Evaluation of antibiotic prescription patterns using WHO AWaRe classification.

Background: Antimicrobial resistance is a rising problem worldwide and it poses a serious risk to public health. In Pakistan, about 70.0% of the Acinetobacter group of bacteria were resistant to all antibiotics and were responsible for high mortality among neonates within the first week of life. Aim: To evaluate the pattern of antibiotic prescription in the Ear, Nose and Throat (ENT) Department of Shalamar Hospital, Lahore, Pakistan, using the WHO AWaRe 2021 classification. Methods: We collected prescription data from the ENT outpatient department of Shalamar Hospital from October to December 2021. We compared the quantitative analysis of antibiotics with the WHO AWaRe classification. We analysed the data using SPSS version 26 and discussed the results with the ENT Department for possible improvements. Results: Some 862 (12.1%) of the total 7126 entries were assessed. Others were excluded because they had some missing data or had no antibiotic prescription. Of all the antibiotics prescribed, around 54.9% belonged to the access category. The WHO 13th General Programme of Work 2019-2023 recommends a country-level target of at least 60% of the total antibiotic consumption in the access group antibiotics. Conclusion: The outpatient department of the ENT did not prescribe any reserve or not recommended antibiotics. The use of watch antibiotics was higher than recommended by the WHO AWaRe classification. More efforts should be made to increase prescriptions from the AWaRe access group to achieve the 60% minimum target recommended by WHO for the country.

Assessment of the Dimensions of Coronary Arteries for the Manifestation of Coronary Artery Disease.

INTRODUCTION: The size of the coronary artery influences the effective outcome of therapeutic measures like coronary artery bypass graft (CABG) surgery, percutaneous coronary interventions (PCI), and diagnosis of coronary artery disease. Patients' age, gender, BMI, anatomical variations, and increased left ventricular size all have an effect on coronary artery parameters. OBJECTIVE: This study aims to compare the average size of the coronary arteries of the Pakistani population in both sexes for manifestation of coronary artery disease. METHODOLOGY: For the analysis of the coronary arteries, 100 patients of both sexes, male and female, were taken. X-ray angiography was performed for two-dimensional images of coronary arteries. For diameter measurement, images were visualized on quantitative coronary angiography (QCA) in different views (caudal and cranial views). The diameters of the left main coronary artery (left main stem/LMS), left anterior descending (LAD), left circumflex (LCx), and right coronary artery (RCA) were measured on angiograms. Data about the dimensions of the coronary artery was gathered through quantitative angiography. Data analysis was done through SPSS version 26 (IBM Corp., Armonk, NY). RESULTS:  There is a notable distinction in the average diameters among the proximal LAD (3.12), mid-LAD (2.40), and distal LAD (1.29). A statistically significant difference is evident among mid-LCx, distal LCx, and proximal LCx (p-value < 0.001). Likewise, the average diameter of the distal RCA (1.89) was smaller when compared to the mid-RCA (3.19) and proximal RCA (3.78). However, there was no significant difference in the average diameter among mid-LMS, distal LMS, and proximal LMS (p-value = 0.09). CONCLUSION: The average diameter of distal RCA was smaller when compared to mid-RCA and proximal RCA. The average size of proximal LAD and proximal LCx was comparatively larger than mid- and distal LAD and LCx. The findings of current research will be beneficial for the diagnosis and management of coronary artery disease patients.

Burden of noncommunicable diseases in Pakistan.

Background: Cases of noncommunicable (NCD) diseases are increasing in Pakistan. They are responsible for 58% of all deaths and information on the risk factors is lacking. Aims: To determine the prevalence of diabetes, hypertension and abnormal heart rate and their risk factors in a multiethnic, low-income area of Lahore. Methods: This was a cross-sectional study conducted in an urban settlement of Lahore in 2018-2019. Eligible participants were aged ≥ 30 years and resident in selected settlements. We used a modified World Health Organization stepwise approach to NCD risk factor surveillance (STEPS) questionnaire to collect data from a random sample of 906 residents. The modified questionnaire had a Cronbach alpha of 80.0%. Participants were interviewed in their homes and their height, weight, heart rate, and hip circumference were measured. Results: Most of the respondents were women (64.5%). The greatest proportion of the participants were aged 30-39 years (42.4%). Of all the respondents, 40.1% had hypertension, 15.8% had diabetes and 17.0% had ischaemic heart disease. Of the risk factors examined, 68.8% of the respondents were overweight or obese, 37.0% had pre-hypertension, 13.6% used tobacco, and 1.8% used alcohol. Age was the most significant risk factor for noncommunicable diseases. Body mass index was significantly associated with diabetes in women, while family history of diabetes was significantly associated with diabetes in men. Conclusion: The prevalence of hypertension and diabetes was higher among our study participants in Lahore than reported in the national statistics. Significant proportions of the respondents had pre-hypertension and pre-diabetes, making them vulnerable to serious complications of hypertension and diabetes.

Prevalence of tobacco consumption and the associated factors among the adults in an urban slum: Findings from the WHO STEPwise survey.

INTRODUCTION: Despite Pakistan's stringent tobacco control policy, its effective implementation has always been a challenge, leading to rising tobacco consumption. The aim of the study is to determine the prevalence of tobacco consumption and associated risk factors in the adult population of deprived urban areas. METHODS: A community-based, cross-sectional survey was conducted from February to July 2019, comprising 607 adults residing in the urban squatter settlement of Lahore using a standardized questionnaire, the WHO STEPwise approach. The outcome was current use of tobacco and/or smokeless tobacco daily. Multivariable logistic regression was applied to determine factors associated with smoking and smokeless tobacco consumption. RESULTS: Among 607 participants, about 64% were females, 49.3% were illiterate, 64.9% were currently unemployed, and 47.1% belonged to the low-income group. The prevalence of tobacco smoke was 10.5% (95% CI: 8.07-12.93), and smokeless tobacco consumption was 8.6% (95% CI: 6.38-10.82). Multivariable logistic regression found that smokeless tobacco was more likely among the aged 50-59 years (AOR=4.1; 95% CI: 1.1-13.8) and unemployed (AOR=3.6; 95% CI: 1.1-12.2). Whereas tobacco smoking was more likely among the aged 30-39 years (AOR=5.5; 95% CI: 1.8-16.7), Urdu ethnicity (AOR=2.9; 95% CI: 1.2-7.3), unemployed (AOR=6.6; 95% CI: 2.9-14.9), and never exposed to any media (AOR=3.2; 95% CI: 1.8-17.4). Participants exposed to health warnings were less likely to smoke (AOR=0.02; 95% CI: 0.01-0.05). CONCLUSIONS: This study reports a high prevalence of tobacco consumption among adults and calls for effective policy implementation using a multi-pronged approach, including health professionals and media, to spread awareness about the harmful effects of tobacco and endorsement of health warnings on tobacco packaging.

Relationship Between Physical Inactivity and Obesity in the Urban Slums of Lahore.

Introduction There are several factors such as physical inactivity, sedentary lifestyle, and diet that can be responsible for weight gain or obesity. Regular physical activity is important for better physical and emotional well-being. The objective of the study is to observe the prevalence of obesity or over-weight and how lack of physical activity contributes to weight gain and other health issues. Methods This cross-sectional study was conducted in Shalamar Town, Lahore on 646 participants. Data was collected using the WHO STEPS instrument. The inclusion criteria were a minimum age of 30 years and residents of Shalimar Town, Lahore for more than five years. The exclusion criteria were participants with comorbid conditions like HIV, TB, and terminal stage of cancer. Test of association and binary logistic regression analysis was performed to observe a significant association between demographic variables and non-communicable diseases among the participants involved in performing physical exercise. Results About 22.1% of the participants had normal BMI, 5.3% were underweight whereas 34.2% of the participants were overweight and 32.4% obese. Male participants were found to be more physically active compared to females. Hypertension and diabetes were statistically significantly associated with physical activity. BMI and waist-hip ratio were found to be associated with moderate physical exercise. Conclusion Most of the participants were not involved in moderate physical activity. Overall, an alarming 66.6% of the participants were either overweight or obese. In general, males were found to participate more in intense physical activity.

Patterns of Dyslipidemia Among Acute Coronary Syndrome (ACS) Patients at a Tertiary Care Hospital in Lahore, Pakistan.

INTRODUCTION: Dyslipidemia refers to the presence of abnormalities in lipid parameters. It has become a global issue with a high risk of cardiovascular diseases (CVDs). The aim of the investigation was to find out the pattern and prevalence of dyslipidemia among patients with the acute coronary syndrome (ACS). METHODOLOGY: A cross-sectional study design was used. Data were collected using convenient sampling from 101 patients presenting with ACS, admitted at the critical care unit (CCU) / Rasheeda Begum Cardiac Centre (RBCC) of Shalamar Hospital, during a 12-month period from January 2020 to December 2021. Dyslipidemia is diagnosed by testing the lipid profile when there are one or more abnormal readings of the lipid profile. RESULTS: Nearly 43 (42.6%) had ST-segment elevation myocardial infarction (STEMI), 27 (26.7%) had non-ST segment elevation myocardial infarction (NSTEMI), and 31 (30.7%) were categorized as unstable angina (USA). Overall dyslipidemia was present in 84 (83.2%) patients. The prevalence of dyslipidemia was 55 (65%) in male patients and 29 (34.5%) in female patients. Dyslipidemia was present in 39 (90.7%) patients with STEMI, 25 (80.6%) in the USA, and 20 (74.1%) with NSTEMI. CONCLUSION: The prevalence of dyslipidemia was quite high among ACS patients. The proportion of obese patients was also high in our study. However, dyslipidemia was more frequent in overweight patients.

Prevalence of antenatal depression among women receiving antenatal care during last trimester of pregnancy in a tertiary care private institute of Lahore.

OBJECTIVE: Pregnancy and depression affect each other. The main objective of our study was to find out frequency of antenatal depression during last trimester and associated risk factors among pregnant female visiting a tertiary care private institution of Lahore, Pakistan. METHODS: This study was conducted at Shalamar Hospital a private tertiary care institution of Lahore during May 2017 to June 2018. Assuming 18% prevalence with design effect 1.5 and 97% confidence interval the calculated sample size was 417. To avoid dropouts the questionnaire was administered to 450 pregnant females in their last trimester that is with gestational age above 28 weeks. In this study we used a modified version of Goldberg's depression scale in Urdu language for data collection. Wherever needed the data collection team read out aloud the questionnaire to the participants who did not know how to read and write. Informed consent in a written form (in Urdu language) was taken from every study participant after explaining the participants about the research. If the participant did not know how to read and write, the interviewers narrated out aloud the script of informed consent for them and got it signed later by the participants. The confidentiality, anonymity and privacy of the study participants were preserved. Ethical approval of this study was obtained from Institutional Review Board of Shalamar Institute of Health Sciences. Data entry and analysis was finalized by using SPSS version 20. RESULTS: The prevalence of depression among women seeking antenatal care during their last trimester according to Goldberg Depression Scale was 40.89% (n=184).Whereas, 30.4% (n=137), 8.67% (n=39) and 1.78% (n=8) suffered from mild, moderate and severe depression respectively. The associations between passive smoking (p < 0.01), family history of preeclampsia (p < 0.05) and depression among family members (p < 0.05) with antenatal depression during last trimester were significant. CONCLUSION: According to Goldberg Depression Scale, 40.89% (n=184) of pregnant women seeking antenatal care in private tertiary care institution of Lahore suffered from depression.

Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals.

BACKGROUND AND OBJECTIVE: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic. METHODS: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17. RESULTS: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years). CONCLUSION: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe.

Haematological reference values for full-term, healthy, newborns of Karachi, Pakistan.

OBJECTIVE: To establish reference haematological values (complete blood count) in healthy full-term newborns of Karachi. METHODS: This is a cross sectional study design based on cord blood sample of 404 newborns and their mothers recruited from Sindh Government Qatar Hospital, Ziauddin University Hospital gole market campus, Sindh Government hospital, Liaquatabad and Chinniot maternity and child hospital. Karachi from July 2006 to April 2008. Both mother's and the new born baby's blood was collected in EDTA containing tubes and analyzed for different haematological parameters. The data entry and analysis was done on computer package SPSS (Statistical Packages of Social Sciences) version 12.0. The results were given in the text as mean, standard deviation and 95% confidence intervals of haematological values (complete blood count). RESULTS: The mean haemoglobin was found to be (14.99 +/- 1.47 gm), which is lower than the standard value described in literature. However the total WBCs count and platelet count were found to be (13.61 +/- 4.23) and (256. 25 +/- 76.54) respectively, which were similar to the other studies. CONCLUSION: Our values provide reference range for haematological values in healthy newborns of Karachi, for clinical use by our physicians.

Prevalence of microalbuminuria with relation to glycemic control in type-2 diabetic patients in Karachi.

BACKGROUND: Diabetes is one of the most common endocrine disorders characterized by hyperglycaemia. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. The present study was conducted to determine the prevalence of microalbuminuria in relation to duration of diabetes, BMI, Serum Creatinine and HbA1c in an ethnic group of Type 2 diabetes mellitus residing in Karachi. METHODS: This cross-sectional descriptive study was carried out in a community diabetic centre, located at Garden East Karachi from July to December 2007. One hundred known Type 2 diabetic patients with age 30-70 years were included in the study. Informed consent and a structured questionnaire of each patient were recorded. Fasting venous blood and morning urine sample was collected for analysis of creatinine, HbA1c and microalbuminuria respectively. Statistical analysis was done using SPSS version 13.0. Pearson correlation was applied to observe association of microalbuminuria with different parameters. All p-values < 0.05 were considered as statistically significant. RESULTS: Microalbuminuria had a highly significant correlation with duration of diabetes, serum creatinine (p < 0.001), HbA1c (p < 0.05) and BMI (p < 0.024). A strong correlation exists between age and serum creatinine (r = 0.73). CONCLUSION: The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control (high HbA1c > 7%) or heredity factors. Screening for microalbuminuria and HbAlc test should be done in both newly and already diagnosed Type 2 diabetic patients as an early marker of renal dysfunction and glycaemic control.

Relationship of non-organic factors with malnutrition among children under three years of age.

OBJECTIVE: To study the association of socioeconomic and physical environmental factors with malnutrition among children under 3 years of age in four districts of Pakistan. DESIGN: Cross-sectional comparative study. PLACE AND DURATION OF STUDY: Selected MCH, Centres of Lahore, Jhang, Gilgit and Pallandri (AJK) providing preventive, promotive and curative services during the month of January 2004. PATIENTS AND METHODS: A total of 448 children under 3-years of age coming to selected MCH centers, during the study period, were examined for malnutrition. The children were divided into two groups (normal/malnourished) on the basis of standard WHO weight for age growth chart. The compared variables were weaning and breast feeding practices, gender, vaccination status, living conditions and parents' educational status. RESULTS: There were 238 (53%) male and 210 (47%) female children examined for malnutrition. The difference in weaning age, gender and vaccination status among normal and malnourished children were found to be statistically significant (p<0.001). A higher proportion of malnourished children (62.6%) was also found in families living in one room houses as compared to 2 or more room houses (p=0.01). There was an inverse association of educational status of both parents with malnutrition of children (p<0.001). CONCLUSION: This series showed a higher proportion of malnutrition among children, who were unvaccinated, weaned after seven months of age, not exclusively breast-fed for first six months, and lived in poor environmental conditions.