Breast self examination - awareness and practices among lady health workers

To find out the awareness and practices regarding breast self examination [BSE] among the lady health workers of Tehsil Arifwala, district Pakpatan, Punjab. This cross sectional study was conducted in July 2011. 300 LHW's fulfilling the inclusion criteria were selected through consecutive sampling technique. Information was collected regarding awareness and practices of BSE through interviews on questionnaire covering all variables. The BSE practices of LHW's were determined on the basis of two criteria: 1. Number of BSE steps performed [categorized as 'average' for performing >2 steps and 'below average' for performing one or two steps]. 2. Interval of BSE [categorized as 'correct' for regular monthly interval and 'incorrect' for >1 month interval]. Data was entered and cleaned using Epi Data 3.1 and analyzed using Epi Info 3.5.1 Mean age of participants was 32.06 +/- 7.8 years. Majority were married [79%], rural dwellers [64.3%], had job experience up to 5 years [55.3%] and were educated above middle [53.7%]. Majority 280 [93.3%] were aware of breast self examination but only 80 [28.5%] were practicing it. Out of 80 who were performing BSE, 34 [12.1%] were practicing BSE at correct interval and only 46 [16.4%] were practicing average steps. Significant relationship was found between the age and awareness while higher levels of job experience had a significant relationship with BSE practice. The awareness level of LHW's regarding BSE was relatively high as compared to their practices of BSE. As a LHW has direct link with the community, there is a need to organize training courses for LHW's regarding correct BSE practices. Special emphasis should be paid to timeliness and steps of the procedure so that she can provide proper information to community for early detection of breast cancer.

Odds of prostate cancer among Pakistani men in relation to their dietary patterns

To determine relationship between dietary pattern of Pakistani men and the odds of prostate cancer. Total of 195 cases of adenocarcinoma of prostate and 390 randomly selected controls were recruited for this retrospective study. Cases and controls were asked about their usual dietary pattern using validated food frequency questionnaire. NutriSurvey software version 2007 was used to compute amount of macro-nutrients and micro-nutrients consumption per week. Odds ratio was used as a measure of strength of association. Unconditional logistic regression was used to compute odds ratios after adjustment of known potential confounding factors and effect modifiers. Mean calories consumed per day for cases was 3720 +/- 878 and for controls was 2918 +/- 487 and this difference was statistically significant [t =11.87 at 255 df ; p<0.001]. Red meat consumption was found to be strongly associated with prostate cancer risk [adjusted OR 2.23 for once a week, OR 10.67 for twice a week, OR 11.82 for thrice a week and OR 14.53 for daily]. On the other hand, consuming chicken for once a week was rather protective [adjusted OR 0.25; 95% CI. 0.14-0.44; p<0.001]. Weekly consumption of seasonal vegetables, fruits were found to play protective role [adjusted OR 0.01; 95% CI.0.005-0.03; p<0.001]. On the other hand, fat consumption demonstrated a strong relationship with prostate cancer risk such that those consuming 80 grams and above fats per day were at higher odds 7.95 [95% CI 4.38-14.43; p<0.001]. Increased risk was also observed with calcium consumption [OR 2.03 [95% CI.1.21- 3.42; p=0.006], however, phosphorous and Iron did not demonstrate any relationship with prostate cancer odds. Pakistan, prostate, dietary pattern, risk, odds, red meat, fruits, vegetables, diary products. Consumption of increased quantities of fats, red meat and dairy products are associated with higher odds of prostate cancer in Pakistani men.

Lifestyle factors associated with the risk of prostate cancer among Pakistani men

Age-adjusted incidence of prostate cancer in Pakistan is 5.3 per 100,000 which is relatively low compared to other Asian countries, but increasing numbers of cases are being reported. Data on risk factors associated with prostate cancer risk among Pakistani men are sparse. The objective of this study was to identify lifestyle factors associated with the risk of prostate cancer in Pakistani men. An unmatched case-control study was conducted in Lahore from February to October 2011. The study enrolled 195 histologically confirmed cases of adenocarcinoma of prostate from Shaukat Khanum Memorial Hospital and Institute of Nuclear Medicine and Oncology Lahore [INMOL] and Lady Reading Hospital, Peshawar, using purposive sampling technique. A total of 390 hospital controls were selected using convenient sampling technique from different teaching hospitals of Lahore after screening with prostate specific antigen levels. A semi-structured interview form was used to collect data through face-to-face interviews. Odds ratio was used as a measure of strength of association and was calculated using unconditional logistic regression. Farmers were found to be at higher odds of prostate cancer [OR=19.76, 95% CI=5.51-70.80, p<0.001]. No significant association was found with marital status, ethnic background, religious affiliation and consanguineous marriages. Level of physical activity was inversely associated with prostate cancer risk [OR=0.05, 95% CI=0.01-0.26, p<0.001]. Positive association was found with increased red meat consumption [OR=11.82, 95% CI=2.88-48.54, p=0.001] and dairy products intake [OR=11.76, 95% CI=4.23-32.67, p<0.001]. Red meat consumption, higher dairy products intake and working as farmers are strongly associated with increased odds of prostate cancer among Pakistani men.

Factors affecting the decision making of australian couples to donate their cryopreserved empbryos for human embryonic stem cell research

The purpose of this review was to describe attitudes of couples in Australia towards donating their surplus frozen embryos for human embryonic stem cell research. A systematic search was conducted including articles published in English, in peer reviewed journals and scientific discourse indexed in MEDLINE / Pub Med database. Embryo donation rate among Australian couples was found to be relatively lower than other countries. Although factors like age of couples, family completion and financial status influenced the decision to donate stored embryos in many countries, willingness to donate embryos among Australian couples based on these factors was less pronounced. Similarly, religious conviction and moral issues played a dominant role in their decision making. On the other hand, a substantial number of Australians would seek help and counseling from their treating physicians at the time of decision to donate embryo for stem cell research. Nevertheless, potential benefits associated with stem cell research should be weighed against potential social, ethical and legal harm to the society

Factors leading to the development of chronic obstructive pulmonary disease in adult Pakistani males

The study was conducted to determine the factors associated with development of COPD among adult Pakistani men of 40 to 70 years of age. This case control study was conducted with total sample of 88 males aged 40 to 70 years old, 44 cases and 44 matched controls with 1:1 ratio. Cases were selected from the patients admitted in the Pulmonology Department Jinnah Hospital Lahore and controls from the other departments of the same hospital, during one month period. The data was collected through questionnaire consisting of variables like age, locality, occupation and smoking status. The spirometric cut off points [FEV1<80% of predicted and FEV1/FVC ratio <70% of predicted] were used as diagnostic tool for COPD. Cross tabulation was performed with dependent variables as presence of COPD and independent variables such as smoking, age, occupational exposure, locality etc. Multivariate logistic regression model was used with backward elimination technique for the adjustment of age, locality, income status, occupation, previous history of disease and smoking status. Cigarette smoking and age of more than 55 yrs have shown significant relationship with the development of COPD [p value<0.05]. Adjusted odd's ratio was 9.1065 for smoking and 4.2315 for age. Urban residents have a risk of developing COPD 2.14 times more than that of rural residents. Cigarette smoking is most important risk factor for development of COPD, so efforts should be made to control it

Sociodemographic and lifestyle factors related with the risk of prostate cancer

Carcinoma of prostate is the most frequently diagnosed cancer among men in developed countries. Incidence rate among African-Americans is highest [185.4 per 100,000] in the world followed by Caucasian-Americans [107.8 per 100,000]. Despite high morbidity and mortality, etiology of prostate cancer remains largely unknown. Advancing age, race and family history are the only established risk factors. However, racial and genetic factors alone cannot explain the wide international variation in disease distribution. The objective of this review was to summarize socio-demographic and lifestyle factors in relation to prostate cancer risk. A systematic search was conducted including articles published in peer reviewed journals indexed in MEDLINE/ Pub Med database. Prostate cancer incidence was found to be proportional to increasing urbanization and rise in socioeconomic status. Factors associated with increased prostate cancer risk include raised androgens levels, high saturated fat in diet, reduced physical activity, obesity, smoking and working as farmer. Pattern of prostate cancer incidence and mortality suggests that both genetic and environmental factors contribute towards an excess risk of disease; nevertheless, environmental and life-style factors, especially trend of urbanization and change in socioeconomic status may have accrued the prostate cancer risk in developing countries

Immunization status among children

To find out the immunization status against vaccine preventable diseases, timeliness of vaccination according to EPI schedule and availability of EPI card among children aged 0-23 months residing in Jallo village district Lahore. This descriptive cross-sectional study was conducted in village Jallo, District Lahore, having a population of 8061. 331 children aged 0-23 months of the area were included in the study. Data was collected by interviewing the mothers of selected children. Data was entered and analyzed using Epi Info. Frequency distribution with percentages were calculated. Out of total 331 children, 63.4% were fully immunized, 30.5% were partially immunized while 6.1% were not immunized. A child was considered as fully immunized if he/she was vaccinated as per EPI schedule according to his/her age. Only 6.2% were vaccinated according to the EPI schedule and vaccination card was available with 89%. Findings of this small scale study revealed that only 63.4% children were fully immunized which was much less than target of 80%. [EPI objective was to achieve 90% immunization coverage with at least 80% in every district by 2010]. Parents must be motivated to get their children completely vaccinated in a timely manner according to the recommended schedule

Awareness regarding viral hepatitis B amongst health care providers at primary health care level and their tendency to get vaccinated against viral hepatitis B in A union council of district Lahore, Pakistan

Objectives: To determine the extent of awareness regarding viral hepatitis B amongst health care providers at primary health care level and their tendency to get vaccinated against viral Hepatitis B in a union council of District Lahore, Pakistan

Material and Methods: Across sectional study conducted on all health care providers of UC 120, District Lahore providing primary health care, using a pre designed questionnaire and data analyzed by Epi Info

Results: All 256 HOPs were interviewed who belonged to various categories recognizable at primary health care level starting from doctors to quacks and spiritual healers. 26[10.1%] HCPs were either unaware of the risk they had from viral hepatitis or did not know about the availability of any vaccination. 139 [54.3%] got vaccinated and out of them 124 [89.2%] got 3 doses or more, with 70 [50.4%] receiving it between 1 to 4 years ago. Out of 117 [45.7%] who failed to get vaccinated, 26 [22.2%] lacked knowledge and 38 [32.5%] had no obvious reason to avoid vaccination, only being 'lazy". 51 [43.6%] had a strong belief contrary to present medical knowledge to avert vaccination and 2 [1.7%] could not afford to get the vaccine. Only 1 HOP got her Anti HBs titers done and even that abroad. Dentists were a community fully vaccinated while spiritual healers and hakims were as a whole unvaccinated

Conclusions: There is reasonable awareness regarding viral hepatitis [90%] amongst health care providers, yet demanding more effort on part of government regarding health education targeting health care providers. The vaccination status against Hepatitis B is comparable to that in tertiary care hospitals and again demands legislative and authoritative intervention on part of the government to get health personnel vaccinated

Endoscopic healing of GERD using esomeprazole therapy

Objective: To assess improvement on endoscopy in patients suffering from gastro-esophageal reflux disease [GERD] with esomeprazole therapy. Place and Duration of study: Gastroenterology section of Medical Unit I, Services Hospital, Lahore from May 2006 to November 2006

Patients and Methods: Fifty patients having symptoms of GERD, like retro-sternal burning, pain epigastrium, nausea, vomiting and any associated complaints suggestive of GERD were selected for upper GI endoscopy. Patients who had positive GERD findings on endoscopy were included in the study and were put on esomeprazole. Repeat endoscopy was done after 4 to 6 weeks to look for any improvement in endoscopic findings

Results: All of the 50 patients who were selected had positive endoscopic findings suggestive of reflux disease. All of them were put on proton pump inhibitor therapy for 4 to 6 weeks and repeat endoscopy was performed. Thirty seven [74%] showed full recovery while 13 [26%] showed no or partial healing on upper GI endoscopy

Conclusion: Esomeprazole is an effective treatment in healing of GERD with improvement in symptoms like retro-sternal burning, epigastric pain, nausea, vomiting and associated symptoms like chronic cough, asthma, non cardiac chest pain

Assessment of smoking practices among male college students of a government college of Punjab province

Background: Smoking finds its roots in early adolescent life and lifestyle changes introduced at this level may prevent one from adopting this life threatening habit

Objectives: To assess the knowledge and practices of smoking among male college students

Methods: 200 male students of a government college were interviewed using pre designed questionnaire. Data was analysed using Epi Info version 3.3.2

Results: 85% did not know about any effect of smoking on health. Radio/TV was the main source of information. Most smokers were in 2nd year class [14%]. Next was 4th year class [1.2%]. Mean age was 18.5 years. Most of the smokers belonged to younger age group i.e. 17-19 years of age. More smokers belonged to urban areas [54.55%]. Most of the smokers had parents who were businessmen [31.82%].The trend was highest in upper class [54.54%]. Majority of the smokers developed the habit being inspired by their fathers [27.28%]. Most of the boys [54.55%] smoked their first cigarette while they were at the college

Conclusion: Major lifestyle modifications may help curb smoking and reduce the harm brought by this menace to mankind

Atrial fibrillation in mitral stenosis and its correlation with left atrial size, mitral valve area and left atrial thrombus

Chronic rheumatic heart disease is the commonest cause of mitral stenosis. Incidence of rheumatic MS parallels that of acute rheumatic fever. Atrial fibrillation usually develops in the presence of pre-existing ECG evidence of left atrial enlargement and is related to the size of the chamber, the extent of fibrosis of the left atrial myocardium, the duration of the atriomegaly and the age of the patient. The tendency for development of systemic embolization correlates directly with the patient's age and the size of the left atrial appendages and inversely with the cardiac output. Eighty percent of the patients of MS in whom systemic emboli develop are in atrial fibrillation. A descriptive study was designed in the Department of Medicine, K E Medical College / Mayo Hospital and Punjab Institute of Cardiology, Lahore. A total of 129 conservative cases of mitral stenosis were included in this study, based upon convenient patient sampling. A total of 112 patients were followed up properly, the remaining 17 were lost to follow. The results showed left atrial size and MVA have an inverse correlation [p = 0.017]. LAT has a strong association with AF in cases of MS [p = 0.002]. The severity of MS does not influence the frequency of AF [p = 0.24]. It was thus concluded that left atrial size and MVA have an inverse correlation [p = 0.017]. LAT has a strong association with AF in cases of MS [p = 0.002]. The severity of MS does not influence the frequency of AF [p = 0.24]

Mortality review of diabetic ketoacidosis in mayo hospital, Lahore - Pakistan

Diabetic ketoacidosis is a known complication of diabetes mellitus. The annual incidence of diabetic ketoacidosis [DKA] among subjects with type 1 diabetes is between 1% and 5% in European and American series respectively. This incidence appears to have remained relatively constant over the last decade in western countries whereas 20-30% of cases occur in newly diagnosed patients. Mortality rate is reported less than 5% in experienced centres whereas internationally overall mortality is 1-10 percent. The objective of this study was to find out mortality rate in patients of diabetic ketoacidosis admitted to east medical ward of Mayo Hospital, Lahore. A descriptive retrospective study was conducted on patients admitted to East medical ward with the diagnosis of DKA. There were 44 patients included in this study. Regarding outcome of patients 84.1% of patients were discharged. The mortality was found to be 15.9% that is much higher as compared to other studies where it was around 5%