Long-term proton pump inhibitors therapy and prevalence of hyperprolactinaemia: A cross-sectional study in outpatient gastroenterology clinics.

Objectives: To evaluate serum prolactin and macroprolactin levels in patients on long-term proton pump inhibitors therapy. METHODS: The cross-sectional study was conducted from January 2018 to November 2019 after approval from the ethics review committee of the Commission on Science and Technology for Sustainable Development in the South University, Abbottabad, Pakistan. The study included patients from two gastroenterology outpatient clinics in the Khyber Pakhtunkhwa province using proton pump inhibitors for ≥3 months either alone or in combination with either histamine receptor antagonists or prokinetics. Blood samples were collected from each patient for hormonal screening. Data was analysed using SPSS 25. RESULTS: Of the 166 patients, 101(60.8%) were females and 65(39.2%) were males. The overall mean age was 42.5±14.2 years, and the median serum prolactin level was 23.2ng/ml (interquartile range: 14.0-38.0ng/ml). There were 96(58%) patients with normoprolactinaemia and 70(42%) with hypreprolactinaemia. There were 19(11.4%) patients using combination therapy, while the rest were on proton pump inhibitors monotherapy. There was a significant increase in serum prolactin level with combination therapy compared to monotherapy (p=0.001). Patients having treatment duration 11-20 months (p=0.006) and >40 months (p=0.001) were at high risk of developing hyperprolactinaemia. CONCLUSIONS: Long-term use of proton pump inhibitors could increase serum prolactin levels, and appropriate evaluation is essential for clinical management.

Consumption of proton pump inhibitors in outpatients of Gastroenterology Clinics in Khyber Pakhtunkhwa: evidence of inexpedient use.

Introduction: Proton pump inhibitors (PPIs) are effective drugs used for multiple gastrointestinal complications. They are commonly used in both hospitalised and outpatients. However, little is known about its utilisation pattern in ambulatory patients. Aim: To evaluate the inexpedient continuous use of PPIs in patients with respect to treatment duration. Material and methods: A cross-sectional observational study was conducted from January 2018 to November 2019 in Khyber Pakhtunkhwa, Pakistan. Regular proton pump inhibitor users were identified through patient histories. Results: During the study period, 171 patients were included using a non-probability consecutive sampling technique, who were using regular proton pump inhibitors for a longer duration, i.e. from 3 months to 15 years. The highest proportion (42.8%) were using PPI regularly from 3 months to 1 year followed by 22.9% for 1-2 years, 12.0% for 2-3 years, 7.8% for 3-4 years, 4.2% for 4-5 years, and 10.24% for > 5 years. Omeprazole and esomeprazole were the most commonly used drugs, with 71.1% and 23.5% prevalence, respectively. A total of 33.73% of patients had continued PPI use on their own after initially being prescribed by the physician. Conclusions: It can be deduced that PPIs are used in outpatients beyond standard treatment guidelines. The inexpedient continuous use of proton pump inhibitors is of concern due to the risk of developing adverse effects. Therefore, patient counselling and periodic monitoring must be carried out to prevent the irrational use of PPIs.

Effects of long-term proton pump inhibitor use on sexual hormones and sexual and reproductive health in female patients.

PURPOSE: Proton pump inhibitors (PPIs) are widely used to treat a range of gastrointestinal diseases around the world. Long-term use of PPIs has been associated to a variety of undesirable effects. Although short-term therapy has been shown to have little or no effect on endocrine hormone in women, however, its long-term safety has received little attention. We aimed at evaluating long-term use of PPIs and its effects on female reproductive hormones as well as related clinical consequences. METHODS: A cross-sectional study was conducted in two outpatient gastroenterology clinics in the province of Khyber Pakhtunkhwa. This study included female patients who had been using PPIs on a regular basis for 3 months or more. RESULTS: In total of 101 participants, patients with sexual complaints have significantly altered levels of prolactin (p = 0.05), estrogen (p < 0.001) and progesterone (p = 0.001) than patient without sexual complaints. The frequency of amenorrhea (p < 0.001), cyclic disturbances (p < 0.001), breast augmentation (p = 0.001) and painful breast (p = 0.004) were statistically significant in patients with raised serum prolactin values. Serum values of Sex hormone binding globulin SHBG (p < 0.001), estradiol (p = 0.002) and total testosterone (p < 0.001) were significantly altered between normal prolactin and hyperprolactinemic patients. CONCLUSION: These findings suggest that long-term PPI use may cause endocrine hormone disturbances leading to sexual difficulties in women.

Are the healthcare providers willing and able to respond to disasters: An assessment of tertiary health care system of Khyber Pakhtunkhwa.

For the tertiary health care system to provide adequate care during disasters, willing and able healthcare providers must be available to respond to the abnormal surge of the patients. Health care professionals (HCPs) constantly face a dilemma because of their profession to either respond to disasters or protect themselves. This study was conducted to assess the willingness and ability of HCPs working in the tertiary healthcare system of Khyber Pakhtunkhwa to respond to disasters. This cross-sectional survey was conducted in all the 8 tertiary care hospitals of the Khyber Pakhtunkhwa province of Pakistan. For different disaster scenarios, between 6% and 47% of HCP indicated their unwillingness, and between 3% & 41% of HCPs indicated that they were unable to respond to the given disaster scenarios. HCPs with childcare obligation indicated significantly lower willingness (p<0.05) to respond to earthquakes, MCIs, and an outbreak of Influenza, and SARS. Male HCPs showed a significantly (p<0.05) higher willingness to respond to earthquakes, MCIs, and an outbreak of Influenza as compared to their female counterparts. The overall ability indicated by HCPs for various disaster scenarios ranged between 54.1% [95% CI 0.503,0.578] for responding to victims of nuclear war and 96.4% [95% CI 0.947,0.976] for responding to conventional war. The HCPs who indicated childcare obligation showed a significantly lower ability (p<0.05) to respond to environmental disaster, influenza outbreak, and responding to victims of nuclear war. Female HCPs indicated significantly higher ability (p<0.05) as compared to their male counterparts. This survey provides an opportunity for the tertiary healthcare system to build on the findings and develop disaster mitigation plans to address the barriers to improving the HCPs' availability during disasters.

Long-Term Proton Pump Inhibitor Therapy and its Effect on Endocrine Hormones in Selected Patient Population.

Proton pump inhibitors (PPI) are commonly prescribed medications for a variety of gastrointestinal disorders around the globe. Long-term utilization of proton pump inhibitors is linked with different adverse events. Although, short-term therapy has been demonstrated to have little or no impact on endocrine hormones in men, yet its safety with long-term use has poorly been studied. We aimed to evaluate the impacts of long-term utilization of proton pump inhibitors on male reproductive hormones and its clinical outcomes. A cross-sectional study was performed in two out-patients gastroenterology clinics in Khyber Pakhtunkhwa province. Male patients who were using PPIs regularly for≥3 months were enrolled in this study. Among 65 enrolled participants, patients with sexual complaints have significant variations in mean serum levels of prolactin (p<0.001), sex hormone binding globulins (p=0.043), total testosterone (p<0.001) and progesterone (p=0.001) as compared to patients without sexual complaints. Significantly high values of prolactin mean ranks were observed in patient with sexual complaints (p<0.001). There were statistically significant correlations of serum levels of sex hormone binding globulins (p=0.003), total testosterone (p=0.008) and progesterone (p<0.001) with serum prolactin levels. Similarly, statistically significant variation was observed for decreased libido (p=0.001), erectile dysfunction (p=0.001) and decreased semen mass ((p<0.001) between normal and hyperprolactinemic PPI users. Highly significant differences were observed in serum sex hormone binding globulins (p<0.001), total testosterone (p<0.001) and progesterone (p<0.001) values in normal and hyperprolactinemic groups. In conclusion, long-term utilization of PPI may induce endocrine hormone disruption with subsequent sexual complications.

Proton pump inhibitors therapy and risk of hyperprolactinemia with associated sexual disorders.

Proton pump inhibitors (PPIs) are the most widely prescribed medications in the world. According to numerous studies, PPIs have been linked to hyperprolactinemia, which can lead to a variety of sexual and reproductive issues. This review summarizes the effects of numerous PPIs on the blood prolactin levels and associated sexual dysfunctions, which have an effect on the patient's life quality and fertility. The study is taken into account all the available resources till January 31, 2021. Out of total 364, only 27 relevant resources were involved in this review. In certain studies, short-term PPIs use has been shown to have little or no effect on the blood prolactin and other reproductive hormones levels. PPIs have been linked to the development of hyperprolactinemia in several case studies with varying degrees of the blood prolactin levels increase seen in individuals taking PPI alone or in combination with medications, like prokinetics. The relative risk of the sexual consequences development, such as gynecomastia, has been documented using lansoprazole and omeprazole in various cohort studies. On the other hand, other bits of data are insufficient to establish a definite relationship that can turn a possibility into certainty. The majority of the literature data is comprising of double-blind, randomized, crossover studies, case reports, and adverse drug reaction incidents reported to various pharmacovigilance centers. To investigate this link, high-quality studies in patients taking PPIs for a longer time period are needed. We conclude this article with a comprehensive discussion of the hyperprolactinemia clinical implications and the PPIs' function.

An assessment of existing surge capacity of tertiary healthcare system of Khyber Pakhtunkhwa Province of Pakistan using workload indicators for staffing need method.

BACKGROUND: Globally the occurrence of disasters has increased more than fourfold during the last three decades. The main concern for the healthcare system responding to a disaster is its ability to deal with the sudden influx of patients and maintaining a certain level of surge capacity. Health workers are considered to be the major driving force behind any health system. Their role gets even more prominent during disasters or public health emergencies. With the lack of information on the health workforce in the tertiary healthcare system of Khyber Pakhtunkhwa, where most of the disaster surge is diverted, it is difficult to plan and respond to accommodate the sudden surge of patients. METHODS: This was a mixed method cross-sectional survey conducted in all the tertiary care hospitals of Khyber Pakhtunkhwa province of Pakistan to assess the current staffing situation and surge capacity based on the current workload. Annual service statistics of 2018 were collected from all the tertiary care hospitals of the province. WISN was piloted with only one healthcare staff category, i.e., for doctors in Ayub Teaching Hospital before assessment in all the tertiary care hospitals was undertaken. RESULTS: Overall, there were 1215 surplus doctors in medical and allied specialties and 861 doctors in surgical and allied specialties in the tertiary healthcare system. The health care system has an acute shortage of 565 emergency department doctors. The tertiary healthcare system of KP has an overall shortage of 1099 nurses. Based on the WISN generated numbers for doctors, the tertiary care system of KP has a combined healthcare staff (doctors and nurses) that can manage an additional surge of 6.3% of patients with the current patient workload. CONCLUSION: The tertiary health care system of the Khyber Pakhtunkhwa Province of Pakistan does not possess the required ≥ 20% HR surge capacity indicating that the tertiary healthcare system is poorly prepared for disasters or public health emergencies. The lack of nursing staff, more than the doctors, is the major reason behind the lack of HR surge capacity of the tertiary health care system.

Managers' Perspectives on the Devolved Health System Response to the Public Health Needs of Internally Displaced Persons in Pakistan: A Qualitative Study.

Population displacement has been embedded in Pakistan's history since its inception in 1947. The displacement of more than 3 million people from the tribal areas of the Khyber Pakhtunkhwa Province of Pakistan and their settlement in recipient areas have posed challenges to governance, service delivery, financial management, and integration of internally displaced persons (IDPs) into existing devolved district health systems. Evidence is lacking on the management of devolved health systems to respond to the public health needs of IDPs. The authors adapted qualitative methods to explore challenges faced by managers of health departments in Khyber Pakhtunkhwa Province in responding to the public health needs of IDPs and to explore policy recommendations for a devolved health system. Study findings revealed that the lack of a skilled workforce, lack of political will, financial limitations, and poor intersectoral collaboration had an impact on the humanitarian crisis response in the province. These findings suggest a dire need for overarching binding international laws and local national policies for complete protection of IDPs, particularly in regard to their health, shelter, and social security.

Level Of Pre-Tertiary Care Hospital Management Of Traumatic Spinal Cord Injured Patients; Where Do We Stand?

BACKGROUND: Traumatic spinal cord injury is a debilitating condition that may cause long term disabilities with tremendous socioeconomic impact on affected individuals and their families. Secondary injuries can best prevent or minimized by appropriate pre hospital management and proper referral and transfer. This study was conducted to assess the clinical profile of traumatic spinal cord injuries and level of pre-hospital care provided to patients either at the site of injury or at other healthcare facilities. METHODS: This prospective study was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad, from January 2012 to January 2017. All patients with suspected spinal injury were included in the study. Age, gender, mode of injuries and the pre-tertiary care provided were recorded. RESULTS: Out of 4464 patients with suspected spinal cord injury, 3685 (82.5%) were male, 779 (17.4%) were female. Age ranged from 10-70 years. 1685 (37.8%) were diagnosed as having spinal injury. Cervical spine was the most common affected level 743 (44.09%), followed by thoracic spine 135 (8.01%). 1441 (85.5%) were incomplete while 224(14.5%) were complete spinal cord injuries. Road traffic accident was the most common mechanism of injury 884 (52.4%). Only 4 (0.23%) patients directly received in our unit were properly transported, 66 (3.91%) were brought after proper spinal immobilization, intravenous line was maintained in 584 (34.66%) patients, 410 (24.3%) patients received some fluid resuscitation, parenteral analgesia was given to 441 (26.17%) patients while urinary catheterization was done in 195 (11.75%) patients. Those received from other healthcare facilities only 4 (0.23%) were brought by properly equipped ambulance, intravenous access was maintained in 438 (25.99%),320 (18.99%) received some fluid resuscitation, urinary catheterization was done in 229(13.59%) while proper parenteral analgesia was given to 988 (58.63%) patients. CONCLUSIONS: There is a complete lack of proper transport and referral of trauma patients in our area which reflects almost non-existent emergency medical (rescue) services, deficient health care facilities.

Isaric 4c Mortality Score As A Predictor Of In-Hospital Mortality In Covid-19 Patients Admitted In Ayub Teaching Hospital During First Wave Of The Pandemic.

BACKGROUND: Many factors have been identified which can predict severe outcomes and mortality in hospitalized patients of COVID-19. This study was conducted with the objective of finding out the association of various clinical and laboratory parameters as used by International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) World Health Organization (WHO)- ISARIC/WHO 4C Mortality score in predicting high risk patients of COVID-19. Ascertaining the parameters would help in triage of patients of severe disease at the outset, and shall prove beneficial in improving the standard of care. METHODS: This cross-sectional study was carried out in COVID-19 Department of Ayub Teaching Hospital, Abbottabad. All COVID-19 patients admitted from 15th April to 15th July 2020 were included. RESULTS: A total of 347 patients were included in the study. The mean age was 56.46±15.44 years. Male patients were 225 (65%) and female 122 (35%). Diabetes (36%) was the most common co-morbidity, followed by hypertension (30.8%). Two hundred & six (63.8%) patients recovered and 117 (36.2%) patients died. Shortness of breath (80%), fever (79%) and cough (65%) were the most common presenting symptoms. Patients admitted with a 4C Mortality score of 0-3 (Low Risk Category), the patients who recovered were 36 (90%) and those who died were 4 (10.0%). In patients admitted with a 4C Mortality score of more than 14 (Very High-Risk Category), the number of patients who recovered was 1 (20%), and those who died were 4 (80%). The difference in mortality among the categories was statistically significant (p<0.001). Hypertension was a risk factor for death in patients of COVID-19 (Odds ratio=1.24, 95% CI [0.76-2.01]). Lymphopenia was not associated with statistically significant increased risk for mortality. CONCLUSIONS: The ISARIC 4C mortality score can be used for stratifying and predicting mortality in COVID-19 patients on arrival in hospital. We propose that it should be used in every patient of COVID-19 presenting to the hospital. Those falling in Low and Intermediate Risk Category should be managed in ward level. Those falling in High and Very High Category should be admitted in HDU/ICU with aggressive treatment from the start.

Outcome Of Balloon Valvuloplasty In Children With Pulmonary Stenosis - Single Center Experience.

BACKGROUND: Pulmonary valve stenosis (PS) is common congenital heart disease in children and patient can present with cyanosis, chest pain, dyspnea and failure with severe form. The objective of this study was to enlighten the short outcome of balloon pulmonary valvuloplasty in children with severe pulmonary stenosis. METHODS: This cross sectional observational study was done in paediatric cardiology department of Lady Reading Hosptial, Peshawer form June 2019 to December 2020 over 1.5 years. Children aged 6 months to 16 years of either sex diagnosed as case of severe stenosis with doming pulmonary valve and having symptoms of chest pain and dysnea on exeration and pregradient pressure of 64 mm Hg or more on echocardiography were included. Patients were interviened with ballon-valvuloplasty. Outcome was taken as discharge from hospital with complications after procedure if any. Patients were followed up for 3 months. Data including age, sex, pre cath echocardiography, cath pulmonary valve annulus, post ballooning pulmonary valve (PV) gradient, PV gradient on echocardiography after intervention and follow up gradient on echocardiography at three months was documented. Data was analyzed by SPSS 20. Chi square test and paired T - Test was applied where required. Results were taken as significant with p value <0.05. RESULTS: There were 51 patients, 35 (68.6%) male and 16 (31.4%) female. Mean age was 8.35±4.93 years. Mean pre cath gradient across the pulmonary valve on echocardiography was 109.14±31.44 mm Hg. Post intervention mean pressure gradient across PV was 32.41±11.49 mm Hg. Pulmonary valve annulus on echocardiography before intervention ranged from 7 to 25 mm with mean of 14.67±3.79 mm. There was no complication in majority (82.4%) of patients. Mild PR was in 5 (9.8%) patients. There was significant relationship between pre and post intervention pressure gradient across PV valve with p value of <0.001. CONCLUSIONS: Balloon pulmonary valvuloplasty in one of the safest intervention for PS in children with few complications.

Effectiveness Of DIMCI Training In District Abbottabad, Khyber Pakhtunkhwa: An External Pilot Study.

BACKGROUND: Five million deaths per year in under-five children are reported to be due to preventable and treatable causes. IMCI strategy targets these causes through improvement in the case management skills of health care workers. The objectives of this study were to identify eligible clusters and identify & rectify any process, resources, and management-related issues for the main trial. METHODS: This study was conducted in two phases. Phase 1 was conducted for eligibility of Basic Health Units from which sample can be drawn for the main cluster randomized control trial. A single-page proforma was sent to all 54 BHUs of Abbottabad through registered mail service and replies received were analysed through SPSS-V25 and MS Excel-2016. Afterward a sample of 26 BHUs was drawn for the definitive trial. In phase 2, four BHUs were conveniently selected from the remaining sampling frame; one in the control arm while three in the intervention arm. From each BHU, a health care worker responsible for under-five consultations was trained; control arm in standard IMCI while intervention arm on distance learning IMCI. Ten observations in the form of cases managed were assessed at each BHU by a gold standard IMCI master trainer after a specific period. Descriptive summary measures and 95% CI were calculated using SPSS-V25. RESULTS: Out of 54 BHUs, 3 were nonrespondents while 36 were identified as an eligible sampling frame. The mean index of integrated assessment was found to be 0.90 and 0.89 for the control and intervention arm respectively. Discrepancies in filled forms were noted as 60% in control while 63.3% in intervention arm. CONCLUSIONS: Modifications in the plan for the main trial based on the findings of pilot study can ensure credibility and rigor in the definitive trial.

Frequency Of Depression Among Patients With Chronic Liver Disease.

BACKGROUND: Psychiatric co-morbidity is a frequent finding in patients with chronic liver disease (CLD). Patients with CLD may have anxiety, depression, sleep disturbances and behavioural disorders as well as cognitive defects. Therefore, this study was designed to determine the frequency of major depression in patients diagnosed with chronic liver disease. METHODS: This descriptive cross-sectional study was conducted at the department of gastroenterology Ayub Teaching Hospital Abbottabad from January-July 2017. One hundred and eleven patients diagnosed with chronic liver disease were included in the study using consecutive non-probability sampling technique. A detailed medical history was taken and physical exam was conducted before the patients were asked to answer a questionnaire (HADS-D). The answers were marked to obtain a final score. Quantitative variables like age, HADS-D score, and duration of CLD were described in terms of mean and standard deviation. Categorical variables like gender and depression were described in terms of frequencies and percentages. Stratification was done on age, duration of CLD and gender to see the effect modifiers. Chi-Square test was used at 5% significance level for determining statistically significant difference. RESULTS: Out of 111 patients, 38 (34.2%) were found to have depression on the basis of their HADS-D score. When depression was stratified according to age, gender and duration of chronic liver disease, a strong statistical association was seen with duration of chronic liver disease and increased serum ALT levels (p<0.05). CONCLUSIONS: Depression is fairly common in patients with CLD and is significantly associated with the duration of CLD and derangement of liver enzymes.

Forensic Identification Through Tooth Discoloration And Alignment.

BACKGROUND: Due to poor oral hygiene and use of tobacco, dental discolorations are present in some people and may indicate presence of toxic substances in food or body, while some have anatomical faulty alignment of teeth. The objective of the study was to know the frequency of these discolorations and faulty dental alignment in the target population so that a forensic tool could be developed. METHODS: A cross sectional descriptive study was done in the Dentistry Department of Ayub Teaching Hospital Abbottabad during the month of October 2019, on routine patients visiting the department, using non-probability convenience sampling. A Performa was made to be filled by dentists examining their patients using the standard dentition chart to locate teeth; notation chart was used for recording observations. The preliminaries along with subvariables were recorded in the Performa for each of 101 patients observed; data were analyzed by SPSS 20 for descriptive statistics. RESULTS: A cross sectional descriptive study was done in the Dentistry Department of Ayub Teaching Hospital Abbottabad during the month of October 2019, on routine patients visiting the department, using non-probability convenience sampling. A Performa was made to be filled by dentists examining their patients using the standard dentition chart to locate teeth; notation chart was used for recording observations. The preliminaries along with subvariables were recorded in the Performa for each of 101 patients observed; data were analyzed by SPSS 20 for descriptive statistics. CONCLUSIONS: Dental discolorations and faulty alignment of teeth can be utilized as useful tools in exclusionary method of identification which can be used in living and dead for investigation of identification. It was also observed that there is need to emphasize on community dental hygiene in our hospitals.

Estimating The Possible Role Of Testing Capacity And Social Distancing In Predicting The Growth Rate Of Daily Covid-19 Cases.

BACKGROUND: The purpose of this study was to estimate the effect of social distancing (days since the imposition of a lock-down) and the number of daily tests conducted per million population on the daily growth rate of COVID-19 cases. METHODS: After excluding the first 30 days since the announcement of an index case in a country, relevant data for the next forty days was collected from four countries: Belgium, Italy, South Korea and United Kingdom. Two online databases: Our World in Data and worldometer were used for the collection of data which included the number of new COVID-19 cases and the number of tests conducted on a given day. The acquired figures were transformed into per million population of the given country. The growth rate of daily COVID-19 cases was derived and was used as the regress and in a multiple linear regression with the number of tests per million population per day and the number of days since a lock-down was imposed as the regressors. RESULTS: It was found that the growth rate of daily COVID-19 cases decreased by .051% when the number of daily tests conducted per million population increased by 1. A .532% decrease in the growth rate of daily COVID-19 cases was observed with each passing day of a lock-down, which essentially represented the most effective form of social distancing. A significant regression was calculated (F (2, 155) = 35.191, p=.014), with an R2 of .054. Neither the daily number of tests conducted per million population nor the number of days of maintaining social distancing (lock-down) was individually significant contributors to the prediction of the growth rate of daily COVID-19 cases (p=.267 and p=.554 respectively). CONCLUSION: An extensive and rapid increase in the daily number of testing capacity and maintaining social distancing can decrease the growth rate of daily COVID-19 cases. Depending on the availability of the required resources, timely implementation of these measures can lead to better outcomes for a given population.

Quality Of Life And Depression Among Young Patients Suffering From Acne.

BACKGROUND: In addition to depression, acne has considerable negative effects on the quality of life (QOL) which is estimated to be equal to that reported by patients with other chronic diseases. The immense suffering of ace patients both terms of depression and deterioration in quality of life and subsequent compromised social, vocational and academic performance makes them seek professional help more often for non-cutaneous manifestations e.g., poor body image, anxiety, depression etc. This study was conducted to determine the prevalence of depression and status of quality of life in acne patients visiting outpatient dermatology. METHODS: This was a cross-sectional study conducted in the outpatient dermatology department of Ayub Teaching Hospital, Abbottabad between January and August 2018. The 74 consecutive acne cases visiting the dermatology OPD during the study period between the ages of 13 and 30 years were assessed for depression and QOL. Data was collected by Dermatology life quality Index (DLQI) and Patient Health Questionnaire (PHQ 9). RESULTS: The ages of acne patients ranged between 14 years to 28 years with a mean age of 21.6 ±3.034 years. Majority 49 of the acne patients (66.2%) were female. Mean DLQI was 59±5.38. Of the total, 9 (12.2%) acne patients had no effect on the quality of life, 23 (31.1%) had small effect, 23 (31.1%) had moderate effect, 18 (24.3%) had large effect and 1 (1.4%) had extremely large effect on their quality of life. Mean PHQ-9 scale score was 7.72±4.93. Six (8.1%) acne patients were categorized as having no depression, 17 (23%) had minimal depression, 25 (33.8%) were having mild depression, 18 (24.3%) were moderately depressed and patients with moderately severe depression constituted only 8 (10.8%) acne patients. CONCLUSIONS: Acne is associated with depression and deterioration in QOL, which are more pronounced in teens and women.

Seroprevalence Of Brucellosis Among Patients Presenting With Non - Specific Symptoms At Ayub Teaching Hospital Abbottabad.

BACKGROUND: Brucellosis is one of the prevalent zoonotic diseases worldwide. It not only adds to the global burden of disease but also has huge economic impact. Clinical features of human brucellosis are usually vague. This study was carried out to find out the frequency of brucellosis among patients presenting with nonspecific symptoms in hospital setting and to find out risk factors. METHODS: Study was carried out in outpatient Medicine Department of Ayub Teaching Hospital Abbottabad for the period of 3 months. Patients presenting with nonspecific symptoms of fever, body aches, myalgias, arthralgia, headache, backache, malaise and insomnia of either gender between the ages of 18-60 years were included in the study through consecutive sampling technique. Blood Samples from patients were sent for screening Brucella antibodies by serum agglutination method. Antibodies were checked for both Brucella abortus and mellitensis. RESULTS: total 70 patients were recruited in the study. Out of these 49 (70%) were found positive for Brucella. These positive Brucella patients were mostly 42 (85.71%) female and majority 35 (71.4%) were in the age group of 21-40 years. In both male and female patients' majority were positive for both species of Brucella. Nonspecific symptoms included Aches, Pains and Myalgia in all the patients with additional symptoms of Malaise in 13 (18.6%), headache 10 (14.3%) and insomnia and fever in 9 (12.9%) each. Majority of the enrolled patients 53 (75.71) gave negative history of using boiled/pasteurized milk in their daily consumption while 17 (24.3%) patients suggested use of boiled/pasteurized milk. CONCLUSIONS: A high frequency of human brucellosis was found among patients presenting with nonspecific symptoms, therefore it is recommended that such patients should be screened for brucellosis.

Internet Addiction In Medical Students.

BACKGROUND: Internet is a technology that was designed to facilitate research and official communication. According to Internet World Stats, there are 3.36 billion internet users in the world. The internet usage has increased by 832.5% in the world since 2005. In Pakistan there are 25 million active users using internet. It is a multi-dimensional behavioural disorder that manifest in various physical, psychological and social disorders and causes a number of functional and structural changes in brain with related various comorbidities. There is paucity of local researches on this topic but the access to internet and its use is enormous. This study was conducted to find the magnitude of internet addiction in medical students. METHODS: It was a descriptive crosssectional study carried out in Ayub Medical College, Abbottabad. One hundred & forty-eight students were selected in the survey using stratified random sampling. The data was collected using academic and school competence scale and internet addiction diagnostic criteria. RESULTS: In this study, 11 (7.86%) fulfilled the criteria for internet addiction. Most of the students 93 (66.3%) used internet to visit social media applications. Majority of the students 10 (90.9%), showed tolerance as major non-essential symptom of internet addiction. Internet addicts showed significant p=0.01 below average academic performance when compared to non-addicts. Internet addiction showed a significant p=0.03 gender association with internet addiction more prevalent in females than males (12.5% Vs 2.9%). CONCLUSION: This study shows that excessive internet use leads to its addiction and is an entity of concern among medical students.

Left Hand Thumb Imprint Patterns Among Medical Students.

BACKGROUND: Finger printing is an absolute method of identification. Recovery of finger prints from a crime scene is an important method of Forensic identification. Human finger prints are detailed, unique, difficult to alter, easily classifiable and durable over life making them stable and long-term tool of human identification. METHODS: This cross-sectional study was conducted on 95,3rd year MBBS students of Ayub Medical College Abbottabad from December 2014 to August 2015 to establish the frequency of left hand thumb imprints by rolling and plain method. RESULTS: Study shows Loops among most common finger print pattern in 55 (58%) students out of 95, followed by whorls 33 (35%), arches 5 (5%) and composite 2 (2%). CONCLUSIONS: It is thus concluded that most common finger print pattern is loops followed by whorls, arches and composite.

KNOWLEDGE AND PERCEPTION OF ARECA/SMOKELESS TOBACCO USERS ABOUT ORAL CANCER.

BACKGROUND: According to World Health Organization (WHO), six million deaths are attributable to tobacco use globally, of which nearly 1.2 million occur in South-East Asia. Use of smokeless tobacco is highly prevalent in subcontinent and is home to over 250 million smokeless tobacco (ST) users. ST is a major public health problem. It cause localized oral lesions and poses risk for developing oral cancers owing to it containing more than 30 cancer causing substances, in addition to nicotine which is a highly addictive. This study was conducted to assess the overall knowledge and compare knowledge, attitude and perceptions of ST users presenting to private and public health care facilities. METHODS: This cross sectional comparative study was carried out from April to July 2011 to establish the details of underlying factors and perceptions of areca/ST users presenting in public and private health care facilities of Karachi. Through systematic random sampling, 464 male and female users (≥ 14 years) were interviewed. The data was analysed in SPSS-16. RESULTS: Mean age of the users of Private Clinic (PC) was 25 ± 7.183 years while that of Public hospitals (PH) respondents was 34 ± 11.3 years. The respondents present in PC (94%) had comparatively more knowledge than the users in PH (75%). About 78% of the study population in PH wanted to quit this habit of chewing whereas 88% in PC have the same attitude (p-0.01). About 68% in Public and 89% in Private clinics ever tried to quit but failed; (p-0.000). CONCLUSION: Although respondents have substantial knowledge about the harmful effects of smokeless tobacco but due to their perceived psychological and emotional dependency, they remain addicted.