Perceptions, Practices, and Challenges Regarding Menstrual Hygiene Among Women in Karachi, Pakistan: A Comparison Between General Population and Healthcare Workers.

Background Menstruation is a natural physiological phenomenon, yet considered a stigmatized subject, particularly in low- and middle-income countries like Pakistan. It is seldom discussed openly, leading to flow of incorrect and incomplete knowledge. The resultant unhealthy practices not only affect the health of the menstruator but can also contribute to considerable psychosocial stress. Menstrual hygiene management (MHM) is an important facet, which is associated with a variety of practices and beliefs in different parts of the world, some of which may not be correct. Identifying these poor methods is necessary in order to rectify them. Hence, our study aimed at determining the level of knowledge, beliefs, and practices pertaining to menstruation in the general female populace of Karachi. Healthcare workers have a potential role in the dissemination of authentic knowledge and practices. Therefore, we assessed and compared the accuracy and reliability of the aforementioned parameters in them and the need for an educational intervention. Methods A descriptive, cross-sectional study was conducted on females visiting the Gynecologic and Obstetrics Outpatient Department (OPD), and healthcare workers employed at Dr. Ruth K. M. Pfau Civil Hospital Karachi and Dow University Hospital Ojha. Using non-probability convenience sampling, a self-structured questionnaire was used to collect data from 353 respondents over a duration of three months from October 2019 to January 2020. Data was tabulated in Statistical Package for the Social Sciences (SPSS) version 24.0 (IBM Corp., Armonk, NY, US). In accordance with the objectives of the study, descriptive analysis was performed, and data was presented in the form of frequencies and percentages.  Results Of the 353 participants, 176 were from the general population and 177 were healthcare workers. At menarche, only 28.4% of the general population and 29.4% of healthcare workers had an idea of menses and proper placement of absorbent. Significantly lower number of females from the general population were found to be aware of tampons and menstrual cups (15.9% and 11.4% respectively) as compared to healthcare workers. For both groups, the source of knowledge was mostly their mother. The study showed that 77.8% of the general population and 66.1% of healthcare workers avoided bathing on certain days during menses, with the most common reason being that "it causes irregular flow". As compared to healthcare workers, a significantly higher number of women from the general population had restrictions of activity (53.4%) and avoided washing of groin area during menstruation (31.2%). Majority of women from the general population mentioned that they were scared when they menstruated for the first time. The most common absorbent used by respondents was pads, followed by cloth. The data showed 64.2% of females from the general population and 28.8% of healthcare workers abstained from eating certain foods. Seeking treatment for gynecological issues was not widespread among respondents. Conclusion Our study demonstrated insufficient menstrual knowledge, and consequent incorrect practices in the female population of Karachi. Destigmatizing menstruation and educating women and young girls is indispensable to overcoming this gap. At the same time, reinforcing the availability of MHM products is long overdue and is a crucial milestone towards facilitation of MHM for the women of Pakistan.

Thrombocytapheresis in Patient with Essential Thrombocythemia: A Case Report.

Essential thrombocythemia (ET) is one of the myeloproliferative neoplasms, characterized by persistent thrombocytosis, platelets >450,000/µL, and evident clonal abnormalities like JAK2 V617F, MPL, CALR mutation and not fulfilling WHO criteria for MDS, CML, PV, and IDA. Here we report a 24-year-old female who presented with headache and was found to have thrombocytosis with a platelet count of 2,141 × 103/µL, diagnosed as ET as per WHO criteria 2008; she required ICU admission and thrombocytapheresis with a favorable outcome.

Knowledge, Perception, and Prevention Practices Related to Human Papillomavirus-based Cervical Cancer and Its Socioeconomic Correlates Among Women in Karachi, Pakistan.

Background Cervical carcinoma is a widespread disease of the female genital tract, for which human papillomavirus (HPV) is an utmost risk factor. Of the total global burden, the majority is endured by the developing nations of the world, mainly due to inadequate knowledge regarding the disease and ineffective measures taken for its prevention, early detection, and screening. Hence, our study aimed to determine the level of knowledge, general attitudes and perception, and prevention practices related to HPV-based cervical cancer and its socioeconomic correlates among women in Karachi, Pakistan. Methods A cross-sectional, questionnaire-based study was conducted by approaching 450 females in the out-patient department (OPD) of a tertiary care hospital in Karachi, Pakistan from June 2019 to November 2019. The modified Kuppuswamy socioeconomic scale 2018 was deployed to assess the socioeconomic status of participants, while the knowledge score of the participants was determined based on the original Bloom's cut off point. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 24.0 (IBM Corp., Armonk, NY). Descriptive statistics were used to present the knowledge, attitude, and practice level of respondents. The respondents' knowledge, attitude, and practice scores were compared across socioeconomic and demographic variables using the chi-square test. Results Of the 388 females interviewed, 199 (51.3%) were aware of the term cervical cancer, and 68 (34.2%) knew about Pap smear as a screening test; only 80 (40.2%) women were familiar with HPV vaccination as prophylaxis against cervical cancer. The practice of screening and prevention was found to be remarkably low (2.1% and 1.8% respectively). Socioeconomic status and education level had a significant association with knowledge of cervical cancer. Although around 64% of participants had poor knowledge, 308 (79.4%) demonstrated a favorable attitude as they were willing to know more about screening and preventive practices regarding cervical carcinoma. Conclusion The majority of the participants had insufficient overall knowledge about cervical cancer, HPV, Pap smear test, and HPV vaccination, highlighting the need for mass education through health professionals and media. In addition, the government authorities should provide screening services and vaccination against HPV free of cost to promote early detection of lesions and prophylaxis against this deadly disease.

Survey on Knowledge of First Aid Management of Burns Amongst Medical and Non-medical Students in Karachi, Pakistan: Need for an Educational Intervention?

BACKGROUND: Burn related injuries (BRIs) are relatively common, mostly accidental, and highly preventable forms of injury. First aid management of BRIs can have a significant impact on the outcome and morbidity of these injuries, yet there seems to be an inadequacy in the knowledge related to burn management worldwide. Hence, our study aimed to delineate the level of knowledge and awareness of burn first aid treatment (BFAT) amongst undergraduate students, and the impact training courses had on that knowledge. METHODS: A cross-sectional study was conducted by employing undergraduate medical and non-medical students from various universities of Karachi, Pakistan. By means of convenience sampling, 400 students were sent online, structured questionnaires. The analysis was conducted using Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US), and associations calculated through t-tests. A mean knowledge score was calculated to assess the participant's adequacy of knowledge regarding BFAT. RESULTS: Medical students had a better knowledge score than their non-medical counterparts (5.8 ± 1.6 versus 3.6 ± 1.5, P < 0.01), however, overall knowledge of BFAT remained inadequate amongst participants. Students who received formal training scored a higher mean knowledge score than the majority of students with no training (P < 0.01). CONCLUSION: The majority of students had insufficient overall knowledge about BFAT, highlighting the need for integrating this topic into the curriculum. In addition, education of the masses via multimedia and conducting formal training courses, are both imperative in raising awareness and reducing the occurrence of BRIs.

Insight into the Knowledge, Attitude, Practices, and Barriers Concerning Organ Donation Amongst Undergraduate Students of Pakistan.

BACKGROUND: In Pakistan, thousands are reported dead due to organ failure annually, owing to the huge discrepancy between the number of people waiting for organ donation and the number of organs available. It is imperative that the young generation, the future donor force, comprehends the concept and importance of organ donation. Hence, this study was conducted to assess the knowledge, attitude, and practices regarding organ donation amongst the youth of Pakistan, and to delineate the factors that motivate or demotivate the new generation for organ donation so our future campaigns may be more successful.  Methods: A cross-sectional study was conducted on undergraduate medical and non-medical students from various universities of Karachi, Pakistan. Using convenience sampling, 450 students were sent online, structured, 11-item questionnaires. The analysis was conducted using Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US), and associations calculated through chi-square tests. A knowledge score was calculated to reflect a participant's familiarity with organ donation.  Results: 88.7% of students were familiar with organ donation; however, only 34.6% were willing to donate, and 0.6% had donated an organ. Belonging to a medical university and female gender were associated with higher knowledge scores. 'To save lives' (51.7%) was cited by most students as a factor that would motivate them to donate an organ, while 'Religion' (27.6%) was chosen as the most popular factor that demotivates them. CONCLUSION: Majority of the students had insufficient overall knowledge about organ donation, highlighting the need for inculcating this topic in the curriculum. The differences in knowledge between medical and non-medical students were inconsistent with their practices, indicating that future campaigns should focus on eliminating barriers to organ donation to facilitate an accepting attitude and increased practices with respect to this topic.

Statural Growth and Prevalence of Endocrinopathies in Relation to Liver Iron Content (LIC) in Adult Patients with Beta Thalassemia Major (BTM) and Sickle Cell Disease (SCD).

Despite regular blood transfusion and iron chelation therapy, growth impairment and pubertal delay are commonly seen in children and adolescents with transfusion-dependent Beta thalassaemia major (BTM) and sickle cell disease (SCD). We evaluated growth parameters and endocrine disorders in relation to the liver iron concentration (LIC) assessed by the Ferriscan® method in a cohort of adults with SCD (n =40) and BTM (n = 52) receiving blood transfusions and iron chelation therapy since early childhood. Before transfusion, hemoglobin concentration had not been less than 9 g/dl in the past 12 years; subcutaneous daily desferrioxamine was administered for all of them since early childhood (2- 5 years of age). All patients were shifted to oral therapy with deferasirox iron chelation, 20 mg/daily for the past 5 years. BTM patients with higher LIC (> 15 mg Fe/g dry weight)  had significantly shorter stature, lower insulin-like growth factor-I SDS (IGF-I SDS), higher alanine transferase (ALT) and  serum ferritin concentrations compared to thalassemic patients with lower LIC.  Patients with SCD with LIC > 8 mg Fe/g dry weight had significantly shorter stature, lower IGF-I SDS and higher ALT compared to SCD patients with lower LIC.  Patients with BTM had significantly shorted final height (Ht-SDS) , IGF-I SDS and FT4 level compared to patients with SCD.  LIC and mean fasting blood glucose (FBG) were significantly higher in patients with BTM compared to those with SCD. The linear regression  analysis showed  a significant correlation between LIC and  serum ferritin level in SCD and BTM. LIC and serum ferritin level were also correlated significantly with IGF-I level in patients with BTM. LIC was correlated significantly with ALT in patients with BTM. In conclusion, the prevalence of endocrinopathies especially hypothyroidism, DM, and hypogonadism were significantly higher in BTM patients versus SCD patients and higher in patients with higher LIC versus those with lower LIC. These complications occurred less frequently, but still considerable, in chronically transfused patients with SCD.

Labor management in a patient with von Willebrand disease.

von Willebrand disease (VWD) is an inherited bleeding disorder involving a deficiency or abnormal function of a blood clotting protein called von Willebrand factor (VWF). Deficiency of VWF, therefore, shows primarily in organs with small blood vessels such as the skin, the gastrointestinal tract and the uterus. This case report describes management of a patient presenting with type II von Willebrand disease in labor. She had history of life-threatening hemorrhage from an operation for deviated nasal septum and had a risk of severe postpartum hemorrhage (PPH) within 48 hors of delivery, which was avoided by appropriate planning and timely management.