Breaking bad news: a descriptive study of physicians' perspective of Sindh, Pakistan.

OBJECTIVE: To assess the perception and attitude of physicians related to breaking bad news. METHODS: The cross-sectional study was conducted at three teaching hospitals in Karachi and Mirpurkhas, Pakistan, from April 2019 to February 2020, after approval from Hamdard University, Karachi, and comprised physicians of either gender having direct patient contact. Data was collected using a questionnaire based on literature. The questionnaire was pilot-tested before distribution among the subjects. The responses were categorised with respect to age, gender and professional experience. Data was analysed using SPSS 25. RESULTS: Of the 230 subjects, 119(51.7%) were females. The overall mean age was 34.5±8.8 years and mean professional experience was 9.1±8.2 years. Overall, 19(8.3%) subjects believed they had a very good ability to deliver bad news, while 26(11.3%) avoided telling the patient the truth about diagnosis, prognosis and treatment. Age had a significant association with correctly defining breaking bad news (p<0.05). CONCLUSIONS: The skill level related to breaking bad news was found to be deficient.

Health Related Quality of Life amongst Sewerage and Sanitary Workers of Karachi, Pakistan.

Objectives: To find out the impact of occupational and socio-demographic factors on the health related quality of life of sewerage and sanitary workers in Karachi. Methods: A cross-sectional study was conducted during 2019. Four hundred workers were chosen from five districts of Karachi using a non-probability convenient sampling technique. An Urdu version of WHO BRIEF quality of life questionnaire was used to collect the data about workers general health status and quality of life. Descriptive analysis was done and Chi-square test was used for the association of socio-demographic factors and quality of life. Multiple regression model was used to predict QOL of all domains. P-value<0.05 was considered as statistically significant. Results: Out of 400 sanitary workers, 228 (57.0%) were sweepers and the rest 172 (43.0) were sewerage workers. The majority of the workers 321 (80.3%) were male and 246 (61.5%) were illiterate. The vast majority of the workers 386 (96.5%) were not immunized against typhoid, / hepatitis and tetanus. Ninety-one percent (91%) were not using any kind of safety gadgets while at work. Male workers, married workers of both sexes and those with some education had a little better quality of life than their counterparts. Sanitary employees likewise had a higher quality of life score than sewage workers (P-value<0.05). Conclusion: The majority of workers, particularly sewage workers, have a very poor quality of life. Along with very bad working circumstances, their standard of living is significantly below par. They were not given any safety equipment. They were handling untreated sewage/waste with their bare hands, and they have never received a typhoid/hepatitis /tetanus vaccine.

Smartphone addiction and its associated behaviors among medical and dental students in Pakistan: A cross-sectional survey.

INTRODUCTION: Addiction refers to the irresistible urge to engage in certain actions or dependence on a particular substance despite knowing negative consequences. The current study evaluated the severity of Smartphone addiction and the factors associated with cell phone-like activity. MATERIALS AND METHODS: This cross-sectional study was conducted from July to August 2019 among medical and dental students in Karachi, Pakistan. A pretested self-administered questionnaire was used among 400 students. The mobile phone addiction was assessed using a 20-item, Mobile Phone Addiction Scale. A two-stage cluster analysis was used to assess mobile phone addiction-like behaviours. Chi-square test was used to find associations between categorical variables. Kolmogorov-Smirnov to test normality of data were also used. A P < 0.05 was considered to be statistically significant for all tests. RESULTS: Out of the total 400 students, the majority 316 (79%) comprise female students. The mean age was 20.54 ± 1.59 years. In 184 (48%) students, there was evidence of mobile phone addiction-like behavior. The prevalence was higher in female than male students and among older compared to adolescent students; the differences were statistically nonsignificant. A higher median score ≥ of 4 is found in questions related to components reflected intense desire, impaired control, and tolerance and harmful mobile use. CONCLUSION: This study highlights that a large number of students are addicted to their smartphones. Smartphone addiction continues to be the most problematic addiction aided by the presence of intense desire, impaired control tolerance, and harmful mobile use. The phenomenon must be fully understood to draw deeper and richer inferences about the origins of this addictive behavior, which is becoming more prevalent in our Pakistani society on a daily basis.

Prevalence and associated factors of restless leg syndrome (RLS) in Pakistani women during pregnancy.

There is a dearth of literature studying restless leg syndrome (RLS) among pregnant patients in Pakistan. The objective of this study was to determine the prevalence and associated factors of RLS among pregnant Pakistani patients. It was conducted in 2018 among 478 women attending ante-natal check-up in the outpatient department of five hospitals in Karachi, Pakistan. Individuals were interviewed for socio-demographic information, the key criteria for RLS and its associated factors. RLS was reported in 54 (11%) individuals based on International Restless Legs Syndrome Study Group (IRLSSG) criteria. The mean age was 33.44 ± 4.42 years. Association between pregnant women with RLS and those without reveals statistically significant differences with increasing age (p=.01), gravida (p<.01) and para (p<.001). RLS was significant among working women (p=.001), during third trimester (p=.001), with insomnia (p<.001), use of tobacco (p<.001) and among women with gestational diabetes (p<.001), hypertension (p<.001). The study showed a low prevalence of RLS among women during pregnancy. It further reported gestational diabetes, hypertension, insomnia and tobacco use to be independently linked to RLS. Impact StatementWhat is already known on this subject? Pregnancy has been demonstrated to be strongly associated with development of secondary restless leg syndrome (RLS). RLS in pregnancy has also been shown to portend poor maternal and neonatal outcomes such as postpartum depression and preterm birth. Various conditions and lifestyle factors in pregnancy have been shown to be associated with the development of RLS, but there are variations in these across different populations.What do the results of this study add? The prevalence of RLS was only reported twice in pregnant patients in Pakistan and our research helps to address this data shortage. In addition, the results of our study document a strong association of RLS with gestational hypertension and gestational diabetes and also show that smoking and exercise were correlated with RLS during pregnancy, both of which were previously unstudied in the pregnant Pakistani population.What are the implications of these findings for clinical practice and/or further research? Demonstrating the prevalence of RLS in pregnant Pakistani patients highlights the need to screen these patients, particularly those with associated conditions identified in our findings, for RLS during antenatal visits and to treat their condition to improve maternal and neonatal outcomes.

Electrochemical Impedance Imaging on Conductive Surfaces.

Electrochemical impedance spectroscopy (EIS) is a powerful tool to measure and quantify the system impedance. However, EIS only provides an average result from the entire electrode surface. Here, we demonstrated a reflection impedance microscope (RIM) that allows us to image and quantify the localized impedance on conductive surfaces. The RIM is based on the sensitive dependence between the materials' optical properties, such as permittivity, and their local surface charge densities. The localized charge density variations introduced by the impedance measurements will lead to optical reflectivity changes on electrode surfaces. Our experiments demonstrated that reflectivity modulations are linearly proportional to the surface charge density on the electrode and the measurements show good agreement with the simple free electron gas model. The localized impedance distribution was successfully extracted from the reflectivity measurements together with the Randles equivalent circuit model. In addition, RIM is used to quantify the impedance on different conductive surfaces, such as indium tin oxide, gold film, and stainless steel electrodes. A polydimethylsiloxane-patterned electrode surface was used to demonstrate the impedance imaging capability of RIM. In the end, a single-cell impedance imaging was obtained by RIM.

Beliefs and knowledge of osteoporosis amongst female graduate students in Karachi, Pakistan: A cross-sectional study.

OBJECTIVE: To assess the knowledge, belief and preventive measures taken regarding osteoporosis by students of different non-medical educational backgrounds. METHODS: The descriptive cross-sectional study was conducted from January to March, 2018, at one private-sector and two public-sector universities in Karachi, and comprised female participants aged >15 years from engineering, commerce, social and pure sciences background. Osteoporosis Knowledge Assessment Tool questionnaire was self-administered to collect data which was analysed using SPSS 23. RESULTS: There were 400 females with a mean age of 20.55±1.66 years. The overall mean score was 46.49±12.83 and 43(10.8) subjects had a good score, 204(51%) had an average score and 150(37%) had a poor score regarding knowledge about osteoporosis. Also, 186(47%) subjects identified previous studies as their source about osteoporosis, 103(26%) gained knowledge by health professionals and 62(16%) did it through electronic media. The knowledge on risk factors, protective factors and perceived susceptibility were significant (p<0.05) when compared by type of study and age. CONCLUSIONS: The knowledge of the disease was found to be insufficient, indicating need for generating awareness regarding osteoporosis.

Electrochemical Approach to Measure Physiological Fluid Flow Rates.

In vivo measurement of the flow rate of physiological fluids such as the blood flow rate in the heart is vital in critically ill patients and for those undergoing surgical procedures. The reliability of these measurements is therefore quite crucial. However, current methods in practice for measuring flow rates of physiological fluids suffer from poor repeatability and reliability. Here, we assessed the feasibility of a flow rate measurement method that leverages time transient electrochemical behavior of a tracer that is injected directly into a medium (the electrochemical signal caused due to the tracer injectate will be diluted by the continued flow of the medium and the time response of the current-the electrodilution curve-will depend on the flow rate of the medium). In an experimental flow loop apparatus equipped with an electrochemical cell, we used the AC voltammetry technique and tested the feasibility of electrodilution-based measurement of the flow rate using two mediums-pure water and anticoagulated blood-with 0.9 wt% saline as the injectate. The electrodilution curve was quantified using three metrics-change in current amplitude, total time, and change in the total charge for a range of AC voltammetry settings (peak voltages and frequencies). All three metrics showed an inverse relationship with the flow rate of water and blood, with the strongest negative correlation obtained for change in current amplitude. The findings are a proof of concept for the electrodilution method of the flow rate measurement and offer the potential for physiological fluid flow rate measurement in vivo.

Child physical abuse: awareness and practices of medical and dental doctors in Pakistan.

OBJECTIVE: To determine the awareness and practices of doctors and dentists in detecting and reporting suspected cases of child physical abuse. METHODS: The cross-sectional study was conducted from November 2017 to June 2018 at the Hamdard College of Medicine and Dentistry, Karachi, and comprised doctors and dentists practising in public and private hospitals across Pakistan. Data was collected using a predesigned questionnaire to assess knowledge of the social indicators of child physical abuse, response to child physical abuse, and actions taken by the professionals when they believed a child abuse case had been detected. Data was analysed using SPSS 22. RESULTS: Of the 575 healthcare professionals, 371(64.5%) were doctors and 204(35.5%) were dentists; 347(60.3%) were males; 446(77.6%) were working in private hospitals; 384(66.8%) had <10 years of experience; and 99(17.2%) had received formal training of child abuse. While 450(78.3%) subjects strongly agreed on the value of identifying and documenting child physical abuse, 336(58%) did not take any action in suspected cases. CONCLUSIONS: Although doctors and dentists had a positive attitude regarding child physical abuse, the majority preferred to remain silent in suspected cases.

Effect of silver electrode wetting state on oxygen reduction electrochemistry.

Surface wettability plays an important role in heterogeneous electrocatalysis. Here we report a facile laser ablation strategy to directly modify the wettability of the silver catalyst surface and investigate its effect on oxygen reduction reaction (ORR). A broad range tuning of 2e-/4e- ORR pathways was achieved, with hydrophilic silver surfaces (contact angle (θw) 31.1°± 0.6°) showing high activity and selectivity towards 4e- reduction of oxygen to water.

Knowledge and perceptions about the health effects of environmental hazards among students from Hamdard University, Karachi: A cross sectional study.

Environmental hazards increase the health morbidity and mortality burden. This study compared the knowledge and perceptions about the health effects of environmental hazards among medical and engineering students of Hamdard University Karachi. A total of 263 (44.1%) engineering students, and 333 (55.9%) medical students participated in the study. Cumulatively, the three most commonly identified environmental hazards included tobacco smoking 561 (94.1%), global climate change 518 (86.9%), and solar ultraviolet radiation 511 (85.7%). The study results suggest the need for better quantifying the magnitude of understanding environmental hazards, and for health education and promotion programmes at the graduate level for medical and engineering students in Karachi.

Synthesis of gold nanostructures using glycine as the reducing agent.

Biological synthesis of gold nanostructures could potentially offer an environmentally friendly alternative to traditional chemical synthetic methods. During the last decades, various biomolecules, including amino acids, have been successfully used as reducing and capping agents to synthesize multi-shaped gold nanostructures. A grand challenge in this field is to increase our ability to control the size and shape of gold nanostructures formed precisely by systematic synthetic approaches based on the understanding of the mechanism for structural determination. In this study, using glycine as the model amino acid and chloroaurate (AuCl4 -) ions as the precursor solution, we report the finding that the shape of the gold nanostructures synthesized showed a strong correlation with the speciation of gold complexes determined by the pH, precursor concentration and chloride concentration of the solvent system. The gold chloro-hydroxy speciation [AuClx(OH)4-x]- (with x = 0-4) influenced the shape of the gold nanostructures formed, with gold nanoplatelets, nanotriangles, nanokites and nanoribbons observed at x = 4, 3, 2 and 1, respectively, and spherical nanoparticles observed at x = 0. Glycine was found to play a role as a reducing agent, but no significant effect on the morphology was observed, indicating the dominance of gold chloro-hydroxy speciation in the structural formation. These results collectively provide synthetic considerations to systematically synthesize non-spherical to spherical biosynthesized gold nanostructures by controlling the speciation of [AuClx(OH)4-x]-.

Challenges in providing oral and dental health services in COVID-19 pandemic.

Coronavirus disease (COVID-19) pandemic has rendered the world completely unaware and off-balance. Most of the countries of the world are in a lockdown of varying severity to break the chain of transmission. Many non-essential healthcare practices have been shut down to impose social distancing against a population whose slogan has been freedom of movement. Several healthcare providers have also been caught off guard. Many are not well-versed in the use of transmission-based safeguards, and the dental community, is no different. In this article, we identify the challenges faced by the oral and dental care providers, whose procedures generate a significant amount of aerosol, which can be a significant source of disease transmission within the community. It further describes the dynamics of aerosol spread and various strategies to minimise aerosol generation. Guidelines for the delivery of emergency dental treatment are formulated based on different guidelines from various international dental associations and organisations.

Knowledge and awareness regarding spread and prevention of COVID-19 among the young adults of Karachi.

OBJECTIVE: To measure the awareness of COVID-19 infection among the general population following the outbreak in China. METHODS: This descriptive cross-sectional study was carried out during January and February 2020 amongst the general population of Karachi, Pakistan. A pre-tested, self-administered questionnaire was used among 399 young adult participants. The questionnaire was developed keeping in view of the already published study on severe acute respiratory syndrome (SARS) and the available literature on COVID-19. It included sociodemographic information, assessment of knowledge, beliefs regarding coronavirus and the perception of precautionary measures taken by an individual. Chi-square test was used for categorical variables and p<0.05 was used as statistically significant. RESULTS: There were more females 299 (75%) than male participants 100 (25%). The mean age was 20.9 ±2.30 years and 232 (58%) had graduate degrees. There is lack of knowledge and awareness about coronavirus as 226 (56.6%) participants claimed that coronavirus is actually the most dangerous virus in the world, and 171 (43%) did know that the common flu virus is potentially more lethal than coronavirus. Although a large majority of participants correctly identified sources of transmission, measures and precautions to be taken for coronavirus, their knowledge for symptom identification was deficient. The most pursued platform for information for coronavirus was found to be social media, followed by television and print media. CONCLUSIONS: The study highlighted the level of awareness of coronavirus among young adults in Karachi, Pakistan. The study further pointed out the public knowledge gaps for the authorities concerned to help them develop more effective and successful awareness campaigns using preferred channels.

Daughters witnessing domestic violence perpetrated by fathers on mothers: Case study from a private University of Karachi.

Violence against women is a human rights issue and a major public health problem. The objectives of this study were to determine the magnitude and type of emotional and physical domestic violence perpetrated by fathers on mothers of female students of a private university. A total of 564 questionnaires were duly filled and returned with a response rate of 94.0%. The most common form of violence was reported by 93 (16.5%) of the respondents who witnessed their fathers either saying or doing something to humiliate the respondents' mothers. While the most common physical violence witnessed was fathers slapping their mothers as reported by 39 (6.9%) of the respondents. Empowerment of women, and effective endeavours in education of both sexes are important steps towards addressing and preventing domestic violence.

Comparison of medical and allied health students' attitudes on organ donation: Case study from a private university in Karachi - Short Report.

Organ transplantation is often the only hope for patients with end-stage organ failure. Organ transplant surgeries are increasingly becoming available in Pakistan. From May-July 2017, using convenience sampling and statistical programme R 3.4.1, we assessed and compared the organ donation attitudes among medical and allied health undergraduate students of the Hamdard University in Karachi. Compared to non-medical students, medical students were more likely to be concerned that family members of brain-dead patients would be upset if approached for organ donation, and felt that appropriate time for bringing up organ donation would be after the declaration of brain death has taken place. Medical students also considered prolonging life by using human organ transplants more appropriate, and considered organ donation desirable when a patient has been declared brain dead. As demand of human organs for transplantation far exceeds the supply, there is need to better understand the dynamics underpinning positive attitudes towards organ donation, and to improve educational activities by encouraging debate and acceptance of organ donation for saving lives.

10×-Enhanced Heterogeneous Nanocatalysis on a Nanoporous Gold Disk Array with High-Density Hot Spots.

Certain noble metal nanostructures as heterogeneous photocatalysts have drawn significant attention in the recent past because of their unique optical properties which lead to the excitation of localized surface plasmon resonance (LSPR). The LSPR concentrates electromagnetic fields to the surfaces and its relaxation processes can convert photon energy to energetic charge carriers or heat, which can be subsequently harvested to enhance surface catalysis. Here, we report the catalytic performance of a novel plasmonic nanostructure, disk-shaped nanoporous gold (NPG) nanoparticles or simply NPG disks, using a well-tested reduction pathway of resazurin to resorufin. We show that the catalytic reaction rate of NPG disks is enhanced by 10-fold upon external light illumination because of the excitation of LSPR. The plasmon-enhanced catalytic reaction follows a linear-to-superlinear transition in the rate dependence on the input light power. In addition, the light input results in a room temperature reaction rate equivalent to that of an ambient temperature of 70 °C. Together, the results support that hot charge carriers play the dominant role in the enhancement.

Low-Loading of Pt Nanoparticles on 3D Carbon Foam Support for Highly Active and Stable Hydrogen Production.

Minimizing Pt loading is essential for designing cost-effective water electrolyzers and fuel cell systems. Recently, three-dimensional macroporous open-pore electroactive supports have been widely regarded as promising architectures to lower loading amounts of Pt because of its large surface area, easy electrolyte access to Pt sites, and superior gas diffusion properties to accelerate diffusion of H2 bubbles from the Pt surface. However, studies to date have mainly focused on Pt loading on Ni-based 3D open pore supports which are prone to corrosion in highly acidic and alkaline conditions. Here, we investigate electrodeposition of Pt nanoparticles in low-loading amounts on commercially available, inexpensive, 3D carbon foam (CF) support and benchmark their activity and stability for electrolytic hydrogen production. We first elucidate the effect of deposition potential on the Pt nanoparticle size, density and subsequently its coverage on 3D CF. Analysis of the Pt deposit using scanning electron microscopy images reveal that for a given deposition charge density, the particle density increases (with cubic power) and particle size decreases (linearly) with deposition overpotential. A deposition potential of -0.4 V vs. standard calomel electrode (SCE) provided the highest Pt nanoparticle coverage on 3D CF surface. Different loading amounts of Pt (0.0075-0.1 mgPt/cm2) was then deposited on CF at -0.4 V vs. SCE and subsequently studied for its hydrogen evolution reaction (HER) activity in acidic 1M H2SO4 electrolyte. The Pt/CF catalyst with loading amounts as low as 0.06 mgPt/cm2 (10-fold lower than state-of-the-art commercial electrodes) demonstrated a mass activity of 2.6 ampere per milligram Pt at 200 mV overpotential, nearly 6-fold greater than the commercial Pt/C catalyst tested under similar conditions. The 3D architectured electrode also demonstrated excellent stability, showing <7% loss in activity after 60 h of constant current water electrolysis at 100 mA/cm2.

Prevalence of obesity and its risk factors among school children in Karachi, Pakistan.

A cross-sectional questionnaire study was conducted during 2012 in private and public-sector schools of Karachi to determine the prevalence and factors influencing overweight and obesity among school children (aged 11-15 years). Sociodemographic characteristics and dietary habits were explored. The CDC Growth Chart was used to record height and weight. Of a total of 887 children, being overweight and frankly obese was found in 169 (19.1%) and 96 (10.8%), respectively. Of these, 176 (66.4%) were from private schools, and significant associations were found in 202 (76.2%) who were spending > 2 h/day watching television and 139 (52.5%) sleeping > 8 h/day.

Earth-Abundant Tin Sulfide-Based Photocathodes for Solar Hydrogen Production.

Tin-based chalcogenide semiconductors, though attractive materials for photovoltaics, have to date exhibited poor performance and stability for photoelectrochemical applications. Here, a novel strategy is reported to improve performance and stability of tin monosulfide (SnS) nanoplatelet thin films for H2 production in acidic media without any use of sacrificial reagent. P-type SnS nanoplatelet films are coated with the n-CdS buffer layer and the TiO2 passivation layer to form type II heterojunction photocathodes. These photocathodes with subsequent deposition of Pt nanoparticles generate a photovoltage of 300 mV and a photocurrent density of 2.4 mA cm-2 at 0 V versus reversible hydrogen electrode (RHE) for water splitting under simulated visible-light illumination (λ > 500 nm, Pin = 80 mW cm-2). The incident photon-to-current efficiency at 0 V versus RHE for H2 production reach a maximum of 12.7% at 575 nm with internal quantum efficiency of 13.8%. The faradaic efficiency for hydrogen evolution remains close to unity after 6000 s of illumination, confirming the robustness of the heterojunction for solar H2 production.