majority [86.6%] were treated with interferon while only 13.4% received the PEGylated interferon therapy. Patients treated with PEGylated interferon had less frequency of depression than those treated with interferon [62.5% vs 79.6%; p value= 0.131]
Conclusion: Depression and anxiety were found to be common in CHC patients who had been or are being treated with antiviral treatment leading to increased risk of morbidity and mortality. Screening for risk of depression, proper education and timely treatment through anti-depressant followed by close monitoring is mandatory to achieve success in antiviral treatment
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Background: To assess the satisfaction levels of employees in a health care organization at Karachi, Pakistan
Methods: A cross sectional survey was conducted on 598 employees working at University and tertiary care hospital for a period of 5 months. Purposive sampling technique was used for collection of data. All employees working for at least one year at any level of management were included in the study. Part time employees, visiting staff, those absent at the time of data collection and those who refused to consent were excluded from the study. Self administered questionnaires were utilized for the purpose of data collection. Entire analysis was performed using SPSS version 20. P value less than 0.05 was taken as significant. For descriptive statistics frequency and percentages were calculated for categorical variables while mean and standard deviation for numerical variables. Analysis of Variance was applied to see association between different groups. The study was approved by the ethical review board
Results: Majority 69.4% [n=415] employees were found to be satisfied. Upper management was seen to have slightly lower scores of satisfaction compared to middle and lower management levels. Between clinical and non-clinical side there was also no significant difference observed in the satisfaction level. Satisfaction levels were seen directly proportional to age and length of service. When overall benefits were seen non clinical side 61% [n=84] were found to be more dissatisfied than clinical side 40% [n=53]
Conclusion: Study findings conclude that majority employees were satisfied. However most were dissatisfied with the overall benefit package and vacation policy
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Background: To find an association between presence of Chronic disease with Oral Health
Methods: It was a cross sectional study conducted in the Dental OPD of LCMD Karachi in 2014. Three hundred participants were enrolled in this study through consecutive sample technique. Data was collected using the self administered questionnaire along with the assessment of oral health examination, which was carried out by the Researcher and data was analyzed on SPSS version 20
Results: It was observed that 59% [n=176] suffered from chronic diseases and when oral examination was conducted, it was revealed that 39% [n=117] had mobile teeth [P value= 0.001], 39.3% [n=118] had missing teeth P value=[0.001], 60.8% [n=115] had bleeding gums, 60.2% [n=112] had halitosis, 60.2% [n=71] had dry mouth, 61.3% [n=84] had oral ulcers,60.6% [n=117] had complain of food deposition and 60% [n=90] had tooth spacing due to periodontal diseases
Conclusion: It was concluded from this study that majority of participants with chronic diseases had poor oral health which needs immediate attention by the medical practitioners during the treatment of chronic diseases and as well as dentists should counsel the patients for maintenance of oral health. It still remains a chicken egg dilemma regarding the temporal sequence of events as many oral pathogens share a common factor with NCDs
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Background: It is estimated that more than 6 million children die in the developing world at the hands of preventable conditions; primarily pneumonia and diarrhea. WHO in 1992 initiated the Integrated Management of Childhood Illness [IMCI] program as a strategy to provide an integrated approach for the management of major causes of childhood morbidity and mortality
Objective: To assess if IMNCI workshops that are held in hospitals that have post graduate training program in field of pediatrics are effective in enhancing knowledge; hence skills for improving health care delivery in limited resources
Methods: A KAP survey was conducted in 2013 among IMNCI trained doctors working in 5 tertiary care hospitals of Karachi. N=57 doctors were identified and administered a structured questionnaire based on recall questions and scenarios. Questionnaire was developed from a similar study conducted elsewhere. Data entry and analysis was done on SPSS version 20
Results: A total of n=57 doctors were included in the study, out of them resident medical officers [RMO] were n=10, postgraduate trainees [PG] n=38 and Medical Officers [MO] were n=9. Mean score of correct answers was 14 [3]. No significant difference was observed when mean scores of PGs was compared with RMO and MO combined through application of Independent sample t test
Conclusion: The study revealed gaps in knowledge and practices of trained doctors regarding management according to IMNCI guidelines
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Background: Continuing professional education [CPE] or continuous education [CE] is the means by which people maintain their knowledge and skills related to their profession. Mandatory continuing education is a major factor in relicensure that is being licensed to practice for a specific period with the license either getting renewed at the end of that period or forfeited. This study is designed to assess the awareness regarding importance of continuing professional education as a requirement for re-licensing among General Dental Practitioners and Specialists and to identify the role of governing bodies for endorsing re-licensure procedure on the basis of CME
Methods: Cross sectional study was conducted among 450 dentists practicing in Karachi [July 2013 to Dec 2013], divided in to two groups ;General Dental Practitioners [n=350]and Consultant Specialists[n=100]. Simple Random sampling technique was applied thorough lottery from available list of Dentists and Consultants. Data was collected through a self administered questionnaire. SPSS version 20 was used for analysis and Chi -square test to assess associations of categorical variables. P value less than 0.05 was considered as significant
Results: Majority participants n= 250 [55.6%] were aware about re -certification and re-licensing and n= 292 [64.9%]knew the difference between the two. Only n=153 [34%] were of the view that re -certification and re-licensing should be made mandatory in Pakistan
Conclusion: The awareness of CME and re-certification is high among our professionals
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The primary objective of this analysis was to evaluate group 2 carbapenem usage and to model the impact that a formalized de-escalation protocol to ertapenem could potentially have on group 2 carbapenem usage in the hope of alleviating the selective pressure on Acinetobacter and Pseudomonas. This analysis was conducted in three hospitals within the Detroit Medical Center in 2009. Patients were considered candidates for de-escalation of carbapenem therapy when a group 2 carbapenem was utilized to treat Enterobacteriaceae, such as extended spectrum [Beta-lactamase [ESBL]-producing organisms, or if cultures were negative in non-intensive care unit [ICU] patients. In total, 179 patients [28%] and 1074 patient-days [29%] were deemed eligible for de-escalation according to our pre-defined criteria. We concluded that preferential utilization of ertapenem in appropriate patients warranting carbapenem therapy has the potential to significantly decrease group 2 carbapenem usage at our institution
Subject(s)
Humans , Delivery of Health Care , beta-Lactams , Acinetobacter , Pseudomonas , EnterobacteriaceaeABSTRACT
Background: Osteporosis is increasingly observed as a major public health concern as it leads to poor quality of life, pain and often disability for those effected. Especially in the developing countries, its prevalence in alarming in the face of poor awareness and management
Objective: To assess the risk factors for osteoporosis in females coming to a tertiary care hospital of Karachi
Methods: This was hospital based case control study conducted in a private tertiary healthcare facility of Karachi. It was carried out in 2012. 57 cases and 60 controls were selected through WHO Sample size calculator. Matching among cases and controls was based on gender, socioeconomic status and age group. Data was collected through questionnaire based personal interviews. Data entry and analysis was done using Epi Info. Association between categorical variables was found using chi square. Odds ratio was calculated for finding association between different risk factors and osteoporosis. The study was cleared through the Ethical review board
Results: One hundred and seventeen cases and controls were taken in this study with the age range of 45+ years [mean age 56.8 +/- 11.8]. Statistically significant difference was found in under 50 age group where cases were only n=8 [14%] as compared to controls n=25[42%]. Parsi ethnicity showed strong association with osteoporosis [OR 2.23]. Strong association was observed between smoking and osteoporosis with an Odds Ratio of 4.0. Strong association was observed with Rheumatoid arthritis [OR 2.8, CI at 95% 1.2-6.3] and Calcium deficiency [OR 2.2, CI at 95% 1.1-4.7]
Conclusion: The study revealed specific to Parsi ethnicity, family history, smoking, rheumatoid arthritis and Vitamin D deficiency were found to be potent risk factors. Therefore as reaffirmed from our study also, risk factors except from the non modifiable ones should be tackled well in advance through health education and interventions
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Background: Thyroid gland volume [TGV] is highly variable as it is greatly influenced by age, gender, anthropometric measurements and geographical location. It has become essential for every population to determine reference range of their normal thyroid gland volume [TGV] in healthy individuals. This in turn will help the population in grading of goiter and will guide in large scale iodine monitoring programs
Objective: To determine TGV in a subset of Karachi population and to determine its association with age and gender
Methods: A cross-sectional study employing 421 volunteers aged 21 years and above went through the ultrasound [US] examination of their thyroid gland [TG] after being confirmed euthyroid by their serum thyroid stimulating hormones [TSH] evaluation
Results: TGV in the study was found to be 6.26 +/- 2.89 ml. Males had significantly higher TGV 6.78 +/- 2.88 ml as compared to females 5.7 +/- 2.79 ml [P=0.00]. Volume of right lobe was significantly greater than that of left lobe [P=0.00] in both the genders. TGV increased significantly with age till 60 years [P<0.05] and after the age of 60 years it decreased [P=0.035]
Conclusion: Mean volume of thyroid gland in this studied population is not only smaller than that of the Western countries but is also much smaller than the neighboring country Iran. The study has also proved that there was a significant decrease in mean thyroid gland volume after the age of 60 years. Prolonged and severe iodine deficient status of Pakistan till recent past could be an answer for small thyroid gland volume in the studied population. Similar studies in future will give more accurate facts and figures regarding mean thyroid gland volume in this population if Pakistan retains itself as an iodine sufficient State
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Background: Motivation and job satisfaction ultimately effect work performance of an individual. There are various factors which influence the work motivation and knowledge of these factors can help in improving the work performance
Objectives: To assess the different factors that are associated with work motivation among nurses working in private and public tertiary care hospitals of Karachi
Methods: This descriptive, cross-sectional study was carried out among nurses for duration of 3 months in 2013. Total 240 nurses from two tertiary care hospitals of Karachi were selected by convenience sampling. A pretested and self-administered questionnaire was used to assess factors associated with work motivation. Data was analyzed using SPSS version 20.0
Results: Of total 240 study participants, 48.8% [117] nurses were in favor of financial incentives that motivate them most. Salary structure and appraisal system both showed significant difference [p-value= 0.000] between nurses from public and private hospitals while the most content place to work was reported government hospitals by 43.4% [104] nurses. Work motivation mean score revealed significant difference [p-value =0.003] among nurses from different working areas of hospital. Factors associated with job satisfaction showed significant difference [p value = 0.000] among nurses from private and public sector hospitals
Conclusion: Financial incentives were found to be the most important motivating factor for nurses that improve their performance. It was also concluded that public sector hospitals along with so many factors of satisfaction are the most content place of working that motivate them most
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The aim of this study was to determine frequency of thyroid incidentalomas [TI] through ultrasound [US] and its association with age, gender and ethnicities. It was a cross-sectional study. Total 269 adults who were asymptomatic for thyroid disease aged 21 years and above underwent ultrasound examination of their thyroid. Frequency of TI found was 21%. TI was detected in 25% of females and 16% males [P= 0.078]. 61% had thyroid nodules [TNs] in one lobe [right, left or isthmus] and 39% had TNs in more than one location. About 55% had single TN and 45% had multiple TNs. 38% had TNs greater than 1cm while 57% had TNs smaller than 1 cm. 5% had TNs greater and smaller than 1 cm. TI was equally common in individuals of different ethinicities [P= 0.758]. Frequency of thyroid incidentalomas found in our study was higher than most of the other iodine sufficient states. Unlike other studies, incidentalomas were equally common in both the genders of our study. This may be due to the previous iodine deficient status of Pakistan which was prevalent. However further studies on the same topic will help us in identifying the correct status of thyroid incidentalomas if Pakistan retains it's status as an iodine sufficient state
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In Pakistan, tobacco consumption is at an all-time high with the tobacco industry witnessing a boom. According to the Pakistan Tobacco Company, production and sale has taken a sharp leap from Rs.1,000 million rupees to Rs.1, 750 million in 2008. The youth remain particularly vulnerable as massive antismoking ad campaigns have failed to drill in the health hazards. The aim of this study is to assess the attitude, perception and practices of youth regarding cigarette smoking. Comparative cross-sectional study was conducted in Ziauddin University and Bahria University. Sample was taken from all years of teaching. Data was collected through self-administered structured questionnaire that was developed in English. It comprised of questions pertaining to their year of study, smoking history, and perception and practices regarding smoking. A total of 450 students were surveyed, medicine [n=260] and engineering [n=190]. One-fourth of the survey sample admitted to have tried to smoke at least once in their lifetime [p=0.001], and at least 20% medical students [n=53] and 35% of engineering students [n=66] surveyed had smoked a cigarette [p=0.001]. While students studying medicine were better aware of the risks associated with smoking and tobacco consumption, however compared to engineering students their overall knowledge of the health risks was unsatisfactory. A significant number of medical students were unable to list and hence effectively counsel about long and short term health benefits. Peer pressure and media played a large role in students picking up the habit
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Objective: To determine the frequency of various risk factors for Coronary Heart Disease [CHD] among doctors of CMH Lahore Medical and Dental College, Lahore, Pakistan
Design: A cross-sectional study
Place and Duration of Study: The study was conducted at CMH Lahore Medical and Dental College, Lahore from 01 Jun 2011 to 31st Jul 2011
Subjects and Methods: A sample size of 104 subjects was selected by convenience sampling after taking verbal consent. A pre-tested questionnaire consisting of questions about presence or absence of CHD risk factors was self-administered. Variables such as gender, age group, and CHD risk factors such as hypertension, diabetes mellitus, family history of heart disease, smoking, hypercholesterolemia, Body Mass Index [BMI] and exercise were included
Results: Among 104 subjects, 53[51%] were males, 51[49%] females and less than 40 years age group were 53 [51%] and more than 40 years were 51[49%]. Proportions of major risk factors were: hypertension 20.2%, diabetes mellitus 7.7%, smoking 13.5%, hypercholesterolemia 19.2%, overweight 33.7%, obesity 5.8%, and lack of regular exercise 40.4%. Proportions of three major risk factors [smoking, hypertension and hypercholesterolemia] occurring singly, doubly and all three together in the study population were found to be 16.3%, 9.7% and 4.8%, respectively. Data was also analyzed for risk factors by comparing those with and without family history of CHD to eliminate any bias. Results were not statistically significant except for hypertension [P = 0.002]
Conclusion: There is a high prevalence of CHD risk factors in doctors of CMH Lahore Medical and Dental College. Modifiable risk factors like diabetes, hypertension and cholesterol need better control. Preventive screening programs and healthy lifestyles need to be emphasized
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Obesity is considered as a global epidemic. Obesity in childhood and adolescent is an issue of concern because it is an important predictor of adult obesity. Identifying individuals who are physically inactive, overweight or obese in school going age is very important. The objective of this study was to determine the frequency and factors leading to obesity in school children. A cross-sectional survey was conducted on children aged 13-16 years. It was a questionnaire based survey with measurement of height and weight. Total 431 children were included in the study. Three hundred and nine [71.7%] of the students were in the normal category, i.e., less than 85[th] centile while 122 [28.3%] had weight greater than 85[th] centile and were overweight and obese. Positive association was found between eating out and weight categories, eating breakfast, intake of fresh fruits and vegetables and soft drinks, low physical activity, and increased screen time. Frequency of overweight and obese children was high in children from higher socioeconomic status. There is strong association between strong determinants of obesity and overweight. Health education of students for known risk factors should be integrated with curriculum of science from elementary classes.
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To determine the frequency of HPV in eaters of Gutka [betel, areca, lime and tobacco concoction], presenting with oral lesions. A descriptive study. Ziauddin University Research Laboratory, from February to July 2010. Subjects munching Gutka fulfilled the inclusion criteria. Samples were collected in the form of 20 - 40 ml oral rinse from 262 subjects who were habitual eaters of Gutka after an informed consent. Gentle brushings from the lesion were taken from subjects with the help of a brush at the other end of dental floss and the oral rinse was stored at 4[degree sign] C until DNA extraction. DNA was extracted and PCR was performed using HPV consensus primers Gp5+/Gp6+. Oral cavity was examined for the presence of ulcer, trismus, sub-mucosal fibrosis, leukoplakia and/or warts. Out of 262 subjects, 42 were females and 220 males with an average age of 27 +/- 10 years. HPV was positive in 47 subjects [17.9%]. HPV frequency was 2.7% greater in chewers with more than 10 years of habit compared to less than 10 years. Examination of oral cavity showed 78% presenting with more than one complaint including oral ulcers [25%], rough mucosa [62%], sub-mucosal fibrosis [24%], leukoplakia [20%] and erythroplakia [10.6%]. Highest frequency of HPV was observed in erythroplakia [25%]. Association between presence of symptoms and HPV shows an ODDS RATIO: ad/bc= 4982/430=11.6. Oral lesions caused by constant exposure to Gutka are associated with high frequency of HPV infection, which may be a risk factor for squamous cell carcinoma of the oral cavity. People should be educated about the consequences of Gutka abuse