Knowledge, attitude and practice regarding immunization among family practice patients

To determine the knowledge, attitude and practices about immunization among family practice patients. A questionnaire based survey. A questionnaire was developed in line with the study objectives. It was administered to patients visiting family physicians, after they were administered, informed consent and assurance with regards to confidentiality was provided. Epi-info and SPSS software was used for data management. A total of 97 patients were surveyed. The majority were men [59.8%] with a mean age of 29.69 years. Majority was unmarried [51.5%], with graduate and post-graduate education [73%], and in government and private service [48%]. Vaccination was believed to prevent disease by 94%. Majority was informed about immunization by doctors and parents [94%]. Media provided information about immunization to 62% of the patients. A 58% would recommend vaccination to others. Source about harmful effects of immunization was provided by friends and parents [80%]. Hurdles against immunization were lack of education and lack of funds according to 43 [45%] and 29 [30%] respondents respectively. Education of population and mothers were ways to promote immunization according to 23 [24%] and 19 [20%] respondents respectively. Immunization exists against Hepatitis "C" and Malaria according to 35 [36%] and 10 [10%] respondents respectively. Immunization were received against polio, measles and hepatitis "B" by 86 [89%], 51 [53%] and 26 [27%] respondents respectively. The study results have identified a strong need for education program for the masses about immunization, since major deficiencies have been identified. Further studies are strongly recommended along with debate on this important public health issue

clinical manifestations of systemic lupus erythematosus in Pakistan correlate with rest of Asia?

Systemic Lupus Erythematosus [SLE] is known to be different among people with different racial, geographical and socio-economic back grounds. Asia has diverse ethnic groups broadly, Orientals in the East and Southeast Asia, Indians in South Asia and Arabs in the Middle East. These regions differ significantly from the Caucasians with reference to SLE. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and compare it with Asian data. Patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted at the Aga Khan University Hospital between 1986 and 2001 were studied by means of a retrospective review of their records. The results were compared with various studies in different regions of Asia. Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is generally consistent with Asian data. There was less cutaneous manifestations, arthritis, serositis, haematological and renal involvement compared to various regions in Asia. The neurological manifestations of SLE, however, place Pakistani patients in the middle of a spectrum between South Asians and other Asian races. This study has shown that the clinical characteristics of SLE patients in our country may be different to those of other Asian races. Although our population is similar to South Asians, but clinical manifestations of our SLE patients are considerably different, suggesting some unknown etiology. Further studies are required to confirm the above results and to find statistically sounder associations

Systemic lupus eryhematosus presenting as Hemolytic uremic syndrome: a case Report

Associating systemic lupus erythematosus [SLE], with an initial presentation of hemolytic uremic syndrome [HUS] is rare. We report a case of 21-year old Afghani female admitted to our hospital with an initial complaint of high grade fever and diffuse maculopapular rash and swelling of lower limbs. Diagnosis of atypical HUS was established according to the clinical triad of HUS without a veriotoxin-producing organism in her stool and the pathological finding compatible to thrombotic microangiopathy. In addition, her symptoms fulfilled the 1982 revised criteria for the classification of SLE. After pulse methylprednisolone, cyclophosphamide and plasmapheresis therapies, her laboratory findings and general condition improved. Unfortunately she was lost to follow up as she decided to return back to Afghanistan

Clinico-laboratory findings in male lupus patients from a tertiary care hospital, Pakistan

This study was conducted to delineate the clinical pattern of a cohort of Pakistani male patients with systemic lupus erythematosus [SLE]. Clinical and laboratory data were collected of 24 male patients who were diagnosed with SLE and admitted to a tertiary care hospital between 1986 and 2001. Imaging and invasive studies [including aspirations and biopsies] were also recorded. Fourteen patients [58%] had renal involvement, with WHO class 4 and 5 comprising 89% of the cases. Eight patients [33%] had neurological involvement. Out of these 8 patients, 3 presented with psychosis [12.5%] and 4 [17%] with seizures. Twenty three patients [96%] had hematological involvement, 6 [25%] had serosal and 10 [41%] had articular involvement. Cutaneous lesions were noted in 10 [41%] patients. A majority of the patients were noncompliant and were lost to follow-up; therefore, ultimate outcome could not be clearly delineated. A high index of suspicion for SLE in males may permit early diagnosis and dictate the need for more aggressive therapy

Level of prepatedness of patients for medical emergency

A questionnaire-based survey was conducted at the Emergency Room, The Aga Khan University Hospital, Karachi, during March and April 2003. One hundred patients visiting the Emergency Room for the treatment of a medical emergency were surveyed. The average age of patients was 42 years, with 54 men and 46 women. The majority was married, well educated, housewives or in private/government services. Only those patients who were well enough to respond to questions were interviewed. Seventy [70%] respondents had financial resources available to meet the expenses of the medical emergency. Patients were accompanied by someone in 89% cases. The majority was accompanied by husband [20%], son [20%], brother [14%], father [08%], wife [06%], sister [06%], mother [05%], daughter[05%] or a friend [05%]. Seventy-nine% respondents felt that experiencing the present medical emergency will enable them to be better prepared for such events in the future. Since we conducted the study at the Emergency Room of a teaching facility, and the study subjects were well-educated and socioeconomically better off, we cannot generalize the results to the population at large. We should not be surprised that 70% of the study subjects had the resources to pay for the expenses the medical emergency. Far less people in the community will be able to meet such expenses

Renal cortical necrosis: a case series of nine patientns and review of literature

The purpose of this study is to review cases of renal cortical necrosis [RCN] which we came across during a period of five years, confirmed on needle biopsy specimens, with literature available so far. All renal biopsy records between January 1996 to December 2001 at the Aga Khan University Hospital, Karachi, Pakistan were reviewed to identify patients with histologically proven renal cortical necrosis. Seven patients were also referred by the department of Nephrology, Lady Reading Hospital, Peshawar, Pakistan. Patients' medical records were reviewed for demographic, clinical, and follow up data. There were total of nine patients identified with renal cortical necrosis. The mean age was 26.21 +/- 13.01 year. Five cases [55.5%] were caused by obstetric complications. The most common histology type of RCN was patchy cortical necrosis in seven patients [77.8%]. Three patients were alive at last follow up; remaining patients were lost to follow up. Obstetric complications remain the leading cause of renal cortical necrosis in our setting. The recognition of this entity and value of renal biopsy in cases of acute renal failure needs to be emphasized as this helps in establishing diagnosis, to assess prognosis and to aid in selection of a rational approach to therapy

Perceptions on bioethics among general practitioners in Karachi, Pakistan

To study the perceptions on bioethics among general practitioners in Karachi, Pakistan. A questionnaire based cross sectional survey. 85 general practitioners in Karachi were surveyed at their clinic premises. Main outcome measures: Perceptions on the broad principles of bioethics. The majority of general practitioners were males, with mean age of 36.3 years, had minimal postgraduate qualifications and continuing medical education. They reported the top five moral duties of a physician and their reaction in the event of the death of a close relative due to a doctor's negligence. A significant number of respondents agreed that a 'doctor is next to God'. Other issues studied include discontinuation of artificial life support, giving of gifts by pharmaceutical companies to doctors, sickness certification, organ donation, human cloning, disclosure of information to cancer patient and patient confidentiality. We have documented the perceptions of general practitioners on broad principles of bioethics. These views have significant implications for medical practice