Diagnostic Accuracy of Cartilage Oligomeric Matrix Protein (COMP), for Cartilage Damage in Rheumatoid Arthritis

Background:Cartilage oligomeric matrix protein (COMP), is an extracellular matrix (ECM) non-collagenous glycoprotein that is mainly localized within the cartilage, and also be found in tendon and synovium.RecentstudiesinwestandAsiaPacificregionhasshownthatCOMP, is a prognostic marker in Rheumatoid arthritis(RA).Objective:To correlate serum COMP levels with disease severity and cartilage destruction in rheumatoid arthritis.Methods:The study was conducted in Department of Pathology and Rheumatology, Ziauddin University Hospital, Karachi from June 2018 to May 2019. Patients were recruited as per American College of Rheumatology (ACR) 2010 classification criteria. The study populationconsists of 88 healthy subjects and 88 RA patients. Sandwich ELISA technique was used to assess serum COMP level. Other inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) antibodies like rheumatoid factor, and anti-cyclic citrullinated protein (anti-CCP) were also assessed. Results were analyzed using SPSS-20 and P-value ≤0.05 was considered as significant.Results: Serum COMP levels were significantly higher in RA patients 51.35ng/ml than controls 21.454ng/ml with significant p value=<0.0001. There was strong positive correlation between COMP level and disease severity in RA patients with moderate as well as high disease activity score (DAS) with significant p value. Serum COMP showed 96% sensitivity and 83% specificity at level of 27.01ng/ml for diagnosis of RA.Conclusions:COMP has significant positive correlation with severity of RA. Serum COMP can be utilized as a biomarker to quantify cartilage destruction in RA patients

Effects of Diabetogenic Agent Streptozotocin on Hematological Parameters of Wistar Albino Rats “An Experimental Study”

Background:Diabetes mellitus has remained the major concern for medical sciences researches duetoits deleterious effects on general, physical and mental health of patients. To understand the pathophysiology and to explore better treatment options for such kind of metabolic disorders it is necessary to generate the experimental animal models. To create diabetic animal models, streptozotocin has shown predominance in selectivity as a diabetogenic agent. While studying effects of any intervention in the diabetic animal models, being a cytotoxic drug streptozotocin may affect the study results by inhibiting highly replicating cells especially hematopoietic cells.Original ResearchArticle Aims:The aim of study was to analyze the effects of streptozotocin on various cellular components of blood such as RBCs, WBCs (Lymphocytes, Neutrophils, Eosinophils), Hb%, HCT and Platelets, at baseline,5thday and 15thday without any intervention.Study Design:Animal based Experimentalstudy.Place and duration of Study:The study was conducted at animal house of faculty of Pharmacy Ziauddin University Karachi, while laboratory work was performed at MDRL-1 Ziauddin University.Methodology:In Group A normal saline and in group B and C 60mg / kg streptozotocin diluted in normal saline was administered intraperitoneally. After the confirmation of induction of Diabetes in rats, on fifth day blood samples were drawn from Group A and B and were analyzed. While blood samples from group C weredrawn on fifteenth day.Results:Analysis of various hematological parameters on 5thday revealed that there was a decrease in the levels of Hb, HCT, RBCs and WBCs with an increase in platelet count in group B in comparison to group A (control). On the other hand, in Group C (15th day), blood cell counts (Hb, HCT, RBCs, WBCs, Lymphocytes, Neutrophils and platelets) seemed to recover from streptozotocin induced decline that was observed in group B, however did not reach the baselines as in group A(control).Conclusion:It is concluded that change in hematological parameters of rats after administration of streptozotocin is reversible. The blood parameters may recover near to base line values without any intervention within two weeks

review of family planning policies and services in WHO Eastern Mediterranean Region Member States

Background: Family planning (FP) is a cost-effective public health and development intervention. Eastern Mediterranean Region (EMR), has one of the lowest contraceptive prevalence rate (CPR) and high unmet need for family planning.

Aims: The aim of this review is to assist Member States in highlighting those areas that need strengthening to improve quality of FP services in information and commodity supplies.

Methods: A structured questionnaire focusing on FP services was sent to 22 Member States of the WHO Eastern Mediterranean Region between August and December, 2015. Sixteen (73%) countries responded.

Results: Family planning services are part of the basic health benefits package and are delivered at hospitals, primary healthcare centres and outreach clinics to all women regardless of their ability to pay in the majority of Member States. In 16 Member States the family planning/birth spacing (FP/BS) counselling and FP methods are provided by general practitioner/ family doctor, nurses and midwives. In many Member States the services are integrated with child health, STI and HIV services. In 16 Member States FP/BS is part of the pre- and in-service training programmes for all cadres of healthcare providers. FP/BS is actively promoted through effective social marketing of FP/BS methods in two thirds of Member States.

Conclusions: The findings of the survey indicate that national policies and programmes endorse FP to achieve national targets. Despite progress in many areas in FP services, many countries still struggle with weak implementation of FP programmes. There are also policy gaps for key vulnerable groups including the poor, the disabled and adolescents. This review highlighted policy and programmatic gaps required to strengthen those FP services that can help improve maternal and infant health outcomes. Special programmes for adolescents, refugees and persons with disabilities need to be streamlined and strengthened

Task sharing in health workforce: an overview of community health worker programmes in Afghanistan, Egypt and Pakistan

Background: Community health workers [CHWs] help reduce healthcare disparities and improve access to and quality of care in many countries.

Aim: To provide an overview to compare and contrast characteristics of CHW programmes in Egypt, Pakistan and Afghanistan and describe the strengths, weaknesses and challenges of the programmes.

Methods: Scientific databases and grey literature were searched including PubMed, Medline, Cochrane Review Library, WHO databases, and grey literature websites including those of national health ministries. We shortlisted 23 articles to be included in this study.

Results: The three programmes reviewed vary in their organization, structure, enrolment and payment structure for CHWs. Key challenges identified in the review include: commodity security that compromises quality of services; inadequate and irregular training; unpredictable or inadequate remuneration structure; and lack of standardization among organizations and government ministries. Strengths identified are that the programmes are accepted and integrated into many communities; and have the support of health ministries, which enhances sustainability and regulates standardized training and supervision. These also increase participation and empowerment of women, evident in the fact that CHWs have organized among themselves to demand better treatment and more respect for the work that they do.

Conclusion: Our findings should alert policy-makers to the need to review CHWs' scope of practice, update education curricula, and prioritize in-service training modules and improved working conditions. The effectiveness and impact of CHW programmes has been shown countless times, demonstrating that task sharing in healthcare is a successful strategy with which to approach global health goals.

Unilateral spinal anesthesia for major lower limb surgery in patients with cardiac failure

Objective: To determine the safety of unilateral spinal anesthesia in elderly patients with cardiac failure undergoing major lower limb surgery

Study Design: Prospective, quasi- experimental study

Place and Duration of Study: Department of Anesthesiology, Combined Military Hospital Rawalpindi, during the period of October 2012 to December 2013

Material and Methods: In this study, 20, American Society of Anesthesiologists [ASA] III and IV patients with different severities of heart failure due to previous myocardial infarction [MI], aged between 60-110 years undergoing unilateral lower limb orthopaedic surgery were included by non probability consecutive sampling. All patients received unilateral spinal anesthesia using hyperbaric 0.75% Bupivacaine 7.5mg. They were given preload of 2ml/kg colloid. Patients were placed in the lateral position with fractured limb on lower side and kept in this position for 10 minutes. Haemodynamic variations were monitored and recorded for the whole duration of procedure. Dobutamine, Ephedrine and Atropine were used as vasopressor/inotropic agents

Result: In this study 20 patients were included. Sixteen [80%] were male. Mean age of group was 80.8 +/- 12.5 years. The mean duration of surgery in our patients was 63.55 +/- 16.47 minutes. Ephedrine was needed in 12 patients, atropine in 4 patients. One patient required Dobutamin infusion and one patient required norepinephrine infusion for 15 minutes. Two patients did not require inotropic or vasopressor support. The average percent fall in mean arterial pressure from prespinal value was 20.59%. The block remained unilateralin all cases. Motor blockade was adequate in the limb to be operated

Conclusion: Unilateral subarachnoid block with hyperbaric bupivacaine does not produce adverse hemodynamic changes. Under controlled setting and meticulous monitoring elderly patients with variable degree of heart failure can be safely given unilateral spinal anesthesia for major lower limb orthopaedic surgery. Unilateral subarachnoid block with hyperbaric bupivacaine does not produce adverse hemodynamic changes. Under controlled setting and meticulous monitoring elderly patients with variable degree of heart failure can be safely given unilateral spinal anesthesia for major lower limb orthopaedic surgery

Beneficial effects of sitagliptin and metformin in non-diabetic hypertensive and dyslipidemic patients

Obesity, dyslipidemia and hypertension are major risk factors for cardiovascular disease and its associated complications. To evaluate the beneficial effects of sitagliptin and metformin in non-diabetic dyslipidemic and hypertensive patients. A prospective randomized clinical trial was conducted on 70 newly diagnosed dyslipidemic patients with BMI >/= 25 and blood pressure >/= 130/80 at outpatient clinic of medical unit-1 of sheikh medical college /hospital Rahim Yar Khan. They were divided in to three groups each containing 35 patients; First group served as a healthy control while second and third study groups were given tablet sitagliptin 50mg and tab metformin 850mg respectively twice a day for twelve weeks. After three months treatment with sitagliptin and metformin there was significant reduction in body weight [Sitagliptin 6.5% vs Metformin 7.65%] and BMI [Sitagliptin 2.2% vs Metformin 2.8%] with p

Nephrin: an emerging biomarker for detecting damage of glomerular filtration barrier

Nephropathy due to damage of filtration barrier is a primary origin of end stage renal disease in Diabetics. It is associated with considerable morbidity and mortality. Mostly clinicians rely on urine analysis of Albumin. In the recent years extensive research has been conducted to find out a novel biomarker which can help in the early diagnosis of nephropathy. A search was conducted regarding publications of new diagnostic biomarkers for nephropathy. Among many renal biomarker researched lately, Nephrin was identified as the one that can become an early predictor of nephropathy and the levels of which can also ascertain the severity of the disease

Risk factors of congestive heart failure in patients admitted for coronary artery bypass grafting

Background: Congestive heart failure, has high morbidity and mortality outcomes

Objective: To evaluate the association between the risk factors and congestive heart failure in patients admitted for CABG surgery

Subjects and Methods: This comparative cross sectional study includes 102 consecutive patients aged >50 years, admitted for CABG surgery and were classified as with and without congestive heart failure. They were selected from cardiac surgery department of Punjab Institute of Cardiology, Lahore over a period of 6 months from 1[st] January 2014 to 31[st] June 2014. Pre-operative risk factors were recorded while, the data was analyzed by using SPSS Version 20. P-value < 0.05 was taken as significant

Results: Out of 102 patients, 48 were males and 54 were females. Females were older than males. Risk factors i.e. AF, raised creatinine [>1.4 mg/dl], impaired LV function, renal disease, valvular heart disease [VHD], COPD, smoking and hypertension were found to be comparatively higher in heart failure group than non- HF group. [P<0.05]

Conclusion: CHF in patients admitted for CABG surgery leading to increased morbidity. Male gender, age, hypertension, smoking, renal disease, VHD, raised creatinine [mg/dl], impaired LV function, chronic obstructive pulmonary disease [COPD] and artial fibrillation were independently associated with CHF

Variation in serum vitamin D levels in healthy population of Islamabad

Objective: To determine the levels of Vitamin D in apparently healthy population of Islamabad

Study design: A Descriptive Study

Place and duration: From March 2012 to April 2013 at Rawal Institute of Health Sciences, Islamabad

Methodology: Two hundred and ninety nine healthy subjects were selected between the age of 10-85 yrs. Convenient sampling was done. Subjects with complain of bone pain, musculoskeletal or rheumatologic problems, pregnant and lactating mothers, smokers or alcoholics were excluded from the study. History was taken and Blood samples were collected and stored at -80[degree]C for estimation of Vitamin D levels in batches. Vitamin D level was determined by ELISA technique [Enzyme linked immunosorbant assay] after standardizing it and controls were run simultaneously. The data was collected and analyzed on SPSS version 17.Percentage was determined and Chi square test applied on data

Result: Vitamin D levels of 299 subjects were categorized according to deficiency and insufficiency criteria specified [Roche]. The study shows that 65.2% [n =195] subjects were deficient in Vitamin D, 26.09% [n = 78] were insufficient and only 8.7% [n=26] had normal 25 OH Vitamin D levels

Conclusion: The subjects in the population are suffering from hypovitaminosis D. The cause of vitamin D deficiency remains an area of concern, when availability of sunlight is adequate especially in asian population

Effect of uric acid on vitamin C and E in induced hyperuricemic model

To measure the level of uric acids and find out the effect of uric acid on vit C and E in induced hyperuricemic model. Comparative study. This study was conducted at Baqai Medical University, Karachi from June 2010 to January 2011. Forty male albino rats with an average weight of 180 +/- 2 g were selected. The rats were grouped. The animals were fed on standards diet and given tap water ad libitum untril treatment. The protocols for experiment was according to institute of laboratory animal resources on life sciences, US National research council, 1996 and institutional animal ethical committee [IAEC] of baqai medical university, Karachi. Albino rats were divided into four groups. Group [A] 10 - control given only standard diet, group B[10] fed on 60% fructose with standard diet, group C[10] fed on fructose, standard diet and intraperitonially oxonic acid 250 mg/kg and group D[10] only on injection intraperotonially oxonic acid 250mg/kg. at the end of study 10 ml of blood was drawn from heart of rats. Then blood was estimated for vitamin C,E and uric acids done by kit methods randox-manual /Rx monza UA230/UA233. The concentration of vitamin C and E were significantly lowered as compared to uric acid concentration in the group B, C and D. Decrease level of vit C and E increase the level uric acids were observed. Therefore, it may be suggested that increase intake of vitamin C may be helpful in lowering uric acid concentration

Blood and Body Fluid Exposure Related Knowledge, Attitude and Practices of Hospital Based Health Care Providers in United Arab Emirates

OBJECTIVES: Knowledge, attitudes, and practices of healthcare providers related to occupational exposure to bloodborne pathogens were assessed in a tertiary-care hospital in Middle East. METHODS: A cross-sectional study was undertaken using a self-administered questionnaire based on 3 paired (infectivity known vs. not known-suspected) case studies. Only 17 out of 230 respondents had an exposure in the 12 months prior to the survey and of these, only 2 had complied fully with the hospital's exposure reporting policy. RESULTS: In the paired case studies, the theoretical responses of participating health professionals showed a greater preference for initiating self-directed treatment with antivirals or immunisation rather than complying with the hospital protocol, when the patient was known to be infected. The differences in practice when exposed to a patient with suspected blood pathogens compared to patient known to be infected was statistically significant (p < 0.001) in all 3 paired cases. Failure to test an infected patient's blood meant that an adequate risk assessment and appropriate secondary prevention could not be performed, and reflected the unwillingness to report the occupational exposure. CONCLUSION: Therefore, the study demonstrated that healthcare providers opted to treat themselves when exposed to patient with infectious disease, rather than comply with the hospital reporting and assessment protocol.

Response to standard interferon and ribavirin combination in the treatment of patients with chronic hepatitis C

Background: Chronic hepatitis C is common in our country and before development of decompensation, it is treated with interferon and ribavirin. This is a costly treatment and many patients remain untreated due to financial constraints

Objective: To determine end of treatment response [ETR] to combination of standard interferon and ribavirin [non original brands] provided through Prime Minister program for prevention and control of hepatitis in management in chronic hepatitis C in our setup

Patients and Methods: This interventional study was carried out in medical outpatient clinic of Sheikh Zayed Hospital, Rahim Yar Khan, from August 2006 to February 2009. Adult patients [more than 18 years of age] suffering from HCV RNA positive chronic hepatitis were enrolled. Patients were given standard interferon 3 mu s/c thrice a week and ribavirin 800-1200 mg per day for 24 weeks. Four different brands of drugs were used. HCV RNA by qualitative PCR was tested at the end of treatment. End of treatment response was defined as absence of viral RNA

Results: 260 patients of chronic hepatitis C were enrolled. 148 patients were male and 112 were female. Their mean age was 34.11 +/- 9.18 years. Mean baseline serum ALT of these patients was 91.44 +/- 63.00. 217 patients [83.5%] achieved ETR. There was no statistically significant difference in ETR between various brands of interferon and ribavirin. Moreover, there was no significant difference in gender, age and ALT between patients who achieve ETR and those who did not achieve it

Conclusion: Combination treatment with non original brands standard interferon and ribavirin provided through Prime Minister program for prevention and control of hepatitis is effective in our patients with chronic hepatitis C

In-hospital outcome of acute myocardial infarction in correlation with 'thrombolysis in myocardial infarction' risk score

Effective risk stratification is integral to management of acute coronary syndromes [ACS]. The Thrombolysis in Myocardial Infarction [TIMI] risk score for ST-segment elevation myocardial infarction [STEMI] is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'lowrisk', 'moderate-risk' and 'high-risk' based on their TIMI scores [0-4 low-risk, 5-8 moderate-risk, 9-14 high risk]. The frequencies of complications and deaths were compared among the three risk groups. Post MI arrhythmias were noted in 2.2%, 16% and 50%; cardiogenic shock in 6.7%, 16% and 60%; pulmonary edema in 6.7%, 20% and 80%; mechanical complications of MI in 0%, 8% and 30%; death in 4.4%, 8%, and 60% of patients belonging to low-risk, moderate-risk and high-risk groups respectively. Frequency of complications and death correlated well with TIMI risk score [p=0.001]. TIMI risk score correlates well with the frequency of electrical or mechanical complications and death after STEMI

Frequency of carotid atherosclerosis in cerebral infarction

To know the frequency of carotid atherosclerosis in ischaemic stroke patients in our population using color Doppler ultrasound. This is an observational study conducted in Medical Unit-II of Jinnah Postgraduate Medical Centre [JPMC], Karachi from Oct 2003 to Feb 2004 in collaboration with Radiology Dept. All the patients admitted during this duration with CT scan proof of stroke were included in the study. Risk factors in all these patients were stratified. Doppler ultrasound was performed on all patients with ischaemic stroke according to the study protocol. A total of 100 patients were included in this study over a period of five months. 66% of these were having cerebral infarction. Hypertension [72%], diabetes [35%], smoking [29%] and obesity [20%] were the common risk factors. The frequency of significant carotid atherosclerosis in acute ischaemic stroke patients was 21%. Carotid atherosclerosis is one of the most important indicators, predictors as well as an independent risk factor in the development of ischaemic stroke

Road traffic injuries in Pakistan: challenges in estimation through routine hospital data

Injuries are becoming one of the most important public health challenges at the dawn of the new century. It is estimated that almost one fifth of the total global burden of disease is due to injuries. Road traffic injuries [RTIs] are a leading cause. This is a cross-sectional survey based on hospital records of Rawalpini General Hospital for reference year 2005. The yearly hospital record showed that a total of 119,214 persons visited the emergency during 2005. Twenty-four percent [28,679] of these cases were retained in the emergency department for treatment and 64% 18229 cases of the retained cases were shifted to concerned wards for further management. Injuries amounted to a total of 1,244 [6.8%] cases were recorded in the ER as RTIs. The proportion of injured males was [71%]. The surgical/orthopaedics presentations were 33% of the total ER cases with injuries. The amount of missing information was [11%] and the deficiency of the data regarding emergency admissions indicated flaws in the information systems. The findings surprisingly showed that RTIs have a very low proportion in the total presentations and this leads to doubts about the information systems at the hospital. The inability to follow the progress of these cases indicates that the data is under reported. Furthermore the small percentage of cases requiring retention in ER and even smaller requiring admission leads to the conclusion that a majority of the presenting cases in the ER may be outpatient cases, who for lack of an evening outpatient clinic, are coming to the ER. Further investigation is required involving other public/private sector hospitals to estimate the magnitude of the problem and comprehensiveness of the relevant data is also required

Challenges in access to and utilization of reproductive health care in Pakistan

Pakistan's maternal mortality rate is high, and adequate and timely emergency services could prevent most maternal deaths. A woman's right to life-saving services of skilled health care providers in childbirth is undeniable. This paper examines factors restricting women's access to emergency obstetric care services in Pakistan. This cross-sectional survey on emergency obstetric care services collected information at the health facility level using UN process indicators. The study enrolled 170 health facilities from nineteen randomly selected districts in Punjab and NWFP. Diverse factors limit women's access to Emergency Obstetric Care [EmOC] services. EmOC services were unavailable in most health facilities surveyed. Staff absenteeism, geographic remoteness, delayed access, and ambulance shortages jeopardize the transferral of seriously ill patients to higher level care facilities. Cultural norms dictate that women should be examined by women doctors, whose dearth makes these services inaccessible. Many maternal deaths would be avoidable if EmOC health services were accessible. The geographic obstacles to timely access, poor hospital infrastructure, and high staff absenteeism rates require immediate attention. Health facilities' working hours were inconsistent with the provision of around-the-clock essential services, depriving and endangering the lives of many in need. It is imperative to increase skilled female workers capable of managing EmOC problems through proper incentives. A focused approach at local levels through proper supervision, motivation, and management would unquestionably save women's lives

Correlation of severity of ST segment elevation in acute inferior wall myocardial infarction with the proximity of right coronary artery disease

A number of researchers have used different electrocardiographical criteria to predict the culprit vessel in acute inferior wall myocardial infarction [MI] cases. Therefore, the determination of infarct related artery in AMI is extremely important with regard to prediction of potential complications, furthermore, predicting the probable site of occlusion within RCA is worthwhile because proximal occlusions are likely to cause greater myocardial damage and an early invasive strategy may be planned in such cases. Our study aimed at evaluating the ECG criteria to predict the proximity of lesion in the right coronary artery [RCA] in acute inferior wall MI cases. The Objectives were to predict the presence of a proximal lesion in right coronary artery by severity of ST segment elevation in inferior ECG leads. This cross-sectional study carried out at the department of cardiology and cardiac catheterization at Jinnah Hospital, Lahore from April 2008 to September 2008. A total of 60 patients who suffered from inferior wall MI were included in the study who underwent coronary angiography in the first week. The ECGs of these patients were then compared with the angiographic findings to correlate the proximity of culprit lesion in RCA with the degree of ST segment elevation in inferior limb leads. Out of 60 patients, 29 [48.4%] had the culprit lesion in proximal, 23 [38.5%] in mid and 8 [13.4%] in distal RCA. Patients with proximal RCA disease showed a mean ST segment elevation of 12.55 +/- 1.38 mm, with mid RCA disease 8.39 +/- 0.89 mm and with distal RCA disease 6.0 +/- 0.54 mm. This study demonstrated that the severity of ST segment elevation was correlated with proximity of RCA lesion

Esophageal varices: major endoscopic finding on upper GI endoscopy

To document the frequency of esophageal varices and their importance in a tertiary care hospital of Southern Punjab. Endoscopy unit of Sheikh Zayed Medical College/Hospital. From Nov 2005 to May 2007. The data of 500 patients who underwent upper GI endoscopy was analyzed. Demographic features, reasons for referral and endoscopic diagnoses were noted. Among 500 patients, 57% were referred due to upper GI bleeding, 9% due to dysphagia, 8% due to persistent vomiting and 7% due to dyspeptic symptoms. Common endoscopic diagnoses were esophageal varices [44%]. Major Endoscopic finding in our study was esophageal varices gastric or duodenal ulcers, congestive gastropathy, obstructive lesions of esophagus and stomach were the next most common observations

Ischaemic stroke; role of Carotid Doppler

To determine the frequency of carotid atherosclerosis in ischemic stroke patients in our population using color Doppler ultrasound. Observational. This study was conducted in Medical Unit II of Jinnah Postgraduate Medical Centre, Karachi from Oct 2002 to Feb 2003. All the patients admitted in our ward during this duration with CT scan proof of stroke were included in the study. Risk factors in all these patients were stratified. Complete history and examination was done and carotid Doppler ultrasound was performed on all patients with ischaemic stroke according to the study protocol. A total of 100 patients were included in this study following the above-mentioned protocol over a period of five months. 66% of these were having cerebral infarction. Hypertension [72%], diabetes [35%], smoking [29%] and obesity [20%] were the common risk factors in these patients. The frequency of significant carotid atherosclerosis in acute ischaemic stroke patients was 21%. Doppler ultrasound is non-invasive, safe and cost-effective modality for evaluation of carotid vessels. In symptomatic and high-risk group, it should be used as first diagnostic modality for management or selecting patients for further investigation

Hospitals; caring and curing palaces, or threats of infections for the community from infectious waste

To know the amount of total waste generated in the hospital daily, to know the types of waste and the amount of infectious waste generated daily, and to know about knowledge and attitude of the health care workers, doctors nurses and sanitary staff about hospital waste. The study area is the Pakistan Railway Hospital a tertiary level care Hospital consisting of 380 beds and all the essential Departments. the study was conducted from June 2006 to September 2006. This was a cross sectional study Single tertiary level care hospital was studied due to limitation of time and resources. Data was collected by using structured questionnaire and weighing of one day [24 hours] waste from all the units. Other relevant data was collected by structured interviews, meetings, discussions. waste generated in twenty four hours is 229.75 Kg. The average waste generated per patient per day is 1.05 Kg, the quantity of infectious waste generated is 104.8 Kg i.e. 0.478 Kg per patient per day. Quantity of waste generated in order of maximum to minimum waste was Gynae/Obs 1.29Kg, Paediatrics 1.15Kg, Surgery 1.13 followed by Orthopaedics 0.80Kg, ENT 0.71 Medicine 0.48 and ophthalmology 0.4Kg all per bed per day. The responses show that all the categories of hospital workers are nearly not having the proper knowledge about the hazards and therefore unable to give suggestion or solution of the problem. Health care waste management in Railway Hospital is in bad shape. The general awareness on the subject is very much lacking both by the producers as well as handlers of waste. There is acute need for training and sensitization of managers, staff and sanitary staff for safe disposal of waste