Pre-Ramadan diabetes risk stratification and patient education

The fast (Sawm) is one of the religious obligations "Pillars" of Islam. The target audience of pre-Ramadan diabetes risk stratification and pre-education are the healthcare providers (particularly the Primary care physicians), diabetic patients and community members including general public. As per IDF-DAR (International Diabetes Federation & Diabetes and Ramadan International Alliance) guideline, it is advisable that healthcare providers should arrange pre-Ramadan session (appointment) at least 6-8 weeks prior to Ramadan quantify/stratify the patient risk category and educate all the diabetic patients on Ramadan aspects of Diabetes Mellitus. Diabetic patients are classified in to three risk groups (very high risk, moderate risk and low risk) based on specific patient characteristics. The physician should estimate the effect of fast on the patient, whether he will be able to fast or not, and the patient will estimate his ability and endurance to fast. The mode of Pre-Ramadan diabetes patient education could be group sessions or one to one consultation. Patient education should include information on risks, glucose monitoring, nutrition, exercise and medication adjustment. Studies have shown that pre-Ramadan counseling reduces the incidence of hypoglycaemia. Altering the drug dosage, dietary counseling and patient education, together with regular blood glucose monitoring enables the patients to fast without major complications. Patients classified as very high/high risk including T1DM and pregnant women with diabetes need close medical supervision and focused Ramadan-specific education if they insist on fasting. With the correct advice and support from healthcare providers most people with T2DM can fast safely during Ramadan.

Parenteral iron therapy in the treatment of iron deficiency anemia during pregnancy: a randomized controlled trial

OBJECTIVE

To compare the efficacy and safety profile of total dose infusion of low molecular weight iron dextran with divided doses of intravenous iron sucrose for the treatment of iron deficiency anemia during pregnancy.

STUDY DESIGN

Randomized controlled trial.

PLACE AND DURATION OF STUDY

Shifa International Hospital, Islamabad, over a period of two years from January 2008 to December 2009.

METHODOLOGY

Pregnant women at gestational age more than 12 weeks with the confirmed diagnosis of Iron Deficiency Anemia (IDA) were divided into two groups. In the group-A, intravenous iron sucrose was given in divided doses while in the group-B, total daily intake of Low Molecular Weight (LMW) of iron dextran was given. Post-infusion Hemoglobin (Hb) was checked at 4 weeks and at the time of delivery for both groups. Paired sample t-test is applied and comparison (in terms of rise in hemoglobin from pre to post) of both groups was not found to be significant.

RESULTS

In the group-A (iron sucrose group), mean pre-infusion Hb levels was 9.09 ± 0.83 gm/dl. Mean increase in Hemoglobin (Hb) was 10.75 ± 1.097 gm/dl after 4 weeks of infusion and 11.06 ± 0.866 gm/dl at delivery (p < 0.001). In group-B (iron dextran group) pre-infusion haemoglobin was 8.735 ± 0.956 gm/dl and the mean increase in hemoglobin was 10.613 ± 1.22 gm/dl at 4-week while mean increase of 10.859 ± 1.11 gm/dl at the time of delivery (p < 0.001).

CONCLUSION

Both LMW iron dextran, as well as iron sucrose are equally effective in treatment of IDA during pregnancy, however, LMW iron dextran has the advantage of single visit treatment.

Smokeless tobacco consumption in a multi-ethnic community in Pakistan: a cross-sectional study

Smokeless tobacco is commonly used in south Asia. In addition to causing oral and pharyngeal cancers, its harmful effects are comparable to smoking tobacco. A cross-sectional survey with systematic sampling was conducted in 2010-2011 to investigate smokeless tobacco use in a multi-ethnic, semi-urban population in Islamabad, Pakistan (n = 2030). The prevalence of smokeless tobacco use was 16.0% (21.6% among males and 8.8% among females); 51.7% of smokeless tobacco users were also cigarette smokers. The rate of smokeless tobacco use was comparatively high among Pakhtun males (38.2%) and Sindhi females (22.4%). The associations between smokeless tobacco use and ethnicity, age group, income level and cigarette smoking were statistically significant among male smokeless tobacco users. Of the sample 41.4% (840/2030) had inadequate knowledge about the health problems associated with smokeless tobacco. Appropriate interventions are needed to raise awareness of the health risks and to prevent smokeless tobacco use.

Public health and the undergraduate medical curriculum: are we preparing physicians for the 21st century?

OBJECTIVE

To investigate the adequacy of the undergraduate medical curriculum in Pakistan to address primary healthcare and public health needs of the community at national level.

METHODS

The cross-sectional study used standardised pilot-tested instruments from January 12 to July 14, 2010. Stratified purposive sampling technique was employed to include public and private-sector medical colleges in the study. A total of 174 faculty members were interviewed at 11 medical colleges. Data entry and analysis was done using SPSS 17.0.

RESULTS

Of the 174 faculty members, 93 (53%) were male. The age of the respondents ranged between 26 and 68 years (Mean: 43 +/- 9 years). Of the participants, 64 (37%) had worked in a primary healthcare facility at some point in their career. Various aspects of maternal, newborn and child health are not covered by the medical curriculum as reported by the faculty members.

CONCLUSION

There is disconnection between academia, primary healthcare providers, policymakers and the regulators. The primary healthcare providers have inadequate representation in the curriculum design. There is a need to re-direct financial resources, medical education, and medical practitioners with a focus on addressing the needs of the rural areas.

Pakistan's health system: performance and prospects after the 18th Constitutional Amendment

Pakistan has undergone massive changes in its federal structure under the 18th Constitutional Amendment. To gain insights that will inform reform plans, we assessed several aspects of health-systems performance in Pakistan. Some improvements were noted in health-systems performance during the past 65 years but key health indicators lag behind those in peer countries. 78·08% of the population pay out of pocket at the point of health care. The private sector provides three-quarters of the health services, and physicians outnumber nurses and midwives by a ratio of about 2:1. Complex governance challenges and underinvestment in health have hampered progress. With devolution of the health mandate, an opportunity has arisen to reform health. The federal government has constitutional responsibility of health information, interprovincial coordination, global health, and health regulation. All other health responsibilities are a provincial mandate. With appropriate policy, institutional, and legislative action within and outside the health system, the existing challenges could be overcome.

Primary health care: what is it and what is it not? Views of teaching faculty at an undergraduate medical college in Pakistan

Over 30 years after the Alma-Ata declaration on primary health care in 1978 there are still misconceptions about the basic concept of primary health care. This study aimed to investigate the knowledge and opinions about various aspects of primary health care and its appropriate implementation among the teaching faculty at Shifa College of Medicine in Islamabad, Pakistan. A structured questionnaire was answered by 70 physicians present at the end of the month seminar. Two-thirds of the doctors (67.1%) believed that primary health care involved only basic health care for common illnesses. Few respondents suggested that community-oriented programmes (4.3%), maternal and child health (2.9%), screening (1.0%) or treatment of noncommunicable diseases (2.9%) should be components of primary care. The concepts to primary health care as defined at Alma-Ata in 1978 were not well understood by teaching faculty from the basic and clinical health sciences in this medical college.

Predictors of depression in patients presenting with dyspeptic symptoms in a GI clinic

BACKGROUND

The association between dyspepsia, H. pylori and psychological distress has remained a topic of intense debate over the past several decades. In Pakistan, where depression is highly prevalent and dyspepsia is possibly present in a high percentage of population, little data exist about these common health problems. This study was conducted to determine the frequency and predictors of depression among patients presenting with dyspeptic symptoms in the Gastrointestinal (GI) Clinic of a tertiary care hospital in Pakistan.

METHODS

Two hundred and sixty-nine consecutive patients were enrolled in the study based on their presenting symptoms in the GI clinic at Shifa International Hospital, Islamabad. Subjects with prior history of peptic ulcer disease (PUD), gallstones and HCV infections were excluded from the study. Demographic and socioeconomic variables as well as dyspeptic symptoms and important causes of dyspeptic symptoms were recorded. Depression was analysed based on the Urdu version of Beck's Depression Inventory-II (BDI-II). The data were analysed using SPSS-10 for univariate and multivariate analyses.

RESULTS

Mild depression was associated with lower education status (p < 0.001), lesser income (p < 0.018), and lower socioeconomic status (0 < 0.009) as well as rural residence (p < 0.026). Smoking, alcohol-use, H. pylori infection, gender and dyspepsia were not found to have any association with depression. On multivariate analysis, education and income group remained significantly associated with mild depression. Clinically significant depression was found to be associated with lower education and rural residence.

CONCLUSION

Depression among dyspeptic patients was found to be associated with socioeconomic status rather than dyspeptic symptoms or important risk factors associated with dyspeptic symptoms.

To determine the probable causes of death in an urban slum community of Pakistan among adults 18 years and above by verbal autopsy

OBJECTIVE

To identify the probable causes of deaths through verbal autopsy and identify the health problems prevalent in underprivileged and marginalized communities.

METHODS

This was a cross-sectional survey conducted at the community of Nurpur Shahan (Urban Slum), Islamabad, Pakistan in January 2010. W.H.O validated questionnaire was used and 300 adults (age > 18 years) were assessed on their knowledge regarding death of their relatives. All data collected was entered into SPSS version 10.0. The data was re-validated and analyzed.

RESULTS

Out of the three hundred deaths, 191(63.7%) were male and 109(36%) were female. One hundred and ninety one (63.7%) deaths were due to heart diseases, 69 (23%) due to accidents and 37 (12.3%) due to unknown causes. One hundred and thirty one of the deceased (43.7%) were issued death certificates.

CONCLUSION

This study concludes that heart diseases are the most common cause of death in the urban slum community followed by accidents. A significant proportion of the deaths went unreported which suggests the need of record keeping of such deaths to enrich epidemiological purposes and health and safety interventions in such communities. Ways and means have to be searched to cater to the cardiac health care needs of the underprivileged and marginalized segments of the society.

Association of passive smoking with respiratory symptoms and clinical correlates, among married women, in a rural community in Islamabad

OBJECTIVE

To investigate the association of passive smoking with respiratory symptoms and clinical correlates in married women in a rural area of Pakistan.

METHOD

A Cross-sectional study was carried out on married women of Nurpur Shahan (rural Islamabad) by means of an Interviewer administered questionnaire. Systematic sampling of households was done. A total of 296 women were surveyed. The study period extended from January to July 2009. All data was entered and analyzed using SPSS v 10.0.

RESULTS

The two major respiratory symptoms that were found to be associated with passive smoking were sinusitis [adjusted O.R(95% CI) 2.2 (1.3 - 3.5), p = 0.001] and cough [adjusted O.R (95% CI) 2.4 (1.2 - 4.8), p = 0.017]. Wood used as fuel for cooking purposes also contributed to one of the symptoms such as headache (p = 0.007). The pulse rate (79 +/- 11 beats/min) of the passive smoking women was statistically significantly higher than the pulse rate (76 +/- 9 beats/min) of the non-passive smoking women (p = 0.012).

CONCLUSION

Passive smoking was found to be associated with respiratory symptoms among married women in this study. Higher pulse rate was associated with passive smoking.

Attitudes and perceived barriers of tertiary level health professionals towards incident reporting in Pakistan

BACKGROUND

A limited framework of incident reporting exists in most of the health care system in Pakistan. This poses a risk to the patient population and therefore there is a need to find the causes behind the lack of such a system in healthcare settings in Pakistan.

AIMS

To determine the attitudes and perceived barriers towards incident reporting among tertiary care health professionals in Pakistan

MATERIALS AND METHODS

The study was done in Shifa International Hospitals and consisted of a questionnaire given to 217 randomly selected doctors and nurses. Mean ± SD of continuous variables and frequency (percentage %) of categorical variables are presented. Chi square statistical analysis was used to test the significance of association among doctors and nurses with various outcome variables (motivators to report, perceived barriers, preferred person to report and patient's outcome that influence reporting behaviors). P value of <0.05 was considered significant. Student doctors and student nurses were not included in the study.

RESULTS

Unlike consultant, registrars, medical officers and nurses (more than 95% are willing to report), only 20% of house officers will report the incident happened through them. Sixty nine percent of doctors and 67% of nurses perceive 'administration sanction' as a common barrier to incident reporting. Sixty percent of doctors and 80% of nurses would prefer reporting to the head of the department.

CONCLUSIONS

By giving immunity from administrative sanction, providing prompt feedback and assurance that the incident reporting will be used to make changes in the system, there is considerable willingness of doctors and nurses to take time out of their busy schedules to submit reports.

Impact of wealth status on health outcomes in Pakistan

Maternal and childhood morbidity and mortality are high in Pakistan and health disparities exist. Multivariate logistic regression analysis of the Pakistan Demographic and Health Survey database 2006-07 was performed. There was an excess of 25 neonatal, 34 infant and 41 under-five deaths per 1000 live births in the poorest quintile of wealth index compared with the richest. Women in the richest quintile had a 35%, 38% and 20% higher probability of getting prenatal care, delivery by skilled provider and emergency obstetric care, respectively. Pakistan needs to enhance social equity so development benefits can accrue to the underprivileged by introducing social protection interventions so that those in the informal sector are not excluded from accessing health care, scaling-up poverty reduction strategies and promoting intersectoral action. This study assesses the independent impact of wealth status, as determined by a validated index, on health outcomes in Pakistan.

Investigating the awareness level about diabetes mellitus and associated factors in Tarlai (rural Islamabad)

OBJECTIVES

To determine the baseline level of awareness amongst a rural community about Diabetes Mellitus (irrespective of type 1 or type 2), its risk factors and complications.

METHODS

This was a cross-sectional survey conducted at the community of Tarlai, Islamabad, Pakistan, in January of 2008. A structured questionnaire was used and 300 adults (age > or = 18 years) were assessed on their knowledge regarding awareness of Diabetes Mellitus, its risk factors and complications. All data collected was entered into SPSS version 10.0. The data was re-validated and analyzed.

RESULTS

Out of the three hundred adults subjected to the survey, only 129 (43%) adults had any awareness of Diabetes Mellitus. Adults with no regular, scheduled exercise were 221 (73.7%) and 256 (85.3%) did not have healthy eating habits. Awareness of risk factors was present in 42 (14%) while awareness of the complications associated with the disease was 65 (22%). Adults which reported as never going for regular checkups to any clinic or hospital were 232 (77%). Family history of diabetes mellitus was statistically significantly associated with awareness about diabetes mellitus (65% vs 32%, p < 0.001), people who were in contact regularly with health care providers were more aware about diabetes and the associated risk factors than those who were not (71% vs 35%, p < 0.001). Sex was not associated (p = 0.28) with awareness about diabetes mellitus, nor was the educational status (p = 0.46).

CONCLUSIONS

Majority of adults were unaware of Diabetes Mellitus itself and associated risk factors. Raising public awareness of the disease through outreach programmes and mass media should be planned and implemented.

The structure and function of a new clinical skills and medical informatics laboratory (SCIL) in a developing country--a two year institutional experience

OBJECTIVE

To combine clinical skills and medical informatics learning by offering a combined 'SCIL' rotation to third year medical students and to determine its long-term impact.

METHODS

A combined clinical skills and medical informatics laboratory (SCIL) was set up at our institution with international collaboration. Nine months to one year after formal third year SCIL rotations were conducted, a questionnaire rated on (1-5) Likert Scale was administered to the inaugural class undergoing this rotation.

RESULTS

The rotation was rated positively in terms of both acquisition of clinical skills as well as medical informatics skills. (overall rotation rating: 3.32 +/- 0.53)

CONCLUSION

Our results have shown the positive long-term impact on undergraduate medical students of a combined clinical skills and medical informatics rotation.

Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding

BACKGROUND AND OBJECTIVES

We compared endometrial sampling by pipelle endometrial curette with conventional dilatation and curettage (D&C) in patients with abnormal uterine bleeding.

METHODS

Endometrial sampling with pipelle curette was performed on 100 patients followed by formal D&C. Samples were labeled as A and B, respectively, and sent to a histopathologist who was blinded as to the method of sampling. The histopathology reports of both samples were compared, taking D&C as the gold standard.

RESULTS

An adequate sample was obtained in 98% of cases by pipelle and in 100% of cases by D&C. Pipelle had a sensitivity, specificity, positive predictive value and negative predictive value of 100% for diagnosing endometrial carcinoma, hyperplasia and secretory endometrium. Pipelle also had high diagnostic sensitivity, specificity and negative predictive value (100%, 98% and 100%, respectively) for hyperplasia with atypia, and low sensitivity (57%) and positive predictive value (57%), but high specificity (97%) and negative predictive value (97%) for endometritis. Similarly, for proliferative endometrium, the pipelle technique had values of 94% and 93% for sensitivity and specificity, respectively. Both samples labeled as inadequate for histology by pipelle were polyps on the D&C report. Difficult endotracheal intubation was encountered in two cases of D&C. No other complications of the procedure were observed.

CONCLUSION

The pipelle is a safe device for getting an adequate endometrial sample for histology, with a high sensitivity and specificity for detection of hyperplasia and malignancy.

Investigating socio-economic-demographic determinants of tobacco use in Rawalpindi, Pakistan

BACKGROUND

To investigate the socio-economic and demographic determinants of tobacco use in Rawalpindi, Pakistan.

METHODS

Cross sectional survey of households (population based) with 2018 respondent (1038 Rural; 980 Urban) was carried out in Rawalpindi (Pakistan) and included males and females 18-65 years of age. Main outcome measure was self reported daily tobacco use.

RESULTS

Overall 16.5% of the study population (33% men and 4.7% women) used tobacco on a daily basis. Modes of tobacco use included cigarette smoking (68.5%), oral tobacco (13.5%), hukka (12%) and cigarette smoking plus oral tobacco (6%). Among those not using tobacco products, 56% were exposed to Environmental tobacco smoke. The adjusted odds ratio of tobacco use for rural residence compared to urban residence was 1.49 (95% CI 1.1 2.0, p value 0.01) and being male as compared to female 12.6 (8.8 18.0, p value 0.001). Illiteracy was significantly associated with tobacco use. Population attributable percentage of tobacco use increases steadily as the gap between no formal Education and level of education widens.

CONCLUSION

There was a positive association between tobacco use and rural area of residence, male gender and low education levels. Low education could be a proxy for low awareness and consumer information on tobacco products. As Public health practitioners we should inform the general public especially the illiterate about the adverse health consequences of tobacco use. Counter advertisement for tobacco use, through mass media particularly radio and television, emphasizing the harmful effects of tobacco on human health is very much needed.

Clinical diagnosis of polycystic ovarian syndrome and response to metformin therapy

OBJECTIVE

To determine the accuracy of diagnosing polycystic ovarian syndrome (PCOS) predominantly on clinical features and the response to metformin therapy.

STUDY DESIGN

Quasi experimental study.

PLACE AND DURATION OF STUDY

Shifa College of medicine and Shifa International Hospital, Islamabad from January 2003 to July 2006.

PATIENTS AND METHODS

Women fulfilling the inclusion criteria (oligo/hypomenorrhea, infertility, weight gain, hyperandrogenism) were enrolled. Ultrasound pelvis was obtained in all women. Presence of eight or more multiple follicles in both or one ovary without presence of mature follicle was the cutoff number for positive ultrasound. Thyroid stimulating hormone levels were performed in all patients, and patients with abnormal levels were excluded from the study. Metformin was adjusted to 500 mg thrice daily. Six months later patients were again evaluated for response to metformin therapy and those who failed to conceive were given clomiphene citrate along with metformin. Fertility was re-evaluated at the end of one year.

RESULTS

At the start of the study, 81% women had menstrual irregularity and 84% had infertility. Hirsutism was seen in 72% while history of weight gain was present in 62% of patients. Ultrasound evidence of polycystic ovaries was seen in 93% of women. After 6 months of metformin therapy, 80% patients had achieved correction in their menstrual irregularity. After 6 months on metformin alone, 51% patients conceived while an additional 20% conceived on both metformin and clomiphene citrate during next 6 months. Overall fertility rate was 71% at the end of one year. There was statistically significant change in pre-treatment and posttreatment BMI.

CONCLUSION

Combination of three or more of the clinical features (irregular cycles, history of weight gain, infertility and hirsutism) provide an appropriate basis for the diagnosis of PCOS. Metformin alone was an effective treatment for PCOS in this series.

Preliminary experience with a new medicine morning report format incorporating multimedia and up-to-date

To determine the impact of multimedia and up-to-date on internal medicine resident learning in morning report (MR), we converted our traditional medicine morning report to 'Up-to-date' programme incorporated and multimedia supported format which includes computer, multimedia projector and up-to-date CD ROM. A questionnaire was administered three months after the change and rated on a Likert scale. Preliminary experience demonstrated of a favourable overall resident and faculty perception and acceptance of the change.

Training in reference management software--a part of new medical informatics workshops in Pakistan

BACKGROUND

Researchers in Pakistan can increase writing productivity, reduce errors in manuscripts and improve quality of their papers by hands-on workshops on bibliographic reference software.

METHODS

A workshop was conducted in an interactive tutorial format using an overhead projector to show screenshots of software at each step. Our Workshop included: starting the Endnote program (www.endnote.com); manually entering a reference of a journal article; searching and importing references from PubMed; inserting a reference in Microsoft Word document in a journal-specific format; essentials of journal article formatting; and the ethics of respecting other peoples of intellectual effort by proper citations and avoiding plagiarism.

RESULTS

A post-workshop test was administered to assess whether instructional objectives were attained. All the participants passed the post-workshop multiple choice questions and 85% rated the workshop as good, very good or excellent.

CONCLUSION

A workshop on reference formatting in research writing is useful to promote high quality research work. We recommend holding workshops twice a year on research article formatting and reference software at medical colleges in Pakistan and other developing countries.

Frequency and antimicrobial susceptibility of aerobic bacterial vaginal isolates

OBJECTIVE

To determine the frequency and antimicrobial susceptibility of aerobic bacterial isolates from high vaginal swab cultures.

DESIGN

Cross-sectional survey.

PLACE AND DURATION OF STUDY

Shifa International Hospital, Islamabad, from January 2003 to February 2004.

PATIENTS AND METHODS

The subjects included 136 symptomatic women attending Obstetrics and Gynecology Out-Patient Department. A proforma was filled to document the demographic details, presenting complaint and examination findings. High vaginal swabs were taken for gram staining, culture and antimicrobial sensitivity testing using standard microbiologic techniques.

RESULTS

Normal flora was isolated in 30% of the cases, followed by Candida spp. (21.3%), Enterococcus spp. (14.7%), E.coli (10.2%), Beta hemolytic Streptococcus spp. (7.3%), Staphylococcus spp. (4.4%), Enterobacter spp. (4.4%), while Streptococcus pyogenes, Staphylococcus epidermidis and Klebsiella spp. were isolated 1.5% each. Enterococcus, Staphylococcus and Streptococcus were mostly sensitive to penicillin and amoxicillin while E.coli and Klebsiella were sensitive to (piperacillin-Tazobactum, Imipenem and vancomycin. Enterococci species showed significant resistance to aminoglycoside antibiotics (68.8% to 81.3%) resistance to vancomycin was 5%.

CONCLUSION

Thirty percent of symptomatic patients had normal flora on culture. Candida spp was the most frequent pathogen isolated. Co-amoxiclav should be used as empiric therapy until culture-sensitivity report is available.

Risk factors for hepatitis C virus infection in patients on long-term hemodialysis

OBJECTIVE

To estimate the frequency of hepatitis C virus (HCV) infection in patients on hemodialysis at Shifa International Hospital and determine the association of various risk factors in the acquisition of hepatitis C infection.

DESIGN

A cross-sectional analytical study.

PLACE AND DURATION OF STUDY

Shifa International Hospital from January 2002 to June 2003. patients and

METHODS

All patients on long-term hemodialysis in Nephrology Unit of Shifa International Hospital were studied. Their medical records were reviewed for the presence of anti-HCV in all patients. Any risk factors were noted from the patient's records and from the history of those patients who were regularly attending the dialysis unit.

RESULTS

A total of 97 patients on hemodialysis were included. Out of these, 23 (23.7%) were found to be anti-HCV positive. The mean age of HCV positive patients was 55.2+/-15.5 years while for the anti-HCV negative patients it was 54.9+/-15.1 years. There were 18 (78.3%) males in the HCV positive group while 46 (62.2%) males in the HCV negative group. The mean duration of dialysis among HCV positive patients was 2.9+/-2.7 years while the mean duration of dialysis in HCV negative patients was 1.51+/-0.86 years (p-value 0.000). Anti-HCV positive group had significantly greater proportion of patients with a history of dialysis more than 2 years (43.5% vs 9.5%), adjusted odds ratio being 0.45 (95% CI 0.27-0.75). No significant difference in other risk factors between the two groups was found. When years of dialysis were treated as categorical variable, significant difference between the anti-HCV positive and negative groups was found. The risk of getting HCV was found to be significantly associated with increasing years of dialysis, (adjusted p-value 0.002).

CONCLUSION

Patients on hemodialysis in our unit had 23.7% positivity of anti-HCV and history of dialysis over more than 2 years was noted to be a significant risk factor for acquisition of infection in these patients.

Treatment of chronic hepatitis B with lamivudine

OBJECTIVE

To study the efficacy of antiviral drug lamivudine for treatment of chronic hepatitis B in Pakistani population.

DESIGN

Experimental study.

PLACE AND DURATION OF STUDY

A tertiary Care Center, from January 2000 to January 2004.

PATIENTS AND METHODS

Patients who had positive hepatitis B surface antigen (HBsAg) and elevated ALT were recruited. Both hepatitis Be antigen (HBeAg) positive and HBeAg negative patients were included. Treatment was given with lamivudine 100mg once a day for 12 months and they were followed every 2-3 months with ALT, HBeAg, and in certain cases with, HBV DNA (PCR). Those patients who were HBeAg positive were considered to have achieved end of treatment response (ETR) when ALT was normal and HBeAg was negative and this was documented at two consecutive occasions, at least one month apart. Those patients who were HBeAg negative were considered to have achieved ETR when their ALT was normal and HBV DNA was undetectable. Patients were followed for further 6 months to evaluate for any relapse.

RESULTS

A total of 105 patients were included. Eighty-two (78.1%) were males and 23 (21.9%) were females. Mean ALT of all patients was 87.15 +/- 46.01 u/dl. Seventy-two HBeAg positive and 15 HBeAg negative patients completed treatment with 23.6 % and 80.0 % response rate respectively (p <0.001).

CONCLUSION

The response of lamivudine in chronic hepatitis B in Pakistani population is encouraging in HBeAg negative patients but is rather low in those who are HBeAg positive.

Knowledge of type 2 diabetic patients about their illness: pilot project

OBJECTIVE

To evaluate the baseline level of knowledge and awareness of diabetic patients about their disease and it's complications.

METHODS

It was a Cross Sectional Survey conducted at Foundation Clinic, Shifa College of Medicine, Islamabad, in April 2004. A structured questionnaire was used. Forty diabetic patients were interviewed to know their knowledge attitude and practices about diabetes. All data was entered into SPSS version 10.0. The data was re-validated and analyzed.

RESULTS

Mean age of study participants was 45.35 +/- 13.05 years, 11(27.5%) were male and 29(72.5%) were female. The mean BMI of the study participants was 27.06 +/- 6.29 kg/m2. Majority of the patients 27(67.5%) had type 2 diabetes. The mean fasting blood sugar was 159 +/- 73.89 mg/dl and random blood sugar was 200 +/- 91.2 mg/dl, 50% of the patients were using antidiabetic drugs regularly and only 15% of the patients were regularly monitoring their blood glucose at home using a glucometer. Awareness level of the study participants was low.

CONCLUSION

The awareness about the disease in majority of diabetic patients was not adequate in this study. Routine individual teaching and counseling represents an effective educational model.

Comparative study of knowledge, attitude and practices among antenatal care facilities utilizing and non-utilizing women

OBJECTIVE

To compare the knowledge, attitude and practices among antenatal care facilities utilizing and non-utilizing women, aged 15-49 years.

METHODS

A Cross-sectional survey was conducted between October 2003 and April 2004, including 200 married women in the age range 15-49 years. Knowledge, attitude and practices of women utilizing and not utilizing antenatal care facilities during their previous pregnancy were compared by calculating odds ratios and 95% confidence intervals. P values were obtained by doing chi-square test.

RESULTS

Pallor was significantly lower among women utilizing antenatal care (57%) as compared to those who were not (77.6%). (O.R 0.38 95% CI(0.18-0.81) p value 0.02). Tetanus toxoid coverage was higher among women utilizing antenatal care (92%) compared to those who were not (59.2%) (O.R 10.8 95% CI(4.5-26.2). Knowledge about danger signals in pregnancy and realization of the importance of eating a healthy diet during pregnancy was significantly higher among women utilizing antenatal care.

CONCLUSION

Lesser prevalence of Anaemia and better tetanus toxoid coverage was seen among women attending antenatal care facilities. Identification of danger signals in pregnancy and recognition of nutritional demands of pregnancy are better understood by women utilizing antenatal care facilities.

Temperature regulation and standardization practices of clinical laboratories in Karachi

OBJECTIVE

To examine the temperature regulation and standardization practices of clinical laboratories in Karachi.

METHOD

Forty five clinical laboratories in Karachi were examined for observing the standard protocols for running a lab with particular reference to temperature regulation. A questionnaire to the effect was filled.

RESULTS

Among the 45 labs included, the mean complete blood count performed per day was 52+/-47. Only 5 (11%) labs had a temperature reader. Thirty (66.7%) labs had an air-conditioner installed, of which only 24 were found in working condition. Maintenance of instruments was carried out every 67.5+/-.30.6 days. The mean number of haemolyzed samples was 2.3+/-1.7. Control was available in 24(53.3%) labs, which was used daily in only 10 labs. Quantity of blood was the same in all the tubes in only 33(73.3%) labs.

CONCLUSION

Commercial laboratories should be properly registered and their quality standardized.