Zika virus - an international public health emergency

Zika Virus is a member of the virus family flaviviridae and the genus flavivirus. It is spread by day time active Aedes mosquitoes, such as A. aegypti and A. albopictus. This is the same mosquito that spread and causes dengue, chikungunya and yellow fever

The first known case of Zika fever was reported in a sentinel rhesus monkey stationed on a tree platform in the Zika Forest in Uganda in 1947. Sexual transmission of Zika virus from men to women has been witnessed in at least 4 cases

Zika virus has also been isolated from semen samples. Cases of vertical perinatal transmission, from mother to the baby during pregnancy have been reported. WHO declared the couple of microcephaly and Guillain-Barré syndrome [GBS] cases reported in Brazil are strongly suspected to be associated with the Zika virus outburst. Thus, World Health Organisation [WHO] declared that a coordinated and an organized international response is required to improve surveillance, identification of infections, congenital malformations, and neurological complications, to heighten the control of mosquito populations at risk, and to execute the development of diagnostic tests and vaccines to secure people from this international public health emergency

Frequency and risk factors of cognizable physical violence by intimate partner against women seeking medical care at a tertiary care centre, Karachi

Objective: To determine the cognizable frequency of physical violence by intimate partners against women seeking medical care at a tertiary care center, Karachi

Methods: A hospital based cross sectional survey was conducted at a medical care emergency of a tertiary care center, Karachi. The sample size was 345. A non-probability purposive sampling technique was used for selecting the study subject. A Performa was used to collect the information directly through recorded data and interviews. Written informed consent was obtained from each participant. Data was entered and analyzed by using SPSS software version 15. Means with standard deviation for numerical variables and proportions for categorical variables are presented. Chi square test was performed for association of education level and occupation with frequency of physical violence by intimate partners

Results: There were 345 cases reported during August 2014 to February 2015. Mean age +/- SD was 33.50 +/- 8.41 years and family income 1,855 +/- 962 rupees per month. Cognizable physical violence was observed in 286 [77.7%] by intimate partners against women seeking medical care at a tertiary care center Karachi. Housewives were 271 [78.6%] seeking care for physical violence injury. Fractures were found in 226 [65.5%] women. There was no education in 46 [13.3%] and 5 year education was 191 [55.4%]. The percentage of cognizable physical violence was 77.7%. Non-cognizable physical violence found higher among younger age group 24-36 years as compare to older women

Conclusion: The frequency of cognizable physical violence was two third by intimate partners against women seeking medical care in metropolis megacity, Karachi. Major risk factors found were age more than 36 years, housewives, low family income and only five years education

Behavioral risks factors associated with spread of dengue infections: a community based study

Objective: To determine the behavioral risks factors associated with spread of dengue infections in a rural community of Gulshan-e-Iqbal town, Karachi, Pakistan

Methods: A questionnaire based cross sectional survey was conducted during September 2013- February 2014 in union councils of Gulshan-e-Iqbal town, Karachi. The sample size was 350. Systematic random sampling was used for selecting the study subject, from each household taken as one unit. Sample was taken from a total of 3225 houses to achieve total sample of 350 households. All the data was entered and analysed by using SPSS software version 15. Means with standard deviation for numerical variables and proportions for categorical variables are presented. Chi square test was performed to find the association of behavioral risks factors with spread of dengue infections in a rural community of Karachi, Pakistan

Results: Dengue infection was clinically diagnosed in 203 [58%] patients and were hospitalized during August 2012 to February 2013. Among all patients, higher frequency was found in the middle age group 37 to 54 years i.e. 44% [n=154].The behaviors of self-mosquito bite protection [p<0.01], selfprevention in breading mosquitoes [p<0.01], density of vegetation [p<0.01], behaviors regarding lack of self-efficacy in controlling vector [p<0.01] and lack of preventive measure in community [p<0.01] were significantly associated with transmission of dengue infections

Conclusion: The behavioral risks factors associated with spread of dengue infections in a rural community included lack of preventive measure in community, lack of comprehension of Health belief models, lack of knowledge,lack of self- prevention in breading mosquitoes, high density of vegetation and lack of self-efficacy in controlling vector

Epidemiological surveillance of dengue infections: a community based study in rural, Karachi (2010 - 2012)

Objective: To determine the incidence cases and their demographic, clinical and haematological risk factors of dengue infections in a low resource rural community during outbreaks of 2010-2012 in Gadap town Karachi, Pakistan. Methods: An active surveillance data collection on epidemiological and clinical observations on patients with Dengue infections in a low resource community during 2010 - 2012 was done. The surveillance reports were collected from union councils of Gadap Town, Karachi. The diagnosis of Dengue fever, Dengue haemorrhagic fever and Dengue shock syndrome was confirmed by IgM and IgG anti bodies detection using Enzyme-linked immunosorbent assays [ELISAs] technique based on World Health Organization [WHO] criteria. The sampling technique was cluster random sampling from the union councils of Gadap Town, Karachi and sample size calculated was 350. Data was collected on a performa after informed consent of patients. Data analysis was done on SPSS version 16. Frequency was reported for categorical variables and chi-square test performed for statistical significance to determine associated risk factors among positive cases of dengue infections. Results: Out of 350, 105 [30%] cases had dengue infections in rural area of Gadap town Karachi. About 58 [16.6%] had dengue fever, 30 [8.6%] dengue haemorrhagic fever and 17 [4.9%] had dengue shock syndrome. Twelve patients died during treatment. Presence of fever and cutaneous manifestation were observed in all cases. The significant associated risk factors were found in female, unmarried having 5 years education and severe pain at p<0.001. Conclusion: In endemic areas during dengue surveillance dengue infections were found in 30% cases. The significant associated risk factors were female, unmarried, with 5 years education and severe pain. Febrile illness represented patients with typical clinical features and haematological findings suggestive of dengue fever

community based knowledge and practices survey on passive tobacco smoking and its impact on fetal outcome

To determine the proportion of passive tobacco smoking during pregnancy and estimate the level of knowledge and practices regarding Passive tobacco smoking and its adverse fetal outcome. A community based cross sectional survey was conducted in four union councils of Malir Town. This is a small semi urban community of 77216 population. Currently pregnant women were interviewed regarding passive tobacco smoking consumption and their knowledge about its adverse fetal outcome. A semi structured questionnaire was used during June to August 2011. Pregnant women either exposed or not exposed to passive tobacco smoking were interviewed for their knowledge and practices regarding its impact as adverse fetal outcome. A total of 190 mothers were interviewed. In the study 133 [70%] women were found subjected to passive tobacco smoking. About [85.5%] exposed to passive tobacco smoking were knowledgeable about adverse effect of maternal passive tobacco smoking on fetus. The fetal adverse effects comprehend by mothers included stillbirth 35 [63.6%], small size baby 65 [100%], fetal congenital abnormality 33 [86.6%]. The proportion of passive smoking exposure during pregnancy was 70% and 85.5% mothers were knowledgeable regarding Passive Smoking exposures and adverse fetal outcome including stillbirth 63.6%, small size baby 100%, fetal congenital abnormality 86.8%

Domestic violence causing abruptio placenta and feto-maternal death: case report on autopsy

A 22 year old primigravida with 28 weeks/7 months pregnancy was brought in police custody 10 hours after her death reported at a Tertiary Care Center, Karachi. There was a history of soft tissues direct abdominal trauma 10 hours back. On complete physical examination there were no external marks of violence except a contusion on her back of 5 cm diameter. The internal examination after opening the uterus, placenta was separated and baby was delivered after opening the amniotic sac. A fresh still birth of male baby with 1.5 kg was delivered. The chemical and histopathology report evidenced that uterus, fallopian tubes and ovaries had decidua with necrotic tissues, edema and congestion. The final opinion after receiving the chemical/histopathology reports on this post mortem was that the death occurred due to fetal hypoxemia developing secondary to maternal shock as a result of direct uterine trauma and disseminated intravascular coagulation [DIC]. DIC develops due to circulating placental products responsible for fetal losses. This case reports fetal hypoxemia developing secondary to maternal shock, maternal hypotension, abruptio placentae, direct uterine trauma and disseminated intravascular coagulation [DIC]

experience of teaching bioethics at secondary schools in Karachi

Bioethics is the "critical analysis of emerging moral issues in health". The term was first used to refer to "the moral problems of the life sciences encompassing medicine, biology, environment, population and social sciences". Teaching bioethics is complex and challenging within multi-system educational program as in Pakistan for secondary schools. The objectives are difficult as bioethics teaching require changes in knowledge, skills and attitudes along with strong improvement in moral reasoning. The objectives of the study were to teach bioethics and evaluate comprehension and skills of ethical reasoning in students of secondary school in Karachi. This was a quasi-experimental study conducted in two schools [public and private-sector] of Karachi from January 2007 to December 2009. This was a preliminary study and used simple random sampling to recruit one hundred and ten students. The qualitative analysis of comprehension and skills were evaluated on numeric scales. The study found higher comprehension and skills level in females [66%] compared to male students during class-room sessions

Diabetes mellitus and limb loss: an analysis from a tertiary care center

To compare the frequency and determinants of prosthesis fitting [artificial limbs] in diabetic and non-diabetic amputees at a tertiary care center. Cross Sectional Comparative Study This study was conducted at Institute of Physical Medicine and Rehabilitation [IPM and R] at Dow University of Health Sciences, Karachi during Oct 2007- Sep 2010. Data was collected from amputee records files seeking carefor prosthetic fitting. There were 1469 prosthesis fitted in both diabetic and non-diabetics patients. The data from both groups were compared for frequency of amputation in diabetic and non-diabetics. The data was entered and analysis was performed on SPSS windows version 16. The analysis of data was performed for patients who were provided prosthesis fitting at IPM and R. Diabetic males were 327[73.6%] female were 117 [26.4%].About a third of amputees had primary, secondary and tertiary health care services for control of diabetes. About 60% of all diabetics were not able to seek medical care for control of diabetes. The use of primary, secondary and tertiary health care services to control diabetes were also recorded to correlate with health seeking facilities among diabetics. The prosthesis fitting was given to one third of diabetic patients after lower limb amputation. The major determinants of diabetic amputees were old age, man uneducated, low socioeconomic status. The facilities for primary, secondary and tertiary health care services to control diabetes are available only to one third of diabetic patients. Diabetic control, education of foot care and accessibility to diabetic and prosthesis centre can markedly improve functional integration of diabetic amputees in community

Determinants of upper limb amputations in a tertiary care center, Pakistan

To determine the frequency and causes of accidental upper limb amputations seeking rehabilitation [prosthesis] care in a tertiary care center. Observational Descriptive Study. This study was carried out at outpatients Department of Institute of Physical Medicine and Rehabilitation at Dow University of Health Sciences, Karachi from Jan 2007 to Dec 2010. The Sampling Technique was non Probability Purposive sampling. A study specific Performa was prepared which included patient age, stump complications, level of amputation and associated risk factors. The data was analyzed in SPSS version 15. The Mean+/-SD age of ULA was 28.56 +/- SD 11.97 [years]. Most ULA were reported from Karachi 65 [67.7%]. Labourers were the most commonly affected groups 33 [34.4%].Accidents leading to ULA were reported in 89 [92.70] and machine injury [chaff cutting] was responsible in one third of the ULA. Quarter of the ULA had leading cause electric injury. Only, 16 [16.7%] amputees had road traffic accidents. The study concluded that majority of upper limb amputation were caused by machine accidents affecting mostly labourers. Therefore, machine safety protocols for labourers, farmers and workers should be implemented in their local language and through pictoral messages and inbuilt safety measures machines should be sold by company representatives

Determinants of lower extremity amputations: an institutional experience

To determine the determinants of lower extremity amputations in diabetics and non-diabetics in a tertiary care institute. Cross-sectional, analytical study. Outpatients Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from January 2007 to December 2010. All patients with amputations reporting at the study centre for prosthesis fitting were included in the study. Patient's age, level of amputation, stump complications and associated risk factors of amputation were recorded on a structured proforma. Prosthesis and orthotic assessment were carried out. The frequency and determinants were collected to compare diabetic and non-diabetic amputees. The data was analyzed in SPSS windows version 16. A total of 1091 subjects were provided prosthesis, including 847 males [77.6%]. Mean age in diabetic and nondiabetics being 49.6 +/- 15.2 and 26.6 +/- 17.9 years respectively which is significant at [p < 0.001]. Socioeconomic status and educational levels were significantly associated with diabetic status [p < 0.001]. Amputation was more common in non-diabetic 858 [78.6%] compared to diabetics 233 [21.4%]. This study has identified that most common and significant predictors were gender, low social status and educational levels. Other significant predictors of amputation identified were type of lesion, [infections and ischaemia], initial diagnosis acute/chronic arterial insufficiency and diabetic foot

Spectrum of medico-legal deaths in metropolis of Karachi: an autopsy based study

Background: The number and variety of medico-Iegal deaths has inflated tremendously in the recent years in relation to acts of terrorism using explosive material and street crimes which often result in tragic death

Objectives: To determine the frequency, causes and manners of medico-legal autopsies at three major mortuaries in Karachi

Methods: A case study, involving the medico legal deaths autopsied at three major mortuaries in Abbasi Shaheed Hospital, Jinnah Postgraduate medical center and Civil Hospital, from March 01, 2008 to February 28, 2009. A detailed autopsy was conducted in each case to determine the cause of death. The bodies were first examined externally followed by dissection of body cavities in accordance with Robert Virchow's technique. The results were collected from the respective institutions on a structured performa and were statistically analyzed using SPSS version 15. The Mean +/- SD was calculated for age

Results: Out of total 2,090 autopsies c0nducted during the period of study, 98.7% of the deaths were found to be due to unnatural causes. Homicides accounted for 54% of the deaths where as 39.3% were accidental deaths. Firearms were the most common cause of deaths [44.6%], followed by road traffic accidents [27.7%]. Male to female ratio was 9:1 with 88.8% of the victims being males. Majority of the victims belonged to age group 19-32 years [47.3%]

Conclusion: Homicides were the most common manner of death [54%], followed by accidents [39.3%]. Frequency in relation to cause of death revealed firearm injuries accounting for 446% deaths followed by road traffic accidents [278%]

Obstetrics determinants of cerebral palsy in children from birth to five years

To determine obstetrics risk factors for cerebral palsy from birth to 5 years children. A hospital based cross sectional survey. This study was conducted in outpatient department, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences Karachi, Pakistan during October 2007 to October 2010. Children with cerebral palsy between births to 5 years of age were included in the study. The Sampling technique was non probability purposive. Data was analyzed as frequency and association by chi-square in SPSS version 15. Children enrolled in this study were 300 their Mean age +/- SD was age 4.9 +/- SD 3.6 yrs. Mean maternal age +/- SD was 30.8 +/- 6.5 years. Mostly mothers had secondary level of education 110 [36.7]. Father's Mean income +/- SD was 11587 +/- SD. During assessment the pregnancy risk factors were mostly hypertension 55 [18.3%], diabetes mellitus 28 [9.3%] seizures 11 [3.7%] placenta previa 4 [1.3%]. The commonest risk factor was birth asphyxia in one third of children and two third of the deliveries were conducted in institutions as spontaneous vaginal deliveries. Birth asphyxia is the major obstetrics risk factors for cerebral palsy from birth to 5 years children. The obstetrics practices require revisiting and reprogramming to reduce cerebral palsy

implication of maternal periodontal disease and C reactive protein on adverse pregnancy outcome

To determine the role of periodontal disease in the development of adverse pregnancy outcome including low birth weight, preterm labor and to measure abnormal C reactive protein and its impact on adverse pregnancy outcome. This was a case control study. Periodontal disease was considered as 3 mm in 33 or more teeth. Adverse pregnancy outcome [APO] was defined as a singleton preterm birth and low birth weight. All mothers were interviewed and examined for periodontal disease. A blood sample of 3 ml was taken for C reactive protein assessment at the time of examination. Data was entered and analyzed on SPSS windows version 17. There were 600mothers observed for periodontal disease and c reactive protein and adverse pregnancy outcome. The adverse pregnancy outcome [APO] included preterm labour and low birth weight 129[21.5%].The birth weight < 2500 gms [low birth weight] was twice more prone to develop APO due to Periodontal disease [PD] compared to controls with birth weight> 2500gms.The gestational age before 37weeks [preterm] was 4 times more common with PD compared to controls. Adverse pregnancy outcome is a possible complication of maternal periodontal disease

Implications of practices and perception on oral hygiene in patients attending a tertiary care hospital

The objective of the present study were to determine the oral hygiene practices and perceptions of patients attending Dr. Ishrat-ul- abad Institute of Oral health Sciences, Dow University of Health Sciences, Karachi Across-sectional questionnaire based survey was conducted during January to June 2011.A total of 1059 patients were interviewed from a structured questionnaire at Periodontology Department of Dr. Ishratul- Ebad Institute of Oral Health Sciences, DUHS, Karachi. All patients seeking dental care at Outpatients Department were examined and interviewed by Dentists and Periodontist. The dental examinations were conducted focusing the oral hygiene as per standard oral hygiene practices. The study participants were recruited by non probability convenience sampling. A structured questionnaire was used to collect information regarding practices and perception on oral hygiene. Data was recorded and analyzed using SPSS version 16. 1059 respondents consented for interview regarding oral hygiene practices and perception. Most of the patients 694 [65.5%] belonged to 18-25 years of age. Most of the patients seeking dental care were female 684 [64.6%]. The optimum oral hygiene practices and ideal perceptions 694 [65.5%] were found in age group 18-25 and were higher in females 684 [64.9%] at significant level of 5%. Oral health practices and perception vary based on age group and gender. The poor resources for dental care, common malpractices and the non availability of professional care were the main barriers in seeking optimum dental care

clincopathological correlation of hysterectomies: a hospital based surgical audit

To determine correlation of clinical indication of hysterectomies with histological findings and association with age and parity. Institution based cross sectional study. This study was conducted at the Lady Dufferin Hospital, Karachi, Pakistan from Jan. 2007 to Dec. 2009. 322. Non Probability Purposive sampling. A structured standardized Proforma was used to collect data between Jan 2007 to Dec 2009 from the pathological laboratory data on surgical hysterectomies. The data comprised of clinical, physical and histological examination. The analysis was made on correlation of clinical indication of hysterectomies with histological findings and association with age and parity. Correlation of Clinical Indications and histological findings on uterus [endometrium and myometrium], cervix and ovaries. Three hundred twenty two abdominal hysterectomies were studied. Among the study subjects the mean +/- SD age was 42.36 +/- 6.36. Only 12 [3.7%] women were unmarried. Clinically the commonest indications were Leiomyoma in 167 [519%] and DUB 120 [37.7%]. Ovarian mass was clinical indication in 4 [1.3%] cases. Histopathology revealed leiomyoma 149 [46.3%] as the commonest uterine pathology, followed by adenomyosis. Inflammation with squamous metaplasia 252 [78.2%] was the most common pathology noted in the cervix whereas 101 [46.4%], cystadenomas were noted in 6 [2.8%] and Benign teratoma in 3 [1.4%]. Hysterectomy is a major gynecological procedure therefore it should be performed after accurate clinical assessment and with proper and justified indications

Determinants of maternal genital tract colonization by group B streptococci during the last trimester of pregnancy

The objectives of the present study were to determine the magnitude and associated risks factors of genital tract colonization by Group B Streptococci [GBS] during the last trimester of pregnancy. A Hospital based cross sectional study was conducted at primary care clinic from 15th Jan to 14th June2008 at Union Council 1 and 2, Orangi Town Karachi. Pregnant women in the last trimester of pregnancy [approximately 27-40 gestational weeks] attending antenatal clinic were included in the study. A total of 1099 women underwent an evaluation that included standardized history, pelvic examination and rectovaginal culture. The age of the patient in the study was 27.81 +/- 6.36 years; income per month 1089 +/- 1031Rupees, Hemoglobin percentage 8.67 +/- 1.311mg%.The frequency of booked status was seen only in 475[43.2%] mothers. The magnitude of GBS positive report was seen in 323[29.4%] women. The risk factors for GBS positive mothers in current pregnancy included history of previous preterm pregnancy in 103[9.4%], GBS in previous pregnancy was found in only 50[4.5%] and previous history of neonatal sepsis in 35[3.2%].The magnitude of GBS positive report was seen in 323[29.4%] women. The magnitude of GBS positive report was 323[29.4%].The determinants of vaginal colonization by GBS were high parity, low Body Mass Index [BMI], inadequate antenatal care and high rates of adverse pregnancy outcome

Frequency and determinants of oral substance abuse in urban population of Karachi

The study was conducted to determine the Frequency and determinants of oral substance abuse among patients seeking dental care at Department of Periodontology, Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences, Dow University of Health Sciences, Karachi. Across session study was conducted during January to June 2011.Atotal of 2259 patient were interviewed from a structured questionnaire at Department of Periodontology, Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences, Dow University of Health Sciences, Karachi. The questionnaire was based on demographic data along with risk factors resulting in use of substance abuse. The substance abuse included Pan and cigarettes, Niswar, betel nut, Pan, cigarettes, Niswar and Betel nut and gutka. The data was collected on the performa and analyzed using SPSS windows version 17. Frequencies and percentages were calculated for categorical variables including age, gender, education, type of substance used. Stratification was done with substance user and non-user to see the effect on their oral health. Chi-square was used to compare the categorical variables at 5% level of significance between substance user and non-user. There were 2259 respondents consented for interview regarding use of substance abuse by them. Most of the patients 1362 [60.3%] belonged to younger age group 18-25 years. Female respondents were 1384[61.3%]. Most of the dental care seekers were graduates 984 [43.6%] out of 2259, there were 884 [39.1%] substance abuser. The type of substance abused mostly were pan and cigarettes both 1375 [60.9%] and cigarettes, niswar, beetle nuts all together in 483 [21.4%]. On examination the oral health status was good only in 582 [25.8%].Mostly substance abuse was started on self basis 433[49%] compared to others 45 [51%]. It was also found that unemployment 300[33.9%]was the major reason for substance abuse. The frequency of oral substance abuse was found in 39.1% of the patients seeking medical advice at the dental and oral institute. The commonest determinants of substance user were younger age group between 18- 25 years, commoner in male than female, one third were graduates and unemployed were found more addicted to substance use. The study found that the type of substance abuse at the time of interview were multiple variety of substance. Pan along with cigarettes was used by maximum number of participants. Pan and cigarettes along with Niswar and betel nuts were used by quarter of the sample