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Background: Healthcare for mothers and children is a significant indicator of a country's well-being. In-dia is one of the nations that were experiencing a rather slow improvement in maternal and child health. Aims: The objective of this study is to analyse the changes in health infrastructure, government health expenditure, antenatal care, postnatal care, institutional delivery, Maternal Mortality Ratio (MMR) and the determinants of MMR in India. Methodology: The study is based on secondary data. It employs an Average Increasing Rate (AIR) and Average Reduction Rate (ARR), as well as a panel data random effect model. Results: Empirical results say MMR has a statistically significant inverse relationship with female litera-cy, Per capita Net State Domestic Product (PNSDP), and institutional delivery. The study concludes that after the introduction of NRHM and its constituent elements like JSY and JSSK, government expenditure on health, health infrastructure, the percentage of antenatal care, post-natal care, and institutional deliv-ery increased in most of the Indian states, thus helping to increase the pace of the reduction of MMR. However, state performance varies greatly. Conclusions: Policy alone will not provide the desired results; it is also critical to focus on education, particularly female literacy, and economic empowerment.
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Background: Aloe vera (Family Liliaceae) has been used for the treatment of diabetes, skin disorders and as anti-inflammatory agent. Objectives: behavioral testing of antiparkinsonian effect of Aloe vera in MPTP induced animal model.Methods: Rotarod test and Catalepsy bar test were used for behavioral assessment. Assessment of oxidative stress was done in the striatal region of the brain by reduced glutathione (GSH) measurement.Results: A. vera (200 and 400mg/kg, p.o.) was found to significantly increase the retention time in rota rod test and significantly decrease the latency period in catalepsy bar test as compared to MPTP groups. A. vera was found to have significant anti-oxidative effect in the striatal region of the brain by GSH measurement.Conclusions: Thus, it can be proposed that A. vera has a potential anti-parkinson effect in mice.
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Background: Self-medication practice is widespread in many countries and the irrational use of drugs is a cause of concern. It assumes a special significance among medical students as they are exposed to knowledge about diseases and drugs. To assess practice and perception of self-medication among undergraduate medical students.Methods: It is a descriptive study in which study population was comprised of 2nd year undergraduate medical students of Gulbarga Institute of Medical Sciences, Kalaburagi, Karnataka, India. Total 134 students were included in the study. Written informed consent was obtained from each volunteer prior to the study. Students were given a questionnaire that included both open and close ended questions about self-medication practice. Data was analysed and presented as counts and percentages.Results: It was found that 72 (54%) students practiced self-medication. The principal morbidity for seeking self-medication was cold and cough as reported by 70 (53%) students. Antibiotics were most commonly self-medicated as reported by 55 (36%) students. Only 34 (25%) students opined that self-medication is part of self-care.Conclusions: Self-medication is widely practiced among under graduate medical students. In this situation, we should educate the students about advantages and disadvantages of self-medication.
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Recent recognition about snake bite envenomation on June, 2017 as neglected tropical disease under categoryA by World Health Organization advocated again its undeniable importance. Present circumstances reasoned to work on a neglected subspecies of Naja naja, i.e., Naja naja karachiensis [N. n. karachensis] has been documented for frequent deaths in Pakistan. In this study median lethal toxic dose [LD50] was determined intraperitoneally in Swiss albino mice and was found to be 2.0microg/g [2.0mg/kg] equal in potency to Naja pallida [red spitting African cobra]. Total protein contents [188+/-0.011microg / 200microg of dry weight] were high enough [94%] to represent an arsenal of proteins. Furthermore, 99mTc was labeled 99.9% with venom and didn't find to alter hemolytic activity of venom in dose dependent manner at 125 microg/ml [p<0.5], 250 microg/ml [p<0.1] and 500 microg/ml [p<0.1] when compared with its crude form. Present work will pave the way for proteomics study in effective production of antidote against specific species of snakes as dare demand of it has been felt since long period of time in Pakistan
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The aim of this study was to determine the frequent post insertion complaints associated with complete denture. This cross sectional study was done on 117 patients wearing complete dentures who came to the Department of Prosthodontics of Dow International Dental College with post insertion complaints from January to December 2017. These patients came for the first visit within the first month after the insertion of complete denture. The assessment of all post-insertion complaints was done by one prosthodontist. The questionnaire included information on age, gender, type of denture, chief complaint and place where the denture was fabricated. This was followed by a clinical examination. Patients were informed about the study. After obtaining consent the data were collected. Regarding the post insertion complaint, 75% of patients faced pain and discomfort. 65% reported difficulty in eating. Looseness of denture was reported by 58%. 35% experienced difficulty in speech complaints regarding food accumulation under and around the prosthesis were reported by 17%. The most common post-insertion complaint of complete denture was pain and discomfort followed by difficulty in eating. Identification of post insertion complaints in different types of prosthesis would be very supportive to developing strategies to prevent and manage these more effectively by reducing all negative factors associated with these complains
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Pioglitazone is widely used for the management of type.II diabetes mellitus. The objective of the present study was to develop a simple and cost-effective HPLC method for the quantification of pioglitazone in human plasma. The mobile phase comprises of Acetonitrile, 0.1 M ammonium acetate and glacial acetic acid [25:25:1 v/v/v] at a flow rate of 1.2 mL/min., using Macherey-Nagel Column C18, [dimensions: 5 Mum; 250 * 4.6mm] with a guard column. The UV detector was set at 269nm. The method was validated according to FDA guidelines. The present method showed good linearity [R[2]=0.9998] from 0.1 to 2.0Mug/ml standards, with a limit of detection 0.1 Mug/ml. Intra-day accuracy and precision in terms of %CV [range: 93.33% to 100.4% and 3.8% to 9.2%] and interday accuracy and precision [range: 94.1% to 102.7% and 4.8% to 9.6%] were in agreement with FDA guidelines. Freeze thaw stability showed that the plasma samples could be stored for one month at -20 degree C without any appreciable degradation. The present method was successfully applied to the blood samples obtained from one volunteer after oral administration of 30 mg pioglitazone tablet. Some preliminary pharmacokinetic parameters were calculated. It is concluded that the present method could be conveniently used for the routine analysis of pioglitazone blood samples obtained in pharmacokinetics studies.
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Carica papaya Linn is the member of Caricaceae family of Kingdom Plantae. The study was executed for the development of qualitative standards of male and female leaves of the plant. The study included evaluation of macroscopial, physico-chemical and preliminary phytochemical parameters to authorize the purity and authenticity of leaf of Carica papaya Linn based on guidelines provided by WHO. Qualitative phytochemical screening of extracts revealed the existence of alkaloids, flavonoids, tannins, phenolic compounds, glycosides including cardiac glycosides, proteins and carbohydrate in different extracts of Carica papaya Linn which are majorly rich in female leaves as compared to male. Mean ash values, acid insoluble ash, water soluble ash, foaming index, swelling index and moisture contents were also evaluated which are more or less similar. FTIR profile of the samples were also generated that confirmed distinct peak values with respective functional groups exhibited by Carica papaya male and female plant. The current research reflected that female and male plant showed variations in phyto-constituents. This data will be utilized for additional Pharmacological and Instrumental evaluation of the plant which can not only be beneficial in discriminating and refining the type as well as nature of various phytochemicals present in Carica papaya male and female leaves but also establish the quality standards for future researches
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Background: Neonatal sepsis [NS] is a major cause of neonatal admissions to hospital and mortality. This study was conducted to evaluate different methods for rapid and reliable diagnosis of NS with an aim to rationalize the use of antibiotics and stay in Neonatal Intensive Care Unit
Objectives: To compare the different available methods for rapid and reliable diagnosis of neonatal sepsis. Study design, settings and duration: This comparative study was conducted in Emergency Department of National Institute of Child Health [NICH] Karachi for the period of six months
Subjects and Methods: Neonates who were brought to the emergency department of National Institute of Child Health with suspicion of NS were clinically examined. Those, supposed to be septic were included as study population and informed written consent was taken from their parents. After this, 3 ml blood was drawn for complete blood count [CBC], blood culture, C-reactive protein [CRP], polymerase chain reaction [PCR] and neutrophilic ratio. PCR and CRP results were compared with blood culture for specificity, sensitivity, positive and negative predictive values
Results: Out of 129 neonates, 23 [17.82%] were positive for bacterial DNA by PCR method while 42 [32.55%] were positive for infection when tested for C reactive protein marker of the blood. Whereas, only 15 [11.62%] were positive by blood culture. Sensitivity and specificity of PCR were 60% and 88% while positive and negative predictive values were 39% and 94% respectively. Sensitivity and specificity of C reactive protein were 60% and 71% while positive and negative predictive values were 21% and 93% respectively
Conclusion: Our study revealed high specificity and positive predictive values of PCR suggesting that PCR is more reliable, rapid and specific adjunct of blood culture for diagnosis of NS
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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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Objective: To evaluate the benefit and efficacy of streptokinase therapy on ST-segment elevation resolution in different types of myocardial infarction in more than 60 years age group
Materials and Methods:This Hospital based cross sectional study was conducted at National Institute of Cardiovascular Diseases [NICVD] of Karachi, Pakistan. The study included patients more than 60 years of age having different types of myocardial infarction. Fifty patients both male and female fulfilling the inclusion criteria for thrombolytic therapy were included. Baseline ECG was recorded before streptokinase infusion and repeated at completion of infusion, at 90 minutes, day 1 and day 2. Effect of streptokinase therapy [SK] on blood pressure, CKMB, and ST-segment resolution was also evaluated at 90 minutes, day 1, and Day 2
Results: The mean systolic blood pressure was 138.20 +/- 4.57 and 125.20 +/- 3.92 pre and post SK therapy reflecting a percentage decrease of 9.40 and highly significant [P<0.001]. The Diastolic blood pressure was decrease to 9.52% with a mean value of 84.80 +/- 2.46 and 76.80 +/- 1.89 before and after the Streptokinase therapy's, segment resolution at 90 minutes was decreased to 50.69 percent from the baseline and continued to decrease at Day-1 and Day-2 with a percentage reduction of 69.12 and 84.33% respectively. The P values were highly significant [P<0.001]
Conclusion: Thrombolysis when given within 12 hours of the onset of symptoms, improves survival, is beneficial and effective.The magnitude of benefit is greatest when reperfusion is established early. Age itself should not be considered a contraindication for fibrinolysis
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Brenner tumors of ovary are relatively uncommon neoplasms and constitute about 1.4-2.5% of all tumors of ovary. Most of these tumors present as an incidental finding either on gross examination of ovary or as a microscopic finding. They are classified in surface epithelial tumors of ovary. We report here a case of a 50 year old woman who presented to the gynecology and obstetrics department of Jinnah Post Graduate Medical Center, Karachi, Pakistan. The presenting complaints were irregular and heavy per vaginal bleeding for a few months. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed and the specimen was received at the department of Pathology, Basic Medical Sciences Institute [BMSI], JPMC,Karachi. The microscopic examination of left ovary revealed benign Brenner tumor composed of well demarcated nests of uniform transitional cells
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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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Aims: Acute Kidney Injury (AKI) is seen in 15% of hospitalized patients and a renal ultrasound (RUS) is often ordered to exclude an obstructive cause in the initial evaluation of AKI. This study was done to evaluate the usefulness of a RUS in patients with AKI in a developing country. Methods: This was a retrospective study on all patients who were referred to nephrology with AKI and had a RUS, over a one-year period at a tertiary care teaching hospital of Karachi, Pakistan. The patients’ charts were reviewed for clinical characteristics and the RUS findings were documented. Results: A significant number of patients did not have documented risk factors for obstruction based on the medical history. Hydronephrosis was found in 22.5% (25 out of 111) of patients, and in 14 of these cases, the etiology of the acute kidney injury was found to be obstructive uropathy. The presence of nephrolithiasis and/or benign prostatic hypertrophy was associated with and increased likelihood of finding hydronephrosis on RUS. Conclusions: We thus recommend doing a renal ultrasound in all cases of AKI due to the fact that most of the time in a developing country, an accurate history is not available, and the prevalence of stone disease and obstructive uropathy is high.
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An algorithm for extracting tachograms for Heart Rate Variability (HRV) analysis on the basis of Photoplethysmographic (PPG) signals (instead of electro cardiograms) has been proposed. The main feature of this proposal is to detect peaks from correlograms between a pattern waveform and a sliding time window in the PPG signal. Analysis was carried out with a set of two groups of patients (young and elderly).HRV variables were estimated using the publicly available Kubios HRV package. Results showed that both the sympathetic component of the autonomous nervous system (assessed by LF/HF) and the cardiovascular complexity (assessed by correlation dimension) are reduced with age. These results are supported by literature and may be taken as a support for the validity of the proposed algorithm. Since oximeters for getting PPG signals are affordable even in poor settings, this allows extending autonomic nervous system studies into remote areas of developing countries(AU)
Se propone un algoritmo para obtener tacogramas con la finalidad de realizar estudios de variabilidad de la frecuencia cardiaca, partiendo de registros de señales fotopletismográficas (PPG). La principal peculiaridad de esta propuesta lo es la detección de los picos en las ondas de la señal PPG a partir de un correlograma obtenido como una secuencia de correlaciones entre una onda patrón y una ventana deslizante de la señal PPG. Se realizó un análisis de variabilidad de frecuencia cardiaca sobre dos grupos de pacientes (jóvenes y de avanzada edad). Las variables de variabilidad de frecuencia cardiaca seleccionadas se obtuvieron a partir del programa Kubios HRV, de acceso público y gratuito. Los resultados mostraron que tanto el componente simpático del Sistema Nervioso Autónomo (evaluado a través de la variable LF/HF) como la complejidad cardiovascular (evaluada a través de la dimensión de correlación) disminuyeron con la edad. Estos resultados encuentran apoyo en datos de la literatura que apoyan así la validez del algoritmo propuesto. Por cuanto el oxímetro utilizado para obtener las señales PPG está al alcance de instituciones primarias de salud se hace posible de esta manera extender estudios del sistema nervioso autónomo hacia áreas remotas de países en desarrollo(AU)
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Humans , Male , Female , Autonomic Nervous System , Cardiography, Impedance/methods , Cardiovascular Abnormalities/diagnosis , Heart Rate Determination/methodsABSTRACT
Studies of non-metric cranial variants have been a field of considerable interest to research workers especially because of their racial and regional importance. 28 north Indian skulls of U.P. were studied for the zygomatico facial foramen, a cranial variant in the present study. Findings are discussed and compared with other global studies and are found to be of considerable regional and racial significance.
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Background: Hygiene practices of women during menstruation are of importance as it has health impacts in terms of increased vulnerability to reproductive tract infection. Proper menstrual hygiene, correct perception and belief protect women folk from this suffering. This study is aimed to explore the knowledge, attitude, social practices during menstruation among adolescent secondary schoolgirls. Methods: This descriptive cross sectional study was undertaken among 150 adolescent school going girls by using provisional sampling in Thiruporur, India. Required data was collected through a pre-tested questionnaire during the study period and simple frequencies and comparative percentages were used to analyze the results. Results: Only 18.67% of adolescent girls had knowledge about menstruation before menarche. As high as 67% of them did not know the cause of menstruation. 23.33% of the girls believed that menstrual bleed comes from the same pathway from which urine comes. Nearly all girls (96.67%) reported sanitary pad usage during the duration of mensuration. Two-third (66%) of the girls were secluded during menstruation and majority (81.3%) were restricted to attend school. Conclusions: Though knowledge among the participant girls regarding mensuration and menstrual hygiene was not adequate, it was satisfactory to find that the sanitary pad usage among the sample was 100% due to government services which are provided free of cost. Definitely, it will improve the menstrual status of the girls from cloth to a safer sanitary absorbent usage.
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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