Preferences and attitudes of the Saudi population toward receiving medical bad news: a primary study from Riyadh city

Breaking bad news is one of the most stressful and difficult things a physician has to do. Good communication skills are required in order to ensure that bad news is delivered in a humane but effective way. This study was designed to explore the preferences and attitude of the Saudi population toward receiving bad news. Second, it was to identify the associations between preferences, attitudes, and sociodemographic characteristics. This was a cross-sectional study conducted during the month of April 2009 in Riyadh. Data were collected from 1013 adult Saudis. Stratified random sampling technique was used through a self-administered questionnaire. In this study, 474 [46.8%] were males and 539 [53.2%] were females. Almost two-third of the participants preferred to be the first to receive the bad news. A majority of the participants 695 [68.6%] preferred to be told the bad news at a private place, whereas, 441 [43.5%] preferred to be told by the head of the medical team. Moreover, almost half of the participants would like the one who breaks the bad news to remain with them to give them some more information about the disease. Significant associations were observed between participants' perception and attitude with age, marital status, gender, and education [P < 0.001], respectively. Factors such as marital status, age, and gender, and education play significant roles in how bad news is received. Understanding what is important in the process of breaking bad news may help in determining how best to perform this challenging task

Attitude towards the use of complementary and alternative medicine by patients in Saudi Arabia

Complementary and Alternative Medicine [CAM] covers a wide range of over 100 healing approaches, philosophies and therapeutic modalities that are not provided by conventional medicine. Complementary and Alternative Medicine [CAM] covers a wide range of healing approaches not provided by conventional medicine. The study was aimed at identifying sources of information about CAM that patients usually depend upon, estimating common diseases for which patients use CAM, reasons of using CAM, attitudes towards using CAM and its relation to patients' socio-demographic characteristics. This was a hospital based cross - sectional study. Data was collected using random sampling during March 2010 from patients attending the outpatient clinics of King Saudi Medical complex and King Khalid university hospitals. All patients aged / 18 years were included in the study using pre-tested questionnaire, after execution, the data was available for 399 patients out of 409 distributed questionnaires. After execution the response rate was 399 [97.5%]. The percentage of patients who used CAM before for the treatment of any disease was 348 [87.4%]; Abdominal pain 195 [48.9%] and common cold 195 [48.9%] were the most common conditions for CAM use, followed by evil eye 110 [27.6%]. Most of patients 286 [71.7%] supported that CAM helps conventional medicine and majority of them also don't consider it as a myth 278 [69.7%]. Fever, abdominal pain and acne were treated more commonly among manhood [25 - 59 years group] by using CAM [p < 0.01], while treatment of headache using CAM was more commonly reported in adulthood [18 - 24 years group] [p<0.006]. No significant association was observed between CAM usage and socio-economic status [p > 0.05]. Majority of the patients 296 [74.2%] used internet as the main source of CAM knowledge. CAM is commonly used by all age groups, different educational levels, singles, married, and all socio-economic standards for many diseases. It should be investigated more thoroughly in this community. Internet websites addressing CAM should also be considered. This emphasizes the role of having official locally directed Arabic websites that target the use of CAM in Saudi Arabia

Quantitative and qualitative analysis of cadaveric human pinealocytes in various age Groups

To determine age-related quantitative and qualitative changes in human pinealocytes using cadaveric material. Analytical cross-sectional study. The study was conducted in the Department of Anatomy, University of Health Sciences, Lahore, from January to December 2008. Thirty pineal glands from human cadavers ranging from 16-80 years of age were collected from mortuary of King Edward Medical University, Lahore, using purposive non-probability sampling. These were divided into three different age groups: I, II and III each between 16 to 30, 31 to 45 and 46 to 80 years of age respectively. Pinealocytes were counted; their mean diameter and that of their nuclei was calculated from a total of 30 cells per slide, using 4 microm thick H and E stained histological sections. Mean +/- S.E.M. was calculated for quantitative variables. One-way ANOVA was applied to observe group mean differences among three groups. The number of pinealocytes decreased with aging but the difference was statistically insignificant when compared between groups [p=0.234]. There was no change in size of pinealocyte soma and its nucleus [p=0.889 and 0.898 respectively]. The number and size of pinealocytes, and their nuclei remained unaltered with advancing age

Ethanol induced hepatotoxicity in albino rats

Twelve male albino rats of 6-8 weeks old, weighing 150-200 gm each were divided into two groups of 6 rats each. Group A was used as control while Group B was given ethanol at a dose of 0.6 ml [0.5 gm]/100 gm/day for 8 weeks. Serum enzymes and liver histology was determined in both groups. Statistically significant increase in the mean enzyme levels, liver weight and volume were observed in the ethanol treated group compared to the controls. Histologically, hepatocytes contained large number of cytoplasmic vacuoles, pyknotic nuclei, and lymphocytic infiltration in treated animals. Ethanol appeared to be hepatotoxic in albino rats

Effects of annona squamosa leave extract on gross congenital anomalies in diabetic albino rats

To investigate the effects of aqueous leave extract of Annona squamosa on gross congenital anomalies in diabetic albino rats. A randomized controlled trial [RCT] study. This study was conducted during the period of one year in the Anatomy department of University of Health Sciences [UHS] Lahore, Pakistan. Eighteen albino pregnant rats were randomly divided into three equal groups; Control [A], Diabetic [B] and Treated [C]. Diabetes was induced by single intra peritoneal injection of streptozocin [STZ, 45 mg/kg], in the rats of groups B and C on 8th gestational day. Group C rats were additionally given the Annona squamosa leave extract [350mg/kg/day] throughout the gestation after the confirmation of diabetes by checking blood glucose levels on 10 th gestational day. Fetuses were obtained by sacrificing the animals on 20 th gestational day; these were euthanized; their birth weight and crown rump length [CRL] were recorded and gross malformations were observed under stereomicroscope. After fixation with 10% formalin, the position of thoracic and abdominal viscera was also observed. Mean birth weight and CRL in group B fetuses were significantly low [3.2 +/- 0.9g and 3.3 +/- 0.5cm] as compared to group A [4.7 +/- 0.5g and 4.3 +/- 0.3cm] and group C [3.8 +/- 0.2g and 3.9 +/- 0.2cm, p<0.05]. Group B fetuses showed high frequency of craniofacial malformations and positional abnormalities of heart, diaphragm and kidneys. The group C fetuses did not show such malformations. It is concluded that gestational use of Annona squamosa tends to alleviate the diabetes induced fetal malformations

Gentamycin induced nephrotoxicity in albino mice

Twelve, male albino mice, aged 6-8 weeks, were injected intraperitoneally, aqueous solution of gentamicin [80 mg / kg / day] for fifteen days and the effects observed on the kidney structure and function. Group A served as control while Group B was given gentamicin. At the end of the experiment, blood was drawn from each animal by cardiac puncture for renal function tests and kidneys were fixed for histological studies. In group B, values of serum urea [66.40 +/- 0.54 mg/dl] and serum creatinine [1.41 +/- 0.08 mg/dl] were significantly increased [p < 0.001] when compared with control group A [34.73 +/- 0.84 and 0.53 +/- 0.04 mg/dl respectively]. Both body weight [p < 0.001] and kidney weight [p < 0.05] decreased significantly in gentamicin treated groups. In histological preparations from group B, the proximal convoluted tubules in cortex were dilated and their epithelial cells showed hydropic changes with cytoplasmic vacuolations in some areas. Loss of brush border, patchy necrosis, presence of cellular debris and accumulation of inflammatory exudates within lumina of proximal convoluted tubules were also observed. The renal medulla from group B, showed an increase in intra-luminal tubular protein casts. Chi-square test showed statistically significant [p < 0.00] association between tubular necrosis and tubular casts. It is concluded that gentamycin is nephrotoxic in albino mice

Immunohistochemical expression of cytokeratin-19 in non small cell lung carcinomas - an experience from a tertiary care hospital in Lahore

Previous literature reveals a significant recognition of Cytokeratin [CK] 19 as a reliable tumour marker in epithelial malignancies. With the hypothesis that CK 19 is extensively released by the tumour cells in patients with non small cell lung carcinomas [NSCLCs], this study was designed to assess [1] the clinicopathological characteristics of lung cancer in this sub-region [2] the pattern of immunohistochemical expression of CK-19 in different NSCLC subtypes with respect to their histological grades. A cross-sectional descriptive study comprising of detailed account of clinical data of 225 patients presenting with NSCLCs. After H/E staining, immunohistochemistry [IHC] was performed using prediluted ready to use mouse monoclonal antibody to CK 19. Our findings of the study revealed that the mean age of the patients was 45 years with the male to female ratio being 5:1. Most prevalent type seen was squamous cell carcinoma [SCC] and adenocarcinoma [AC] in males and females respectively. Some cases were not easily classifiable as squamous or adenocacinoma and hence they are classified as NSCLs Unclassified. SCC was commonly associated with smoking in both genders. Immunohistochemical staining of the histological tissue sections of 93.7% NSCLCs demonstrated a varying immunopositivity while showing strong, diffuse to focal cytoplasmic staining of the tumour cells. A significant association [p=0.001] was found between the increasing grades of malignancy and the strength of CK-19 expression. Supporting the previous literature, we have also come across that CK-19 is credibly expressed in patients with NSCLCs and may be applied as a reasonably reliable immunohistochemical marker. In future the patients over expressing CK-19 histologically might constitute potential candidates to be followed up through non invasive serial serum levels estimation intended for assessment of tumour burden in recurrence or advanced disease

Frequency of antineurtophil cytoplasmic antibody in glomerulonephritis

Aim of the study was to determine the frequency of antineutrophil cytoplasmic antibody [ANCA] [p-ANCA and c-ANCA] in clinically diagnosed glomerulonephritis. Autoimmune diseases including systemic vasculitis, affect a large number of people ill whom the leading cause of morbidity and mortality is glomerulonephritis that is often associated with chronic kidney disease. There are many risk factors for kidney diseases such as chronic inflammation, auto-immune diseases, immunosuppressive therapy, etc. Early phases of renal injury in autoimmune patients are clinically silent. For the detection of nephron damage, histopathological examination is gold standard but detection of antineutrophil cytoplasmic antibody [ANCA] can be used to find out early nephron damage. Design was analytical Cross-sectional. The study was conducted at the Department of Immunology, University of Health Sciences, Lahore in a period of November 2008 to October 2009. Study included 64 clinically diagnosed of glomerulonephritis. Levels of ANCA [MPO and PR3] were determined by ELISA technique. Out of which four [6.25%] patients showed positive reaction to myeloperoxidase [MPO] antigen while1 [1.56%] patient was positive for proteinase-3 [PR3] antigen. In 40-60 years of patients, sero-positivity for MPO and PR3 was 14% and 3.6% respectively, p-value for MPO and PR3 was <0.05 and >0.05 respectively. We concluded that glomerulonephritis is better related with MPO-ANCA than PR3-ANCA. The difference in the levels of MPO-ANCA in different age groups was significant but it was non-significant among different genders. Difference in the levels of PR3-ANCA was not significant for both age and gender

Evaluation of four ELISA based immunoassays for the detection of IgM antibodies against dengue virus

Dengue fever is a problem of serious concern which is mainly transmitted by mosquito, Aedes aegypti. These days' different ELISA kits are used for the diagnosis of dengue fever. It was a validation study. Study was conducted in the Department of Immunology at University of Health Sciences, Lahore during the period of August 2009 to October 2009. In this study four ELISA kits [Human, Nova Tech, Vircell and DRG] were used to determine IgM antibodies against dengue fever in forty four patients who were labelled positive for dengue fever by different commercially available ELISA kits. Human ELISA kit gave most accurate results with respect to the agreement, sensitivity, specificity and K value. Human ELISA kit was found most reliable for the diagnosis of dengue fever

Biostatistics education for undergraduate medical students

Biostatistics is relevant to students and practitioners in medicine and health sciences and is taught as a part of the medical curriculum. The Biostatistical literacy of medical students is a problem all over the world including Pakistan which is actively discussed in different publications. Biostatistics is the subject in the medical curriculum that is not popular among the undergraduate students. The negativity of the medical students towards biostatistics is real and their perception can easily be changed through interactive teaching techniques by trained faculty. This paper describes the problems and challenges confront in teaching biostatistics to medical students. Some suggestions and guidelines are presented which may help to surmount these problems and enhance the teaching of biostatistics in health sciences

Morphological evaluation of colorectal carcinoma with grading staging and histological types

To evaluate the morphology, grading and staging of colorectal carcinoma [CRC] and to assess the relationship between these parameters. This cross-sectional study was carried out at the Departments of Pathology, University of Health Sciences and Sheikh Zayed Federal Post Graduate Medical Institute Lahore, Pakistan, over a period of one year. The study consisted of 100 colectomy/ hemicolectomy specimens, received fixed in 10% formalin. The specimens were examined grossly to observe the various macroscopical features of tumours Haematoxylin and Eosin stained slides were examined to determine the histological type, grade and stage of CRC. Amting the 100 cases, 59 were non mucinous adenocarcinomas, of which 4 were in Dukes stage A, 51 were in Dukes' stage B and 4 were in Dukes'stage C. Cases of nonmucinous CRC of grade I to grade i were 55 in number. In thirty, cases of mucinous carcinomas, 18 were in Dukes' stage B and 12 were in Dukes' stage C, of these 2 were of grade I, 20 were of grade II and 8 were of grade III. All the 11 signet ring cell carcinomas were of grade III and in Dukes' stage C. Mucin secreting and signet-ring cell adenocarcinomas of colon and rectum are high grade tumours and presented at an advanced stage

Protective role of vitamin c and e against sodium arsenate induced changes in developing kidney of albino mice

Arsenic is a teratogenic agent present in the environment as oxides and arsenate and humans are exposed to it through contaminated drinking water, food, soil and air. This investigation was undertaken to evaluate protective role of Vitamin C and E against teratogenic injury produced by sodium arsenate in developing kidney of the mouse. Twenty-four pregnant albino mice of BALB/c strain, were randomly divided into 4 groups of 6 each: A[1], A[2], A[3] and A[4]. Group A[1] served as the control and received weight related distilled water by intra-peritoneal [I/P] injection, group A[2] was given a single doses of 35 mg/kg on 8th GD whereas groups A[3] and A[4] were treated with Vitamin C and E by IP injection, 9 mg/kg/day and 15 mg/kg/day respectively, starting from 8th day and continued for the rest of the pregnancy period. The foetal kidneys were weighed and histological studies carried out including micrometry on different components of nephron. Sodium arsenate toxicity manifested as an increase in weight of the kidneys, wider nephrogenic zone and significant reduction in the mean of number of mature renal corpuscles as compared to the control group [p<0.000]. There were moderate to severe necrotic and degenerative changes in proximal and distal convoluted tubules; glomeruli were hypercellular, the Bowman's spaces were obliterated. There was a statistically significant difference in mean diameter of renal corpuscles of group A[2] when compared with groups A[1], A[3] and A[4], [p<0.000]. The findings implied that groups receiving Vitamin C and E along with sodium arsenate showed an overall improvement in all parameters, indicating the protective role of Vitamin C and E against arsenic induced teratogenicity in developing kidney and are safe to use during pregnancy without deleterious effect on human conspectuses in arsenic exposed areas

Comparison of iron stores in healthy individuals and patients with ischemic heart disease

Excess body iron has been linked to atherosclerosis owing to its pro-oxidative properties. However, inconsistent results have emerged from the epidemiological studies linking iron status and the risk of cardiovascular diseases [CVD]. Objective of the present study is to compare iron stores of healthy individuals and patients with ischaemic heart disease [IHD]. A total of 137 subjects were included in the study, 90 patients of IHD and 47 healthy subjects with no history of IHD as controls. We compared body iron stores of patients and controls. Serum ferritin, serum transferrin receptor [sTfR] and sTfR/ferritin ratio were used as measures of body iron stores. Our results revealed that mean serum ferritin concentration of cases was significantly higher than controls. Moreover, mean sTfR and sTfR/ferritin ratio of controls was significantly higher than the patients. We conclude from our results that IHD patients have higher iron stores than healthy subjects suggesting a possible association between high iron stores and the risk of IHD

In hospital outcome of patients undergoing coronary endarterectomy: comparison between off-pump vs on pump CABG

Due to advancement of non-surgical methods of coronary revascularization the patients referred for surgery have extensive and complex coronary anatomy. Patients with diffuse atheromatous coronary artery disease required coronary artery reconstruction or coronary endarterectomy [CE]. Coronary endarterectomy on beating heart needs skill and better surgical technique. Coronary endarterectomy along with coronary artery bypass grafting [CABG] done on beating heart is compared with coronary endarterectomy done by using conventional CABG technique. Seven hundred and ninety five consecutive patients underwent CABG from January 2006 to March 2007 in a prospective randomized trial at cardiac surgery department, Punjab Institute of Cardiology, Lahore; out of these 115 patients underwent coronary endarterectomy [CE] and were included in this study. Coronary artery bypass grafting was performed in 115 patients. Seventy two [62.6%] were in group A on-pump and 43 [37.39%] were in group B off-pump. Mean age in group A was 55.68 +/- 1.06 and 52.63 +/- 1.40 in group B. Sixty six male and 6 female were included in group A, 40 male and 3 female patients were in group B. In-hospital mortality among patients undergoing CABG was 5.6% in on-pump group and 2.3% in offpump group [p=0.649], the duration of post-operative mechanical ventilation in on-pump was 6.78 +/- 9.34 hours and 5 +/- 4.0 hours in off-pump group [p=0.060], 66.7% patients in on-pump and 58.1% patients in off-pump group required blood transfusions, Intra-aortic balloon pump [IABP] was required in 5.6% of the patients in on-pump group. Other factors included, smoking 26.4% in on-pump and 41.9% in offpump group [p=0.01], Intensive care unit [ICU] stay was statistically significant 4 +/- 3 in on-pump group and 4 +/- 2 in off-pump group [p=0.02], and drain in on-pump group was 455 +/- 208 ml and 540 +/- 370 ml in off-pump group [p=0.01]. Coronary endarterectomy [CE] has higher post-operative morbidity and mortality but the post-operative outcome after the procedure on either technique is comparable and CE is feasible on off-pump technique as well

Early vascular complications of intraaortic balloon counterpulsation in patients undergoing open heart surgery

The use of IABP is helpful for haemodynamic stability of patients with low cardiac output and compromised left ventricular function in patients who undergo coronary artery bypass grafting. This procedure is also associated with some vascular complications due to the insertion of IABP. The objective of this research was to study the vascular complications in patients with IABP counterpulsation. We observed the clinical outcome of these patients with special reference to post IABP complications in our research. One hundred and six consecutive patients were included in this study from August 2005 to February 2007. Mean age of patients was 58.08 +/- 1.814 years. Seventy nine patients [74.5%] were male and 29 [25.5%] were females. Out of these 106 patients, 101 were operated for CABG, one for angina due to aortic stenosis, two patients had ischemic mitral regurgitation and one patient had post infarct VSD. In 102 [96.2%] patients IABP was inserted percutaneously, one patient received transthoracic and in three patients IABP was inserted with open technique. Thirteen [12.3%] patients received IABP with sheath and 93 [87.7%] received IABP without sheath. Ten patients [9.4%] out of 106 developed vascular complications due to insertion of IABP. Seven patients [6.6%] had the major complications and 3 [2.8%] patients developed minor vascular complications. Mortality due to vascular complications in 106 patients was 8.49% with p<0.005. IABP has remarkable beneficial effects in patients with haemodynamic instability due to myocardial ischemia and low cardiac output syndrome. At the same time IABP is related to significant morbidity and mortality related to vascular complications due to its insertion which include limb ischemia, limb loss and even mortality

Ki-67 proliferating index and histological grade, type and stage of colorectal carcinoma

The objective of this study was to assess the relationship of histological type, grade and stage of colorectal carcinoma with proliferative activity as measured by Ki-67 LI. It was a descriptive study and conducted at the Department of Pathology, University of Health Sciences, Lahore. Ki-67 is a protein associated with cell proliferation and is expressed in all the phases of cell cycle except G0. In the present study, Ki-67 expression in 50 patients with colorectal adenocarcinomas was observed using immunohistochemistry with monoclonal antibody MIB-1. Ki-67 LI was high in well and moderately differentiated adenocarcinomas [mean Ki-67 LI 392.50 +/- 56.58 and 342.24 +/- 96.84 respectively] as compared to poorly differentiated adenocarcinomas [mean Ki-67 LI 250.00 +/- 113.46]. Ki- 67 LI was high in non mucinous adenocarcinomas than mucin secreting and signet ring cell adenocarcinomas [mean Ki-67 393.93 +/- 55.91 vs 220.00 +/- 49.72 and 200.00 +/- 79.05 respectively]. As regard the Dukes' staging, Ki-67 LI was high in colorectal carcinomas in Dukes' stage B than tumours in Dukes' stage C [Mean Ki-67 LI 360.13 +/- 90.03 vs 241.66 +/- 101.31 respectively]. The proliferative activity as measured by Ki-67 antibody is related to histological type, grade and stage

Plasma osteopontin as an indicator of metastasis in patients with prostate cancer

Objective: To evaluate plasma osteopontin [OPN] levels in prostate cancer [PCa] patients for determining its association with disease stage

Material and Methods: The study was conducted at University of Health Sciences Lahore [UHS]. 60 diagnosed patients of prostate cancer were included in this study and comparison was made with 30 healthy males as controls. OPN was measured using an enzyme linked immunosorbent assay [ELISA] technique

Results: OPN levels were significantly elevated in PCa patients with metastasis against the patients without metastasis

Conclusion: The current study provides useful local data suggesting an association between elevated plasma OPN and bone metastasis in patients with PCa

Cardiac mortality trends in the emergency department of a tertiary care cardiac centre

Limited information is available on trends in mortality from cardiovascular diseases in Pakistan. The objective of this study was to examine the various cardiac causes of early deaths and asses the treatment strategies in emergency department of a tertiary care cardiac centre. We conducted a prospective observational study of early deaths over an eight months period. Data of emergency admissions from June 2006 to January 2007 was analyzed. There were 357 early deaths; median age 60 years, and median survival time 1.55 hours. There were 6221 emergency admissions, with 4.6% of men and 9.4% of women having early mortality in emergency department. Only 14 were non-cardiac deaths and 314 [88%] were cardiac related deaths. Valvular heart disease comprised 6% of cardiac deaths. There were 373 cases received dead in emergency and assumed to be sudden cardiac deaths. Cardiogenic shock [CS] was the leading cause [265, 74%] of cardiac deaths and ST elevation myocardial infarction [STEMI] comprised nearly half of those deaths [130, 49%]. Only 39% [51/130] of STEMI patients were thrombolysed and there was only marginal difference in the survival time of patients with or without lytic therapy. ST depression was seen in 17% of CS patients. Ventricular fibrillation and ventricular tachycardia constituted only 20% of cardiac deaths. Complete heart block [CHB] was seen in a quarter of CS patients and emergency transvenous pacing was successful in 67% [42/63]. The survival time was shorter in patients with failure to pace acutely; men [0.50 vs. 1.30 hrs], women [1.00 vs. 2.15 hrs]. A very large number of early deaths were cardiac and cardiogenic shock was the major cause. Only half of cardiogenic shock patients had diagnostic ECG changes of ST segment elevation and less than half of these were thrombolysed