Nutrition and dietetics curriculum for BS study program - assessment and evaluation

The main objective of this study was to evaluate the curriculum for BS degree program in Human Nutrition and Dietetics in Pakistan. For this purpose, a working group comprising of experts in the field from NEAT [a Pakistan based registered organization: www.neat.org.pk ] was assigned the responsibility to evaluate the curriculum. As suggested by the working group, a modified Delphi technique was used and a group of expert panelists [n=46] was identified. Three main 'areas of enquiry' '[AE]' were proposed, where the responses from the panels were requested: AE[1] evaluated the curriculum against a set of 15 characteristics reported in the literature; AE[2] evaluated the curriculum against 32-item 'knowledge areas' based on findings of a recent investigation. AE[3]: scored the course contents of individual courses against a 'perceived standards' in light of a 14-item Battery. For AE[1] and [2] and [3], the panelists responded, respectively, on scoring scale [0 - 4] and ticked any one from 1 -3. The data were analyzed for mean and median scores for each individual item. Findings of AE[1] suggest that majority of the panelists agreed that the curriculum 'adequately'/'excellently' highlighted the fifteen criteria set-forth. Findings of AE[2] suggest 8 out of 32 'knowledge areas' being 'poorly' reflected in the curriculum. Findings of AE[3] suggest majority [28/43: 65%] of courses fulfill the perceived standards except 2 courses ["Nutrition through Life Cycle"; and "Research Methods in Nutrition"] fulfilling <50% of the required standards. In all, the findings are of suggestive that the curriculum is 'good' except certain shortfalls. It was recommended that the deficiencies may be addressed in the coming revision

PAIgG and PAIgM levels in secondary dengue virus infections lead to thrombocytopenia in patients from KP, Pakistan

Objective: To understand the impact of platelet associated immunoglobulin G (PAIgG)/platelet associated immunoglobulin M (PAIgM) on severity of dengue virus infection leading to thrombocytopenia. Methods: In this study we examined a total of 52 patients who were having secondary infection of dengue in acute phase by using competitive ELISA. Results: A decrease in the platelet count was observed at the acute phase of infection while all along the recovery stage the count of platelet was significantly increased. A significant decrease was observed in PAIgG and PAIgM in these subjects. Inverse correlation was found between platelets count and PAIgG/PAIgM among the subjects studied. In the platelets elution from ten subjects, anti-dengue virus immunoglobulin G and immunoglobulin M were observed. PAIgG and PAIgM with inclined levels were higher in dengue hemorrhagic fever than the classical dengue fever. In the development of dengue hemorrhagic fever PAIgM inclined level was independently associated with high specificity, showing a possible indication of dengue hemorrhagic fever. Conclusions: This study suggests that in secondary dengue virus infection, the PAIgG and PAIgM levels, and the activity of anti-dengue virus play key roles, both in the development and severity of the disease.

Surgical site infection; frequency after open cholecystectomy using Southampton wound scoring system in surgical unit Khyber teaching hospital Peshawar

To assess the post operative wound complication after open cholecystectomy for uncomplicated Cholelithiasis. Cross sectional descriptive. Surgical unit of Khyber Teaching Hospital Peshawar Pakistan. 223 patients underwent elective open cholecystectomy January 2011 to July 2012. 90% patients had normal healing [grade 0 or I] ,7.5% had minor complications [grade II or III], 2.5% patients had major complication [grade IV or V] recorded during hospital stay. On follow-up in out-patient department 81%patients found to have normal healing [grade 0 or I], 15% patients had minor complications [grade II or III] and 4% patients had major complications [grade IV or V]. There was an increase noted in wound grades during follow up for surgical site infections as compared to their record during hospital stay. Southampton wound scoring system is a useful tool for detection of surgical site infection and standardization. Auditing of surgical site infection by Southampton wound scoring will help the patient, surgical team and sterilization protocol to be improved

Weight loss in HCV patients can be used as a surrogate marker for evaluation of interferon [IFN-alpha] treatment efficacy - a prospective pilot study

The aim of the study was to investigate whether weight loss followed the same pattern in HCV patients ['responders' and 'non-responders] after interferon [IFN-alpha] treatment. A total of 20 male HCV positive patients [mean age 33.1 +/- 9.9] in Peshawar, Pakistan participated in this study. They were initially tested as HCV positive, and were given IFN/Ribavarin treatment for 6 months. Changes in body weight [BW], lean body mass [LBM] and body fat [BF] were monitored on monthly basis. End to treatment response [ETR] was established by a final undetectable HCV RNA in serum at the end of therapy and the patients were categorized as either 'responders' or 'non-responders'. The results show a total of 12 out of 20 patients as 'responders' [60%]. All patients lost weight and the mean weight loss in 'responders' and 'non-responders' was 6.2 [ +/- 1.5] and 5.8 [ +/- 1.4] Kg, respectively. There was a significant difference in the mean change in BW, LBM, and BF between 'responders' and 'non-responders' during the last 3 month period only. This suggests that difference in drug response in HCV starts from month 4 and onwards [i.e. during the last 3 months]. In conclusion, weight trends during treatment should be monitored as weight loss may be used as a surrogate marker for ERT to the current standard of care.

First degree hemorrhoids; efficacy of injection sclerotherapy experience in surgical department

Traditionally the treatment of Ist, 2nd and 3rd degree haemorrhoids is conservative management with fibre rich diet and better defecation discipline. If symptoms prevail then there are a wide range of treatment modalities. To evaluate the efficacy of injection Sclerotherapy for First degree haemorrhoids using 5% Phenol in Almond oil. This case series study was conducted on 83 patients with first degree piles in Surgical-C unit, Department of Surgery, Khyber Teaching Hospital Peshawar from 01/09/2010 till 01/03/2011. After Informed consent, injection Sclerotherapy with 1-2ml of 5% Phenol in Almond oil was injected in the sub mucosal plane of each pile case above the dentate line. Patients were reviewed at 3 weeks interval for bleeding per rectum for effectiveness of the procedure. A total of 83 patients with first degree haemorrhoids included in the study out of which 62 [74.7%] were male and 21 [25.03%] were female with M: F=2.99:1. Average age 41.1 years+0.1 SD with range 20-60 years. Efficacy was observed in 68 [81.83%] patients where 15 [18.07%] patients showed no results. Injection sclerotherapy is simple, convenient and effective outdoor procedure for first degree haemorrhoids

Scintigraphic evaluation of kienbock's disease in comparison to plain radiography

Kienbock's disease is a rare pathology of uncertain etiology, resulting in osteonecrosis of lunate bone. The authors present interesting images for comparison of both plain radiography and bone scan findings done in a young male laborer.

effects and underlying mechanism of interferon therapy on body weight and body composition

Body weight changes in HCV patients on interferon therapy are well documented. However, the underlying mechanism involved in these changes is poorly understood and rarely reported. The main objectives of this review are to 1] discuss changes in body weight and other compartments of body composition, particularly, body fat, and 2] to discuss the underlying mechanism for these changes. The literature review suggests weight loss [12-29%] as a function of interferon therapy is common, affecting up to 90% of HCV patients. Whilst, loss in weight means proportionate loss in other body compartments [lean body mass and body fat, in particular] data on changes in segmented body composition are fragmentary. The possible mechanisms underlying weight loss or changes in other body composition have been reported and these include suppressed appetite due to induction of TNF by IFN, a decrease in serum leptin level, and importantly mitochondrial damage induced by the therapy. It is, therefore, suggested that close monitoring of chronic HCV patients receiving PEG-IFN and/or ribavirin for side effects of these drugs, particularly those related to weight loss, is vitally important from clinical point of view

Nutritional care of patients with pressure ulcers: some evidence based guidelines

Malnutrition has been shown to be a significant factor in the development and deterioration of pressure ulcers [PU]. However, whether nutritional intervention can be effective in the treatment of PU is still unclear and controversial mainly due to inconsistent results reported in some recent studies. The objective of this review is to evaluate the effectiveness of nutritional care in patients with PU. The review is expected to comprehend the definition, prevalence and effectiveness of nutritional care on the prevention and treatment of PU. In addition a discussion on the level of adequacy of nutritional care and the role of enteral and parenteral nutrition on the prevention and treatment of PU is also provided. Data from survey reports, health statistics, descriptive, cross-sectional and longitudinal studies published between 1990-2008 on the topic were included. Data searches concentrated on human studies only excluding those with irrelevant and incomplete conclusions. The literature was accessed using data bases and abstracting systems including Medline, PubMed, Science Direct, Research GATE, etc. The prevalence of PU may range from 5-50%. Nutritional status is an independent risk factor for the development of pressure ulcers. Data from nutrition supplementation studies show faster recovery from PU and lesser hospital stay. Diets with high energy and protein, supplemented with vitamins, minerals and immunomodulators are generally indicated in PU. Enteral and parenteral nutrition are indicated when the patient fails to achieve nutritional needs through oral route and are recommended to be used without any contraindications

Mortality in above 40% thermal burns patients

To find out the frequency of mortality of thermal burns in different ages and gender. Descriptive study. The study was conducted in Burn Unit, Khyber Teaching Hospital Peshawar, from October 2007 to 31[st] March 2008. One hundred patients with TBSA more than 40%, any degree of depth and any thermal cause were included in the study. The interpretation and analysis of data were done with the help of SPSS 10.0. There were 52 [52%] males and 48 [48%] females. The mean age was 17.90 year + 14.5 year. The maximum number of patients [30%] were less than 10 year of age, followed by 18 [18%] of 21-30 year and 15 [15%] of 31- 40 year age group. According to TBSA burns, 47 [47%] patients had 51-60% burns, followed by 40 patients [40%] having 40-50% burns. Fifty five patients died, including 28 males [50.90%] and 27 females [49.10%]. Mortality was 100% in patients who were above 80 year of age having more than 80% TBSA burns. Thirty three patients [60%] died of septicemia, followed by 11 [20%] and 10 [18.19%] patients with acute renal failure and irreversible shock respectively. The mortality in this study was high due to large TBSA burns, deep burns, referral from peripheral areas without proper treatment, failure to avail medical treatment in time and septicemia

Colorectal carcinoma; frequency of common histological types in patients below 40 years of age presenting to tertiary care hospital

Colorectal cancer is the second commonest cause of death in the world. Its incidence in young patients is on rise. To determine the common types of colorectal carcinoma in patients below 40 years of age presenting to tertiary care level hospital. Study Descriptive study It was carried out at Surgical Department, KTH, Peshawar January 2007 to January 2008. Total of 50 patients younger than forty years of age with colorectal cancer were included in study for the determination of histologic types. There were 66% males and 34% were females. The commonest affected age group was 31-35 years old having 46% cases. On history 86% patients complained of altered bowel habits and on clinical examination anemia was present in 72% patients. Left and right sided tumors were found in 70% and 30% patients respectively. Adenocarcinoma was the commonest type found in 94% cases followed by lymphoma [4%]. The incidence in young age group [

Multiple myeloma in younger age

A Multiple Myeloma [MM] is rare in younger age group. We report MM in a 30-year-old female, who presented with multiple lytic areas upon skeletal survey, but with negative Bence Jones protein. Bone marrow biopsy confirmed it to be a case of multiple myeloma. Patient was put on chemotherapy and radiography to which she responded and now is ambulatory

Dietary patterns of macro and micro nutrients intake of children and mothers of the christian community living in peshawar

To find out the dietary patterns and nutrient and energy intakes of school going children and nursing mothers from the Christian minorities of Peshawar. A total of 259 individuals [186 children mean age 7.21 +/- 1.28 yrs and 73 nursing mothers mean age 37.6 +/- 4.7 yrs] of 68 families were included in the study. Information regarding dietary patterns and food intakes were obtained and recorded in a pre-tested questionnaire. Nutrients were calculated using food composition tables. Percent adequacy for each nutrient was calculated dividing the total nutrient content by the value of recommended daily allowance [RDA] for that nutrient and multiplying with 100. Children and mothers of the Christian communities consumed almost the same types of diets that are consumed by the genera] population of the country. Rice, wheat bread, meat, pulses, vegetable curry, and tea were the main constituents of the diets used by these subjects. The nutrients were calculated from actual ingredients used for dish preparation and the quantity of food consumed by the families. The percent adequacy of energy, protein, Ca, Fe, vitamin A, D, C and niacin, were respectively 85.8, 68.9, 49, 5, 65.2, 44.8, 48, and 70% of the RDA for children. While in case of nursing mothers, the percent adequacy for these nutrients were 75.8, 70.4, 34.5, 56.2, 54.2, 68, 7 and 80.2%. respectively. Children and nursing mothers of the Christian community suffer from malnutrition and have poor nutritional status when compared to the rest of their counterparts of the country

General and nutritional protocol nasogastric [NG] feeding of neonates in a public hospital of peshawar, NWFP

The purpose of the study was to evaluate the nutritional intake of the infants through nasogastric [NG] feeding and the associated complications. Ten infants [mean age=17.3 +/- 9.3 days, mean wt=2.1 +/- 0.5 Kg] were included in the study. Nutrients and energy were calculated from the NG feed using food composition tables. Monitoring protocol and complications were observed. The mean total energy intake was 114.62 +/- 9.48 Kcal/day [47% of RDA]. The mean protein intake was 1.25 +/- 0.07 g/day, fulfilling only 27% of the requirements. The mean per day intakes of Ca, P, Zn, Fe, and Mg and mean per day intake of vitamins A, D, E, B6, B12, folate, thiamin, and ascorbic acid from NG tube were much lower than RDA. Aspiration, reflux, tube blockage, tube displacement, gut infection and diarrhea were noted. Monitoring of NG feed was satisfactory. The intake of protein and energy and frequency of most of complications is an issue of concern. Stress must be placed to increase the energy and nutrients intake [particularly protein], further strengthening monitoring and to minimize associated complications of NG feeding in neonates

Human embryology and nutrition - some factor from the Holy Qur-an

The Holy Qur-an has provided vast information on various stages of human embryology. It has been stated that man has been created from the elements provided mainly from water and soil. Qur-an states that after fertilization, nutfah [zygote] rests in the mother's womb for some time, where it gets its nourishment and protection from the outside stresses. It grows into alaqa [a clot of congealed blood] and then into mudgha [fetus lump]. Then the mudgha is converted into izaman [mass of bones]. Then the mother gives birth to the child. The term used in Qur-an for giving birth is nukh-raja-kum tiflan [expulsion of the baby]. The newborn feeds on the mother's breasts for at least two years or two and a half years, as Allah states in the Holy Qur-an