Knowledge, attitudes and practices [KAP] regarding sexuality, sexual behaviors and contraceptives among college/ university students in Karachi, Pakistan

To assess the knowledge, attitudes and practices regarding sexuality, high risk sexual behaviors and methods of contraception, among college/university students of Karachi, Pakistan. Cross-sectional observational study. Higher Education Commission-recognized government and private colleges/ universities in Karachi from 2005-2006. two colleges/universities were randomly selected from each category i.e. government medical, government non-medical and private medical and non-medical colleges/universities. Three stage cluster sampling was employed to draw a representative sample of students. A self administered questionnaire was used to elicit information on knowledge, attitudes and practices regarding high risk sexual behaviors, methods of contraception and sources to obtain information about sexual issues. A total of 957 students were interviewed. They comprised 542 [56.6%] males and 415 [43.4%] females with mean age of 21 +/- 1.8 years. Bivariate analysis showed that students enrolled in medical colleges/ universities were less likely to watch adult films [O.R. 0.7, CI; 0.5-0.9] to acquire sex related knowledge and go out on dates [O.R.0.6, CI; 0.4-0.8]. Similarly, medical students were less likely to consider contraception as being against Islamic teachings [O.R. 0.7, CI; 0.5-0.9]. the curricula of non-medical studies at undergraduate level should include education regarding sexual health and contraception

Intervención psicológica única multifamiliar en la Unidad de Cuidado Agudo de una clínica psiquiátrica / Psychological intervention in an only multifamily session at an Acute Care Unit of a psychiatric clinic

Este artículo ofrece una panorámica sobre la intervención sicológica en una Unidad de Cuidado de Salud Mental. Se definen los objetivos y las acciones terapéuticas a seguir, a través de la participación del equipo interdisciplinario y del trabajo en red, en el que se vinculan grupos de apoyo, en particular de las familias de los pacientes que sufren un trastorno mental severo. Los materiales y recursos empleados fueron sesiones semanales de una hora y cuarenta minutos, por dos años de seguimiento (2005-2007). La población objeto de estudio estuvo conformada por familiares de los pacientes con patologías diversas, que se encontraban internos en la Unidad de Cuidados Intensivos. En cuanto al diseño, se realizó un análisis cualitativo de 100 diarios de campo, diligenciados en una matriz de análisis de contenidos. En éste se revisaron los objetivos, los multifocos de abordaje, la metodología, las técnicas empleadas, los procedimientos desarrollados y la retroalimentación dada en cada una de las sesiones. Los hallazgos del estudio muestran que los trastornos mentales están relacionados con el ambiente en el que se desarrolla el paciente y con procesos sociales complejos. También sugieren una mayor necesidad de atención al paciente psiquiátrico y a su sistema de redes, de manera oportuna y pertinente. Por otra parte, señalan la importancia de incrementar esfuerzos orientados a hacer más accesibles en el campo de la salud mental las intervenciones estratégicas breves de los equipos interdisciplinarios; además, se evidencia que es apropiado un abordaje psicoeducacional y terapéutico en el que se coordinen las acciones en diferentes niveles.

This article provides an overview of the psychological intervention in a Unit Care of Mental Health. The objectives and therapeutic actions to follow are defined through the participation of an interdisciplinary team and networking; it includes support groups and, especially, the families of patients that suffer a severe mental disorder. The materials and resources used were weekly sessions of one hour and forty minutes, for two years of monitoring (2005-2007). The study population consists of families of patients with different pathologies, which are in the Intensive Care Unit. In terms of design, it is made a qualitative analysis of 100 field day formats, and fills a matrix of content analysis. It is reviewed the objectives, the approach Multi-Focus, methodology, used techniques, the procedures developed and the feedback given at each session. The findings from this study show that mental disorders are related to the environment in which the patient is developed and complex social process. They also suggest a greater need for psychiatric patient care and its networks, timely and relevantly. By the other hand, it shows the importance of increasing efforts to make available in the field of mental health brief strategic interventions in interdisciplinary teams, it is appropriate a psycho educational and therapeutic approach in which the actions are coordinated at different levels.

Depresión posparto en el embarazo adolescente: análisis del problema y sus consecuencias / Adolescent pregnancy and postpartum depression

El embarazo adolescente es un importante problema de Salud Pública, que se asocia a consecuencias biológicas, psicológicas y sociales negativas tanto para la madre como para el hijo. Uno de los riesgos frente a los que las madres adolescentes están particularmente vulnerables es a la depresión posparto (DPP). Existen extensas investigaciones sobre el fenómeno de la DPP, pero los estudios en madres adolescentes son limitados y suelen provenir de países desarrollados. En Chile no existen estudios publicados que se aboquen específicamente a la DPP en adolescentes. Por lo mismo, es que esta revisión pretende dar cuenta de los principales hallazgos internacionales y nacionales sobre prevalencia, factores de riesgo, consecuencias y abordaje de la DPP en general, y en madres adolescentes en particular, con el propósito de fortalecer el conocimiento de los profesionales que trabajan con estas jóvenes, ya sea en el área de salud mental, obstetricia o pediatría.

Adolescent pregnancy is an important public health issue associated with negative biological, psychological and social consequences for the mother and the child. One of the main risks adolescent mothers is particularly vulnerable to postpartum depression. Literature on postpartum depression is broad, but studies regarding the phenomenon in adolescent mothers are scarce, and come mostly from developed countries. In Chile there are no published studies centered on postpartum depression in adolescents. Therefore, this article aims to describe the main international and national findings on the prevalence, risk factors, consequences and management of postpartum depression in general, and in adolescents in particular, with the goal of strengthening the knowledge of professionals caring for adolescent mothers in mental health, obstetric and pediatric services.

Ultrastructural changes of the testicular tissues of immature and mature mice under the effect of lithium carbonate

Lithium carbonate [one of the antipsychotic drugs] was a mainstay and long term maintenance treatment in manic depressive disorders, the broad use of this element in treating mood and behavioral disorders had led to the realization of the fact that prolonged treatment with this alkali metal may lead to a wide rang of adverse effects. In the present study, the question of the toxicity of the antipsychotic drug [Lithium carbonate] was tested by direct injection of the drug to mature mice and indirect injection of the drug to immature mice as the pregnant mother received the injection from the 10th days of the pregnancy till the end of lactating period. Both the pregnant mothers and adult male mice received [23.25 mg/ mouse - a cumulated dose throughout 31 days], the drug was injected intraperitoneally. The adult male and the weaning male for the pregnant female were scarified by decapitation and the testis were taken after intracardiac perfusion by gluteraldhyde to insure the success of fixation for the electron microscopic study. The results explained the ultrastructural changes which involved the irregularity of the basal lamina, vacuolation of the lining epithelium, degeneration of spermatocytes. Dilated smooth endoplasmic reticulum and multivescular bodies were recorded in Sertoli cells. Altered rough endoplasmic reticulum, shedding of ribosome, hypertrophied Golgi apparatus, destruction of mitochondrial cristae and fewer amounts of lipid droplets were observed in Leydig cells. Mitochondria and smooth endoplasmic reticulum were sensitive indicators to the slightest pathological changes induced by drug administration which might lead to dysfunction. The results of this study strongly indicated that Camcolit [Lithium carbonate] induced profound ultra structural changes nearly similar in the adult and weaning mice and the fine morphological abnormalities induced by lithium carbonate cannot be isolated from testicular functional abnormalities, in terms of, cellular differentiation and spermnation abnormalities

Estudio descriptivo-exploratorio del trastorno depresivo mayor: aproximaciones psicológicas y sociodemográficas de pacientes hospitalizados en la Clínica Psiquiátrica Nuestra Señora de la Paz / Descriptive-Exploratory Study of Major Depressive Disorder: A Psychological and Sociodemographic Approximation of Inpatients at the Clínica Nuestra Señora de la Paz

Objetivos: Analizar la relación entre la depresión mayor y las características sociodemográficas y psicológicas de pacientes hospitalizados en la Clínica Nuestra Señora de la Paz que habían sido atendidos por el Servicio de Psicología, en el período 2000-2001 con diagnóstico de depresión mayor. Métodos: Diseño de tipo descriptivo-exploratorio; se trabajó con una población de 100 pacientes a quienes se les hizo una entrevista semiestructurada; se revisó la historia clínica institucional con el fin de complementar información. Para el análisis se utilizaron procedimientos de estadística descriptiva: combinación de variables. Resultados: 47% presentó diagnóstico de depresión mayor con uno o más intentos de suicidio; 25% presentó como método de suicidio utilizado la ingesta de sustancias. Conclusiones: Este estudio refleja la notoria influencia de variables psicológicas y sociodemográficas en la manifestación del trastorno depresivo mayor.

Objectives: An approximation to the relation between Depression and attempted suicide and the sociodemographic and psychologic features in inpatient males and females at Clínica Nuestra Señora de la Paz. These patients were admitted to the Psychology Departament, referred from Psychiatry in the period between 2000-2001 with a diagnosis of Major Depression. Methods: Descriptive-Exploratory method designed with a population of 100 patients who were subject to a semistructured interview. The medical charts and histories were alsoreviewed to complement the information. Variables were analyzed using procedures of descriptive statistics. Variable combination and crossing. Results: Of the patients included in the study 53% had a diagnosis of Major Depression and 47% of them, besides the diagnosis, had 1 or 2 attempted suicides. Of the totality of the group, 25% used substance ingestion as the method for suicide, noting the influence of Psychologic and sociodemographic variables in the expression of Major Depressive Diorder. Conclussions: There is a notorious influence of psychological an sociodemographic variables in clinical signs of Major Depressive Disorder.

comparison of the effect of breast feeding, mixed feeding and top feeding on weights of infants and children

A retrospective analysis of 503 patients admitted to diarrhoea ward between June to August 2003 was done regarding their weight and feeding practices. Out of them 36 children were excluded as they did not full fill the required criteria. So a total of 467 patients were studied. The patients were divided into three groups depending upon whether they were breast fed, mixed i.e. both breast and top fed, or top fed respectively. All patients between the ages of birth and 24 months were included. The number of patients in breast fed, mixed fed and top fed were 134,135 and 198 respectively. Male to female ratio was 1.4:1,1.5:1,1.4:1,with mean age in breast fed group for females 6.9 +/- 4.7 months and males 10.3 +/- 7.63,in mixed fed group 8.3 +/- 5.97 months and 8.4 +/- 6.4 months and in top fed group 8.25 +/- 7.35 months and 7.65 +/- 5.72 months respectively. Mean weight in each group was 6.1 +/- 1.9, 5.7 +/- 2.1 and 4.9 +/- 2.0 kg. When weight of breast fed children was compared with those of mixed fed the difference was not statistically significant with p value of 0.236 while the comparison with top fed was highly significant with p value of 0.000. Similarly babies on mixed feeding had significantly better weight than that of top fed with p value of 0.004. Although it has been stressed upon and a lot of effort has been put in to encourage breast feeding but still top feeding and mixed feeding are on the top resulting in malnourished and wasted children. From our study it is obvious that top fed children are grossly malnourished, and exclusive breast feeding is low. We need to take more steps to encourage breast feeding

Radial forearm flap versus anterolateral thigh flap in the treatment of problematic wounds of the leg a clinical prospective study

Deep electrical and thermal burns and crushing injuries often result in exposure and devascularization of underlying structures. This study was done to evaluate the results of free flaps in reconstruction of these problematic wounds. Our study included 30 patients who were treated by free flap reconstruction. Twenty-three patients were males [76.67%] and 7 patients were females [23.33%]. Their mean age was 36.5 +/- 12.31 years. Problematic wounds were post-traumatic in 22 cases and post burn in 8 cases. The free flaps used were radial forearm flap [n=15] and anterolateral thigh flap [n=15]. Reconstruction was done using microsurgical technique by one team of surgeons. The total success rate was [90%]. The radial forearm flap succeeded in 14 cases [93.33%] and failed in 1 case [6.67%]. The anterolateral thigh flap succeeded in 13 cases [86.67%] and failed in 2 cases [13.33%]. Post-traumatic wounds were found to have a lower success rate compared to post-bum cases. We think that free flaps should be strongly considered in the management of problematic wounds for their advantages as better preservation of tissues, less number of operations and short hospitalization than other traditional techniques

Role of enalapril maleate in controlling hypertension: a clinical study

Enalapril maleate, an angiotensin converting enzyme inhibitor, was given to patients suffering from mild to moderate hypertension to observe its antihypertensive effect. Twenty hypertensive patients were put on enalapril maleate 5mg to 40mg daily for four months after discontinuing previous antihypertensive therapy for six weeks. Sitting systolic blood pressure decreased from 163.3 +/- 2.9 mmHg to 143.6 +/- 5.4 mmHg while sitting diastolic pressure decreased from 106 +/- 1.3 mmHg to 89.5 +/- 1.9 mmHg. Standing systolic blood pressure decreased from 165.9 +/- 3.5 mmHg to 145.7 +/- 4.7 mmHg while standing diastolic blood pressure decreased from 108.5 +/- 1.1 mmHg to 92.8 +/- 1.8 mmHg. There was no change in pulse rate both in sitting and standing position. Only one patient showed hypersensitivity reaction. Blood pressure control was satisfactory in 14 patients. Enalapril Maleate was found effective in decreasing blood pressure in patients with mild to moderate hypertension

Disease pattern, health services utilization and cost of treatment in Pakistan

Population based data on disease patterns, health services utilization and cost incurred on treatment in Pakistan were collected through a nation-wide sample survey in 1982-83. The survey for the first time revealed, the burden of disease on the society. The analysis done here suggest, that about one-sixth of the population suffered from an illness during the past one month period. As expected, illness was more prevalent among children, women in reproductive ages and the elderly. Over two-thirds of those who fell ill, suffered from malaria and fever and one-fifth from diarrhoea and dysenteries. There was heavy reliance on private physicians for treatment of those who fell, about two- thirds in the urban and one-third in the rural areas, consulted private physicians. On the other hand in both the areas, less than one-sixth utilized the government health facilities. The cost of health care on an average, was 4% of the total income in the urban and 5% in the rural areas. In both the areas, this constituted over 7% of the monthly household income of the poorest. Suggestions are made to overcome the high cost of health care through broad based national health policy and implementation of primary health care programme

Isradipine in Pakistani hypertensive patients

Isradipine, a calcium channel blocker, was given to 124 [29 females and 32 males] hypertensive patients for eight weeks after three weeks on placebo treatment. Mean age was 46.5 +/- 0.86 years, mean weight before treatment was 70.04+1-1.2 kg, after treatment it was 69.7 +/- 1.3 Kg, mean height was 154.5 +/- 0.8 cm and mean duration of hypertension was 4.2 +/- 0.31 years. Mean sitting systolic pressure decreased from 164 +/- 1.5 mmHg to 146 +/- 2.19 mmHg [p<.001] while mean sitting diastolic pressure dropped from 106.5 +/- 0.62 mmHg to 93.1 +/- 0.8 mmHg [p<.001]. Mean standing systolic pressure fell from 166 +/- 1.08 mmHg to 147 +/- 1.8 mmHg [p<.01] while erect diastolic pressure fell from 108 +/- 0.6 mmHg to 96.9 +/- 1.7 mmHg [p<.001]. Mean sitting arterial pressure decreased from 125 mmHg to 110 mmHg while standing mean arterial pressure decreased from 127 mmHg to 119 mmHg. No statistically significant fall in heart rate both in supine and standing position was observed. Laboratory results did not show any variation. After eight weeks on active treatment 34% of the patients were taking 1.25 mg B.D while 66% of the patients were on 2.5 mg B.D. Isradipine was found effective and safe in patients with mild to moderate hypertension who tolerated the drug

Mean duration of hospital stay of IHD patients at CCU Mayo Hospital, Lahore

The objective of the study was to determine the mean stay of patients with acute myocardial infarction and unstable angina admitted to Coronary Care Unit of Mayo Hospital, Lahore. This prospective study carried out during one year period included three hundred fifty patients. Out of these, two hundred and fifty-seven [73.4%] were males and ninety-three [26.6%] were females. About 59.4% had acute myocardial infarction as per WHO criteria, 33.7% had associated Left Ventricular Failure [LVF]. The average stay was 11 +/- 0.43 days. Those with Acute Myocardial Infarction stayed for average of 10 +/- 0.43 days. The shortest stay was for young patients between forty-one to fifty years old. The longest stay with extensive ant. wall myocardial infarction patient was 13 +/- 2.6 days. It is concluded that patients stay much longer in CCu in one set-up. This may be due to physician's attitude or condition of the patient admitted in CCU

Maternal malnutrition and low birth weight

Low birth weight accounts for a large proportion of newborn infants in developing countries and is a major determinant of perinatal mortality. The bulk of these infants are growth retarded and maternal malnutrition plays a major etiological role. A maternal pregnancy weight gain in excess of the 12 kg is necessary to ensure a birth weight > 2.5 kg. It is essential that adequate nutritional assessment and supplementation be ensured during pregnancy