Barriers to exclusive breastfeeding in children under 6 months of age in district kasur

Objectives: The objectives of my study were to identify major factors which prevent mothers to breastfeed their infants in the first six months and to analyze the behavioral constraints to develop a suitable strategy for strengthening the practices of exclusive breastfeeding

Study Design: Descriptive Study

Methodology: The study was conducted on 37 subjects, who were mothers with young children under six months of age and were not breastfeeding their children due to any reason. The study was based on direct interview taken at DHQ Hospital Kasur and BHU Rao Khan Wala in the district Kasur. The interviews lasted for about half an hour with each subject. Subjects who were breastfeeding regularly or who were HIV, Hepatitis and other diseases positive were not included. The interviews were conducted in a separate room with least disturbance. Quantitative data like age was presented by mean and standard deviation while qualitative data education, profession were presented by frequency and percentages. SPSS [version 20] software was used for data analysis

Results: The mean age of infants of group [62.1%] was of 2.2 months ± 0.7 and other group of infants [37.9%] was of mean age 5.2 months +/- 0.6. The mean weight [kg] and standard deviation of the index children at birth was 3.1 [kg] +/- 0.2. Among index infants 37.8% were male infants and 62.2% were female infants. By place of birth of children, 75.6% births took place in a health facility. 32.4% mothers were illiterate. 13.5% mothers were on job. Only 83.7% females had fed colostrum to their infants. 62.1% mothers were those who never fed their infants. 27.0% were those who initially fed their infants for short period of time and then stopped feeding who fed irregularly was 10.8%. Important factor identified was insufficient milk production [65.2%] with significance of p-value = <0.05 and Sickness of mothers and consequently advised by doctor to avoid breastfeeding to their infants, was contributing [52.1%] with significance value p= <0.05 among mothers who never breastfed their infants under six months of age

Conclusion: Inadequate milk production and mothers' sickness were most commonly stated factors

Relationship between the family environment and childhood obesity

Objective: To determine the association of family environment with childhood obesity

Methodology: This case control study was conducted in Public and Private schools of Lahore city and was analyzed in Department of Community Medicine, Allama Iqbal Medical College Lahore from November 2015 to May 2016.Students having age 8 to 10 years studying in grade 4 and 5 were selected for this study

Results: After compiling the results, it was noted that childhood obesity was associated with parental BMI, eating between regular meals, TV viewing >4hours/day and physical activity <20min/day

Conclusion: Results of this study revealed that childhood obesity is associated with risk factors of family environment [parental BMI, eating between regular meals, TV viewing >4hours/day and physical activity <20min/day]

Economic burden of thalassemia on parents of thalassemic children: a multi-centre study

Objectives To determine the economic burden of thalassemia on parents of thalassemic children

Study design, settings and duration: Descriptive nonprobability, purposive sampling done in PHRC Research Centres of Multan, Lahore, Islamabad, Karachi, Peshawar and Quetta from July 2013 to June 2014

Patients and Methods: After taking informed written consent, parents/guardians of thalassemia major children were interviewed. All information was recorded on the pre-tested questionnaire. Data was entered and analyzed using SPSS version 11

Results: A total of 600 guardians/ parents of the thalassemic children were included in the study. There were 57% boys and 43% girls with a mean age of 9.40 +/- 5.66 years. Among them, 47.8% were from rural and 52.2 % from urban areas. Almost 71% children were transfusion dependent. The family history of cousin/interfamilial marriage was present in 78.2% while parental consanguinity was present in 72.8%. Only 1.7% parents got premarital screening for thalassemia. In private sector 56.8% had to pay nothing while others had to pay from Rs. 500 to Rs. 2000 per visit. Expenditure per month in private thalassemia centres showed that 57% had to bear no cost at all, 12.2% had to spend up to Rs. 1000, while 24.8% Rs. 1001 to 5000 and 6% had to pay more than Rs. 5000. In the government sector cost per visit in 35.5% was up to Rs. 500 while others had to pay between Rs. 501 to more than Rs. 2000. Monthly cost at government sector almost doubled. Total expenditure [private and government sector] per month was Rs. 9626 for each patient

Conclusion: Total cost [both direct and indirect] for the management of thalassemia was quite high and this cost puts significant economic burden on the affected thalassemic families. This disease puts social, financial and psychological impacts on suffering families, so prevention-based strategies like premarital screening, prenatal diagnosis and genetic counseling should be adopted in Pakistan. A national screening project for thalassemia is the need of the day

To assess health-related quality of life and co-morbidity pattern in hemodialysis patients

Objective: To assess health-related quality of life and co-morbidity pattern in hemodialysis patients

tudy Design: Observational / cross sectional study

Place and Duration of Study: This study was carried out in the Department of Nephrology Department, Nishtar Medical Hospital, Multan from February 2015 to January 2016

Materials and Methods: By a non probability purposive sampling procedure, 123 hemodialysis patients from our hemodialysis center in Nishtar Hospital Multan[Pakistan] were interviewed by resident doctor according to the SF-36 Scales. The means and standard deviations for each of eight scales were calculated, each domain ranges from 0-100, the highest scores indicating better quality of life. Comorbidities like DM, Hypertension ,ischemic heart disease lung disease etc were also recorded

Results: The scores of the eight scales in the hemodialysis patients were 49.92 +/- 0.90, 38.82 +/- 41.39, 46.73 +/- 26.54, 40.52 +/- 21.65, 43.98 +/- 21.82, 49.43 +/- 27.76, 49.85 +/- 40.59 and 59.93 +/- 17.36. Co-morbidities pattern were hypertension in 104[84.6%],DM 59[48%],ischemic heart disease 23[18.7%] and other co morbidities were less common. The scores of most of the scale in the patients with co morbidities were lower as compared to patients without co morbidities. Data obtained was entered by a doctor in SPSS version 20 and was analyzed to compute descriptive statistics of the numerical variables while frequencies and their percentages for categorical variables of the study

Conclusion: The results of our study indicate that quality of life was poor among patients on hemodialysis particularly those having co-morbidities. Hypertension and diabetes were major co-morbidities in our study. Quality of life score was lower in female patients than that of male patients. Proper management of co-morbidities can improve quality of life of these patients which will decrease disease morbidity and mortality. This will also provide psychological and financial relief to the suffering families and also be cost effective for hospital authorities in terms of availability of space

Thoracolumber vertebral fractures; outcome of short segment transpedicular fixation

For spinal injuries, thoracolumbar junction is common site in our population. Surgical management of unstable fractures and fracture dislocations of thoracolumbar spine is still controversial. This study was conducted to document efficacy of short segment fixation of thoracolumbar verterbral fractures

Objectives: To determine the outcome of short segment transpedicular fixation of thoracolumbar fractures

Study design: Descriptive cross-sectional study

Sampling technique: Non-probability purposive sampling

Material and Methods: A total of 103 study cases with thoracolumbar vertebral fractures were taken in this descriptive case series study which was conducted at department of Neurosurgery, Nishtar Hospital Multan from February 2014 to June 2015. Informed verbal consent was taken from each patient before participation in this study ensuring them confidentiality of the information and explaining them objectives and procedure of our study. Once registered, detailed history and clinical examination was done by a Neurosurgeon, investigations like X-ray dorsolumbar spine, CT scan and Magnetic resonance imaging [MRI] dorsolumbar spine were also done. Short segment transpedicular fixation was done and outcome of surgical management was assessed in terms of improvement in power, hardware failure and infection by consultant neurosurgeon. All the study cases were called for follow up visits after every month till 6 months to record final outcome of management. All the information were recorded in the study proforma. Data were entered and analyzed by SPSS version 22

Results: Out of these 103 study cases, 66 [64.1%] were male patients and 37 [35.9%] were female patients and male to female ratio was 1.85:1. Mean age of our study cases 33.92 +/- 9.72 years ranging from 20 years to 54 years. Mean ages of male patients was 36.68 +/- 10.37 years while in female patients it was 29.00 +/- 5.89 years [p=0.000].Post-surgical management improvement in power was seen in 55 [53.4%] of our study cases, hardware failure in 11 [10.7%] and infection was observed in 20 [19.4%]

Conclusion: According to our study short segment transpedicular fixation is safe and effective procedure providing efficient spinal stability. Short segment fixation is associated with minimum blood loss and trauma and leads to early mobilization of the patient and ease in physiotherapy. Transpedicular screw fixation is a useful choice for achieving better neurological recovery and good pain control in post-traumatic thoracolumbar fractures

Low vision devices; visual outcome among population of Dera Ghazi Khan, southern Punjab, Pakistan

Objective: The main objective of the present study was to find out visual outcome of Low Vision Devices among patients suffering from different diseases causing reduced visual acuity in the area of Dera Ghazi Khan, Southern Punjab, Pakistan

Setting: Ophthalmology Department, Dera Ghazi Khan which is a tertiary care hospital

Period: 10[th] February, 2014 to 31[st] December, 2014

Material and Methods: Patients [n=55] presented for their low vision assessment included two groups age wise as patients equal or more than 18 years age [n=22] and patients less than 18 years [n=33]. LOG MAR VA charts, contrast sensitivity test, visual fields through arc perimeters, color vision with color pencils hue 16 test along with objective and subjective refractions were applied. All the data were entered and analyzed using SPSS version 16.00

Results: Patients [n=55] aged 7-90 years presented for their low vision assessment had mean age 23.73+ 2.9 years. The patients were divided into two age groups. First group was 22 [40%] patients equal or more than 18 years age and second consisted of 33[60%] patients less than 18 years age group. Among the patients examined, 40 [72.7%] were males and 15 [27.3%] were females. Our study results revealed that the low vision devices provision was associated with a statistically significant improvement in both near and distance visual acuities and with patients' fulfillment

Conclusion: There was a significant improvement in far and near visual acuity of the patients suffering from a multiplicity of blindness caused diseases by which patients are able to improve their quality of life and able to do their tasks without getting help from others

Association of Endothelial Nitric Oxide Synthase [eNOS] gene polymorphism [Glu 298 Asp] with coronary artery disease in subjects from Multan, Pakistan

Acute Coronary Syndrome [ACS] is the most common disease and cause of mortality in both genders across the world and certain risk factors i.e. age, gender, smoking, diabetes, hypertension, drugs usage, weight etc are known to be associated with the disease. The aim of this study was to find if there is any correlation exists between ACS and hereditary genetic defect in endothelial nitric oxide synthase [ecNOS] gene as eNOS generates Nitric oxide in blood vessels and regulates the vascular tone hence directly affecting the cardiovascular function. Single nucleotide polymorphism [SNP] [Glu 298 Asp] in ecNOS was determined in 280 subjects, from Southern Punjab [in Pakistan] population, including [160 ACS patients and 120 healthy controls] by PCR-RFLP method and genotype was correlated with various risk factors as well as with serum cholesterol and triglyceride levels. Our results indicated that the genotype Glu 298 Asp was not associated with ACS but when various studied parameters were compared among patients suffering from various forms of ACS and their healthy controls, it was observed that age [45-55 years] [P = 0.05], gender [male] [P < 0.001], education [P<0.001], family history [P=0.03], hypertension [P<0.001], diabetes [P<0.01] and smoking habit [P = 0.03] were the significantly different parameters among them and may be associated with the incidence of cardiovascular disease. Cholesterol [161.5 +/- 79 mg/dL] level was found to be higher in patients [P = 0.04] than controls while triglyceride remained unaffected [P = 0.87] in both groups

3rd trimester of pregnancy; frequency of anemia

To see the frequency of anemia in pregnant ladies and its possible outcomes. Descriptive cross sectional study. Fatima Jinnah Women Hospital, Multan. Six months. This prospective cross sectional study was conducted at Gynae and Obst. OPD at Fatima Jinnah Women Hospital, Multan. Non probability convenient sampling technique was used. All the pregnant women between 20-35 years irrespective of gestational age or any concurrent illness having parity upto 5 were registered for the study after getting written consent for participation. The pregnant ladies were evaluated by asking history of blood loss, parity, multiple pregnancy, worm infestation, use of NSAIDS and blood transfusion. They were especially asked about dietary habits which were rated as good, average and poor. Their socio economic status was assessed and was placed into high, middle and low income groups. Blood samples were drawn for blood counts and hemoglobin estimation in all the women presenting at hospital. Reflotron photometer, Roche Diagnostic was used for the blood testing. A cut off value of< 11 g/dl irrespective of duration of pregnancy was used for anemia. Peripheral blood film was examined for RBC morphology. Mean corpuscular volume [MCV] was used to categorize into micorcytic [< 76fl], macrocytic [>98fl] and normocytic [78-98fl]. Fetal well being was evaluated by serial abdominal ultrasounds. Three hundred pregnant women attending Gyne and Obst. OPD, Fatima Jinnah Women Hospital, Multan, were registered according to the study protocol. The duration of the study was 6 months. Maternal age was between 25-35 years. 86 % women were multiparous, 79% women presented during 3rd trimester, 15% during the 2nd trimester and 6% during 1st trimester. Thirty eight percent women had hemoglobin 8-9.9 g/dl, 48% had from 7-7.9 g/dl and 10%were falling between 5-7 g/dl. Eighty eight percent had microcytic hypochromic anemia, 12% with dimorphic picture and 4% were having low MCV and MCH but normal MCHC and these were referred for hemoglobin electrophoresis. Fifty eight percent had monthly income 2-4 thousands rupees and only 10% were earning 4-10 thousands per month. Seventy eight percent had poor diet and 22% had an average and no women were fit into the criteria for good diet. History of breast feeding was positive in 92% of the women. History of use of iron supplement was also asked, 28% had used various preparations of iron and folate for a variable period from 1-4 months, 72% never used hematinic supplements. History of previous blood transfusion during pregnancy and labour was present in 16% of the women. Three percent had fetal growth retardation. Prevalence of anemia during 3rd trimester of pregnancy in is high our society. It can have significant effects on maternal and fetal out come. It is a preventable cause which can be treated easily. Poverty and lack of education are the most important causes of anemia during pregnancy

Acute myocardial infarction; frequency of family history of ischemic heart disease [IHD] and related risk factors in the first degree relatives

To determine the frequency of family history of IHD and related risk factors in the first degree relatives of patients suffered from acute myocardial infarction [AMI]. Descriptive study. PMRC Research Centre, Nishtar Medical College, Multan, Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology, Multan. One year from July 2011 to June 2012. In this descriptive study 331 patients of AMI of either sex and age >/= 20 years admitted in Cardiology unit of Nishtar Hospital Multan and Chaudhary Pervez Elahi Institute of Cardiology Multan were registered. For data collection non-probability convenient sampling technique was used. Informed consent was taken from each patient. The information were recorded in a pre-designed questionnaire. The data were analyzed through SPSS-11. Mean age of the study cases was 54.99+/-11.25 years [Minimum age was 20 years and maximum was 90 years]. Two hundred sixty four [79.8%] were male and 67 [20.2%] were female patients and male to female ratio was 3.9:1. Out of these 331 patients 111 [33.6 %] were having positive family history of IHD. In these 111 [33.6 %] cases history of diabetes was seen in 45 [40.5 %], 43[38.8 %] had history of hypertension and history of hyper-cholesterolemia was present in 23 [20.7 %] of cases. The family history of IHD in addition to traditional risk factors such as hypertension, hyperlipidemia, diabetes mellitus and smoking is itself an important risk factor for IHD. Relatives of the young patients with IHD should be considered as high risk group and it calls for close surveillance of their first degree relatives and early intervention. All their family members should be advised life style modification, appropriate management of risk factors and regular follow up of even apparently healthy descendents

Transmission of Anti-HCV from mother to infant and its natural course

Background: Anti HCV is transferred from positive mother to her newborn. To prevent this transfer of anti HCV, many health care providers stop the mother from breast feeding and recommend the checking of the newborn for anti HCV. If found positive, they take it as a chronic infection and recommend treatment of the child as soon as possible. Prohibition from breast feeding not only pushes these neonates towards nutritional deficiencies but also make them prone to infections. The testing also stigmatizes the mother and her newborn for life. The literature proves that this antibody transfer is passive and clears in majority of cases without any residual disease. Mother to infant transfer of anti-HCV and its natural course in Pakistani population is not known

Objectives: To determine the frequency of anti-HCV positivity and its natural course in infants born to anti-HCV reactive mothers

Subjects and Methods: Anti-HCV reactive mothers were registered from gynecology department and labor room of Nishtar Hospital Multan from 07-10-2010 to 07-04-2011, using non probability purposive sampling. The ALT of mothers was also checked. The babies born to these mothers were checked for anti- HCV by ELISA and ALT at 0 day [at the time of birth] and then at 6, 12, 18 and 24 months using venous blood samples. Data was entered and analyzed using SPSS-11

Results: Out of 35 anti-HCV reactive mothers; only one had ALT above the upper limit of normal [> 40 IU/L]. A total of 35 babies were born to these mothers, out of whom 34[97.1%] were reactive to anti-HCV at the time of birth and only one was non reactive. At 6 months 2 babies had expired and 3 were lost to follow up, leaving 30 babies. Out of these 30 babies 11 became non-reactive and 19 were still reactive for anti-HCV at 6months. At 12 months, all 19 anti-HCV reactive cases became non reactive, indicating passive transfer of antibodies from the mother to these neonates which they lost by 12 months. ALT of all babies except 3 was raised at 6 months [> 40 IU/L] which became normal during the subsequent visits

Conclusion: Almost all children born to anti-HCV positive mothers were reactive at the time of delivery but they all became non-reactive by the age of 12 months indicating passive transfer of anti HCV from the mother to the neonate

Painless myocardial infarction; its frequency in patients of acute coronary syndrome

To determine the frequency of painless MI in patients with acute coronary syndrome. Descriptive cross-sectional study. Setting and duration: This study was conducted at cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan. The study duration was 1 year starting from July 2011 to June 2012. This descriptive study included 331 patients of AMI of either sex and age which were admitted at "Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan" using non-probability convenience sampling technique. Informed verbal consent was taken from each patient for participation. Out of these 331 patients 308 [93.1%] patients reported chest pain as the presenting complaint. Remaining 23[6.9%] presented with clinical feature other than chest pain. Of these 23 patients who presented without chest, minimum age was 30 years while maximum was 90 years with mean age 54.82 +/- 12.28 years. Patients with painless AMI presented with variety of symptoms. Most common symptoms seen in patients of AMI without chest pain were generalized weakness and cold sweats. Out of 23 patients with painless AMI, 15[65.22%] patients were male and 08[34.8%] were female. Diabetes mellitus was present as co-morbid condition in 16[69.56%] while 7[30.44%] patients were non diabetic. Hypertension was present in 8[34.78%] patients with painless AMI. Painless AMI or atypical presentation of AMI is seen in substantial proportion of ischemic heart disease patients. Absence of chest pain in AMI patients may misguide the doctors and diverts his attention towards other diagnosis which can lead to considerable delay in the essential therapies required in the management of AMI. It definitely affects morbidity and mortality of emergency department. Health care professionals particularly those working in emergency set up must keep in mind that absence of chest pain in suspected cases of ischemic heart disease does not necessarily rule out AMI. Features of AMI other than chest pain should also be kept in mind while dealing with a suspected case of ischemic heart disease. Further research work on painless AMI and presentation of AMI other than chest pain is needed

Chest pain as a presenting complaint in patients with acute myocardial infarction [AMI]

Objective: To study various characteristics of chest pain in acute myocardial infarction patients

Methodology: A total of 331 patients of AMI admitted at Cardiology unit Nishtar Hospital Multan and Chaudhry Pervez Elahi Institute of Cardiology Multan, irrespective of the age and gender, were included in this study. The study duration was one year starting from June 2011 to June 2012. Non-probability purposive sampling technique was used in this descriptive study. Informed consent to participate in this study was taken. Data were entered and analyzed using SPSS-11

Results: A total number of 331 patients with AMI were included in the study. Mean age was 54.99+/-11.25 years with minimum age 20 years and maximum age 90 years. It included 264[79.8%] male and 67[20.2%] female patients with male to female ratio of 3.9:1. Out of these 331 patients 308 [93.1%] patients reported chest pain as the presenting complaint. Remaining 23[6.9%] presented with clinical features other than chest pain. There were 127[38.4%] patients with pre-cordial chest pain, 115[34.7%] had retrosternal chest pain, 58[17.5%] were having epigastric pain. Severe chest pain was seen in 281[84.9%] patients while 26[7.9%] had only mild chest discomfort. Radiation of the pain to shoulder, neck and jaw was seen in 75 [22.7%] patients. In 42[12.7%] patients, pain radiated to both sides of chest. Another 55[16.6%] patients had pain radiation to chest, shoulder, upper arm and ulnar side of left forearm. Chest pain radiation to interscapular region along with both sides of chest was present in 10[3.0%] patients. In 11[3.3%] patients' pain radiated only to left side of chest. Pain persisting for >20 minutes was reported by 298 [90%] patients while only 10[3.1%] had pain persisting for <20 minutes

Conclusion: There is considerable overlap in chest pain of cardiac as well as non cardiac causes. However, vigilant evaluation of characteristics of chest pain in history taking may help to overcome this dilemma. Severe and prolonged precordial chest pain in a male patient between the age of 41-70 years, with pain radiation to left shoulder, neck and jaw is highly suggestive of AMI

Chronic liver disease [CLD]; frequency in patients presenting with upper gastrointestinal bleeding [UGIB] at Nishtar hospital, Multan

To determine the frequency of chronic liver disease in patients presenting with upper gastrointestinal bleeding [UGIB] at Nishtar Hospital, Multan. Descriptive case series. Six months from August 2009 to January 2010. Department of Internal Medicine, Nishtar Hospital Multan. A total of 88 patients with upper GI bleed were registered. Prior permission was taken from Institutional Ethical Committee to conduct this study. Informed consent was taken from each patient. Upper GI Endoscopy was done to find out the source of bleeding. For identification of each patient, personal data was collected. All the data collected were entered and analyzed using SPSS-10. Mean age was 41.64 +/- 13.56 years with 49 [55.70%] male patients and 39 [44.30%] female patients. Majority of the patients 38[43.18%] were between 36-50 years of age. In our series frequency of chronic liver disease was 56.82%. Chronic liver disease is the most common cause of upper GI bleeding in our setting

Anemia in pregnancy; related risk factors in under developed area

To see frequency of anemia and its related risk factors in pregnant women in an under developed area of Southern Punjab. Descriptive study. Ante natal outpatient clinic Tehsil Headquarter Hospital Kabirwala [Khanewal]. October2006 to March 2007. Sampling technique: Non-probability purposive. Two hundred and fifty pregnant ladies attending ante natal outpatient clinic at Tehsil Headquarter Hospital Kabirwala [Khanewal] irrespective of reproductive age, socio economic, educational and residential status were included in this study. After taking consent a pre-designed proforma was filled in. Hemoglobin level was checked. Subjects were categorized according to the hemoglobin levels into mild [10.0-10.9 g /dl], moderate [8.0-9.9 g/dl] and severe [< 8.0 g/dl] anemia. Two hundred and fifty pregnant women were studied. Mean age of the pregnant women was 28.28 +/- 5.20 years. Out of these 250 pregnant women, 138 [55.2%] were anemic and out of these 83 [60.14%] were moderately anemic while 55 [39.86%] had mild anemia and none of these had sever anemia. Among participating pregnant women, 28 [11.2%] were in 1st trimester, 85 [34%] in 2nd trimester and 137 [54.8%] were in the 3rd trimester. Anemia was observed in 10 [35.71%] women in first trimester, 35 [41.18%] in 2nd trimester and 93 [67.88%] in 3rd trimester. One hundred and thirty two women were from rural background, out of these, 83 [62.88%] were anemic. Seventy were uneducated and out of these, 58 [82.88%] were anemic while 180 women were educated and of these 81 [45%] were anemic. Ninety five [38%] were having poor dietary habits and out of these, 78 [82.10%] were anemic. One hundred eight pregnant ladies were not taking any iron supplement, out these 83 [76.85%] were anemic while 142 [56.8%] pregnant ladies were taking iron supplements, out of these 55 [38.73%] were anemic. Twenty one pregnant women were with gravida more than 6 and out of these 19 [90.47%] were anemic, of these 11 [57.89%] had moderate anemia while 8 [42.10%] were mildly anemic. The results of present study showed high frequency of anemia in the targeted population. Anemia was related with poor dietary habits especially poor iron intake. Anemia was more related with multi gravidity

Frequency of anti-HCV, HBsAg and related risk factors in pregnant women at Nishtar Hospital, Multan

Viral hepatitis is a global issue. Among the hepatitis viruses hepatitis B and C are important in South Asia including Pakistan. There are various modes of transmission of these viruses. Vertical transmission is also gaining importance. Antepartum screening for HBV and HCV would help the infected women for appropriate antiviral therapy at appropriate time as well as for taking proper care of the newborns. The present study was designed to see the frequency of HBsAg and anti-HCV in pregnant women at Nishtar Hospital, Multan. This was a cross-sectional study carried out using non-probability purposive sampling technique. The period of the study was from June 2006 to August 2007. Five hundred [500] pregnant women attending outpatient department of Gynaecology and Obstetrics were included. Informed consent was taken. A specially designed proforma was filled in. Anti-HCV and HBsAg were tested by device method. Data were analyzed on SPSS-11. Out of 500 pregnant women 35 [7.00%] were found to be anti-HCV positive and 23 [4.60%] were positive for HBsAg. Mean age was 26.7 +/- 4.8 years. Majority of the patients 263 [52.60%] were in the age group 26-35 years. 138 [27.60%] women were nulliparous and 282 [56.40%] were para 1-4 and anti-HCV and HBsAg were common in this parity group. Only 80 [16.00%] women were para 5 or more. All anti-HCV and HBsAg positive women were house-wives. Most of them were belonging to rural areas having poor socio-economic status. Among 35 anti-HCV positive women, 20 [57.14%] had history of previous surgery, while 13 [37.14%] had history of multiple injections, 5 [14.28%] received blood transfusion, 4 [11.42%] had ear/nose piercing while tattooing was seen in only 2 [5.71%]. Among 23 HBsAg positive women, 10 [43.47%] had history of previous surgery. History of multiple injections was present in 6 [26.08%] patients, 4 [17.39%] patients had history of blood transfusion, tattooing, ear/nose piercing, history of dental procedure, history of sharing needles was observed in 1 each. Frequency of anti-HCV is more common than HBsAg in our study population. Previous history of surgery, multiple injection therapy and blood transfusion were observed as risk factors among anti-HCV and HBsAg positive pregnant women

Knowledge regarding the transmission of hepatitis-B, hepatitis-C virus infection and HIV among patients attending medical outpatient department at Nishtar hospital, Multan

To assess the level of knowledge regarding the transmission of hepatitis-B, hepatitis-C and HIV among the patients of medical outpatient department, Nishtar Hospital, Multan. Patients attending Medical outpatient department, Nishtar Hospital, Multan were interviewed in this cross-sectional study for the assessment of knowledge regarding the spread of Hepatitis B, Hepatitis C and .HIV. A total of 350 patients attending medical outpatient department were interviewed. Of these participants, 208 [59.4%] were males and 142 [40.6%] were females. Mean age of the participants was 35.15 +/- 6.57 years. Three [0.85%] were familiar with only hepatitis B, Three [0.85%] with only hepatitis C and 3 [0.85%] with only HIV and 290 [82.8%] were familiar with all three diseases while 51[14.5%] were unfamiliar with these diseases. Two hundred and sixty eight [16.6%] participants were knowing that these diseases could be transmitted by syringes while 265 [75.7%] by needles. Two hundred sixty one [74.6%] were knowing that these could be spread by the transfusion of contaminated blood, 217 [62%] knew that these could be spread by dental procedure with contaminated instruments, 233 [66.6%] reported that by unsafe sex, 169 [48.3%] by tattooing, 196 [56%] by ear/nose piercing, 261 [74.6%] by infected razors and 198 [56.6%] knew that these could be transmitted by mother to newborns. Knowledge regarding the spread of hepatitis B, C and HIV was found to be low in our study population which emphasizes the need for strong awareness campaigns and programs to address this issue

Parasitic infestation in children of district Vehari: an underdeveloped area of Pakistan

To determine parasitic infestation among children of rural and urban areas of district Vehari. Children Complex Hospital, at District Headquarter Hospital Vehari and PMRC Research Center, Nishtar Medical College, Multan, Pakistan. A cross-sectional study was done in 2006 where 500 children aged 1-10 years presenting with anaemia and malnutrition were studied. Demographic information included residential area [rural/urban], gender, socio-economic status, hygienic conditions, source of drinking water were recorded on a questionnaire. Parents were interviewed, while stool and blood samples of children were collected for parasites and to determine anemia. Parasites were found in 140[28%] children and anemia in 236[47%]. Prevalence of protozoa 102 [20.4%] was greater than intestinal helminthes 38 [7.6%]. The most common protozoa was Entamoeba histolytica 101 [20.2%] and in nematodes, Hymenolepis nana was seen in 28 [5.6%], Ancylostoma duodenale [hook worm] in 5 [1%], Ascaris lumbricoides [round worm] in 3 [0.6%] and Taenia saginata [tape worm] in 2 [0.4%]. Diarrhoea was seen in 254 [50.8%] cases, constipation in 191 [38.2%], abdominal pain in 245 [49%], anorexia in 181 [36.2%] and abdominal distension in 86 [17.2%] children. Rural children were significantly more infected with parasites, 81 cases [32.27%] compared with urban children 59 cases [23.69%] [p<0.05] and same was for poor children 81 [34.9%] compared with middle income 57[21.8%] [p<0.05]. Infected cases with poor hygienic conditions [77 cases 35.2%] were more infected than those with satisfactory 62 [24.4%] and good hygiene 1[3.7%]. Worm infestation was common 84[35.9%] in those using drinking water from hand pumps compared to those obtaining drinking water from government water supply 47[23.9%] and water filtration plant 9[13.%], a significant difference in infection due to poor quality drinking water was observed[p<0.05]. Worm infestation and anemia were inter related and 85 [60.7%] children with anaemia had parasites against 55 [39.3%] who were not anaemic [p<0.05]. Poor sanitation, hygiene and source of drinking water have appeared as major contributors towards parasitic infestation. Ent.histolytica was the most common protozoal infection found compared to helminths. Use of clean drinking water and good hygienic practices should be instituted throughout the country

Frequency of non alcoholic fatty liver disease [NAFLD] and its biochemical derangements in type-2 diabetic patients

To see the frequency of non-alcoholic fatty liver disease in Type-2 diabetic patients and to see biochemical derangements in NAFLD patients. It is a cross-sectional study, conducted at Diabetic Research Centre and outpatient department Nishtar Hospital and PMRC Research Centre Nishtar Medical College, Multan. One hundred patients of either sex having type 2 diabetes mellitus attending diabetic out-patient department Nishtar Hospital Multan were included in the study. A pre-designed study pro forma was filled with relevant investigations and clinical assessments were carried out in all cases. All the patients underwent abdominal ultrasonography. Data were entered in SPSS-11 and analyzed. Out of one hundred patients, 51 [51%] were female and 49 [49%] were male. Mean age of the patients was 47.93 +/- 8.57 years. Fifty one [51%] of the diabetic patients had fatty liver. Out of these 32 [62.75%] were female and 19 [37.25%] were male. Fatigue was present in 49 [53.26%], generalized weakness in 48 [52.18%], heaviness right upper abdomen in 22 [64.70%] and pain right upper abdomen in 20 [58.82%] of fatty liver patients. Corresponding figure in Non Fatty Liver Patients were 43 [46.74%], 44 [47.82%], 12 [35.30%] and 14[41.18%], respectively. Itching was noted in 19 [44.18%] patients of fatty liver while it was 24[55.82%] in non-fatty liver patients. Serum triglyceride level more than 160 mg/dl in 47 [92.15%] patients of fatty liver while serum cholesterol level more than 200mg/dl was seen in 24[47.05%]. Aspartate amino transferase [AST] more than 35 u/l was noted in seven [13.72%], alanine amino-transferase [ALT] more than 40u/l was noted in 6[11.76%] fatty liver patients while serum albumin and serum billirubin were within normal range in all fatty liver and non-fatty liver patients. Nonalcoholic fatty liver disease [NAFLD] is more commonly seen in Type-2 diabetic patients. Serum triglyceride and serum cholesterol are significantly raised in NAFLD patients. Raised ALT and AST was not a common finding in our NAFLD study patients. Diabetic patients having heaviness or pain right upper abdomen with raised serum triglycerides and cholesterol should be more closely observed for NAFLD and liver complications

Hepatitis B, hepatitis C and HIV: knowledge among general public of peripheral areas of Multan

To assess the level of knowledge regarding hepatitis B hepatitis C and HIV among general public of peripheral areas of Multan. Cross-sectional study. Peripheral areas of Multan, village Budhla Sunnat, kusba Ayazabad Marrhal and PMRC Research Centre Nishtar Medical College Multan. From 01.05.2007 to 30.04.2008. Medical camps were established in peripheral areas of Multan, village Budhla Sunnat and kusba Ayazabad Marrhal. It was a cross-sectional study which was carried out using non-probability convenient sampling technique. Subjects of both sexes and adult age attending these medical camps were included in the study. Informed consent was taken and confidentiality of the personal information was ensured. Specially designed Proforma was filled in by the Research Officers and data entered in SPSS-11 and analyzed. Three hundred and eight subjects were interviewed. The age of subjects varied from 15-70 years. The mean age was 37.06 years +/- 15.59 years. Two hundred and twenty three [72.4%] were familiar with hepatitis B, 196 [63.6%] with hepatitis C and 146 [47.4%] with HIV and 133 [43.2%] were familiar with all three viruses while 81 [26.5%] were unfamiliar with these viruses. Most of the subjects 93 [30.2%] knew about the transmission through injection by un-sterilized syringes, 90 [29.2%] were knowing that infected blood is important source of spread while 87 [28.2%] of the subjects were knowing that these are spread through infected razors, 84 [27.2%] were knowing unsafe sex as a mode of transmission. Sharing objects can be the source of spread was known to very less number of people, 9 [2.9%] were aware that these can spread through sharing infected tooth brushes, 7 [2.3%] with sharing infected [Miswaks] and only 3 [1%] were aware that these can spread through infected combs. Electronic media was the major source of knowledge 82 [26.6%], interpersonal communication 69 [22.4%] and newspapers in only 1 [0.3%]. knowledge about hepatitis B, hepatitis C and HIV is low in our study population. The results of the study have shown that many people still think that HIV is the only virus which is transmitted through sexual contacts and hepatitis 8 and C through contaminated blood. The knowledge about the modes of transmission is lower in the rural and un-educated community. General public has very little knowledge that infected combs, infected toothbrushes and infected [Miswaks] can also lead to transmission of hepatitis B and C. Electronic media particularly television and radio and newspapers are the main source of knowledge and awareness for the urban population while in rural population it is not the case. Effective health awareness campaigns are needed to be started among rural population

Pattern of diseases in a medical unit at Nishtar Hospital, Multan

To assess the frequency and pattern of diseases in a medical unit at tertiary care, [Nishtar Hospital] Multan. Cross-sectional study. Medical Unit-I, Nishtar Hospital Multan. May, 2004 to May, 2005. Patients admitted at Medical Unit-I, Nishtar Hospital, Multan were included in the study. Specially designed proforma was filled, data were collected and analysed on SPSS-10. Total admitted patients in medical unit-I at Nishtar Hospital, Multan from May, 2004 to May, 2005 were 660. 390 [59.1%] were males and 270 [40.9%] were females. Age ranges from 12-70 and above. Mean age was 43.88 years with standard deviation 18.87 years. Mostly [63.5%] patients were from home district. Chief complaints were uncontrolled diabetes mellitus [17.6%], fever [13.6%], weakness of one-half of body [10%], uncontrolled hypertension [9.7%], cough and fever [8.5%], yellowness of eyes [5.8%] and vomiting [4.2%]. Most common disease was diabetes mellitus [19.1%] followed by hypertension [17.9%], cerebro-vascular accidents [10%], chronic liver diseases [9.7%], acute hepatitis [8.9%], pneumonia [7.4%], meningitis [5.9%], chronic renal failure [3.2%], acid peptic disease [2%] and acute myeloid leukemia [1.5%] [Table No. 5]. Study revealed diabetes mellitus, hypertension, ischemic heart disease [IHD] and Cerebro-vascular accident [CVA] are most common diseases. Important measure to control diabetes mellitus and hypertension must be adopted. More detailed and large scale study are needed on pattern of diseases at tertiary care hospital so that disease pattern are known and on these basis strategies for control of diseases and patients care can be derived