South Asian Working Action Group on SARCOpenia (SWAG-SARCO) e A consensus document

The South Asian population is rapidly ageing and sarcopenia is likely to become a huge burden in this region if proper action is not taken in time. Several sarcopenia guidelines are available, from the western world and from East Asia. However, these guidelines are not fully relevant for the South Asian healthcare ecosystem. South Asia is ethnically, culturally, and phenotypically unique. Additionally, the region is seeing an increase in non-communicable lifestyle disease and obesity. Both these conditions can lead to sarcopenia. However, secondary sarcopenia and sarcopenic obesity are either not dealt with in detail or are missing in other guidelines. Hence, we present a consensus on the screening, diagnosis and management of sarcopenia, which addresses the gaps in the current guidelines. This South Asian consensus gives equal importance to muscle function, muscle strength, and muscle mass; provides cost-effective clinical and easy to implement solutions; highlights secondary sarcopenia and sarcopenic obesity; lists commonly used biomarkers; reminds us that osteo-arthro-muscular triad should be seen as a single entity to address sarcopenia; stresses on prevention over treatment; and prioritizes nonpharmacological over pharmacological management. As literature is scarce from this region, the authors call for more South Asian research guided interventions.

Determination of positivity of computed tomographic angiography in poorly visualized left anterior descending artery on conventional angiography

Objective: To determine the positivity of CT angiography in visualization of poorly visualized left anterior descending artery [LAD] on conventional angiography for decision of its surgical revascularization. Study Design: Descriptive study. Place and Duration of Study: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad, from July 2014 to March 2015

Methodology: This study involved 55 patients who had non-graftable LAD on conventional coronary angiography [CCA]. All patients underwent computed tomography angiography [CTA]. Patients having graftable LAD on CTA then underwent coronary artery bypass grafting [CABG]. Peroperatively, the characteristics of LAD such as diameter, calcification and graftability were also recorded

Results: The mean age of the patients was 52.76 +/-8.52 years. There were 45 [81.8%] male and 10 [18.2%] female patients. Out of 55 patients, CTA revealed graftable LAD in 33 [60%] cases while LAD was non-graftable in 22 [40%] cases. Out of 33 patients having graftable LAD, 26 [78.79%] patients underwent CABG; whereas, remaining 7 [21.21%] patients had different reasons like other associated diseases and refusal from surgery. Among those who underwent surgery, LAD was graftable in all the patients [100%] peroperatively. Peroperatively 11 [42.3%] patients had mild calcification followed by severe calcification in 9 [34.6%] and moderate calcification in 6 [23.1%] cases. Fifteen [57.7%] patients had LAD caliber >1.5 mm while 11 [42.3%] patients had LAD caliber between 1.25 - 1.5 mm preoperatively

Conclusion: Positivity of the CT angiography for poorly visualized LAD on conventional angiography was 60% in the present study

Determination of positivity of computed tomographic angiography in poorly visualized left anterior descending artery on conventional angiography

Objective: To determine the positivity of CT angiography in visualization of poorly visualized left anterior descending artery [LAD] on conventional angiography for decision of its surgical revascularization

Study Design: Descriptive study

Place and Duration of Study: Department of Cardiac Surgery, Faisalabad Institute of Cardiology, Faisalabad, from July 2014 to March 2015

Methodology: This study involved 55 patients who had non-graftable LAD on conventional coronary angiography [CCA].All patients underwent computed tomography angiography [CTA]. Patients having graftable LAD on CTA then underwent coronary artery bypass grafting [CABG]. Peroperatively, the characteristics of LAD such as diameter, calcification and graftability were also recorded

Results: The mean age of the patients was 52.76 +/-8.52 years. There were 45 [81.8%] male and 10 [18.2%] female patients. Out of 55 patients, CTA revealed graftable LAD in 33 [60%] cases while LAD was non-graftable in 22 [40%] cases. Out of 33 patients having graftable LAD, 26 [78.79%] patients underwent CABG; whereas, remaining 7 [21.21%] patients had different reasons like other associated diseases and refusal from surgery. Among those who underwent surgery, LAD was graftable in all the patients [100%] peroperatively. Peroperatively 11 [42.3%] patients had mild calcification followed by severe calcification in 9 [34.6%] and moderate calcification in 6 [23.1%] cases. Fifteen [57.7%] patients had LAD caliber >1.5 mm while 11 [42.3%] patients had LAD caliber between 1.25 - 1.5 mm peroperatively

Conclusion: Positivity of the CT angiography for poorly visualized LAD on conventional angiography was 60% in the present study

Innovative curriculum: evidence based practice for nursing professionals

Introduction: Evidence based medicine and practice needs to have a robust and reliable curriculum. This curriculum has been designed keeping in mind the latest technology and teaching strategies. There has been a major shift in context to the patient physician relations, care and utilisation of best available evidence in making informed decisions about the various treatment options and approaches to patient care. Nurses form an integral component of the healthcare delivery system and of the health system itself. There has been substantial research in the nursing principles and indexed nursing journals are publishing articles pertaining to the various disciplines and components of nurse practitioners and related patient care services

Methodology: It is a cross sectional study and total of 50 registered nurses were recruited from a public hospital to engage in the evaluation for statistically meaningful and valid results or interpretations. A self-administered questionnaire was distributed among 62 registered nurses; 12 registered nurses did not fill the questionnaire therefore 50 registered nurses were recruited

Result: Pie chart shows the major differences in frequency of all themes, the junior registered nurses have more knowledge about EBM as compared to their seniors 70% and 10% respectively but when asked about doing post-graduation the seniors showed more interest as compared to junior nurses 67% and 2% respectively. The junior nurses showed more counselling ability and also practiced EBM. Overall there was significant decline in senior nurses' performance when compared with junior nurses p-value is 0.001

Conclusion: Evidence based medicine is based on three components; utilising prior knowledge based on clinical experience, searching systematically evidence and acknowledging patient's preferences. Junior registered nurses understand evidence based medicine and are eager to apply EBM in their career whereas senior nurses where more interested in obtaining higher degree and were less interested in patient care

Impact of terrorism on the development of posttraumatic stress disorder [PTSD] among the residents of Khyber Bazaar and its immediate surrounding areas in Peshawar, Khyber Pakhtunkhwa, Pakistan

This study evaluated the prevalence of posttraumatic stress disorder [PTSD] and the severity of PTSD symptoms in survivors, rescuers and witnesses of terrorist attacks on Khyber bazaar, Qissa Khawani bazaar, and All Saints Church in Peshawar city area. Cross-sectional survey is carried out on a sample of one hundred survivors, rescuers and witness of terrorist attacks using structured interviews to assess the severity of posttraumatic stress, five months after the attacks. The study period extended from January 24, 2014 to March 24, 2014 which constitutes a total of period of 8 weeks. PTSD symptoms are measured using Posttraumatic Symptom Scale Interview [PSSI] and conferred to a diagnosis of PTSD at 5 months. Additionally, the severity of PTSD symptoms were determined using PSSI scores, severity ranged from 0-51. Of the one hundred survey respondents, 88% were males and 12% were females. Forty percent [40%] had attained 10 years of education, matriculation, but irrespective of the gender or educational status, all had some degree of PTSD. Sixty-six [66%] percent respondents are diagnosed as having moderate PTSD while 11% of the sample suffered from severe PTSD level. Age, gender, occupation and education level did not have any correlation with PTSD development. The contemporary findings indicate that any person who has witnessed or survived catastrophes of terrorist activities like bomb blast or being exposed to suicide attacks is at risk for developing PTSD, and there is necessity to deliver specialized post-disaster mental health facilities to the people having substantial levels of PTSD after calamities of such great intensity

Counter effects of N. Sativa L. and P. ovata L. on indicative markers of non alcoholic fatty liver disease

The broad spectrum of non-alcoholic fatty liver disease [NAFLD] diseases ranges from simple liver inflammation to steatosis, leading to fibrosis and cirrhosis. Four groups of weaning [30g] Rattus norvegicus were designated as W-0, W-I, W-II and W-III. For sixteen weeks group W-0 was given standard pallet diet, group I consumed diet "A" [20% fat Sucrose + 33% tea whitener + 34% ground pallet diet +13% water], group W-II was fed on diet "B" [50g Nigella sativa seeds/kg of A] and group W-III was provided with diet "C" [50g Plantago ovata husks /Kg of A]. The analysis of CBC, LFTs, and Lipid profile revealed that there were highly significant changes [P<0.001] in the MCV, PLT, Hb, MCH, MCHC, RBC, RDW%, WBC, MPV, Triglycerides, cholesterol, LDL and the significant alterations [P<0.01] in albumin, AST, bilirubin, AST/ALT, HDL and cholesterol/HDL were observed in the experimental groups when compared with control by using one way ANOVA. We concluded that high-energy diet can alter the blood profile. Moreover fat plummeting agents have counter impact on the hematology as well as serology of diet induced NAFLD in R. norvegicus

Association of specialty and working hours with compassion fatigue

Objective: To find out association of speciality and working hours with compassion fatigue

Study Design: Cross sectional comparative study

Place and Duration of Study: Military Hospital and Combined Military Hospital Rawalpindi, Combined Military Hospital Sialkot, from December 2013 to July 2014

Material and Methods: Fifty four doctors from departments of Medicine, Surgery, Anesthesia and Gynaecology participated in the study. Other health care related personnel, not directly related to patient care, were excluded from the study. The data collection tool was a questionnaire "Professional Quality of Life Measure version 5". Data was analysed by SPSS version 22. Chi Square test for goodness of fit was used to determine difference in the frequency distribution of various categories of a single variable whereas Chi square test for independence was used to find association between two categorical variables. The p-value was kept at < 0.05 for significance

Results: Results showed 11 females and 43 males with mean age of 37.69 +/- 9.72 years. Cronbach's alpha was 0.81. Eleven participants [20.4%] showed low compassion fatigue, 37 [68.5%] showed average whereas only 6 participants [11.1%] showed high compassion fatigue scores and the difference was significant [p-value < 0.001]. Working hours were associated with compassion fatigue [p-value = 0.03] but speciality was not [p-value = 0.41]

Conclusion: Chances of suffering from compassion fatigue are significantly higher if working hours are 12 or more, however the disorder is not associated with speciality

Spectrum of trigeminal neuralgia

Trigeminal neuralgia [TN] is a very painful condition characterized by paroxysmal shock like pain in the distribution of one or more branches of trigeminal nerve caused by neurovascular conflict at the root entry zone of trigeminal nerve. This study was conducted to analyse the demography and pattern of TN in our setup. This descriptive study was conducted in the Oral Surgery unit, Department of Dentistry, Ayub Medical College, Abbottabad, from April 2009 to October 2011. A total of 117 patients were included in study by convenience [non probability] sampling technique. All the patients presenting with the clinical features of TN were included in study. Out of 117 cases, 49 [41.9%] were males and remaining 68 [58.1%] were females. Age of the patients ranged from 32-72 [53.90 +/- 10.21] years. Right side was involved in 63 patients [53.8%], while the left side was involved in 51 patients [43.6%]. In only three cases [2%] there was bilateral involvement. The maxillary division was involved in 68 cases [58.1%] and mandibular division was involved in 37 cases [31.6%]. The most common site of involvement was infra-orbital, which was involved in 68 cases [58.11%]. The next common site was the mental nerve which showed involvement in 35 cases [29.9%] followed by inferior alveolar nerve which was affected in 14 cases [12%]. Thirty three [28.2%] patients were having mild pain, 54 [46.2%] patients having moderate, 21 [18%] patients with severe and 9 [7.7%] patients were having very severe pain. No patient in our study had a family history of TN. Among our patients 103 [88%] patients underwent dental extraction for the same pain. The incidence of TN is more in old age especially in females. TN is frequently misdiagnosed in with tooth ache, so there is need to educate the medical practitioners and masses in order to avoid un-necessary tooth extractions

Diabetic patients and ramadan / Journal of the ASEAN Federation of Endocrine Societies

@#More than 50 million people with diabetes mellitus fast during Ramadan, a religious obligation for all healthy adult Muslims. Fasting leads to several physiological changes in the body and these may result in acute complications in persons with uncontrolled diabetes such as hyperglycemia, hypoglycemia, diabetic ketoacidosis, dehydration and thrombosis. Evidence from existing literature guides the physicians in their assessment of Muslim patients with diabetes who wish to fast. Assessment should include risk stratification based on existing control of diabetes and its chronic complications. In the light of this assessment medical recommendation is given which includes dose modification of oral medication and insulin, dietary advice and structured patient education.

Inequity in childhood immunization between urban and rural areas of Peshawar

Background: Purpose of this study was to find coverage of vaccines in EPI and compare the factors related to vaccine failure or missed vaccination in urban and rural areas of Peshawar. Methods: This cross-sectional survey was conducted in Urban and rural of Peshawar from 20th to 31st of June 2010. A questionnaire was used to interview parents of 548 children, aged 1 year and below, about demographics, vaccination status, reasons for missed vaccination and views on immunization. Results from both urban and rural areas were compared to find the impact of different factors on immunization failure. Results: The immunization coverage in urban areas was 76.5% while in rural areas it was 48.8%. Causes for non immunization were different in urban and rural areas. In urban areas, lack of awareness and care takers/parents being busy were the main reason for non immunization. In rural areas, in addition to formers, lack of accessibility to health centres and misconceptions about vaccination were major reasons for non-immunization. Parents were more educated in urban areas than rural areas. Conclusion: Rural areas had a lower immunization rates due to lack of awareness, low accessibility and much lower education of parents. Keywords: EPI Pakistan, children, immunization, urban, rural