Chronic bronchitis and chronic obstructive pulmonary disease [COPD] among textile workers in Karachi, Pakistan

Objective: To determine the frequency and predictors of chronic bronchitis and COPD among textile workers in Karachi, Pakistan

Study Design: Cross-sectional survey

Place and Duration of Study: Karachi, Pakistan, from October to December 2009

Methodology: Male textile workers from 15 mills of Karachi were inducted. Data was collected using American Thoracic Society respiratory questionnaire [ATS-DLD-78-a] and spirometry

Results: Out of 372 participants, 29 [7.8%] workers had chronic bronchitis [4, 9.1% aged >/= 40 years] and 25 [6.7%] had COPD [12, 27.2% aged >/= 40 years]. Workers with chronic bronchitis had significantly decreased lung function compared to the healthy workers. Those reporting severe self-perceived dust exposure at work, >/= 10 pack years of smoking, uneducated, longer duration of work [>/= 11 years], and ever smokers were more likely to have chronic bronchitis or COPD. In the multivariate analyses, severe self-perceived dust exposure at work [AOR = 7.4; 95% CI: 1.9, 28.0], family history of respiratory illness/symptoms [AOR = 4.8; 95% CI: 1.1, 20.9] and lack of education [AOR = 4.2; 95% CI: 1.1, 16.9] were significant predictors of chronic bronchitis. Duration of work >/= 11 years [AOR = 5.5; 95% CI: 1.5, 19.7] and pack years of smoking >/= 10 years [AOR = 3.5; 95% CI: 1.1, 11.7] were strong predictors for COPD

Conclusion: There is a high frequency of chronic bronchitis and COPD among textile workers. Multiple important predictors for prevention are identified

Burnout among female nursing students

Objective: To determine the frequency of burnout among Pakistani military female nursing students and to find out its association with demographic factors and common stressors during training

Study Design: Cross-sectional analytical study

Place and Duration of Study: This study was carried out at Combined Military Hospital [CMH] Lahore and CMH Lahore Medical and Dental College from Mar to Apr 2015

Material and Methods: Sample consisted of 84 female nursing students. Since it was a relatively small sample and participants were easily accessible so all 84 students available at the time of study were included. Mashlach Burnout Inventory [MBI] [which included 20 questions] was used to measure emotional exhaustion, and burnout. The questionnaire also elicited information about socio-demographic characteristics and various perceived stressors during their training. Data analysis was performed by using SPSS version 20.0

Results: On the MBI, 66 [78.6%] nurses showed mild emotional exhaustion, 17 [20.2%] showed moderate emotional exhaustion and only 1 [1.2%] showed high emotional exhaustion. Similarly no burnout was found in 29 [34.5%] nurses; whereas mild burnout was found in 30 [35.7%], moderate burnout in 19 [22.6%], severe burnout in 5 [6%], and only one nurse student [1.2%] showed extreme burnout. No significant association was found between various stressors and burnout [p>0.05]

Conclusion: There is low level of burnout in female military nursing students in this study. This is a favorable finding and may be considered helpful in increasing productivity, performance and quality of patient care

Prevalence and associated factors of burnout among military doctors in Pakistan

To determine the frequency of factors contributing to burnout among military Physicians in Lahore, Pakistan. Cross-sectional analytical study. Combined Military Hospital [CMH] Lahore and CMH Lahore Medical and Dental College from March 2014 to September 2014. Sample consisted of 133 physicians [n=66] males and n=67 females]. Convenient sampling procedure was used. Mashlach Burnout Inventory [MBI] which included 22 questions was used to measure emotional exhaustion, depersonalization and personal accomplishment. The questionnaire also elicited information about socio-demographic and work characteristics. Data was entered and analyzed by using Statistical Package for Social Sciences [SPSS version 20.0]. Chi-square test of significance was used to see the significance of association between age, gender, duration of service in years and working hours per week. p value <0.05 was considered statistically significant. On the MBI, 29 [21.8%] physicians showed high emotional exhaustion, 22 [16.6%] showed high depersonalization and 34 [25.6%] showed low personal accomplishment. Thirty-seven physicians [27.8%] were identified as experiencing a high degree of burnout [high emotional exhaustion and depersonalization and low personal accomplishment]. The frequency of high degree of burnout was higher among males [36.4%] as compared to females [17.9%] and this difference was statistically borderline significant [p = 0.057]. However, there was statistically significant difference [p = 0.03] of burnout between those working >/= 41 hours per week as compared to working

Impact of constructive feedback on the undergraduate medical students' attitude towards psychiatry

To determine the impact of constructive feedback, during clinical attachment, on the undergraduate medical students' attitude towards psychiatry. Quasi-experimental study. CMH Lahore Medical College, Lahore, Pakistan from December 2012 to October 2013. Participants were 107 students of final year MBBS. They were divided into study and control groups. Demographic data was recorded and attitude towards psychiatry [ATP-30] questionnaire was administered to all the students before the clinical attachment. Both the groups underwent 3 weeks clinical attachment. However, only the students in study group received constructive feedback. ATP-30 was re-administered to students of both groups soon after completion of attachment. Because of errors and omissions in data, forms of two students were excluded. Statistical analysis was carried out on data of 105 students, which consisted of 53 students in the study group and 52 in control groups. The mean age of study group was 22.21 years [SD=0.885], while that of control group was 22.19 years [SD=0.886]; with 32.1% and 34.6% males in the study and control group respectively. Both the groups had comparable demographic features. Pre-attachment ATP30 scores of both groups were comparable i.e. 84.47 +/- 5.29 versus 84.56 +/- 5.30 [p-value < 0.934]. However, post-attachment scores of both groups increased i.e. 103.11 +/- 5.98 versus 85.85 +/- 4.31 [p-value < 0.001]. This increase in score was statistically highly significant in the study group. Constructive feedback during clinical attachment has a significantly positive impact on the undergraduate medical students' attitude towards psychiatry

Postoperative analgesia; comparison of caudal bupivacaine and bupivacaine - tramadol in children with inguinal hernia repair

To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with inguinal hernia repair. Department of Paediatric Anaesthesia, Children Hospital Complex, Multan. August 2008 to May 2009. A total of 100 children aged between 2-5 years were included in the study. The duration of analgesia was significantly prolonged in group-A patients [P= 0.001]. A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group-A and 6.7% in group-B [P=0.64]. No respiratory depression, flushing and pruritis were observed. Low dose combination of bypivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects

Role of PH and leukocyte count in prediction of preterm labour

The objective of this study was to determine the significance of pH and leukocyte count in the prediction of preterm labour. Case control study. This study was carried out at Department of Obstetrics and Gynaecology Nishtar Hospital Multan from 01-04-2008 to 30-09-2008 and 01-11-2008 to 01-05-2009. Women seeking antenatal care at outpatient department of Obstetrics and Gynaecology, Nishtar Hospital Multan between 22-28 weeks of gestation with singleton pregnancy were enrolled in this study. Vaginal pH was measured using a pH paper and leukocyte count by making a slide of vaginal secretions from posterior fornix and were sent to pathologist for counting number of leukocytes. Women with high pH and leukocyte count were enrolled to group A [cases] and those having normal pH were included in the group B [controls]. These women were followed till delivery and the number of women going into preterm labour were counted and matched with the results of pH and leukocyte counts. Mean age was 25.80 +/- 48 years in cases and 24.61 +/- 0.56 years in controls. Low socioeconomic status was evident in 43 [61.43%] cases and 34 [48.57%] controls, while 27 [38.57%] case and 36 [51.43%] controls had middle socioeconomic status. Preterm labour was observed in 42 [60%] cases and 7 [10%] controls, while preterm premature rupture of membrane was evident in 30 [42.86%] cases and 9 [12.86%] controls. Mode of delivery was vaginal in 44 [62.86%] cases and 54 [77.14] controls. 26 [37.14%] cases and 16 [22.86%] controls had lower segment caesarean section. Significantly more number of women with elevated pH and leukocyte count likely to have preterm delivery

Protective effect of vitamin E [a tocopherol acetate] on gentamicin-induced nephrotoxicity in adult albino rats

To determine the preventive role of Vitamin E on renal parenchyma after given of gentamicin in adult albino rats. Experimental study. This study was carried out in the Department of Anatomy Baqai Medical University and Muhammad Medical College, Mirpurkhas from June 2011 to November 2011. For this study, 30 adult albino rats were taken. They were divided into three groups ; A, B and C. The animals in group-A given normal saline 10 ml/kg/day intraperitoneal for 2 weeks. Group-B received gentamicin 100 mg/kg/day intraperitoneal for 2 weeks and group-C receives gentamicin 100mg/kg/day intraperitoneal with vitamin-E 2 mg/kg/day orally for 2 weeks. On day 15 all animals were sacrificed with deep ether anesthesia. Their kidneys were removed, fixed in 10% formalin. Representative blocks were taken and embedded in liquid paraffin. For routine histological examination 5 micro m thick section cut by microtome and stained with H and E, PAS and silver methenamine. Renal histology was done under light microscope to see the proximal and distal tubular diameter and count. No significant [P>0.05] changes were observed in the histopathology of kidney tissues of the groups A and C rats. The group B significantly [P<0.001] affected the histopathology of kidney. It may be concluded that gentamicin produces changes in kidney, which may be attributed to ischaemia resulting in tubular necrosis in adult albino rats simultaneous administration of vitamin-E partially protect the morphological and histological changes induced by gentamicin

Comparative pharmacokinetics of levofloxacin in healthy volunteers and in patients suffering from typhoid fever

The aim of this study was to characterize the effect of typhoid fever on pharmacokinetic parameters of levofloxacin [LF] and compare the pharmacokinetic parameters of the said antibiotic in healthy human volunteers and patients with typhoid fever. Total of 12 subjects were divided into two groups "A" [healthy volunteers] and "B" [typhoid patients]. Single oral dose of LF 500 mg was given and 5 mL of blood was collected from each subject at 0, 0.25, 0.5, 1, 2, 3, 6, 12, 24, 36 and 72 h. Plasma concentrations of LF were measured by HPLC. Pharmacokinetic parameters were calculated from plasma concentration-time data by using MW/PHARM pharmacological analysis. In healthy volunteers, the average pharmacokinetic parameters were as C[max] [6.79 Microg/mL], T[max] [1.84 h], T[½] [10.03 h], Ka [2.23 h[-1]], AUC [110.09 [micro]gh/mL], Vd [85.84 L], Cl [4.57 L/h] and in typhoid patients were C[max] [6.90 Microg/mL], T[max] [1.82 h], T[½] [9.42 h], Ka [2.21 h[-1]], AUC [105.55 [micro]gh/mL], Vd [64.31 L], Cl [4.75 L/h]. The difference between pharmacokinetic parameters of LF in healthy human volunteers and typhoid patients was calculated by using unpaired t-test. As the p-value in case of all pharmacokinetic parameters was more than 0.05, the difference between pharmacokinetic parameters in both healthy human volunteers and typhoid patients was insignificant. It is concluded that there is no need to adjust the dose of LF in typhoid patients

Role of laparoscopy in the management of malfunctioning peritoneal dialysis catheters

To document the results of laparoscopic management of peritoneal catheter dysfunction. Descriptive case series. Department of Surgery King Fahad Medical City Riyadh KSA, from January 2009 to October 2011. A retrospective review of the records of all the patients who underwent laparoscopy for evaluation and management of peritoneal dialysis [PD] catheter dysfunction was performed. Three trocars [one 10mm and two 5 mm] were used. Recorded data included patient demographics, catheter implantation method, and date of malfunction, cause of dysfunction, procedure performed and complications. A total of 16 patients underwent laparoscopic evaluation and management for PD catheter dysfunction The primary etiology of dysfunction was omentum and / or small bowel wrapping around the catheter with adhesions [n=8], malposition of cathter [n=5] and infection [n=2]. Adhesiolysis was performed in eight cases with partial omentectomy. In five cases with malposition of catheter but no adhesions, the catheters were repositioned in the pelvic cavity. Two catheters were withdrawn because of infection [peritonitis]. In one case with tunnel infection the catheters were exchanged simultaneously making another tunnel. Laparoscopy is highly effective and successful method for evaluation and management of peritoneal dialysis catheter dysfunction.

Efficacy and safety of metformin in over weight and obese patients with polycystic ovary syndrome

To evaluate the efficacy and safety of metformin in overweight and obese women with polycystic ovary syndrome. Forty-four overweight and obese female patients with diagnosed polycystic ovary syndrome were evaluated in an open label study. Patients were assigned metformin SOOmg thrice daily for six months. The primary outcomes were to assess change in the fasting serum insulin level, fasting plasma glucose, insulin sensitivity, weight, BMI, Waist to hip ratio and ultrasonographic features of overweight and obese women. The secondary outcomes were systolic and diastolic blood pressure, menstrual cyclicity and hirsutism. The safety of intervention was assessed by recording the self-reported adverse effects and performing renal and hepatic profiles. The patients were evaluated at monthly intervals. Forty subjects [90.9%] completed the study. At the end of six months, there was a significant effect of the drug on all the clinical parameters. Weight decreased from 85.71 +/- 1.04 to 84.38 +/- 1.02, BMI from 33.2 +/- 0.32 to 32.8 +/- 0.33[p <0.05] and Waist to hip ratio from 0.85 +/- 0.003 to 0.83 +/- 0.002.Ultrasonographic features, systolic and diastolic blood pressure also showed statistically significant improvement. Menstrual cyclicity, hirsutism, and metabolic parameters [serum fasting insulin level, fasting plasma glucose, HOMA index] also showed statistically significant improvement. The drug was well tolerated by the patients. No change was observed in blood urea, ALT and serum creatinine levels. Metformin is a safe and effective drug for the treatment of obese and over weight, women with PCOS

Association of progression of pulmonary fibrosis with severity of liver cirrhosis

Background: it has been found that frequency of pulmonary fibrosis increases in patients with cirrhosis of liver. We hypothesized that as the stage of cirrhosis advances, the frequency of pulmonary fibrosis should increase. We used child's pugh classification to stage the cirrhosis of liver

Material and Methods: fifty five patients of age range 16 to 80 years, both males and females having established cirrhosis of Fiver on ultrasonography, regardless of etiology, visiting the outpatient and inpatient department for treatment were selected. Patients were divided into three groups according to child's criteria i.e. group A, group B, and group C. HRCT of chest was performed on patients in all three groups to look for pulmonary fibrosis

Results: 27 [49%] patients were found to have pulmonary fibrosis on HRCT. The frequency of pulmonary fibrosis in different groups of child's classification was also assessed and it was found that class C and class B, are affected more than A

Conclusion: pulmonary fibrosis progresses with severity of liver cirrhosis

Preventable Lifestyle Risk Factors for Non-Communicable Diseases in the Pakistan Adolescents Schools Study 1 (PASS-1) / 예방의학회지

OBJECTIVES: The rising burden of preventable risk factors for non-communicable diseases (NCDs) among adolescents is a major public health challenge worldwide. We identified the preventable risk factors for NCDs in adolescents. METHODS: In a school-based study, pre-tested structured questionnaires were completed by 414 adolescents (14 to 17 years) at six schools in three cities in Pakistan. The chi-squared test and adjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated in a multinomial logistic regression analysis. RESULTS: Over 80% of the adolescents had unhealthy diets, and 54% were physically inactive. Most adolescents were exposed to passive smoking, and 14% were also current smokers. More than one-third of participants chewed betel nut, and one-quarter used oral tobacco. More girls were physically inactive (OR, 4.07; 95% CI, 2.69 to 6.17), whereas a greater proportion of boys were current smokers (OR, 2.17; 95% CI, 1.19 to 3.91), exposed to passive smoking (OR, 2.57; 95% CI, 1.72 to 3.83), and using betel nut (OR, 2.03; 95% CI, 1.34 to 3.06). Only 3.1% of the participants were without any preventable lifestyle risk factor for NCDs, and over 80% had > or =2 factors. Co-existence of risk factors was independently associated with fathers being blue-collar workers (aOR, 3.57; 95% CI, 1.07 to 11.92) and parents not treating their child fairly (aOR, 5.05; 95% CI, 1.29 to 19.78). CONCLUSIONS: Most of the adolescents studied had preventable risk factors for NCDs. These results warrant comprehensive and integrated interventions to prevent lifestyle risk factors, and parents are front-line stakeholders.

Study to assess the effect of topical clindamycin gel in acne vulgaris

Acne vulgaris is very common and all individuals of either sex suffer from this ailment at adolescent. The areas involved are cheeks, nose fore head, sometimes back also. Number of treatment options are available but clindamycin gel as topical preparation has been found effective. To find the suitability of clindamycin topically used. Study was performed on 40 patients of either sex, age group 14-29 years they were instructed to apply clindamycin topically twice daily up to three months. The results were significant at the end of treatment. The results were discussed with other studies. Clindamycin topical in the form of gel is suitable and effective for treatment of acne

Study of socio-demographic and service characteristics of servicemen treated for depression at Combined Military Hospital Multan cantonment

To describe the socio-demographic and service characteristics, of the active duty servicemen, of Pakistan Armed Forces, presenting with depression. Descriptive study [cross-sectional survey]. The study was conducted at Combined Military Hospital Multan from Septernber2006 to April 2009. Servicemen [n=305] meeting [DSM-IV-TR] criteria for depression were included in the study. Socio-demographic characteristics [age, education, marital status, duration of marriage, No of kids, monthly income] and service data [rank, service bracket, arm, trade, exposure to hard area and duration of exposure to hard area, service and non-service factors and working hours] were recorded with the help of proforma designed for this purpose. Out of 305 depressed servicemen 208 [68.2%] were in the age group 18-35 years. Two hundred and fifty three [83.0%] were married while 52[17%] were single. One hundred and one [39.9%] were married for the last 5-15 years. One Hundred and eighty four [60.3%] were receiving monthly income PKR6000-10000 and 207[67.9%] were having educational level Matric /FA. One hundred and sixty six [54.4%] were Soldiers [Sepoy / Lnk] and 224[73.4%] had technical trades. One hundred thirty four [43.9%] had service bracket 1-10 years. Two hundred and four [66.9%] had no exposure to hard area. Two hundred and five [67.2%] had working hours more than 8 hours. Fifty nine [19.3%] reported inadequate rehabilitation while 140 [45.9%] had family related stressors. Most of the depressed servicemen in this study were relatively young, married personnel from junior ranks, technical trades, having Matric/ FA level education and low monthly income. However there is a need to conduct further studies to establish association of depression with various socio-demographic and service factors

Assessment of severity of esophageal varices by splenic index in cirrhotic patients

Objective: to determine the relationship between the splenic index and the severity of esophageal varices in cirrhotic patients

Material and Methods: fifty patients who had coarse echotexture of liver on abdominal ultrasound and clinically .palpable spleen were selected. Splenic index was calculated using abdominal ultrasound as a product of longitudinal length and transverse width across the hilus of the spleen. These patients were then subjected to upper gastrointestinal endoscopy and esophageal varices were noticed and severity was assessed using grades from 0-3

Results: relationship was observed between the splenic index and the severity of esophageal Varices

Conclusion: splenic index can be a useful noninvasive method to determine the severity of esophageal varices in patients suffering from hepatic cirrhosis

comparison of pressor respons following laryngeai mask airway vs laryngoscopy and endotracheal tube inserition

To test the hypothesis that laryngeal mask airway [LMA] insertion is associated with less pressor response as Compared to endotracheal intubation. A prospective, comparative study. Department of Anaesthesiology Intensive Care and Path Management, Nishtar Medical Institution Multan [Pakistan] from July 2007 to January 2008. 60 adult, ASA grades land II patients undergoing elective general surgery of less than one hour duration were divided in two groups with 30 patients in each. These patients were operated under general anaesthesia and either endotracheal tube [Group I] or LMA [Group II] was used to maintain the airway. The rise in heart rate, systolic and diastolic blood pressure was recorded before induction of anaesthesia and at one, three, five and ten minutes after insertion of laryngeal mask airway or tracheal tube and the results compared in both groups. A statistically significant rise in heart rate, systolic blood pressure and diastolic blood pressure was seen in group-I while statistically significant rise in heart rate only was seen in group-II subsequent to their insertion. Mean maximum increase was statistically more after laryngoscopy and endotracheal intubation than after laryngeal mask airway insertion. The duration of pressor responses was also longer after endotracheal intubation. Laryngeal mask airway is an acceptable alternative techinque offering advantages in terms of haemodynamic stability compared to tracheal intubation

Comparison of 0.5% lignocaine vs 0.5% lignocaine plus 0.25% tramadol in intravenous regional anaesthesia

To compare the quality, onset and duration of intravenous regional anaesthesia [IVRA] with 0.5% lignocaine plus tramadol and 0.5% lignocaine alone. A comparative, double blind, randomized, prospective study. Orthopaedic operating rooms, Nishtar Medical Institution, Multan, Pakistan, from June 2005 to June 2006. In our of 60 adult ASA class I and II patients undergoing upper limb surgeries in patients were divided in two groups having 30 patients in each. We used tramadol, a weak opioid as a component of IVRA with lignocaine to suppress intra-operative pain and enhance postoperative analgesia. Patients received IVRA with 40ml of 0.5% lignocaine to which either 100mg tramadol or saline was added. The onset of anaesthesia and recovery was compared by loss and regain of sensations. Tramadol with lignocaine was found to be significantly better for rapid onset and quality of anaesthesia compared to lignocaine alone and devoid of opioid related side effects. We conclude that tramadol as a component of IVRA is significantly better adjunct to lignocaine

PONV-A comparative study of meto-clopramide alone and with dexamethasone in strabismus surgery

To determine the efficacy of intravenous metoclopramide alone and in combination with dexamethasone in preventing postoperative nausea and vomiting [PONV] in patients undergoing strabismus surgery. Single blinded, randomized, interventional study. This study was conducted in the department of Anaesthesiology at Nishtar Hospital, Multan from October 2005 to October 2006. After the approval of the hospital's ethical committee, the study was conducted on 60 patients who were randomly divided into two groups, each group containing 30 patients. All of the patients were between 2-14 years of age and were A.S.A-I. Randomization was done by envelope draw method. The patients received either metoclopramide 150 micro g/kg or dexamethasone 150 micro g/kg with metoclopramide 150 micro g/kg combination IV, 30 minutes before the induction of anesthesia. General anesthesia was induced with thiopentone sodium, nalbuphine, succinylcholine and maintained with isoflurane and N[2]O+O[2] in both groups. PONV were evulated postoperatively. Patients in group II who received metoclopramide plus dexamethasone experienced significantly less PONV during the first 24 h after surgery. In this study, a single dose of metoclopramide plus dexamethasone [150 micro g/kg of each drug] produced better antiemetic effects after strabismus surgery than metoclopramide alone

Relationship between total cystic area of ovaries and acanthosis nigricans in polycystic ovarian syndrome

To correlate the total area of Acanthosis Nigricans with total cystic area of ovaries in women with polycystic ovaries. Thirty young females with polycystic ovaries were selected and in them total cystic area and total area of Acanthosis Nigricans was measured. Mean total cystic area was 92.0 [SD 35.12] and mean total area of Acanthosis Nigricans was 224.46 [SD 234.90]. The relationship between total cystic area [TCA] and total area of Acanthosis Nigricans [TAAN] was statistically significant with p of 0.007. There is a significant correlation between total cystic area and total area of Acanthosis Nigricans in subjects with PCOS. So Acanthosis Nigricans could be a useful cutaneous marker for PCOS and the extensiveness of the cysts presents