Lymph node biopsies: Evaluation of disease pattern and role of surgery – Our experience from South Punjab, Pakistan

Objective: The objective of the study was to determine the frequency of different pathologies presenting with lymphadenopathy in patients from South Punjab and to evaluate the role of surgery in reaching the diagnosis. Materials and Methods: It was a cross-sectional study done at Recep Tayyip Erdogan Hospital, Muzaffargarh (managed by The Indus Health Network), from August 2014 to October 2017. Those being biopsied at some other hospital and the lymph node dissection biopsy done for a known primary cancer were excluded. Results: Lymph node biopsy was done on a total of 71 patients (56.3% n = 40 males, 43.7% n = 31 females). The mean (standard deviation) age of the patients was 27.30 ± 17.07 years. Open biopsy was performed on 70 cases (98.6%), whereas laparoscopic biopsy was performed on one case (1.4%). The most common pathology found on histopathology report was Tuberclosis (TB) lymphadenitis (49.3%, n = 35), followed by lymphoma (25.4% – Hodgkin's disease [HD] 15.5% and non-Hodgkin's lymphoma [NHL] 9.9%). Conclusion: TB is the most common pathology, followed by lymphoma. HD is more common than NHL. Surgical biopsy is the gold standard. Laparoscopy and other minimally invasive techniques are very safe and useful for excision biopsy of the central lymph nodes.

Practice and enforcement of national Hospital Waste Management 2005 rules in Pakistan

Background: Hospital waste management [HWM] rules in Pakistan were issued in 2005. Despite a decade of enactment, adherence to HWM 2005 rules has been inconsistent and systematic assessment of adherence using a World Health Organization [WHO]-recommended questionnaire has not been done in all teaching hospitals of Peshawar District.

Aims: This study assessed the adherence to HWM 2005 rules by tertiary care teaching hospitals of Peshawar District with respect to HWM personnel, policy and practices.

Methods: Pretested structured questionnaires based on WHO recommendations were used to survey all teaching hospitals of Peshawar District from January to March 2015. Data were also collected on HWM infrastructure and processes from 1 randomly selected medical, surgical, paediatric, and obstetrics/gynaecology unit in each hospital. Besides descriptive statistics, public and private hospitals were compared using Fisher's exact and Wilcoxon rank-sum tests.

Results: Most surveyed hospitals lacked formal HWM plans [70%], written procedures [80%], related job descriptions [80%] or records [90%]. Many hospitals neither had trained HWM supervisors [56%] nor did they organize formal HWM trainings for new staff [40%]. None of the hospitals followed waste segregation and colour coding. When compared to national HWM 2005 rules, multiple gaps in appropriate transportation, storage and disposal were found with no statistically significant difference between public and private hospitals.

Conclusions: Serious gaps in adherence to HWM 2005 rules exist in surveyed hospitals. With recent devolution of environmental function, the Government of Khyber Pakhtunkhwa should enact provincial HWM rules [and ensure their implementation] to facilitate effective HWM practice across provincial healthcare facilities

Public health education and health system needs in Pakistan: a mixed methods study

Background: Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs.

Aims: We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs.

Methods: A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce.

Results: We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic [i.e. with no specific concentration track] and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills.

Conclusions: Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways

Farmer field school's training on knowledge level of citrus growers regarding improved production practices / Impacto do treinamento da escola de campo para agricultores quanto ao nível de conhecimento dos produtores de citros em relação às melhores práticas de produção

ABSTRACT: The major objective of this paper was to assess the impact of the Farmer field school (FFS) training program on the knowledge level of farmers (citrus growers) regarding improved citrus production practices. Distract Sargodha was the targeted research area for this study being the leading producer of citrus in Pakistan. Quantitative data were collected through interview schedule and analyzed through Statistical Package for Social Sciences (SPSS). It was conclude that young people were more tend towards getting training under FFS program than old age farmers. Educated farmers were in majority in FFS farmers while; conversely illiterate farmers were in majority in the category of non-FFs farmers. In category of FFS farmers livestock farming was their primary income as reported by majority (31.3%) of FFS farmers and in the case of non-FFS farmer's crop sale was their primary income source as reported by 28.4% of non-FFs farmers. In addition to that both FFS and non-FFS farmers also earn income from nonfarm sources like business, job, foreign remittances and labour. FFS training program had positive and significant impact on the knowledge level of farmers regarding citrus production and protection practices. T-test statistics showed highly significant (P<0.05) difference in knowledge level of FFS farmers and non-FFS farmers.

RESUMO: O objetivo principal deste trabalho foi avaliar o impacto do programa de treinamento da escola de campo para agricultores (FFS) quanto ao nível de conhecimento dos agricultores (produtores de citros) em relação às melhores práticas de produção de citros. O Distrito de Sargodha foi a área de pesquisa escolhida para este estudo por ser o principal produtor de citros no Paquistão. Os dados quantitativos foram coletados por meio de entrevistas e analisados por meio do Statistical Package for Social Sciences (SPSS). Conclui-se que os jovens eram mais tendenciosos à obtenção de treinamento através do programa FFS do que os agricultores mais velhos. Os agricultores escolarizados estavam, em sua maioria, na categoria de agricultores FFS, enquanto que os agricultores analfabetos estavam, na categoria de não FF. Na categoria de FFS, a pecuária se mostrou o principal rendimento, conforme relatado pela maioria dos agricultores (31,3%), enquanto que, em 28% dos agricultores não-FFs, a principal fonte de renda era a venda de suas colheitas. Além disso, tanto os agricultores FFS como não FFS também ganham renda com fontes não agrícolas. O programa de treinamento FFS teve impacto positivo e significativo sobre o nível de conhecimento dos agricultores em relação às práticas de produção e proteção de citrus. O teste-T mostrou diferença altamente significativa (P<0,05) no nível de conhecimento dos agricultores FFS dos não-FFS.

Effects of mother's literacy on child health assessed by personal hygiene, nutritional and vaccination status

Background: In Pakistan, literacy means 'the ability to read and write'. Mother's education is a stronger determinant of child survivorship. This study was carried out in order to determine the impact of mother's literacy on child health in terms of personal hygiene of child, nutritional status and vaccination status, and to compare the child health status of literate and non-literate mothers

Methods: It was a cross-sectional study carried out in Paediatric Unit, Ayub Teaching Hospital, Abbottabad, from Dec 2015 to Aug 2016. Data was collected using non probability sampling and analysed on SPSS-21. Frequencies and percentages were calculated for categorical variables like gender, residence, education, immunization and hygiene status, and Mean+/-SD were calculated for quantitative variables like age

Results: Among total 160 children, mothers of 48 [30%] children were completely uneducated. Nutrition status showed that 89 [55.6%] were of normal height for age while rest of them were having stunting of mild to severe categories. Immunization of 135 [84.4%] of the children was done as per their age. Regarding hygiene, clothing of 129 [80.6%] was clean, nails of 95 [59.4%] children were properly clean and trimmed, while hair hygiene of 119 [74.4%] children and dental hygiene of 109 [68.12%] children was well maintained. Majority of those whose immunization, nutrition, and hygiene status was maintained had educated mothers

Conclusion: Maternal literacy has a direct effect on the overall child health with respect to personal hygiene, nutritional and vaccination status

Development of cetyl dimethicone based water-in-oil emulsion containing botanicals: Physical characteristics and stability

The aim of current research was to develop a water-in-oil emulsion containing grape seed extract for application in cosmeceuticals. Finally grinded dried grape seeds powder was extracted with hydro alcoholic mixture. Emulsions consisting of different concentrations of cetyl dimethicone [Abile EM90], the nonionic emulsifier, liquid paraffin as oily phase and water as aqueous phase were developed. Color, odor, pH, viscosity, liquefaction, phase separation, centrifugation and thermal stability of the formulated emulsions were observed at various storage temperatures i.e. 8 +/- 0.5[degree sign] C, 25 +/- 0.5[degree sign] C, 40 +/- 0.5[degree sign] C and 40[degree sign] C +/- 0.5[degree sign] C with 70% RH. The stable formulation consist of 16% mineral oil, 4% of ABIL EM 90[registered sign], 4% grape seeds extract, 1% rose oil and 75% distilled water. All the results derived from this study showed good stability over the three months study period which indicates w/o emulsion can be used as carrier of 4% grape seeds extract to enhance desired effects when applied topically

Pulmonary alveolar proteinosis: a rare cause of respiratory failure

Pulmonary Alveolar Proteinosis [PAP] is a rare syndrome in the paediatric age group and characterized by intra-alveolar accumulation of proteinaceous phospholipid-laden material called surfactant. The diagnosis is made by High Resolution Computed Tomography [HRCT] chest which shows characteristic crazy paving appearance and diagnosis confirmed by Bronchoalveolar Lavage [BAL]. We report two cases. First was a 9-month old infant who presented with respiratory distress and peripheral cyanosis since birth. He was diagnosed on High Resolution Computed Tomography [HRCT] chest as a case of pulmonary alveolar proteinosis and broncho-alveolar lavage confirmed his diagnosis. Second case was a 10-year old female child who had a history of repeated chest infections for 5 years and now presented with cough and respiratory distress for 45 days. She was also diagnosed on HRCT chest but unfortunately she died before bronchoalveolar lavage

Ultrasonographic assessment of amniotic fluid index in post date pregnancies

To assess fetal outcome in postdate pregnancies [40 weeks and beyond] with women having amniotic fluid index [AFI] < 6 cm and between 6-15cm using greyscale ultrasound. Cross-sectional comparative study. CMH Rawalpindi from 26 October 2006 to 09 May 2007. A total of 60 patients were studied. The antenatal fetal surveillance in these patients was based on ultrasound assessment of AFI after 40 weeks. An abnormal AFI was defined as less than 6 cm, between 6-8 cm as equivocal and more than or equal to 8 as normal. Patients were equally divided into two groups of 30 each based on AFI as group I having AFI <6 cm and group II with AFI of 6-15 cms. Delivery mode, fetal distress and early neonatal complications were main assessment parameters for the fetus. Rate of caesarean section [50%] in the women with AFI< 6 cm was found significantly higher than 17% rate of caesarean section of the women having AFI > 6 cm .Proportion of early neonatal complications was also significantly higher in the women with AFI< 6 cm. AFI assessment by ultrasound is a reliable fetal surveillance test. It may allow the conservative approach till 42 weeks to reduce the caesarean section rate and neonatal complications

Impacted third molar extractions-are we following any recommended guidelines?

Among the minor oral surgeries done by an oral surgeon and surgeries carried out in the department of oral and maxillofacial surgery all over the world third molar removal is one of the most frequent procedures done. The procedure is accompanied by significant risks, with possible damage to the inferior alveolar and/or lingual nerve being of special concern. Considering these risks of mor-bidity, it is essential to establish the need of removal. National Institute of Clinical Excellence [NICE] in the United Kingdom introduced guidelines for removal of third molars in 2000, advocating that only pathological third molars should be removed. The following article makes reference to a study carried out in Ireland where third molars are extracted in accordance with NICE guidelines. This study was carried out to assess the compliance of general dental practitioners and oral surgeons to the NICE guidelines. It was noted that 90% of the patients referred for third molars extraction fulfilled the criteria set forth by NICE.A few modification were carried out in the guidelines provided which were done under scientific evidence based knowledge i.e. Prophylactic extraction of impacted third molars. These guidelines cut down lot of unnecessary referrals and allowed for organization of the patient load by the secondary referral center, as well as limiting unnecessary surgeries and postoperative complications. It is suggestive that the governing authorities in Pakistan should also implement such guidelines for extractions of impacted third molars

Probiotics and their beneficial effects against various diseases

Joint FAO/WHO expert's consultation report defines probiotics as: Live microorganisms which when administered in adequate amounts confer a health benefit on the host. Most commonly used probiotics are Lactic acid bacteria [LAB] and bifidobacteria. There are other examples of species used as probiotics [certain yeasts and bacilli]. Probiotic supplements are popular now a days. From the beginning of 2000, research on probiotics has increased remarkably. Probiotics are now day's widely studied for their beneficial effects in treatment of many prevailing diseases. Here we reviewed the beneficiary effects of probiotics in some diseases

Trends of tobacco smoking among students of private university, Lahore - Pakistan

Objective: To assess the trends of tobacco smoking among students of private university Lahore

Study design: A cross-sectional study

Place and duration of study: From April 2012 to May 2012 at Becanhouse National University, Lahore

Subjects and Methods: A self-administered questionnaire was used to collect the data from 51 students after obtaining informed consent. Data was entered and analyzed by using Statistical Package for Social Sciences [SPSS] version 16.0

Results: Prevalence of smoking was 60.8%. There were 62.5% male smokers and 60% female smokers. 'Sheesha' smoking was most common [40.6%]. Sixty-eight per cent smokers started smoking between 15-19 years of age. Cause of smoking in 64.5% was just for fun. Forty-eight out of 51 [94.1%] knew the hazards of smoking. Health education and high tax on cigarettes were pointed out by students to control the rising trend of smoking in the country

Conclusions: There is a high prevalence of smoking among university students which is disturbing. There is also very high prevalence of smoking among female students which is worrisome. Prevention and cessation of smoking among university students is drastically needed

Awareness and compliance about forensic dentistry among dental professionals of twin cities of Rawalpindi-Islamabad: a questionnaire based study

The objective of the present study was to evaluate the awareness and compliance among dental surgeons working within twin cities about "forensic dentistry". Secondary objective was to evaluate the need of this specialty to be added in BDS curriculum as an independent subject or part of any major subject. This cross sectional Study was done in five teaching dental hospitals of Rawalpindi and Islamabad which are affiliated with Dental colleges. 318 questionnaires consisting of fourteen basic questions were distributed in the dental colleges/ hospitals selected for the study. Data were then compiled, categorized and analyzed using SPSS. The response rate was 93%. Participants who had never studied forensic dentistry at any level were 99.32% and who never got any formal training in forensic dentistry were 100%. Individuals who opted to study forensic as a subject if opportunity of training was given within Pakistan were 60%. Forensic Dentist may play a major role in identification of those individuals who cannot be identified otherwise. Recent tragedies and situations have increased awareness concerning the importance of forensic dentistry in identification of victims especially in current era in Pakistan. Forensic dentistry must be introduced into the BDS curriculum effectively as a subject. Moreover, the likelihood of future disasters due to terrorism, earthquakes and other causes require the dental profession in Pakistan to be prepared for an ex-pended role

Analytical, nutritional and biological evaluation of various brands of fortified and non-fortified wheat flour

In Pakistan, a funded flour fortification program was launched for malnourished population, residing mainly in rural low income areas, but the urban population having comparatively better nutritional as well as economic status was focused wherein excessive intake of fortificants might cause complications. Therefore, the present study describes the physicochemical properties, elemental composition, nutritional components and hemoglobin/ferritin increasing potential of fortified and non-fortified flour. Domesticated chicken [Gallus gallus domesticus], either sex, age one month, weight 380 +/- 18.28 g, were randomly segregated into 4 groups [n=6]. The group I, II and III were fed on fortified flour, whereas group IV was fed on non-fortified flour for 30 days. The birds were weighed and blood samples of each of the birds were analyzed for determination of markers of iron status, hemoglobin [Hb] and serum ferritin [SF]. Moisture, ash and iron contents were found to be lower in non-fortified flour than that of the fortified samples. Hb and SF levels in groups fed on fortified flour were significantly higher than the one received non-fortified flour [P < 0.05]. The consumption of iron-fortified flour increases iron stores in the body without any further complication but long-term usage needs to be monitored.

Seropositivity of hepatitis B and C in blood donors at CMH Lahore, Pakistan

Background: There is high prevalence of Hepatitis B and C infections in Pakistan; especially Hepatitis C has adopted the shape of epidemic. Due to their mode of transmission through blood and blood products, it has made the provision of safe blood difficult and the screening of blood absolutely necessary

Objective: To find out the seroprevalence of Hepatitis B and C virus among the healthy blood donors at Combined Military Hospital [CMH] Lahore, Pakistan

Subjects and Methods: A cross-sectional study was carried out at Blood Bank of CMH Lahore Laboratory from 1[st] January 2011 to 31[st] April 2011. All healthy blood donors [n = 2155] reporting to blood bank during the above mentioned period were screened for Hepatitis B and C. Written records of blood bank of CMH Lahore laboratory were reviewed. Study Performa was designed for collection of data. Data was entered and analyzed by using Statistical Package for Social Sciences [SPSS] version 16.0

Results: Total number of 2155 donors was screened. Out of these, 2041[92.7%] were males and 114[5.3%] were females. The results of the study showed higher prevalence of Hepatitis C in the blood donors constituting 77 [3.6%] donors. Out of 2155 donors, 21 [1.3%] were positive for Hepatitis B. Age group of 34-41 was most affected in both Hepatitis B and C positive blood donors

Conclusions: Prevalence of Hepatitis C is clearly on the rise. To control its further spread, public awareness programs and health education programs and proper selection of healthy blood donors, proper screening and discouraging professional donors should be done. Policy message: Media should be used by National Hepatitis Control Programme of Pakistan to educate the public about hazards of unscreened blood transfusion. Blood screening for Hepatitis B and C infections should be made mandatory at all blood banks

Comparison of silastic and acrylic interpositioning for the treatment of temporomandibular joint ankylosis

The aim of this study was to compare the treatment outcome of thirty unilateral temporomandibular joint [TMJ] ankylosis cases treated in Pakistan Institute of Medical Sciences [PIMS], Islamabad within four years by either silastic or acrylic interpositional arthoplasty. Patients having bilateral TMJ ankylosis, age less than 16 years, coronoidectomy required during procedure, already operated cases and medically compromised patients were excluded from the study. Pre and post-operative assessment was done by thorough history, physical examination and radiographic evaluation [OPG and CT scan] to determine the cause of ankylosis, the maximal inter-incisal opening, complications including infection, presence of facial nerve paralysis and recurrence rate. The maximal inter-incisal opening in the pre-operative period ranged from 0-11mm and was recorded at a mean of 32.7+/-5.8mm for cases treated with silastic interposition and 29.5+/-6.8mm for the ones treated with acrylic one year after surgery. Infections, swelling, pain and nerve injuries were reported in both the groups post-operatively. Both silastic and acrylic were found to be statistically similar in terms of maximal inter-incisal opening, complications and recurrence rates. Recurrence was observed in only one patient treated by acrylic inter-positioning. Silastic however demonstrated itself to be a better choice in terms of handling and patient tolerability

Clinical audit and performance measurement in a newly established service of oral and maxillofacial surgery

The objective of this clinical audit was to evaluate the performance of a newly established Oral and maxillofacial surgery department during the first twenty four months of its existence.It was a Cross-sectional study. The audit took place from September 2011 till September 2013 consisting of 24 months duration at oral and maxillofacial surgery department of Rawal Institute of Health Sciences, Islamabad. Data were collected by the staff members during their routine work. Data was then compiled, categorized and analyzed, to evaluate the quality of work. During the audit period 8522 patients who visited the Department from September 2011 to Sep 2013 were included in the study irrespective of age and gender. Among which 5237[61.45%] were male and 3285[38.55%] were female [3:2].Majority of the patients were from Islamabad and Rawalpindi [85.70%] with the peak in the first decade of life. Maxillofacial injuries and Pathologies comprised 210 patients [2.46%], Patients who suffered maxillofacial trauma patient's mandible fractures were the most common 83[39.72%]. A service like this in the private sector is both valuable and commercially viable. The findings of this audit can be used to forecast the future service use. It will also provide the parameters for auditing the services provided by the department in future

Juvenile rheumatoid arthritis

To determine the spectrum of clinical presentation, laboratory parameters and drug therapy in patients with Juvenile Rheumatoid Arthritis [JRA]. Case series. The Children's Hospital and The Institute of Child Health, Lahore, from October 2008 to October 2011. All patients who fulfilled the American College of Rheumatology criteria for JRA were enrolled. Their clinical features, investigations done and treatment received for JRA were noted. Statistical analysis of data was done on SPSS version 16.0 for obtaining descriptive statistics. Out of 185 patients, 50.3% [n = 93] were females; 54% [n = 100] were between 10 - 15 years of age. Polyarthritis was found in 71.9% [n = 133] followed by oligoarthritis [22.7%, n = 42] and systemic onset disease [5.4%, n = 10]. Morning stiffness [78%] and fever [68%] were the most common clinical presentations. All patients with systemic onset disease had fever [n = 10] followed by skin rash, hepatosplenomegaly and lymphadenopathy. Uveitis was found in 2 patients, and both belonged to the oligoarticular group. Rheumatoid factor was found in 10.27% [n = 19] of all patients. All patients were given non-steroidal anti-inflammatory drugs [NSAIDs]. Disease modifying agents [methotrexate] were given to 43.8% [n = 81]. Steroids were used in 61% [n = 113] of patients either with NSAIDs alone or NSAIDs plus methotrexate. Disease profile of JRA at the study centre showed that polyarthritis is the commonest type. Recognition of subtypes will help in planning the management of these patients

Frequency of coronary heart disease: risk factors among doctors of CMH Lahore medical and dental college, Lahore - Pakistan

Objective: To determine the frequency of various risk factors for Coronary Heart Disease [CHD] among doctors of CMH Lahore Medical and Dental College, Lahore, Pakistan

Design: A cross-sectional study

Place and Duration of Study: The study was conducted at CMH Lahore Medical and Dental College, Lahore from 01 Jun 2011 to 31st Jul 2011

Subjects and Methods: A sample size of 104 subjects was selected by convenience sampling after taking verbal consent. A pre-tested questionnaire consisting of questions about presence or absence of CHD risk factors was self-administered. Variables such as gender, age group, and CHD risk factors such as hypertension, diabetes mellitus, family history of heart disease, smoking, hypercholesterolemia, Body Mass Index [BMI] and exercise were included

Results: Among 104 subjects, 53[51%] were males, 51[49%] females and less than 40 years age group were 53 [51%] and more than 40 years were 51[49%]. Proportions of major risk factors were: hypertension 20.2%, diabetes mellitus 7.7%, smoking 13.5%, hypercholesterolemia 19.2%, overweight 33.7%, obesity 5.8%, and lack of regular exercise 40.4%. Proportions of three major risk factors [smoking, hypertension and hypercholesterolemia] occurring singly, doubly and all three together in the study population were found to be 16.3%, 9.7% and 4.8%, respectively. Data was also analyzed for risk factors by comparing those with and without family history of CHD to eliminate any bias. Results were not statistically significant except for hypertension [P = 0.002]

Conclusion: There is a high prevalence of CHD risk factors in doctors of CMH Lahore Medical and Dental College. Modifiable risk factors like diabetes, hypertension and cholesterol need better control. Preventive screening programs and healthy lifestyles need to be emphasized

Pyogenic granuloma of scrotum case report and review of literature

Pyogenic granulomas are common, acquired, vascular lesions of the skin traumatically. We present adult patient who developed pyogenic granuloma on scrotum, only second case report in English literature