Effect of Ramadan fasting on glucose level, lipid profile, HbA1c and uric acid among medical students in Karachi, Pakistan

To assess the effect of Ramadan fasting on blood pressure, fasting glucose, lipid profile, uric acid, HbA1c, body mass index, body adiposity index and visceral adiposity index among fasting medical students, 35 students were recorded before, during and after Ramadan [August] 2011, for their blood pressure, anthropometric measurements, questionnaire response and blood sample. A blood sample was taken at each visit for glucose, lipid profile and HbA1c. Total physical activity, weight-to-height ratio, body adiposity index and visceral adiposity index were calculated for insulin sensitivity. Changes in anthropometric measurements were not statistically significant. However, physical activities increased significantly after Ramadan. Changes in blood pressure, fasting blood sugar, total cholesterol, HbA1c, uric acid and triglyceride were not statistically significant. Mean high density lipoprotein decreased significantly in Ramadan, while low density lipoprotein increased significantly

Knowledge of nursing students regarding housing characteristics and its evaluation

Objective The purpose of this research study is to assess the knowledge of housing characteristics and associated health problems in nursing students of Dow University of Health Sciences [DUHS]. Moreover, nursing students' knowledge about housing condition and public health risks were also analyzed

Methodology The study was conducted at Institute of Nursing, DUHS, Karachi. In 2012, 90 nursing students were asked to participate in this study with their consents. A teaching session was conducted as a part of this study that lasted for two hours. At the end of teaching session students were requested to fill out the questionnaire about their housing condition and health related problems along with a feedback of the session

Results The study highlighted that on average, participants had been living in the same housing for the last one year, with median and inter-quartile range of 12 and 16 months respectively. Twelve participants [13%] mentioned that they had suffered from diarrhea or vomiting during last three months, and 7.6% participants reported that their housing conditions were affecting their respiratory health. A large number of participants [89.1%] and [87.2%] did not find any visible mold in their house/hostel or kitchen respectively. Almost 61% and 80% participants reported about the mechanical ventilation and window in the bathroom respectively

Conclusion Reduction in dampness results in improvement of various health symptoms. House dust mite can be controlled through constant mechanical ventilation. The majority of the participants showed willingness towards such seminars and discussions for their future classes

Asymptomatic left ventricular diastolic dysfunction in NIDDM; evaluation and association with glycemic control

DM is an established risk factor for congestive cardiac failure, in which the diastolic function is impaired. The majority of these patients may be asymptomatic without signs of overt heart failure. The aim of this study was to determine asymptomatic Left Ventricular Diastolic Dysfuction [LVDD] in Non-Insulin Dependent Diabetes Mellitus [NIDDM] in association with glycemic control and to assess the risk factors for the development of diastolic dysfunction. This cross sectional study was conducted at the Tabba Heart Institute, Karachi from Dec, 2011 to Nov 2012, 101 asymptomatic patients with type 2 diabetes without evidence of cardio-respiratory illness were enrolled. LVDD was evaluated by Doppler echocardiography, which included the valsalva manoeuvre. A total of 101 patients, LVDD was found in 67 subjects [66.34%] of whom 52 [51.48%] had impaired relaxation and 15 [14.85%] had a pseudonormal pattern of ventricular filling. The potential risk factors for the development of LVDD in type 2 diabetics were [a] age ?45 years was associated with an almost three times higher risk for LVDD, [b] females had almost two times a higher risk of LVDD as compared with men, and [c] Diabetic patients of more than two years' duration had a two times higher risk of LVDD. The study results also indicate that LVDD was significantly associated with increased age, longer duration of Diabetes and glycemic control [glycated HbA1c levels] and LVDD is found in diabetic patients before the onset of clinically detectable disease. The high prevalence of LVDD suggests that screening for LVDD should include procedures such as the valsalva manoeuvre

Therapeutic evaluation of kalonji [nigella sativa] in dyslipidemia - a randomized control trial

Dyslipidemia is one of the most common risk factors of cardiovascular diseases. An increased level of cholesterol is responsible for atherogenesis, which ultimately leads to the development of cardiovascular, cerebrovascular, and peripheral vascular diseases. According to a survey report, 36.3% patients are dyslipidemic; therefore, the problem is increasing day by day as a huge cause of morbidity and carries economic burden for society. These days, dyslipidemia is treated using lipid-lowering agents with lifestyle intervention; however, lipid-lowering agents produce various side effects. In Unani system of medicine, several drugs are used as lipid-lowering agents, which are comparatively safe. However, such drugs are still not validated on scientific parameters. Thus, a clinical trial was conducted with the objective to evaluate the efficacy and safety of Unani drugs in the management of dyslipidemia. The study was designed as single-blind, randomized with standard control. Thirty patients of dyslipidemia were selected and randomly assigned to control and test groups, the test group comprising 20 patients and the control group comprising 10. The test group received the powder of Kalonji in the form of capsule [two capsules twice a day] and the control group received Lipotab[R] [two tablets once a day for 60 days]. All the patients were assessed on subjective and objective parameters. The result was analyzed statistically using appropriate statistical tests. The test drug shows significant results on few subjective and objective parameters in comparison to the control drug. Overall, improvement was observed in the test group without any clinically and statistically significant side effects or toxicity. The compliance to the treatment was found good. The study revealed that the comparative analyses of both test and control drugs were not statistically significant, but improvements in subjective and objective parameters were present in both groups

Reliability of cast index for dental caries detection

To access the inter-examiner reliability of CAST [Caries Assessment Spectrum and Treatment] index for detecting dental caries status among patients visiting a public sector dental hospital of Karachi, Pakistan. Cross sectional study. This study was conducted in the dental diagnostic outpatient department of a public sector dental hospital, Karachi, Pakistan, over a period of one month from September 2013 to October 2013 Selected/consented participants were examined for dental caries status by the two trained and calibrated examiners using CAST index. A structured and validated proforma was used to record the findings. The inter-examiner reliability was undertaken to find out the reproducibility of this novel method of caries examination. Data entry and analysis was done using SPSS software at 5% level of significance. Descriptive statistics were performed that involved the frequencies of age and gender. Inter-examiner reliability of CAST was assessed using percentage agreement and Cohen's Kappa value. A total of 100 subjects were recruited for the present study. There were 63% females and 37% males with a mean age of 31 +/- 17 years. The percentage agreements obtained for the two examiners were between 70-100% for 9 different codes of the CAST index. The Cohen's Kappa value identified was 0.99. A strong inter-examiner reliability has been observed for scoring the CAST index which exemplifies the entire patho-physiological phases of dental caries. Results of this study substantiate the potential of CAST index for reproducibly scoring the enamel, dentine and pulp lesions

Current efficacy of antibiotics against Klebsiella isolates from urine samples - A multi-centric experience in Karachi

Due to emergence of bacterial resistant strains, the effectiveness of current antibiotic treatment without culture/sensitivity testing is questionable. Our study aims to assess the present sensitivity profiles of Klebsiella isolates from urine samples and provide options for empiric prescription in critically ill patients. Klebsiella pneumoniae isolates collected over a period of 28 months till January 2011 from 1, 617 urine samples of subjects presenting with Urinary Tract Infections were identified at a local diagnostic lab using standard protocol and subjected to Kirby-Bauer disk diffusion sensitivity testing. MICs were also estimated by E-nephelometry. Among 20 drugs used, low sensitivity was found to amoxicillin [0.1%], doxycycline [11.5%], nitrofurantoin [15.5%], amoxiclav [18.2%], gentamicin [35.4%], pipemidic acid, cephradine [40.3%] and cotrimoxazole [43.1%]. The isolates were more sensitive to cefuroxime [55.9%], cefixime [57.7%], ciprofloxacin [62.5%], ofloxacin [63%], ceftriaxone [66.2%], ceftazidime [66.4%], cefotaxime [66.6%], fosfomycin [77.5%] and amikacin [89.4]. Most effective were cefroperazone.sulbactam [95.8%], piperacillin.tazobactam [95.7%] and imipenem [97.7%]. Self-medication, lack of awareness, and the misuse of antibiotics by doctors has exacerbated the menace of microbial resistance. The study warrants the prudent choice of drugs in adherence with prevailing sensitivity profiles

Effects of Ramadan fasting and physical activity on glucose levels and serum lipid profile among type 2 diabetic patients

To assess the effect of fasting and physical activity on blood pressure, fasting glucose, cholesterol, triglyceride, high density and low density lipoproteins among diabetic type 2 patients. Seventy five patients who had three visits [last ten days of Shabann [visit 1], Ramadan [visit 2] and Shawwal [visit 3]] were included in the study. Physical measurements, clinical measurements and 12 hours fasting blood sample were taken, along with an interview for demographic information and physical activity on each visit. The samples were analyzed for 1] Glucose, 2] Cholesterol, 3] Triglyceride, 4] Uric Acid, 5] HDL-C, and 6] LDL-C. The mean weight of the patients decreased significantly from 71.43 kg to 69.41 kg from visit 1 to visit 2. Mean systolic blood pressure also decreased significantly from 124.25 mm/Hg to 119.86 mm/Hg while. Mean triglyceride level decreased from 239.095mg/L to 207.07 mg/L from visit 1 to visit 2 and it kept decreasing to 159.25 mg/L till third visit. Mean LDL value increased from 104.12 mg/L to 112.64 mg/L from visit one to visit two and then further increased to 119.0 mg/L on the third visit. Ramadan fasting is safe for diabetes type II patients and is associated with weight loss and improvement in the overall diabetic control. Furthermore, the physical activities could reduce the body weight, waist measurement, systolic blood pressure, triglyceride and HDL

Prevalence of HBV and HCV infection in Faisalabad

Blood-borne pathogens like hepatitis B virus [HBV] and hepatitis C virus [HCV] are considered major but preventable public health problems in the developing world. Routes of transmission include unsafe injections, blood, sex and transmission from infected mothers to their babies and many other unusual routes like through barbers, dentists and beauty parlors. In Pakistan, national efforts have been made to reduce potential transmission of HBV and HCV, e.g. HBV vaccination programmes, public health education programmes on safe sex, blood and injection practices and legislation to standardise and ensure safety in blood banks. A common element of these programmes and initiatives is a baseline situation analysis using routine surveillance data, or data from surveys or studies, typically followed by a repeat analysis to determine if any change has occurred as a result of an intervention. Given the paucity of surveillance data in Pakistan, high risk areas are an excellent sites for sentinel surveillance of blood-borne pathogens to determine trends in prevalence and disease distribution defined on social, demographical, geographical, and biological variables. We therefore conducted a baseline analysis of residents in Faisalabad city which is a high risk area as part of a pilot phase to develop a sentinel surveillance system for HBV and HCV infections. Similar analysis are expected to follow data in subsequent years to allow comparisons based on time, place and person to determine trends and evaluate interventions. A total of 193 blood samples were collected from Faisalabad. Blood samples safely reached Laboratory and were tested for HBV and HCV by ELISA technique. Results showed that 4.5% blood samples were reactive for HBV and 22% blood samples were reactive for HCV. In HBV reactive cases co-infection is 22% and in HCV reactive cases co-infection is 4.6%

Management of macular pucker

To document the outcome of macular pucker surgery in terms of improvement of visual acuity. Design: Interventional quasi experimental study. Setting: Ophthalmology Department, Civil Hospital, Karachi. Patients and Twenty-two patients with macular pucker underwent surgical repair. Pars plana posterior vitrectomy with epiretinal membrane peeling and internal limiting membrane peeling [maculorrhexis] was carried out. Postoperative follow-up was done for one year. Main outcome measure were visual acuity, causes and ocular complications. Data was analyzed using SPSS Version-10. Non-parametric sign test with chi-square statistic was used to compare the pre-operative and postoperative outcome. The macular pucker was successfully removed in 18 patients that revealed high statistical significance regarding improvement in visual acuity. Earlier, significant improvement [18 / 22 cases] was observed at three-month postoperative examination [p < 0.0001]. Insignificant [9/22] postoperative complications were noted at six-month postoperative follow-up. Metamorphopsia was relieved in 18 patients. Ten patients developed cataract, 4 patients developed increased intra-ocular pressure [transient] and two patients developed retinal detachment. Pars plana posterior vitrectomy with epiretinal membrane peeling and internal limiting membrane peeling [maculorrhexis] can successfully remove macular pucker, improve vision and relieve metamorphopsia