INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE RESEARCH

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.

67-71

Authors: Shamoon Noushad, Sadaf Ahmed, Huma Khalid , Rida Nasir , Ikram Tunio & Shaikh Tahir

The mental and physiological stresses can be an important trigger of migraines & headaches. These strains act to enhance the progression of migraine that could be psychological, physiological stress, Environmental stress or Chemical stress. The population data of 185 people have taken which include the ages from 14-60 years. The data were analyzed by ICHD-II criteria .The duration of the research was from-February 2012 to December 2012.The targeted population were of both genders age ranges 18-25 years. The data have collected in two parts, before examination and during examination. The obtain result shows that the frequency of migraine is higher in women as compare to men. Mostly people were suffering from mild psychological stress that might be periodical stress as approximately 50% people were students who were under examination stress as the exams were about to held. Nutritional stress is another major factor as the high temperature causes dehydration resulted in vasoconstriction resulted in sensation of pain. Environmental stress was an additional cause for students. Physiological stress was also noticed as the main cause that bring about the initiation of migraines period whether it could also leads towards the Menstrual migraine that has a sign of vomiting or nausea. Individual concerns with healthy life patterns and stress free conditions could help a person to reduce or prevent the migraine.

78-81

Authors: Saniya Khalique

Diabetic Foot Ulcer subjects (DFUS) were clinically examined in the urban areas of Karachi. Neuropathy, peripheral vascular disease, foot deformity, improperly fitted shoes can make a diabetic person at risk of foot ulcer. In the present study, prevalence, role of inadaptable risk factors (age, gender, height) and socio-economic status were examined in DFUS and normal diabetic patients (NDP) taken as control. A total of randomly selected subjects N= 59; male=33, female=26 (DFUS: n=41; male=22, female=19; NDP: n=18; male=11, female=7). In this study prevalence of DFU was found in male gender as 54% of our patients were male and 46% were female. Mean ± S.E.M. of male DFUS height was 5.7 ± 0.353 ft while that of women was 5 ± 0.306 ft, this greater height in male makes them predominant for DFU. Mean ± S.E.M. of age for DFUS males: 58 ± 10.237 years, that is comparatively higher than control NDP males: 56.81 ± 10.235 years. Mean ± S.E.M. of age for DFUS females: 54 ± 11.18 years which is also significantly higher than control NDP females: 49.57 ± 9.727 years. The greater part of the investigated patients belonged to lower class (54% males & 74% of females).

93-96

Authors: Saima khan1&4 , Sadaf Ahmed1&2, Nelofer Sultana3 & Shamoon Noushad1&4

This evidence-based study is to provide the awareness of breast self-examination; its outcomes and significance. There is a never matching increase noted in the incidences of breast cancer worldwide. Pakistani women are on top of the list in the region to develop this disease and it has also been observed that they diagnose to have higher grade disease in early age. Early detection followed by timely treatment is the best prognosis for long-term survival. This a retrospective study in which the data was gathered through a questionnaire for the selected variables. Out of 100 patients 49 were doing BSE while 51 were unaware of breast self-examination. Out of these 49% , 42% were doing BSE randomly,2% were doing monthly,3% were doing weekly while 2% were doing on daily bases, and 24 (49%) patients were found to have microscopically confirmed carcinoma and 12 (24%) were found to have negative microscopic exams remaining 13 (27%) patients who were doing BSE were not gone through microscopic exam. Breast self-examination is the simplest tool that can play an important role in the detection of breast cancer. There is need to encourage BSE practices among the women along with the development of awareness program to make it successful.

100-103

Authors: Samreen Soomro, Samina Baig , Saima Naseem & Shaheen Sharafat

SEASONAL VARIATION AND RECENT STATUS OF TYPHOID FEVER IN A TERTIARY CARE HOSPITAL Samreen Soomro1, 2, Samina Baig1 , Saima Naseem1 & Shaheen Sharafat1 1. Dow University of Health Sciences, Karachi. 2. Dr. Panjwani center for molecular medicine and drug research, University of Karachi. Corresponding Author Email: samreen@samerica.com ABSTRACT In many developing countries, typhoid fever is endemic. Early diagnosis is important for appropriate treatment on time. Typhi dot is important diagnostic tool for early diagnosis of typhoid fever. In the current study from February, 2012 to May 2014, samples from 19433 febrile cases referred to Dow Diagnostic Research and Reference lab were screened for serum IgM and IgG for Salmonella typhi by Typhi dot test. Results showed that about 12501 patients had both IgM and IgG antibodies against Salmonella typhi. Male patients were more commonly affected than female patients. Highest frequency of positive cases was seen during the month of October. Age group >15-44 was most likely affected among different age groups. This study suggested that still we are far behind in improving sanitation and elimination of such controllable disease. Therefore prompt measures should be taken to control the disease especially during hot season by vaccination, improved sanitation and education as well.

108-116

Authors: Iqbal A. Muhammad Khyani, Masood A. Qureshi, M. Umar Farooq & Talat Mirza

Objective: To evaluate salivary detection of interleukin 6 & 8 and high risk HPV-16 & 18 are informative biomarkers of Oral Pre-malignant Lesion (PML) and Oral Squamous Cell Carcinoma (OSCC) in our population. Duration: July 2011 to December 2012. Subjects and Methods: Total 105 cases were included. The subjects were divided in three groups ‘A’, ‘B’ & ‘C’ having 35 participants each. Group ‘A’ comprised of patients having strong clinical evidence of oral PML. Group ‘B’ constitutes histologically proven OSCC and Group ‘C’ includes disease free subjects as controls. Relevant clinical history was recorded after informed consent on institutional approved performa. Saliva was collected as per standard drooling method’. Samples were stored at +4oC and later transferred to Dow Diagnostic, Research & Reference Laboratory to store it at -20oC before further process. Samples were subjected to centrifugation at 4500 rpm for 15 minutes at 4oC. Supernatant fluid phase was used in ELISA for detection and quantification of IL6 and IL8. . Cell pellets were used for identification of high risk HPV-16 & 18 by real-time PCR. Data was entered and analyzed on SPSS version 16. P-value of 0.05 was taken as standard reference. Results: In group ‘A’, IL6 was not detected in almost all the subjects except one case. IL8 was detected in 26/35 (74.3%) subjects and not detected in 09 (25.7%) cases. In group ‘B’, IL6 was detected in 13 (37.1%) cases and in 22 (62.9%) cases, it cannot be detected. IL8 was detected in 33 (94.3%) and it was not detected in 02 (5.7%) subjects. It is observed that IL8 is consistently found raised in group ‘A’ & ‘B’. In group ‘C’, IL6 was not detected in any of the subject while IL8 was detected in 10(28.6%) cases. Significant association was found for qualitative salivary detection of IL6 and IL8 between the groups (P= < 0.0001 and < 0.0001 respectively). Regarding quantitative salivary concentration of IL6 & IL8, no significant co-relation was found in salivary levels of IL6 between the groups while there was significant association of salivary IL8 levels between the groups (P= <0.0001). On post Hoc multiple comparison, significant co-relation was found in IL8 levels between oral PML group and controls (P=0.001) and OSCC group and controls (P= <0.0001). In group ‘A’, HPV-16 was detected in salivary samples of 3 (8.6%) cases while HPV-18 was not detected. In group ‘B’, HPV-16 was detected in the salivary samples of 07 (20%) cases while HPV-18 was detected in 06 (17.1%) cases. Mixed HPV-16 and HPV-18 were found in 02 (5.7%) cases. In group ‘C’, HPV-16 was detected in 03(8.6%) cases while HPV-18 was not detected in any of the subjects. Significant relationship was observed between the groups for salivary HPV-18 detection (P= 0.002) while for detection of HPV-16, no significant association was found (P= 0.245). Conclusion: Salivary concentration of IL6 and IL8 in oral PML and oral cancer are useful biomarkers in our population. Detection of HPV infection for the causation of oral cancer cannot be fully established possibly due to small sample size. More over different genetic makeup, environmental and geographic differences, indulgence in peculiar risk factor habits and different sexual practices compared to west due to socio-cultural and religious restrictions could be the reason.

123-127

Authors: Sadaf Ahmed, Shamoon Noushad, Syed Zain Azher & Shaikh Mohammad Tahir

Binge eating or chaotic eating refers to unhealthy eating patterns that are found in low incidences comparatively to verify and diagnosed eating disorders. Altered eating behaviors may lead to severe eating disorders like Binge eating disorder and bulimia nervosa that could be life-threatening if left undiagnosed The purpose of this study is to investigate unordered or binge eating attitudes among individuals with respect to their eating patterns. An observational study has been done in which a randomized data of 120 individuals have been selected within a group of 24 males and 96 females with the help of a questionnaire based survey on food habits, preference of type of food intake, tea consumption, munching habits, workplace or home eating and eating during working hours. R Results were analyzed on the basis of percentage values and SPSS 17.0 different associations between variables. out of 120 people 58.3%of the individuals including both genders did not have a feeling of fullness, 50.83 % of the total individuals eat during working hours and possess munching habit, 83% use to eat biscuits to munch .Unordered eating patterns also affect the frequency of bowel movements, 58.30% people have bowel movements once a time. Irregular eating and munching habits does not initiate a feeling of fullness in the beginning of a meal, due to binge eating people do get satisfied by the smell of food and did not take a proper meal to fulfill nourishment requirements. However, binge eating lead to increase appetite as the munching material including snacks digest quickly which cause more food intake and people did not get fully satisfied by the smell of food only and excessive tea intake is one of the contributing factors. Binge eating affects normal appetite, eating attitudes and Bowel movements which may further lead to severe eating disorders like Bulimia nervosa which should be clarified early instead left undiagnosed.

5-10

Authors: Saima Gul , Humaira Gul & Rukhsana Nawaz

Mentha arvensis (MA) is traditionally used in hypertension and in patients with ischemic heart disease. The scientific rationale for its use is not known. In order to find a pharmacological basis of its use in traditional medicine we made three polarity based fraction from the crude extract of MA and investigated their effects on arachidonic acid metabolism. MA inhibited arachidonic acid metabolite thromboxane B2-a stable analogue of thromboxane-A2, formed via cyclooxygenase pathway and lipoxygenase product 1 and 12-hydroxyeicosatetraenoic acid formed via lipoxygenase pathway. More potent inhibition of thromboxane-B2 compared to lipoxygenase product 1 and 12-hydroxyeicosatetraenoic acid was observed and indicates MA might possess antiplatelet activity as thromboxane-B2 is one of the strongest proponents of platelet aggregation. When MA was investigated for antiplatelet activity, it was found to inhibit human platelet aggregation induced by arachidonic acid as well as by adenosine diphosphate and platelet activating factor while collagen-induced platelet aggregation was unaffected by MA. Since arachidonic acid-induced aggregation is mediated through thromboxane-A2, these results indicate that inhibition of platelet aggregation may be responsible for the observed beneficial effects of MA in patients with ischemic heart disease. Furthermore, MA was also effective in enhancing glutathione peroxidase activity, although it had no significant effect on superoxide dismutase activity. These activities were however, distributed throughout various fraction of MA.

16-18

Authors: Shaista Taufiq Meghani, Muslim Shah, Neelam Saleem Punjani, Salima Shams & Rashid Abbas

Child Sexual Abuse (CSA) is one of the major public health problems that exist globally. Abuse, is the term which has been using for long period of time since the human societies existed in the world. But, we would like to be more specific to the CSA in Pakistani context. For the purpose, Logical Framework Analysis (LFA) was developed to design project in the community health settings for a health prevention, promotion, and health maintenance of the people living in the community. Child Sexual Abuse, issue was identified after thorough assessment of the community which was prevalent but unreported. LFA approach was used to explore the problems through root cause analysis and discover some of the relevant strategies to solve the identified problems. In conclusion, there is an intense need of awareness regarding child sexual abuse to prevent this problem not only in the community but also at country level.

22-27

Authors: Syed Muhammad Faiq, Nazish Naz, Fatima Batool Zaidi & Adeeb ul Hassan Rizvi

The objective of the study was to compare the sensitivity and specificity of ultrasound, X-ray KUB and CT for the diagnosis of ureteral colic in patients with acute flank pain. This study was carried out in Department of Radiology Sindh Institute of Urology and Transplantation (SIUT) from Aug 2010 to Nov 2010. A total of 190 patients with mean age of 35 years were included in the study. All individuals underwent pre-procedural imaging X-ray KUB, U/S, and CT. On these imaging modalities, obstruction of urinary tract and stones were determined. X-ray KUB was done as a guide for U/S exam only. Ureteral stones were confirmed in 190 patients. Specificity for ct was 100% whereas X-ray KUB and U/S was 94% and 76% respectively. Sensitivity for CT 100%, U/S 52.6% and X-ray KUB 89.5% respectively. Some stones were not detected by U/S and few stones were not detected on X-ray KUB due to bowel gases. Cases were correctly diagnosed with all three techniques. CT is the most reliable technique for the detection of uretric stones however, X-ray and U/S also be chosen alternative to CT with a reduce radiation dose.

31-33

Authors: Mohammad Ishaq, Muslim Shah, Shaista Taufiq Meghani & Neelam Punjani

After every 16 minutes, one individual die not merely from a disease or an accident but intentionally through suicide. Literature reveals that it is a long process usually stretches over years from suicidal ideation to planning and finally an attempt. The causes of suicidal behavior are immense which captivate these poor and innocent creatures in great troubles. In teenagers, the suicidal ideations are related to multiple internal and external factors. They consume different lethal liquids and adopt different methods for performing this violent act. Further on its impact is not only on her individual and family life but has a great impact on the society as well. It is not an essay task to eradicate this violent act but as we a responsible member of the society we can assess their suffering and agony and help them identifying different social groups. Along with it we can also prevent the suicide at three different levels that’s primary secondary and tertiary. We can also do the counseling. In conclusion, I would say that it is a rising issue of today’s world and we all must give our efforts to show a reduction in its prevalence.

38-41

Authors: Neelam Saleem Punjani, Salima Shams & Sahreen Malik Bhanji

Health plays an important role in shaping the human capital. Good health enhances the productivity and efficacy of the labor force which leads to the economic growth and human welfare. World health organization (WHO) has defined health system as “all organizations, people and actions whose primary intent is to promote, restore or maintain health". Healthcare delivery system is comprehensive therefore; for the analysis purpose; WHO health care system framework will be used. It has six building blocks which will be utilized as an instrument. The six blocks is comprised of leadership, human resource, information, medical products and technology, financing and service delivery. Intermediate output leads to the desired health outcomes. This paper presents the comprehensive analysis of the healthcare systems of Pakistan and United States America with the help of WHO health care system framework followed by health system challenges and concludes with some practical strategies to overcome those challenges.

46-50

Authors: Shaista Taufiq Meghani, Sana Sehar & Neelam Saleem Punjani

Healthcare delivery system is an arrangement that serves best to any country’s population with effective, efficient and fair distributions of resources, and funds through organized infrastructure to thrive well. Better health improves country’s labor force and ultimately raises human welfare and economic stability. This healthy labor force and productive human capital resources can be attained through structured healthcare facilities by the government for its people. Globally, health sectors varies from country to country and it depends on how much expenditures on health is been effectively utilized. In majority of the developing countries, private healthcare sectors, donor, and out of pocket expenditures are the primary contributors in health care services that may raise human capital and economic growth of the country. Whereas, public health sectors remains underprivileged due to structural fragmentation, lack of resources, and functional inabilities. This paper is mainly going to discuss about health care delivery system of Pakistan in comparison to China followed by organizational structure, analysis of both the healthcare systems, and some recommendations to improve healthcare reform and its utilization.

54-57

Authors: Neelam Saleem Punjani & Sahreen Malik Bhanji

Nursing as a profession today still faces several challenges. There seems a dire need to produce such professional nurses that up bring the dignity of this distinct profession. The heavy responsibility of producing such professional nurses lies in the hands of nursing institutions and primarily the schools and colleges of nursing. The standard of the education offered by these institutions plays an important role in this regard. While addressing at the inaugural ceremony of the Aga Khan University School of nursing and midwifery, His Highness the Aga Khan, chancellor of the Aga Khan University spelt out the vision for the nursing profession in the following words “today, this is the beginning, the birth of a new medical institution in Pakistan, the Aga Khan University…and I hope, this day will also be the dawn of a new dimension for the profession of nursing in Pakistan”. Thus it is important that nursing institutions undergo continuous quality assurance process to maintain the high standards of nursing education to develop nurses that can claim their position in this challenging era.

62-65

Authors: Sadaf Ahmed, Saima khan , Shamoon Noushad & Amna khan

A good clinical practice (GCP) is an ethical and scientific quality act from oldest enduring customs in the historic times of medicine. As the guiding ethical code it is primarily known for its edict to do no harm to the tolerant. However, the complexities of modern medical research necessitate a more elaborate set of guidelines that address a physician’s ethical and scientific responsibilities such as obtaining informed consent or disclosing risks of these biohazards. Our country in last decades has excelled so much in terms of offering training programs for these professionals to bridge the gap between the therapeutic interventions and knowledge of these working individuals. We have done a survey on both male and female working in specific hospitals in Karachi. They were interviewed about their skills, duties and knowledge about standards of clinical practice. With reference to the patient care and conditions they were inquired about the medical background, awareness of the sufferer’s ailment and ethical concerns like patient safety & rights. We have found nearly disappointing results as most of these workers were ignorant of the fact that they lack basic knowledge of related responsibilities 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 of this set of serving individuals at ground levels along with the technical fine tuning with the help of case studies and good clinical practice.