Epidemiological profile of children with acute respiratory infections in pediatrics outpatient department in secondary care hospital of Tando Muhammad Khan, Sindh, Pakistan

Objective: To determine the epidemiological profile of children with acute respiratory infections from 1 month to 1 year of age attending the pediatric out patient department [OPD] of secondary care hospital in TMK, Sindh and determine the frequency of treatment methods used by mothers when encountered with acute respiratory infection in children

Study Design: A cross-sectional study

Place and Duration of Study: Pediatrics outpatient department, Taluka Headquarter Hospital District Tando Muhammad Khan [TMK], Sindh Pakistan, from Jul to Sep 2017

Material and Methods: During the study period of three months about 230 children from 1 month to 14 years of age were sampled through non-probability convenient sampling technique according to the set criteria and structured pro-forma was administered to their mothers to gather the required information. The proforma was pre-tested in the similar setting at THQ hospital, Kotri before its administration at the study setting. The findings of questionnaire were analyzed in SPSS version 22

Results: Out of 230 patients 53 percent [n =121] were males and 47 percent [n = 109] were females. The age group maximally affected was 5-14 years which were almost 47.9 percent [n=110] and the other age groups contributed to the remaining part of the patients that is 52.1 percent [n=120]. Most of the patients belong to the lower class and lower middle class that approximately comprised 75 percent [n=170] of the patients and the remaining 25 percent [n=60] comprised of poor patients. Approximately 95 percent [n=218] of mothers were preferring medical practitioners for treatment with 5 percent [n= 12] going in favor of local remedies

Conclusion: Our study revealed that age group of 5-14 years is mostly the victims of the disease with male predominance as compared to females in this part of the world. Poor socioeconomic status seems to have no effect on occurrence of ARI. Future research is needed in this area to further enhance the study findings

Vaginal hysterectomy: outcomes as 24 hr short stay surgery

OBJECTIVES: To find out feasibility, acceptability and Patient satisfaction with vaginal hysterectomy performed as 24 hour hospital stay case

Study settings:- This study was carried out at Gynae Obs. Unit-IV of Liaquat University Hospital Jamshoro [tertiary care hospital] from Feb 2011 to july 2012

METHODOLOGY: This is a descriptive observational studyin which women with utero vaginal prolapse, non-obese, with adequate home support and telephonic accessibility are included. Patients with un-controlled co-morbidities like hypertension, diabetes,obstructive lung disease etc requiring monitoring were excluded from the study, along with the women having adnexal pathology requiring removal vaginally. All parameters of post-operative recovery and satisfaction of patients were noted, compiled and presented

RESULTS: Out of 57 suitable candidates for vaginal hysterectomy as 24 hour hospital stay surgery only 20 gave consent for participation in study and one refused to go after surgery because of vomiting .None of the19 patient returned back before their first follow up visit that was 9th post-operative day .Three [15%] complained about offensive vaginal discharge,1 [.2%] woman had an episode of heavy bleeding after reaching home but that was controlled by the instructions given on phone. Four [20%] patients, who initially agreed for 24 hour stay, did not want a discharge. Seventeen [85%] patients were not satisfied because lot of apprehension for post-operative home care,and multiple visits to out-patient-department before admission causing financial burden on the family

CONCLUSION: Vaginal hysterectomy can safely be performed as short hospital stay surgery but lack of infra-structure and awareness of community as well as of primary healthcare provider make it less acceptable, less satisfying and costly at receivers end

Age and symptoms at natural menopause: a cross-sectional survey of rural women in Sindh Pakistan

Age at menopause and symptoms vary among populations and societies. Scarce data is available about menopausal age, symptoms and socio-demographic and reproductive factors from rural women of Sindh, Pakistan. The present study was conducted to find out the self reported age at natural menopause, prevalence of menopausal symptoms, and to identify sociodemographic and reproductive factors that may influence the onset of menopause. A survey was carried out on women aged 40-70. A multistage random sampling technique was used to retrieve 1,355 women with natural menopause from 10 union councils of district Matiari. These women were further categorised into 3 groups, I, II, and III having menopause for 1-5, 6-10, >10 years respectively. Pearson's chi-square test was used to analyse the percentage of symptoms distribution. ANOVA was used to analyse the relationship between demographic, reproductive factors and the age at natural menopause. Age at menopause in our subjects was 46.2 +/- 6.4 years. The prevalence of menopausal symptoms ranges from 26% to 83%. Frequency of somatic, psychological and urogenital symptoms was high in group II. No significant association was found between parity, socioeconomic status and age at natural menopause. The results have shown the early age at menopause. The prevalence of menopausal symptoms is high. Results regarding correlation of age at menopause with socio-demographic and reproductive characteristics were different from literature.

Profile of women who experienced vesicovaginal fistula due to obstetric trauma: results from survey at gynecological surgery camp 2005

To assess the demographic, sociocultural and environmental factors responsible for the causation of Vesicovaginal fistula [VVF] due to obstetric injury. This was a descriptive survey carried out among patients with Vesicovaginal fistula, recruited from free fistula repair camps arranged at the interior of Sindh Province Pakistan from 6[th] January 2005 to 18[th] January 2005. Twenty seven patients were interviewed. The information regarding demography, sociocultural and environmental factors was gathered and analyzed by SPSS V 16. The mean age of patients was 25.37 +/- 6.5 years. The mean age at first delivery was 18.55 +/- 2.4 years. Majority of patients 22[81.5%] were illiterate and 21[77.8%] belonged to poor socioeconomic class. Nineteen [70.4%] patients had availability of transport 24 hours a day. Twenty four [88.9%] patients traveled for 1-5 hours to reach health facility. Early age at the time of marriage and pregnancy, illiteracy, poor socioeconomic condition and unavailability of emergency obstetric care by skilled person are the causative factors for Vesicovaginal fistula

Hypertensive disorders of pregnancy: frequency, maternal and fetal outcomes

To determine the frequency and distribution of different types of hypertensive disorders of pregnancy and to determine the impact of hypertensive disorders of pregnancy [HDP] on maternal and fetal outcomes. A descriptive retrospective study. The study was conducted in the department of Gynaecology and Obstetric of Isra University Hospital Hyderabad from January to December 2007. All the patients who were diagnosed to have hypertensive disorders of pregnancy during study period were categorized as group I. One hundred nineteen women delivered during the same period without hypertensive disorders of pregnancy were included as group II. The data regarding demographic and obstetrical parameters, associated risk factors, fetal and maternal complications were gathered from available data on medical record files. Total number of deliveries during the same period was obtained. Frequency of hypertensive disorders of pregnancy was calculated. Statistical analysis was performed by SPSS V11. Pearson's chi square and student's t test was used for comparison of variables in between two groups. P value < 0.05 was considered significant. The frequency of Hypertensive disorders of pregnancy was 8.9% in our study. The mean maternal age was 28.57 +/- 5.8 years and 26.56 +/- 5.0 years for group I and II respectively. Forty eight [76.2%] of group I patients were Unbooked for antenatal care, 37[58.7%] belonged to poor socioeconomic status and 82[45.1%] were multipara. Statistically significant difference was found for antenatal booking status [P. 0.04] and socioeconomic status [P. 0.01] and parity [P 0.04] in both groups. Twenty three [36.5%] patients from group I had past history of hypertensive disorders of pregnancy, while it was reported only by 8[6.7%] of group II patients. It was observed that women with HDP have strong family history of hypertension [P. <0.001]. Regarding maternal outcome more patients from group I were shifted to ICU as compared to group II. Maternal mortality was significantly high in group I [P <0.001]. The mean gestational age was 35.29 +/- 2.6 weeks and 38.03 +/- 1.3 weeks in group I and II respectively. The mean birth weight of baby was 2.5 +/- 0.73 kilograms and 2.8 +/- 0.41kilograms in group I and II respectively. Statistically significant difference was observed in both groups for mean gestational age [P<0.001] and mean birth weight of baby [P<0.001]. Statistically significant difference was observed for Preterm birth, Still born, Neonatal death and admission of newborn in neonatal intensive care unit [P <0.001], [P <0.001], [P <0.001], [P<0.001] respectively. The Perinatal mortality was 230/1000 births in group I, while it was 40/1000 in group II. Frequency of HDP is high in our set up. It is associated with high maternal and perinatal morbidity and mortality

Tobacco use and its health hazards among male teaching and non-teaching staff of a public sector health sciences university in Pakistan

To determine the frequency of tobacco use and to assess the health hazards of tobacco use in male teaching and non-teaching staff of Liaquat University of Medical and Health Sciences [LUMHS] Jamshoro, Sindh - Pakistan. This descriptive cross sectional survey was conducted from 15[th] July to 14[th] December 2005. One hundred forty nine staff members belonging to teaching and non-teaching cadres were selected for study through systematic random selection by the use of standardized formula, Informed consent was taken and data were gathered on a questionnaire containing variables regarding demography, use of tobacco, form of tobacco and health related problems due to use of tobacco. Female staff members were excluded from the study. All the data were analyzed by software programs SPSS 11.0. One hundred forty-nine staff members were interviewed. Frequency of tobacco use was 55[37%]. Among them, 33 [60%] subjects were cigarette smokers, 06[11%] had habit of chewing paan/chaalia mixed with tobacco, 11[20%] were taking naswar while 03[5.45%] and 02[3.6%] were using gutka and mainpuri respectively. The most frequent reason for use of tobacco was friends/company in 37[67.27%] subjects. Out of fifty-five tobacco users, 36[65.45%] had some health related problem. The most frequent reported complaints were teeth staining in 24[66%] subjects while cough with sputum in 06[16.6%] cases. Other problems were GERD in 03[8.3%] and gum ulcers in 02[5.5%] subjects respectively. This study concludes that high proportion of staff working at LUMHS consumes tobacco. The frequent pattern of tobacco use is cigarette smoking and health related problems are common in the users of tobacco

Presence of postgraduate students in gynecology outpatient department: how do patient feels?

Objectives: the purpose of this study was to document the views of patients about presence of postgraduate students during gynecology consultation, to highlight the reasons of acceptance or refusal of student's participation in outpatient care and to make implications for both patient satisfaction and medical training

Design: descriptive study

Place and duration of study: conducted on patients who attended gynaecology outpatient services at Isra university hospital from 1st April to 1st June, 2007

Patients and methods: total 115 patients were selected randomly. 20-40 year aged patients were included in this study while pregnant women and unmarried girls were excluded. Total number of postgraduate students was 15. No more than six students were present at a time during consultation. All were female trainees for fellowship of College of Physicians and Surgeons Pakistan [FCPS] trainees. These trainees were present to observe and discuss management of patients with consultant. Written informed consent was taken from all women for participation in this study. Information was collected through questionnaire

Results: mean age of the patients was 33.35 years. Out of 115 patients, 78.3% [90] patients felt comfortable in the presence of post-graduate students and accepted their presence, while 21.7% [25] patients refused their presence. Among 78.3% [90] women who accepted the presence of students, 96.7% [87] were willing to be examined in front of students in future, if they come to hospital for any other problem. While 3.3% [3] patients refused to be examined in front of students

Conclusion: majority of patients were willing to have postgraduate students presence during their consultation. Women who refused their presence, had reasons of previous bad experience, shyness, no privacy, diversion of doctor's attention from patient to trainee and because number of trainees were more during examination . Reducing number of trainees during consultation and doing discussion with post graduate students at the time when patient have left the room will further increase the willingness of patients for students presence. Information brochure should be distributed to patients highlighting the benefits of clinical teaching may help to persuade some unwilling patients to reconsider the presence of post graduate students

Innovation in teaching strategies for undergraduate medical students at Isra University Hyderabad, Sindh-Pakistan

Objective: to evaluate the academic performance and to assess the experience of 4th year MBBS students before and after introduction of Problem Based Learning Curriculum [PBLC]

Study design: a comparative study

Place and duration of study: academic session of 2006-2007 at Isra University Hyderabad, Sindh-Pakistan

Subjects and methods: one-hundred and nine students of 4th year MBBS were taught Obstetrics and Gynecology by Traditional curriculum [TC] and Problem Based Curriculum; both for 150 hours. Their academic performance was evaluated by 06 continuous assessment tests [CATs] scheduled fortnightly. At the end of every curriculum their experiences were recorded on a questionnaire. Data were analyzed and Chi- square test and student's t-test were used to obtain significant values

Results: study detected statistically significant difference of class test attendance [p<0.001] and marks obtained in each test [p<0.001] after PBLC and TC. Students liked PBLC more and their experience was excellent and good [p<0.001] with PBLC than with TC. Classroom attendance was not different in both curriculum as 75% of attendance was required by student to be eligible to appear in the end-semester examination as per rules of examination department of the university

Conclusion: PBLC introduced in the 4th year MBBS at Isra University with traditional curriculum significantly improves the academic performance of students. Students' experience of PBLC was good and they liked it because of more understanding of the subject, feeling of independence and confident

Knowledge, attitude and preferences of pregnant women towards modes of delivery

Objective: to determine the knowledge, attitude and preferences of pregnant women towards vaginal and caesarean delivery

Study design: KAP [Knowledge, attitude and preferences] study

Place and duration of study: antenatal clinic of Obstetrics and Gynecology Department at Isra University Hyderabad Sindh, from August 2007 to February 2008

Subjects and methods: four hundred and forty-six women who have attended the antenatal clinic during the study period were interviewed after taking informed consent. The information regarding sociodemographic, obstetric history, knowledge and attitude statements towards vaginal and caesarean delivery, the source of their knowledge, information regarding willingness to accept caesarean delivery as a primary mode of delivery for current pregnancy and the reasons for chosen preferences were recorded on questionnaire. All data were analyzed by using SPSS v.12. Overall scores for knowledge and attitude statements, mean +/- SD were calculated

Results: the mean +/- SD age was 26.54 +/- 5.08 years. Majority [39.7%] of women interviewed have received no formal education. Overall rating for knowledge about modes of delivery was weak in 392 [87.9%] women, while medium and good was rated by 47 [10.5%] and 7 [1.6%] respectively. Mean attitude score was 21.99 +/- 3.12 for vaginal delivery and 8.78 +/- 4.47 for caesarean delivery. It shows that 304 [68.1%] women regarded vaginal delivery as a natural and accepted mode of delivery. Majority of women reported that they obtained the knowledge regarding modes of delivery from their relatives. Three hundred and fifty-seven [80%] women refused to accept caesarean delivery as primary mode of delivery in current pregnancy, common reason given was fear of operation. Only 89 [20%] accepted it and the main reason for acceptance was doctor's advice

Conclusion: women in our setup have low level of knowledge regarding modes of delivery and positive attitude towards vaginal delivery. There is need for a program to increase women's understanding about different modes of delivery

Frequency, intensity and impact of premenstrual syndrome in medical students

To determine the frequency and severity of Premenstrual Syndrome [PMS] in medical college students, evaluate the impact of the condition on the quality of life and find out the associated risk factors. An observational study. Isra University Hospital, Hyderabad, Sindh, Pakistan, from August to December 2006. Unmarried medical students aged 18-25 years with regular menstrual period for the last 06 months were recruited by convenience sampling. PMS-related data was collected on daily record of severity of problems [DRSP] for two prospective cycles. Health-related quality of life data was collected on medical outcome study Short Form 36 [Sf- 36] after taking informed consent from participants. Descriptive and inferential analysis was done by two-tailed t-test and multivariate logistic regression analysis. Study participants [n=172] had mean age of 21.2 +/- 1.9 years. Eighty-nine [51%] girls met the criteria for PMS recording to ICD - 10, among them, 53 [59.5%] had mild PMS, 26 [29.2%] had moderate and 10 [11.2%] had severe PMS. Ten [5.8%] girls were found to have Premenstrual Dysphoric Disorder [PMDD] according to DSM - IV criteria. The order of frequency of symptoms were anger, irritability, anxiety, tiredness, difficult concentration, mood swings and physical symptoms like breast tenderness and general body discomfort with great impairment in social life / activities and work efficiency/productivity. Dysmenorrhea [p=0.003] and family history of premenstrual syndrome [p <0.001] were significantly associated with premenstrual syndrome on univariate and multivariate analysis. Sf - 36 score on Mental Component Summary [MCS] and Physical Component Summary [PCS] were significantly lower in the affected group. Premenstrual syndrome is a common problem in young girls which adversely affects their educational performance and emotional well-being. Strategies should be adopted for detection and management of PMS in young girls