Outcome of dietary intervention on weight and Anthropometric indices of overweight and obese females: a randomized controlled trial

Objective: To study impact of dietary intervention and counseling on weight and anthropometric indices of obese females

Study Design: Prospective randomized controlled trial

Place and Duration of Study: This study was conducted at Pakistan Navy Ship [PNS] Shifa, from Feb 2014 to Sep 2014. Patients and Methods: Study subjects were 320 obese females from Karachi, Pakistan, aged 20 to 40 years. Before randomization all baseline anthropometric measurements were recorded. After that females were randomly placed into intervention and control groups. Anthropometry and 24-hour dietary recall were used for nutritional assessment. Intervention strategy was individualized diet plan by registered dietitian according to base line body weight and anthropometric indices of study subject. Primary outcome was the change in body weight and body mass index

Results: The final analysis was run on 280 participants [intervention=127, control=153]. Both intervention and control group were comparable with respect to anthropometric variables at start except intervention group had more body mass index [BMI] [28.024 +/- 3.561]. A significant change was observed in body weight [p=0.001], BMI [p=0.001], waist circumference [p=0.001], hip circumference [p=0.01], waist hip ratio [p=0.04] in an intervention group while control group only showed significant reduction in waist circumference [p=0.041]. Intervention group showed significant improvement in dietary behavior which was depicted by increased intake of fruit and fiber consumption [p=0.001], reduction in consumption of simple carbohydrates [p=0.001], animal protein [p=0.001] and fatty food [p=0.001]. Control group showed decrease in waist circumference in response to reduction in dietary fat intake and increase intake of fruits [p=0.001] and vegetables [p=0.042]

Conclusion: The results of our study have positively demonstrated that nutritional intervention among obese females was successful in reducing weight and BMI. Reduction inwaist and hip circumference and change in diet behavior were also observed as secondary outcome variable

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

Kingdom of Saudi Arabia: a potential destination for medical tourism

To perform a comparative study of Medical tourism in the Arab world with special reference to Saudi Arabia and find ways to upgrade medical tourism in Saudi Arabia. A comprehensive literature review and analysis of statistical data from Saudi Ministry of Health is performed. With more than 37 million health-related trips and the generation of more than £ 33 billion each year, medical tourism has become an important element in the global economy. Travelling abroad to seek medical care is increasing steadily in both developing and developed countries: people in developing countries seek new technology and skills in developed countries, while people in rich developed countries seek medical care elsewhere because of high costs and long waiting lists in their home countries. India, Malaysia, Singapore and Thailand dominate the Asian market, and the United Arab Emirates, with the construction of the Dubai Health Care City, attracts clients from western, Gulf Cooperation Council, Middle Eastern and North African countries. Kingdom of Saudi Arabia is not one of the most popular countries, even though it has all the basic attributes for a successful medical tourism industry, including modern, well-equipped hospitals, a well-established private health care sector, foreign-trained doctors and specialists and a stable, peaceful environment. It is also home to the main holy places of Islam and an important religious center. Kingdom of Saudi Arabia could take the lead in this market by combining medical tourism with religious tourism, not only for the 1.6 billion [23% of the world's population] Muslims but also for the rest of the world. Recent accreditation of many Saudi hospitals by the Joint Commission International in the United States shows their commitment to promoting medical tourism. If properly managed, medical tourism could open the door for an income generation revolution in Kingdom of Saudi Arabia

Chest pain as a presenting complaint in patients with acute myocardial infarction [AMI]

Objective: To study various characteristics of chest pain in acute myocardial infarction patients

Methodology: A total of 331 patients of AMI admitted at Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan, irrespective of the age and gender, were included in this study. The study duration was one year starting from June 2011 to June 2012. Non-probability purposive sampling technique was used in this descriptive study. Informed consent to participate in this study was taken. Data were entered and analyzed using SPSS-11

Results: A total number of 331 patients with AMI were included in the study. Mean age was 54.99+/-11.25 years with minimum age 20 years and maximum age 90 years. It included 264[79.8%] male and 67[20.2%] female patients with male to female ratio of 3.9:1. Out of these 331 patients 308 [93.1%] patients reported chest pain as the presenting complaint. Remaining 23[6.9%] presented with clinical features other than chest pain. There were 127[38.4%] patients with pre-cordial chest pain, 115[34.7%] had retrosternal chest pain, 58[17.5%] were having epigastric pain. Severe chest pain was seen in 281[84.9%] patients while 26[7.9%] had only mild chest discomfort. Radiation of the pain to shoulder, neck and jaw was seen in 75 [22.7%] patients. In 42[12.7%] patients, pain radiated to both sides of chest. Another 55[16.6%] patients had pain radiation to chest, shoulder, upper arm and ulnar side of left forearm. Chest pain radiation to interscapular region along with both sides of chest was present in 10[3.0%] patients. In 11[3.3%] patients' pain radiated only to left side of chest. Pain persisting for >20 minutes was reported by 298 [90%] patients while only 10[3.1%] had pain persisting for <20 minutes

Conclusion: There is considerable overlap in chest pain of cardiac as well as non cardiac causes. However, vigilant evaluation of characteristics of chest pain in history taking may help to overcome this dilemma. Severe and prolonged precordial chest pain in a male patient between the age of 41-70 years, with pain radiation to left shoulder, neck and jaw is highly suggestive of AMI

Primary malignant carcinoid tumour of the kidney

A primary malignant carcinoid tumour of right kidney in a 40 years old male patient is described. The neoplasm displayed histological features resembling the carcinoid tumours of gastrointestinal or respiratory tracts with trabecular pattern predominating. It revealed focal argyrophil positivity and was argentaffin negative. Despite an extensive search, no primary tumour else-where in the body was detected

Endoscopic cut to light management of posterior urethral strictures

Seven patients with impassable traumatic, iatrogenic and infective posterior urethral strictures were managed by this technique. The results of endoscopic CUT TO LIGHT" technique compare favourably with other more invasive open procedures. This procedure is easy to do and carries very low morbidity

Clinical usefulness and diagnostic value of digital rectal examination, prostate specific antigen and serum acid phosphatase, in the early diagnosis of prostatic carcinoma and benign prostatic hyperplasia

In seeking to define the relative value of digital rectal examination [DRE], prostate specific antigen [PSA and serum acid phosphatase [SAP] in prostate cancer [CaP] and benign prostatic hyperplasia [BPH], a series of 129 patients with symptoms of bladder outlet obstruction were studied prospectively and the findings compared. Out of the total 129 patients evaluated in this study, DRE detected malignancy in 46%, PSA in 32% and significantly elevated SAP suggested malignancy in 45% of cases. The diagnostic value for BPH of these three investigations were also compared with DRE detected BPH in 54%, PSA in 68% and SAP in 55% of patients. Age or the presence [or absence] of an indwelling catheter had no effect on PSA and SAP concentrations. The specificity of PSA for detecting prostate cancer in this study was 58.33% with a sensitivity of 100%, in contrast to values for SAP of 83.33% and 71.4% respectively. It was concluded that the routine use of SAP as a marker for CaP should be abandoned. The use of PSA as a screening test in a group of patients with prostatism appears justified, but with a positive predictive value of only 32%, its use in a general screening programme is not recommended

Treatment of vesico-ureteric reflux [preliminary report]

The results of various modalities of treatment used in 22 children and 4 adults with obstructive and non obstructive Vesico-ureteric reflux, treated in Shaikh Zayed Hospital over a period of 3.5 years [between June, 1987 and December, 1990] are presented. The primary treatment of reflux grade-IV and V was surgical. Majority of children with reflux Grade I-Ill were treated conservatively with antibiotic prophylaxis. Re-implantation was carried out in 12 ureters, antibiotic prophylaxis treatment in 9 ureters and 22 ureters were treated by minor surgical procedures followed by conservative chemoprophylaxis. Conservative management of reflux Grade IV and V seems to be less successful than surgery. The results of conservative, non-surgical treatment of reflux Grade I to III are satisfactory, but for Grades IV and V reflux surgery seems to be the treatment of choice, if detrussor instability can be excluded

Balloon dilatation for prostatic obstruction

Retrograde balloon dilatation of prostatic urethra was performed for prostatic obstruction under cystoscopic visual Control, reusing the balloon dilatation catheter. All 31 patients were treated as in patients. Old, high surgical risk cases, because of their underlying medical problems, Were selected for the procedure. General or epidural anaesthesia was used. All patients had urethral catheter for acute retention of urine. Successful results were noted in 26 cases [84%] for upto 3-18 months follow up. In 5 cases [16%], the procedure was unsuccessful, requiring trans-urethral resection of prostate in 3 cases [10%], and conservative management in 2 cases [6%]

Benign prostatic hypertrophy [Patients profile and management]

A retrospective review of 235 patients of Benign Prostatic Hypertrophy [BPH] who were managed surgically in the Department of Urology, Sheikh Zayed Hospital, Lahore from June, 1987 to June, 1989 is presented. Out of these patients, 192 cases [81.7%] were treated by trans-urethral resection of prostate, 32 patients [13.6%] treated by open protectomy and 11 cases [4.6%] had bladder neck incision. Majority of the patients [70.21%] had significant preexisting medical problems. The mean age of the patients was 68.1 years and 89.37% were more than 55 year of age. The overall mortality rate of surgical management of B.P.H. was 1.2% with a morbidity rate of 15.6%. The mean age was 68.1 years. The common modes of presentation were prostration [43.41%], acute urinary retension [35.33%], chronic retension [17.44%] and other like vesical calculi [3.82%]. The overall morbidity was 15.79% and included intra-operative bleeding [3.41%], TUR syndrome [1.70%], cardiac arrythmias [0.85%], extravasation [1.70%], failure to void [3.41%], post-operative bleeding [1.28%], UTI [2.12%] and epididymitis [1.28%]. Increased morbidity was noticed in patients, presenting with pre-operative acute urinary retention, those who have had prolonged indwelling bladder catheterization, those aged more than 70 years, urban population, when T.U.R.P. time was more than 75 minutes, prostate gland size was more than 45 grams, patients who had pre-existing urinary tract infection and those who had associated vesical calculi. The overall mortality was 1.28%. Morbidity and hospital stay was comparable to previously reported international studies