Showing papers in "Journal of Pakistan Medical Association in 2017"

Molecular biology of glioblastoma: Classification and mutational locations.

Abstract: Glioblastomas are regarded as the most common malignant brain tumours with great morphological and genetical heterogeneity. They comprise 12% to 15% of all intracranial tumours, with its peak observed in the 8th decade of life. The five-year survival is only 5%. Primary glioblastomas are more common in elders while secondary glioblastomas mostly involve younger people. Based upon gene expression profile, researchers have classified glioblastomas into several subtypes. Genetic mutations provide an advanced standard platform essential for diagnosis, therapeutic remedies and prognosis of glioblastomas. Common mutations observed in glioblastomas are loss of heterozygosity at 10q followed by epidermal growth factor receptor amplification (34%) and others. Vascular occlusion model and tumour stem cell model can explain the possible mechanism in glioblastomas pathogenesis. This review highlights glioblastomas' classifications, genetic mutations, pathogenesis and prognosis of different sub-types.

Incidentaloma: from general practice to specific endocrine frame.

Abstract: Incidentaloma, a modern concept connected to technology progress, represents an accidentally discovered tumour, usually used for hypophysis and adrenals, and rarely for thyroid, parathyroids, and ovaries. This is a narrative review based on PubMed research, between 2012 and 2016 focusing on general and endocrine approach and current controversies. Main dilemma is the terminology itself: randomly imagery finding is enough or non-functioning profile and low-growth rate (not requiring surgery) should be mandatory? The controversies refers to best time framing of re-scanning pituitary and adrenal incidentaloma and setting of clear criteria for subclinical Cushing's syndrome. The need for general practical guidelines is imperative so clinicians from different areas of medicine touse the same definition and protocols. Currently, the widely accepted part is represented by incidental finding. For restricted defined incidentaloma the best intervention is no intervention, while some cases may require surgery depending on tumours features, patient's age and preference.

Therapeutic uses of pineapple-extracted bromelain in surgical care - A review.

Abstract: Bromelain is an extract obtained from the pineapple plant and is used as a traditional folk remedy for several ailments. In this review, a comprehensive electronic database search was carried out to compile available literature on therapeutic implications of bromelain. Pharmaceutical value of bromelain has been demonstrated in different surgical sub-specialties. Diverse biological processes like anti-inflammatory, anti-oedematous, analgesic, anti-thrombotic, exfoliation etc. are involved in bromelain's therapeutic actions, mediated through the kallikrein-kinin and arachidonic acid pathways as well as through effects on cell mediated immunity. Bromelain equals non-steroidal anti-inflammatory drugs as an anti-inflammatory agent, but has been shown to have fewer side effects. In Europe it is approved for oral and topical use, mainly for surgical wounds, inflammation due to trauma and surgery, and debridement of deep burns. Literature suggests a promising role of bromelain in surgical care. More clinical trials to establish its utility as an anti-inflammatory agent in surgical care are recommended.

Academic performance of male in comparison with female undergraduate medical students in Pharmacology examinations.

Abstract: Objective To compare the academic performance of male and female medical students in Pharmacology examinations. Methods The comparative study was conducted at Rehman Medical College, Peshawar, Pakistan, from March to August 2015. For evaluating the students' academic performance, male and female students of academic sessions 2013-14 and 2014-15 were divided into 4 groups. Group 1: 80% marks. SPSS 20 was used for data analysis. Results Of the 200 medical students enrolled, 102(51%) were male and 98(41%) were female. There was no significant difference in the academic performance in terms of gender in multiple choice questions (p=0.811) and short essay questions (p=0.515). The effect of attendance was also insignificant (p=0.130). Significant difference was found between the academic records of urban male and female students compared to rural students (p=0.038). Boarder students' results were insignificantly different from those of day scholars (p=0.887). Conclusions There was no significant difference between the academic performance of male and female students.

Microbiological pattern of diabetic foot infections at a tertiary care center in a developing country.

Abstract: Objective To determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers in a tertiary care hospital Karachi, Pakistan. Methods This descriptive study was conducted at the Baqai Institute of Diabetology and Endocrinology (BIDE), from January 2013 to March 2014. Bone, pus and tissue samples were collected from 342 patients with diabetic foot infections and inoculated on appropriate media. Antibiotic susceptibility tests were done by Kirby Bauer disk diffusion method. Results A total of 671 aerobic bacteria were isolated from 473 specimens with an average of 1.45 isolates per specimen. Poly-microbial infection was 56.87%. Gram- negative isolates were predominant 76.27%.Staphylococcus aureus was most frequent among Gram-positive 20.7% and Escherichia coli 15.72% in Gram negative isolates. MRSA was found in 26.76% Staphylococcus aureus. About 33.48% of antimicrobial resistant isolates were observed. Conclusions In our study, Gram negative aerobes were predominant in the diabetic foot infections. A significant number of MDR isolates were also observed in this cohort. Delayed referral and inappropriate use of broad spectrum antibiotics may be the main cause of increase in the frequency of MDR isolates.

Prognostic significance of IDH 1 mutation in patients with glioblastoma multiforme.

Abstract: Focus of brain tumour research is shifting towards tumour genesis and genetics, and possible development of individualized treatment plans. Genetic analysis shows recurrent mutation in isocitrate dehydrogenase (IDH1) gene in most Glioblastoma multiforme (GBM) cells. In this review we evaluated the prognostic significance of IDH 1 mutation on the basis of published evidence. Multiple retrospective clinical analyses correlate the presence of IDH1 mutation in GBM with good prognostic outcomes compared to wild-type IDH1. A systematic review reported similar results. Based on the review of current literature IDH1 mutation is an independent factor for longer overall survival (OS) and progression free survival (PFS) in GBM patients when compared to wild-type IDH1. The prognostic significance opens up new avenues for treatment.

The confounding factors leading to plagiarism in academic writing and some suggested remedies: A systematic review.

Abstract: There is a staggering upsurge in the incidence of plagiarism of scientific literature Literature shows divergent views about the factors that make plagiarism reprehensible This review explores the causes and remedies for the perennial academic problem of plagiarism Data sources were searched for full text English language articles published from 2000 to 2015 Data selection was done using medical subject headline (MeSH) terms plagiarism, unethical writing, academic theft, retraction, medical field, and plagiarism detection software Data extraction was undertaken by selecting titles from retrieved references and data synthesis identified key factors leading to plagiarism such as unawareness of research ethics, poor writing skills and pressure or publish mantra Plagiarism can be managed by a balance among its prevention, detection by plagiarism detection software, and institutional sanctions against proven plagiarists Educating researchers about ethical principles of academic writing and institutional support in training writers about academic integrity and ethical publications can curtail plagiarism

Risk factors of cardiovascular disease and its recommendations in Pakistani context.

Abstract: Cardiovascular diseases possess a major cause for fatality and disability the world over. Since last several decades, the rates of cardiovascular diseases-related deaths have decreased in a number of high-income countries but increased in low- and middle-income countries with around 80% of the burden. Despite the seriousness of cardiovascular diseases in low- and middle-income countries, minimal attention is given to the prevention of cardiovascular diseases risk factors in South Asia, particularly in Pakistan. In addition, economic and political instability is accelerating the rates of cardiovascular diseases in the country. Practical efforts are required to enhance the understanding of cardiovascular diseases risk factors such as diet, physical activity, and tobacco-control policies to support prevention and control at the population level. This paper reviews the major modifiable risk factors in Pakistan, highlights available preventive services, and presents the most likely ways to promote risk-factor reduction.

A historical glance: Challenges for male nurses.

Abstract: Nurses are primary care providers and are responsible for caring of patients. Since centuries, the nursing profession has been known as a profession only for females. Therefore, the history of nurses in early ages only states the role of the female, although males at that time also took part in patient-care along with females. The aim of this paper is to provide detailed review of national and international literature available related to male nursing students, and their experiences in the nursing profession.

Urdu translation and validation of GAD-7: A screening and rating tool for anxiety symptoms in primary health care.

Abstract: OBJECTIVE To translate and validate Generalized Anxiety Disorder -7scale in Urdu, for use in Pakistan in the primary healthcare setups. METHODS The validation study was conducted at the Combined Military Hospital, Gilgit, Pakistan, from February to May 2016.We followed a systematic six-step process to validate the Generalized Anxiety Disorder-7 scale in the target population. The instrument was translated independently and then fused together. Back-translation was followed by recommendations by an expert committee, and face validity improvement by a language expert. A pilot study was done to get user's feedback on the construct. Volunteers were administered the questionnaire for validation procedure, along with a well-being scale, at three different cities representing volunteers from four different administrative regions of Pakistan. RESULTS There were 285 volunteers in the study. Principal component exploratory factor analysis supported unidimensional structure of the scale with an eigenvalue of 5.18 and it explained 64.8% of the total variance. Total score on the scale was negatively correlated with positive effect (r = -0.44, p<0.001) and life satisfaction (r = -0.49, p<0.001) subscales of a the well-being scale, while it was positively correlated with the negative affect (r = 0.63, p<0.001) subscale of the same, indicating a good level of convergent and discriminate validity. Cronbach's alpha for the scale was 0.92 and split-half reliability was 0.82, revealing a good level of reliability. CONCLUSIONS The Generalized Anxiety Disorder -7 scale was found to be a validated, brief, self-administered Urdu tool to screen, rate, and monitor outcome of anxiety disorders in primary healthcare setups.

Dietary habits, lifestyle pattern and obesity among young Saudi university students.

Abstract: OBJECTIVE To investigate dietary habits, lifestyle pattern and obesity in young university students. METHODS This cross-sectional study was performed at the Rabigh campus of King Abdulaziz University, Jeddah, Saudi Arabia, from March to May 2016, and comprised healthy male students. A close-ended questionnaire was filled by all students about their dietary habits and lifestyle pattern and the lipid profile, blood glucose levels and body mass index was determined. The participants were selected by convenience sampling method. SPSS 21 was used for data analysis. RESULTS Of the 116 participants, 34(29.3%) were obese, 34(29.3%) were overweight and 48(41.4%) had normal body mass index. Overall, 66(57%) participants were taking 3 to 4 fast food meals weekly and was also taking junk food at least once in a day. Also, 50(43%) participants were using soft/energy drink more than once per day. Besides, 82(70.7%) respondents were spending 3 to 4 hours daily in watching TV, using the Internet or PlayStation. Significant differences were observed for low-density lipoprotein and high-density lipoprotein cholesterol levels (p=0.02 and p=0.006, respectively) among overweight and obese subjects as compared to those having normal weight. The majority of the overweight and obese participants' had experienced shame or other uncomfortable feelings and had a negative impact on their activity (p<0.001). CONCLUSIONS Dietary habits and lifestyle of the majority of the participants were not up to the mark and the obesity prevalence was common.

Cervical cancer in Pakistan: A review.

Abstract: Cervix carcinoma is the second commonest condition in women under 50 years of age and third after breast and oral cavity cancers across all age groups. Though a preventable disease, the mortality rate is very high because it is an ignored ailment in Pakistan in terms of screening, prevention and vaccination. More than 70% of cancer patients report with very advanced stage of malignancy and this is the cause of the high rate of mortality in Pakistan. We covered studies cited during the previous 11 years (2005-2015) that reviewed many aspects of cervical cancer in Pakistan, including epidemiology, risk factors, screening test and their barriers, clinical presentation and prevention. Our analysis indicated that infections associated with human papillomavirus posed the greatest risk of carcinoma and consequent mortality rate, especially because of low socioeconomic status and poor knowledge of screening. Emphasis is laid on a need to organise proper screening programme taking into account what already is known about Pakistani women.

Clinical manifestations of patients with Systemic Lupus Erythematosus (SLE) in Khyber Pakhtunkhwa.

Abstract: Objective To determine major symptoms and signs in patients of systemic lupus erythematosus. Methods This cross-sectional study was conducted at the Lady Reading Hospital, Khyber Teaching Hospital and Hayatabad Medical Complex, Peshawar, Pakistan, from January 15, 2014, to August 15, 2016, and comprised patients of systemic lupus erythematosus. Data was collected through an interview-based questionnaire containing questions about different symptoms. SPSS 20 was used for data analysis. Results Of the 663 patients, 606(91.4%) were females and 57(8.6%) males. The overall mean age of patients was 33.09 ± 12.40 years and the mean age of diagnosis was 31.85 ± 12.40 years. The most common general symptom in our study was fatigue which was present in 524(79.03%) patients. Other constitutional symptoms were fever 334(50.04%), body aches 443(66.08%) and weakness 411(62%). The most common clinical manifestation in our study was arthritis 518(78.1%). Malar rash was found in 487(73.5%) patients. Dry eye was in 227(34.2%) patients, followed by conjunctivitis 156(23.5%). Anaemia was present in 444(66.96%) patients, followed by leukopenia 166(25.03%) and thrombocytopenia 42(6.33%). Conclusions Significant regional differences existed in the clinical manifestations of systemic lupus erythematosus in Khyber Pakhtunkhwa compared to other regions.

Assessment of caregiver burden of patients receiving dialysis treatment in Rawalpindi.

Abstract: OBJECTIVE To determine the burden on the caregivers of patients receiving dialysis treatment. METHODS This cross-sectional study was carried out in four different dialysis centres of Rawalpindi, Pakistan, from June 1 to December1, 2015, and comprised attendants of patients receiving dialysis. The data was collected from the attendants of patients receiving dialysis, and caregiver burden was measured using the Zarit Burden Interview questionnaire. SPSS 22 was used for data analysis. RESULTS Of the 164 subjects, 97(59%) were females. The majority of caregivers reported stress for caring (2.28±1.31), patients asking for more help than needed (2.14±1.13), health problems (1.03±1.11), financial constraints (1.70±1.15) and little time for self-care (2.15±1.21). Besides, 107(65%) caregivers perceived the burden of their patients as mild to moderate. A positive correlation was found between the duration of a person on dialysis, daily hours of care-giving and the total burden score of his/her caregiver (p<0.05 each). CONCLUSIONS Care-giving can create enormous burdens on caregivers, affecting their physical and psychological health.

Knowledge and attitude of physicians about antimicrobial resistance and their prescribing practices in Services hospital, Lahore, Pakistan.

Abstract: A cross sectional study was conducted in Services Hospital, Lahore using a self administered questionnaire to test the knowledge, attitude and prescribing practices of residents and attending physicians using non-probability convenience sampling. A total of 116 questionnaires were filled (Response rate=77.3%). Knowledge was below average (mean score of 3.66±1.1). Only 18 physicians (16%) could correctly estimate the rates of resistance of Klebsiella pneumoniae and pseudomonas aeruginosa to cephalosporin. Mostly physicians reviewed their decisions to prescribe an antibiotic by discussing with a senior colleague (n=93; 80%). When they did, the senior colleague sometimes recommended a different antibiotic (n=106; 91%). Seventy seven physicians (66%) reported that they prescribed more than one antibiotic per day. Physicians also stated that their decision of antimicrobial prescription was influenced by patient's socioeconomic status (n=108; 93.1%) and patients' demands (n=24; 20.7%). This study highlighted the importance of Antimicrobial stewardship and revealed topics to address during future antimicrobial prescribing interventions such as dissemination of information about local resistance rates and encouraging knowledge about antimicrobials.

Health literacy in Pakistan: Exploring new ways of addressing an old challenge.

Abstract: Pakistan continues to struggle with low health literacy that often results in late presentation of disease, poor adherence to treatment and meagre understanding of wellness and disease prevention. In a country burdened by diseases of the developing and the developed world, with poor healthcare infrastructure and low literacy levels improving healthcare literacy could have major influence on health and wellness of our masses. Utilising our rapidly expanding mobile technology and media for dissemination of health information is a viable solution. Public service announcements for media and health information apps for mobile technology can be developed by the government, health sector and media partnership. A systematic, multi-level targeted approach to health literacy would allow health seekers the opportunity to understand and comprehend disease prevention, symptomatology and treatment.

Effects of supervised aerobic training on the levels of anti-Mullerian hormone and adiposity measures in women with normo-ovulatory and polycystic ovary syndrome.

Abstract: OBJECTIVE To evaluate the change in the levels of anti-Mullerian hormone, adiponectin, weight loss and fertility parameters in obese women with or without polycystic ovary syndrome, following 12 weeks of supervised aerobic exercise. METHODS This study was conducted from August 2013 to October 2014 among obese women with or without polycystic ovary syndrome referred to Obstetrics and Gynecology clinic, Mansoura University Hospital, Faculty of Medicine, Mansoura, Egypt. Patients were classified into three age-matched groups; group A had controls, group B had patients with polycystic ovary syndrome and group C had obese women. Anti-Mullerian hormone, adiponectin, follicle-stimulating hormone, oestrogen, fasting insulin, fasting glucose, homeostasis model of assessment of insulin resistance, antral follicle count, hirsutism score, weight, menstrual cyclicity and ovulatory function were assessed at baseline and following 12 weeks of supervised aerobic exercise. Statistical analysis was performed using SPSS 17. RESULTS Of the 90 patients, there were 30(33.3%) in each group. The mean age was 28.7±3.84 years in group A, 27.9±4.1 years in group B and 27.6±5.7 in group C. The 30(33.3%) participants who responded to aerobic exercise interventions showed significant improvements in reproductive function), with lower baseline anti-Mullerian hormone levels, greater weight loss and higher adiponectin level compared to the the 30(33.3%) participants who did not respond to the exercise programme. Weight loss, fertility hormones, follicle-stimulating hormone, prolactin, oestrogen, antral follicle count, baseline anti-Mullerian hormone, and adiponectin were significantly correlated to the improvement in reproductive function (p<0.05 each). The change in anti-Mullerian hormone and adiponectin levels correlated significantly with physical activity level in both responders and non-responders (p<0.05). In women with anovulatory syndromes, there were significant improvements in ovarian process with an ovulation rate of 13(43.3%) and a restoration of menstrual cycle with a rate of 17(56.7 %) following 12 weeks of supervised aerobic exercise. CONCLUSIONS Moderate aerobic training for 12 weeks had a positive significant effect on reproductive functions via modulating adiposity, the levels of adiponectin, anti-Mullerian hormone and fertility hormones.

Gestational diabetes mellitus and the predisposing factors.

Abstract: Objective To evaluate the occurrence of gestational diabetes mellitus and its association with demographic and anthropometric variables in pregnant women. Methods This cross-sectional study was conducted at the Aga Khan University Hospital, Abbasi Shaheed Hospital and Memon Hospital in Karachi, from February 2014 to December 2015, and comprised pregnant women who were screened by 75-g 2-hour oral glucose tolerance test, (24-28 weeks of gestation) and classified as per the criteria of the International Association of Diabetes and Pregnancy Study Group. Weight, body mass index and serum glycated haemoglobin levels were measured. Women with pre-gestational diabetes were excluded. SPSS 21 was used for data analysis. Results Of the 1,210 participants, 208(17.2%) had gestational diabetes, while 1,002(82.8%) did not have the condition. Gestational diabetes was associated with advancing age, deranged glycated haemoglobin, elevated body mass index at booking (p 0.05). Conclusions Pre-existing adiposity and presence of strong family history rendered a considerable number of pregnant women to suffer from gestational diabetes.

Management of diabetes distress.

Abstract: This article discusses a comprehensive approach to the management of diabetes distress. It mentions the screening and diagnosis of diabetes distress, and discusses its etiopathogenesis, investigations and management strategies in detail. The management of diabetes distress, termed as diabetes therapy by the ear, is based upon four pillars: strengthening of self-care skills, optimization of coping skills, minimizing change-related discomfort, and utilization of external support. The article describes coping skills training and change-related discomfort mitigation in detail.

Simulation based medical education; teaching normal delivery on intermediate fidelity simulator to medical students.

Abstract: Objective To assess the effectiveness of medium fidelity simulator in teaching normal vaginal delivery to medical students. Methods The quasi-experimental study was conducted at the professional development centre of the Jinnah Sindh Medical University, Karachi, from June to December 2015, and comprised medical students. Third-year medical students were included. They were divided into two groups. Group A was taught normal delivery through traditional PowerPoint and group B through simulator. The instruments used for assessing knowledge were pre-test and post-test, for skills of labour/delivery checklist of performance was used, and perception forms were filled to evaluate workshops/learning environment by students. Results Of the 76 participants, there were 36(47.4%) in group A and 40(52.6%) in group B. The overall mean age of the participants was 20.86±0.76 years in group B and 20.60±0.95 years in group A (p=0.19). The mean grade point average of the participants was 2.89±0.47 in group A and 2.87±0.48 in group B (p=0.81).Group B performed much better in skill of delivery having a mean score of 8.91±3.20compared to group A which had mean of 5.67±1.84 (p Conclusions Simulation-based skill learning showed significantly better results.

Femto-lasik: The recent innovation in laser assisted refractive surgery.

Abstract: Femtosecond laser has been introduced in refractive surgery to create a thin-hinged corneal flap without using any blade. The current review was planned to analyse and compare femtosecond-assisted laser in-situ keratomileusis (LASIK), the latest refractive procedure, with conventional techniques in refractive surgery. The analysis showed that femtosecond-assisted LASIK yielded more predictable corneal flaps, lesser ocular aberrations, better uncorrected visual acuity, lesser variations in intraocular pressure (IOP) and fewer chances of developing dry eyes. Transient light sensitivity, diffuse lamellar keratitis, opaque bubble layer, corneal haze and rainbow glare are some of the demerits of femtosecond-assisted LASIK, but these can be prevented with certain precautions. The early visual rehabilitation and preservation of corneal anatomy are added benefits in the long run. Though it is expensive currently, the competition in market is expected to cut down the cost soon.

Comparison of ketamine-propofol and ketamine-dexmedetomidine combinations in children for sedation during tooth extraction.

Abstract: Objective To evaluate the efficiency of ketamine-propofol and ketamine-dexmedetomidine drugs in children for sedation during tooth extraction. Methods The randomised, prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey, from September to November 2013, and comprised children who were due to undergo tooth extraction. Non-invasive blood pressures (systolic and diastolic), peripheral oxygen saturation, heart and respiratory rates and Ramsay Sedation Scores were assessed at baseline, after applying the drugs and then every 5 minutes thereafter. Further, the ketamine-propofol group received 1mg kg-1 of ketamine and propofol, and the ketamine-dexmedetomidine group received 1mg kg-1 of ketamine + 0.5 µg kg1 of dexmedetomidine. Results Of the 60 participants, there were 30 (50%) in each group. No statistically significant differences were found in terms of heart rate, non-invasive blood pressures at any time and the number of drug repetitions (p>0.05). Nausea-vomiting was statistically higher in the ketamine-dexmedetomidine group (p Conclusions Ketamine-propofol might be a better option due to lower vomiting and nausea episodes and higher surgeon satisfaction levels.

Relationship of seminal free L-Carnitine with functional spermatozoal characteristics: Results from an observational study conducted in a tertiary care hospital of Karachi, Pakistan.

Abstract: OBJECTIVE To investigate the relationship of seminal free L-carnitine with functional spermatozoal characteristics. METHODS This observational study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, from August 2009 to June 2013, and comprised fertile and infertile subjects. Semen analysis was performed and reported for its volume, sperm count, motility and morphology according to the World Health Organisation's guidelines. Seminal free L-carnitine was estimated by high-performance liquid chromatography. Mean values of demographic characteristics, semen analysis and seminal free L-carnitine were compared, and possible relation of seminal free L-carnitine with functional spermatozoal characteristics was explored. RESULTS Of the 61 participants, 19(31.1%) were fertile controls, while 42(68.9%) were infertile men. The mean age of controls was 32.7±1.44 years and that of infertile patients was 33.4±0.75 years (p=0.655). The mean seminal free L-carnitine was 447.6±23.86mmol/L among controls and 154.6±12.99 among patients (p=0.001). There was a strong positive correlation of seminal free L-carnitine with sperm count, total motility and normal morphology (p<0.01 each). CONCLUSIONS The role of seminal free L-carnitine in the maintenance of normal functional spermatozoal characteristics was validated.

Awareness and attitudes towards organ donation among medical students at King Abdulaziz University, Jeddah, Saudi Arabia.

Abstract: OBJECTIVE To assess awareness and attitude of medical students about organ donation. METHODS This cross-sectional study was conducted in 2014 at King Abdulaziz University, Jeddah, Saudi Arabia, and comprised medical students. The participants were asked about their religious and other beliefs towards organ donation, their reasons for not donating organs, and their personal opinions about organ donation through a questionnaire. SPSS 21 was used for data analysis. RESULTS Of the 481 participants, 250(52%) were females, and 231(48%) were males. The overall mean age was 21.36±1.63 years. Besides, 437(90.9%) students knew what organ donation means, 433(90%) supported organ donation, and 90(18.7%) knew someone who had donated an organ. Moreover, 245(50.9%) participants were willing to donate their organ to their family alone, 198(41.2%) were willing to donate to any deserving patient while 439(91.3%) rejected that religion precluded organ donation, and 354(73.6%) did not know about the grafting of organs from a man to a woman and vice versa. CONCLUSIONS Awareness and attitude towards organ donation were not up to the mark among the participants.

Diagnosis of paediatric sepsis by automated blood culture system and conventional blood culture.

Abstract: Objective To evaluate the time required for isolation of aerobic bacterial pathogen from paediatric septicaemia suspects by using BACTEC 9240 blood culture system, and to compare the results with conventional blood culture technique. Methods This comparative cross-sectional study was conducted at the Jinnah Hospital, Lahore, Pakistan, from July to December 2013, and comprised blood samples of suspected septicaemia children. The blood samples were inoculated into automated BACTEC 9240 Peds Plus/F resin-based media. At the same time, conventional blood culture bottle was also inoculated for comparison. The time of culture positivity and bacterial spectrum isolated from these samples was evaluated. SPSS 20 was used for data analysis. Results Of the 100 blood culture samples, 36(36%) were true pathogens on BACTEC 9240, while 24(24%) were positive through the conventional method. The mean age of the participants was 0.65±20 days. Staphylococcus aureus was detected in 12(12%) samples by BACTEC 9240 and in 7(7%) cases by conventional system. BACTEC 9240 significantly reduced time of positivity from 48 hours to 21 hours compared to conventional system. The number of samples detected within 36 and 48 hours was 7(19.4%) by BACTEC 9240 and 17(70.8%) by conventional system (p Conclusions Diagnosis of paediatric septicaemia through BACTEC 9240 was quicker with high yield and great sensitivity compared to the conventional technique.

Compliance of surgical hand washing before surgery: Role of remote video surveillance.

Abstract: OBJECTIVE To evaluate and increase the compliance of surgical hand scrubbing with periodic feedback. METHODS This study was conducted at the Aga Khan Hospital for Women and Children, Karachi, Pakistan, from April to July 2014. A remote video auditing system consisting of human auditors was used for visualising surgical hand wash compliance of the surgical team. The equipment, which used motion sensor, was installed in the scrub area wall, visualising the scrub sink only. A clock was displayed for the healthcare professionals to aid in ensuring two-minute hand washing. All surgeons, technicians and surgical assistants were included in the study. Surgical scrubbing was measured during a 4-week period by remote video auditing without feedback and a 12-week period with feedback. SPSS 19 was used for data analysis. RESULTS Of the 534 observations, 150(28%) were made during the pre-feedback period and 384(71.9%) during the post-feedback period. During the first 4 weeks, the overall compliance was 22(14.6%). The rate of compliance increased to 310(80.7%) during the 12-week post-feedback period. CONCLUSIONS Video surveillance with feedback for hand washing was found to be an effective tool for measuring hand hygiene and improving compliance.

Accuracy of frozen sections in oral cancer resections, an experience of a tertiary care hospital.

Abstract: The aim our study was to determine the accuracy of frozen sections in oral cancer resections. Patients who underwent oral cancer resection at Patel Hospital were included in the study. Tissues for frozen sections were obtained from the mucosal margins and tumour bed. Frozen sections were compared with the paraffin embedded sections which served as the gold standard in our study. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and kappa statistics were calculated. A total of 299 frozen sections were obtained from 77 patients who underwent oral cancer resection, mean (3.88±0.76). Frozen sections' sensitivity in relation to permanent sections was 72.7% and specificity of 93.9%. The overall accuracy of the test was 90.9%. Kappa value was calculated to be 0.642, which showed a moderate agreement. Frozen sections are accurate enough to be used in assessing intraoperative margin assessment for tumour clearance.

Prevalence of diabetic foot syndrome amongst population with type 2 diabetes in Pakistan in primary care settings.

Abstract: OBJECTIVE To determine the prevalence of diabetic foot syndrome in type 2 diabetes mellitus patients. METHODS This cross-sectional study was conducted at 25 centres across eight cities in Pakistan from August 2010 to March 2011, and comprised adult type 2 diabetics. The subjects underwent ankle brachial pressure index evaluation for diabetic foot, and neurological assessment using 10g monofilament for sensation and 128Hz tuning fork to elicit vibration. RESULTS Of the 230 subjects, 94(40.86%) were males and 136(59.13%) females. The overall mean age was 53.82±9.96 years and mean glycated haemoglobin was 8.81±2.04%. The prevalence of diabetic foot syndrome was 32(13.9%). Based on established diabetic foot risk classification, 37(16.08%) patients were in category-1, 6(2.60%) in category-2, 32(13.91%) in category-3 and 148(64.34%) in category-0. On ankle brachial pressure index assessment, 94(40.86%) patients had impaired values (p<0.9). Sensation was impaired in 50(21.73%) patients, vibrations could not be detected in 37(16.08%), ankle reflexes could not be elicited in 35(15.21%), and foot pulses could not palpated in 28(12.17%) patients. CONCLUSIONS A high prevalence of diabetic foot syndrome was observed.

Frequency and determinants of malnutrition in children aged between 6 to 59 months in district Tharparkar, a rural area of Sindh.

Abstract: OBJECTIVE To assess the nutritional status of children living in Tharparkar. METHODS This cross-sectional study was conducted in four villages of Tharparkar district of Sindh, Pakistan, in 2014, and comprised children aged between 6 and 59 months. Data was collected from mothers and anthropometry of children was done using standard techniques. Nutritional status was assessed by using age- and sex-specific World Health Organisation standard charts for underweight, stunting and wasting. Data was analysed using SPSS 16. RESULTS Of the 304 children assessed, 117(38.5%) were stunted, 58(19.1 %) were wasted and 101(33.2 %) were underweight with no gender discrimination. Under-nutrition was particularly observed in the second year of life. Statistically significant factors associated with stunting were illiteracy of mother, family size of >5 members, pregnancy>4 times, child mortality in last 6 months, absence of breastfeeding and no history of child vaccination(p<0.05 each). Logistic regression revealed family size of <5 members, pregnancy ?4 times, breastfeeding and vaccination were protective factors for stunting (p<0.05 each). Mortality of a child in the last 6 months in the family was 3 times more likely to have a stunted child. CONCLUSIONS Stunting was the most common type of under-nutrition with no sex discrimination.