Evaluation of hospital-learning environment for pediatric residency in eastern region of Saudi Arabia / 보건의료교육평가

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.

Case fatality rate and etiological factors of malnutrition in children less than 5 years of age

To calculate the case fatality rate and etiological factors of malnutrition in children less than 05 years of age presenting to a tertiary care hospital. A descriptive cross sectional study was conducted in the admitted patients in the Department of Pediatrics and Neonatology, Lady Reading Hospital, Peshawar, during one and an half year period from January 2009 to June 2010. A total of 976 patients [aged from 0 day to 60 months, both male and female] with various diseases were recorded as samples. The frequency of different types and grades of malnutrition and important etiological factors for malnutrition in these children were scrutinized. Case fatality was also calculated among the malnourished children. Out of 976, 294 [30.12%] were malnourished. Among these, majority [n= 195, 66.3%] were in the age range of 13-60 months, with mean age of 36.20 + 3.82 months. Many [n=157, 53.4%] were male children with male to female ratio of 1.14:1. majority 139 [44.28%] had grade I malnutrition. The commonest medical etiological factors was chronic or recurrent diarrhea n=205, 69.72%], anemia [n=139, 47.27%], respiratory tract infections [n=115, 39.11%]; and inadequate feeding history [n=111, 37.75%]. Most prominent social etiological factors were poverty [n=236, 80.27%], uneducated mothers [n=223, 75.85%], more than 2 children under 5 years in family [n=136, 46.25%] cases. Case fatality [mortality] rate was 40 [13.6%]. Majority of malnourished children are males between the age of 13 to 60 months. Mass media campaign should be started for the eradication of malnutrition in children

Prevelance, risk factors and outcomes of hypoglycemia in elderly diabetic patients

To estimate the clinical outcomes of hypoglycemia in elderly diabetic patients, its associations with the different antidiabetic drugs and some predisposing factors or comorbid conditions. Both type 1 and type 2 diabetic patients with age 60 years or above fulfilling Whiple's criteria for hypoglycemia were included in this study. They were collected from the medical unit Hayatabad Medical Complex Peshawar from November 2010 to July 2011. The patient's history, clinical examination and investigations were recorded on a proforma. Patients with abnormal CNS findings on CT or MRI scan and those who didn't give any partial or complete response to the IV glucose, were excluded from the study. Eighty five patients with mean age of 75+6 years were included in this study. The average hospital stay was 10 days. Sixty-five percent [n=55] of these patients were using sulfonylureas, 20% [n=17] were using metformin alone and in combination, while 25% [n=21] were using insulin [combination of regular and intermediate acting]. Impaired renal function in 40% [n=34], impaired liver functions in 20% [n=17] and neglected elderly in 30.6% [n=26] were the most common predisposing factors. Diabetic treatment related hypoglycemia is more severe in the elderly population with a poor prognosis. Sulfonylureas are the most frequently associated drugs with poorer outcomes. Predisposing factors like impaired renal functions, liver functions and neglected elderly increase the frequency of hypoglycemia. HbA1c is not a good predictor of hypoglycemia in elderly population

Risk factors for preterm births in lady reading hospital, Peshawar

To determine the various maternal and neonatal risk factors of preterm birth. A descriptive case series was conducted from 1st January 2010 to 3Jxt December 2010. In this study all cases, a live Pre term birth [PTB] [29 - <37 weeks] by vaginal delivery or caesarean section and their mothers were included. A total of 205 [04.04%] neonates were identified as premature neonates. Majority [29.3%] were in the age range of 2 days with mean age of 1.5073 +/- 1.2627 days. Out of 205, 51.7% were male and 48.3% were female. Maternal age of 21-35 years was recorded in majority 79.51% with mean age of 28.10 +/- 5.8982 years. Majority of mothers [96.1%] were illiterate, 76.6% belonged to rural areas, 76.1% belonged to poor class, 35.1% were multiparas. A history of Premature rupture of membrane [PROM] was found in 61% cases, history of burning micturition 4.9%, physical injuries 0.5%, polyhydramnios 14.14%, previous low birth weight baby 41.5%, threaten abortion 27.8%, antepartum hemorrhage 36.1%, previous perinatal loss 31.2%, previous premature birth 30.2%, maternal pyrexia 14.1%, previous twins 6.3% and placenta previa 4.4%. Frequency of prematurity was 04.04%. Among the various risk factors maternal age, illiteracy, rural residence, poverty, joint family setup, history of PROM, previous low birth weight babies, history of antepartum hemorrhage, multiparity, previous perinatal loss, previous premature babies, threaten abortion, were the prominent risk factors found in majority of cases

survey on effect of health education on health volunteer performance and knowledge in prevention of cutaneous leishmaniasis in Yazd

Cutaneous leishmaniasis [CL], is one of the health priorities in many of the tropical areas of the world, and is also very common in Iran, especially in urban areas of the country. The best way of prevention of the disease is to increase knowledge in terms of prevention and early referral of suspected cases to physician, as well as suitable treatment for patients. To define the influence of education on health volunteer performance and knowledge about CL in Yazd. In this semiempirical survey, knowledge and performance of 74 randomly selected health volunteers in Yazd were assessed via questionnaire before and after the education. The resulting data were processed and analyzed by SPSS software and with ANOVA and paired t test exams. This survey showed that knowledge and performance of health volunteers after the training course increased by 44% and 56%, with mean of 7.53 before education to 10.84 after the course, and from 1.12 to 1.75 respectively. The effect of the training course in terms of level of literacy and age group were assessed resulted in meaningful differences, as well. It seems that the education has a significant influence on increase of knowledge and performance of health volunteer, and as these personnel have essential role in people's knowledge and health situation in community, so continuous use of these educational courses may result in a decline in prevalence of the disease

Frequency of various neonatal complications in infants born to diabetic mothers - a hospital base study

To determine the frequency of various complications occurring in infants of diabetic mothers. This descriptive study was conducted in the neonatal unit and obstetric units of Lady Reading Hospital, Peshawar from January to July 2010. Forty two consecutive cases of infants of diabetic mothers were enrolled in the study. Maternal history especially obstetric history and history regarding diabetes mellitus was obtained and complete neonatal examination was performed. The physical findings and anthropometric measurements were recorded into a printed Proforma. Serum glucose, serum calcium, hematocrit and echocardiography was performed in all enrolled babies. Out of 42 diabetic mothers, gestation diabetes was seen in 71.4% while pre-conceptional diabetes was seen in 28.5%. The male Infants of Diabetic Mothers in this study were 69%. Infant of Diabetic Mothers delivered by C-section were 45%. Macrosomia 40.4% [n=42] was found to be the most common complication followed by hypoglycaemia 23.8%. The mortality rate in our study was 4.7% [n=2]. This study confirms the high occurrence of complications in newborns, born to diabetic mothers. Large for gestational age and hypoglycemia were the commonest complications

Prevalence of rhesus type and abo incompatibility in jaundiced neonates

To determine the prevalence of Rh and ABO incompatibility in jaundiced neonates. This hospital based descriptive study was conducted in Pediatrics Unit, Lady Reading Hospital Peshawar. A total of 200 neonates with clinically diagnosed jaundice were included in the study. Out of 200 neonates 70% were male and 30%female. Majority of neonates 99.5% age was ranged from 0-10 days while only 0.5% neonate was 13 days. Out of 200 neonates, the frequency of ABO-incompatibility and Rh-incompatibility in jaundiced neonates in this study was 22.5% and 12.5% respectively. Out of the remaining 65.5% cases physiological jaundice was diagnosed in 40.5% neonates, prematurity in 15% neonates and G6PD in 9.5% neonates. Among 22.5% cases of ABO incompatibility there were 16.5% males and 6% females. Majority 15% presented on 1[st] day of life, followed by 3% on 2[nd] and 3[rd] day of life respectively, 1% on 4[th] day, 0.5% on 5[th] day of life. Out of 200 neonates presented with jaundice, prevalence of ABO-incompatibility was found to be 22.5% followed by Rh-incompatibility 12.5%

Glucose-6-phosphate dehydrogenase deficiency in jaundiced neonates

To detect the frequency of G-6-PD deficiency in 200 consecutive neonates admitted with jaundice to the neonatal unit, LRH, Peshawar. This descriptive study was conducted in the Neonatal Unit of Lady Reading Hospital, Peshawar from March 2009 to August 2009. Two hundred consecutive cases of neonatal jaundice of both sexes, admitted to the Neonatal Unit, Lady Reading Hospital, Peshawar were enrolled in the study. Detailed history and clinical examination was recorded. All the neonates were subjected to be estimation of Serum Bilirubin levels [Total, Direct and Indirect], G-6-PD detection via Hemolysate Decolorization time test and blood groups of both the mother and the baby besides looking at the peripheral smears and other relevant investigations. Out of the 200 icteric neonates, 145 [72.5%] were males while 55 [27.5%] were females. Thirty two [16%] babies were found to be G-6-PD deficient. No specific precipitating factor for haemolysis was found. Majority of the patients 188 [94%] presented with neonatal jaundice in the first week of life, while the age of presentation amongst the G-6-PD deficient neonates was between 2nd to 4th day of life. An Indirect serum bilirubin level of 9 to 40mg% was found in these G-6-PD deficient neonates. G-6-PD deficiency is a common cause of neonatal jaundice and has more preponderance for male sex. Babies suffering from G-6-PD deficiency present with jaundice relatively earlier than the other causes of neonatal jaundice like ABO/Rh incompatibility and idiopathic causes

Schizophrenia, substance use and aggressions: What are the relationships?

Objectives: The objective of the study is to determine the prevalence of substance abuse for alcohol, cannabis, opiates, stimulants, solvent and other substances among patients with schizophrenia in Hospital Bahagia Ulu Kinta (HBUK), Perak , Central Peninsular of Malaysia. This study also aims to determine the association of substance abuse with aggression, the demographic characteristics and total duration of hospitalization. Methods: This was a retrospective cross-sectional study whereby the first 194 subjects diagnosed to have schizophrenia based on International Classification of Disease, 10th edition (ICD-10) criteria were taken from data registry of patients admitted to HBUK from January until February 2004. The subjects’ medical files were examined for documentation of substances abuse, aggression and accumulative duration of hospitalization. Results: The results showed the prevalence of substances misuse among patients with schizophrenia in general (including alcohol) was 24.7%. Cannabis 16.7%, alcohol 13.4%, opiates(heroin) 6.7%, Amphetamine type stimulants (amphetamine, metamphetamine, ecstacy) 5.7%, and other substances (benzodiazepine, solvents) 1.5%. Conclusion: There is higher prevalence of substance misuse in patients with schizophrenia as compared to general population. Male patients with history of substance misuse are more likely to have aggression than female. This group needs special precaution and probably in need of specialist help.

Awareness of viral hepatitis in ten villages of district nowshera

Viral hepatitis is a cause of great concerns the world over and more so in the developing countries like Pakistan. Its incidence has increased to alarming proportions and is likely to increase further in near future. This study was conducted to assess awareness of a rural community to Hepatitis B and C. A cross-sectional study was conducted from November 2007 to October 2008, in ten villages of District Nowshera. Questionnaire was designed to assess their knowledge about viral Hepatitis. Data was computed using SPSS version 10. A total of 3654 respondents were interviewed, 642 [17.6%] were aware that Hepatitis B and C were diseases of liver and transmitted by a virus. Respondents reported that there were multiple routes of transmission of this disease. Used syringes were the most common factor reported to be responsible for spread of this disease, followed by dental apparatus, injuries caused by nail cutters and sexual contact. One fifth [20%] of the respondents were unable to identify any physical sign or symptom of the disease. Television, Doctors and Radio appeared to be the most popular sources of information used for obtaining health information on these diseases this was reported by 43%.42% and 40% of the population respectively. Knowledge and awareness regarding the causative agent, mode of transmission and the consequences of Hepatitis B and C are poor in rural communities

Relationship between silica dust exposure and chronic obstructive pulmonary disease in workers of dust generating industries of district Peshawar

Chronic Obstructive Pulmonary Disease is a common cause of morbidity worldwide. This study was conducted to assess the relationship between silica dust inhalation and COPD among workers of dust generating industries. This cross sectional study was conducted in three main industrial regions of Peshawar i.e. Industrial Estate Hayatabad, Industrial area Ring Road and Industries of Warsak Road Peshawar. A preformed questionnaire was used to interview 160 workers, 40 each from stone-grinding, ceramics, pottery and brick industries respectively. Only workers having worked for more than five years were selected through convenient sampling. A total of 160 workers were interviewed out of which 56[35%] were symptomatic while 104[65%] were asymptomatic. Among symptomatic ones, 20[19.8%] were in 20-40years age group and 36[61%] in 41-60 years age group. In regard to exposure status, 7[26%] were symptomatic in those exposed for 5-10 years, 29[31.5%] amongst those exposed for 11-15 years and 20[49%] in those exposed for 15-20 years. With respect to working hours, none was symptomatic in those who had worked for 6 hours or less while 56[40%] were symptomatic in those who had worked for 8 or more hours. Among 128 smokers, 48[37.5%] were symptomatic and amongst 32 non-smokers 8[25%] were symptomatic. Amongst the symptomatic cases symptoms appeared within 5-10 years in 7[12.5%] of the cases, within 10-15 years in 29[51.8%] of the cases and within 15-20 years in 20[35.7%] of the cases. The major symptoms reported were cough in 56[100%] of the cases, dyspnea in 48[85.7%] and wheezing in 49[87.5%] of the symptomatic cases. The study revealed that majority of respondents who were exposed to silica dust for ten years or more, had respiratory problems. The severity of the problems was directly proportional to the duration of exposure to silica dust, density of dust [maximum in stone crushing], hours of daily exposure and other contributory factors like tobacco smoking and increasing age

Varenicline - A New Pharmacotherapy For Smoking Cessation: Implication For Smokers With Mental Health Problems

Objective: The smoking rate among patients with mental health problem is higher than in the general population. Effective pharmacotherapy to treat nicotine addiction is thus needed to reduce the morbidity and mortality associated with cigarette smoking among these patients. This article reviews the literature on the suitability of varenicline for smokers with mental health problems. Methods: A search of the literature was conducted using PubMed from year 2001 to July 2009 using key words varenicline alone and varenicline and mental health. Articles chosen were narrowed to those published in English. The type of articles chosen included clinical trials, meta-analyses, case reports, and review articles. Results: The search produced a total of 322 articles on varenicline and 14 articles on varenicline and mental health. Varenicline, a new drug for smoking cessation is an α4β2 partial agonist and partial antagonist at nicotinic acetylcholine receptor. As a partial agonist, varenicline relieves craving and withdrawal symptoms that occur during smoking abstinence and also reduce the rewarding effects of smoking in patients who relapse. However, at present, there is concern regarding the neuropsychiatric side effects such as aggressive behaviour, suicidal ideation, mania and depression associated with varenicline use in patients with mental health problems, but these reports did not show a causal-link or lack of link between these symptoms and varenicline. Conclusion: Current available data support the effectiveness of varenicline to treat nicotine dependence. However its safety among smokers with mental health problems remains to be elucidated. At present, further safety assessment is needed in this patient population. Until new data is available regarding the safety of varenicline in these populations, psychiatrists and physicians prescribing this medication should be extra cautious and monitor for possible psychiatric side effects when prescribing this medication to patients with pre-existing psychiatric disorders or have vulnerability to psychoses.

Effect of diclofenac suppository on tramadol consumption in posthysterectomy pain

To determine reduction in dose of tramadol and side effects in posthysterectomy patients on addition of diclofenac on rectal suppository. Randomized double blinded placebo controlled study. The Aga Khan University Hospital, Karachi, Pakistan, from August 2004 to January 2006. Seventy ASA I and II females, aged 20 and above, who underwent elective abdominal hysterectomy, were included in this study. Patients received identical looking suppository of either 100 mg diclofenac sodium or placebo after induction of anaesthesia and then 12 hourly for 24 hours. General anaesthesia was standardized and tramadol was given by patient controlled intravenous analgesia delivery system in the recovery. The mean dose +/- SD of tramadol used in first 24 hours was found to be 317 +/- 153 mg in the placebo-tramadol group compared to 258 +/- 192 mg in the diclofenac-tramadol group [p = 0.15, 95% CI = 1.24 to -1.34, 6.63]. Seventeen [49%] patients in the placebo-tramadol group and 14 [40%] in the diclofenac-tramadol group used rescue analgesia [p=0.47]. Sedation score was similar in both the groups and there was no difference in the incidence of nausea and vomiting and use of antiemetics between the groups. This study did not show any reduction in tramadol consumption, given via patient controlled intravenous analgesia when rectal suppository of 100 mg diclofenac was added

Bronchodilator response to nebulized salbutamol in elderly patients with stable C.O.P.D

To assess the response of elderly patients with stable COPD to beta-2 agonist. Material and This inter ventional study was conducted in Pulmonology unit, Lady Reading Hospital, Peshawar. Patients were recruited after considering inclusion and exclusion criteria. A detailed history and clinical examination performed. On first day, baseline pulmonary function test [PET] [FEV 1, FVC, FEV1/FVC, PEFR] was taken. Then 3 ml normal saline [placebo] was administered via cho-neb nebulizer. PET measurements were repeated after 15, 30, 60 and 120 minutes. The best of three readings was recorded. On next day, the same protocol was applied except that placebo was replaced by nebulized salbutamol 5 mg [1 ml] plus 2 ml normal saline was administered via nebulizer. Out of 40 patients fulfilling entry criteria 30 completed the study. Age range was from 60-80 years. The mean baseline for FEV1 and FVC were 0.52 and 0.76 respectively. There was no significant difference in the mean baseline values on two days. The results expressed as mean and peak percentage changes about the baseline are shown in tabular and graphical form. 60% patients responded to salbutamol and 25% to normal saline. Analysis of variance comparing change in FEV1 between salbutamol and normal saline revealed highly significant drug effect [P<0.01]. The drug effect comparing changes in EV.0 was statistically not significant [P>0.05]. Salbutamol can produce useful bronchodilatation in elderly patients with stable COPD which can be readily assessed using spirometry

Eosinophilic Gastritis; An unusual and overlooked cause of chronic abdominal pain

Eosinophilic gastritis is an extremely rare disorder. The disease is associated with eosinophilic infiltration of various layers of gastrointestinal tract along with significant peripheral eosinophilia and increased Immunoglobulin E [IgE]. We report a case of 37 year old Saudi male who presented with chronic non-specific upper abdominal pain. On initial workup, the diagnosis was missed. However the diagnosis was established after subsequent work up in Gastroenterology clinic. Our case demonstrates that patients with uncharacteristic abdominal pain who are unresponsive to conventional treatment, rare illnesses like eosinophilic gastritis should be considered. We also aim to review the clinicopathological features, differential diagnosis and various treatment options of this disorder. To the best of our knowledge, this disease has not been previously reported from Saudi Arabia

Use of pulsed radiofrequency in failed back surgery syndrome

Failed back surgery syndrome [FBSS] is a well-recognized complication of spinal surgery. Pulse radiofrequency of dorsal root ganglion has been recently described for such patients. In this report, pulsed radiofrequency was applied in 3 patients with failed back surgery syndrome, presenting with severe pain. Reasonable to good pain relief was achieved in 2 patients in 6 months follow-up, however, one patient got short-term pain relief. Based on this limited experience in FBSS where conventional and non-conventional treatments are not effective, pulsed radiofrequency may be considered a logical choice

Essential newborn care practice in hospital versus home deliveries

Newborn mortality is one of the most neglected health problems in the developing world. In Pakistan it also remains very high. Most of these deaths could be prevented through cost-effective interventions. A large proportion of births continue to occur at homes. The study was undertaken to describe newborn care practices in the hospital and at homes, as an initiative to focus this alarming problem. This comparative cross-sectional study was carried out during the months of June and July 2005 in District Mardan, Pakistan. Data was collected and compared in hospital-based and community based deliveries. Gynae labour suite in District Headquarter Hospital Mardan was chosen as hospital-based facility. Irum colony in Mardan city was taken as community-based population. Information from 30 delivery cases was gathered; half the cases were hospital-based and half at homes. Sampling method was convenient. Descriptive statistical analysis was performed. The result of this study showed that among hospital deliveries 80% were conducted by nurses, 20% by skilled dais and none by doctor. Among these cleanliness was kept in 33%, cord care 100%, thermal protection 83.3%, breast feeding initiation within an hour was noted in 66.6%, spontaneous breathing was 100%. All of the home based deliveries were conducted by unskilled birth attendants. Among these; cleanliness 16.6%, cord care 80%, thermal protection 100%, breast feeding within an hour 14%, spontaneous breathing 100%. In both of these groups eye care was 0%, and immunization was 100%. This small scale study highlighted the deficiencies in the newborn care. Both hospital practices and traditional ones neglected the basic principles of newborn cleanliness, early breast feeding, eye care and cord care. A community based essential newborn care strategy is recommended

Tobacco use, a public health problem of epidemic proportion

Background: Tobacco smoking is increasing day by day. One of every three persons who start smoking falls ill and dies prematurely. The UN Health Agency says 4.9 million deaths attributable to smoking in a year now, are likely to exceed 10 millions in a year in next 20 years. At the present billions of dollars are being spent to support antismoking campaign all over the world. The efforts are being focused on different aspects like: creation of public awareness about hazards of smoking, introduction about the measures regarding prevention, importance of putting ban on advertisement and promotion of smoking, restriction on smokers activities, protection of non smokers from second-hand smoke, provision of free consultations and required supplements to those who wants to quit smoking and many more. The reported success rates of antismoking campaigns vary from country to country. The highest reported by the State of California Department of Health and National Cancer Institute; which includes, 20% lowering of adults smoking prevalence, 50% lowering of per Capita cigarette consumption. The California's TCP [Tobacco control programe] has saved an estimated 3.62 dollars for every dollar spent on program, is an other encouraging aspect

Materials and Methods: This is a review article, literature survey was carried out from various available sources

Conclusion: In Pakistan, Federal Government had already enforced an Ordinance regarding the prohibition of Smoking and protection of Non-smokers Health since 30 June 2003. Moreover, through a notification "No Smoke and No Tobacco Use Places" had been identified very clearly. At the moment we need to implement it with full force and vigor

Assessment of knowledge, attitude and skills of lady health workers

Government of Pakistan launched National Program for Family Planning and Primary Health Care in 1994. Lady Health Worker has a key role in providing these services. This study was designed to assess the quality of these services. It was a descriptive, cross-sectional study, conducted at District Kohat, Pakistan, in July 2005. Lady Health Workers with a job experience of more than 24 months were interviewed to assess their knowledge, attitude and skills, in terms of variables according to their job description. These variables included home visits, antenatal care, family planning, newborn care, vaccination, growth monitoring, common diseases, medicines and referrals. Fifty lady health workers were interviewed. Knowledge of lady health workers was above 36%, attitude score above 88% and skill assessment score above 86%. Sixty four percent lady health workers had established their health houses. Seven lady health workers showed non-satisfactory results with poor health house management. Much improvement in skills was required in the use of contraceptives. There was poor display of knowledge regarding vaccination schedule and insufficient knowledge 36% for the doses of common medicines. This study opened a window to peep through deficiencies of health system. It showed that most of the LHWs had optimum knowledge and an optimistic attitude. Deficiencies were seen in vaccination and contraception. It is recommended to arrange workshops and courses for LHWs on regular basis to refresh their knowledge