Cost effectiveness of screening of all newly recruited employees for diabetes at a tertiary care hospital

Diabetes Mellitus is a disease which remains asymptomatic for long duration of time and usually diagnosed either when gets complicated or by routine or opportunistic screening. The practice of universal screening is not recommended, particularly in constraint resources. However, we embarked with a study to assess the yield of recommended screening for Type 2 diabetes in all the newly recruited employees at a tertiary care hospital in Karachi. All the information required for this study was collected from medical records of all newly recruited employees of nursing services department of a tertiary care hospital of Karachi, Pakistan, over a period of 5 months [August 2004 to December 2004]. Out of 360 subjects, 326, whose information was found to be complete, were included for final analysis. Mean age of the study subjects was 25.3 +/- 4.7 years and their mean casual plasma glucose level was 99.1 +/- 16.3 mg/dl. 315 [96.6%] study subjects had casual plasma glucose level of 139 mg/dl or less. Only 10 [3.1%] study subjects had casual plasma glucose levels between 140 to 199 mg/dl. Just one employee, 41 years old, was found to have casual plasma glucose level of 213 mg/dl. In this study, screening of all individuals for diabetes had a very low yield. Recommendation of universal screening for diabetes does not represent a good use of resources and perhaps not cost-effective. However, periodic screening of high risk individuals should be warranted

three month old infant with skeletal deformities

Osteogenesis imperfecta [OI] is a heritable disease of bone the hallmark of which is bone fragility. It is an autosomal dominant disorder. Diagnosis is usually clinical, based mainly on typical features. There is no curative treatment for OI. Active physical rehabilitation in the early years allows children to attain a higher functional level than does orthopaedic management alone. Therefore family physicians need to play an active role in guiding their patients to optimal rehabilitation

Hepatitis B vaccination status and identification of risk factors for hepatitis B in health care workers

To assess the vaccination status of health care workers and to identify the risk factors for hepatitis B at a tertiary care hospital. A descriptive study. The Aga Khan University Hospital, Karachi from March 2003 to May 2003. Three hundred and ninety-three health care workers were interviewed after taking verbal consent using a self-administered questionnaire by convenience sampling. A sample size of 385 was calculated, using 5% level of significance, margin of error as 5% and an expected prevalence of 50%. Descriptive statistics like percentages, mean and range were obtained. A total of 393 respondents, [age range 19-59 years] were interviewed. Amongst them 86% were completely vaccinated, 12% had incomplete vaccination and 2% didn't have even a single dose. Needle stick injuries were highest amongst those health care workers who had complete vaccination. Despite the availability of free vaccination, a target of 100% coverage has not yet been achieved. All health care workers should be motivated and ensured for vaccination. Regular educational campaigns for health care workers are needed to increase vaccination compliance

Womens' beliefs and practices regarding food restrictions during pregnancy and lactation: a hospital based study

Maternal diet is an important determinant of outcomes of pregnancy. Malnutrition during pregnancy and its consequences maximally affect the health and long-term outcomes of the population. Low birth weight accounts for almost 30% of all births; with maternal malnutrition as a dominant risk factor. This study aims to investigate the existing beliefs and practices regarding food restrictions during pregnancy and lactation and also to assess whether there is any relationship with education level of the respondent and their beliefs and practices. A cross-sectional survey was conducted at Community Health Center [CHC] of The Aga Khan University Hospital, Karachi from July- September 2000. Four hundred adult female respondents, who came to the outpatient services as a patient or as an attendant, were interviewed after taking verbal consent. A self administered pre-coded and pre-tested questionnaire was filled by the respondent. More than three fourths of respondents were literate. Twelve% believed in restricting some food item during pregnancy and about 25% believed the same during lactation. No statistically significant association was found between belief about food restriction during pregnancy or during lactation and education level of the respondent. Undue food restrictions during pregnancy and lactation do exist in our culture. To assess the true picture we need to conduct larger studies in the community. The information obtained from the studies will help us in addressing these issues for improvement of nutritional knowledge and dietary practices and to avoid undue food restrictions

Women's perception about food properties in A teriary care Hospital

To understand the existing food beliefs regarding hot, cold and badi [gas-producing] properties of different food items and also to assess whether there is any relationship with education of women and these beliefs. Design: A cross-sectional study. Place and Duration of Study: Community Health Center [CHC], The Aga Khan University Hospital, Karachi from July to September 2000. Subjects and Four hundred adult female respondents, who came to CHC as a patient or as an attendant, were interviewed after taking verbal consent. A self-administered pre-coded and pre-tested questionnaire was filled by the respondent. Descriptive frequencies and cross tabulation were computed to assess the existing food beliefs. Chi-square test was used to assess the association between education level of women and belief regarding these food items. More than three-fourth of respondents were literate. The percentages of respondents saying that certain foods were hot, cold and badi were 71%, 55% and 80% respectively. Meat, either beef or mutton, fish, egg, chicken, was perceived as hot by majority of the respondents. Majority of vegetables was perceived as cold foods in our study. The other foods like rice, yogurt, banana, watermelon, milk and cold drink were also thought to be cold by many of the respondents. Cabbage, cauliflower, potato, rice, gram and mash pulses [chane and mash-ki-dal] were highly rated as badi foods. Level of education of women didn't show any statistically significant difference in keeping beliefs regarding hot, cold and badi properties of food items. A significant concept of different properties of food exists in our culture. We recommend future studies to explore scientific basis for classifying hot, cold or badi foods and also to look into its impact on health by their restriction based on their beliefs

Guidelines for prophylaxis of rabies in Pakistan

Rabies is highly fatal and ends in an extremely painful and torturous death. All carnivorous animal [dog, cat, fox, jackal, skunk, mongoose, raccoon] and bats are considered potentially rabid. Rodents [rat, mouse, squirrel], rabbit or bird are not rabid. Transmission is usually through the bite of an infected animal. However, the percentage of rabid bites leading to clinical disease ranges from 10% [on the legs] to 80% [on the head]. Rabid animals can also transmit the disease by licking abraded skin or mucosa and by scratching. Patients with scratches from rabid animals are about 50 times less likely to develop rabies than those with bites. World Health Organization [WHO] Rabies Survey in 1992 estimated that 90% of human rabies occurred in the developing world. There are no known studies on the incidence of rabies in Pakistan; the problem of dog bite from possibly rabid dogs is rising alarmingly. Therefore the prevention of rabies infection after exposure is of utmost importance. It is preventable if WHO guidelines for post exposure treatment are followed. This guideline includes, immediate local treatment of the wound, passive immunization with rabies immunoglobulin and administration of an efficacious vaccine. Although there is a great urgency to improve post-exposure treatment, it will remain a costly and inefficient method of controlling rabies. It is the canine rabies epidemic which needs to be addressed

Assessment of knowledge, beliefs and practices of our population regarding effects of viewing a solar eclipse

To assess the prevalence of knowledge, beliefs and practices of people coming to The Aga Khan University Hospital, about viewing a solar eclipse. A cross-sectional survey was conducted at The Aga Khan University Hospital, Karachi from January 2000 to April 2000. A self-administered questionnaire was filled by the patient or attendant who were aged 18 and above. Total of 202 respondents were interviewed. The data was analyzed by Epi Info. Mean age of respondents was 35.8 years. Overall, awareness regarding the harmful effects to their eyes by viewing an eclipse directly was 83.2%. Females were more knowledgeable. Majority had obtained information from TV. One third thought it was safe to view the eclipse through binoculars or through smoked glasses. Half of the respondents thought the same about photographic films and sunglasses. Viewing an eclipse by a pregnant mother had an adverse effect on the fetus and on herself was thought to be 50% and 45% respectively. Use of knife or scissors by pregnant females at the time of solar eclipse was thought to be harmful for the fetus and to herself by 41% and 38% respectively. Majority knew that viewing a solar eclipse could be harmful to their eyes but they did not know the safest way. As there is no effective treatment for solar retinopathy, the emphasis should be on prevention. We need to increase public awareness regarding the safest way to watch an eclipse, which is by indirect method using projection. Myths regarding ill effects of solar eclipse on pregnant mother and on fetus need to be removed

Protocol for evaluation and management of urinary tract infection in adults

Urinary Tract Infections in adults are quite commonly encountered in General Practice. It remains a significant cause of morbidity. Categorization of the infection by clinical syndrome and by host helps the physician to determine the appropriate diagnostic and management strategies. Clinical judgement should dictate whether urine culture is needed or not. The most effective therapy for an uncomplicated infection is a three-day course of trimethoprim-sulfomethoxozole [Co-Trimoxazole]. Nitrofurantoin can also be used. Complicated infections require a more prolonged course of therapy. Quinolones or third generation cephalosporins can be used for at least 10 to 14 days