Factors Responsible for Work Stress among Health Care Providers and Frequency of Antidepressant Medicine Use

Objective:To assess the contributing factors of occupational stress and frequency of antidepressant medicine use among healthcare providers working at Isra University Hospital.Study Setting: IsraUniversity Hospital, Hyderabad Sind Pakistan.Study Design: Cross-sectional.Materials and Methods:All the health care providers of Isra University Hospital, Hyderabad of either gender formed the sample of the study. A structured questionnaire in English language was designed to gather data on factors contributing to occupational stress. Data was analyzed by using SPSS version 20.Results:The impact of work stress on work performance was explored in 100 study participants. The results indicated that 87% of study sample affirmed that stress lead topoor performance. Out of all participants, 79% were female and 21% were males. The analysis of stress elevating factors showed that 56% study participants had stress due to low salary, 17% felt stress due to seniors ‘negative attitude’ and 15% due to low job satisfaction. Result showed that 27.0% subjects reduce stress by sharing with theirfriends, 25% by prayers, 21% use the music during stress, 19.0% share with family and 8% using the antidepressant medicine during stress.Conclusion:It was concluded that low job satisfaction, lesser pay and seniors’ attitude are common contributing stress factors. Sharing with family and friends, music, prayers and use of the antidepressant medicine were the common methods of stress reduction

Effect of silymarin therapy on liver aminotransferase in non-alcoholic fatty liver disease

Objective: The present study evaluated the effects of silymarin on blood glucose, blood lipids and liver amino-transferase [AST and ALT] in Non-alcoholic fatty liver disease [NAFLD]

Study Design: Randomized Placebo Controlled [double blind] Trial

Place and Duration of Study: This study was carried out at Consultant Clinic Cant area Hyderabad andDepartment of Medicine, Isra University Hospital Hyderabad from April 2012 to August2013

Materials and Methods: A sample of 64 subjects [33 cases and 31 controls] was selected for evaluating effects of silymarin. Subject selection observed the inclusion and exclusion criteria. Subjects with aspartate transaminase [AST] and alanine transaminase [ALT]>1.2 of normal were included. NAFLD diagnosis was confirmed by ultra-sonography. NAFLD cases were given silymarin[140 mg x2 tablets] daily for duration of 3 months. Controls received placebo. AST and ALT were checked after three months. Data variables were analyzed by SPSS version 21.0

Results: Mean +/- SD of aspartate transaminase [AST] and alanine transaminase [ALT] before intervention were found as 73.2 +/- 9.7 vs. 69.3 +/- 17.6 IUL[-1][p<0.021] and 92.1 +/- 19.4 vs.83 +/- 15.6 IUL[-1]in cases and controls [p < 0.0001] respectively. After three months the AST and ALT were found reduced compared to baseline. AST and ALT were found as 39.3 +/- 7.5 IUL[-1]and ALT to 39.3 +/- 10.9 IUL[-1]35.9 +/- 11.7 IUL[-1]and 83 +/- 15.6 IUL[-1]in cases and controls respectively. Blood lipids and blood glucose also showed statistically significant differences [p=0.0001]

Conclusion: Silymarin improves blood glucose, blood lipids and liver amino transferase in non-alcoholic fatty liver disease

Acute malnutrition; mid upper arm circumference [MUAC] of children

To determine the frequency of low mid upper arm circumference [MUAC] of children with acute malnutrition. This study was conducted in the department of paediatrics at Liaquat University Hospital Hyderabad from 01-06-2012 to 30-11-2012. All the children with features of malnutrition, of either gender were recruited and evaluated for their mid upper arm circumference which was measured through plastic measuring tape. During six month study period, total 135 children with acute malnutrition were studied for their mid upper arm circumference [MUAC], of which 95[70%] were males and 40[30%] were females. The mean age +/- SD of overall population was 30.24 +/- 10.57 month while the mean age of male children was 32.88 +/- 11.76 and the female child was 31.62 +/- 10.97 months. Regarding the MUAC, was low in 93[68.9%] children with acute malnutrition. The mean age +/- SD of child with low MUAC was 28.99 +/- 12.52 while the mean +/- age of male and female child with low MUAC was 27.63 +/- 10.73 and 29.85 +/- 11.64 respectively. The mean MUAC in children of acute malnutrition with low MUAC was 8.85 +/- 3.93 while it was 8.66 +/- 3.96 and 8.93 +/- 3.31 in male and female child with low MUAC respectively. The present study suggested that MUAC is appropriate and good tool for identifying severe malnutrition in children

analysis of risk factors in severe protein energy malnutrition in order to know their significance for outcome in children from 2 months to 5 years of age

OBJECTIVES: To investigate risk factors in severe protein energy malnutrition and their significance for outcome in children from 2 months to 5 years of age

STUDY DESIGN: Descriptive

PLACE AND DURATION OF STUDY: This study was conducted in the Department of Pediatrics Unit II Liaquat University Hospital, Jamshoro from 01-08-2010 to 29-02-2012

SUBJECTS AND METHOD: One hundred fifty two patients from 2 month to 5 years age who presented with severe protein energy malnutrition, defined according to WHO as presence of oedema of both feet and severe wasting [70% weight-for-height/length or <-3SD] or clinical sign of severe malnutrition, were included in study. The risk factors were evaluated and investigations were recorded on a proforma. Diagnosis was based on clinical signs and anthropometric measurement like height, weight, mid upper arm circumference were taken which was compared with WHO height /weight or height and length reference card. The risk factors were analysed to know their significance for outcome

RESULTS: The study group comprised of 152 children ranging from 2 months to 5 years, 51.3% [n=78] were male, 48.6% [n=74] were female, the mean age of presentation 24.6months. The 15.7% [n=24] out of 152 either died or left in serious condition against medical advise. The risk factors the mother 66% [ill working, in competent], father 48% [ill, unemployed], parental loss 7%, large family size 43%, mixed or bottle feed, improper dilution 47%, delayed feeding of solid food or inadequate weaning 69%, chronic recurrent diarrhea 61%, recurrent respiratory infections 51%, measles 31%, pneumonia 34%, incomplete vaccinations 66% are the statistically significant for severe protein energy malnutrition and mortality

CONCLUSION: The risk factor in order of significance are the mother [ill working, in competent], father [ill, unemployed], parental loss, large family size, mixed or bottle feed, improper dilution, delayed feeding of solid food or inadequate weaning, chronic recurrent diarrhea, recurrent respiratory infections, measles, pneumonia, incomplete vaccinations are the statistically significant for severe protein energy malnutrition and mortality

Thrombomodulin, a protective marker against coronary artery disease

1] To compare the serum thrombomodulin levels between apparently healthy subjects and patients with myocardial infarction and unstable angina 2] To assess, whether it may be identified as a protective marker for determining the incidence of coronary artery disease The controls and patients were taken by convenient sampling. A total of 32 control [healthy] subjects were compared with 32 consecutive patients with history of myocardial infarction, [M.I.] and 32consecutive patients with history of unstable angina [U.A.] respectively. The diagnosis of myocardial infarction [M.I.] and unstable angina was made on the basis of history, E.C.G. and Trop. I levels. Serum thrombomodulin and serum lipid profile of each subject were determined by ELISA Kit methods. One way analysis of variance [ANOVA] was conducted for comparison of serum thrombomodulin level among healthy, Myocardial infarction [M.I.] and unstable angina [U.A.] patients. Serum Thrombomodulin levels were significantly higher in controls when compared to patients of myocardial infarction and unstable angina. Serum L.D.L. cholesterol and total cholesterol levels were significantly higher in diseased group in comparison with control Incur study healthy population had increased Thrombomodulin levels as compared to patients of coronary artery disease [C.A.D.]

Ventilator-associated pneumonia in children

To determine the frequency of Ventilator-Associated Pneumonia [VAP] and to identify the associated factors, causative organisms and outcome of VAP in children admitted to ICU. Cross-sectional, observational study. Medical ICU [MICU] of the Children/'s Hospital and Institute of Child Health, Lahore, from August 2008 to March 2009. All children admitted to MICU and requiring ventilation during the study period were included and monitored for any features suggestive of VAP. Partial septic screen was done in all suspected cases. VAP was labelled when any patient on the ventilator for more than 48 hours had at least 2 of the following features of nosocomial infection - fever > 101'F, TLC < 4000 or > 15000 per mm[3], neutrophils > 85%, CRP > 48 mg/L or new findings on chest examination suggestive of pneumonia' and radiological evidence of new or progressive and persistent infiltrates. Percentages were compared using chi-square test with the significance at p-value less than 0.05. Of the 93 children requiring mechanical ventilation during the study period, 16 developed VAP [17%]. Almost half [46%] were younger than 1 year with male to female ratio of 1.2:1. Children developing VAP required ventilation for 13.5 [+ 10.1] days compared to 7.7 [+ 5.5] days in those who did not develop VAP. The common organisms isolated were Pseudomonas, Klebsiella and E. coli. Factors associated with increased frequency of VAP included age less than 1 year, unplanned emergency intubation and use of continuous intravenous sedation. Features that strongly suggested underlying VAP included purulent tracheal secretions compared to increased secretions alone, CRP > 48 mg/L, positive radiological findings and positive tracheal aspirate culture. Overall mortality was 23% among the ventilated cohort. Thirty two percent of them had VAP compared to only 13% among those who survived to discharge [p = 0.03]. The frequency of VAP was 17% in this series. Factors significantly associated with VAP were age less than 1 year, unplanned intubation and continuous sedation. The important predictors of VAP included purulent tracheal secretions, high CRP and persistent new radiological findings

Inflamatory Pseudotumor of the Bladder: A Histopathological Diagnostic Challenge from Its Malignant Variant

Inflammatory Pseudotumor (IP) of bladder is one of a variety of lesions which may arise from spindle cell lesions in the bladder. It is benign in nature compared to the other end of the spectrum of spindle cell lesions, such as sarcoma, sarcomatoid carcinoma and leiomyosarcoma. The diagnosis of IP and its differentiation from a malignant pathology is a diagnostic dilemma for Urologist and Pathologist as both entities share certain similar morphological and histo-pathological appearance as well as immuno-histo chemistry staining. It is however crucial to avoid misdiagnosis as the treatment option varies significantly between a radical or partial cystectomy with future surveillance cystoscopes. Hereby, we highlight a case of a benign variant of spindle cell tumour of bladder which needed second pathology review for confirmation and thus avoiding a radical cystectomy. We also review the literature on its presentation and emphasis characteristics differentiating a benign from a malignant pathology.

Clinical spectrum of infantile spasm at presentation

To determine the clinical and EEG findings in children with infantile spasms at their initial presentation to the Neurophysiology Department, Children's Hospital, Lahore, Pakistan. Observational study. The Neurophysiology Department, Children's Hospital, Lahore, Pakistan, from January 2008 to December 2010. Children aged

Childhood primary angiitis of the central nervous system

To analyze the clinical course and magnetic resonance angiographic [MRA] abnormalities in children with primary angiitis of the central nervous system [cPACNS]. Cohort study. Neurosciences and Neuroradiology Department of the Children's Hospital, Lahore, from January 2009 to December 2010. The cohort comprised consecutive patients diagnosed as having cPACNS based on clinical findings and identification of arterial stenosis on magnetic resonance angiography [MRA] in the absence of an underlying condition that could cause these findings. The treatment protocol for ischaemic infarcts consisted of induction therapy with intravenous steroids pulses and intravenous immunoglobulin followed by maintenance therapy with azathioprine and low dose aspirin. When indicated, they were treated with anticoagulants at least for 4 weeks along with induction therapy. Patients were followed at a single centre and systemically assessed for clinical presentation, classification of disease as progressive or non-progressive, adverse effects of anticoagulants, aspirin, azathioprine and their hospital course. Sixty-eight children with medium-large vessel cPACNS [62% boys, 38% girls] with mean age of 8.5 +/- 3.5 years were enrolled in this study. Motor deficit [70%]; headache [64%] and fever [20%] were the commonest symptoms; whereas hemiparesis [60%]; seizures 55% [focal 35%, generalized 20%] and decreased conscious level [30%], were the commonest neurological findings. Neuroradiological findings were ischaemic strokes in 50 [73.5%], haemorrhagic strokes in 10 [14.7%] and ischaemic haemorrhagic lesions in 8 cases [11.8%]. Angiographically 51 [51/68, 75%] of the cohort had non-progressive [obliterative] and 17 [17/68, 25%] had evidence of progressive arteriopathy at the time of admission. No secondary haemorrhagic lesions were documented among infarcts strokes, which were treated with heparin and oral anticoagulants. Outcome was survival in 56 cases [81.5%] and death in 12 cases [18.5%]. All survivors were discharged on long-term oral aspirin; 15 of them were also commenced on azathioprine. Neurological findings among the 56 survivors were; normal 20%, minor disabilities in 25%, moderate disabilities in 20% and severe disabilities in 35%. The spectrum of cPACNS includes both progressive and non-progressive forms with significant morbidity and mortality. This treatment protocol of immunosuppressive therapy may improve long-term neurological outcome in children with medium-large vessel childhood primary angiitis of the CNS

Work-family conflict and burnout among lecturers of public sector colleges

The aim of the current study was to investigate the relationship between work-family conflict and burnout among the lecturers of Govt. Colleges. Work-family Conflict Scale [Carlson, Kacmar, and Williams, 2000] and Maslach Burnout Inventory [Maslach and Jackson, 1986] were administered on the present sample. A purposive sample of lecturers [N = 200] including male [n = 100] and female [n = 100] was selected from different colleges of Faisalabad Division. Age range of the sample was 26-60 years [M = 41.20]. Pearson correlation was applied to study the relationship among study variables. The findings of the study indicate that Work-family conflict has significant positive correlation with emotional exhaustion, depersonalization, personal accomplishment, and burnout. Time-based conflict, strain-based conflict, and behavior-based conflict exhibited significant positive correlation with emotional exhaustion, depersonalization of' others, reduced personal accomplishment, and overall burnout. Finally, practical implications are discussed

Relationship between emotional intelligence and academic achievement among higher secondary school students

The main objective of the present study was to examine the relationship between emotional intelligence and academic achievement among students of higher secondary schools. The secondary objective was to examine the role of various demographic variables of the students including gender socio economic status, parental education and geographical origin in emotional intelligence. The Bar-On Emotional Quotient Inventory was for data collection. Academic achievement of the participants was measured through their annual results. Pearson correlation and t-test was applied to test the hypotheses. Findings are in line with the hypotheses. Significant relationship found between the two constructs. First born students scored high on emotional intelligence as compared to later born students. Students with literate parents scored high as compared to students with illiterate parents. Students from urban areas scored high as compared to students from rural areas. Students from upper socio-economic students scored high on emotional intelligence as compared to students from lower socio-economic status. Female students scored high as compared to male students

Childhood epilepsy

To determine the community-based prevalence of childhood epilepsy and its treatment gap in rural and urban population in Punjab, Pakistan. Cross-sectional study. Gujranwala District, from March to June 2007. Ten out of 52 Union Councils of District Gujranwala, Pakistan, were randomly selected. Field officers, specifically trained for screening children with active epilepsy, performed a door-to-door survey in the selected Union Councils using area vaccinators as key informants. Final confirmation of active epilepsy and treatment details were ascertained by a qualified paediatrician and a paediatric neurologist, where required. Treatment gap was defined as relative [when treated inappropriately] and complete [complete lack of treatment]. Among a total, under 16 years population of 92254, prevalence of childhood epilepsy was found to be 7.0/1000 [n=643] with similar distribution between urban and rural residents. Up to 66% [n=424] patients were being managed by an unqualified person including paramedics and faith healers. Treatment gap was found in 88% [n=566] patients. Childhood epilepsy is common in both urban and rural areas of District Gujranwala. Area vaccinators may be incorporated into screening and referral program to bridge the treatment gap utilizing minimum available resources

qualitative study to assess the awareness level of diabetes mellitus in patients coming to JPMC

The study was conducted to assess the awareness level about diabetes in patients coming to JPMC and to initiate steps to increase their knowledge and clear misconceptions. Descriptive Cross-Sectional Study. This study was conducted in JPMC hospital from April 2008 to October 2008. A non- probability convenience sampling technique was applied in a population aged 15

Attitude and analysis of using computers by the medical students in Karachi

Computers provide the wealth of information and the means of communication, education and patient management. Although several studies in different countries have explored the extent to which health science students use the computer and the internet, a few researches are available on this subject in Pakistan, where the Internet culture is cultivating rapidly. Hence this study was conducted to assess the knowledge, skills, proficiency of using computers and browsing internet by the medical students and their implement of this knowledge in the medical field for the purpose of study and research. To assess the frequency and purposes of computer and subsequent internet usage among medical students. A Descriptive cross-sectional study. This study was conducted during 1[st].September - 1[st]. November 2008 amongst the Medical Students enrolled in public and private Medical Colleges of Karachi. The sample size was 450. A well designed structured questionnaire was used to collect responses in a voluntarily and confidential manner. 91% medical students were computer literate. The main reason for lack of computer knowledge was lack of time and lack of access to a computer. 88% agreed that computer has revolutionized and better off the world. 93.3% use internet for research, chatting, health information and medical news, emails, music and entertainment.86.3% students use Google as the main search engine. 83.7% have used internet for the research purpose. 77% use internet for latest medical news. 68.5% students use it for the diagnosis, prognosis and treatment of diseases. Only 17% are the members of Medical Journals. The medical students using computers have a positive attitude towards its use in the medical field, which not only has made a significant impact but also encourages them in study, research and keep them updated in this fast developing world. Use of computers enhances decision-making, management planning and medical research among the students

Susceptibility pattern of pathogens isolated from the prostatic tissue

There is significant incidence of bacterial growth in the prostatic tissue in the patients with Benign Prostatic Hyperplasia [BPH], whereas pre-existing urinary tract infection is not a reliable indicator by which this group can be identified pre-operatively and prostatic infection could be treated. To identify the presence of various types of bacteria and fungi in prostatic tissue and cultures from urine samples of patients undergoing transurethral resection of prostrate. Cross-sectional observational study design. This study was conducted at The Basic Medical Science Institute at Jinnah Postgraduate Medical Center [JPMC] Department of Microbiology Karachi from. The samples were processed by the standard protocol. Culture medium of Blood agar and MacConkeys agar were used and biochemical tests were performed by using different sugar media, triple sugar iron agar, Simon citrate agar, urease, indole, and MRVP tests. Out of 100 cases 25% showed identical type of growth, 11% cases had different type of growth in urine and prostatic tissue culture whereas 5% had no growth in urine while 32% had no growth in prostate only 32% had no growth in both urine and tissue culture. The significance of prostatic tissue culture of patients undergoing surgery facilitates prompt diagnosis and the ideal choice of antibiotic can shorten the duration of treatment

Predictors of intractable childhood epilepsy

To determine the prognosis of seizures in epileptic children and identify early predictors of intractable childhood epilepsy. Case-control study. The Epilepsy Centre of the Children's Hospital Lahore, from February 2005 to April 2007. All children [aged 1 month to 16 years] with idiopathic or cryptogenic epilepsy who were treated and followed at the centre during the study period were included. The patients who had marked seizures even after two years of adequate treatment were labeled as intractable epileptics [cases]. Children who had no seizure for more than one year at last follow-up visit were the controls. Adequate treatment was described as using at least three anti-epileptic agents either alone or in combination with proper compliance and dosage. Records of these patients were reviewed to identify the variables that may be associated with seizure intractability. Of 442 epileptic children, 325 [74%] intractable and 117 [26%] control epileptics were included in the study. Male gender [OR=3.92], seizures onset in infancy [OR=5.27], >/= 10 seizures before starting treatment [OR=3.76], myoclonic seizures [OR=1.37], neonatal seizures [OR=3.69], abnormal EEG [OR=7.28] and cryptogenic epilepsy [OR=9.69] and head trauma [OR=4.07] were the factors associated with intractable epilepsy. Seizure onset between 5-7 years of age, idiopathic epilepsy, and absence seizures were associated with favourable prognosis in childhood epilepsy. Intractable childhood epilepsy is expected if certain risk factors such as type, age of onset, gender and cause of epilepsy are found. Early referral of such patients to the specialized centres is recommended for prompt and optimal management

Re-do orchidopexy in a general surgical unit-reliability of clinical diagnosis and the outcome of surgery

Re-do Orchidopexy is not very common, expertise is limited and the results of clinical examination and ultrasonography are not always reliable. This cross-sectional study was based on medical records of patients under-going re-exploration of inguinal region for a missing testicle after previous groin surgery, and no mention of orchidectomy. All patients were thoroughly examined, investigated with ultrasonography and offered re-exploration. Results were graded as Good, Fair and Poor. Out of 11 boys included in the study, 7 [63.63%] had failed orchidopexy. Another 3 [27.27%] were opened for 2nd stage orchidopexy and 1 [9.09%] had iatrogenic ascent of testis after herniotomy. On clinical examination 4 [36.36%] had a palpable testicle at the superficial ring, 2 [18.18%] were in inguinal canal [1 doubtfull], and no testicle could be palpated in 5 [45.45%]. Ultrasonography picked up 2 testicles [18.18%] at the superficial Inguinal ring, 1 [9.09%] in Inguinal canal and 1 [9.09%] testicle in the abdominal cavity. On reexploration, 10 [90.9%] testicles were found and brought down, 7 [63.63%] being considered of reasonable consistency and size. Another 3 [27.27%] were considered soft or small in size, and in 1 [9.09%]], no testicle was found. In 5 patients [45.45%], the testicle was at superficial ring, in 3 [27.27%] in the inguinal canal, and in 2 [18.18%] in the abdominal cavity. Results were considered good in 6 [54.54%], fair in 3 [27.27%]] and poor in 2 [18.18%]. Groin examination after previous inguinal surgery is tricky. Ultrasonography is also not very reliable. Re-exploration via the inguinal approach is adequate and recommended. Thorough exploration is essential before declaring the testicle absent

Neurofibromatosis type II: a rare neurocutaneous syndrome

Neurocutaneous syndromes are heterogeneous group of disorders with abnormalities of central as well as peripheral nervous system. Neurofibromatosis type II [NF-II] is an autosomal dominant neurocutaneous syndrome rarely diagnosed in pediatric population. Diagnosis is based on clinical history and radioimmaging. We present a 14 years old boy with headache and decreased hearing, who turned to be a case of neurofibromatosis type II