Showing papers in "Journal of Pakistan Medical Association in 2013"

Effectiveness of Aloe Vera gel compared with 1% silver sulphadiazine cream as burn wound dressing in second degree burns

Abstract: Objective To assess the efficacy of Aloe Vera gel compared with 1% silver sulfadiazine cream as a burn dressing for the treatment of superficial and partial thickness burns. Methods This Interventional Comparative study was carried out at the Burn unit and Plastic surgery department, Nishtar Hospital Multan, Pakistan from July 2008 to December 2010. A total of 50 patients with superficial and partial thickness burns were divided into two equal groups randomly by consecutive sampling method, one group was dressed with Aloe Vera gel while the other was treated with 1% silversulphadiazine cream, and the results regarding duration of wound epithelialization, pain relief and cost of treatment were compared. Results In patients treated with Aloe Vera gel, healing of burn wounds were remarkably early than those patients treated with 1% silver sulfadiazine. All the patients of Aloe Vera group were relieved of pain earlier than those patients who were treated with SSD. Conclusion Thermal burns patients dressed with Aloe Vera gel showed advantage compared to those dressed with SSD regarding early wound epithelialization, earlier pain relief and cost-effectiveness.

Role of probiotics in health and disease: a review.

Abstract: For some decades now, bacteria known as probiotics have been added to various foods because of their beneficial effects for human health. The mechanism of action of probiotics is related to their ability to compete with pathogenic microorganisms for adhesion sites, to antagonize these pathogens or to modulate the host's immune response. The potential application of probiotics includes prevention and treatment of various health conditions and diseases such as gastrointestinal infections, inflammatory bowel disease, lactose intolerance, allergies, urogenital infections, cystic fibrosis, various cancers, reduction of antibiotic side effects, in oral health such as prevention of dental caries, periodontal diseases and oral malodour and many other effects which are under investigation. The results of many of these clinical investigations suggests that probiotics may be useful in preventing and treating various health conditions and diseases. However, many of these clinical studies require validation so as to apply these results to clinical realm. The role of clinical trials is instrumental in such investigations and in near future the results of such trials will decide the usefulness of probiotics in health and disease. This article strives to summarize the currently available data on the potential benefits of probiotics in health and disease.

Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre.

Abstract: Objective To observe the prevalence of anxiety and depression in chronic low back pain population at a tertiary care centre Methods The prospective cross-sectional study was conducted using convenience sampling at the Department of Neurosurgery, at Liaquat National Hospital, Karachi, Pakistan, from January to June 2010 The prevalence of anxiety and depression in chronic low back pain patients was studied according to specified age and gender groups using Hospital Anxiety and Depression Scale Results Of the 140 patients in the study, 66 (4714%) were females and 74 (5285%) were malesThe average age of the patients was 4302+/-1334 years The average duration of symptoms was 429+/-33 years Abnormal level of anxiety and depression were found in 77 (55%) and 68 (4857%) patients respectively Out of them 54 (385%) and 51 (364%) were borderline abnormal for anxiety and depression respectively, while 23 (164%) and 17 (121%) were abnormal for anxiety and depression respectively Among the males, there were 20 (1428%) and 23 (1642%) patients with abnormal levels of the corresponding numbers among the females were 57 (4071%) and 45 (3214%) There was a significant association in anxiety (p 005) Conclusion Individuals with chronic low back pain were at high risk to experience anxiety and depressionThis risk was higher for females

Treating cancer with heat: hyperthermia as promising strategy to enhance apoptosis.

Abstract: The fundamental idea and the effects of heat on cancer cells are well known. However, the results obtained in therapy by hyperthermia (HT) alone have been only partially satisfactory. Treatment at temperatures between .40 and 44 degrees C is cytotoxic for cells in an environment with a low oxygen partial pressure and low pH, conditions that are found specifically within tumour tissue, due to insufficient blood perfusion. Under such conditions radiotherapy is less effective, and systemically applied cytotoxic agents will reach such areas in lower concentrations than in well-perfused areas. Therefore, clinically, it is preferred to use hyperthermia in combination with radiation therapy and chemotherapy. Hyperthermia can be applied by several methods: local hyperthermia by external or internal energy sources; regional hyperthermia by perfusion of organs or limbs, or by irrigation of body cavities; and whole-body hyperthermia. Number of studies have reported the combination of thermo-radiotherapy. Consequently, much attention has been focussed on identifying agents among the conventional chemotherapeutic substances that can sensitise tumour cells to hyperthermia-induced damage with minimal effects on normal cells. In this review, we overviewed important mechanisms of hyperthermia-induced apoptosis and the substances which can act as heat sensitisers in cancer therapy.

Anatomical variations of nose and para-nasal sinuses; CT scan review.

Abstract: Objective: To determine the frequency of anatomic variations on computed tomography scan of para-nasal sinuses. Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised computed tomography scans of 77 patients who had presented between October 2007 and March 2011. All the scans were reviewed using Picture Archiving Communication System computer software. The scans were reviewed for the presence of deviated nasal septum, paradoxical middle turbinate, Haller cell, Onodi cell, and pneumatisation of the middle turbinate and uncinate process. Results: The mean age of the patients was 31±13.15 years. One or more types of anatomical variants were observed in 40 (51.9%) of the patients; the most frequent being the deviated nasal septum 20 (26%) and the Concha bullosa 14 (18.2%).

The effect of ginger for relieving of primary dysmenorrhoea.

Abstract: Objective To assess the effectiveness of ginger in providing relief to patients of primary dysmenorrhoea. Methods The clinical trial was conducted at Toyserkan Azad University in western Iran from July 10 to September 5, 2010. It comprised of 70 female students of the university with primary dysmenorrhoea.The subjects were randomly divided in to two equal groups and were given either placebo or ginger in capsule form for 3 days in first menstruation cycles. They graded the severity of their pain using a visual analogue scale. A 5-point Likert scale was used to assess response to treatment. Wilcoxor's rank-sum test was used to compare the severity of pain in the two groups. Results Compared with the baseline, the decrease in the visual analogue scores of post-therapy pain in the ginger group was significantly greater than that for placebo group. In the ginger group, 29 (82.85%) subjects reported an improvement in nausea symptoms, compared with 16 (47.05%) in the placebo group. Conclusion Ginger is effective in minimising the pain severity in primary dysmenorrhoea.

Semen analysis parameters: experiences and insight into male infertility at a tertiary care hospital in Punjab.

Abstract: Objective To determine the prevalence of low sperm count including oligospermia and azoospermia in male infertile population, and to assess the pattern and distribution of abnormal semen parameters in infertile men. Methods The descriptive cross-sectional survey was carried out at the Department of Gynaecology and Obstetrics, Sharif Medical City Hospital, Lahore, from June 2009 to June 2010. A total of 500 consecutively consenting male partners of women fulfilling the inclusion criteria between 20 and 40 years of age were approached. Semen analysis was performed according to methods and standards defined by the World Health Organisation (WHO). Samples were categorised into normospermia, oligospermia and azoospermia on the basis of sperm count. After exclusion of azoospermic samples, normospermic and oligospermic samples were compared for ejaculated volume, pus cells, motility and morphology. SPSS 10 was used for statistical analysis. Results Out of the 500 males approached, 104 (20.8%) had to be left out either because of their unwillingness or inability to pass semen. The study sample comprised of 396 (response rate 79.2%); normospermia was observed in 293 (73.99%) males, azoospermia in 59 (14.89%), and oligospermia in 44 (11.11%). The oligospermic samples had low ejaculated volume, but significantly higher percentage of non-motile sperms 62% +/- 23.9% and abnormal morphology 55% +/- 15.6% in comparison to normospermic samples (p 0.0001). Asthenospermia was observed in 37 (25.81%), teratospermia in 11 (3.26%) and oligoasthenoteratospermia in 4 (9.09%) of samples. Conclusion Semen analysis is the cornerstone for the evaluation of infertility in men. Sperm concentration, motility and morphology are related to each other, factors that cause deterioration of one of them usually also have negative impact on the other two as well.

Is depression an inflammatory condition? A review of available evidence.

Abstract: The current review examines the relationship between depression and the inflammatory immune response. Mood disorders are a significant cause of morbidity and the etiology of depression is still not clearly understood. Many studies have shown links between inflammatory cytokines and mood disorders, including elevated level of cytokines like tumour necrosis factor-alpha (TNF alpha), Interleukins (IL-1,IL-6) and others. Raised levels of cytokines have been shown to increase depressive behaviour in animal models, while many anti-depressants reverse this behaviour alongside reducing the Central Nervous System (CNS) inflammatory response and reduction in the amounts of inflammatory cytokines. Cytokines reduce neurogenesis, Brain Derived Neurotrophic Factor (BDNF) and neuronal plasticity in the CNS, while many anti-depressants have been shown to reverse these processes. The considerations of anti-depressants as anti-inflammatory agents, and implication of other anti-inflammatory therapeutics for the treatment of depression are pointed out.

Antenatal depression: prevalence and risk factors in a hospital based Turkish sample.

Abstract: Objective To assess the prevalence and associated risk factors for antenatal depression. Methods From April to September 2011, a total of 651 pregnant women who had no chronic diseases, were at low risk for obstetric complications and who had no diagnosed depression before pregnancy were recruited for interview at Merkez Efendi Hospital, Maternal and Child out-patient department in western Turkey. The evaluation of depression was scored according to the Beck Depression Inventory. Statistical analysis was carried out using Chi-square, Fisher exact, t test and stepwise multiple regression analyses. Result Of the total, 71 (10.9%) women scored > or = 17 on the inventory. Low level of education, unplanned pregnancy, lack of social support and pregnancy-related physical symptoms were found to be the most important risk factors for antenatal depression. Conclusion Early identification and treatment of antenatal depression may improve pregnancy outcomes, and healthcare providers need to be sensitive to the risk factors for depression and strengthen the women's skills in coping with stress to improve their emotional health.

Pattern of illicit drug use in patients referred to addiction treatment centres in Birjand, Eastern Iran.

Abstract: Objective: To evaluate the pattern of use of opioid and other illegal drugs in patients seeking addiction treatment in Birjand, eastern Iran. Methods: The prospective study was conducted from March 21, 2009 to March 21, 2010, and comprised all patients referred to the seven addiction treatment centres in Birjand. Data was obtained through pre-designed questionnaires and it was analysed using SPSS 16. Results: Of the 700 substance users referred to the 7 centres and who volunteered to participate, 632 (90.3%) were males and 68 (9.7%) were females. The male/female ratio was ~ 9.3/1. Mean age was 34±10.2 (range: 10-75) years. The type of drugs used included traditional drugs (n= 342; 48.9%) and newer modern drugs (n=314; 44.9 %). The mean age of the first experience with drugs was 21.91±7.1 (range=0-60) years. There was significant different between the type of drugs used and the place of residence (p<0.019), age (p<0.0001), martial status (p<0.0001), occupation (p<0.006) and education (p<0.017). Conclusion: The prevalence of illicit drug addiction was quite high. There seemed to have been a change in the pattern of drug use and in the type of illegal drugs used in the study area, from traditional drugs to new and modern drugs. As such, identifying risk factors related to addiction and the prevention of addiction should be one of the most important health priorities for the authorities.

Routine parathyroid autotransplantation during total thyroidectomy: a procedure with predictable outcome.

Abstract: Objective To compare parathyroid gland autotransplantation with parathyroid gland preservation in situ with respect to the preservation of parathyroid gland function in patients undergoing total thyroidectomy. Methods The quasi-experimental study was performed from July 1998 to June 2009 at the Khyber Teaching Hospital, Peshawar, Pakistan. A total of 388 patients underwent total thyroidectomy for a variety of thyroid gland disorders. They were divided into two groups; 97 patients in Group A had parathyroid glands preserved in situ, while 291 patients in Group B had at least one parathyroid gland autotransplanted in ipsilateral sternocleidomastoid muscle. Both groups were followed for six months for the assessment of parathyroid function. Fisher's exact test was used for comparison between the two groups. Results The mean age of Group A was 42.46 +/- 15.30 years, while in Group B it was 39.16 +/- 18.91 years. Overall male-to-female ratio was 1:3.5. In Group A, 3 (3.09%) patients developed permanent hypocalcaemia while in Group B only 1 (0.34%) patient developed permanent hypocalcaemia. Conclusion Autotransplantation of at least one parathyroid gland after total thyroidectomy is a procedure with predictable outcome associated with minimal risk of permanent hypoparathyroidism.

A survey of energy-drink consumption among medical students.

Abstract: Objective To determine the frequency and pattern of energy drink consumption among medical school students, their knowledge of its effects and side effects and to see its relation with alcohol and cigarette usage. Method The descriptive analytical study was conducted at Marmara University Medical School, Istanbul, Turkey from October 2011 and January 2012. A semi-structured questionnaire was filled by students who were asked about their socio-demographic status and their energy drink consumption. SPSS 12 was used for statistical analysis. Results The mean age of the 390 students in the study was 20.98+/-1.96 years (range:16-27). Of them, 204 (52.3%) were females and 186 (47.7%) were males. Overall 52(13.3%) were smoking regularly at least one cigarette per day; 122(31.3%) were consuming alcohol; 127 (32.6%) had consumed energy drinks at least once and 73(18.8%)more than once. In terms of perception, 110(28.2%) students said energy drinks were similar to sports drinks, while only 121(41.1%) named the brands correctly; 96 (24.6%) students did not answer this particular question. Conclusion Although consumption of energy drinks was common among medical students, the knowledge of ingredients and knowledge of health risks of energy drinks among them was unsatisfactory.

Childhood acute lymphoblastic leukaemia: experience from a single tertiary care facility of Pakistan.

Abstract: Objective To evaluate the demographic features, outcome and prognostic factors seen in children with acute lymphoplastic leukaemia at a tertiary care hospital. Methods The retrospective descriptive study was conducted at Aga Khan University Hospital, Karachi, comprising data related to children below 15 years of age and treated between January 1997 and December 2006. Kaplan Meir survival curves were used to describe overall and event-free survival rates. Cox Proportional Hazards model was used to describe factors associated with death and relapse. SPSS 16 was the main statistical tool. Results Of the total 121 children diagnosed with the condition, 79 (65.3%) were males; 86 (71.1%) patients were between 1-9 years of age; Immunophenotyping was done in 99 (81.81%) patients: 86 (87%) cases had precursor B and 13 (13.13%) had precursor T. Of the total, 106 (87.6%) patients opted for treatment, while 15 (11.6%) were lost to follow-up. Besides, 26 (21.7%) patients had at least one relapse; the most common site being bone marrow in 13 (50%) followed by central nervous system in 9 (36.6%). There were 20 (16.5%) deaths in the sample. Infection was the most frequent cause of death. The event-free survival and overall survival was 63% (n = 76) and 65% (n = 79) respectively. Conclusion Through the clinical characteristics of children with acute lymphoblastic leukamia were similar to those reported in literature, the outcomes were inferior. The high rate of infections and relapse warrant better supportive care and risk-based approach.

Anti hepatitis E virus seropositivity in a group of male blood donors in Makkah, Saudi Arabia.

Abstract: OBJECTIVES To determine the seropositivity of Immunoglobulin-G and Immunoglobulin-M to hepatitis E virus in male blood donors in Makkah, Saudi Arabia. METHODS The study was carried out from March to August 2009, in which 900 blood samples were collected from 4 different hospital blood banks in Makkah City: AL-Noor Hospital, Central Blood Bank, Maternity and Children Hospital, and Herra Hospital. All the samples were tested for Immunoglobulin-G and Immunoglobulin-M antibodies specific to hepatitis E virus using the enzyme-linked immunosorbent assay test. RESULTS Hepatitis E virus-specific Immunoglobulin-G antibodies were detected in 168/900 (18.7%), and IgM in 39/900 (4.3%) samples. Prevalence of the former was found to be higher in non-Saudi donors. In addition, its prevalence increased with age. Moreover, its prevalence was found to be higher in uneducated donors and in donors who drank well-water. CONCLUSION Exposure to hepatitis E virus among blood donors in Makkah City was high in comparison to the neighbouring areas in the region. Further studies are warranted to determine the true seroprevalence of the virus in the society at large.

Colorectal cancer in younger population: our experience.

Abstract: OBJECTIVE To promote awareness regarding increased occurrence of colorectal cancer in younger population and its clinicopathological features compared to older patients. METHODS The cross-sectional study was conducted from February 2010 to January 2011 on patients with diagnosis of colorectal carcinoma admitted through emergency or outpatients' departments to Surgical Unit 5, Civil Hospital, Karachi. Data regarding age, gender, presentation, site of tumour, surgery performed and Dukes staging was collected and analysed. RESULTS A total of 23 patients were operated during the study period: 13 (56.52%) males and 10 (43.47%) females. Of them 12 (52.17%) were below the age of 40 years, while 3 (13.04%) patients were in the 11-20 age group. In 7 (30.4%) patients, tumour was irresectable at the time of presentation so a palliative procedure (diversion colostomy or ileostomy) was performed.There was a higher proportion of younger patients with metastatic disease at the time of presentation (n = 9; 75%) while 10 out of 12 patients in the younger age group (83.3%) had a tumour of left colon, particularly rectum. CONCLUSION Although colorectal cancer is usually a disease of older patients, it is increasingly becoming more common in younger population. Data suggests a leftward distribution for colorectal carcinoma and that younger patients present with more advanced disease and poorer prognosis.

Gastric pathophysiological ins and outs of helicobacter pylori: a review.

Abstract: Helicobacter pylori infection induces chronic gastritis, peptic ulcer disease, gastric cancer and a number of related extragastric morbidities. Hence, it is now recognised as a worldwide problem. Although clinical outcomes are dependent upon bacterial virulence factors, host genetic diversity and environment, but the major focus of this review is on recent findings relevant to bacterial factors and gastric pathophysiology of H. pylori infection. This article presents a review of the published literature mainly from year 2000 to 2012. The topics of main concerns were bacterial virulent factors and the inflammatory response to H. pylori infection. The authors used MeSH terms "Helicobacter" with "pathophysiology," "pathogenesis," or "gastric inflammation" to search the PubMed database. All relevant studies identified were included and are described according to the aforementioned subheadings.

Assessing the Objective Structured Clinical Examination: Saudi family medicine undergraduate medical students' perceptions of the tool.

Abstract: OBJECTIVES To assess the perception and opinion of the medical students about Obejective Structured Clinical Examination. METHOD The descriptive study was conducted at King Saud University College of Medicine, Riyadh, Saudi Arabia, from March to May 2010. Total population sampling, which is a type of purposive sampling technique, was used. A structured pre-tested questionnaire was circulated among the undergraduate medical students doing Family Medicine clerkship immediately at the end of Objective Structured Clinical Examination. RESULTS Of the 97 questionnaires distributed, 95 (98%) were received. A number of positive aspects of the OSCE exam were identified by students such as 63 (66%) felt that it provided practical and useful experience; 63 (66%) perceived as having a positive impact on student learning; 62 (65%) stated it is a standardised exam; 53 (56%) felt that it should be used more often in undergraduate assessment; 54 (57%) stated that it evaluated a wide variety of clinical skills; 50 (53%) stated that the format allowed students to compensate for deficiency in some areas; 49 (52%) were of the opinion that the exam was fair; 45 (47%) preferred it over other forms of assessment; 39 (41%) perceived exam scores to be truly reflective of competence in clinical skills; and 34 (35%) felt that the format minimises chances of failure. Also, 46 (48% found it to be stressful, and 38 (40%) found it not easy. CONCLUSIONS Overall, the Objective Structured Clinical Examination was perceived very positively and welcomed by the undergraduate family medicine students. Certain negative perceptions such as stress and difficulty were also highlighted, which could be managed through better orientation and preparation of the students.

Assessment of stress among physiotherapy students at Riphah Centre of Rehabilitation Sciences.

Abstract: OBJECTIVE To assess stress and psychological morbidity in undergraduate students of physiotherapy at Riphah Centre of Rehabilitation Sciences (RCRS). METHODS A cross-sectional study was conducted from 2008 to 2010 at RCRS. Two hundred and thirty one students from first semester to fourth semester were included in the study. The data was collected through a semi-structured proforma and the Student Life Stress Inventory (SLSI) scale. Data was analysed by applying t-test and ANOVA with SPSS version 17. RESULTS Two hundred and three respondents (88%) reported feeling stressed: 97(42%) students were mildly stressed, 92(40%) were moderately stressed, and 14 (6%) were severely stressed. Significant gender differences were found on the total score of stress, stressors and reactions. The findings revealed that females face more stressors especially pressures (p<0.001), physiological, emotional (p<0.01) and behavioural (p<0.05). An analysis of variance on SLSI is significant, F = 3.747 (p<.05). Mean difference indicates that prevalence of stress is higher in 4th semester RCRS students. CONCLUSION The findings reveal the higher level of stress in undergraduate physiotherapy students. The high psychological morbidity necessitates the need for interventions like counseling and psychological support to improve the quality of life for these allied health care professionals.

Health and spirituality 'walk along' in wellness journey of medical students.

Abstract: OBJECTIVE To assess and compare knowledge, attitudes and practices of male and female medical students of Karachi in the context of physical, emotional and spiritual wellness. METHODS The cross-sectional questionnaire-based survey was conducted from January to December 2010, comprising randomly selected 800 male/female medical students in eight medical colleges of Karachi. The responses--'never,' 'sometimes,' 'mostly' and 'always' (numbered 0-4 )--were analysed in terms of frequency, proportion and percentages by Predictive Analysis Software (PASW) version 18. Chi-square test was applied for comparison of categorical aspects of wellness, and results were declared significant at p < 0.05. RESULTS Of the 800 questionnaires, 736 (92%) fully-completed questionnaires comprised the study universe. According to the survey, 503 (68.37%), 504 (68.45%) and 658 (89.35%) medical students were aware of the concept of physical, emotional and spiritual wellness respectively. Males had greater involvement in physical activity (p < 0.001), while females selected healthy diet (p < 0.03). The dimensions of physical and emotional wellness on an aggregate did not differ significantly in both genders, but knowledge and practices of spiritual wellness in females gave them direction to face episodes of anxiety for which males had to take help from mentors and psychologists (p < 0.034, p < 0.0001). CONCLUSION Spirituality, the key success factor in better wellness management, was found to be greater among female medical students.

The relationship between menarche age and anthropometric indices of girls in Sabzevar, Iran.

Abstract: Objective: To determine the relationship between anthropometric indices and the age of menarche in female students of Sabzevar, Iran. Methods: The cross-sectional study was conducted in Sabzevar, Iran, from April to September 2010, and involved girls of 11-18 years of age. The required sample size for analysing the relationship between menarche age and Body Mass Index was estimated to be 110 by correlation coefficient and Cox survival regression model and by using the NCSSPASS software. The study had 130 students who were selected by multi-stage probability sampling. Relevant data were collected through a questionnaire as well as by measuring the anthropometric indices such as height, weight etc. Analysis of data was done by independent t-test, Pearson's correlation coefficient, Chi-square, Kaplan- Meier and Cox survival regression model using SPSS 15. Results: The mean menarche age was 12.5±1.4 years. Mean body mass index, weight and height of the menstruated girls were higher and significant than the corresponding figures of the non-menstruated girls. The correlation coefficient showed a significantly negative relation between body mass index and menarche age (r=-0.221, p=0.025), but correlation between menarche age and height or weight was not significant. Menarche occurrence rate was significantly higher in overweight girls than girls with normal weight. Menarche occurrence rate in girls with low weight was lower than those of normal weight. Conclusion: The menarche age and body mass index are significantly related; the higher body mass index, the lower was the menarche age, resulting in a higher menarche occurrence rate.

Family planning and contraception in Islamic countries: a critical review of the literature.

Abstract: Introduction: The population of the world reached seven billion in 2012. Pakistan's population stands at more than 180 million, is growing rapidly, and has the highest unmet need for family planning (FP) in isolated rural areas. The low usage of contraception in the rural areas of Pakistan correlates with the level of isolation, poverty, illiteracy, and to a large extent, religious misinterpretations/misconceptions. Almost 25% of couples who desired FP services were not receiving them for a variety of reasons of which religion could be one, especially in the rural remote areas where the media is still not reaching and influencing mind-sets. In this scenario, the role of social marketing in bringing about attitudinal and behavioural change among users in underserved areas and gatekeepers and opinion makers in society must not be neglected. The work in promoting FP, contraception and birth spacing requires authentic evidence from similar sociocultural contexts and this endeavour of compiling case studies from various Islamic countries on their FP initiatives is a good step. Governments around the world, including many in the Islamic world, support FP programmes to enable individuals and couples to choose the number and timing of their children. Methods: This paper is a review of secondary data accessed through PubMed and Google Scholar. It provides an overview of Islamic countries' policies on, and support for FP and modern contraception. For this purpose, literature from Afghanistan, Bangladesh, Egypt, Indonesia, Iran, Jordan, Kuwait, Malaysia, Morocco, Nigeria, Pakistan, and Turkey was included. Results: There are significant internal social and economic reasons to focus on FP in the Muslim world. Thus, arguments by religious scholars who see FP as an external western conspiracy aimed at curtailing the growth and strength of the Islamic world appear to be uninformed of both the socio-political and demographic realities in many Muslim countries, as well as the historical permissibility of contraception within the Islamic legacy. In fact, it can be argued that given the profound socio-economic and political difficulties in various parts of the Muslim world, a lack of FP and increasing populations would weaken and curtail the pace of overall development. Conclusion: Private institutions and the government must collaborate in leveraging initiatives and bridging gaps for more robust advocacy with clergymen and religious scholars to support the larger cause of FP and birth spacing i.e. improving infant and maternal health in Pakistan.

Physical activity and its effect on forced expiratory volume.

Abstract: Objective To assess and compare changes in pulmonary functions before and after exercise in young healthy adults. Methods The case-control study was carried out from January to March 2010 on 292 medical students aged 18-24 years at Bahria University Medical and Dental College, Karachi. Baseline values for forced expiratory volume (FEV1) and forced vital capacity (FVC) were measured with a digital spirometer, and the FEV1: FVC ratio was calculated. The lung functions of group I comprising 192 volunteers after aerobic exercise of 30 minutes daily, for five days over eight weeks, was compared with group II having 100 controls who did not participate in any physical activity. SPSS 15 was used for statistical analysis. Result At the end of eight weeks, there was a significant rise in FEV1 (2.49 +/- 0.82 to 2.59 +/- 0.79 liters), decline in FVC (2.80 +/- 0.92 to 2.7 +/- 0.87 liters) and an increase in the FEV1: FVC ratio (89.52 +/-12.66 to 95.56 +/- 13.42) in group I students. Conclusion Improvement in pulmonary functions was noticed as a result of physical activity.

HIV, hepatitis B and hepatitis C in garbage scavengers of Karachi.

Abstract: Objectives To determine the seroprevalence of human immunodeficiency virus, hepatitis B and C, and to study the associated risk factors in garbage scavengers of Karachi. Methods The cross-sectional study was performed in a colony inhabited by low socioeconomic garbage-collecting people. Data was collected from April to December 2011. After informed consent and pre-test counselling, a set of questions were asked from a questionnaire, and 5cc of blood was drawn for pathological testing. SPSS 18 was used for statistical analysis. Results A total of 141 males agreed to participate in the study with a mean age of 21.33+/-9.28 years. Most of the respondents (n=67; 47.5%) were in the age group 11-20 years; 86 (61%) were single; 89 (63%) were illiterate and 127 (90%) had a monthly income less than Rs.10,000. Prevalence of hepatitis B was 18.8% (n=22), followed by 8.5% (n=10) and 0.85% (n=1) of hepatitis C and HIV respectively. Besides, 108 (77%) collected needles/syringes and 76 (54%) got pricked more than once. Only 23 (16%) wore gloves while collecting garbage. Overall, 79 (56%) had a history of sexual contact; 18 (23%) had three or more partners. Conclusion The important factors contributing to the high prevalence of hepatitis B and C were needle prick injuries, bare-handed/bare-footed collection of garbage, poor vaccination status, improper garbage disposal system and the site of waste collection.

The relationship between social support and quality of life in patients with heart failure.

Abstract: Objective To describe the level of social support and quality of life in heart failure patients, and to examine their relationship with perceived social support and quality of life. Methods The cross-sectional study was carried out in the cardiology outpatient units of two university hospitals in Izmir, Turkey, between January and September 2010. Using convenience sampling the study comprised 150 patients who were assessed on the 12-point Multidimensional Scale of Perceived Social Support, and the 36-point Left Ventricular Dysfunction Scale. Data were analysed through SPSS 15, using descriptive statistics and Pearson's correlation test. Results The mean total scores for each variable are as follows: perceived social support (49.34 +/- 17.57), perceived social support from family (24.25 +/- 6.17), perceived social support from friends (12.75 +/- 8.16) and perceived social support from others (12.33 +/- 7.81). The mean quality of life score was 69.25 +/- 23.12. There was a moderately significant negative correlation between the scores of the two scales employed by the study. Conclusions The quality of life of the patients improved with increasing social support. Determining and improving family and other social support for heart failure patients should be an essential part of nursing practice.

Impact of ethanol, dry care and human milk on the time for umbilical cord separation.

Abstract: Objective To compare the extraction time and infection rate of umbilical cord by applying ethanol, humanmilk or dry care. Method The parallel single-blinded randomised clinical trial was performed on 300 neonates at Shahid Sadougi University of Medical Sciences and Health Service, Yazd, Iran, between March and September 2010. The neonates were divided into three random but numerically equal groups. Each group was assigned the application of ethanol or mother's milk or to keep the stump dry. The neonates were visited on the 3rd and the 7th day after birth and follow-up was maintained telephonically until umbilical separation. Umbilical separation time and umbilical local infection frequency were considered as the study outcome, which was compared among the three groups according to age, gender and delivery type of the neonates. Results Umbilical separation time in neonates of the human milk group had significant difference with the ethanol group (p=0.0001) and drying groups (p = 0.003). Frequency of omphalitis had no significant difference among the three groups. Conclusion Topical usage of human milk on umbilical cord stamp decreased separation time and incidence rate of omphalitis.

Polypharmacy in elderly: a cautious trail to tread.

Abstract: Polypharmacy has now increasingly come into focus as the recipient of healthcare in old age worldwide. In elderly it is associated with frequent adverse drug reactions (ADRs) and drug-drug interactions resulting in significant morbidity. Geriatrics is still an emerging specialty in South Asia, especially in Pakistan, where multiple reasons for polypharmacy exist. An extensive literature review of articles using key words like 'polypharmacy,' 'elderly' was conducted. The recently updated Beers Criteria of classification of inappropriate drugs in the elderly was reviewed in detail. Articles of relevance to polypharmacy and evaluation of guidelines for appropriate interventions to minimise inappropriate drug prescribing were also reviewed. Commonly prescribed drugs like psychotropic, cardiovascular, nonsteroidal anti-inflamanatory drugs (NSAIDs) and oral hypoglycaemics can cause significant adverse events when prescribed to the elderly. Primary care physicians may use evidence based non-pharmacological interventions which may be appropriate to use in selected cases. Drugs can affect quality of life and morbidity in the elderly. A basic understanding of ageing physiology and pharmacology along with a step-wise approach to prescribing in the elderly maybe helpful in minimising iatrogenic complications of commonly used drugs in this age group.

Serum leptin values in the healthy obese and non-obese subjects of Rawalpindi.

Abstract: OBJECTIVE To determine serum leptin concentrations from a sample of Rawalpindi population in relation to body mass index, age and gender. METHODS The observational, comparative study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, and Benazir Bhutto Hospital, Rawalpindi from August 2008 to December 2008. Subjects were 100 including healthy obese, overweight and non-obese of both genders aged between 20-50 years. Sampling was done by non-probability convenience method. Body Mass Index was calculated by formula BMI = weight in kg/height in m2: non-obese subjects were defined as 18.5-23.0 kg/m2; overweight 23.1-27.4 kg/m2; and obese 27.5-40 kg/m2. Serum glucose was measured using Glucose oxidase-phenol amino phenazone (GOD-PAP) method and serum leptin by sandwich enzyme-linked immunosorbent assay method. RESULTS Serum leptin concentrations were higher in obese subjects (mean 52.8 +/- 24.6 ng/mL; range 28.2-77.4 ng/mL; P < 0.001) than in non-obese subjects (mean 12.7 +/- 6.1 ng/mL, range 6.6-18.8ng/mL). Mean Body Mass Index in obese group was 31.7 +/- 3.1 kg/m2 (range 28.6-34.8 kg/m2) while it was 21.2 +/- 1.5 kg/m2 (range 19.7-22.7 kg/m2) in the nonobese group. Body Mass Index was strongly positively correlated with serum leptin concentration (r = 0.59, p < 0.001) in the obese group. The mean serum leptin concentration was much higher in the healthy obese and non-obese women (64.4 ng/mL and 8.7 ng/mL respectively) than in men of both categories (40.4 ng/mL and 5.5 ng/mL respectively). Age had no significant relation with serum leptin level (p = 0.416). CONCLUSIONS In the study sample, serum leptin concentration was positively correlated with Body Mass Index in healthy obese and non-obese subjects of both genders. The levels were higher in women than in men. Age had no significant relation with serum leptin level in this age group.

Promoting fruit and vegetable consumption among students: a randomized controlled trial based on social cognitive theory.

Abstract: OBJECTIVE To assess the effectiveness of an educational intervention based on social cognitive theory on increasing consumption of fruit and vegetable among Grade 4 students. METHODS The randomised study was conducted in Isfahan, Iran, during 2011 and comprised 138 students, who were randomly divided into intervention and control groups. Data was collected at the beginning and three months after the intervention. A self-administered questionnaire based on constructs of social cognitive theory and food consumption was used. Theory-based nutrition education was imparted on the intervention group. Data was analysed using SPSS 15 and appropriate statistical tests. RESULTS The intervention group had 68 (49.27%) subjects, while there were 70 (50.72%) controls. After the intervention, mean scores of behavioural capability (p < 0.001), self-efficacy in difficult situations (p = 0.04), self-efficacy in selecting fruits and vegetables (p = 0.01), social support (p = 0.03), and observational learning (p = 0.002) had significantly improved in the intervention group. Nutritional behaviour also showed significant improvement on mean daily intake of fruits and vegetables in the intervention group (p < 0.001). CONCLUSION Intervention based on social cognitive theory led to increase in the consumption of fruits and vegetables among students, which confirmed the efficiency of social cognitive theory for such interventions.

Students' feedback on teaching and assessment at Nishtar Medical College, Multan.

Abstract: OBJECTIVE To obtain feedback on teaching and assessment methods in professional undergraduate medical examinations. METHODS The study was conducted at Nishtar Medical College, Multan, Pakistan, from May 21 to May 26, 2012. A written questionnaire covering topics on various teaching and assessment methods was used to get feedback from students of 2nd, 3rd, 4th and 5th year M.B.B.S. SPSS version 17 was used for statistical analysis. RESULTS Of the 534 questionnaires distributed, 538 (99%) were returned duly filled. Overall, 382 (71%) students were satisfied with all aspects of the lectures delivered and 393 (73%) students agreed that teaching staff was punctual in delivering lectures. Although 312 (58%) students were satisfied with the teaching conducted in the wards, students felt dissatisfaction with the teaching carried out in outpatient departments and operating theatres. Multimedia was favoured by 306 (56%) students as a supporting teaching tool. Although the students agreed that questions asked in examinations were relevant and the pattern of Objective Structured Clinical Examination (OSCE) / Objective Structured Practical Examination (OSPE) was satisfactory, they felt that the time allowed was insufficient. 399 (74%) students agreed that multiple modes of assessment improved their knowledge and skill. There was no consensus among the students on the best form of assessment. Number of students favouring short essay questions (SEQ's), multiple choice questions including true/false type, single best choice questions (BCQ'S) and descriptive questions were 209(38.8%), 176(32.7%), 70 (13%) and 28 (5%) respectively. There was disparity in students' satisfaction in internal assessment and university examination. Although 226 (42%) students were satisfied with internal assessment, 199 (37%) were satisfied with university assessment. CONCLUSION Overall, the students were satisfied with the lectures and clinical teaching conducted in the wards. Preferred methods of assessment included short essay questions (SEQ's) and multiple choice questions. Most of them wanted sufficient time for OSCE/OSPE and the satisfaction with university examination was only 37%.

Morbidity from episiotomy.

Abstract: Objective To assess the morbidity from episiotomy. Methods The prospective randomised control study was conducted at the Military Hospital Rawalpindi's Gynaecology & Obstetrics Department from January 2006 to April 2008. It comprised 100 patients who were given a mediolateral episiotomy at the crowning of the foetal head (group 1). Another group of 100 patients were delivered without an episiotomy (group 2). Postpartum morbidity was compared in the two groups. Morbidity included perineal damage by tears, subjective assessment of pain at perineum, dyspareunia after puerperium, feeling of pressure puerperium, incontinence and objective assessment of prolapse after puerperium. Results Morbidity including perineal damage by tears, pain at perineum and dyspareunia, was much more in group I as compared to the group II. There was no significant difference in feeling of pressure perineum, subjective feeling of urinary and flatus incontinence or objective assessment of prolapse of vagina and uterus. Conclusion There are no significant advantages of episiotomy. In fact, it leads to morbidity which is otherwise avoidable in deliveries that are episiotomy-free.