Assessment of factors associated with practice of breast self-examination in a tertiary care health setting in Karachi

Objectives: [1] To determine the knowledge, attitude and practice towards breast self-examination [BSE] in tertiary care health setting in Karachi

[2] To assess factors associated with practice of BSE

Study Design: Cross sectional study

Place and Duration of Study: This study was carried out at the Dow University Hospital, Dow International Medical College and Dow Medical College / Dow University of Health Sciences Karachi from July to December, 2014

Materials and Methods: Study participants were medical students, interns, residents, consultants, as well as female patients and their lady attendants visiting General Surgical Out Patient Department. A questionnaire was developed including demographic details, knowledge about BSE, attitude towards and practice of BSE

These questionnaires were filled in by interns and residents of Department of General Surgery

Interviews were done in privacy after taking verbal consent

Data were entered and analyzed using SPSS version 16. Categorical variables about knowledge, attitude and practice are presented as frequencies. Predictors of BSE ie., age groups, level of education, occupation, income, marital status, personal history of benign breast disease and family history of breast cancer are also presented as frequencies

Their association with ever practice of BSE is determined by using chi square test

Results: Total of 729 women were interviewed to achieve a sample size of 500 positive responders, who had heard about BSE, which was 68.6%. Further questioning was done from these women

Majority of participants were young, 74% being less than 30 years of age. Around half of them were graduates and 21% were post-graduates

Sixty four percent respondents belonged to medical profession, while 22.2% were housewives and 13.8% had other professions

Majority belonged to high income group. 61.4% were married and 11.4% had family history of breast cancer. 29% respondents knew correct age to start BSE. Proposed frequency was stated correctly by 49.6%, appropriate time by 42.6%. Around 42% women said they knew how to perform and 36% could verbally explain the procedure correctly. More than 96% women thought that BSE was useful and should be practiced. Only 39.2% women claimed that they practiced BSE, while just 63 of the total 500 women interviewed, were doing it regularly

Level of education, profession, income, marital status and family member with breast cancer were found to be significant factors associated with BSE practice

Conclusion: Although overall awareness about BSE was average but correct knowledge and actual performance were poor. Medical profession, graduate level of education, handsome income, married status and family history of breast cancer were associated with BSE practice

Frequency of silent myocardial ischemia in type 2 diabetic patients having cardiovascular autonomic neuropathy

Introduction: Early detection of silent myocardial ischemia plays an important role in prevention of sudden cardiac death and acute myocardial infarction. The studies regarding the frequency of silent myocardial ischemia in diabetic patients having cardiovascular autonomic neuropathy are few so we planned this study to determine the frequency of silent myocardial ischemia among patients with diabetic cardiovascular autonomic neuropathy in our population

Objectives: To determine the frequency of silent myocardial ischemia in type 2 diabetic patients having cardiovascular autonomic neuropathy

Study Design: Cross-Sectional study

Place and Duration of Study: Medical Departments of Allied Hospital and Aziz Fatimah Hospital Faisalabad from 01-08-2013 to 31-01-2014

Methods: This study included 91 type 2 diabetic patients with cardiovascular autonomic neuropathy. All the patients had ECG done. Those who had normal ECG underwent ETT, to determine if there was any silent myocardial ischemia which was described as frequency distribution table. The data was collected on specially designed performa

Results: Total 91 patients were included in the study. Silent myocardial ischemia was present among 35 [38.5%] patients while 56 [61.5%] did not have silent myocardial ischemia. The mean age of the patients was 52.99 + 7.00 years [range 41-71years]. 57 [62.6%] patients were male and 34 [37.4%] patients were female. ECG was positive for ischemia among 25 [27.5%] patients and ETT was positive for ischemia among 10 [11%] patients

Conclusion: The frequency of the silent myocardial ischemia is high among patients with diabetic cardiovascular autonomic neuropathy, so every diabetic patient with cardiovascular autonomic neuropathy should be screened for ischemic heart disease

Frequency of estrogen and progesterone receptor status in breast cancer patients: a single institutional experience

Introduction: Breast cancer is hormone related disease and concerned hormones are Estrogen and Progesterone. Not all patients with breast cancer are positive for Estrogen receptor[ER] and Progesterone receptor [PR]. Western literature shows majority of patients have positivity for ER /PR or both but our experience at Allied Hospital is different as majority of patients have negativity especially the young patients. The objective of this study is to determine the frequency of ER and PR status in breast cancer patients

Material and Methods: Duration of study: January 2010 to December 2011

Study design: Descriptive case series

Place of study: Department of Clinical Oncology Punjab Medical College /Allied Hospital Faisalabad

Sample Size: All breast cancer patients visited our department in two years in all age groups

Data collection and analysis: Data was collected and entered in specified proforma and analysed manually

Results: Total number of patients enrolled in this study were 866[100%] out of which 860[99.3%] were female and 6[0.7%] were ale. 470 [55%] female patients were premenopausal and 390 [45%] were postmenopausal. Immunohistochemical staining was done in 396[45.7%] only others were not affording for it. ER positive, PR positive [both] were 130 [32.8%] patients and both negative were 205 [51.8%]. ER positive, PR negative were 40[10.1%] and ER negative, PR positive were 21[5.3%]. Among 214[54%] premenopausal patients, both positive were 70[32.7%], both negative were 116 patients [54.2%], ER +ve /PR -ve 18 [8.4%] and ER -ve /PR +ve were10 patients [4.7%]. Among 182[46%] postmenopausal patients both positive were 65[35.7%] and both negative were 93 patients [51.1%]. ER +ve / PR -ve were18 [9.9%] and ER -ve/ PR +ve were 6 [3.3%]

Conclusion: Hormone receptor positivity is less than the negativity especially in premenopausal females

Role of amantadine in treatment of chronic hepatitis C

Background: Interferon afla [IFN-alfa] is the only effective treatment for patients with Chronic hepatitis C. Forty percent of patients have an initial response to therapy. But most subsequently relapse. Amantadine, an antiviral agent, in addition ability, of preferably concentrating in liver, has shown a role in reducing hepatic inflammation and suppressing viral replication. The aim of this study was to assess the efficacy and safety Of amantadine for treatment of chronic infection with hepatitis C virus [HCV]. Design: Prospective study. Period: From January 2002 to Dec 2003, Setting: Allied Hospital, Faisalabad

Methods: Fifty patients either naive or interferon resistant, with age range of 18-65 years, were enrolled and treated with amantadine 100 mg orally twice daily for six month. Control groups included the same cohort followed of therapy for 12-18 month or during therapy with interferon. All patients were assessed for safety. Tolerance and efficacy at the end of every month during treatment was completed. Patients were followed up for an additional six month to assess durability of response. The primary end - point were loss of detectable HCV-RNA six month after cessation of therapy

Findings: Out of 50 patients treated for six months with amantadine compared to intervals without therapy or to interferon therapy, 17 [34%] had normal serum alanive aminotransferase [ALT] values and had cleared HCV RNA in serum by the end of treatment. The sustained virological response was found in 11 patients with an undetectable serum HCV RNA level six month after therapy Baseline low serum HCV RNA levels were associated with higher rates of Response. During the therapeutic trial, amantadine caused no potential treatment limiting side effects but had a good safety profile

Interpretation: Therapy with amantadine results in biochemical as well as virological response both in the naive and interferon resistant cases of chronic hepatitis C

Prevalence of retinopathy in hypertensive patients

Objective: The objectives of this study were to find out the prevalence of hypertensive retinopathy among hypertensive patients in this area of Pakistan and grading of hypertensive retinopathy at the time of examination according to the Keith-Wagener retinal changes classification for hypertension. Study Design: An observational study. Period: 5½ months Setting: Outdoor/emergency department as well as in medical unit - II of Allied Hospital, Faisalabad

Material and Methods: Three hundred consecutive patients with hypertension of either sex and between 20-85 years of age were examined. Opthalmoscopy was done after dilating the pupil with 1% Mydriacyl and retinopathy graded according to Keith-Wagener Classification

Results: Among these patients, 168 had the finding of hypertensive retinopathy, with overall prevalence of 56%. Out of these 168 patients, 70 had grade I, 75 had grade II, 18 had grade III and 05 had grade IV changes according to the Keith-Wagener Classification of hypertensive retinopathy. Among these 168 patients with hypertensive retinopathy, 64 were males and 104 were females, with overall prevalence in males 58.18% and in females 54.73%. It is found that prevalence of hypertensive retinopathy is maximum in patients with 50 years of age or above. The prevalence of hypertensive retinopathy increases with the duration of hypertension and is maximum in patients with duration of 10 years or more. Two hundred twenty five [225] patients were taking single drug and out of these 110 patients were found to have retinopathy with prevalence of 48.8%, 40 patients were taking combination therapy and out of these 34 patients were found to have retinopathy with prevalence of 86%. The remaining 35 hypertensive patients who had never taken medicine for their B.P control, out of these 35, 22 patients were found to have hypertensive retinopathy with prevalence of 62.8%

Conclusion: Prevalence of hypertensive retinopathy in our population is quite high, seen in both sexes and almost in all age groups. It increases with duration of the disease, higher in patient who are taking combination of drug as compared to those who were on single drug