Public health education and health system needs in Pakistan: a mixed methods study

Background: Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs.

Aims: We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs.

Methods: A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce.

Results: We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic [i.e. with no specific concentration track] and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills.

Conclusions: Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways

Diffuse large B cell lymphoma of the rectosigmoid junction: case report and literature review

Primary colorectal lymphoma [PCL] is a rare condition that accounts for a small percentage of all gastrointestinal [GI] malignancies. There are several reports in the literature regarding the most common features of PCL. However, primary lymphoma in the rectosigmoid junction has been rarely reported. Our case was a 67-year-old male who presented with non-specific symptoms of bowel obstruction which, upon further workup, was diagnosed as a rare case of PCL located in the rectosigmoid junction

Generalized anxiety disorder: can we rest now?

Generalized anxiety disorder is a complex psychiatric syndrome. Current understanding on the epidemiological risk factors, genetic vulnerability and neurobiology of the GAD is beginning to unfold the complexities behind this disorder. This narrative review has attempted to put together the recent advances in the area of GAD research with intent to identify the gaps requiring further research

Spontaneous bacterial peritonitis; microbiological analysis of ascitic fluid in patients with complicated liver cirrhosis

Spontaneous bacterial peritonitis is a serious event in patients with liver cirrhosis and associated with significant morbidity and mortality. Most common causative organisms of SBP are E.coli, streptococcus pneumonia and klebsiella. Liver cirrhosis has multifactorial etiology and the most common causes in our country are hepatitis C and hepatitis B. [1] To observe the culture and sensitivity pattern of ascitic fluid in patients with liver cirrhosis. [2] To examine the resistance against various antibiotics. 6 months. Study was conducted in department of Gastroenterology Hepatology in collaboration with department of microbiology of Sheikh Zayed Hospital, Lahore. Sample size; 80 patients of liver cirrhosis with ascites. Sampling technique, Non probability purposive technique was adopted. Sample selection; By Inclusion and Exclusion criteria. Data collection procedure; Eighty patients with liver cirrhosis and ascites diagnosed on the basis of history, examination and ultrasound findings. After detailed history examination and full aseptic measures at least 10 ml of ascitic fluid in 20ml syringe with 16G needle was drawn in blood culture bottle at bed side and was sent to microbiology laboratory for culture and sensitivity and record of resistance and sensitivity against various antibiotics used to treat SBP. Data analysis procedure; Data was analyzed by SPSS version 10.Quantitative variables and were recorded as mean+S.D and qualitative variables, were recorded as frequencies and percentages. Out of 80 patients with suspected SBP 38[47.5%] were culture positive while 42[52.5%] were culture negative. Among these 14[36.84%] showed gram positive growth and 20[52.63%] gram negative growth while 4[10.52%] showed anaerobes. Most of the organisms were resistant to ceftazidim, cefoperazone and augmentin while sensitive to levofloxacin, ceftriaxone, cefotaxime and ciprofloxacin. Highest resistance was against ceoftazidim which was 36[95%] followed by cefoperazone 35[92%]. Spontaneous bacterial peritonitis is devastating complication of liver cirrhosis and ascites and is a leading cause of disability and death in patients with chronic liver disease. Early diagnosis and treatment with proper antibiotics and dosage are necessary for better outcome

Chronic hepatitis C and efficacy of a interferon chemotherapy

Background: Chemotherapy with various drugs is in practice for the management of chronic hepatitis C. One of these drugs is ainterferon

Objectives: To study the efficacy of a-interferon therapy in male hepatitis C patients of Faisalabad region of Pakistan

Period: Jan. to June 2000

Setting: Clinical laboratory Nawaz Medicare Hospital, Model Town, Faisalabad

Material and Methods: This international study was conducted on 20 male hepatitis C patients of 24 to 51 years of age, receiving injection of a-interferon thrice a week were selected and their sera were analyzed after the completion of 6 months chemotherapy

Results: After six month of treatment with ? interferon, [18]90% of the patients became negative for HCV. The levels of serum total bilirubin before [0.939+/- 0.07mg/dl] and after treatment [0.924+/- 0.09mg/dl] with a-interferon remained almost normal. Similar results were observed for serum direct and indirect bilirubin.The levels of alkaline phosphatase [ALP] in our study subjects were within normal limits before and after treatment with a-interferon. The levels of Serum Glutamate Pyruvate Transaminsae [SGPT] were highly raised [337.40 +/- 75.38 U/l] prior to treatment and became normal [26.8+/-7.42U/l] after treatment with a-interferon

Conclusion: a-interferon therapy in chronic hepatitis C patients for a period of 6 months gives sustained virological as well as biochemical responses and is useful for maintenance of SGPT values within normal limits in hepatitis C patients like other countries of the world

Antituberculous treatment induced ALT and ALP derangements and the role of onion extract in male albino rats

Study was designed to investigate the biochemical derangements induced by antituberculous drugs and role of onion extract in male albino rats. March to December 2008. Study was conducted on non-tuberculous male albino rats, which were kept in animal house of University of Health Sciences, Lahore. 48 male albino rats, obtained from NIH Islamabad weighing 200-250 gms were divided into four groups, each group consisting of 12 rats. Group A; received normal diet and fresh water orally. Group B; received normal diet, fresh water and antituberculous drugs orally. Group C; received 100mg/kg body weight of onion extract and antituberculous drugs orally and Group D; received 200mg/kg body weight of onion extracts and antituberculous drugs orally, rats were treated with this regimen for 45 days. After the last administration, blood samples were collected. Serum samples were separated into sterile appendorf tubes and stored at -20 C until used for estimation. Following methods were followed for biochemical investigations. Estimation of Serum Alanineaminotransferase [ALT] and estimation of serum Alkaline Phosphatase [ALP]. In this biochemical study; there was a significant elevation in the levels of serum diagnostic marker enzymes [ALT, ALP] in group B antituberculosis drugs administered rats as compared to that of non-antituberculosis drugs administered in group A. Co-administration of onion extract and antituberculous drugs, decreased enzyme levels were noticed in a dose dependent manner in group C and group D rat's serum samples. Antituberculous drugs causes significant elevations in the level of serum diagnostic marker enzymes [ALT and ALP] and onion extract lowers the enzyme levels indicating its cytoprotective effect

Insulin resistance syndrome in type - 2 diabetes mellitus patients

Objective: To find out the presence or absence of insulin resistance syndrome [lRS] in type-2 diabetes mellitus patients

Material and Methods: The study included 55 TZDM patients [34 male and 21 female], who were already taking oral anti diabetic drugs for the last 3 - 5 years. Obesity or weight gain in TZDM patients aggravates metabolic disturbances along with increased insulin resistance. The five variables in TZDM patients were studied as per recommendations of the United States National Cholesterol Education Program Adult Treatment Panel-Ill [ATP-Ill], to find out the presence or absence of insulin resistance syndrome [IRS] in TZDM patients. The TZDM patients who had shown the presence of three or more variables out of five 2 were considered to have IRS

Results: 32 [58.18%] TZDM patients [20 male and 12 female] had IRS. The T2DM patients with lRS had significant [p<0.001] increase in mean blood glucose levels, waist circumference, triglyceride levels and in systolic and diastolic blood pressure. The mean HDL Cholesterol was significantly [p<0.001] decreased in TZDM patients with IRS as compared to TZDM patients without IRS

Conclusion: An increase in waist circumference in TZDM patients will increase the prevalence of insulin resistance syndrome