ABSTRACT
@#Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, especially in the Western world and Asia-Pacific regions. This study was designed to determine the prevalence of NAFLD detected by sonographic assessment among the rural indigenous population in Peninsula Malaysia and its association with anthropometric and biochemical factors. Methods: A cross-sectional survey was carried out from January 2014-February 2016. Subjects were recruited among indigenous peninsula Malaysia population in rural villages, aged ≥18 years old. The survey was questionnaire-based followed by anthropometric and blood parameters measurements. All subjects underwent abdominal ultrasound assessment to screen for the presence of NAFLD. Semi-quantitative visual grading was performed to assess for mild, moderate or severe NAFLD. Results: A total of 270 subjects underwent the screening program (mean age 43.3 ±14.0 years). Approximately 53 subjects (19.6 %) were identified with NAFLD. Of those with NAFLD, approximately 83% had moderate grade of fatty liver and the remainder were diagnosed with mild grade. NAFLD was closely associated with age, body mass index (BMI), central obesity, hypertension, total cholesterol (TC), triglyceride/high density lipoprotein-cholesterol (TG/HDL-C) ratio. On multivariate logistic regression, a high BMI (≥23.0 kg/m2), central obesity, and raised TG/HDL-C ratio were independent risk factors for developing NAFLD. Conclusion: This pioneer study defines the prevalence of NAFLD among rural indigenous population in Peninsula Malaysia. Lifestyle-related diseases, such as NAFLD can affect both rural and urban communities with equal severity. High BMI, central obesity, and elevated TG/HDL-C ratio were independent risk factors for developing NAFLD.
ABSTRACT
Purpose: Evidence-based medicine practice is now inevitable and health professionals are bound to understand researchconcept thoroughly to practice based on evidence. When we are talking about research, usually health professionals avoidinvolving in researches for many reasons. This study was designed to assess the fear regarding health professionals basedon a small scale designed focusing on scoring system and assess having some avoidance behavior.Methods: It was a cross-sectional study design. Between July and September 2019, a self-administered questionnaire wasdistributed through online after getting data regarding contacts details of health professionals. We have approached 600subjects in total, these participants were doctors, nurses, and allied health professionals. This health professional’s works allover the country (e.g., Ministry of Health, ministry centers, university, and private sectors). The inclusion criteria were all healthprofessionals work as registered health professionals. The Research Ethics Committee of the university approved the study.Results: The results depict out of total, 26.2% of male and 26.4% of female have high FEAR scores, and 29% of male havelow FEAR score in comparison to 18.4% of female. Health-care providers with bachelor show the highest FEAR score about27.7%, while those with postgraduate degrees show the lowest fear with 22.2%. A bivariate logistic regression analysis doneshows a statistically significant (P = 0.027) association seen with high fear score and age group, especially the youngestbetween 19 and 30 years and educational level (P = 0.024). Whereas, no statistically significant difference (P = 0.290) seen inthe FEAR score with working experience. No statistically significant difference (P = 0.251) seen in the FEAR score with living.Conclusion: Conclusively, the health professionals have fear about researches so need to assess its reasons for the rectificationof the problem.
ABSTRACT
@#Background: Malaysia continues to have a very low cadaveric organ donation rate of 0.48 per million population. The aim of this paper is to assess the attitude, beliefs and knowledge of patients and relatives at three different hospitals in Negeri Sembilan towards organ donation to increase the acceptability of organ transplant. Methods: A cross-sectional descriptive study with convenient sampling was carried out Hospital Tuanku Ja’afar, Hospital Port Dickson and Hospital Tuanku Ampuan Najihah in Negeri Sembilan, Malaysia. The participants answered a questionnaire regarding the source of their information about organ donation, their knowledge about brain death and willingness to donate. The association between variables was tested using chi-squared test or Fischer’s exact test as appropriate. Results: A total of 385 individuals completed the survey of whom 134 (35%) were willing to donate their organs upon death and 25(19%) were registered donors. Higher educational level (41%), age 30 and below (42%) and people who attended organ donation awareness campaigns (60%) were more willing to donate their organs. Correct understanding of brain death was associated with willingness to be an organ donor. The commonest reason cited for unwillingness to donate was opposition from family members. Conclusion: Marital status, religion, source of knowledge and occupation are significant factors in willingness to donate organs among Malaysians. Lower age and higher educational level were positive factors towards organ donation. Direct personal contact through awareness campaigns, family and friends has a potential for greater positive impact on organ donation.
ABSTRACT
The aim of this study was to identify the prevalence of functional disability and the possible factors that may be associated with functional disability in children and adolescents with juvenile idiopathic arthritis (JIA) in Sharkia Governorate. Methods: This cross sectional study was carried out in Rheumatology and Rehabilitation department, Faculty of Medicine, Zagazig University Hospitals. Forty-eight consecutive patients of JIA aged from 7 to 17 years underwent assessment of socio-economic and demographic characteristics, functional ability using the childhood health assessment questionnaire (CHAQ), disease activity using the Juvenile Arthritis Disease Activity Score based on 27 joints (JADAS-27), psychological symptoms using the Children's Depression Inventory (CDI) score. Results: Multivariate modeling was applied to determine the factors that associated with functional disability. A total of 80 % of the patients (39 of 48) had functional disability. In multiple regression analyses, high CDIscores (OR 20.78, 95 % CI 1.64 to 262.91, P =.019),JADAS-27 (OR 17.49% CI 2.16 to 141.62, P =.007), low socioeconomic status (OR 10.43, 95 % CI 1.24 to 87.57, P =.031) were strong predictors of functional disability in JIA patients.Conclusion: Our study on patients with JIA provides evidence suggesting that a total of 80 % of the patients had functional disability, that is associated with higher CDI scores, higher JADAS -27 and a low socioeconomic status
Subject(s)
Adolescent , Arthritis, Juvenile/epidemiology , Arthritis, Juvenile/physiopathology , Child , Disability Evaluation , EgyptABSTRACT
Background: Heart block to needs pacemaker implantation as management plan in emergency room
Objective: To determine the risk factors and indications for permanent pacing in patients presenting to a single cardiac center in Pakistan
Methodology: A cross sectional, single centered, study, was conducted from 1stSeptember 2015 to 30th April 2017. A total of 213 patients with different conduction defects, who presented to Punjab Institute of cardiology were included in the study. Patients of either sex with different conduction defects were included in the study after fulfilling inclusion criteria. Prevalence rates were calculated and analyzed by age, sex, different types of conduction defects and conventional risk factors for selected population. Data was entered in SPSS 21 and analyzed
Results: A total number of 213 patients were included. Frequency of conduction defect was increasing with age was observed with maximum frequency [28%]noted between 61 to 70 years of age. Hypertension [38%] and diabetes [23%] were the leading risk factors with female predominance and smoking in males among conventional risk factors. Among conduction defects third degree heart block was frequent [75%] among studied population
Conclusion: Rates of pacemaker insertions are increasing with age. The results are inline with international registries. Most common indication was 3rd degree heart block and common conventional risk factors were hypertension and DM. It is the need of time to establish a registry in Pakistani population and to record their patterns of presentation
ABSTRACT
Objective: To determine effectiveness and safety of echocardiography guided bed side Balloon Atrial Septostomy [BAS] in dextro transposition of great Arteries [dTGA] with intact ventricular septum [IVS] at a public sector tertiary care hospital Karachi, Pakistan
Methods: This case series include 40 patients with echocardiographic findings of dTGA with IVS and restricted PFO [
Results: Median age was 16 days, Majority of them [n=23, 58%] were severely cyanosed with SpO[2] of 41.4 +/- 3.4% and underwent emergency BAS and remaining underwent elective procedure. An increase in SpO[2]% from 46.0 +/- 6% to 81.0 +/- 3.0% [p=<0.001] and ASD size from 1.4 +/- 2.8mm to 5.45 +/- 0.4mm was observed [p=<0.001]. No complication was observed in most of cases [n=28, 70%]. Mean hospital stay was 3.4 +/- 1 days. Success rate was 97.5% however, one neonate died due to neonatal sepsis
Conclusion: Our study provides sufficient evidence that bed side balloon atrial septostomy is a safer technique, save a lot of time and resources which were required otherwise in transporting these patients to catheterization laboratory
ABSTRACT
Pioglitazone, peroxisome proliferator-activated receptor [PPAR-gamma] agonist, is a therapeutic drug for diabetes. Present study investigated the interaction between PPAR-gamma and alpha adrenoceptors in modulating vasopressor responses to Angiotensin II [Ang II] and adrenergic agonists, in diabetic and non-diabetic Spontaneously Hypertensive Rats [SHRs]. Diabetes was induced with an i.p injection of streptozotocin [40 mg/kg] in two groups [STZ-CON, STZ-PIO], whereas two groups remained non diabetic [ND-CO, ND-PIO]. One diabetic and non-diabetic group received Pioglitazone [10mg/kg] orally for 21 days. On day 28, the animals were anaesthetized with sodium pentobarbitone [60mg/kg] and prepared for measurement of systemic haemodynamics. Basal mean arterial pressure of STZ-CON was higher than NDCON, whereas following pioglitazone treatment, MAP was lower compared to respective controls. MAP responses to i.v administration of NA, PE, ME and ANG II were significantly lower in diabetic SHRs: STZ-CON vs. ND-CON [35%]. Pioglitazone significantly decreased responses to NA, PE, ME and ANG II in ND-PIO versus ND-CON by 63%. Responses to NA and ANG II were significantly attenuated in STZ-PIO vs. ND-PIO [40%]. PPAR-gamma regulates systemic hemodynamic in diabetic model and cross-talk relationship exists between PPAR-gamma and alpha1-adrenoceptors, ANG II in systemic vasculature of SHRs
ABSTRACT
The cough and cold are very widespread conditions and a common purpose for advice in general practice. Utmost often the sign and symptoms of cough are produced by acute viral airway infection and the course is frequently benign. But it can be converted into bacterial super-infection and can cause acute bronchitis. Herbal medicines are used to treat symptoms of the cough and cold, and among these medicines Ivy leaf is used to treat mucous discharge and irritation in throat due to the cough and cold. In addition to synthetic substances such as acetylcysteine, carbocisteins, ambroxol and bromhexine, herbal medicines contain saponins, which are used in these indications. Not just Ivy, but also the marshmallow and mustard seeds used for these indications. This clinical trial was conducted in 220 patients, in which 110 receive the CofNovex plus European Medicines Agency [EMA] syrup and 110 receive the placebo. The age range of patients was 3 years to above 15 years. The sample paired t-test was applied to evaluate the significant level. CofNovex plus [EMA] syrup was very effective in treating cough and cold symptoms. The new treatment CofNovex plus [EMA] syrup was safe and well tolerated in patient at given specific age group
ABSTRACT
Objective: To evaluate the effectiveness of using two different sizes of veins on upper limb for the prevention of propofol intravenous injection pain
Methodology: This prospective randomized clinical trial was conducted at Department of Anesthesia, King Saud University, Riyadh [KSA] from May 1, 2013 - May 31, 2014. A total of 160 patients, ages between 20-50 years, both male and female, American Society of Anesthesiologist [ASA] class I and II, posted for elective surgery under general anesthesia [GA] were included in the study and were divided into two groups. Patients with known history of allergy to lidocaine or propofol, obese patients, anticipated difficult intubation, already on any analgesics and pregnant patients were excluded from the study. Both groups received an admixture of propofol [1%] - lidocaine [2%] on induction of anesthesia through antecubital vein [Group-1] or through a vein on dorsum of hand [Group-2]. Pain was assessed as none, mild, moderate or severe
Results: Moderate to severe pain on intravenous injection of propofol-lidocaine admixture through antecubital vein and small vein on dorsum of hand was 20% vs 71%
Conclusion: There is marked reduction of pain when propofol - lidocaine admixture was injected through antecubital vein as compared to small vein on dorsum of hand
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Elbow/anatomy & histology , Hand/anatomy & histology , Administration, Intravenous , Pain, Procedural , Pain Measurement , Prospective StudiesABSTRACT
Objective: To determine the predictive validity of induction assessment scores of family medicine residency program for performance in final year of residency. Study Design: Psychometric [predictive-validity] study
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2008 to 2014
Methodology: All family medicine residents were evaluated
Family Medicine Residency induction assessment scores were used as independent predictor variables, whereas resident assessment scores during the final year residency program were used as dependent or outcome variables. Data was analyzed using SPSS version 19. Linear regression was used to determine predictive validity of induction scores as independent variables with outcome variables at 95% confidence level
Results: There were 33 residents. MBBS scores accounted for 30.1% of variance in final year Objective Structured Clinical Exam [OSCE] scores; whereas, induction written test accounted for 37.1% of variance in final year written test. Induction communication skill scores did not correlate with in-training communication skill scores or with the final year OSCE scores. Induction professionalism scores accounted for 13.7% of the variation in final year OSCE scores, but not with in-training continuous professionalism scores
Conclusion: Induction knowledge scores have acceptable predictive value for future knowledge and its application. Other valid and reliable assessment methods, such as multiple mini-interviews, should be explored for assessment of non-cognitive domains at induction
Subject(s)
Humans , Female , Male , Work Performance , Internship and Residency , Validation Studies as Topic , Linear Models , ProfessionalismABSTRACT
Objective: This brief research was initiated to search for cytotoxic effect of bio surfactant produced by Leuconostocmesenteroidesssp. cremorisisolated from raw cow’s milk. Methods: Extraction of extracellular bio sufactant was completed and partially purified by cold acetone precipitation, bio surfactant were tested against two cell lines, AMN3 (cancer cell line of mice mammary gland) and REF (noon cancerous normal cell line transformed) specifically regarding cell viability and proliferation. Results: Bio surfactant was found to decrease viability of AMN3 cancer cell line studied at concentrations 1:3,2:2 and 1:3 V/V (biosurfactant: free serum media), the inhibition percentage were 56.4%, 56.8% and 51.8% respectively, without affecting normal fibroblasts growth. Conclusion: The results gathered in this work are very promising regarding the bio surfactant potential for cancer treatment and encourage further work with other cell lines.
ABSTRACT
Introduction: In the course of their undergraduate training at the International Medical University, students receive a Basic Trauma Life Support course. Objective: We wanted to test the long-term retention of knowledge (after 16 months) of third year medical students who had received training in Basic Trauma Life Support Method: To assess the retention of knowledge one cohort of students who received the training course were tested again 16 months later using the same 30 question One Best Answer quiz. Results: Seventy-three students who underwent the course sat for the Retention test. The number of students who passed the Retention test was not significantly different from the test taken immediately after the course. The mean scores, 62.5% and 59.5% respectively, were however significantly different. Conclusion: Our study involves a relatively long interval between the course and retention of knowledge test shows encouraging results.
ABSTRACT
PURPOSE: No study had been conducted to assess the hospitals' environment for learning purposes in multicenter sites in Saudi Arabia. It aims to evaluate the environment of hospitals for learning purposes of pediatric residents. METHODS: We applied Postgraduate Hospital Educational Environment Measure (PHEEM) to measure the learning environment at six teaching hospitals in the Eastern Region of Saudi Arabia from September to December 2013. RESULTS: The number of respondents was 104 (86.7%) out of 120 residents and 37 females and 67 male residents have responded. The residents' response scored 100 out of 160 maximum score in rating of PHEEM that showed overall learning environment is favorable for training. There were some items in the social support domain suggesting improvements. There was no significant difference between male and female residents. There was a difference among the participant teaching hospitals (p<0.05). CONCLUSION: The result pointed an overall positive rating. Individual item scores suggested that their social life during residency could be uninspiring. They have the low satisfactory level and they feel racism, and sexual discrimination. Therefore, there is still a room for improvement.
Subject(s)
Female , Humans , Male , Surveys and Questionnaires , Discrimination, Psychological , Hospitals, Teaching , Internship and Residency , Learning , Pediatrics , Racism , Saudi ArabiaABSTRACT
Objectives: to determine the diagnostic accuracy of color Doppler ultrasound in the detection of malignancy in cold nodules in thyroid gland at Nishtar Hospital Multan, taking histopathology as gold standard
Materials and Methods: this cross-sectional study was carried out at Department of Diagnostic Imaging in Nishtar Hospital, Multan during May, 2012 to May, 2013. 81 patients with solitary thyroid nodule were included in the study. Ultrasonography including gray scale and color Doppler ultrasound was performed in each patient with high resolution probe. Findings suggestive for malignancy like microcalcifications, irregular margins, marked hypoechogenicity, shape taller than wider and intranodular vascularity on color Doppler ultrasound were noted. Nodules were labeled as malignant, if one or more positive findings were present. Sonographic findings were compared with histopathology. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated
Results: total 81 patients fulfilling inclusion criteria were included. 58.02% [n=47], were male and 41.08% [n=34] were female. Mean age and SD was calculated as 35.67+/-4.78.Frequency of malignancy in thyroid nodules [on histopathology] was recorded in 22.22% [n=18] while 77.78% [n=63] were benign. Sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and diagnostic accuracy of ultrasonography were 83.33%, 88.89%, 68.18%, 94.92% and 87.65% respectively
Conclusion: ultrasonography is a non-invasive technique having high diagnostic accuracy in detection of malignancy in cold nodules thyroid gland
ABSTRACT
Objective: To determine the accuracy of MR Spectroscopy [MRS] in diagnosing brain tumors
Study Design: Analytical study
Place and Duration of Study: Neurosurgery Department, Jinnah Postgraduate Medical Centre, Karachi, from November 2010 to April 2011
Methodology: Fifty cases with brain tumors, who presented to Neurosurgery Department of Jinnah Postgraduate Medical Centre, Karachi, during the study period, were included in the study. All patients underwent MRS and later brain. Those with recurrent disease were excluded. Data was collected with the help of proforma. Data was analyzed using SPSS version 16. Comparison of MRS findings and biopsy diagnosis was done. Sensitivity, specificity, negative and positive predictive values [NPV and PPV] were determined keeping histopathology as the gold standard
Results: Out of the 50 patients, there were 20 [40%] females and 30 [60%] males with mean age of 37 +/- 13.24 years. The commonest presenting complaint was headache [76%] followed by weakness [62%] and seizures [30%]. MRI had diagnosed 27 [51%] as neoplastic lesion. Spectroscopy reported 44 [88%] as neoplasms, while on histopathology, 42 [84%] were confirmed to have neoplasm. The accuracy of MRS was 94%, with 97.6% sensitivity, 71.42% specificity, 95.45% PPV and 83.3% NPV
Conclusion: Magnetic resonance spectroscopy can readily help in differentiating neoplasm from non-neoplastic brain tumors, thus an invasive brain biopsy procedure can be avoided
ABSTRACT
Background: Anti-streptolysin O titer is related to rheumatic heart disease
Objective: To assess anti-streptolysin O titer in rheumatic heart disease patients at Punjab Institute of Cardiology Lahore
Methodology: It was a cross-sectional study, 130 consecutive patients of rheumatic heart disease admitted at Punjab Institute of Cardiology Lahore between 1[st] January to 31[st] December, 2014, fulfilling the inclusion and exclusion criteria were enrolled. Their laboratory findings were taken; CRP and ESR levels were measured. ASO titer was measured by latex agglutination test. ASO Titer more than 200IU/ml was taken as significant
Results: It was found that 81[62.31%] patients of rheumatic heart disease has ASO levels more than 200IU/ml and 49[37.69%] patients has ASO less than 200IU/ml. Fifty two percent study subjects were female and 60% were between 4-15 years of age
Conclusion: Majority of the patients admitted with RHD has raised level of ASOT
ABSTRACT
Despite the great efforts in the past decade to control TB, the disease remains an enormous global health problem. Important goal of the International Standards for Tuberculosis Care ISTC is to promote unified approaches to the diagnosis and management ofTB among all categories of C clinicians. To assess the adherence of National Tuberculosis Programme NTP to ISTCs forTB care. A cross sectional study involved all the 15 District TB Coordinator DTCs in Baghdad from March 1st 2012 to May 30th 2012 through direct interview with their physicians, lab technicians, and treatment providers by a structured questionnaire extracted from the International Standards for Tuberculosis Care ISTC. Standards for diagnosis were implemented by most DTCs except for sputum culture of smear negative and childhood pulmonary tuberculosis 26%, 6% respectively. Standards for treatment also were implemented by the majority; poor implementation was only in tracing defaulters 40%.No incentives were given to patients, and in follow up pulmonary TB only 7% used two specimens of sputum as recommended. Most DTCs implemented standards for HIV in TB patients. Concerning standards for public health, only 33%evaluated all the highest priority contacts. Infection control plan was poorly implemented by most DTCs The NTP are partially adhering to the ISTCs, so we need more effort to promote TB health services
ABSTRACT
Objective: This study was designed to measure the outcome of the continuous professional development [CPD] course [Family Medicine Essentials] conducted and organised by the Ministry of Health [MOH] on the knowledge, skills, and attitude of primary healthcare [PHC] physicians in patient care
Materials and Methods: This study was based on pre- and post-implementation of training evaluation, which included the seven CPD modules in family medicine customised for non-certified family physicians working at MOH and PHCs in Saudi Arabia. The study was conducted from March 2009 to 2010 and it included 259 family physicians working in PHCs and MOH. The pre- and post-test scores for mean knowledge, skills and attitude were compared using paired t-test. P < 0.05 was considered significant
Results: The results showed that the percentage of male participants [80.3%] was higher than females [19.7%]. The mean age of the participants was 39.6 +/- 8.0 years. A significant difference was found in pre- and post-test scores of PHC physicians' attitude, knowledge and skills. Attitude increased from 77.5 +/- 6.1 to 83.0 +/- 7.8 [P < 0.0001], knowledge increased from 51.3 +/- 14.8 to 66.7 +/- 14.3 [P < 0.0001] while skills increased from 41.2 +/- 20.1 to 66.9 +/- 19.1 [P < 0.0001]
Conclusion: Participants in the CPD course showed significant improvement in their level of knowledge, clinical skills and attitude in patient care. However, further case-control studies and practice evaluations are required to obtain more in-depth information on the impact of this course on PHC physicians
ABSTRACT
To assess and compare three different types of feedback for presentation skills, self, peer and trainer feedback. Cross-sectional study. Faculty of Medicine at Atatürk University, Erzurum, Turkey, from March 2012 to December 2012. Participants were faculty members and instructor nurses. Each participant gave a 10-minute presentation, which was rated by peers, course trainers and the presenter himself/herself using a thirteen-item questionnaire [designed as a 5-point Likert scale]. Peers and trainers conducted the assessment during the presentation while the self-assessment was done later by watching a video recording of the presentation. Comparison of the points between the groups was made using the two-way ANOVA. Pearson correlation analysis was conducted to evaluate the relationship between the mean scores of self-assessment, peer and trainer assessment. Ten faculty members, 27 instructor nurses and 4 trainers participated in the study. A total of 775 feedback reports were collected for 37 participants. There was no significant difference between the feedback scores of the evaluators as well as the occupation groups [p > 0.05]. There was a strong positive and statistically significant correlation between trainer and peer [r = 0.73, p < 0.001]. Consequently, there were no differences in the evaluations of presentation skills between different stakeholders. Trainers should use the video recording method to self-evaluate their presentation skills, and they should invite their peers from time to time to improve their own personal development by using peer review methods