Association of obesity with pelvic floor disorders and its effect on the quality of life in women awaiting bariatric surgery

Objectives: To assess the association of obesity with frequency of pelvic floor disorders [PFDs] and their effects on quality of life [QoL] in obese women

Design: A case-matched study

Setting: University hospital in Saudi Arabia between October 2014 and October 2015

Subjects: Seventy-five obese [BMI >30 kg/m[2]] women awaiting bariatric surgery and 91 age and parity-matched, non-obese controls were selected

Intervention: Three validated disease-specific and QoL questionnaires about PFD [PFDI-20, PFIQ- 7 and International Consultation on Incontinence Questionnaire-Urinary Incontinence [ICIQ-UI]] were administered to all participants

Main outcome measures: The frequency of PFD and the effect on QoL. Data were analyzed by chi-square and t-test

Results: Overall, PFDs were frequently present in 47 [62.7%] women in the obese group compared to 30 [32.9%] in the non-obese group [odds ratio = 3.41, 95% confidence interval: 1.79 - 6.48, p <0.001]. Obese women were found to experience symptoms of pelvic organ prolapse [POP] [p <0.001], stress urinary incontinence [p = 0.003] and fecal incontinence [p = 0.011] as compared to non-obese women. Regarding the different QoL questionnaires, total mean scores of PFDI and ICIQ were statistically higher in the obese group compared with non-obese women

Conclusion: The frequency of POP, urinary incontinence,

and fecal incontinence was increased in obese women awaiting bariatric surgery. Low self-esteem and limited religious activities were the most negative impacts of these symptoms on QoL

Perception of medical students regarding problem based learning

To assess medical students' perception about problem based learning [PBL] Study Descriptive cross-sectional survey College of Medicine, Princess Nourah bint Abdulrahman University [PNU], Riyadh, KSA or more PBL sessions Intervention: a self-administered questionnaire comprising 15 close-ended questions with a 5-point Likert scale responses Student's perceptions and opinions Overall, students had a positive perception towards all the items; self-learning, critical thinking, integration of basic concepts into clinical science, identifying gaps in knowledge and improved problem solving skills. The mean value of all items was 19.77 +/- 2.61 out of 25. Students who perceived that PBL stimulates critical thinking and 90.4% agreed that PBL integrates basic science with clinical knowledge. Although 73.1% of students found that PBL motivates self-learning, majority disagreed about increasing the frequency of PBL. Also, most of students were against increasing marks allocated for the assessment of PBL. Almost three quarters of students realized the value of PBL in improving communication skills and interpersonal relations. Students who thought that PBL is a preferable teaching tool for clinical concepts amounted to 69.2%. Overall, students perceived PBL positively. While positive perception was maximum for integration of basic science into clinical knowledge and critical thinking, problem solving. Students also valued PBL in enhancing communication skills and promoting positive interpersonal relations. However, majority of students disagreed to have more frequent PBL sessions or to increase PBL exam marks

Impact of untreated high blood pressure on renal function tests at initial diagnosis of hypertension

Pakistani population is at higher risk of developing hypertensive complications at a younger age, resulting from undiagnosed and untreated hypertension [HTN]. High cost of medical care is a barrier to early detection and assessment of end organ damage as well as physicians are disinclined to adopt more aggressive therapeutic management to improve blood pressure control. A cross sectional study was planned to determine the effect of high blood pressure on renal function tests in a random population aged 25-50 year, at initial diagnosis of hypertension. The study was conducted on total 276 subjects; 201selected from five general practitioners clinics in Karachi and were classified into pre hypertensive, and hypertensive stages I and II on the basis of 7th JNC report. Two BP readings were taken half an hour apart. A blood sample was drawn for measurement of serum urea, creatinine and a dipstick test was done to check protein in urine. The results were compared with 75 control, normotensive subjects. The percentage, mean and Standard deviation were computed. ANOVA was performed to compare four study groups and LSD test was applied to compare pair-wise group. Pearson's correlation was applied to find out association of renal function with stages of hypertension. The mean urea and creatinine levels were on higher normal side in HTN stages-I and II [39.91 +/- 8.51 and 1.72 +/- 0.54 in stage-I and 44.51 +/- 9.93 and 1.91 +/- 0.88 in stage-II respectively]. The frequency of proteinuria was also more in these groups, indicating declining renal function in these patients as compared to control and prehypertension groups. Subjects diagnosed with stage I and II HTN showed evidence of subclinical renal damage, along with the presence of proteinuria at the time of diagnosis

Evaluation of integrated learning program of undergraduate medical students

When medical schools attempt to place, up to date information without coherence into their vast curricula, students face an overwhelming burden of dispersed information and desperately opt for rote memorisation rather than understanding. The objective of this study was to compare response and performance of students as a result of change from non-integrated to integrated curricula. The need of integration came from students' response to a non-integrated curriculum. Integrated Learning Program [ILP] was designed by curriculum development and integration committee. A structured questionnaire on perception of teaching methodologies and active learning was obtained from 95 students and 14 faculty members. Assessment test results were compared with a nonintegrated module. Overall satisfaction with ILP was shown by 78% students and 72% faculty members. The students realised greater command on subject and utility of course for better prospects in university exam and clinical orientation. Significant test performance was observed [p<0.001] by integrated curriculum. Competency based education and professional learning of medical students can be enhanced by complete integration in basic sciences curriculum

Relationship of life style choices on body fat mass in young adults

Healthy diets and regular, adequate physical activity are major factors in the promotion and maintenance of good health throughout entire life course. Accumulation of fat occurs whenever energy consumed by food and drinks exceeds that which can be utilised by an individual's metabolism and physical activity. The objective of this study was to estimate the effect of lifestyle characteristics of a representative segment of medical students in terms of fast food preferences and participation in physical activity with respect to Body Mass Index [BMI]. This cross-sectional study was carried out in Physiology Department, Bahria University Medical and Dental College, Karachi on 192 students of 1[st] and 2[nd] year MBBS. Body Mass index of students was calculated. They were classified into 4 groups with BMI /= 25 respectively. A life style questionnaire, based on preferences for healthy/unhealthy food, dietary habits and participation in physical activity was filled. Most of medical students [65%] had BMI less than 23. It was because of selection of healthy dietary pattern with nutritious food [p<0.09] and participation in outdoor games [p<0.03]. Males who had high BMI showed a tendency to daily intake of fast food [p<0.03]. Walking in both the sexes had a positive impact in maintaining normal BMI [p= Males<0.04, females<0.001]. Obesity can be prevented by innovative approaches, easiest of which is to promote active life styles with intake of healthy diet and involvement in physical activity

Anthropometric and metabolic indicators in hypertensive patients

To determine the relationship between anthropometric variables with blood glucose and lipid concentrations in different stages of hypertension and evaluate the risk factors involved in progression of pre-hypertension stage in to clinical hypertension stage-1. Case-control study. National Institute of Cardiovascular Disease and General Practitioner's Clinics, Karachi, from 2005 to 2007. The study was conducted on 276 participants aged 25-65 years and classified into four categories of control, prehypertension [pre-HTN], hypertension [HTN] stage I and II, according to 7th JNC report. Anthropometric measurements and blood chemistry were obtained. The relationship between obesity indices [Body Mass Index [BMI], Waist Circumference [WC], Waist Hip Ratio [WHpR], Waist Height Ratio [WHtR], Basal Metabolic Rate [BMR] and Cardiovascular Disease [CVD] risk factors [blood pressure, serum lipids and glucose levels]] were investigated. The analysis of variance and test of Pearson's coefficient correlation were applied to assess relationship of all the variables. The mean WHR had significant correlation with both systolic and diastolic BP in all groups of HTN, as well as with blood glucose level in control and pre-HTN groups. BMI was positively correlated with cholesterol [r=0.29] and triglyceride [r=0.25] in HTN stage-1. Impaired and high blood glucose levels were found in pre-HTN group; all lipid parameters except triglycerides were higher in HTN stage I. WHR was positively and independently related to occurrence of arterial hypertension. Elevated levels of WHR, BMI, fasting blood glucose, total cholesterol and triglycerides were responsible for progression of pre-HTN stage in to HTN stage-1

Apoptosis in oral diagnostics: an overview

Apoptosis describes the molecular and morphological processes leading to controlled cellular self destruction. In recent years, it has been investigated for its biological significance in numerous physiological processes including embryogenesis, differentiation, proliferation /homeostasis and in the regulation of immune system. Its dysfunction and deregulation seems responsible for variety of pathological conditions e.g immune deficiency, autoimmune diseases, neuro-degenerative diseases and cancer. This communication updates molecular understanding of this natural phenomenon and its application in oral diagnostics. The present concept of signaling pathways for initiation of apoptotic characteristic changes is illustrated and the role of certain apoptotic genes identified so far is discussed. Abnormality of apoptosis and apoptotic regulatory genes during oral carcinogenesis. though conflictory, is presented. Further, clinical potential for monitoring reactions to chemo-radiotherapy is evaluated from human and animal studies and their usage as physiological markers for oral preneoplasia and squamous cell carcinoma is analyzed. On the basis of oral cytology the application of new physical and molecular methodological techniques is outlined e.g cytophotometry, DNA cytometry in relation to molecular studies and their diagnostic and prognostic implications. Understanding of molecular mechanisms provides development of newer therapeutic approaches in disease management and in future biomedical research. This overview updates molecular understanding of this natural phenomenon as its applications seem to have potential for managing common diseases in future

Presentation, staging and diagnosis of lymphoma: a clinical perspective

Due to lack of awareness among health professionals, lymphoma is often misdiagnosed. This study was done to evaluate the clinical features and histopathologic subtypes of lymphoma. Sixty diagnosed cases of lymphoma were selected [aged 12-65 years] from medical units of Civil Hospital Karachi, during 1993 to 1998. Clinical history, physical examination and basic laboratory investigations including imaging procedures were done in all the patients. The diagnosis of lymphoma was based on histology, following the International Working Formulation classification system. This included lymph node biopsy and in some cases, biopsy of the bone marrow. The Ann Arbor Staging Classification was used to classify the extent of disease. Out of 60 cases of lymphoma, 81.6% [49 cases] were diagnosed as non-Hodgkin's lymphoma and 18.3% [11 cases] as Hodgkin's disease, with an overall male predominance. Both categories exhibited a bimodal age distribution. Lymphadenopathy was the commonest presenting features in both the types of lymphomas; however, patients with Hodgkin's disease had a prominence of 'B' symptoms, whereas abdominal signs and symptoms were more common in non-Hodgkin's lymphoma. On histopathology, majority of non-Hodgkin's lymphomas [91.8%] showed a diffuse pattern, while mixed cellularity was the commonest type seen in Hodgkin's disease [81.8%]. Non-Hodgkin's lymphoma was 4 times more common than Hodgkin's disease. The vast clinical spectrum of lymphoma sometimes delays its diagnosis, leading to its eventual presentation in late stages. A general awareness is hence required among the health professionals regarding its varied clinical presentations

Changes in blood pressure, BMI and ECG patterns in women using low-dose contraceptives

To determine the cardiovascular risk factors in users of second generation contraceptives by recording changes in body mass index, blood pressure and electrocardiogram. Cross-sectional study. The National Institute of Fertility Research Centers at Jinnah Postgraduate Medical Center and PIB Maternity Home Karachi, from July 1997 to 1999. Sixty four women volunteered for this study [age range 20-35 years], belonging to low-income group with similar socio-cultural background. The Body Mass Index [BMI] was calculated by measuring height and weight of the subjects; systolic and diastolic blood pressure and ECG recording by standard method. The group means, standard deviations and coefficient correlation for interrelationship among variables in respective groups of subjects were calculated using relevant statistical method and software program. There was no significant difference between BMI of two types of contraceptive users as compared to non users; but BMI was significantly correlated with both systolic and diastolic blood pressures in injectable users as compared to controls. ECG alterations frequently observed in contraceptive users [40%] as compared to controls were normal findings. It was observed that women aged < 30 years and using contraceptives for more than three years had a tendency to gain weight and developed a mild increase in systolic and diastolic blood pressures

effects of brushing habits and salivary pH on caries status of first year dental students at a private Dental College in Karachi

To study the effect of brushing habits and salivary pH on caries status of dental students. A secondary aim was to promote awareness among the students regarding their oral health. A total of 90 first year dental students, [aged 18 to 21 years] belonging to middle/high socioeconomic class were questioned regarding their toothbrushing and eating habits and later subjected to estimation of salivary pH and oral examination. The subjects were divided into controls and diseased [carious] categories, the later further subdivided into three groups according to their DMFT indices. [expressed as mean+SD] The overall DMFT index was 1.71 and that in groups A, B and C was 1.75 +/- 0.59, 5.16 +/- 0.81 and 8.22 +/- 0.83 respectively. Brushing frequency decreased from 1.89 +/- 0.55 in controls to 1.50 +/- 0.54 in group B, but increased to 1.88 +/- 0.59 in group C. Likewise, the periodontal status was healthiest in group C. The salivary pH of controls was 7.29 +/- 0.47 and progressively fell to 6.55 +/- 0.39 in group C. Marginal differences were seen in the dietary pattern of controls and diseased subjects. Tooth brushing and salivary pH had a direct relation with dental caries; however, further studies are needed to emphasize the importance of salivary pH as a meaningful indicator of current or upcoming oral health problems

Saliva: a diagnostic tool for various oral and systemic diseases

In recent years salvia has been recognized as an alternate source of body fluid for diagnostic -purposes being safe, conveniently collected, cost effective and its importance in clinical practice, particularly in dentistry has been significant. It is recommended that saliva should be tested for almost all medically important immunoassay and chemistry analytes, including long term therapeutic drug monitoring, disease state testing, wellness-health screening and all rapid diagnostic testing where a non-invasive specimen collection and/or rapid analytic result is desired. Its status for diagnostic and epidemiological testing for various oral and systemic diseases, and the techniques utilized for this purpose, are discussed and reviewed

Fibrinogen titer and glycemic status in women using contraceptives

To assess the coagulation and glycemic status in Pakistani women using contraceptives. Design: The study was conducted prospectively on 70 women and compared with 10 age-matched controls. Place and Duration of Study: The study was conducted at Karachi. Period of study was 18 month. Subjects and Eighty women aged between 20-45 years selected from low socioeconomic class and poor family background were categorized in control [n=10] and oral and injectable contraceptive users [n=70]. The contraceptives used were tablet Lofemenal, injection Norigest and Norplant implant. Their blood was tested for fibrinogen titer and random blood glucose. There was no appreciable difference either in fibrinogen titer or plasma glucose levels in injectable users as compared to controls, but increased incidence of high fibrinogen titer and borderline blood glucose was observed in oral contraceptive users 25% and 20% respectively. It was concluded that long-term use of oral contraceptives [> 3 years] might increase the thrombotic tendency and elevate the plasma glucose levels especially in women above 30 years of age