Atorvastatin as an adjuvant with betamethasone valerate reduces disease severity and cardiovascular risks in Psoriasis

Objectives: To evaluate the effect of Atorvastatin as an adjuvant with betamethasone valerate on disease severity and cardiovascular risks in chronic plaque type psoriatic patients

Methods: It is an interventional study conducted in Pharmacology Department of BMSI, JPMC with the collaboration of Dermatology Department of JPMC, Karachi. The duration of study was from June 2013 to June 2016. Seventy five psoriatic patients were prescribed Tablet Atorvastatin 40-20 mg/day [40mg for first three months twice daily followed by 20mg once daily for the next three month] plus topical Betamethasone Valerate 0.1% once daily for 6 months [three week apply than one week interval]. The efficacy and safety profile of drugs was measured by PASI, DLQI, hsCRP, LFTS and Lipid profile

Results: The percentage change of PASI is 86.749+/-0.547, DLQI is 82.697+/-.2.61 and hsCRP is 40.371+/-8.505, which showed highly significant improvement in patient at the end of last follow up. LFTs and CPK for safety profile of therapy showed non-significant results

Conclusion: Atorvastatin used as an adjuvant therapy with currently existing standard therapy [topical betamethasone] in patients having mild to moderate plaque type psoriasis reduces disease severity and cardiovascular risks

Epidemiological features of dog bite and its awareness among victims: report from abbasi shaheed hospital karachi

Objective: To estimate the burden of recently reported cases of dog bite in a tertiary care center of Karachi and to analyze the awareness of these victims or their attendants about dog bite or rabies

Methods: This cross sectional study was conducted during January to June 2008 at Emergency department of Abbasi Shaheed Hospital. Our sample was comprised of 393 patients, reporting first time after stray dog bite incident. The relevant information was obtained regarding patients' age, gender, details of injury, management and patients' knowledge about dog bite and rabies. SPSS 13 was used to manage data and perform analysis

Results: It was found that 83% of the victims were males and 52.4% were of less than 15 years of age. In our data, 26.7% victims reported within twenty-four hours of the dog bite. Mapping of dog bite cases revealed that 24% belonged to Orangi town while 14% each from North Karachi and Nazimabad. Knowledge of people related to rabies was very poor and 91% did not know that rabies could result after dog bite. Only 7% knew that rabies is a fatal disease and 0.7% responded that it can be prevented by vaccines

Conclusion: Dog bite is a significant public health problem among young males with preponderance in certain areas of Karachi. Lack of education of people and lack of health communication reflected well through carefree practices and attitude of victims of dog bite

Comparing the quality of life by using two therapeutic approaches [10% sulphur ointment and 5% permethrin cream] in scabies patients

To compare the quality of life by using two therapeutic approaches [10% sulphur ointment and 5%permethrin cream] in patients with scabies. Retrospective / comparative study. This study was conducted in Basic Medical Science Institute and Dermatology Department of Jinnah Postgraduate Medical Centre in Karachi from 1[st] Dec 2010 to 30[th] May 2011. This study sample consisted of 130 [4 dropped out] clinically diagnosed cases of scabies divided into two groups; A and B. Each group was further subdivided into three age groups. Group A was asked to apply 5% permethrin cream on day 0 and to be repeated after 15 days and GroupB treated with 10% sulphur ointment for three consecutive nights and repeated on day15. Data was gathered by a questionnaire. Patients follow up was done on days 3, 15 and 30 and quality of life was determined on day 0 and 30 by using Dermatological Life Quality Index. Quality of life was found to be low in scabies patients and treatment with 10% Sulphur ointment and 5% permethrin not only improved clinical symptoms but also their quality of life significantly. Scabies affects quality of life because of severe itching and lack of sleep and proper topical therapy significantly improves clinical symptoms and quality of life

Situation analysis of millennium development goals 4 and 5: Pakistan's perspective

Millennium Development Goals [MDG] are being pursued since the year 2001, to scale up the critical health and development indicators for the world population. In this article we aimed to describe and explain the status of maternal and child health in Pakistan, in the light of MDGs 4 and 5 with their corresponding targets and indicators. Secondary data has been used to analyze the achievements or relative letdown in MCH sector in Pakistan. Though over the last two decades, maternal and child health indicators have been improved here, but still big challenges remain. At present, the under-5 mortality rate has fallen by 24% and maternal mortality ratio is halved since 1990. Pakistan is found to be 83% and 100% off track towards MDG 4 and 5 respectively

Beneficial effect and safety of 5% permethrin cream in scabies patients

To evaluate the efficacy and safety of 5% permethrin in scabies patients. Scabies is a contagious, itchy ectoparasitic infection. It is a common public health problem with an estimated global prevalence of 300 to 400 million cases. They increases day by day.5%permethrin is one of the effective treatment of scabies, it is highly effective, well tolerated, poorly absorbed and rapidly metabolized by skin. Open label clinical trial. This study conducted in Basic Medical Sciences Institute with collaboration of Dermatology Department from . This study sample involved 65 clinically diagnosed scabies patients one was lost from follow up, the duration of study was 90 days. They were treated with 5% permethrin cream, clinical data was collected by using questionnaire. Patients were divided into three age groups and given two applications of permethrin cream on first and 15 day. Follow up was done on Day 3, Day 15, Day 30 and Day 90. It was found that efficacy and safety of permethrin cream in scabies patients was highly significant which clinically improved the symptoms of patients. Scabies patients should advised 5% Permethrin cream with conventional therapy which improves symptoms significantly following proper local

Knowledge, attitude and practice [KAP] about malaria among inhabitants of a slum area of Karachi

To assess the KAP regarding malaria among inhabitants of slum area of Karachi. A community based comparative cross sectional study was conducted in a slum area of Karachi i.e. Arafat town, for a period of seven months from Oct 2011 to April 2012. Total 151 inhabitants of Arafat Town were included and interviewed by trained Lady Health Worker using structured questionnaire, comprising of three components i.e. KAP about malaria. Individuals who scored more than 70% were labeled as having satisfactory KAP. Proportions of score regarding KAP were compared with one another and also with demographic variables by using chi-square test. Most of the participants were married female, having mean age of 33.87 +/- 7.5 years. Large proportion [97%] of sample had satisfactory attitude as compared to knowledge [50%] and practice [59%]. Difference in knowledge and practice was found to be significant [p=0.040]. Inhabitants of Arafat Town, had positive attitude towards prevention of malaria, but their levels of knowledge and practice were found to be low, may be due to low literacy rate or poor socioeconomic condition or both. Prompt interventions are required to enhance their knowledge and practice and thus ultimately would reduce the burden of malaria

Evaluation of efficacy of budesonide in prevention of cardiovascular risks in chronic obstructive pulmonary disease patients

Cardiovascular disease is a major cause of mortality and morbidity in COPD patients. Systemic inflammation plays a major role in the pathogenesis of cardiovascular disease in COPD. It has, therefore, been suggested that anti-inflammatory agents may prevent cardiovascular disease. It would be plausible that inhaled steroids, such as Budesonide, reduce the local inflammation and subsequent cardiovascular morbidity, thus a local effect on the lung resulting in diminished spill-over of inflammation systematically to the cardiovascular system is an attractive hypothesis. To assess the impact of Budesonide in reducing the cardiovascular risk in COPD patients. Experimental Randomized Study. This study was conducted in the Department of Pharmacology and Therapeutic, Basic Medical Sciences Institute, JPMC Karachi in collaboration with Department of chest medicine, JPMC, Karachi from Dec. 2010 to March, 2011. Thirty five patients with moderate stable COPD, hsCRP level >3mg/lit, were evaluated in an open label, intention to treat clinical trial. The patients were assigned to give Budesonide [Pulmicort] inhaled 200mcg BD for 12 consecutive weeks. The primary study outcome was to evaluate the reduction in cardiovascular risk by evaluating the improvement in FEV1 and reduction in hsCRP levels, was evaluated at day 30, 60 and day 90. Thirty four [96%] patients were completed the study. At baseline hsCRP levels was 6.68 +/- 0.26 which decrease to 5.82 +/- 0.20 [P<0.010] at day 90. FEV1[L] at baseline was 2.12 +/- 0.05 and at day 90 FEV1 increased up to 2.40 +/- 0.04 [P<0.001]. This shows that, the Budesonide can statistically significant decrease the hsCRP levels and increase the FEV1. In conclusion, Budesonide effectively decrease the cardiovascular risk by decreasing the systemic inflammation which were indicated by decreasing the hsCRP levels and also improve pulmonary functional capacity in COPD patients

Morbidity due to stress in postgraduate trainee doctors of Karachi

To find out stress level and its related morbidity among Postgraduate Medical Trainees. This Descriptive cross sectional study was conducted at Dow University of Health Sciences and Agha Khan University Hospital Karachi during January to December 2008. Postgraduate Medical trainees who were pursuing FCPS, MCPS and DCPS were included. Self administered Questioner were distributed and doctors were selected by non-probability convenience sampling technique. Trainee doctors were found stressed 62.3%. A large no of trainees [34%] complained of Indigestion. Palpitation, tearfulness, waking at night, poor appetite found in [24 - 25%]. Complain of minor psychiatric illnesses, tiredness and lack of energy, having more responsibility than can handle, in ability to stop thinking about problem, difficulty in taking decisions, feeling of being trapped or cornered in 45- 50% doctors. The stress level of Postgraduate trainees was found to be high There were high prevalence of physical morbidities as well as minor psychiatric illnesses

Indoor air pollution and respiratory illnesses in exposed children

To find out the common indoor air pollutant present in study population and their relation with respiratory ailments in children exposed to these pollutants. It was a descriptive, cross-sectional study. The study was conducted at outpatient clinic and ward of Pediatric department. Abbasi Shaheed Hospital Karachi, Abbasi Shaheed Hospital is a tertiary care teaching hospital, associated with Karachi Medical and Dental College. The study was conducted during January 2010 to June 2010. It was convenient sampling [Non-probability]. The sample size of children aged between 2 months to 12 years was calculated according to an expected prevalence, a precision of 3% and an error risk of 500. The sample and target population size allowed a correction factor leading to a sample size of 100 children. The children with respiratory illness of specified age group were included, a verbal consent was taken from parents and a questionnaire was filled by the trainee doctors and final year medical students. Data was entered in SPSS-14 and analyzed by means of graphs, charts and frequency tables. The average age of the children was 34.8 months and 66% were less than 5 years of age. No of episodes of respiratory illnesses in children was 2.16 per year, while the average no. of admissions was 0.73 per year. The average family size was 9 and parity was 4. The average no of persons sharing a bed room was 4. Male to female ratio was 1:1.04. ln study group 16% had open kitchen while 10% did their cooking inside bed rooms. 39% used wood or coal and 14% used biomass. 36% houses were poorly ventilated and 8% had dampness in the house. Smoking in family was present in 55% use of talcum powder was positive in 71% cases and mosquito repellent was used in 85% of cases. The practice of cooking, cleaning and smoking were found to be important factors contributing to indoor air pollution and thus causing increased risk of respiratory illness in exposed population. As the children between 2 months to 5 years and mothers spent most of their time inside home, they were exposed more to indoor pollutant and thus had increased prevalence of respiratory illnesses. By awareness campaign and corrective measures we can reduce the risk of indoor air pollutants associated respiratory diseases

To study therapeutic effect and benefit on quality of life in scabies patients

To determine the quality of life by using 5% permethrin cream in scabies patients. Scabies is a contagious, itchy ectoparasitic infection caused by sarcoptes scabiei mite. It is a common public health problem with an estimated global prevalence of 300 to 400 million cases. They increases day by day due to resistance/ recurrence and largely effect the quality of life. 5% permethrin is one of the effective treatment of scabies it is highly effective, well tolerated, poorly absorbed and rapidly metabolized by skin. Open Label Clinical Trail study approved by ethics committee of Jinnah Postgraduate Medical Centre, Karachi. This study was conducted in Basic Medical Sciences Institute with Collaboration of Dermatology Department of JPMC, Karachi from 1st Dec 2010 to 30th Jan. 2011. This study sample involved 65 clinically diagnosed scabies patients who were treated with 5% permethrin cream. Clinical data was collected by using questionnaire. Patients were divided into three age groups and given two applications of permethrin cream on first and 15 day. Follow ups was done on Day 3, Day 15 and Day 30 and there quality of life assessed using dermatological life quality index on day 0 and 30. It was found that quality of life in scabies patients was low and treatment with permethrin cream clinically improved the symptoms of patients and their quality of life significantly. Scabies has a social stigma and the quality of life of patient get effected because of night itching and lack of sleep which improves significantly following proper local therapy

Common menstrual disorders in adolescents

To assess the knowledge of adolescent females about menstruation, prior to their menarche. To determine the frequency of common menstrual disorders. To determine the number of adolescents taking medical treatment for menstrual disorders. To assess the awareness of adolescent females about the menstrual disorders they are suffering from. It was a descriptive cross sectional study. The study was carried out in a teaching hospital, various schools and colleges and a slum area of North Nazimabad, Karachi. The study included 150 adolescent females on the basis of non probability purposive sampling. A previously prepared questionnaire was filled which included demographical profile, details about the participant's menstrual history and the treatment taken, if any, for the disorders they were suffering from. One hundred and fifty adolescent females participated in our research aged 11 to 19. The girls were non-married, not pregnant and free of co-morbidities. Out of total, 61% participants had menstrual disorders. Out of which 58.6% girls had dysmenorrhea, 12.7% had menorrhagia, 4.7% girls had oligomenorrhea and 2% girls had amenorrhea. 19.3% girls had such severe dysmenorrhea that it affected their school and social life. Only 38% of the suffering girls were aware that they had a menstrual problem. 15.3% of the participants were taking medication for their menstrual problem. 86% girls had prior knowledge of menstrual cycles before menarche. Most of them were taught about normal menstruation by their mothers. So they considered it to be a normal physiological phenomenon. A majority of adolescents in Pakistani society face menstrual disorders after their menarche. There is also a need to teach people about treatment at the community level so the girls can realize and overcome these problems befre the disorders can go into complications like infertility or uterine cancers

Common handicap conditions in special school children of Karachi

To describe the proportion, to explore the causes leading to handicap and to assess the abilities of handicapped children. The design of our study is cross sectional analytical. The subjects were handicapped children of Imran Rehabilitation Center, DEWA School and Shaheed-e-millat School. The Inclusion criteria was children aged 5-15 years suffering from Cerebral Palsy, Mental Retardation, Visual Impairment and Hearing Impairment. The Exclusion criteria included those children whose mothers declined to give us the information and those children whose mothers couldn't make it to the handicap school. The duration of our research was 7 months from March to October 2009. Sample size was 108 children. Sampling technique was non-probability purposive sampling.Data collection procedure was Closed ended Questionnaire having some Open ended questions. We conducted a research that showed that the most prevalent condition was Cerebral Palsy in 38% [p=0.05] of the children. The major risk factor for cerebral palsy were Caesarean section in 41.46% [p=0.002] and delayed crying of the baby soon after birth in 51.06% [p=0.00] of the cases. The risk factor for visual impairment were lack of iron and folic acid supplements during pregnancy in 52.94% [p=0.00] and instrumental delivery in 50% [p=0.00] of the subjects. The risk factor for hearing impairment was drug exposure during pregnancy in 37.03% [p=0.00] of the cases. Our research showed that the most prevalent handicap condition was Cerebral Palsy. The major risk factors for cerebral palsy were found to be Caesarean section and delayed crying of the baby soon after birth. The risk factors for visual impairment were identified to be lack of iron and folic acid supplements during pregnancy and instrumental delivery. The risk factors for hearing impairment were found to be drug exposure during pregnancy

Association of menopause with osteopenia and osteoporosis: results from population based study done in Karachi

To assess the association of osteopenia and osteoporosis with menopause and compare the health seeking behaviour of women related to menopause in different strata of society. A cross-sectional study. Three different socioeconomic strata of Karachi from May till August 2004. A sample of 925 women, over 35 years of age, was selected from 16 clusters of 250 households [50 houses in each cluster]. All apparently healthy women having age between 35 and 50 years were selected in the cluster houses. Those who were not willing to be the part of the study or giving history of taking treatment for any disease for more than 4 weeks were excluded. In-depth interviews were conducted at their houses by the fourth year medical students trained and supervised by the senior faculty of the Medical College. T-scores were calculated to get BMD [Bone Mineral Density] for all the subjects through heel ultrasound. A total of 287 women were found to be experiencing menopause. The mean age of menopause was 47.8 + 4.7 years. Out of those 287 women, 135 [47%] wanted their menses to continue and 235 [82%] had consulted a physician after menopause. There was a significantly lower score of BMD of postmenopausal women [mean = -1.833 + 0.65] compared to pre-menopausal women [mean = -1.597 + 0.60, p=0.016]. Out of the 925 women interviewed, 53% had consulted a physician for various symptoms related to menopause. The symptoms experienced by pre-menopausal women included lack of sleep [25%], fear of becoming sterile [13%] and urinary incontinence [18%]. The average age of menopause was found to be similar to other studies of the country. Lower bone mineral density was found in greater proportion among older females. Majority needed intervention inclusive of awareness through health education and medication

Health education - the neglected front: a study of health awareness among young females of Karachi

Objective of the study was to assess the knowledge, attitude and practice of primary healthcare amongst young females attending primary healthcare centers in Karachi East. This Cross- sectional study was carried out at Primary health care centers in Malir Cantt from April 2006 to September 2006. Out of a total 1800 households of lower grade government employees a convenient sample of 300 females aged 25-35 years, married 8-10 years and attending various health care centers in Malir Cantt for at least five years were included in the study. A closed ended structured questionnaire was administered to the study participants and filled in by the interviewers themselves. Descriptive diferrential statistics [frequency and confidence interval] were calculated. The results of the study regarding Breast feeding and nutrition section showed that only 11% mothers started breast feed within 2 hours of delivery while 87% of them discarded colostrums as useless during initial breast wash. Bottle feeding and weaning was initiated within 4 months of baby's age in 73% and 86% of the respondents respectively. Thirty five percent respondents had some idea of hand washing as an important hygiene practice and 21% considered Oral rehydration salt [ORS] as an effective treatment of diarrhea in children and merely 9% knew about constitution of home based ORS. There were more than 3 children in 64% of families and 73% had narrow child spacing of less than 2 years. Only 17% had successfully used any contraceptive for full 2 years. Anti- anemic prescription was offered to 92% of antenatal women and only 31% complied with its usage. Only 32% mothers possessed complete and up-to-date EPI vaccination cards of their wards

Frequency of ante-partum depression in public and private sector

To find out the frequency of ante-partum depression in public and private sector. The study was conducted at Abbassi Shaheed Hospital, Nazimabad [Government sector], Liaquat National Hospital, Stadium road [Private sector] and Aga Khan Maternity Hospital, Karim-a-bad [Private sector]. A sample of one hundred and fifty [150] subjects was selected. The survey was conducted by self administered questionnaire comprising of questions regarding Depression, Gynecological, Obstetrical, Medical, History Of Daily Interest, Emotional, Physical and Mental symptoms. All patients were made to fill one more questionnaire that is H.A.D. [Hamilton Anxiety Depression] scale of Abbasi Shaheed Hospital [Department of Psychiatric Medicine]. After selection of subjects from the Hospital, their verbal consent was taken. They were asked questions and the questionnaire was filled after translating it to them in Urdu. The result of the study showed that in Aga Khan Maternity Hospital, 4 [13.3%] out of 30 cases were in severe depression, In Abbasi Shaheed Hospital 23 [41.8%] out of 55 cases were in severe depression whereas in Liaquat National Hospital 14 [21.5%] cases were in severe depression. It also showed that 32.7% were diagnosed as mild depressive patient, while the ratio of moderate, severe and no depression is 17.3%, 28% and 22% respectively. It was found that a great proportion of pregnant ladies attending either public/private sector hospital experienced mild to severe depression. Females with severe depression were more prone to be belonging to low socio-economic group. Further more our research showed that ratio of depression was high among maternal age group of 18-28 years as compared to older age group. The study showed that depression was common among primi-para. It was also seen that house wives were more depressed during pregnancy as compared to working women

Assessment of knowledge and practice regarding HIV/aids and its magnitude among truck drivers

It is estimated that 70,000 to 80,000 persons, or 0.1 percent of the adult population in Pakistan, are infected with the HIV virus, according to UNAIDS. Only 1,972 HIV cases and 231 AIDS cases had been reported to the government's National AIDS Control Program. Under reporting is attributable to social stigma, ill-developed surveillance, lack of screening and as well as lack of knowledge among the population and practitioners. Our country is highly vulnerable to an escalating epidemic due to a number of prevalent risk factors. To assess the knowledge, attitude and practice of truck drivers regarding AIDS and to calculate the magnitude of AIDS among truck drivers. It was a descriptive study, carried out as KAP survey of truck drivers. The truck drivers were interviewed at the truck agency "adda" or midway driver's hotels "charpai hotel" at eight different sites during December 2004 to January 2005. A total of 129 truck drivers were conveniently selected and information was obtained. There 104 in Lahore and 25 in Hyderabad were interviewed. Out of total subjects, 104 respondents [interviewed at Lahore] were tested for HIV antibodies by ELISA / CAPILLUS technique. The drivers were aged 19-56 years, 74% of the drivers were married with families and engaged in driving job for a mean duration of 13 years. Eighty nine [74.4%] of drivers were aware of AIDS and 61% admitted having multiple heterosexual partners, including prostitutes, and 5% admitted to have regular homosexual sexual encounters. Thirty two percent knew most of the correct sources of HIV spread. It was found that 9% of promiscuous drivers used condoms regularly, none admitted taking IV drugs, 35% reported histories of either urethral discharge or genital ulcers, and none of the 104 men tested were found to be infected with HIV. The truck drivers were adequately familiarized with AIDS but the knowledge regarding spread of disease through sexual transmission was found to be poor. No single subject was tested positive for HIV in this study. Although, literacy was found to be significantly associated with awareness of AIDS but attitude and practices were found to be unaffected

qualitative analysis regarding spread of hepatitis B and C: reflection of non-qualified dental care providers

The present study was undertaken to investigate the awareness of non qualified dental care providers about the spread of hepatitis B and C. This is a cross sectional analytical study. Study was conducted at different dental clinics of Karachi from March 2007 to June 2007. Fifty roadside dental practitioners [quacks] were interviewed for assessment of their knowledge and practices. The hygienic measures used for the dental instruments were absolutely substandard. All the clinics showed casing sterilization equipments but the quacks neither knew the concept of sterilization nor were they aware of the desired temperature of the sterilization machines [like autoclave]. Most of the quacks were unaware of the diseases like Hepatitis and AID's and their route to spread