Analysis of attitudes and practices toward gastroesophageal reflux disease among the general population of Pakistan.

Aim: Gastro-esophageal reflux disease (GERD) is a growing health concern. Methods: In this cross-sectional study, participants' knowledge, attitude and practice toward GERD were assessed using a questionnaire. Results: In our study of 411 participants, 92.5% knew about GERD. Correctly identified risk factors were smoking (62.3%), fatty food (84.2%), spicy food (91.2%) and meal timing (80.8%). Identified symptoms were burning sensation (92.2%) and regurgitation (81.0%). 43.6% of participants were unaware of GERD's complications. Only 46.2% would seek medical advice for feeling full after eating, but 85% would for severe symptoms. 88.7 and 86.8% of participants showed willingness to amend diet and lifestyle. Conclusion: General population has knowledge regarding GERD and its risk factors but poor attitude and practices toward the condition.

What is this summary about?: This summary presents the findings of a survey conducted to gauge people's understanding, attitudes and behaviors concerning gastroesophageal reflux disease (GERD). GERD is a condition involving the movement of stomach contents back into the esophagus or mouth, which can lead to the development of symptoms or complications. Common risk factors associated with the emergence of GERD symptoms, such as heartburn and the regurgitation of stomach contents into the oropharynx, include smoking, consumption of fatty and spicy foods and meal timing. While people are aware of these risk factors and the signs of GERD, many do not take proactive steps to seek medical assistance or make lifestyle changes. The goal of this study is to assess people's knowledge, attitudes and practices regarding GERD. What were the results & what do they mean?: In Pakistan, most people have good knowledge of GERD, but there's still a knowledge gap with important public health implications. Greater awareness and education are needed to improve GERD management and health outcomes for those affected. Who is this article for?: The authors of the original article developed this summary to help patients, caregivers, patient advocates, healthcare professionals, policymakers and insurance providers to understand the results of their study.

Comparing equiosmolar hypertonic saline and mannitol for achieving brain relaxation in elective craniotomy patients: A systematic review and meta-analysis.

Background: This study strives to provide a current and thorough assessment of the comparative efficacy and safety between equiosmolar quantities of hypertonic saline (HS) and mannitol in facilitating brain relaxation for patients undergoing elective craniotomies. Methods: This systematic review and meta-analysis, following preferred reporting items for systematic reviews and meta-analyses guidelines, compared the efficacy and safety of equiosmolar concentrations of mannitol and HS in elective craniotomies. PubMed, Scopus, Cochrane Library, ScienceDirect, and Proquest databases were searched using keywords related to mannitol, HS, and craniotomy. Results were analyzed through a random-effects model using Mantel-Haenszel risk ratio and standard mean difference. P < 0.05 was considered significant. Results: Thirteen randomized controlled trials encompassing 965 patients (516 in the HS group and 448 in the mannitol group) were analyzed. The quality of studies was moderate-to-high, and no significant publication bias was observed. The primary outcome, brain relaxation, favored HS over mannitol without significant heterogeneity. Mannitol was associated with increased urine output compared to HS, irrespective of dose, with high heterogeneity. HS was linked to significantly reduced fluid input, confirmed by subgroup analysis with lower heterogeneity. No significant difference was found in serum osmolality between the two agents. Serum sodium (Na+) levels favored HS, whereas arterial blood Na+ levels also favored HS despite considerable heterogeneity. Maximum mean arterial pressure was higher with HS, but it displayed significant heterogeneity. Maximum central venous pressure showed no significant difference between the two agents, with moderate heterogeneity. Conclusion: HS appears more effective than mannitol in achieving brain relaxation, and it may offer advantages in fluid management and Na+ balance. Clinicians should consider these findings when selecting hyperosmotic agents for neurosurgical procedures. Further research is needed to address heterogeneity in certain outcomes and guide clinical practice.

Relation of Copeptin with Diabetic and Renal Function Markers Among Patients with Diabetes Mellitus Progressing Towards Diabetic Nephropathy.

BACKGROUND: Arginine vasopressin (AVP) plays an important role in the pathophysiology of Diabetes Mellitus (DM) and its related complications like diabetic nephropathy. Copeptin is considered as a reliable surrogate biomarker of AVP. If raised levels of copeptin in diabetic patients are detected earlier, prognosis of DM can be improved by timely modulating the treatment strategy. AIMS OF THE STUDY: The study is therefore planned to assess copeptin levels in different groups of DM and in healthy controls to suggest a better and reliable biomarker for progressive stages of DM. METHODS: Subjects were recruited as controls, pre diabetes, DM without nephropathy and diabetic nephropathy. Serum copeptin levels were measured by ELISA. While, Blood Urea Nitrogen (BUN), creatinine, Glycosylated Hemoglobin (HbA1c) and spot urinary albumin creatinine ratio (UACR) were done using spectrophotometry. Statistical analysis was done using ANOVA and Pearson's correlation tests on SPSS. RESULTS: The average copeptin levels were 215.096 pg/mL. Copeptin levels were significantly elevated in subjects with positive family history of DM (p = 0.025), levels were also raised in pre diabetes kpatients (252.85 pg/mL) as compared to other groups. Copeptin levels were also correlated with HbA1c r = 0.171 (p = 0.101), BUN r = 0.244 (p = 0.007), creatinine r = 0.215 (p = 0.018), UACR r = 0.375 (p = <0.001) and GFR r = 0.215 (p = <0.019). CONCLUSION: The significant correlation of copeptin with diabetic and renal biomarkers, along with its positive association with family history of DM support its' role as an early and reliable biomarker of DM and its associated nephropathy.

Frequency, character and predisposing factor of headache among students of medical college of Karachi.

OBJECTIVE: To evaluate the frequency, predisposing factors and symptomatology of headache among medical students. METHODS: The cross-sectional study was conducted from September to December 2013 and comprised students of two medical colleges of Karachi. International Classification of Headache Disorder-II criterion was used to diagnose and classify headache. SPSS 17 was used for statistical analysis. RESULTS: Of the 413 medical students studies, 326(79%) had tension type headache, and 87 (21%) had migraine. Headache was more frequent among females than males, with a ratio of 6.5:1. Both types of headache were significantly associated with self-reported disturbed sleep pattern, stress and various triggering factors (p<0.05 each). Both types greatly influenced individual's daily life with significant association with avoiding academics, extra-curricular activities, family and friends (p<0.05 each). High self-medication rate of 400(96.9%) was observed. CONCLUSIONS: The prevalence of headache among medical students was high with female predominance. Infrequent consultation needs to be addressed through awareness programmes.

Clinical Presentation and Frequency of Risk Factors in Patients with Breast Carcinoma in Pakistan.

BACKGROUND: Breast cancer is known to be one of the most prevalent cancers among women in both developing and developed countries .The incidence of breast cancer in Pakistan has increased dramatically within the last few years and is the second country after Israel in Asia to have highest proportional cases of breast cancer. However, there are limited data for breast cancer available in the literature from Pakistan. OBJECTIVES: The study was conducted to bring to light the common clinical presentation of breast cancer and to evaluate the frequency of established risk factors in breast carcinoma patients and furthermore to compare the findings between premenopausal and postmenopausal women in Pakistan. MATERIALS AND METHODS: A 6 months (from July 2012 to Dec 2012) cross sectional survey was conducted in Surgical and Oncology Units of Civil Hospital, Karachi. Data were collected though a well developed questionnaire from 105 female patients diagnosed with carcinoma of breast and analyzed using SPSS version 17. Institutional ethical approval was obtained prior to data collection. RESULTS: Out of 105 patients, 43 were premenopausal and 62 were postmenopausal, 99 being married. Mean age at diagnosis was 47.8 ± 12.4 years. A painless lump was the most frequent symptom, notived by 77.1%(n=81). Some 55.2% (n=58) patients had a lump in the right breast and 44.8%(n=47) in the left breast. In the majority of cases, the lump was present in upper outer quadrant 41.9% (n=44). Mean period of delay from appearance of symptoms to consulting a doctor was 5.13 ± 4.8 months, from the shortest 1 month to the longest 36 months. Long delay (> 3 months) was the most frequent figure 41.9%. Considering overall risk factors most frequent were first pregnancy after 20 years of age (41%), physical breast trauma (28.6%), lack of breast feeding(21.9%), and early menarche <11 years (19%), followed by null parity (16.2%), consumption of high fat diet (15.2%), family history of breast cancer or any other cancer in first degree relatives (9.5% and 13.3%, respectively). Some of the less common factors were late menopause >54 years (8.6%), use of oral contraceptive pills (10.5%), use of hormone replacement therapy (4.7%),smoking (4.7%) and radiation (0.96%). Significant differences (p<0.005) were observed between pre and post menopausal women regarding history of physical breast trauma, practice of breast feeding and parity. CONCLUSIONS: A painless lump was the most frequent clinical presentation noted. Overall age at first child > 20 years, physical breast trauma, lack of breast feeding ,early menarche <11 were the most frequent risk factors. Physical breast trauma, lower parity, a trend for less breast feeding had more significant associations with pre-menopausal than post-menopausal onset. Increase opportunity of disease prevention can be obtained through better understanding of clinical presentation and risk factors important in the etiology of breast cancer.

Neonatal resuscitation: a knowledge gap amongst obstetrical trainees. A cross-sectional survey amongst medical graduates of Civil Hospital Karachi.

OBJECTIVE: To evaluate the neonatal resuscitation competence of obstetrical trainees to assess the gap in knowledge and to determine training needs. METHODS: The cross-sectional study was conducted at the Department of Gynaecology and Obstetrics, Civil Hospital, Karachi, from January to March 2013 and comprised House Officers and Postgraduate trainees. A questionnaire was used to test the evaluation skills of different conditions and choice of appropriate action required during neonatal resuscitation. Data was collected and analysed through SPSS 17.0. RESULTS: Of the 102 obstetrical trainees, 44 (43.1%) were House Officers and 58 (56.9%) were Postgraduate trainees with an overall mean age 25.69 +/- 2.3 years. Only 19 (18.6%) subjects cleared the test; 8 (42.1%) of them were House Officers and 11 (57.9%) were Postgraduate trainees. The result did not show any significant difference between those who had previous training or those who had performed neonatal resuscitation and those who had no such exposure. Majority, 92 (90.2%) considered their knowledge inadequate and 99 (97%) favoured that updated neonatal resuscitation programmes should be periodically arranged. CONCLUSION: The study showed inadequate level of knowledge on neonatal resuscitation amongst obstetrical trainees. There is urgent need of formal training programmes which can make doctors skilful enough to face any adverse neonatal outcome professionally.