Prevalence of Hypogonadism in males of different age groups: is it a lack of awareness?

Introduction: Hypogonadism in aging male is defined as [Syndrome caused by androgen deficiency which affect multiple organ functions and qualityof life]. Patients present with different symptoms like male erectile dysfunction, decreased sexual desire, anemia etc.

Objectives: To demonstrate the serum testosterone levels and prevalence of hypogonadism in different age groups and their correlation with symptoms of hypogonadism

Study Design: Cross sectional comparative study

Settings: Allied Hospital Faisalabad. Duration: 3 years and 6 months, from Dec 1, 2015 to May 30, 2018

Methodology: 180 healthy looking males were randomly taken from attendants of patients of Urology Department from indoor or from OPD and categorized into six groups according to their age decades: starting from Group-I [20-29 years] and ending at Group 6 [70 years and above]. Informed consent was taken. Symptoms of every person were recorded on Aging male symptoms scale [AMS]proforma/questionnaire. BMI, testicular volume,serum testosterone, Albumin, estradiol, SHBG, HbA1c and Blood Sugar were recorded. Results were recorded and put in SPSS version 10 for statistical analysis

Results: Average serum testosterone of different groups was 9.43+/-2.7ng/ml. The study shows a decrease in average serum testosterone level by 28.95 percent with advancing age. This difference is statistically not significant [chi square test, p-value 0.554]. The prevalence of hypogonadism was 10 percent in advanced age groups of our study population and all persons having low testosterone were symptomatic. Study showed93.44percentincrease in the severity of symptoms with advancing age

Conclusion: Serum testosterone falls with advancing age leading to differentsymptoms of hypogonadism but it is under reported as none of the persons was aware of this problem

Therapeutic outcome of Pulmonary tuberculosis in type-2 diabetes patients

Objective: Tuberculosis is a major cause of morbidity and mortality and diabetes is a leading risk factor of tuberculosis. Co-existence of tuberculosis and diabetes may increase the disease severity and worsen the treatment outcome. Therefore, objective is to find the anti-tuberculosis treatment outcome among pulmonary tuberculosis patients with or without diabetes mellitus; and to see the drug resistance pattern among treatment failure cases in both groups

Methodology: The cross-sectional study was carried out at PHRC Research Center FJMU Lahore in collaboration with PHRC TB Research Centre KEMU Lahore during the year 2013-14. The data of 268 patients including 187 pulmonary tuberculosis patients without diabetes and 81 with diabetes was analyzed. Anti-tuberculosis treatment according to current guidelines of Directly Observed Therapy [DOT] was provided to all patients; and were assessed for improvement of AFB smear; AFB culture and Chest X-Ray before and after four months of starting ATT. Data were analyzed by using Statistical Package for Social Sciences version 20

Results: Mean age of non-diabetic TB patients was 36+/-16 years; and of diabetic TB patients was 50+/-12 years. Mean duration of diabetes was 6+/-4 years. Other characteristics included 57.8 percent males, 42.2 percent females, and 53.7 percent had history of contact. Cough, expectoration, fever and weight loss were commonly occurring symptoms. Infiltration [76.1 percent] was the commonest type of lesion followed by consolidation [14.6 percent] and cavitation [9.3 percent]. Findings of AFB Smear conversion, AFB Culture, and Chest X-ray were improved with time in both groups; and rates of improvement were significantly higher among non-diabetic TB patients [p <0.05]. The frequency of drug resistance was lower among non-diabetic TB patients [7.0 percent vs. 19.8 percent] but the difference was insignificant. The rates of drug resistance and MDR were considerably higher among patients with poor glycemic control [p 0.036]

Conclusion: Therapeutic outcome of pulmonary tuberculosis was poor among diabetic TB patients as compare to non-diabetic TB patients. Therefore, along with anti-tuberculosis treatment, improvement of glycemic control must be considered among diabetic TB patients for better treatment outcome and reduced drug resistance rate

Prevalence of risk factors for noncommunicable diseases in adults: key findings from the Pakistan STEPS survey

Background: Pakistan lacks data on the prevalence of risk factors for common noncommunicable diseases [NCDs]. Objectives: This study aimed to determine the prevalence of risk factors for NCDs among a population-based sample in Punjab and Sindh provinces, Pakistan. Methods: This study was conducted in 2013–2014. The NCD risk factors examined were: current daily smoking, eating fewer than 5 servings of fruits/vegetable a day, low physical activity, overweight and obesity. A total of 7 710 households were selected and 1 adult was enrolled from each household. Data were collected using the WHO STEPS instrument [Step 1 and 2], and analysed according to the STEPS statistical plan. Results: The prevalence of tobacco use was 19.7%. The majority of the respondents [96.5%] consumed fewer than 5 servings of fruits/vegetables a day, 41.5% had a low level of physical activity, 26.3% were overweight and 14.9% were obese. The prevalence of stage I and stage II hypertension, including those on medication, was 37% and 15.9% respectively. The prevalence of NCD risk factors differed significantly by sex and occupation [P = 0.0001] but not by age group [P = 0.118], level of education [P = 0.668] and province [P = 0.056]. Only 0.6% of the sample had none of the 5 NCD risk factors while 40% had 3–5. Conclusion: The high prevalence of NCD risk factors in Punjab and Sindh provinces is of concern. Urgent public health interventions are needed to reduce them, especially in youth and young adults

Type and frequency of mutations in katg and rpob genes in multi-drug resistant strains of mycobacterium tuberculosis complex.

Background: Tuberculosis remains a major cause of morbidity and mortality in several parts of world. Genetic basis and mutations in katG and rpoB genes are responsible for isoniazid and rifampicin resistance in most of the cases of Mycobacterium tuberculosis

Objectives: To determine the mutations in katG and rpoB genes in confirmed multi-drug resistant tuberculosis isolates and to find the frequency of mutations Study design, settings and duration: This descriptive study was undertaken in PHRC TB research Centre, Department of Pulmonology, KEMU/Mayo Hospital Lahore. Polymerase chain reaction and genotyping was done at Institute of Molecular Biology and Biotechnology [IMBB], University of Lahore, Lahore from June 2013 to July 2014

Patients and Methods: A total of 100 acid-fast bacilli smear positive specimens of MDR TB suspects and rifampicin resistant on GeneXpert were collected. Drug susceptibility of isoniazid and rifampicin was carried out by standard drug proportion method. Gene amplification and sequencing was done to detect mutations in katG and rpoB genes

Results: A total of the 53% were females and 47% males with male to female ratio of 1:1.1. Mutations in rpoB Gene were found to be 98% of rifampicin resistant cases and in katG 76.7% of isoniazid resistant cases. Most of the mutations [60%] in rpoB Gene were observed on codon 531 while all the mutations in katG Gene were observed on codon 315. No novel mutation was found in this study

Conclusion: Mutation pattern of rpoB gene that confers rifampicin resistance is different to a little extent from other national and international studies while pattern is same for katG gene that confers isoniazid resistance. No novel mutation was observed in present study

Assessment of attitude, an insight from hepatitis patients and their relatives/ attendants of Islamabad, Pakistan

Background: Pakistan is the 2[nd] highest hepatitis C prevalent country while hepatitis B endemnicity is intermediate. Population has poor knowledge and understanding of these diseases therefore they face different types of stigmas. Stigmatization leads to barriers in the access of prevention and care of this disease. This study was conducted to evaluate the feelings and experiences of patients and their attendants [relatives] about hepatitis B and C and identify the gaps to ease access to treatment and care

Study design, settings and duration: Qualitative study conducted in Pakistan Institute of Medical Sciences and Federal Government Services Hospital, Islamabad for 08 months

Patients and Methods: Patients suffering from hepatitis B and C and their relatives who came to the OPDs of PIMS and Polyclinic were selected from the study. After taking consent from these 2 hospitals and consent from participants, the patients and relatives were grouped into 4 groups each comprising of 5-8 participants. Four focus group discussions [FGD's] were conducted for these patients and their attendants separately. Structured FGD guide was developed and special probes were used to stimulate discussion

Results: There were 06 participants in each of patient group and 07 subjects in relative groups. Among patients, majority had negative perceptions about disease and related the disease with fear. They had misconceptions about disease spread. Most of them experienced change in the attitude of family members, relatives and friends especially in sharing clothes, shoes, and utensils. Break up of relationships and discrimination in getting a job due to the disease was also reported resulting in social and financial problems. The attendants also had negative perception about the disease and its mode of transmission. Although they were cautious about the sharing of utensils and during patient care but they had positive feeling for their patient

Conclusion: Due to misconception about disease spread, the attendants/relatives were not sharing items of daily use items like cloths, crockery and bed linen with the patients thus giving them a feeling of dejection. Proper information about disease spread and its prevention along with the counseling of the patients and their attendants/relatives may build a positive relationship between them and thus ease help and care which is required for these patients

Policy message: There is need of public awareness about mode of transmission of hepatitis B and C and its preventive measures

Induction of innate immunity and its perturbation by influenza viruses

Influenza A viruses (IAV) are highly contagious pathogens causing dreadful losses to human and animal, around the globe. IAVs first interact with the host through epithelial cells, and the viral RNA containing a 5'-triphosphate group is thought to be the critical trigger for activation of effective innate immunity via pattern recognition receptors-dependent signaling pathways. These induced immune responses establish the antiviral state of the host for effective suppression of viral replication and enhancing viral clearance. However, IAVs have evolved a variety of mechanisms by which they can invade host cells, circumvent the host immune responses, and use the machineries of host cells to synthesize and transport their own components, which help them to establish a successful infection and replication. In this review, we will highlight the molecular mechanisms of how IAV infection stimulates the host innate immune system and strategies by which IAV evades host responses.

Comparison of genotype MTBDRplus testing kit with conventional method for drug susceptibility testing of isoniazid and rifampicin in tuberculosis patients

Background: Prompt and accurate diagnosis of multi drug resistant tuberculosis is essential to avoid unnecessary delay in treatment. The conventional methods for testing drug susceptibility requires 4-6 weeks for isolation of Mycobacterium tuberculosis and another 4-5 weeks for testing susceptibility thus delaying the diagnosis and treatment

Objectives: To validate the drug susceptibility testing of isoniazid and rifampicin with Genotype MTBDRplus kit and comparing with the conventional standard drug proportion method. Study type, settings and duration: This cross sectional study was carried out in PMRC TB Research Centre, King Edward Medical University Mayo Hospital Lahore in collaboration with Shaukat Khanum Memorial Cancer Hospital and the Research Centre from November 2008 to October 2009

Materials and Methods: A total of 77 AFB smear positive and negative specimens from adult patients suffering from pulmonary and extra pulmonary TB were included in this study. Samples were processed for drug sensitivity testing by drug proportion method using Lowenstein Jensen medium and also on Genotype MTBDRplus assay

Results: Out of 77 specimens 74% were pulmonary and 26% extra pulmonary. There were 29 females and 48 males with a mean age was 30 years. Culture positivity on LJ medium was 69% while that on MTB PCR was 79%. Out of 53 culture positive specimens, 8[15%] were MDR while out of 61 MTB PCR positive specimens 9[14.7%] were MDR

Conclusion: Genotype MTBDRplus assay, is a highly sensitive technique for diagnosis of MDR TB in smear positive and smear negative complicated suspects; but it requires expensive instruments and skilled personnel

Patients leaving against medical advice: an inpatient psychiatric hospital-based study

To determine the frequency of patients leaving against medical advice [LAMA] in an inpatient psychiatric facility in Rawalpindi, Pakistan. Descriptive cross-sectional study. Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, from August 2010 to February 2011. Patients who got admitted during study period irrespective of duration of illness and mode of admission were recruited through non-probability consecutive sampling and followed till discharge to determine their mode of leaving hospital. A thirteen-item proforma was developed and information was obtained on demographic, socioeconomic, patient related and disease related variables. Descriptive statistics were calculated on SPSS 14. The total number [n] of participants was 246. Among the participants, 96 [39%] left against medical advice [LAMA] whereas 150 [61%] left on regular discharge on physician's advice. Frequency of patients who left against medical advice was found to be more in males [63.5%], younger age groups [21 - 30 years], lesser educated [more than half were under matric] and with the ICD-10 diagnosis of substance abuse [23.9%]. About half of patients who LAMA had a prior history of psychiatric illness and a significant number [37.5%] had a history of previous psychiatric admission. Leaving against medical advice is a frequent problem in psychiatric inpatients and is a matter of great concern for the treating doctors

Tuberculous patients; cross sectional study of BCG vaccination and antibody TITRE in house hold contacts of tuberculous patients

This study was designed to analyze the BCG vaccination status and compare the immune globulins levels in the household contacts of tuberculous patients with non contacts of unexposed healthy peoples. Lahore. Cross sectional study. Investigations like ESR were done and the sera of 200 persons included in the study were tested for anti tuberculous antibodies by ELISA. BCG vaccination present or absent and scars were positive or negative in both groups were included. The combined serological positivity of the household contacts was 65.8% and for non-contacts was 34.1%. BCG scars were mostly absent in the household contacts as well as in non-contacts; But statistically IgG and IgA were present significantly by higher number in the household contacts as compared to non-contacts, where as no significant difference in the IgM levels. These immunoglobulins status were compared with BCG scars in both study and control groups. The results were analyzed by SPSS version 14. Household contacts of tuberculosis patients are more susceptible to tuberculosis as compared to the non-contacts, as shown by positive and negative status of cglitjirculous antibodies in the house hold contacts. More over BCG vaccination has no significant role in humoral evaluation

Colorectal carcinoma

Prognosis is excellent in colonic carcinoma in case of well differentiated growth. All efforts must be done to diagnose the malignancy at an earlier stage for a better outcome specially if it is well differentiated growth. To compare the different modes of presentation of carcinoma of large bowel in a tertiary care hospital and their association with pathological findings. It is a cross sectional retrospective study. Patients with histological proof of carcinoma were included in the study. Data over the period of two year was collected and analyzed. This study included one hundred patients. Mean age was 49.56 years and 56% of the patients were males. 40% of the patients present between the ages of 40 to 60 years. Mean time of start of symptoms and the time of presentation in the hospital was 6.5 months ranges from 1 to 24 months. 76% of the patients had history of altered bowel habits and 60% had anorexia and weight loss. 41.66% of patients had well differentiated growth while 37.55% of patients had moderately differentiated adenocarcinoma. Majority of the patients with colonic carcinoma had well or moderately differentiated growth. If they are diagnosed and properly treated at an early stage, outcome is good

Frequency of compliance with antidepressants using antidepressant compliance questionnaire

To find out the frequency of compliance of patients using anti-depressants prescribed at out-patient department. Descriptive cross sectional study. This study was conducted in the out-patient department of Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi from September 10,2010 till May 10,2011. One hundred and sixteen patients aged 18 years and above, presenting with moderate depressive illness, able to understand and speak Urdu, taking treatment for at least 4 weeks and belonging to both genders were recruited from out-patient department using consecutive [non-probability] sampling technique. Patients having severe depressive illness with psychotic features and severe agitation were excluded. Antidepressant Compliance Questionnaire was translated and validated through a pilot study and then the Urdu translation was orally administered to each participant for the assessment of compliance with antidepressant medication. Among the participants 74.1% were compliant and 25.9% were non-compliant with anti-depressant medications. This study found a high degree of patient compliance with anti-depressants. The results would help in early recognition of non-compliant patients, so that necessary changes could be made in the treatment plan to ensure better compliance

Efficacy and side effects of glyceryl trinitrate in management of chronic anal fissure

Various options are available for treatment of chronic anal fissure, each with its own associated complications. This study aimed to evaluate the efficacy of topical Glyceryl Trinitrate [GTN] for anal fissures in an outpatient setting. A prospective experimental study was carried out at the outpatient department of Surgical Unit IV, Liaquat University Hospital from Aug 2004 to Jul 2005. Total 100 patients fulfilling the criteria of chronic anal fissure were included in the study. Patients presenting with chronic anal fissure but with associated comorbidities were excluded. Data were collected on a designed questionnaire, and analysed using SPSS-10. Sixty women and 46 men were included in the study with a mean age of 30 years. After the end of 8 weeks of treatment, 76 showed healing of fissure and relief in symptoms whereas 20 patients either had improvement in symptoms or did not heal. The commonest side-effect was headache reported by 21 patients. The minimum period of follow-up was one year, and 7 patients had recurrence. Topical 0.2% GTN is an effective first-line agent in managing chronic anal fissure. The associated side effects and recurrence remains a matter of concern.

Patient satisfaction with electroconvulsive therapy in a tertiary care hospital

To determine the frequency of satisfied patients with ECTs in a public sector tertiary care hospital. Cross-sectional, descriptive study. The study was carried out in the in-patient department of Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, a tertiary care public sector hospital, from October 2010 to June 2011. A consecutive sample of 163 inpatients of both genders, excluding acutely disturbed patients was recruited. Proforma regarding the socio-demographic details was filled by the participants. ECT satisfaction Questionnaire was orally administered in Urdu to each participant for the assessment of their satisfaction with ECT. Data was analyzed using SPSS 10.0. Using the ECT satisfaction Questionnaire, 62.6% patients were satisfied while 37.4% were dissatisfied with ECT. Majority of patient was satisfied with Electroconvulsive therapy. However there is a need to explore specific reasons for satisfaction/dissatisfaction with this treatment modality in order to improve the delivery of this treatment in accordance with the patients' expectations for better treatment adherence and improved outcomes

Impact of overweight and obesity on ventilatory function among male medical students

To correlate the respiratory function among normal weight [BMI > 18.5 - 24.9 Kg/m[2]], overweight [BMI > 25 - 29.9 Kg/m[2]] and obese [BMI > 30 Kg/m[2]] male medical students who did not have evidence of obstructive or restrictive airway disease or other underlying diseases affecting their respiratory system. The other objective was to assess the correlation of respiratory function St body mass index [BMI]. Cross sectional controlled study was conducted among 113 eligible male medical students at college of medicine, King Saud University Riyadh, Kingdom of Saudi Arabia during August 2009 - July 2010. Body mass index was used to assess the obesity and forced expiratory volume in one second [FEV1] and forced vital capacity [FVC] were used to assess respiratory function. One way ANOVA was used to find the difference between BMI groups and bivariate correlation analysis was done to find out the strength of the relationship among BMI and respiratory function parameters. FEV1, FVC and FEV1/FVC ratio were linearly and mildly inversely related with BMI in overweight [r = -0.338, -0.291, -0.311 respectively] and obese [r = -0.375, -0.349, -0.040 respectively]. In normal weight subjects, FEV1 and FVC were mildly positively correlated [r = 0.136 and 0.219 respectively] and FEV1/FVC ratio was negatively correlated [r = -0.166] with BMI. Overweight and obesity are associated with pulmonary dysfunction among young male population

Role of oral colchicine in plaque type psoriasis. A randomized clinical trial comparing with oral methotrexate

Patients with moderate to severe psoriasis generally require phototherapy, photochemotherapy or systemic agents to control their disease adequately. The potential toxic effects of long term use of the classic antipsoriatics, prolonged continuous therapy, higher cost and low socio-economic conditions of patients obligate us to consider some cheaper older alternatives like colchicine. A prospective, randomized controlled clinical trial was carried out on two groups of patient of psoriasis, group A [Case, n=30] was treated with 2.1 mg per day oral colchicine, in two divided doses and group B [Control, n= 30] was treated with 7.5 mg of oral methotrexate once weekly for 8 weeks. No topical agent except bland emollients was applied during the trial period. Psoriasis area severity index [PASI] was calculated as main outcome measure at entry level and follow up after one month and two months. The mean percentage reduction of PASI was statistically significant [p=0.001] at both first and second follow up with oral colchicine. PASI-50 was achieved in 23.3% of respondent in colchicine group and 53.3% in methotrexate group [p<0.05]. Oral colchicine is an effective therapy for chronic plaque psoriasis but it is less effective than methotrexate, the gold standard antipsoriatic therapy [p<0.05]

Cutaneous morphological patterns of adverse drug reactions: a study of 50 cases

Adverse drug reactions are common complications in drug therapy. About 3-8% of all hospital admissions are the results of adverse drug reactions, and these can cause significant disability to patients. To evaluate the clinical spectrum of all cutaneous adverse drug reactions and to establish the causal link between suspected drug and the reaction. This observational cross-sectional study was done among the patients having cutaneous drug eruptions. 50 consecutive patients were enrolled. Purposive sampling was done. In every patient a detailed history was taken. Examination was carried out to find out the type of cutaneous reactions. Data were collected in a predesigned structured questionnaire. Statistical analysis was done with the help of SPSS. Out of 50 respondents, 20% had a history of indigenous drug intake followed by 18% sulphonamides, 14% NSAIDs, 14% quinolones, 8% anticonvulsants, 8% cephalosporins, 6% penicillins, 4% antituberculous drugs, 4% metronidazole and 4% tetracyclines. 34% had maculopapular rash, 24% Stevens-Johnson syndrome, 12% exfoliative dermatitis, 10% urticaria, 8% fixed drug eruption, 8% erythema multiforme, 8% bullae, 6% vesicles, 2% lichenoid eruption and 2% scaly eruptions. Frequency distribution of the offending drugs and the adverse reactions revealed that cephradine was responsible for maculopapular rash, sulphonamides for Stevens-Johnson syndrome, indigenous medicines for exfoliative dermatitis, NSAIDs for urticaria and paracetamol for fixed drug eruption

Renal cell carcinomas: Correlation of size with tumor grade and extracapsular extension

To find the association of tumor size with grade of tumor and its extra capsular extension. A review of record of all renal biopsies performed at pathology department King Edward Medical University over a period of two years was done. It was found that large sized tumors tend to have a higher grade and this correlation was found to be statistically significant [P=0.02]. A significant correlation was also seen between the size of tumor and extra capsular extension [P=0.001]. It was concluded patients presenting with larger renal tumors, who subsequently underwent nephrectomy and histopathological analysis were diagnosed with a higher grade. This relation implies that these patients with larger tumors will in turn have poorer prognosis

Pathogenicity of bacterium, Xenorhabdus nematophila isolated from entomopathogenic nematode (Steinernema carpocapsae) and its secretion against Galleria mellonella larvae / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The entomopathogenic bacterium, Xenorhabdus nematophila was isolated from the hemolymph of Galleria mellonella infected with Steinernema carpocapsae. The bacterial cells and its metabolic secretions have been found lethal to the Galleria larvae. Toxic secretion in broth caused 95% mortality within 4 d of application whereas the bacterial cells caused 93% mortality after 6 d. When filter and sand substrates were compared, the later one was observed as appropriate. Similarly, bacterial cells and secretion in broth were more effective at 14% moisture and 25 degrees C temperature treatments. Maximum insect mortality (100%) was observed when bacterial concentration of 4x10(6) cells/ml was used. Similarly, maximum bacterial cells in broth (95%) were penetrated into the insect body within 2 h of their application. However, when stored bacterial toxic secretion was applied to the insects its efficacy declined. On the other hand, when the same toxic secretion was dried and then dissolved either in broth or water was proved to be effective. The present study showed that the bacterium, X. nematophila or its toxic secretion can be used as an important component of integrated pest management against Galleria.

Anxiety assessment in orthopedic patients

Orthopedic specialty is a very versatile specialty, it deals with a wide variety of conditions like degenerative joint disorder, deformities of spine and limbs, including congenital and acquired both, bones and joint infections and of course traumatology which is a major part of orthopedic patient. We did a study to assess pre operative anxiety in orthopedic patients. All the patients above the age of 12 years, admitted to orthopedic unit II of Abbasi Shaheed Hospital, were asked to fill a performa designed to assess different aspects of anxiety- associated problem. The subjects were also inquired about their knowledge of imminent surgery being, its out come and the time period required to get back to their daily activities. Fifty eight percent of patients were anxious about their upcoming surgery, They were anxious due to different reasons like surgery. anesthesia, pain, the risk of complications and of becoming dependent on others. Our study showed a significant proportion of orthopedic patients undergoing surgery as being anxious. In this regard, social and occupational therapist can play a major role in reducing the anxiety of our patients by doing detailed counseling and making the patients maximally aware of their surgery