INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE RESEARCH

14-16

Authors: Shamoon Noushad1 , Sidra Afzal1 , Neelam Barkat1 , Sadaf Ahmed1&2 & Nighat Shah

Introduction Polycystic ovary syndrome (PCOS) is the most common chronic endocrine disorder that is responsible for imbalance of hormones affecting women of reproductive age leading to difficulties in period cycle and getting pregnant. Objective The aim of study was to evaluate the routine eating habit of the patients. Methodology The study was conducted in Gynecology ward of Tertiary care hospital. This analytical study was performed after taking consent including those patients, who came to the clinic to report their problem of infertility (married women) and irregular periods problems (unmarried girls), targeted age group was between 25 to 35. Interview based study was conducted which include all the questions related to their eating habits like; food typically eaten in breakfast, lunch, dinner and amount of snacks taken per meal. High intake of carbohydrate and fats also investigated per meal. There BMI and FBS was also calculated. Results Total 300 patients were studied out of which 50 patients were included in the study and the results showed that in PCOS patients the frequency of obesity & overweight is (92%), followed by (66%) of patients had excess carbohydrate/sugar craving while 34% patients had normal eating patterns. High rates of these complications were seen in the series. Conclusion From the results it is suggested that obese women with PCOS requires more attention toward the appropriate management of their dietary habits , as their high BMI and high fasting blood sugar is correlating with abnormal clinical and biochemical features. Calorie intake should be restricted. Diet control along with exercise was suggested to the patients.

23-25

Authors: Mohammad Yaseen & Nafisa Hassan Ali

Background Malaria vector born disease caused by Plasmodium species is transmitted through female anopheles mosquito. It is becoming a serious health challenge in Pakistan listed among top ten malaria endemic countries. In year 2012, 85,000 malarial cases reported across Sind province. Accumulation of water and poor public healthcare system in post monsoon season facilitates breeding of vector resulting in an increase prevalence of malaria. This study aimed to observe the rate of malaria in children (mean age 07 years) with fever, high temperature, headache and shivering who visited Civil hospital in year 2013. Evaluation of month wise and seasonal distribution of malarial species found to cause disease in Karachi-Pakistan was done. Methods Blood samples collected through finger prick observed by thick and thin microscopy. Immuno chromatography performed to confirm negative microscopy results. Results During period of twelve month, 5519 blood samples screened and 947(18%) found positive for malaria parasites. Most frequent species P. vivax (76%) followed by P. falciparum (24%). Seasonal distribution of malaria patients were 105 in winter, 306 in pre monsoon and 519 in post monsoon. In months of March to September 97-100 % P. vivax species documented and in October to February both P. falciparum and P. vivax found in ratio 1:1. Conclusions Proper awareness regarding wearing of proper protective clothing should be imparted to low socioeconomic people. Non-government and civilian bodies should encourage local population to actively participate in clearing mosquito breeding sites. As number of malarial patients are increasing it is recommended that malaria control programme should also focus on research regarding development of novel compound/synergistic combination effective against drug resistant plasmodium species and anopheles mosquito.

29-31

Authors: Sayani R1 , Mustahsan SM2 , Ali AAM 2 , Anwar M3

Objective To evaluate the diagnostic role of focused ultrasound of right iliac fossa in clinically suspected cases of acute appendicitis in pediatric population and its value as a standard diagnostic tool in that age group Material and Method A retrospective, cohort study was conducted at radiology department of Agha Khan University involving 239 children less than 16 years with clinically suspected appendicitis referred to radiology department from January 2009 to October 2011 were included. Medical records were reviewed for patient demographics, presenting signs and symptoms, sonographic, surgical findings and histopathological results. Results Two hundred and thirty nine patients with clinical suspicion of appendicitis were referred for focused ultrasound for appendix. Ultrasound examination showed 59 cases (24.6%) positive for appendicitis and thus they were operated. All of these were positive on histopathology. The remaining 180 cases (75.4%) that were negative on U/S were managed conservatively. Out of these 180 cases, 13 patients with negative findings on imaging studies were later operated due to clinical decision and/or CT examination. Acute appendicitis was proven in 10 out of the 13 cases. Conclusion Focused ultrasound has high sensitivity in acute appendicitis for the assessment of clinically equivocal cases of pediatrics population. It can be used as an initial screening modality especially in pediatric population, thus reducing additional cost and radiation risk associated with CT scans and also reducing rate of negative surgery.

6-11

Authors: Wais Mohammad Qarani and Samina Iqbal Kanji

The purpose of this paper is to analyze the health system of the two neighboring countries i.e. Pakistan and Afghanistan; and recommend strategies to translate the available opportunities into effective actions within the countries. Therefore, the WHO, Health System Framework is used to analyze the Pakistan and Afghanistan health system in terms of; 1) leadership and governance 2) health financing 3) health workforce 4) medical products and technologies 5) information and research and 6) service delivery. Both the countries are having multiple strengths and opportunities in terms of healthcare delivery system. On the other hand, both the countries are affected by multiple challenges including; un-met Millennium Development Goals and un-met national health indicators. Thus, appropriate strategies are required to be developed and executed in order to meet the national need for health.

15-21

Authors: Pasha Ghazal

Alcoholism is turning in to a growing problem in Pakistan despite its status of a “dry land” where 96% of the population do not drink and alcohol drinking is prohibited by law. Out of estimated ten million alcohol abusers, one million develop alcohol use disorders. Stress is the prevalent factor responsible for alcohol abuse. Moreover, the recent trend of alcohol abuse at a young age of 14 years is of growing concern. Literature research conducted using PubMed, Google Scholar resulted in almost no research articles or reviews directly addressing this problem. Hence, this review is the first on this subject. In this context, this review would try to comprehend current scenario of alcoholism in Pakistan. The role of globally recognized and FDA approved treatment medications is also discussed together with raising importance of psychosocial support therapy for alcohol addicted patients. In addition to that underlying neurobiology and different stages of alcoholism are elucidated.

31-38

Authors: Laila Khan1, Manzoor Ahmed2, Tahira Gul3, Umaira Azeem4

The maternal and infant mortality in Pakistan is still high. The use of safe and important methods of contraception allows men and women to decide the number and spacing of their pregnancies and to improve the uptake and continuation of use of family planning services through improving the quality of family planning services. objectives of this study is to assess the quality of family planning services, asses information provided by providers to clients, asses client knowledge and satisfaction with services provided preferred choice and current method of contraception used by client. A cross sectional study was conducted from May to July 2014 in Family Planning Department of PIMS hospital, Islamabad by using consecutive sampling technique for data collection. Data was analyzed by using SPSS version 16. The information about each element of quality of care is present as a list of 25 indicators of quality of care each indicator specifies a percentage, mean or SD. Among 100 clients with 0.05 margin of error and 95% Confidence level (Zα/2). Majority of the clients were satisfied with the services of the facility. (40.27%) of the clients would like to have next child after >5 years while the mean age of the youngest child was 11.77 months with Standard deviation SD of 9.850. Majority of the clients (57%) choose Intra Uterine Contraceptive Device (IUCD) after consultation and 62.50% want to change their method. Non-availability of IEC material on FP was another problem. Rate of discontinuation is higher among women who have not been adequately counseled about side effects. It is concluded from this research study that the information provided to the clients were inadequate, this might be due to provider’s improper training and poor interpersonal communication and technical skills.

8-12

Authors: Warda Musharraf, Dr. Kiran Khan, Asma Pervaiz, Saba Younis, Sana Shiekh, Hina Rahim & Sara Zehra

Background: Medical students are suspected to be the most compassionate, warm hearted and devoted students to their profession. In the process of cultivating future doctors any bad impact to their personalization may lead to a decrease in self-esteem, spirits and positive mood. Objective: The following study is conducted to make an estimation of different types of abuse that medical students are facing in Medical universities of Karachi. Furthermore, this study also intends to analyze which type of abuse is more prevalent and if the universities have a complaint department for taking a proper action against abuse or not. Methodology: A descriptive cross sectional study was conducted in private and government medical colleges of Karachi, Sindh Pakistan, in the months of June and July 2014. Data collection was based on random data sampling comprising of 250 subjects, which included male and female students between the ages of 20-25 years.Results: According to our study’s findings, about 47.47% of abuse is seen in medical colleges of Karachi. Among those who had faced bullying or harassment, 38.44% reported that they had experienced verbal abuse, 54.76% reported academic abuse, 6.9% faced physical abuse, and 18.56% faced sexual abuse. There was no reported harassment cell found in medical colleges of Karachi and hence, no one has ever taken authority. Conclusion: Therefore, it has been concluded that mistreatment and abuse are common occurrences in our medical colleges. This has found to be very adverse for learning, determination and the self-confidence of our medical students and for a futuristic personality of a doctor as well.

16-17

Authors: Murtaza Ali Gowa, Syed Ali Ammar, Ahmed Ali, Syed Muhammad Kashif Kazmi, Rana Farrukh, Ali Abbas Mohsin Ali & Syed Muhammad Mustahsan

Objective: To determine the prevalence of health issues among hajj pilgrims and the factors associated with them. Method: An observational study conducted during hajj (Year 2011) using a questionnaire which was filled by pilgrims on their visit to the health clinics conducted by the Imamia Medics International. Results: During the period, pilgrims presented complaints related to the respiratory system 52.5%(n=394) followed by musculoskeletal system 29.6%(n=222), gastrointestinal system 15.5%(n=116), skin problems 5.9%(n=44), central nervous system 3.1%(n=23), cardiovascular system 2.9%(n=22), reproductive system 2.7%(n=20), urinary tract problems 2.3%(n=17) were dealt with. Out of 750, 17.9% (n=134) were diabetic and 26.4% (n=198) were hypertensive. Amongst the total, 24.8% (n=186) were vaccinated against hepatitis while 35.7% (n=268) were vaccinated against pneumonia. An astonishingly high percentage of the pilgrims had no prior immunization to both hepatitis and pneumonia. Conclusion: This data tries to emphasize awareness regarding the importance of vaccination and the potential problems which are faced by diabetic, hypertensive and older population which can help to improve the health condition of hajj pilgrims and can lessen the burden faced by concerned authorities.

21-23

Authors: Aatir H. Rajput, Ali Raza Shaikh & Kainat Ali Panhwar

Background: Existing literature on interpersonal affairs amid health professionals and patients has proliferated since the 1960s, highlighting the importance of health professionals of all sorts. Here, in the clinical setup of Liaquat University Hospital, we have another important relationship that is crucial to a patient’s health care plan, is an adjunct to the health care professionals and contributes significantly more to the patients care. This relationship, often taken for granted by the health authorities, is that of a patient and a family member voluntarily staying with the patient at the hospital (commonly termed as attendant). Objective: This study hopes to unearth the major problems (particularly hospital induced psychological distress) faced by attendants and inquire what major complaints they have against the health care setup, health professionals and the hospital. Methodology: This cross-sectional observational study was conducted from May to July 2013. A data sample of 150 patient attendants at Liaquat University Hospital, Jamshoro was chosen by purposive sampling. The data was collected by self-administered structured questionnaire and was analyzed using SPSS v.16.0 and MS Excel. Results: 66% of the patient attendants were males while 34% were females. The most common attendants were sons (22%), mothers (17.3%) and brothers (12%). The most common complaint of the patients was that the attendants had no proper place to stay even if their stay was necessary. The attendants complained of inadequate sleep, health worries, anxiety, depressed mood, agitation, reduced appetite and weight loss due to improper food. Conclusion: We conclude, on the basis of our findings, that an important asset is being mistreated by our healthcare system and this mistake demands to be corrected on a priority basis. Steps should be taken to solve their problems so that they may continue to play their positive role.

27-30

Authors: Shamoon noushad, Hamza Akhtar, Safdar Ali, Zafar Iqbal Abbassi, Sadaf Ahmed, Soobhi Mehdi , Kaneez Fatima & Samina Saleem

Background Diabetes mellitus is characterized by absolute or relative deficiencies in insulin secretion or insulin action correlated with chronic hyperglycemia and other disturbances in carbohydrate, lipid and protein metabolism results in weakening immunity. In addition, various biochemical disorders associated with diabetic vascular complications, such as hyperlipidemia and oxidative stress frequently co-exist with diabetes mellitus. Previous studies have also suggested that these and additional factors might involve with increasing chemical stress in diabetic patients. Material and methods The questionnaire based survey was conducted including both close & open ended questions along with the assessment of chemical stress using Sadaf Stress Scale (SSS) version 2 among diabetic patients. This study was conducted in tertiary care hospitals of Karachi from October 1st till November 10th, 2014. Data was analyzed and plotted using SPSS version 20.0. Results This study showed that 28% of diabetic patients were in severe chemical stress. However, the various symptoms of severity included body temperature alterations (50%), feeling of dehydration (56%) and shortness of breath (63%) were obtained. Conclusion It is concluded that the diabetes patient with type 2 diabetes are at higher risk of developing chemical stress that may indicate multiple metabolic and as indicated by prominent symptoms that can be a oxidative alterations on sequence of increase use of medications and altered glucose metabolism.

34-37

Authors: Farzeen Zehra, Syeda Mehak Fatima & Fatima Syedain

Objective: To determine the current efficacy of antibiotics used in treatment of enteric fever, with respect to age, in a laboratory setting. Study Design: A cross-sectional study. Methodology: A retrospective study was done on 105 specimens that were collected at Dr. Essa Laboratory and Diagnostic Centre from January 2012-December 2013. These specimens were inoculated into blood cultures bottles having Oxoid and incubated. Positive specimens were then cultured on EMB, CLED and chocolate agar. These sub cultures were incubated at 37°C for about two days.With AP120E screening was done of suspected colonies. They were then processed. Identified isolates were confirmed by specific agglutination antisera. Kirby–Bauer disc diffusion method was used to confirm anti-microbial suspects by Mueller-Hinton agar (Oxoid), using eleven antibiotics which were Amoxicillin , Ciprofloxacin , Aztreonam , Cefixime , Cefotaxime , Ceftriaxone , Co-trimaxole, Enoxacin , Fosfomycin, Sparfloxacin , and Ofloxacin. Results: The overall sensitivity profile shown by these antibiotics against Salmonellae species is as follow : Amoxicillin (0 ) , Aztreonam (47.6%) , Cefixime (98.1%) , Cefotaxime (98.1%) , Ceftriaxone (97.1%) , Ciprofloxacin (85.7%) , Co-trimoxazole (64.8%) , Enoxacin (28.6%) , Fosfomycin (85.7%) , Ofloxacin (94.3%) , Sparfloxacin (30.5%). Conclusion: Third generation cephalosporins (Cefixime, Cefotaxime, Ceftriaxone) have maximum sensitivity profile among all age groups, rendering them most suitable for empirical treatment.

5-9

Authors: Sadaf Ahmed & Shamoon Noushad

The investigation of usual dietary patterns are of physiological significance including carbohydrate rich diet, caffeine consumption, protein intake specifically red and white meat along with intake of dietary supplements, milk and juices utilization as they have known to effect BMI and body fat distribution of those with increasing body weight, underweight and normal weight. The study was carried out on 435 university girls aged between 18 to 25 Years, we used the multiple logistic to investigate the relationship of dietary habits, family history, BMI, waist-hip ratio and body fat distribution. The result showed that there is no direct relation of body mass with dietary habits as the Girls with BMI <18 found to take the diet characterized by decrease consumption of good diet (milk, juices, egg, mineral supplements) and increase consumption of bad diet (junk food, fried and oil rich food), while girls with > 23 considered as overweight found diet conscious and were taking healthy diet. The association of these dietary patterns with raised body fat distribution, BMI and hip to waist ratio may specify the risk of developing health maladies but we conclude that in our population the lean girls are taking more junk food and are prone to various diseases more than the obese. We recommend that these unhealthy dietary patterns should be avoided as they may be a silent cause of many health issues.

14-16

Authors: Shamoon Noushad1, Sadaf Ahmed1&2 & Faiza Ahmed1

Caregivers are important escort in the healing journey of any patient. Our country in last decades excel so much in terms of offering training programes for nurses and midwives to bridge the gap between the therapeutic interventions and knowledge of these working individuals. We have done a survey on 182 nurses both male and female working in specifically small towns and trust hospitals. They were interviewed about their skills and the duties allocated to them. With reference to the patient care and conditions they were inquired about the medical background and awareness of the sufferer’s ailment. We have found nearly disappointing results as almost 71% of these workers were ignorant of the fact that they lack basic knowledge of related medical conditions of concerned patients. Rest of the data also gave the evidence for a huge breach among the awareness, education and realistic approach in this selected workforce. We suggest that caregivers must be aware of indications and have strong medical foundation of the concerned departments where they are serving. We propose the medical education and clinical workshops for this set of serving individuals at ground levels along with the technical fine tuning with the help of case studies and practice. We recommend to improve this field force especially who are serving the majorities and in rural areas.

21-22

Authors: Syed Muhammad Mustahsan & Syed Hasan Mustafa Rizvi

Isolated Trochanteric Fracture is a rare clinical entity in adults especially when it occurs due to trauma. Isolated traumatic fracture of lesser trochanter has been reported very rarely in the literature, as usually in adults, it is associated with malignancy which should be ruled out during the diagnosis.