Role of travel motivations, perceived risks and travel constraints on destination image and visit intention in medical tourism: theoretical model

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation

Domestic violence among female healthcare providers: a meta-analysis

Objective: To estimate the prevalence of domestic violence among married female healthcare providers within the Pakistani context

Design: A systematic review has been done

Place and duration: From January 1992 to December 2011 the international and national published literature on domestic violence analyzed and scrutinized

Results: Of the total 54 researched articles revealed that worldwide domestic violence prevalence is ranged of 10% - 69% however, in Pakistan it is 30% to 79%. Verbal violence is the most common type which further leads to other form of domestic violence such as emotional, physical, and sexual violence. Internationally, very limited literatures were available on domestic violence among female healthcare providers but, no literature was found in the Pakistani context

Conclusion: Our literature review reveals that globally female are significantly experiencing in a large proportion with domestic violence and verbal violence in more common. Further research is also need in this regard especially on the ground of domestic violence among healthcare providers

Lung Transplantation Triggered "Jackhammer Esophagus": A Case Report and Review of Literature

A 19-years-old girl was referred for lung transplant due to end stage lung disease secondary to idiopathic bilateral bronchiectasis. Her routine pre lung transplant evaluation showed normal esophageal high-resolution manometry (HRM) and 24-hours impedance pH monitoring. Four weeks after the bilateral sequential lung transplantation (LTx), she developed dysphagia, chest pain and regurgitation, complicated by aspiration pneumonia. Repeated HRM showed Jackhammer esophagus, delayed gastric emptying and abnormal 24-hour pH impedance monitoring consistent with the diagnosis of gastroesophageal reflux disease. Twelve weeks after LTx, she was symptom free, HRM and 24-hour impedance pH monitoring returned to normal. To the best of our knowledge, this rare transient esophageal hypercontractility episode occurred after LTx and recovered without any specific treatment was never reported in literature. The etiopathogenesis of Jackhammer esophagus in general and LTx induced dysmotility in particular is discussed and reviewed.

Nephritis and charcot-marie-tooth disease: an unusual association

A 24 years old male, who presented to us with uraemic symptoms secondary to chronic glomerulonephritis. On examination, he was found to have features of peripheral neuropathy which was confirmed as Charcot-Marie-Tooth type 1 on nerve conduction studies. Very few cases of glomerular disease, mainly focal segmental glomerulosclerosis have been associated with the Charcot-Marie-Tooth worldwide

Is increased erythrocyte lithium sodium counter transport A useful marker for essential hypertension?

Background: Essential hypertension is a very common and wide spread problem. It is associated with maked morbidity and mortality. The pathogenesis of essential hypertension needs to be determined

Objective: To compare the rate of sodium counter transport in mild and moderate essential hypertensives with normotensive subjects

Subjects and Methods: The study was conducted on age and sex matched 20 mild essential hypertensives [G2], 20 moderate essential hypertensives [G3] and 20 normotensives [G1]. All cases were diagnosed after taking detailed history, complete physical examination and laboratory investigations. Lithium efflux and maximum rate [Vmax] of Lithium-Sodium countertransport was measured in red blood cells

Results: Increase in Lithium efflux and Vmax of Lithium- Sodium counter transport of mild and moderate essential hypertensives was highly significant [p<0.001]than that of normotensives

Conclusions: Lithium efflux and Vmax of sodium coutertransport is raised in mild and moderate essential hypertensive as compared to those in normotensive subjects. This can be used as a marker for the diagnosis of essential hypertension

Glycemic changes after vitamin D supplementation in patients with type 1 diabetes mellitus and vitamin D deficiency

A prospective, nonblinded and nonrandomized controlled trial was conducted to test the hypothesis that vitamin D supplementation would improve glycemic control in patients with type 1 diabetes mellitus who have vitamin D deficiency. Eight patients with type 1 diabetes mellitus who had 25-hydroxyvitamin D levels less than 50 nmol/L were assigned to receive 4000 IU of vitamin D3. Calcium supplements were provided to ensure a total calcium intake of 1200 mg/d. Glycosylated hemoglobin and 25-hydroxyvitamin D levels were measured at baseline and at 12 weeks. There was a significant difference in mean [SD] glycosylated hemoglobin level [%] between the groups that achieved 25-hydroxyvitamin D levels of <35.4 nmol/L, 35.4-51 nmol/L and >51 nmol/L at 12 weeks [P=.02]. There was a significant difference in glycosylated hemoglobin change from baseline between the groups that achieved 25-hydroxvitamin D levels of<35.4 nmol/L, 35.4-51 nmol/L and >51 nmol/L at 12 weeks [P=0.4]. There was a significant difference in25-hydroxyvitamin D level between the groups that achieved glycosylated hemoglobin levels of <7.8, 7.8-9.9 and >9.9 at 12 weeks [P=.001]. Patients were more likely to achieve lower glycosylated hemoglobin levels at 12 weeks if they had higher 25-hydroxyvitamin D levels at 12 weeks [r=-0.4, p=0.01]. There was an observed effect of vitamin D supplementation on glycemic control in vitamin D-replete, type 1 diabetes mellitus patients. Further studies are needed to determine if these findings are applicable

Domestic violence among Pakistani women: an insight into literature

The objectives of this search were to estimate the burden of domestic violence, its contributing factors and strategies based on literature preview for the prevention and control of domestic violence. Published literature about domestic violence in Pakistan during the years 1998 to 2008 was analyzed and scrutinized. This article is based on the searched result of 200 articles published in the English language from which finally 13 articles were selected. Search terms included [Violence], [Domestic violence], [Domestic violence in Pakistan] and [Strategies and Recommendations for Prevention of Domestic violence]. According to these studies, the intimate partners' violence is reported as in the range of 30% to 79%. In Pakistan, there are some notable factors which make women prone to domestic violence like women's low education, low empowerment, existing misconceptions about Islamic thoughts and traditional norms, misuse of women in the name of honor justifying honor killing, poverty and existence of unjust traditional dowry system in the society. The most common points made by researchers for prevention and control are 1]the need to recognize the domestic violence against women as an important issue 2]enhancement of educational and health facilities for the prevention and control of violence with combined awareness programs by governmental or non-governmental organizations and 3]enactment and promulgation of comprehensive laws to combat this problem. Our work reveals that a significantly large proportion of women suffer with domestic violence and the factors identified are preventable and modifiable to a greater extent. Further research is also needed in this regard

Estimation of vasicine and vasicinone in ayurvedic formulations containing adhatoda vasica nees leaf extract using HPLC technique

For carrying out the estimation studies of natural Vasaka leaves [Adhatoda vasica Nees] family Acanthaceae, leaves were subjected to authentication. The marketed formulations containing the leaf extract were obtained from local pharmacies. A literature survey reveals that no specific method has been developed for the determination of amount of vasicine and vasicinone in these complex traditional formulations. The vasicine content of various formulations varied from 86.4 micro g to 22.8 micro g/10 ml of the marketed formulations. This method offers greater selectivity for the determination of the active ingredients and limiting of its oxidative product vasicinone. At the operative chromatographic condition vasicinone was not detected in any of the formulations analyzed. The HPLC technique now allows routine analysis of vasicine containing complex traditional formulation. The technique is rapid, precise and accurate and can be applied to a variety of vasicine containing formulations

Evaluation of auditory perception skills development in profoundly deaf children following cochlear implantation

Cochlear implant is a medical treatment option for individuals with severe to profound sensori-neural hearing loss on account of non-functioning cochlea or part thereof. Technology is ever evolving and the candidacy criteria are widening. Appropriate selection of patient, successful implantation of an appropriate device and adequate post-implantation rehabilitation protocol are the key factors that dictate the eventual outcome. Bilateral cochlear implantation in children and combined electro-acoustic stimulation are the new developments in this field of rehabilitation for the deaf. Pakistan Cochlear Implant Programme was started in year 2000 and one hundred and fifty subjects have undergone cochlear implant surgery so far at Karachi, Lahore and Peshawar since. This prospective study was designed to evaluate the development of auditory perception skills and language in children, over a twelve months period, following cochlear implantation. Twenty-one patients were enrolled in this evaluation. These were divided into three groups as per age factor. Group 1 included eleven children of ages less than five years, Group 2 included eight children of ages between five and nine years whereas, Group 3 included two eleven years old children. Furthermore, subjects in Group 1 and 2 were pre-lingual whereas those in Group 3 were post-lingual. The three groups were evaluated using "Evaluation of Auditory Responses to Speech" [EARS]. Improvement in performance on all measures was noticed in all the groups over a twelve months period following implantation. Dynamics of improvement in auditory skills suggested more and rapid development in younger age group. Children of varying ages, both pre and post lingual, did show improvement in the development of auditory perception skills, that was evident more in the younger age group

Preservation of residual hearing in cochlear implanted patients

Aim of this study is to investigate the preservation of residual hearing after the cochlear implant surgery. Lahore and Peshawar during the period 2001 to 2007. Eighteen patients out of an overall of 150 subjects, who underwent Cochlear Implant surgery in Lahore and Peshawar during the period 2001 to 2007, were enrolled for this study. Hearing threshold has been measured in this group of patients following cochlear implantation with Medel Combi 40+ device for the last six years. The assessment was carried out within the first post-operative month as well as at later stage, between six and 72 months, post-operatively. All Eighteen patients in our cochlear implant program who could give good pure tone audiometry results used hearing aids before implantation. The pure tone acoustic thresholds at 250, 500, 1000, 2000 and 4000 Hz were obtained using the standard audiometrical procedures before and after cochlear implantation. Hearing preservation could be achieved in 16/18 patients [86%]. In two patients partial preservation was possible [14%]. These results indicate that it is possible to partially preserve residual hearing during cochlear implant surgery

Abdominal tuberculosis diagnosed on Gallium scintigraphy in a child with pyrexia of unknown origin

We report a case of an eleven year old girl with pyrexia of unknown origin whose illness remained undiagnosed after extensive investigations. We were able to localize the disease to abdomen with a Gallium Whole Body Scan. In the background of a history of tuberculosis in a family member in an endemic area, empirical anti-tuberculosis treatment was given with clinical success that was also demonstrated on a repeat Gallium scan four months later

Tuberculosis diagnosis and treatment practices of private physicians in Karachi, Pakistan

In a densely populated urban area of Karachi, Pakistan, a questionnaire survey was made of the knowledge and practices of 120 private general practitioners about the diagnosis and treatment of tuberculosis [TB]. The majority knew that cough, fever and weight loss were the main symptoms of TB, but less than half knew that blood in sputum, poor appetite and chest pain were associated with the disease. Only 58.3% of physicians used sputum microscopy for diagnosing TB and 35.0% used it as a follow-up test. Only 41.7% treated TB patients themselves, the remaining referring their patients to specialists. Around 73.3% of the doctors were aware of the 4 first-line anti-TB drugs. Efforts to improve the knowledge of private practitioners, and strategies to enhance public-private collaboration for TB control in urban areas are urgently required

Maximizing profit and productivity at a multi-specialty private hopital using linear programming

Managers of health care organizations make financial decisions on a regular basis. An element of uncertainty exists in making budgetary decisions. Managers use mathematical models on financial information to minimize the uncertainty in forecasting future costs or profits. Linear programming with the aid of computer software package, is one such mathematical modeling technique that can be used by hospital managers to predict the behavior of financial variables. This paper demonstrates how Barnes hospital in Saint Louis Missouri, used linear programming to make budgetary allocation and maximize profit. 26 financial variables and 64 constraints were plugged in the linear equation, for a total budget amount of $28 million. Given the various limitations specified by the management, the mathematical equation of linear programming, after 76 iterations, yielded a maximum profit of $4.8 million for the Barnes hospital. Linear programming also suggested budgetary allocations for each of the 26 hospital departments and surgical procedures included in the model. Linear programming is a tool that hospital managers can use to help them in making financial decisions that may require complex calculations. As long as the managers understand the limitations and preferences of the hospital and can plant those as relationships in the linear programming equation, then they can make good use of this modeling technique in financial management

Characteristics of diabetic patients and pattern of diabetic complications

The objective of our study was to elucidate and establish the basic characteristics of diabetic patients in Pakistani population and to determine the prevalence of micro and macrovascular complications in them. This was an observational study conducted in the diabetic clinic of Mayo Hospital, affiliated with King Edward Medical College Lahore. Six hundred and seventy patients attending diabetic clinic in the year 1996-97 were studied. We determined the basic characteristics of patients and diabetic complication on history, physical examination and investigations. A total of 670 patients [174 males and 496 females] were studied. Most of the patient's ages at the onset of diabetes ranged from 36-55 years, with the mean value of 41.1 t 13.5 years. Female to male ratio was 2.5:1. Fifty-four% of patients were overweight [BMI >25 kg/m2] and history of diabetes in first degree relatives was obtained in 46.7% of patients. Ninety one% had NIDDM and 9% IDDM. Out of the total, 22.3% had retinopathy, 14.6% had nephropathy while sensory and motor neuropathy was present in 40.6% and 29.1% respectively. History of angina pectoris was present in 16.4%, myocardial infarction in 5.5%, cerebrovascular accident in 5.8%, and 3.7% had peripheral vascular disease. Approximately 53% of the patients were hypertensive [systolic > 140 or diastolic >90]. Out of 112 patients with an early onset of disease [< 40 years] 8 had experienced ketoacidosis compared to 9 out of 503 [1.8"/0] who had late onset diabetes. Two hundred eighty nine [42.9%] patients required hospitalization, either for the control of diabetes or for the management of its complications. Seventy five% of the patients had at least one complication attributable to diabetes mellitus. We conclude that NIDDM is highly prevalent in our society with seventy five% of patients presenting with one or more complications. Needless to say that more attention given to good metabolic control can reduce the prevalence of diabetic Complications

Strengths and limitations of abgar scor: a critical appraisal

A cross sectional study was undertaken on 200 normally delivered newborns at Lady Aitchison hospital Lahore from august to december 1998. Apgar scores were recorded using the current virginia apgar scoring system at 1 and 5 minute interval. the newborns with scores 0-5 at 5 minutes were considered at higher risk for developing respiratory or neurological complications. our study showed significant difference [p<0.05] in scores of full term average birth weight [3 kg] and preterm low birth weight newborns [< 2 kg]. the 5 minutes scores were improved AS compared To 1 minute in 97% cases. More studies are recommended by increasing the apgar scoring time to 10 minutes in order to enhance the predictive value of this score for respiratory or neurological disabilities

Observations: the chemical profile of urinary calculi

Rental stone disease is an etiologically heterogenous problem associated with a high rate of recurrence. The biochemical profile of urinary calculi removed from the urinary tract of 48 patients in urology ward, Mayo Hospital Lahore was determined. The distribution of stone analysis was calcium oxalate with uric acid 46%, calcium oxalate with phosphate 27%, pure calcium oxalate 19%. Magnesium ammonium phosphate with calcium oxalate 6%, and pure uric acid 2%. The incidence of urolithiasis in upper urinary tract was higher than lower urinary tract in adults. This study suggests calcium oxalate stones to be the most common type

Evaluation of risk factors in antenatal care

A cross-sectional study was conducted on a sample of 198 pregnant woman attending the antenatal clinic. Lady Aitchison Hospital Lahore, to determine the incidence of high risk pregnancy and to demonstrate the risk factors. The scoring system developed by Fortney and Whitehorne was used. The subjects with scores 0-2 were considered at low risk, those with score 3 or more were categorised as high risk Our results revealed that high risk pregnant women constituted 58% of the study population. The most frequently encountered risk factors were bad obstetrical history [52.5%]. anaemia [43.4%]. high gravidity [32%]. and high panty [20 7%] Stepwise logistic regression analysis Indicated that obstetrical history and panty were major predictors of total variation in the score. The use of objective risk scoring is recommended for identification of high risk pregnant women