Lack of association of statin use with vitamin D levels in a hospital based population of type 2 diabetes mellitus patients

Objective: To investigate the relationship of statins [drug given to reduce serum levels of LDL-cholesterol] on vitamin D levels of Pakistani type 2 diabetes mellitus [DM] patients in a hospital in Karachi

Methods: In a cross-sectional survey, 312 consecutive patients with type 2 DM [219 males and 93 females, age 22-70 years] were recruited with informed consent. A questionnaire was administered to find out whether they were statin users or non-users. Serum was analyzed for concentrations of 25[OH] vitamin D [25[OH]D] and other related biomarkers such as serum cholesterol, triglycerides, HDL-cholesterol, LDLcholesterol, phosphate and calcium using kit methods. Multiple Linear Regression was used to evaluate association of statin use with serum levels of vitamin D while adjusting for related covariates including duration of statin use, duration of type 2 DM and smoking

Results: Mean concentrations of serum cholesterol, and LDL-cholesterol were lower among statin users compared to statin non-users [P < 0.01], while HDL-cholesterol levels were higher [P<0.01]. No relationship was observed between statin use and serum levels of vitamin D [P=0.768], when adjusted for age, gender, BMI, duration of type 2 DM, smoking, serum cholesterol and LDL-cholesterol. The adjusted regression coefficient [beta] and standard error [SE[beta]] for statin use duration were 0.012 [0.042], when serum levels of vitamin D was taken as an outcome

Conclusion: Lack of association was found between statin use and vitamin D levels in a hospital-based population of Pakistani patients with type 2 DM

Association of airborne Aspergillus with asthma exacerbation in Southern Pakistan

BACKGROUND: Exposure to airborne fungi has been related with exacerbation of asthma in adults and children leading to increased outpatient, emergency room visits, and hospitalizations. Hypersensitivity to these airborne fungi may be an important initial predisposing factor in the development and exacerbation of asthma. OBJECTIVE: This study was conducted to determine an association between fungal types and spore concentrations with the risk of asthma exacerbation in adults. METHODS: This cross-sectional study was conducted from May 2008 to August 2009 at the Aga Khan University Hospital Karachi, Pakistan. All adult (age≥16 years) patients presenting to the hospital with acute asthma exacerbation were enrolled after informed consent. A home survey was conducted for each patient to assess their environmental characteristics. Indoor air samples were also obtained from the patient's home to determine the type and spore concentration of fungi within the week of their enrollment in the study. RESULTS: Three hundred and ninety-one patients with an acute asthma exacerbation were enrolled during the study period. The mean age of participants was 46 years (standard deviation, ±18 years) and 247 (63.2%) were females. A trend of higher asthma enrollment associated with higher Aspergillus concentrations was found in two consecutive summers. A total of nineteen types of fungi were found in air samples. Aspergillus spp. was the most frequently isolated fungus with acute asthma exacerbation. CONCLUSION: An association of higher concentration of indoor Aspergillus spp. with asthma exacerbation in adults was observed in this study.

Knowledge, attitude and practice of vitamin supplementation among patients visiting out-patient physicians in a teaching hospital in Karachi

To determine the knowledge, attitude and practices regarding the use of vitamin supplements among patients visiting Out-Patient clinics of a teaching hospital. Four hundred patients were interviewed during the period of July to September 2008, at the Out-patient clinics, Aga Khan University hospital, Karachi. A pre-tested and structured questionnaire was used to collect information. It consisted of questions regarding demographics, awareness of vitamin supplements and its consumption, reasons for usage and its effects. The purpose of the study was explained and assurance of confidentiality was given. After obtaining written consent, eligible individuals were interviewed. Statistical Package for the Social Sciences version 19.0 was used to analyze the data. The results revealed that 98% of the respondents were aware of vitamin supplements. The most known vitamin was found to be Vitamin C [16.9%] with Vitamin K being the least well-known [0.4%]; while 51.8% of the respondents were unaware of the harmful effects of vitamin supplements. The results also showed that 84.8% of the study population had taken vitamin supplements, and 79% of the participants considered that vitamin supplements to be helpful. Taking vitamin supplements as a compensation for the deficiencies in the body was the most frequently chosen answer [17.7%] as the reason for use of vitamin supplements. On the other hand, a majority of the population was unaware of the indications for use of vitamin supplements. This study highlights a very significant yet ignored issue of vitamin supplementation in Pakistan. A need exists to inform the general population about the use of vitamin supplementation. The media and the medical community are required to play their role in this regard. Short/ refresher training courses are needed for doctors to update and disseminate adequate knowledge of vitamin supplementation to their patients

BRCA1 status in Pakistani breast cancer patients with moderate family history

To determine BRCA1 status in breast carcinoma patients of Pakistani origin. Observational study. The Oncology Clinics of the Aga Khan University Hospital, Karachi, between May 2005 and December 2009. Fifty three breast cancer patients based on clinical and laboratory diagnosis were recruited for this study. Moderate family history was defined as having a close relative [mother, daughter, sister] diagnosed with breast cancer under 45 years. Peripheral blood samples were collected from each patient in a 5 ml tube containing EDTA as anticoagulant. Subsequent to DNA extraction, mutational analysis of BRCA1 exons 2, 5, 6, 16, 20 and 22 was carried out using single strand conformation polymorphism [SSCP] assay while protein truncation test [PTT] was used to examine mutations in exon 11. All BRCA1 sequence variants were confirmed by DNA sequencing. Twenty-three patients were diagnosed with early onset breast cancer, 30 patients had moderate family history. At the time of diagnosis, the median age of enrolled patients was 39 years [range 24-65 years]. Out of 53 patients, analyzed by SSCP assay, mobility shift was detected in exon 6, 16 and 20 of three patients, whereas one patient was tested positive for mutation in exon 11 by PTT assays. All patients with BRCA1 mutations were further confirmed by DNA sequencing analysis. In exon 16 c.4837A > G was confirmed, which is a common polymorphism reported in several populations including Asians. Moreover, mutations in exon 6 [c.271T > G], exon 20 [c.5231 delG] and exon 11 [c.1123 T > G] were reported first time in the Pakistani population. Several BRCA1 mutations were observed in Pakistani breast cancer patients with moderate family history. Therefore, mutation-based genetic counselling for patients with moderate family history can facilitate management, if one first or second degree relative or early onset disease is apparent

High prevalence of mild hyperhomocysteinemia and folate, B12 and B6 deficiencies in an urban population in Karachi, Pakistan

To find out the prevalence of hyperhomocysteinemia, and deficiencies of folate, vitamin B6 and vitamin B12 in an urban population in Karachi, Pakistan. In a pre and post experimental study, eight hundred and seventy-two apparently healthy adults [aged 18-60 years; 355 males and 517 females] were recruited from a low-income urban locality in East of Karachi from February 2006 to March 2007. Fasting venous blood was obtained. Serum was analyzed for folate and vitamin B12. Plasma was analyzed for pyridoxal phosphate [PLP, coenzymic form of B6] and total homocysteine. A group of vitamin-deficient individuals [n=194] was given 3-week supplementation with folic acid [5mg/day], methycobalamin [0.5mg/day] and pyridoxine hydrochloride [vitamin B6, 50 mg/day]. After supplementation, serum/plasma levels of folate, vitamin B12, PLP and homocysteine were again determined. Prevalence of hyperhomocysteinemia [>15micromol/l] was 32%. Similarly percent values of folate deficiency [<3.5ng/ml], vitamin B6 deficiency [PLP<20 nmol/l] and vitamin B12 deficiency [<200pg/ml] in the study population were 27.5%, 33.7% and 9.74%, respectively. Hyperhomocysteinemia was associated with male sex, folate deficiency, vitamin B12 deficiency [OR [95%CI], 8.3[5.7-12.1]; 2.5[1.76-3.58]; 2.6[1.5-4.5], respectively]. A 3-week supplementation with folic acid, methycobalamin and pyridoxine hydrochloride in vitamin-deficient subjects decreased plasma homocysteine levels by 37%. High prevalence estimates of folate, vitamin B12, and vitamin B6 deficiencies appear to be the major determinants of hyperhomocysteinemia in a low income general population in Karachi

Comparison of urdu version of strengths and difficulties questionnaire [SDQ] and the child behaviour check list [CBCL] amongst primary school children in Karachi

To compare CBCL [Child Behaviour Check Llist] Urdu, with the validated Urdu version of Strengths and Difficulties Questionnaire [SDQ] used as "gold standard" among school children in Karachi, Pakistan, and to develop local cutoffs for CBCL using SDQ as a gold standard. A cross-sectional study. Schools of Karachi metropolitan area from January to December 2006. The Strengths and Difficulties Questionnaire [SDQ] and Child Behaviour Check List [CBCL] was completed by parents of 5-11 years old primary school children in Karachi. Appropriate cutoff points for total problem, internalizing and externalizing scales were obtained for CBCL. A total of 556 parents filled out both the SDQ Urdu version as well as CBCL. Scores from the parent rated total SDQ scores were highly correlated with the total CBCL scores [r=0.589]. The local cutoffs derived for CBCL were considerably lower than USA norms. Slightly higher cutoff for males was found as compared to females for the total CBCL scores. Like the original English version, the Urdu version of CBCL and SDQ are both equally valid assessment tools to be used for both clinical and research purpose in Pakistani settings, where Urdu is widely spoken and understood

Hemodynamic effects of anesthetic induction in patients treated with beta and calcium channel blockers

The response to anesthetic induction and airway manipulation in the presence of cardiovascular disease and anti-hypertensive therapy has not been adequately investigated. The blood pressure, pulse pressure and heart rate changes at induction and following tracheal intubation were compared in patients who were on either preoperative beta-adrenergic blocker therapy [BB group, n = 20] or a combination of beta-adrenergic blocker and calcium channel blocker therapy [BB + CCB group, n = 20]. A standardized anesthesia induction protocol was followed, in the two gourps. No statistical difference was observed in the hemodynamic parameters between the two groups. The total number of hypotensive patients [SAP 90

Hemoglobin status of pregnant women visiting tertiary care hospitals of Pakistan

To determine the status of haemoglobin levels in pregnant women who visited tertiary care hospitals of various cities in Pakistan for their antenatal care from January 1 to April 30, 2007. This was a descriptive cross-sectional multi-centre study This study was conducted at the Aga Khan University Hospital [AKUH], Karachi, Civil Hospital, Karachi [CHK] and Nawabshah Medical College Hospital [NMCH], Nawabshah. Copies of medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected from January 1 to April 30, 2007. Reports or results of hemoglobin concentrations were also obtained from the patients. A total of 1709 pregnant women were recruited. Majority 1145[67%] were from the age group of 25 to 34 years and 1555[91%] had some degree of anemia. The number of women with moderate to severe anemia [hemoglobin levels < 8 or 8-9.9 gm/dl, respectively] was significantly higher in CHK and NMCH compared to AKUH [p < 0.001]. Whereas mild anemia [hemoglobin levels 10-10.9gm/dl] or normal hemoglobin levels was significantly higher at AKUH [p < 0.001]. Moderate anemia [hemoglobin levels of 8-9.9gm/dl] was statistically more frequent in second and third trimester, while mild anemia [hemoglobin levels of 10-10.9gm/dl] was more in first trimester of pregnancy. The distribution of severe anemia however; was not different is the three trimesters. About 90-92% subjects received iron/vitamin/mineral supplements irrespective of the hemoglobin status of the woman. Prevalence and severity of anemia in pregnant subjects attending the tertiary care hospitals of Pakistan is exceptionally high. Current findings highlight the anemia in pregnancy as a priority area of concern

Work flow analysis: audit of the turn around time in chemical pathology in a tertiary care hospital

A retrospective analysis of the laboratory results was performed to explore the turnaround time [TAT] for the laboratory services. The TAT for specimens arriving at the main laboratory from wards, main laboratory and critical care areas was noted and compared with the standard set for reporting. Median TAT for results of 169 blood samples was on average 195 min [n=170], 172 min [n=169], 121 min [n=167] from main lab, wards and for STAT samples from critical care areas respectively. Median analytical time was 170 min, 105 min, and 72 min from main lab, from wards and for STAT samples respectively. This TAT is within acceptable limits according to the standard sets. However, high transport time from critical care areas [median 49 min] was noted, which can be further improved if the portering and transport arrangements of the specimens are made more effective

Impact of working status on their lives: a survey of working women at a teaching hospital in Karachi, Pakistan

To study the impact of working status on the lives of working women. A questionnaire based cross sectional survey was conducted at the Family Practice Center, Aga Khan University Hospital, Karachi, Pakistan, from July to December 2006. The Questionnaire included data on the demographic profile of the patient and questions in line with study objectives. Ethical requirement including the administration of written informed consent and the provision of confidentiality were ensured. SPSS computer software was used for data analysis. Two hundred working women were interviewed. The mean age was 29.05 years. A majority was married [53.5%] with more than grade XII education [67%]. Sixty three [31.5%] women were working due to need and eighty three [41.5%] were finding it difficult to carry out home responsibilities because of it. Extra understanding and support was received from family by 155 [77.5%] and 115 [57.5%] women respectively. One hundred twenty three [61.5%] women felt they did not have enough time for themselves. The status of working women is better than non-working women according to 123 [61.5%] respondents. Financial benefits outweigh other disadvantages according to 105 [52.5%] respondents. Marriage prospects of working women and their children are better than non-working women and their children according to eighty one [40.5%] and eighty [40%] respondents respectively. Confidence in working women is higher than non-working women according to 142 [71%] respondents. Eighty one [40.5%] respondents feel that working women's financial independence has negative impact on theirs husband's self esteem. Working women find it difficult to carryout their home responsibilities. There is need for further studies on how to improve the working conditions and home situation for working women in our society

Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital

To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006.One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer [Precision Abbott] by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer [SYNCHRON CX7] by glucose oxidase method. We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L [60 mg/dl] and 16.7 [300 mg/dl]. A significant difference was observed for glucose values less than 3.3 mmol/L [p=0.002] and glucose values more than 16.67 mmol/l [p=0.049]. Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels

Awareness about reproductive health and rights among students of a public university in karachi, Pakistan: a cross sectional study

To determine the knowledge, attitude and practices of Karachi University students about reproductive health and rights. Cross sectional study. A survey was conducted from February to May 2005 to determine the understanding and knowledge related to reproductive health and rights among the students of the department of Biochemistry, University of Karachi, Pakistan. A pre-coded questionnaire was developed and pre-tested. The questionnaire was introduced to those students, who agreed to participate in the study. Data collected was double entered and analyzed on SPSS and Epi-info latest version. Fifty five percent [55%] of participants believed the reproductive rights to be as important as other human rights. About 80% of participants thought that proper birth spacing can improve maternal and child health but very few Pakistani women have birth spacing rights. Quality of life of women and men can be improved by knowing their reproductive rights in view of 71% and 63% of respondents respectively. Although one third of participants claimed to be aware of their reproductive rights but majority were unable to identify what exactly comes under the domain of reproductive rights. Majority knew that appropriate use of contraception and birth spacing can have positive impact on maternal and child health. The study recommends that awareness sessions should be conducted at all levels of society and more efforts should be made to improve reproductive health and increase awareness and the implementation of reproductive rights

Womens' beliefs and practices regarding food restrictions during pregnancy and lactation: a hospital based study

Maternal diet is an important determinant of outcomes of pregnancy. Malnutrition during pregnancy and its consequences maximally affect the health and long-term outcomes of the population. Low birth weight accounts for almost 30% of all births; with maternal malnutrition as a dominant risk factor. This study aims to investigate the existing beliefs and practices regarding food restrictions during pregnancy and lactation and also to assess whether there is any relationship with education level of the respondent and their beliefs and practices. A cross-sectional survey was conducted at Community Health Center [CHC] of The Aga Khan University Hospital, Karachi from July- September 2000. Four hundred adult female respondents, who came to the outpatient services as a patient or as an attendant, were interviewed after taking verbal consent. A self administered pre-coded and pre-tested questionnaire was filled by the respondent. More than three fourths of respondents were literate. Twelve% believed in restricting some food item during pregnancy and about 25% believed the same during lactation. No statistically significant association was found between belief about food restriction during pregnancy or during lactation and education level of the respondent. Undue food restrictions during pregnancy and lactation do exist in our culture. To assess the true picture we need to conduct larger studies in the community. The information obtained from the studies will help us in addressing these issues for improvement of nutritional knowledge and dietary practices and to avoid undue food restrictions

Knowledge, attitude and practice regarding obesity among patients, at Aga Khan University Hospital, Karachi

Obesity is a major public health problem and responsible for significant morbidity and mortality among our patients. It is important to study the knowledge, attitude and practices with regard to obesity among patients, in order to devise interventional strategies. Patients visiting the out-patient clinics of Aga Khan University Hospital, Karachi, were included in the study. The interview was questionnaire-based and recorded the demographic profile of the patients and questions relevant to the objective of the study. The ethical requirements for the study were met. SPSS computer software was used for data management. A hundred patients were surveyed. Women [55%] were more than men [45%], under 39 years [73%], married [55%], with graduate or more education [65%], in private service [44%] and housewives [19%]. A substantial number of respondents [75%] understood the meaning of obesity and considered it a major health problem [90%]. More respondents felt the need to reduce weight [52%], despite the fact that lesser number considered themselves to be overweight or obese [34%]. A majority of the respondents did exercise [59%] but a minority did it more than five times a week [17%] and more than 30 minutes on each occasion [31%]. A substantial proportion of the respondents stated their preference for oily food [34%], sweets [34%], fried food [40%], red meat [21%], fast food [37%], butter, cheese and cream [31%]. Conclusions: We have found a significant level of understanding about obesity among our patients. Physical exercise and dietary measures to control body weight are lacking despite the desire to have appropriate body weight. There is a need and we strongly recommend patient education programs to control obesity

Patient compliance among family practice patients

To document patient compliance and perceptions among family practice patients. Design: A questionnaire-based survey of a convenience sample. Place and Duration of Study: Family Practice Center of Aga Khan University Hospital, Karachi, Pakistan, between October 2003 and January 2004. Subjects and Family practice patients were interviewed without systematic randomization. A questionnaire including data on demographic profile of the patient and compliance, was administered by the study investigators. Ethical requirement including the administration of written informed consent and confidentiality were ensured. SPSS computer software was used for data management. A total of 119 patients were interviewed, of which 86 [72%] were females. The mean age was 34.6 years. Thirty two [27%] of the respondents had graduate education. Forty three[36.1%] respondents had the last physician's visit within the previous two weeks. Recommendations made at the previous physician's visit were followed in 170 [79.8%] cases. Desire to get better was reported by 172 [79.6%] respondents, as a reason for compliance. In patient's view, being polite, friendly and kind to the patient and explaining treatment to the patient, could improve patient compliance. There is a need to have a broad based approach to improve patient compliance including patient education, following principles of good clinical practice and giving due consideration to financial costs. We recommend further research and debate on the important issue of patient compliance

Physical exercise as a key health determinant among patients

Physical exercise is among the key determinants of health. The role of physical exercise in health promotion was well known to the ancient Chinese. Even moderate activity such as daily brisk walking for 30 to 60 minutes, is associated with significant reductions in the incidence and mortality of cardiovascular disease. Benefits of increased physical activity have been shown among patients with hypertension, diabetes mellitus, and dyslipidemia. Therefore, a need was identified to study the perceptions and practice concerning physical exercise among patients in Karachi, Pakistan. A questionnaire based cross-sectional survey was conducted at the Family Practice Center, The Aga Khan University Hospital, Karachi, from March to July 2002. A total of 393 patients were surveyed. This is a short Communication

Women's perception about food properties in A teriary care Hospital

To understand the existing food beliefs regarding hot, cold and badi [gas-producing] properties of different food items and also to assess whether there is any relationship with education of women and these beliefs. Design: A cross-sectional study. Place and Duration of Study: Community Health Center [CHC], The Aga Khan University Hospital, Karachi from July to September 2000. Subjects and Four hundred adult female respondents, who came to CHC as a patient or as an attendant, were interviewed after taking verbal consent. A self-administered pre-coded and pre-tested questionnaire was filled by the respondent. Descriptive frequencies and cross tabulation were computed to assess the existing food beliefs. Chi-square test was used to assess the association between education level of women and belief regarding these food items. More than three-fourth of respondents were literate. The percentages of respondents saying that certain foods were hot, cold and badi were 71%, 55% and 80% respectively. Meat, either beef or mutton, fish, egg, chicken, was perceived as hot by majority of the respondents. Majority of vegetables was perceived as cold foods in our study. The other foods like rice, yogurt, banana, watermelon, milk and cold drink were also thought to be cold by many of the respondents. Cabbage, cauliflower, potato, rice, gram and mash pulses [chane and mash-ki-dal] were highly rated as badi foods. Level of education of women didn't show any statistically significant difference in keeping beliefs regarding hot, cold and badi properties of food items. A significant concept of different properties of food exists in our culture. We recommend future studies to explore scientific basis for classifying hot, cold or badi foods and also to look into its impact on health by their restriction based on their beliefs

Perceptions on bioethics among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan

To study the perceptions on bioethics among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan Study design: Questionnaire based cross sectional survey Settings: The study was carried out at the family practice center, the Aga Khan University Hospital, Karachi Main outcome measures: Perceptions on the broad principles of bioethics Majority of the respondents were young and well educated and better placed socioeconomically. Respondents reported the moral duties of a physician and their reaction in the event of the death of a close relative due to a doctor's negligence. The majority 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 found interesting patient's perceptions on Bioethics with important implications for clinical practice

Assessment of knowledge, beliefs and practices of our population regarding effects of viewing a solar eclipse

To assess the prevalence of knowledge, beliefs and practices of people coming to The Aga Khan University Hospital, about viewing a solar eclipse. A cross-sectional survey was conducted at The Aga Khan University Hospital, Karachi from January 2000 to April 2000. A self-administered questionnaire was filled by the patient or attendant who were aged 18 and above. Total of 202 respondents were interviewed. The data was analyzed by Epi Info. Mean age of respondents was 35.8 years. Overall, awareness regarding the harmful effects to their eyes by viewing an eclipse directly was 83.2%. Females were more knowledgeable. Majority had obtained information from TV. One third thought it was safe to view the eclipse through binoculars or through smoked glasses. Half of the respondents thought the same about photographic films and sunglasses. Viewing an eclipse by a pregnant mother had an adverse effect on the fetus and on herself was thought to be 50% and 45% respectively. Use of knife or scissors by pregnant females at the time of solar eclipse was thought to be harmful for the fetus and to herself by 41% and 38% respectively. Majority knew that viewing a solar eclipse could be harmful to their eyes but they did not know the safest way. As there is no effective treatment for solar retinopathy, the emphasis should be on prevention. We need to increase public awareness regarding the safest way to watch an eclipse, which is by indirect method using projection. Myths regarding ill effects of solar eclipse on pregnant mother and on fetus need to be removed