New Private Practice Paradigms in Pakistan

Introduction: The medical private practice is changing quickly due to many reasons. Most of practitioners need a comfortable environment and working conditions to deliver healthcare services to the patients. Multi-specialty clinics, owned by private entrepreneurs, have been established in the big cities to earn maximum revenue. The small GP clinics are very difficult to be established in big cities. The revenue earned by the small clinics is very low as compared to their expenses such as rent, utility bills & paramedical staff payments. It is the need of the time that complete revised private practices paradigms should be developed. Objective: to find out (1) future employment structure of the doctors in private sector. (2) To find out whether single specialty clinics are better than multi-specialty clinics in the future scenario Sample Size: A total no of 302 personnel’s data was collected through survey. MBBS Doctors, PG Diploma Holders, FCPS, Teaching Medical College Professors from different specialties were enrolled in the survey. Study design & Methodology: The collected data was collected and graded in the excel sheet. The data was analyzed on SPSS version 20 to find the different relationships. The statistical analysis has been recorded and reproduced in the conclusions and results. Sampling Method and Design: Consultant of various disciplines working in private sector having their own clinics or working with different multi-specialty clinics were included in the study. The privately owned GPs were also included in the study for purpose of comparison for compensation in various disciplines. Results: The landscape of medical practice is changing very quickly. Various practice options requires financial and legal knowledge of the various fields. New health commission reforms have provided a platform for healthy competition among the competing physicians and surgeons .Conclusions: It has been found out that the private practice has taken the shape of industry. All the resources should be used carefully to earn the maximum revenue for meeting the requirement of all stakeholders. The change in the private practices paradigms is very huge which is very difficult for the general practitioners and single specialty clinics to adopt.

Falciparum malaria; its diverse clinical spectrum: a descriptive study of 150 admitted patients

To determine how Falciparum Malaria can present clinically in various ways. A study conducted on 150 admitted patients. This descriptive case-series, single center study was conducted in Medical B Unit, Khyber Teaching Hospital, Peshawar from November 2012 to June 2013. A total of 150 patients admitted with falciparum malaria were studied. A detailed history and clinical examination was performed. The falciparum malaria was diagnosed by examining peripheral blood film. All patients were thoroughly investigated to find out the complications of falciparum malaria. Out of 150 patients, 95 [63.33%] were males 55 [36.67%] were females with mean age of 30 years. Fever was present in all patients, rigors and chills in 93%, headache and vomiting in 60%, jaundice in 50%, confusion in 37%, abdominal pain in 26% were main presentations. Other presentations were Oliguria, hypotension, cerebral malaria, dyspnea and cough, hypoglycemia and seizures. Clinical examination showed splenomegaly [58%], hepatomegaly [46%], hepato-splenomegaly [22%] of patients. Laboratory investigation showed Hemoglobin < 10gm% in 22% and leukocytosis > 12000/?l in 10% of patients. As Falciparum Malaria presents in multiple ways clinically, it should be considered as a possibility in all febrile illnesses

Plasmodium falciparum malaria with bleeding diathesis-an experience in NWFP

Falciparum Malaria is a syndrome and a disease of protean clinical manifestations including DIG. This descriptive study was conducted in Medical department of Khyber teaching hospital Peshawar from January 2004 to August 2005. Fifty patients between the ages of 15 to 70 years, who presented with fever and bleeding manifestations, having positive trophozoites of plasmodium falciparum in blood smear, were included. Out of 50 patients 27 [54%] were males, while 23 [46%] were females. Male to female ratio was 1.17:1. The age of the study group ranged form 15 to 70 years. Maximum number of patients were in the age group 15-29 years [44%]. Fever was noticed in 48 [96%], anemia in 32 [64%] and splenomegaly in 33 [66%]. Bleeding diathesis was noticed in 3 [6%] patients with prolonged PT, APTT, thrombocytopenia and raised FDPs, Four patients had thrombocytopenia and positive FDPs in low titre, with 03 patients having prolonged PT and APTT but no clinical evidence of bleeding. We conclude that any patient with history of fever and bleeding diathesis, falciparum malaria should be considered in the differential diagnosis

Comparative analysis of risk factors and complications of hepatitis B and C infections at Khyber Teaching Hospital, Peshawar

To analyze comparatively the risk factors and complications of hepatitis B and C infections at Khyber Teaching Hospital, Peshawar. A cross-sectional observational study was conducted in Department of Medicine, Khyber Teaching Hospital, Peshawar, from March 2005 to October 2006. Relevant information's were obtained from the patients with the aid of a pre-designed questionnaire prepared in accordance with the objectives of the study. A total of 432 patients with positive anti-HCV antibody 252 [58.33%] and positive HBs Ag 180 [41.66%] were included. The age range of the patients with anti-HCV antibody was from 11 to 84 years with the mean age of 47.5 years, while in HBV cases was 50.5 years [range: 7 to 87 years]. In HCV positive cases, 165 [65.47%] were males and 87 [34.52%] were females while in HBV patients, 123 [68.33%] were males and 57 [31.67%] were females. The risk factors of HCV patients were: intravenous drug users, 23.81%; HCV positive sexual partners, 15.07%; blood or blood products transfusion, 13.49%; and occupational acquired-HCV, 7.14%. The major risk factors of HBV were: intravenous drug users, 33.88%; HBsAg positive sexual partners, 23.33%; blood transfusion, 14.44%; and dental procedures [tooth extraction or root canal treatment], 9.44%. Unknown source of infection was recorded in 25% of HCV and 10.56% of HBV patients. Complications consequences in HCV patients were: chronic hepatitis, 34.52%; liver cirrhosis, 16.26%; hepatocellular carcinoma, 0.79%; fulminant hepatitis, 0.79%; while 47.61% were asymptomatic or sub-clinical symptomatic. In HBV patients, complications were acute hepatitis, 5.56%; fulminant hepatitis, 0.5%; chronic healthy carriers, 31.67%; chronic hepatitis, 24.44%; liver cirrhosis, 6.11%; and hepatocellular carcinoma, 1.10%; while 40.55% were clinically asymptomatic or with sub-clinical disease. Coexistence of HCV and HBV were recorded in 52 [12.03%] patients. History of sexual transmission favors HBV infection while blood transfusion and occupational exposure were recorded mainly in HCV positive patients. Chronic persistent hepatitis and liver cirrhosis were recorded more significantly with HCV infection while HBV favor carrier state or presents as a sub-clinical disease