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Review Arlick 25Assumptions And Attitudes Towards Childhood BereavementDr. Syed Qamar Abbas

Abstract Presenud in~ Annual Medical Symposium 2011 28Morphological study of sodium tungstate effects on liver and lcidney of strptozotocin induced diabetic rabbits.Authors: Afra Samad, Mohammad Tayyil>,Toxicological profile of typical and atypical drugs in psychotic disordersAuthors: GhuJam Rasool Bhurgli, ObuJam Mustafa DabriMuhammad All Qazi, . Hussain Bux KorejoEvaluation at departDleD.tof community medicine and health sciences of fourth year MBBS medical students batch 2010Authors: Dr. Noor All Samoon AP DOCHS MMC MPK.10detmnjne morphology after ciprofloxacin &zinc cllloEide in adolt albino at pre- Dalal period.Author: HajiMuhammad As1am awma. ShanbtAwanAnatomyDiagnostic Accuracy of Alvarado Scoring System in Acute AppendicitisAuthors: Abdul Ghani Soomro, Faisa! Ghani Siddiqui, Arshad Hussain Abro, Shahnawaz Abro, Noshad Ahmed Shaikh, and Abdul SattarMemonFrequency &Presentation of Allergic Fungal Rhinosinusitis in Muhammad Medical College MirpurldlasAuthors: Arsa1an Ahmed, Noor Ahmed, Salman MatiuIlah Shaikh, Muhammad Saleem MarfaniOutcome of 82 cases of Fascio-Cutan.eous flap for complicated wound leg with exposed bonesAuthor: Dr.Mahesh Kumar, Associate Professor Plastic Surgery L.U.M.H.SJamshoroi HydetabadProton pump inhibitors - over - prescribed in a rural community?Authors: Dr. Syed Zafar Abbas, Dr. Rehmatullah Soomro, Sadaf ShaffiCan an experienced Urologist is do a better TURPAuthors: Dr. Javed Rajput, Dr. RehmatullahSoomro Dr. ObuJam Akbar Arain,Post-operative complications, observed in onr ward; a reeeat six month review.Authors: Dr. Rehmatullah Soomro, Dr. Jawaid Rajput, Dr.Ahmed Ali LaghariFistula in ano: onr experience at a rural based teaching.Authors: Dr. Muhammad Jawaid Rajput, Dr. Rehmatullah Soomro, Shahnam Rani, Naseer AhmedBlood Transfusion arrangements and use of blood in elective surgical procedureAuthors: Dr. Rehmatullah Soomro, Sara Ahmed Ali, Muhammad Rizwan JavedPlexiform neurofibromatosisAuthor: Prof. Ghulam All Memon, Prof. & Principal, Muhammad Medical College, Mirpurldlas.Yield of G-I consultant referred endoscopies is higher than non-GI consultant :refmers.Authors: Abdul Ghaffar (FiD.alYear) Dr. Syed Zafar AbbasSection of Gastroenterology, Department of Medicine, MMCHAn Audit of Colonoscopy at MMCHAuthors: Abdul Ghaffar (Fmal Year) Dr. Syed Zafar Abbas (Prof. of Medicine IGastroenterology).Symptom of dysphasia has high probability of significant pathology.Authors: Abdul Ghaffar (Fmal Year) Dr. Syed Zafar Abbas (Prof. of Medicine IGastroenterology).Section of Gastroenterology, Department of Medicine, MMCH.Upper GI Bleed AuditAuthors: Abdul Ghaffar (Final Year) Dr. Syed Zafar Abbas (Prof. of Medicine I Gastroenterology).Section of Gastroenterology, Department of Medicine, MMCH.Oesophageal malignancy is common among women presenting with Dysphagia.Authors: Abdul Ghaffar(Fmal Year) Dr. SyedZafar Abbas (Prof. of Medicine I Gastroenterology).Section of Gastroenterology, department of media MMCH.An andit of bladder outflow obstruction at MMCH

Ori~Ankk-----------------------------------------Prevalence Of Malaria Among The Patients Living InAreas Of District Sba (Shaheed Benazir Bhutto) And Merpmkhas 2Author. Dr. Fayaz Ahamed Memon, Dr. UzmaBukhari. Dr. MilMohammad Sahito,Hyper Chelostrolemia As A Risk Factor For Type 2 Diabetic RetinopathyAuthor: Dr. Fayaz Ahamed Memon, Dr. Uzma.Bnkhari, Dr. MilMobammad Sahito, Dr.Mashoor Alam shah.State of needle stick injuries among paramedic nurses of civil hospitals at sindh.Authors: Dr. Noor Ali Samoon, Dr. Asif Shah, Dr. Allah Bachayo RajarFactor affecting the utilization of Antenatal care services among pregnant women at District Headquarter Hospital. MirpurkhasAuthors: Dr.Muhammad Asif, Dr.Muhammad Farooq Baig, Dr.Ghulam Mustafa YousfaniTreatment Outcome of Tuberculosis Patients Registered at TB Centre in a Private Teaching Hospital, SindhAuthors: Dr. Muhammad Asif, Dr. Gohar Rather, Dr. Allah Bachayo Rajar

1

CONTENTS&firoriU _Failure of Polio eradication in PakistanASIFSHAH

Authors: Aurangzeb, MuhAmmAd Jawad, Muhammad lmran,ZaigamIsmail, Hasan Shams, lees Somro,MuhAmmAd Waqas, Iftikhar Khan, (4e.Year) Prof. Noor Ali Samoon, Asif Ali Shah, •MMC, PirMuqaddas Jan Sarhandi,Commonest e1fec1sof mood swings during menstruation on academic petfoo.nance of female medical students at MMC.Authors: AmnaRiaz, Madiha Shah. MahrukhAbbas, Sonia Zalar, AneeqaIshtiaq, Shel!.aryarAjmaAimanDyas. Abubakar Riaz (Fmal Year) Dr.Yasmcen K.obaro (Assistant Professor Department of Gynaecology,MMC)Prevalence of gender based discrimination among medical students of Pakistan.Authors: Fatimah Hameed,Zain Sbarif. Farah Sattar. MariaMazbar. Yasir A1am Khan, Sbahnawaz, Naveed Wattoo. Mohummad Bilal,Muhammad Sbahid, ZainAli Raza. MMC, Mirpwkhas.Prevalence of psychiatric symptoms among medical students of PakistanAuthors: Fatimah Hameed. ZainSharif, Farah Sattar,MariaMazbar, Yasir A1am Khan, Sbahnawaz, Naveed Wattoo, Muhammad Bilal,Mohammad Sbahid, ZainAli R.aza Dr.Noor Ali Samoon, MMCWhy quacks are more soccessful in small towns and villages?Authors: Gada Hussain, Mohammad Sohail Qadir, Rashid Ali Lashari, ImranDl.ahi, HassanAli, ADahnOOt, Asma Israel, Mehak Fatima, SabaSanaj, Reeta Jrumari, Asma Rani,Aftab Ahmed Dr. Noor Ali SumoonInfection control practices in government hospitals of two provinces of Pakistan.Authors: Haidet Ali.Nadia Manzoor, Muhammad Arshad, Azeen Ran, Hammad Raziq, Farwa Khizar, AbdulR.ehmanAnum Farooq Haroon,ImranSafdar, (411)Year) Dr. Asif Ali Shah,Do you cheat??? Academic disbonesty among undergraduate medical students.Authors: Manzoor Hussain, Numan Majeed, Aneela Ambe,r, Sahar Khalid, AhsanRasheed, (Final Year MMC)General physicians and irritable bowel synome a KAP studyAuthors: Numan Majeed, Marriam Noor Malik, Hita Pervez, Marryam Tahir, Naeem M~eed, Adee lAbas Chatha (Final Year)Job satisfactioo among psychiatristsAuthors: Numan Majeed, HiraParvez, MaaiamNoor Malik, Naeem Majeed, Somia IqtadarChoices, inf1oeo.ces and satisfactioo of medical students regarding professioo.Authors: RabiaAli ,Aneela chandio Kbadija Safdar AnumAyaz, Dr. Syed Razi MuhammadSIDdy of causes of depressive state of medical students among girlsAuthors: Sadia Ismail, Sumaya gill, HinaArif, Itfat Safdar (Fmal Year MBBS). Dr. Syed Razi MuhammadIsHijab a hiDance inprogressing inmedical collegeAuthors: Sahar Khalid, Aneela Amber, NumanMajeed, Absan Rasheed, Manzoor Hussain (Fmal Year MBBS)Knowledge attitude practice & behavior of medical students regarding communication skills.Authors: Sajida Zafar, Sia Noureen, Sumba Javaria, Nosbeen Bano, Afroz Gull, Numan Majeed (Fmal Year MBBS)Audit ofJ.oguino scrotal swelling in surgerical department ofMMCH between July 2010-july2011Authors: SbamasudDin, WaqasNaseem, Jameel Ahmed, GhulamMurtaza, SajidYarKhan,Ahmed Abbas (Final Year MBBS ), Dr. Syed RaziMubammd (Professor of Surg~).Motivator and baaiers for blood dooation among the students of Mubammad Medical College Mirpw:khas.Authors: Syeda Tahira Sberazi, Fahad Riaz Warraich, Tuba Khan, Sajjad Sarwar, Farah Nureen, Zahid Mnsbtaq, Hamid Saleem. Saba Faiz,(4·Year) Dr. Asif Ali Shah (Assistant Professor Community Medicine,)Effect of Supplementary Exam on studentsAuthors: Shebaryar Ajmal. Aimanllyas. Abobakar Riaz, Gohar Janjua(Final year) Dr. Syed Razi MuhammadThe prevalence of Low Back pain among medical students, doctors and supporting staff at MMC.Authors: Darakhsban Rehman, Saba Oyas, Sia Khan, Adnan Khalil. (Fmal Year) Dr. Syed .RaziMllbammad,To assess the scope for improvement in hostel facilities by residents of MMC hostelsAuthors: Sumera Bibi, Sbazia Parveen, Rabia Akram, Khawar Abbas, Dr. Syed Razi Muhammad.1yPes of sleep disorders among medical stndents of MMCAuthers: Sia Maqsood, Rabia Saleem, Sumaira N-. WabeedAhmad, Nauman Ahmad, NabeelAsbrafCbandoor ,Paisa! Nawaz, MalikAhmadM.Usman, (4· Year MBBS). Noor All Samoo. Asif All Shah, MMe.Prevalence of the skinproblems IDiseases in the cosmetic usersAuthors: Yahya Abdul Hanan. Abdul Sattar. MariaZahi.d, Zubair Tebseen, Ammara Khalid. Sbaista Fatima, Huma Ameez Awan Hasbmamllab,Ameer Khan, (Fourth Year) Dr. Noor Ali Sumoon ,Dr. Asif Ali.MMC.Prevalence or cosmetic use in malesAuthors: Zubait tehseen, Yahya Abdul Hananm, Abdul Sattar, Maria Zabid, Ammara Khalld, Sbaista Fatima, Huma Ameer Awan, Hasbmatullah,Ameer Khan, (4e. year) Dr. Noor All Sumoon, Dr. Asif Ali. MMC.An audit of malignant disease at MMCHAuthors: Saba 1acob .(House Offocer), Dr. Syed Zafar Abbas (Professor of Medicine)

Mubammad Medical Co.. bolcls 8tb Annual Medical Sympo8ium, and inaugurates its own Sdeotific JoumaI _

3"" ANNUAL MEETINGOFsooerv OFSURGEONSPAKISTANMIRPURKHASCHAPT'EA _

The government needs to modify the policies andplan effective strategies with media and religiousleader to increase awareness against negativepropagandas. Furthermore, a strong encouragement isrequired for continue funds to increase staff,resources, and community participation throughdifferent strategies'.

Polio activities activists showed resistant and bannedthe BPI workers to function in Taliban controlledareas and have also discouraged local populationfrom availing the services. They claimed that thesetypes of campaigns are used by the intelligenceagencies to gather data against them and it wasshown in the case of Osama bin Laden"

Poor knowledge and misconception among parentsregarding Immunization is an important barrier forpolio immunization. Some of the local religiousleader take the advantage of poor knowledge ofparents and develop misconception about thevaccines like "vaccine it is not in Islam and it is notrecommended that to vaccinate the children and thosewho die from these diseases will be martyrs"

Staff Shortage and unavailability of trained motivatedstaff for polio campaign is another identified barrier.Most of the vaccinators and paramedics are ghost orabsent staffs, so absenteeism and ghost the mostserious concern for polio immunization activities.Due to staff shortage, it is a common complaint aboutthe health care workers that they do not work:properly and do not maintain professional attitudeand behaviors which enhance the negative behaviorof the parents towards immunizationviii •

the majors factors were limited resources anddifficulty to reach BPIs center .

To maintain the quality and efficacy polio Vaccineshould be store under the range of 2 to 8 centigradefor one to 3 month in cold chain system.Unfortunately in Pakistan, the cold chain system isnot up to the mark the main reason are electricity falldown, lack or malfunction of cold chain equipment athealth facilities, poor knowledge and practices ofvaccination team regarding importance of coldchainvD•

Difficulty to reach in population residing in remoteand far flung areas from health facilities is one of theimportant determinants of vaccination failure. Theidentified factors for poor access are inadequatemobility, lack of incentive and inflexible workingworker of vaccinator team. Pakistan house holddemographic survey 2006-07 concluded that half ofthe children are not immunized living in remote area,

Pakistan is one of the three countries wherepoliomyelitis is still considered as an endemic viralinfection', In every round of National Immunizationday (NIDs) over 30 million children are immunizedfor polio by Expanded Program on Immunizationwith the support of multiple multinational donors andprivate sector. ii In every campaign over 6000permanent centers and more than one millionoutreach and mobile vaccination sessions providesimmunization services with the support of more than10,000 vaccinators and approximately 6000 ladyhealth visitors (LHVS)iii. Despite the utilization ofhuge amount of resources Pakistan fail to eradicatethe polio resulted international communities imposeda travel ban on Pakistan in 2013.ivLiterature reviewsuggested multiple reason for failure in eradication ofpolio, some are discussed below.

Polices and Management on immunization are anunstable due to frequently change by the governmentofficials resulted in delay and disrupt the healthbudget, policy. planning, effective strategiesimplementation, and evaluation". Corruption initiateslow quality in the, finance, human resources, andmaterials which result implementation failures in thehealth policies and programs against polio vi. Inaddition to above factors unsatisfactory managementskills, low pay scale of staff, lack of incentives,insufficient resources, and supervision are the majordeterminant of eradication of polio in Pakistan.

ASIFSHAHDepartment of Community Medicine Muhammad MedicalCollege,Mirpurkhas, Pakistan.

Failure of Polio eradication in Pakistan

ISSN: 2075-9983-APR 2014-QOC~TG2?QO~14~~~~~~~~1 Q_01_1~I~~~~ __111111!~~~~~~~~~~~.

Editorial

02ISSN: 2075-9983-0CT 2013-APR 2014

Conclusion: In the areas (Nawabshah andMirpurkhas), Plasmodium Vivax and PlasmodiumFalciparum are the cause of Malaria.

Results: Plasmodium Vivax in 70.8% of cases andPlasmodium Falciparum in29.2%of cases.

Methodology: This descriptive and experimentalstudy was carried out at department of pathology,People's University of Medical & Health Science(PUMHS), Nawabshah. The cases were collectedfrom paediatrics& Medical outpatients departmentsof PUMHS Hospital Nawabshah and also fromMuhammad Medical College (MMC) Hospital &Civil hospital Mirpurkbas (CHM) from January 2010to December 2011. A total of 1200 patients wereincluded. The prevalence of malaria on the basis ofage, sex, areas of resident, and clinical finding of allpatients were recorded and blood tests performed.

Abstract:Introduction: Malaria is a major cause of morbidityin the tropics and about 300 million causes werereported word wide in 2006 among the 100 species ofgenous plasmodia, the four species such as PL:falciparum, vivax, ovaule and malariae causesmalaria The malaria is transmitted by the bite offemale anopheles mosquitoes.

Addresses IDepartment of Medicine MuhammadMedical College, Mirpurkhas, Pakistan2 Department of Pathology Muhammad MedicalCollege, Mirpurkhas, Pakistan.3 Department of Forensic Medicine MuhammadMedical College, Mirpurkhas, Pakistan.Corresponding author Email:fayyaz.memon@gmail..com*Published: 4 October 2014 Received: 20 July 2014Accepted: 1st October 2014

Author: FayazAhamedMemon-1, Uzma.Bukharr',Mir Mohammad Sahito",

Original article

PREVALENCE OF MALARIA AMONG THEPATIENTS LIVING IN AREAS OF DISTRICTSBA (SHAHEED BENAZIR BHUTTO) ANDMERPURKIIAS

10wais,Aatekah, Asif RazaKhowaja, Syed Asad Ali,and Anita KM Zaidi. "Pakistan's expandedprogramme on innnunization: An overview in thecontext of polio eradication and strategies forimproving coverage." Vaccine 31, no. 33 (2013):3313-3319.

1Galland, Anne. "Polio vaccination worker is shotand killed inPakistan." BMJ345 (2012).

1 Abdullah, Amir, and Muhammad Anwar."Immunization Barriers inKyberPukhtunkhwa (KP),Pakistan."

1 Sultanow, Eldar, and CarstenBrockmann. "AnInformation Technology Model for PharmaceuticalSupply Chain Security." The Electronic Journal ofInformation Systems in Developing Countries 57(2013).

1 Lorenz, Christian, and Muhammad Khalid."Influencing factors on vaccination uptake inPakistan." JPak Med Assoc 62 (2012): 59-61.

1Kazi, AdbulMomin, M Khalid, and A N. Kazi."Failure of Polio Eradication from Pakistan: Threat toWorld Health?" Journal of Pioneering MedicalSciences 4, no. 1 (2014).

1 Shah. Masaud. Muhammad Kazim Khan.SalehaShakeel, FaizaMahmood, ZunairaSher,Muhammad Bilal Sarwar, and AleenaSumrin."Resistance of polio to its eradication inPakistan." VirolJ 8 (2011): 457.

lHasan, Q., A. H. Bosan, and K.MBile. "A reviewof EPI progress in Pakistan towards achievingcoverage targets: present situation and the wayforward." (2010).

ReferenceslCenters for Disease Control and Prevention (CDC."Update on vaccine-derived polioviruses." MMWR.Morbidity and mortality weekly report 55, no. 40(2006): 1093.

ISSN:2075-9983-APR 20M-OCT 201403

N=Numberof patients

AGE SEX RESIDANCAge in years 5- Male770(64.1%) E65years mean Female430 Ruralage35+30 (35.9%) 800(66.7%)

Maleto urbanFemaleratio!.7:1 400(33.3)

Adults children total

500(41.7%) 700(58.3) 1200(100%)

TABLE 1Prevalence of malaria among the children and adultson the basis of age, sex and area OF residance ofdistrict SBAlMirpurkhas

N=1200

Results: A total of 1200 cases were studied. Amongthese 700 (58.3%) were children and 500 (41.7%)were adults. The age of these patients ranged between5 and 65 year, and their mean age was (35+30), whilemale to female ratio was 1.7:1. Of 1200 patients,400(32.3%)were residents of Nawabshah city and800(66.7%)were resident of the rural areas of districtSBA and Mirpurkhas. (Table I).The clinical findingin these patients as shown in tableITwere fever withrigor, sweating or feeling of cold and hot pallor, bodyache and splenomegaly. The laboratory finding inthese patients as shown in table 111 showed that themean value of hemoglobin, RBC and platelet countswere significantly reduced, while WBC count withpercentage of neutrophils and ESR were significantlyincreased. The microscope examination of stainedthick and thin blood smears of all these patientsshowed Plasmodium Vivax in 70.8% of cases andPlasmodium Falciparum in 29.2%of cases. The ICTmalaria test was positive for Plasmodium Vivaxin70.8% cases and 29.8% positive for PlasmodiumFalciparum.

and thin blood smears were made on the clean glassslide and examined under the microscope fordetection of various of developmental stages ofmalarial parasites after staining with Giemas, stain.The (CBC) including Hemoglobin Concentration.Total Leucocyte count (TI.C), Differential LeucocyteCount (OLC) and Platelet Count were determined byhematology analyzer from the blood sample. TheESR and Malaria Rapid Diagnosis Test were alsodone from the same blood sample.

Patients and methods: This descriptive andexperimental study was carried out at department ofpathology, People's University of Medical & HealthScience (PUMHS), Nawabshah. The cases werecollected from paediatrics& Medical outpatientsdepartments of PUMHS Hospital Nawabshah andalso from Muhammad Medical College (MMC)Hospital & Civil hospital Mirpurkbas (CHM) fromJanuary 2010 to December 2011. A total of 1200patients were included. The prevalence of malaria onthe basis of age, sex, areas of resident, and clinicalfinding of all patients were recorded. To establish thelaboratory diagnosis of malaria and its hematologicalcomplication, Z-3ml of venous blood sample wastaken from each patient in the tubes containingEDTA and sent to the pathology department. Thick

The life cycle of malaria parasite is completed inhuman and female anopheles mosquito. Thesprozoites are transmitted into blood by mosquito biteand they first infect the liver cells, then red bloodcells by releasing merozoites which mature into themale and female gametocycle. When a mosquitobites a malaria infested human, these gametocycle inthe mosquito"s stomach unite together to formzygotes that develop into oocysts, which grow andrupture to relesingsporozoites and cycle starts again'.Malaria causes haematological complications such asanemia leucocytosis and thrombocytopenia, feverwhich rigor, sweating, body ache, headache,vomiting, pallor and splenomegaly. Death can occurdue to complications including cerebral malaria andhematological complications. The microscopeexamination of peripheral blood for detection ofmalarial parasite and along with estimation ofhemoglobin concentration ,ESR and complete bloodcount are important laboratory investigation for thediagnosis of malaria and its hematologicalcomplicationThe aim of this study was to evaluate prevalence ofmalaria among the patients living in areas of Districtsof Nawabshah and Mirpurkhas . We also studied thehematological complication in these patients.

Introduction: Malaria is a major cause of morbidityin the tropics and about 300 million causes werereported word wide in 2006 among the 100 species ofgenous plasmodia, the four species such as PL:falciparum, vivax, ovaule and malariae causesmalaria. The malaria is transmitted by the bite offemale anopheles mosquitoes.

Key Words:Malaia, Plasmodium, Pakistan,Nawabshah, Mirpurkhas.

ISSN: 2075-9983-APR 2014-QOC£TG2?QO~14~~~~~~~~1 Q04~1~~~!I!!I!~I11111!~~~~~~~~~~~~

In our study, prevalence of P.vivax malaria(70.8%) is more common than the P. Falciparum.(29.2%) among the 700 children (58.3%) and 500adults (41.7%) out of total 1200 cases in district SBAandMirpw:khas.The significant clinical finding inthese patients were fever with rigors, pallor, bodyache and headache.Hematological complication inthese patients were anemia, leukocytosis withneutrophilia, ESR and thrombocytopenia and thesewere detected by hemoglobin, BSR and completeblood count estimations. In our study. Hemoglobin,platelet count and RBC count were significantlyreduced while BSR, leukocyte count and percentageof neutrophils were significantly increased

Discussion: Malaria remain a major cause ofmorbidity and mortality in Asian as well as Africancountries of the world and about 300-500 millioncases of malaria while 1 million death case per yeardue to malaria occurs globally'. 90% of malariacaused by plasmodium falciparum occurs in Africa".Prevalence of malaria is common cause of deathamong the children and pregnant woman'", ManyPakistani studies have shown that the ratio of P.vivaxto Plasma Falciparum is at least 2 or just above thae­H.The hematological complications of malaria suchas anemia, leukocytosis with neutrophilia andthrombocytopenia have been reported. .Anaemia isone of the most common complications in malariathat result from a combination of haemolyticmechanisms and accelerated removal of bothparasitized and non parasitized red blood cells,depressed and ineffective erythropiesis. Age as a riskfactor for thrombocytopenia and anaemia in childrentreated for acute uncomplicated falciparum malaria'"16

6. Platelet count 750 62.5%40,000-11O,OOO/cumn(75000+35(00)

7. MicroscopyPl:vivax 850 70.8%PI :Falciparum 350 29.2%

8. Malariadiagnosis testImmunochrom 350 70.8%atograpbly 850 29.2%(lC)Technique +veforPl:vivx+ ve for PI:Falciparum

S.N Laboratory Number of percentago. finding patients e1. Hemoglobin 800 66.6%

concentration5.5-11.5/d1(8.5+3)

2. ESR 1200 100.0%4O-11Omn37.5+72.5

3. Total 900 75.0%leukocytescount 6500-25000/cumm(1625+8750)

4. Red cell 700 58.3%counts25-4.5mlcumn3.5+1.0

5. Differentialleukocytes 1,000 83.3%count 900 75.0%neutrophils 67- 950 79.1%85%(80.5+5.5) 1200 100.0%Lymphocytes10-14%(11+3)Monocytes 10-18%(14+4)Eosinophils 2-4%(3+1)

TablemLaboratory finding in patients with malaria and itshematological conmlication

N=l200

N=Total Number of patients

S.N Clinical finding Numb percentageo. er of

patients

1. Fever 1200 100%2. Associated symptoms 980 81.7%

with fever like chill,sweating or feeling orcoldness and hotness

3. body ache 750 625%4. headache 600 50.0%5. pallor 800 66.6%6. Splenomegalv 300 25.0%

TABLEUClinical finding in patients with malaria

N=1200

ISSN:2075-9983-APR 20M-OCT 201405

Author: Fayaz Ahamed Memon", Uzma.Bukharr',Mir Mohammad Sahito", Mashoor Alam shah".

Addresses lDepartment of Medicine MuhammadMedical College, Mirpurkhas, Pakistan2 Department of Pathology Muhammad MedicalCollege, Mirpurkhas, Pakistan.3 Department of Forensic Medicine MuhammadMedical College, Mirpurkhas, Pakistan.

Original article

HYPER CHELOSTROLEMIA AS A RISKFACTOR FOR TYPE 2 DIABETICRETINOPATHY

9. Nizamani MA, Kalar NA, KhushkIA:Burden of malaria in Sindh, Pakistan: a two yearssurveillance report.J Liaquat University of MedHealth Sci 2006, 5:762-83.10. Ghanchi NK, Ursing J, Beg MA, Veiga MI,Jam S, Martensson A: Prevalence of resistanceassociated polymorphisms in Plasmodiumfalciparum field isolates from southernPakistanMalarJ2011,10:18.11. Rana MS, Tanveer A: Chloroquineresistance and Plasmodium falciparum in Punjab,Pakistan during 2~2001.Southeast Asian J TropMed Public Health 2004, 35:288-291.12. Lathia TB, Joshi R Can hematologicalparameters discriminate malaria from non malariousacute febrile illness in the tropics?Indian J MedSci 2004, 58:239-244.13. Reyburn H, Mbakilwa H, Mwangi R,Mwerinde 0, Olomi R, Drakeley C, WhittyCJ: Rapid diagnostic tests compared with malariamicroscopy for guiding outpatient treatment offebrile illness in Tanzania randomizedtrlal.BMJ2007,334:403.14. Wever PC, Henskens YM, Kager PA,Dankert J, Tom van Goo1:Detectetion of importedmalaria with the cell -Dyn 4000Hem.atologyanalyzer.J ClinMicrobiol2002, 40:4729-4731.15. Price RN, Simpson JA, Nosten F,Luxemburger C, Hkirjaroen ,terKuile F,Chongsuphajaisiddhi T, White NJ: Factorscontributing to anemia after uncomplicatedfalciparum malaria. Am J Trop MedHyg 2001, 65:614-22.16. Wickramasinghe SN, Abdalla SH: Bloodand bone marrow changes inmalaria. InBailliere'sClinHematol. Volume 13.Harcourt Pub Ud; 2000::277-299.

References:1. World Health Organization:World MalariaReport. 2010.http://www.whointlma1aria/world malaria report 2010/enfrndexJDtcrll2. Cotter C, Sturrock Hl, Hsiang MS, Liu J,Phillips AA, Hwang J, Gueye CS, Fullman N,Gosling RD, Feachem RG: The changingepidemiology of malaria elimination: new strategiesfor new challenges.Lancet 2013,382:900.3. WHO: Policy recommandation: SeasonalMalaria Chemoprevention (SMC) for Plasmodiumfalciparum malaria control in highly seasonaltransmission areas of the Sahel sub-regions in Africa.WHO Global Malaria Programme; 2012.4. O'Meara WP, Beeman JG, McKenzieFE: The promise and potential challenges ofintermittent preventive treatment for malaria ininfants (lPTi)Malar J2005, 4:33.5. Cairns M, Roca-Feltrer A, Garske T, WilsonAL, Diallo D, Milligan PJ, Ghani AC, GreenwoodBM:Estimating the potential public health impact ofseasonal malaria chemoprevention in Africanchildren.Nat Commun 2012, 3:881.6. Beg MA, Sani N, Mehraj V, Jam W, KhanMA, Malik A, Menezes E, Hussain R, Smego RJr:Comparative features and outcomes of malaria at atertiary care hospital in Karachi, PakistanJnt J InfectDis 2008,12:37-42.7. Durrani AB, Durrani ill, Abbas N, JabeenM: Epidemiology of cerebral malaria and itsmortalityJ Pak Med Assoc 1997,47:213-215.8. WHO: World malaria report. Geneva:World Health Organization; 2011.

CONCLUSSIONThe following conclusion has been made from theabove study.1. The prevalence rate of the malaria caused byP. Vivax is 2.5 times greater than the malaria causedby P. Falciparum among the children and adults inDistrict ShaheedBenazeirabad.2. The hematological complication such asanemia, leucocytosis with neutrophilia andthrombocytopenia among the children and adult wereassessed by hemoglobin RBC estimation andcomplete blood count. It has been observed thathaemoglobin ,RBC count and platelet count weredecreased while ESR and total leukocyte count withpercentage of neutrophils in these patients wereincreased.3. Further studied are needed to determine thecold agglutination test, platelet aggregation test andserum interleukin level in the malaria.

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Results: The mean age in group A patients was 52+7years and in group B the mean age was 5l+8(p=NS).The mean duration of diabetes in group A was 9+4years compared with 7+4 years(p=NS) are almostsimilar. The mean of BMI in group A is 26+1compared to the mean of BMI in group B is 26+2 arealmost similar.Fasting blood sugar andHbAlc whencompared in both groups it is found that there is nomuch difference (mean of PBS 188+67 and HbAlc7+0.9).In lipid profiles there was marked difference of meanin two groups. In group A the mean level ofcholesterol, triglyceride and LDL were higher thangroupB.

Analysis: On the basis of already filled performa, adatabase was developed on SPSS ver. 10.0 forwindows. The comparison of two groups was doneby student, t-test of proportion. Also correlation ofhypercholesterolemia to diabetic retinopathy wasevaluated by relative risk and linear regression andcorrelation analyzed.

Methodology: A retrospective study was done indiabetic clinic attached with mdica1 unit-ill (Ward 7),JPMC, Karachi..100 consecutive patients between theages of 40-70 years, who attended the diabetic clinicbetween Decembers 2002 to April 2003 with type 2diabetes, had a Fundoscopic examination to see thepresence of diabetic retinopathy (Group A) or itsabsence (Group B). Lipid profile was done to see thecorrelation between hypercholesterolemia,hypertriglyceridemia, raised LDL and raised HDLand diabetic nephropathy. Additionally followinginvestigations were done on all patients.· Fasting blood sugar· Randomblood sugar· HbAlcInclusion criteria included:· Known cases of type2 diabetes with DR.· Known cases of type2 diabetes without DR.· Age between 4O-7Oyears.· Patient of both sexes were selected.Exclusion criteria included:Typel diabetes.Known cases of familial hypercholesterolemia.

prevalence of diabetes and by the year 2025 isexpected to rise to the 4th position'. In Pakistanvarious studies have reported between 5-7%prevalence of diabetes mellitus, with diabetiC3-11.Diabetes mellitus encompasses a family of disordersof carbohydrate metabolism that are characterized byhyperglycemia in the development of long-termmacro vascular, micro vascular and neuropathiccomplication.

Introduction: Diabetes mellitus encompasses afamily of disorders of carbohydrate metabolism thatare characterized by hyperglycemia in thedevelopment of long-term macro vascular, microvascular and neuropathic complication',It effects more than 120 million people work wide,and it is estimated that it will effect220million by theyear2020. Pakistan has an estimated number of 7million diabetics in the page group of 25 years andabove and another 6 million are suffering fromimpaired glucose tolerance. Currently Pakistan is Sillin the world according WHO estimation of

Key Words: Diabetes Retinopathy,hypercholesterolemia, hypertriglyceridemia, LDL,HDL

Conclusion: In diabetic patients,hypercholesterolemia, hypertriglyceridemia andraised LDL predispose to retinopathy and raisedHDL prevents against diabetic retinopathy.

Results: Statistically significant positive correlationwas found ofdiabetic retinopathy withhypercholesterolemia, hypertriglyceridemia andraised LDL and statistically significant negativecorrelation was found betweendiabetic retinopathyand raisedHDL

Methodology: A retrospective study was done indiabetic clinic attached with medical unit-ill (Ward7), JPMC, Karachi. 100 consecutive patients betweenthe ages of 40-70 years, who attended the diabeticclinic with type 2 Diabetes between Decembers 2002to April 2003 had a Fundoscopic examination to seethe presence of diabetic retinopathy. Lipid profilewas done to see the correlation betweenhypercholesterolemia, hypertriglyceridemia, raisedLDL and raised HDL and diabeticnephropathy.SPSS version 10 was used to See thestatistic correlation, evaluated by relative risk andlinear regression and correlation analyzed.

Abstract:Introduction: Diabetes mellitus encompasses afamily of disorders of carbohydrate metabolism thatare characterized by hyperglycemia in thedevelopment of long-term macro vascular, microvascular and neuropathic complication.

4 Department of Medicine JPMC, Karachi, PakistanCorresponding author Email:fayyaz.memon@gmail.com ...Published: 4 October 2014 Received: 20 July 2014Accepted: 4 October 2014

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2. http://www.who.int/diabeteslfactslworld figureslenlindex2.html3. Basit A, Hydrie MZ, Hakeem R,Ahmedani MY, Masood Q. Frequency ofchronic complications of type II diabetes. JColI Physicians Surg Pak 2004;14:79-83.4. Ahmed N, Khan I, Siddiqui TS.Frequency of dyslipidaemia in type 2diabetes mellitus in patients of Hazaradivision. J Ayub Med Coll Abbottabad2008;20:51-4.5. Khoharo HK, Qureshi F. Frequencyof cardiac autonomic neuropathy in patientswith type 2 diabetes mellitus reporting at ateaching hospital of Sindh. J CoIl PhysiciansSurg Pak 2008;18:751-4.6. Wahab S, Mahmood N, Shaikh Z,Kazmi WHo Frequency of retinopathy innewly diagnosed type 2 diabetes patients. JPak Med Assoc 2008;58:557-61.7. Ahmed N, J adoon SA, Khan RM,Mazahar UD, Javed M. Type 2 diabetesmellitus: how well controlled in ourpatients? J Ayub Med Coll Abbottabad2008;20:70-2.8. Moin S, Gondal GM, Bano U. Risk ofdevelopment of chronic kidney disease inpatients with type 2 diabetes havingmetabolic syndrome. J ColI Physicians SurgPak 2008;18:472-6.9. Govender VM, Ghaffar A, Nishtar S.Measuring the economic and socialconsequences of CVDs and diabetes in Indiaand Pakistan. Biosci Trends 2007;1:121-7.10. Khowaja LA, Khuwaja AK, CosgroveP. Cost of diabetes care in out-patient clinicsof Karachi, Pakistan. BMC Health Serv Res2007;7:189.11. Khuwaja AK, Khowaja LA, CosgroveP. The economic costs of diabetes indeveloping countries: some concerns andrecommendations. Diabetologia 2010;53:389-90.12. Haddad 0, Saad MK. Prevalence and riskfactors for diabetic retinopathy among Omanidiabetics. Br J Ophthalmol. 1998 Aug; 82(8): 901-906.

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References:1. Chew BY, Klein ML, Ferris FL ill, et a1.Association of elevated serum lipid levels with retinalhard exudates in diabetic retinopathy. ArchOphthalmoI1996;114:1079-1084

Conclusion: This study suggests thathypercholesterolemia has got a significant associationwith diabetic retinopathy.Duration of diabetes,hypercholesterolemia, hypertriglyceridemia andraised LDLpredispose to retinopathy and raised IIDLprevents against diabetic retinopathy. We recommendthat further studies should be done to assess thateffect of lipid lowering agents in delaying theprogression or prevention of diabetic retinopathy.

Discussion: We analyzed our study and found thathypercholesterolemia has got a significant associationwith diabetic retinopathy. In addition to the same, wealso found serum triglyceride. Serum LDL andduration of diabetes have got a positive correlationwith diabetic retinopathy.Studies have found that there is positive correlationof diabetic retinopathy with elevated serum level oftriglyceride, cholesterol,and LDL 1.

Another study of 500 patients have studiedcorrelation of diabetic retinopathy with various riskfactors in his study where diabetic retinopathy wascorrelated with serum cholesterol (p-<O.OOOI),serumtriglyceride (p-<O.OOOI)and duration of diabetic (p­<0.0001>, there was a strong positive correlation.When correlation was sought with age.(p-O.OO6),andFPG(p-<O.OO2) a positive correlation, was found12•In our study which was done on 100 patients thecorrelation of diabetic retinopathy with serumcholesterol <p-0.02,cl-35to-2), serum triglyceride(p­<O.04,-9Oto-17),serumLDL(p-<O.005,cl-3lto-5) andduration of diabetic (p<O.01,c1-3to-0.3).when wecorrelated diabetic retinopathy with age and serumFBS it was found insignificant.When compared, our study proves the same point asthese two studies have proven that there is positivecorrelation of diabetic retinopathy with serumcholesterol, triglyceride, LDL, and duration ofdiabetes.

Group A:Serum cholesterol means 223+45 mg fdlSerum triglycerides mean 238+104 mgldlSerums LDL mean 145+29mgldlSerums IIDL mean 44+7mgldl

GroupB:Serum cholesterol means 204+36 mg fdlSerum triglycerides mean 183+78mgldlSerums LDL mean 126+34mgldlSerums IIDL mean 43+9mg/dl

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In order to decrease incidence of NSls among HCWsadaptation of universal precautions and care to avoidinjuries from contaminated sharps and instrumentsare effective strategy, resulted decline the risk ofblood-born pathogen infections. In addition,vaccination against HBV is an important adjunct touniversal precautions'?". However, when NSI occur,the risk of infection can be significantly reduced byfollowing protocols for post exposure prophylaxis(PEP). Guideline issued for the management of NSIsin 1983 and 1991 by Centers for Disease Control andPrevention (CDC) Xlt"f and Occupational Safety andHealth Organization (OSHA) xxvi respectively. Thisincludes urgent evaluation of the source and exposedperson's status along with the timely administrationof hepatitis B immune globulin (HBIG), hepatitis B

Globally, every year more than 35 million HCWsface the risk of injuries with a contaminated sharpinstrument or needles among them 3 millionaccidently got the injuriesxlli; more than 90% belongsfrom low and middle income counties F". NSIsresulted in transmission of more than 20 types ofblood-borne pathogens such as humanimmunodeficiency virus (HIY), hepatitis B virus(HBV) and hepatitis C virus (HCV)xv.Each year asresult of occupational injuries 66,000 Hepatitis B,16,000 Hepatitis C and up-to 1,000 HIV infectionsoccur among HCWsxvi, these infections are attributedto 2.5% of HIV cases.and 40% of Hepatitis B and Ccases among HCWr. Nurses have the highest rateof NSI among health-care workersxviii, in a studyfrom Malaysia the prevalence of NSIs was27.9%=,38.5% in staff nurses and 78% in nursingStudents of Republic Hospital of Kaunas xx40% innurses of Jamaicaf", 53.2% in African nursesniiand55.5% in nurses of Thailandxxiii•

Introduction: Needle stick injuries (NSl) areunintentional occupational wounds reported in healthcare settings, triggered by needles or sharps likeblood collection needles, hypodermic needles,intravenous cannulas or needles used to join parts ofintravenous delivery systems". It is highly reportedamong surgeons, physicians, nurses, laboratorytechnicians and waste handlers, because of the natureof work" . The annual number of injuries per HCWsvaries from 0.2 - 4.7/ye~

Keywords: Needle sticks injuries, Nurses,Prevalence andRisk Factors

lack personal protection.Establishment of NSlssurveillance, training of HCWsandpromotion ofstandard precautions are highly recommended.

Conclusion: Results revealed thatparamedic nurse ashigh NSIs prevalence associated with fatigue and

Results: The prevalence of NSIs for the last one yearwas n=41 (29.4%), of these, n=O(91.1%) caused byneedle. Near half n=() (48.6%) occurred inemergency rooms followed by wards.One third n=()(65.3%) occurred during recapping of the needle;most of respondents n=() (70.45%) identified injuriesfatigue as a cause of NSI. Only n=22 (53.65%) weargloves at the time of procedure. Immediate responseof n=27(65.85%) respondent was washed with tapwater and soap after NSIs. Among the total onlyn=2(4.87%) took Post exposure management and n=()(38.2%) of them had been vaccinated againsthepatitis B.

Methodology: A cross sectional study wasconducted from September- December 2012among139 randomly identified paramedic nurses of DHQhospitals Mirpurkbas, Matiari and Hala, Face to faceinterview was conducted to collect information onincidence of NSIs, circumstances surrounding, postexposure management and associated factors. Datawas entered and analyzed by SPSS version 17.

Addresses: lDepartment of CommunityMedicinePeople's University of Medical & HealthSciences, Nawabshah, Pakistan2-3 Department of Community Medicine MuhammadMedical College, Mirpurkbas, Pakistan.Corresponding author Email:noor.samoon@gmail.com •Published: 4 October 2014 Received: 20 July 2014Accepted: 4 October 2014

Abstract:Background: Needle stick injuries (NSIs) are themost prevalent and preventable occupational hazardfor health care workers (HCWs), resulted intransmission of blood-borne pathogens. Globally 35.7million HCWs face the risk of NSIs duringperforming their professional activities.Among theHCWs paramedical nurses have the highest risk ofinjuries. Current study was conducted with objectiveto determine the prevalence of NSIs amongparamedic nurses.

Author: Noor Ali Samoon", ASIF SHAH 2, AllahBachayoRajar 3

Original article

STATE OF NEEDLE STICK INJURIESAMONG PARAMEDIC NURSES OF CIVILHOSPITALS AT SINDH.

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5485

734

UnmarriedMarried

Marital Status

< 19 1 020-29 24 3

30-39 51 21

41-49 33 750-59 21 660 and above 9 4

Table # 01: Distribution of NSIs according to thecharacteristic of the

Results: One hundred thirty nine nurses participatedin the study, 65 from Muhammad Medical College,Mirpurkbas 41 from DHQ hospital of Mirpurkbasand remaining 29 from DHQ hospital of Matiari. Of154, n=15 (9.7%) refuse to participate in the study, soresponse ratewas 90.3%. More than one third n=51(36.6%) of the respondents were aged between 20and 39 years, with a median age of 29 years (range18-61 years). Nearly n=59 (42.2%) had been workingas nurses from six to ten years; their median workduration was 7.5 years. Most of the nurse n=34(24.4%) was belong to Casualty Department. Amongtotal 32 (23%) were qualified nurses and completedtheir Bachelor of Science in Nursing (BSN) degree.Among total of n=41 (29.4%) nurses reported to haveNSIs during the last one year, which is higher n=37(90%) in less qualified nurses groups (G. Nursing ILHV I CMWs). The frequency of NSIs was highern=14 (34%) among nurses who were working atCasualty Department. (Table # 01)

Ethical Consideration: Approval and clearance forthis study was received from Ethical reviewcommittee of Muhammad Medical College,permission was obtained from respective hospitals,before commencement of the study. WrittenInformed consent was sought and obtained from theparticipants before face to face interview andparticipation was voluntary.

proportion of those who received PEP. We usedbivariate analysis to determine measure ofassociation (odds ratio) between occupationalexposure and associated factors. Statisticalsignificance of the associations was determined byChi-square, with a P-value of less than 0.05considered significant.

Methodology: A cross-sectional study wasconducted in District Headquarter hospital ofMirpurkhas, Matiari and Hala among random sampleof nurses from September to December 2012. Studypopulation consisted of nurses who were workingwith close contact with patients, or were potentiallyexposed to NSIs while attending to or handlingsamples from patients. All nurses who were workingat DHQ hospital the time of data collection wererecruited. Face to face interviews were conducted byusing standard semi-structured questionnaire basedon literature reviewed to collect information. Thequestionnaire consisted of 30 questions divided intothree parts. The first part presented socio­demographic questions. The second part hadquestions about the needle stick and sharps injuries atwork, their frequency (including number, nature andreason), the place where the NSIs occurred andwhether the event was reported. The third part listedquestions about safety and health at work includingHBV immunization status. A 12-month recall periodwas used throughout the questionnaire. Theoperational definition of NSI for the study was, "anyprick to the respondent by a needle previously usedon a patient, is work related and sustained within thehospital premise in the last 1 year." Collected datawas coded, entered and analyzed with the help ofBpi-info version 3.5.1 (CDC, Atlanta, USA).Descriptive statistics like frequencies, proportionsand means were calculated. We evaluate theprevalence of NSIs, frequency of reporting and

Most developing countriesincluding Pakistan nothave surveillance for occupational exposure to bloodand body fluids, hence limiting estimation of theexact magnitude of such accidents.little is knownabout the factors that predispose to this. Previousstudies on needle stick injury mainly focused on theprevalence of injuries. This study aims also toidentify the factors associated with needle stickinjury.Therefore, this study was conducted with theobjectives (a) to determine the prevalence of NSIsamong the nurses, (b) to determine the associationbetween NSI and selected variables such as age,marital status, years in service, educationalqualification and (c) to assess the measuresundertaken by the respondents after the NSIs.

vaccine and/or HIV PEP where applicable. For HCV,testing should be performed to determine if infectiondevelopsxx-rii._xxviii_xxix. Reporting occupational NSIsdirectly to the occupational health service is of majorimportance preventing transmission of blood-bornediseases. Furthermore, reporting facilitatesappropriate counseling and timely post exposureinterventions

10 ..

Table # 03: Immediate MeasuresafterNSIs

Measures FrequencyofNSIs % age

Wash with water only 5 12%

Wash with water and soap 9 21.9%

Applied with antiseptic only 4 9.7%Wash with water and applied 17%antiseptic 7Wash with water and soap, 26.8%applied antiseptic 11Wash with water and soap, 5 12.1%applied antiseptic & PEP

Factors, which led to injuries among nurseswerefatigue n=9 (31.7%), heavy workload n=12(29.2%), un-cooperative patients n=9 (21.9%), lackof assistance n=4 (9.7%) and others n=3 (7.3%).Most of respondents n=29 (70.8%) inwere notwearing gloves duringprocedures. The immediatemeasure was wash with water only n=5 0,wash withwater and soap n=9 0, Applied with antiseptic onlyn=4 0,Wash with water and applied antiseptic n=7,wash with water and soap, applied antiseptic n=11,wash with water and soap, applied antiseptic & PEPn=5. Among total NSIs exposed nurses n=22 checktheir blood for blood born pathogen on this n=3checked blood for HBV, n=19 for HBV and HCV,and n=1 for HBV & HeV & HIV. In the exposureperson n=13 were positive for HBV vaccination.Only38.2% of nursing students completed full vaccinationagainst HBV. Over one fourth 26% of remainingnurses had history of incomplete vaccination and35.8% didn't vaccinated against HBV. Table # 03

29.2%70.8%

29.2%21.9%9.7%31.7%7.3%

2.4%9.7%7.3%14.6%

Surgery 1Placing needle in container 4Needle left in appropriate place 3Suturing 6FactorsHeavy workload 12Un co-operative patient 9Lack of assistance 4Fatigue 13Others 3Use gloves at the time of procedureYes 12No 29

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LocationProcedure room 11 26.8%Ward 7 17%Emergency Room 15 36.5%Operating room 8 19.5%ProcedureRecapping a needle 13 31.7%Breaking of needle 10 24.3%During Injection Puncture 4 9.7%

% ageFrequencyof NSIsVariables

Table # 02: Distribution of NSIs according place,procedure and associated factors

Staff nurses reported 41 (29.4%) NSIs events,onethird n=15 (36.5%) occurred in the emergency roomsfollowed by Procedure room n=l1 (26.8%),mostinjuries n=13 (31.7%) happened at the timeofrecapping the needle followed by breaking ofneedle n=10 (24.3%), suturing n=6 (14.6%), duringInjection Puncture & Placing needle in container n=4(9.7%), Surgery n=1 (2.4%), and needle left inappropriate place n=3 (7.3%). Table # 02

69 (49.6%)41 (29.4%)29 (20.8%)

23117

MirpurkhasMatiariMala

Place ofworking

G. Nursing / LHV / 107 37CMWs

432B.S.NQualification

Less than 1 19 61to5 30 186to 10 59 811to 15 22 7GreaterThan 15 9 2

ExperienceinYears.

Surgery 25 9CasualtyDepartment 34 14Obs: and Gynecology 31 6Medicine 23 4Pediatrics 14 3Others 12 5

S ecial area

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XMuralidhar S, Singh PK, Jain RK.Malhotra M,BalaM. Needle stick injuries among health care workersin a tertiary care hospital of India. Indian J Med Res2010;131:405-10.xiJahnavi R, Manjunath M, Mahendra BJ, Ragini R,Swetha HJ, Harshitha MC, Nishitha P. Needle StickInjury among Health Care Workers in a GovernmentTeaching Hospital, Mandya. Int J Sci Stud2014;2(7):103-106.xUprugs-Ustiin A, Rapiti E, Hutin Y: Estimation of theglobal burden of disease attributable to contaminatedsharps injuries among health-care workers. Am J IndMed 2005, 48:482--490.~eisenhammer S, Radon K, Nowak D, Reichert J:Needlestick injuries during medical training. J HospInfect 2006, 63:263-167xivPruss UA, Rapiti E, Hutin Y. Estimation of globalburden of disease attributable to contaminated sharpsinjuries among healthcare workers. AM J Ind Med.2005; 48(6):482-490.xvHasselhom HM. The hepatitis B, Hepatitis C orHIV infectious health care worker. In: HasselhomHM, Toomingas A, Lagerstrom M (eds).Occupational health for health care workers: apractical guide. The Netherlands: Elsevier Science,1999; 44-49.xviPrliss-trstiin A, Rapiti E, Hutin Y: Estimation ofthe global burden of disease attributable tocontaminated sharps injuries among health-careworkers. Am J Ind Med 2005, 48:482--490

~ais, Aatekah, Asif RazaKhowaja, Syed Asad Ali,and Anita KM Zaidi. "Pakistan's expandedprogramme on immunization: An overview in thecontext of polio eradication and strategies forimproving coverage." Vaccine 31, no. 33 (2013):3313-3319.

viiiGulland, Anne. "Polio vaccination worker is shotand killed in Pakistan." BMJ345 (2012).

vii Abdullah, Amir, and Muhammad Anwar."Immunization Barriers in KyberPukhtunkhwa (KP),Pakistan."

vi Sultanow, Eldar, and CarstenBrockmann. "AnInformation Technology Model for PharmaceuticalSupply Chain Security." The Electronic Journal ofInformation Systems in Developing Countries 57(2013).

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V Lorenz, Christian, and Muhammad Khalid."Influencing factors on vaccination uptake inPakistan." JPaleMed Assoc 62 (2012): 59-61.

iVKazi, AdbulMomin, M. Khalid, and A. N. Kazi,''Failure of Polio Eradication from Pakistan: Threat toWorld Health?" Journal of Pioneering MedicalSciences 4, no. 1 (2014).

ill Shah. Masaud, Muhammad Kazim Khan.SalehaShakeel. FaizaMahmood, ZunairaSher,Muhammad Bilal Sarwar. and AleenaSumrin.''Resistance of polio to its eradication inPakistan." Virol J 8 (2011): 457.

UHasan, Q., A. H. Bosan, and K. M. Bile. itA reviewof EPI progress in Pakistan towards achievingcoverage targets: present situation and the wayforward." (2010).

iCenters for Disease Control and Prevention (CDC."Update on vaccine-derived polioviruses." MMWR.Morbidity and mortality weekly report 55, no. 40(2006): 1093.

References:

Despite the risk of transmitting blood-borne diseasesin the workplace, little is known about the factors thatpredispose to this. Previous studies on needle stickinjury mainly focused on the prevalence of injuries.This study aims also to identify the factors associatedwith needle stick injury. The objectives of this studywere to determine the prevalence of needle stickinjury and to determine the level of knowledge ofblood-borne disease and Universal Precautions, riskperception as well as the practice of UniversalPrecautions.

Discussion: We determined the prevalence ofpercutaneous injuries and splashes, described thecircumstances surrounding the exposures anddetermined the associated factors among healthcareworkers in a provincial hospital in Nakuru., Kenya.

Blood test done after NSI Only 7.3%forHBV 3Blood test done after NSI for 46.3%HBV&HCV 19Blood test done after NSI for 1 2.4%HBV & HCV & HIV

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Results: Among 464 respondents n=119 (25.7%)didn't received ANC services duringlast pregnancy due to multiple reasons lack ofawareness n=44 (34.4%) financialconstrain n=40 (33%), lack of personal interest n=39(32.5%), busy schedule n=21(16%), difficulty in access n=25 (21%), shame andembracementn=17 (14%), familyrestriction n=14 (11.6%), fear of illness & preferencefor traditional practices n=15(12.6%). Among total6l.6% complain they wait> 2Hrs. The utilization of services wasmore in literate respondents n;::365(85%).

Methods: It is a hospital based cross sectional study,conducted at District Mirpurkbasin June-August 2010. A total of 464 multigravidapregnant women attending antenatalclinic were selected by systematic random sampling.For data collection face to faceInterview was conducted by using a pre-tested semi­structured questionnaire. Thevariables assess were demographic characteristics,socioeconomic status, and ANCservices utilization with reasons of inadequateutilization.

AbstractBackground: In Pakistan every year 276/100,000women die during pregnancy relatedcauses, which can be avoided by receive of medicalcare before (antenatal), during (intranatal)and after (post-natal) childbirth. This study wasdesign to find out prevalence ofAnte natal care (ANC) services and factors associatedwith its utilization among thepregnant women of ruralSindh.

Address: l,Department of Community MedicineMuhammad Medical College, Mirpurkhas, Pakistan2Department of Pathology Muhammad MedicalCollege, Mirpurkhas, Pakistan30epartment of Forensic Medicine MuhammadMedical College, Mirpurkhas, Pakistan

Email: MuhammadAsif*-asif.mph@gmail.com* Corresponding authorPublished: 4 October 2014 Received: 20 May2014Accepted: 4 October 2014

Author: Muhammad Asif*l, Muhammad FarooqBaig2, Ghulam Mustafa Yousfani3

Factor affecting the utilization of Antenatal careservices among pregnant women atDistrictHeadquarter Hospital,Mirpurkhas

1viiWHO Reducing risks, promoting healthy life. Theworld health report. Geneva: World HealthOrg~on.2002.~eSchobrxvll1CNon preventing needle stick injuries. Nursingmatters: Fact sheets 2009. Available from:http://www.medica1kenya.co.kel2011/02nursingmattera,whoJac_sheet [Accessed on 2011 Sep 29].xirRampalL, Zakaria R, Sook LW, Zain AM. Needlestick and sharps injuries and factors associatedamong health care workers in a Malaysian hospital.Eur JSocSci2010;13:354-62.uNeedle sticks and sharps injuries experienced bystaff nurses and nursing students and their preventionxxiPrevalenceof Needlestick Injuries and other HighRisk Exposures Among Healthcare Workers inJamaicaXlIiiSimonLP. Prevention and management of needle­stick injury in Delhi.Br JNurs2009;18:252-6.XldiISharpsInjuries among Nurses in a Thai RegionalHospital: Prevalence and Risk FactorsxxivPerspectives in Disease Prevention and HealthPromotion Update. Universal Precautions forPrevention of Transmission of HumanImmunodeficiency Virus, Hepatitis B and otherBlood-borne Pathogens in Healthcare settings.MMWR 1988; 37: 377-88.XXVMay0, Brewer S. Sharps injury: prevention andmanagement. Nurs Stand 2001;15(32): 45-52.xxviTanL, Hawk JC, Sterling ML. Report of thecouncil on scientific affairs: preventing needlestickinjuries in health care settings. Arch Intern Med2001; 161(7): 929-936.nvaupdated US Public Health Service Guidelines forthe Management of Occupational Exposure to BBV,HCV and InV and Recommendations for PostExposure Prophylaxis. MMWR 2001 Jun; 50(RRll): 1-42.XX'riii Department of Health. mv post-exposureprophylaxis: Guidance from the UK Chief MedicalOfficers Expert Advisory Group on AIDS. 2nd ed.2004.www.advisorybodies.doh.gov.uk:leaga/publications.htm.XlIi10uidelinesfor the prevention of mv and HBV inhealthcare setting at the Caribbean subregional level.Caribbean Epidemiology Centre, Portof Spain, 1994.v3Op.

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Material and Methods:A hospital based Cross Sectional studywas conducted in the department of Gynecologyand obstetrician at District hospital Mirpurkhas,Sindh from June-August 2011. The objective ofcurrent study was to find out the prevalence andfactors associated with antenatal serviceutilization. Sample size was calculated by usingprevalence 28% of women who made four ormore prenatal care visits during their pregnancyreported in PDHS 06-07, by applying theformula for calculating the prevalence (p= t:lxP(l-p )/m2) at 95% confidence interval. A samplesize of 309 women was calculated, incorporatethe design effect of 1.5, the final sample sizewas calculated as an n=309 x 1.5 = 464.Multigravida pregnant women, residentof Mirpw:khas (urban or rural), reported ANCclinic at department of gynecology &

In Pakistan only 28% percent of pregnant womenattend four or more antenatal care visits during thewhole period of their pregnancy with 48% in urban20% in rural.Among these 61% received ANC from skilledhealth providers that is, from a doctor, nurse,midwife or Lady Health Visitor & 3% from atraditional birth attendant (DAI)3. ComparativeReports of Demographic Household Survey ofdifferent countries shows the percentage ofwomen attend 4 or more ANC visit Bangladesh20%, Cambodia 27%, India 37%, Indonesia81%, Nepal 29.%, Philippines 77%, Vietnam30.1 %8. A study conducted in Bangladeshshowed factors poor socio-economic status, lackof women empowerment and decreaseawareness associated with under coverage ofANC9. Another study conducted in turkey alsofinds relationship of ANC utilization withdemographic and socio-cultural factors likematernal age, number of children. education, andplace of residencel0. In a study carried out in arural community in Northern Nigeria the majorbarriers were associated with economic, culturaland women's perception of their conditionl1.There is a lack of specific researchexplain the reasons of underutilization ofantenatal care services among women of ruralarea of Sindh. To fill this existing gap ofknowledge a study was conducted to find out theprevalence and factors associated with antenatalcare services utilization. The result of this studycould help to policy maker in development ofinterventions for increasing the utilization ofantenatal care services.

Introduction: Maternal morbidity and mortalityduring child labour, birth and after birth is a seriouspublic health problem in low and middle incomecountries. Globally in 2008, an estimated 358,000women died due to complications developed duringpregnancy and childbirthl. The maternal deaths ishigh in developing countries 240/100,000 asompared to developed countries 16/100,000 andlifetime risk of death due to pregnancy is higher 1 in150 in women of developing countries thendeveloped countries 1 in 38002. In Pakistan everyyear 276/100,000 women die during pregnancyrelated causes and this rate is high in rural area319/100000 than urban 175/1000003. 75% percentof maternal deaths occur during childbirth and thepostpartum period, a great proportion of maternaldeaths are avoidable by early receive of medicalcare in before, during and after childbirth4.Antenatal care (ANC) is one of the key strategiesin reducing maternal and newborn mortality in "safemotherhood package"5. ANC is a group of servicesprovided to the mother for monitoring of mother's &fetus' health by trained health care personnel duringentire pregnancy at regular intervals. According toWorld Health Organization (WHO)recommendations, aminimum of four antenatalvisits (at least 20 minutes duration for each) isneeded to accomplish the essenti.allevel ofANC6.In Pakistan there are two types of ANC servicesare provided one is hospital and other is domiciliarybased. In former ANC services are provided byDoctor, LHV or nurse & in later services areprovided by UIW & TBA 1Dai.Domiciliary ANC service is beneficial forwomen of low socio economic status causesimprovement in level of satisfaction, medicalknowledge & level of satisfaction7. Estimatedpopulation of Pakistan in 2011 was 187 million.Approximately 24.7% are women aged 15 to 49years, with a Total Fertility Rate of 4.1 (pDHS 2006-2007)3.Majority of them have poor health condition &suffering from diseases associated with pregnancy.

Key Words: ANC, Reason of low coverage, level ofsatisfactions

Conclusion: The study showed that low level ofANC coverage. The main reason wasidentify limited knowledge, preference on traditionalpractices, & low level of socioeconomicstatus. There is need to uplift the quality of services,socio-economic status &level of awareness are recommended

14 ...

On inquired regarding the Place of last babyborn 63.5% (n=295) said at home, 22.4%(n=I04) at public hospitals and 14% (n=65) at privatehospitals (Figure 1). Among the total respondents25.6% (n=1l9) didn't utilize ANC services in lastpregnancy, on asking they revealed more than onereason for this such as lack of awareness 34.4%(n=41), due to financial problem 33% (n=40), lack ofpersonal interest 32.7% (n=39), difficulty in access21% (n=25), too much busy schedule 16% (n=21),unavailability of health facility 16% (n=21), due toshame and embracement 14% (n=15), preference fortraditional practices & fear of

Variables Frequency(N=464) Age In years< 30 Year > 30 Year340 (73.2%) 124 (26.7)Area of living RuralUrban 312 (67.2%)152 (32.7%) Women

OccupationHouseWife Working women439 (94.6 %) 25 (5.3%)Women Education III-literaturePrimary secondaryMetric & above 76 (16.3%)281 (77%) 62(17%)22(6%) Monthly income6,000-15000 >15000340(73%) 124(27%)Parity Multi Gravida

464(100%}Table-1: Distribution of Demographic,Socioeconomic and maternal Child HealthCharacteristics of women attendingantenatal care visits

started ANC services from the first trimester,34.7% (n=120) second trimester and 38%(n=131) third trimester. Only 40.5% (n=140)received four or more ANC visits during theirpregnancy either from hospital or domicallyANC services. The outcome of last pregnancywas live birth 95.2% (n=442), still birth 3.4%(n=16) & abortion 1.2% (n=6).

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Practices of ANC services utilization in lastpregnancy among Multigravida Mothers:Out of 464 Multigravida mothers 74.3 %(n=345) mentioned that they received ANCservices during last pregnancy, among them23% (n=80) and 77% (n=247) received ANCservices at home and health facilitiesrespectively. LHW 57.5% (n=46) and Dai42.5% (n=34) were the main services provider athome. Doctors 54.6% (n=135), Nurse 21.4%(n=53), LHV 23.8 %, (n=59), was the mostfrequent source of ANC services in healthfacilities. 27% (n=94) women said that they

Results: We approached 484 multigravidapregnant women, attending ANC clinic atdistrict hospital Mirpurkhas among them 20were refused to participate in the study. Theaverage age of the respondents was 25.5 years(S0=6.3), with a range of 16 to 49 years, andmajority of 73.2% (n=340) belonging to the 15-30 year-old age group. Among the total 67.2%(n=312) were living in rural area of districtMirpurkhas. Most of them 94.6 %( n=439) wereHouse Wife. Household income was 6,000-15000 rupees per month. In this study 73%(n=340) respondents state that her husband haseducation among these 70.5% (n=240) haveprimary education, 10.2% (n=35) secondary &19% (n=65) metric & above. Out of 464respondents 83.4% (n=387) were ill-literature &16.6% (n=77) were literature.

Obstetrician were enrolled by using systematicrandom sampling (every 3rd women).A ellstructured and pre-tested questionnaire was usedto collect the quantitative data. The questionnaire wasinitially designed in English but later translated toUrdu & Sindhi. For achieving the accurate dataquestionnaire was pretested in same setting with 20participants.This study was conducted after approval byethical review committee of MuhammadMedical College with permission of Medicalsuperintendent of respective hospital. Writtenconsent was obtained after telling the study aimand objectives to the respondents & than face-tofaceinterviews was conducted. The variablesassess were demographic characteristics,socioeconomicstatus, utilization of ANC services inlast pregnancy with reasons of not utilization,outcome and place of last pregnancy. The datacollected was entered and analysis by usingSPSS version 11.

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identification of high risk women & pregnancies. Thepresent study has indicated that 74.4% of. thepregnant women utilized antenatal care servicesduring last pregnancy which is higher from stud~conducted in Indonesia 63.13%12 and Karachi51%13. The current study shows that 40.6% ofwomen attend ANC clinic four or more times whichis higher from the findings of PDHS 06-07,Bangladesh household demographic survey 07 &India household demographic survey 05-06 whereresults were 28%,20.6% & 37.% respectively. Thesedifference may be due difference in study setting. Inour study first reason which identifies for poorutilization of ANC was difficulty in access of ANCservices 16% same type of reason were found instudy conducted in Indonesial4. A qualitative studyalso reported that long travel time worsened by poorroad conditions prevented communities fromattending antenatal servicesl5. This result showsthat improvement in access to health serviceswill effect on utilization of services. The otherbarrier for underutilization were lack ofknowledge & permission from family reportedby 34.4% & 11.6% respondents respectivelysame type of result 28% & 8% found in studyconducted in Karachi13. Same study which wasconducted in Karachi also reported associationbetween absence of transport with utilization ofANC services which is closest to this study. Thistype of obstacles could be removed by arranging

Outcome of last_prepancyLive birth Still birthAbortion 442195.2%)16 (3.4%) 6(1.2%)Reason of not usin2ANC services (n=119)Lack of awareness Financial problemLack of personal interest Difficulty in accessToo much busy schedule Unavailability of health

facilityDue to shame and Traditional practicesembracement PreferenceFear of illness Not allowed from the

familyAbsence of Transport 41_(34.4%)40(33%) 39 (32.7%)25 (21%) 21J.l6%)21 (16%) 17 (14 %)15 (12.6%) 15_(12.6%)14(11.7%) 12 (10%)Table-2: Practices of ANC services utilization in lastpregnancy amongMultigravidaMothers

Variables I Frequency(N=464)

ANC durfns last PrReceived I Not Received345 (74.3%) I 119 (25.6%)Place of rece~ ANCAt home I Health facilities80f_23%) 1247177%)Total number of ANC VisitsFour or more than four I Less than four140 (40.5%) I 205 (59.5%)

Discussion: Antenatal care is responsible forprevention of maternal morbidity and mortalitydirectly through early detection and treatment ofpregnancy related illness & indirectly by

Problems & attitude of pregnant Mother:This study revealed that in ANC users 28.8% (n=134)feel difficulty in access of ANC services, 21.7%(n=101) were poorly satisfied from quality ofservices & 68.7% (n=319) form medicine. 61.6%(n=286) complain that they wait> 2 Hrs for receivingANC services. 32 % (n=149) said that they receivedinstruction about ANC, exercise & bed rest. Only Onefourth 26.2% (n=123) of the population told that theywere using family planning for spacing the birth.Among the non-user group 52.5 % (n=244) haveIntention to Use FP (Table 1).

illness 12.3% (n=15), not allowed from thefamily 11.7% (n=14) and absence of transport. 10%(n=12). The utilization of services was 15% (n=65) inill-literate 85% (n=365) in literate respondents. In theliterate respondents this utilization was increase withlevel of mother education 13% (n=48) in primaryeducated mother 24% (n=89) in secondary and 63 %(n=228) in metric or above educated mother (Table2)

Figure I: Place of Birth inLast Pregnancy

• Home 0 Public hospitals II Private hospitals

63.5%

22.4%

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Limitations: First, this is hospital bases cross­sectional survey was conducted in only one districtlocated in rural area of Sindh which might affectits generalizability23 Second socio-culturalbarriers were faces at the time of interview somany respondents didn't give detail informationthird one the chance of recall bias in answers ofrespondents Finally, time and budgetaryconstraints played a limiting role inextendingthis study beyond one hospital & district

Recommendation: Based on the above finding it isrecommended that, encourage the womeneducation beyond the primary school andincrease women's empowerment within theirfamily. Develop a system for increases theknowledge mother, husband & mother in lawregarding the importance of ANC, institutionaldelivery, family planning and child spacing.Moreover, the health department providestraining to TBAs/Dai & improves public sectorhospital obstetric services through increasingresources, adequate medicine supply, andassurance of staff on duty.

Conclusion: This study revealed that utilization ofmaternal health service is inadequate in ANC &delivery services. Financial problem, lack ofpersonal interest, difficulty in access, toomuchbusy schedule, and unavailability of healthfacility, shame and embracement and preferenceof traditional practices are major obstacles toutilization of ANC. The study finds that eventhough women attend the ANC visit in hospitalduring pregnancy but many of them deliveredtheir last baby at home. Majority of respondentswere poorly satisfied from quality of servicesform medicine & complain that they wait> 2hours for receiving ANC services

This study shows that 21.7% werepoorly satisfied from quality of services &68.7% form medicine same level ofdissatisfaction from the medicine found in studycarried out in a teaching hospital ofHyderabad22. Same study found that 86.2%women have to wait more than two hoors whichis higher form our study the reason may bedifference in level of health care facility

conducted in rural area of Pakistan reported 31%deliveries were conducted at home which is lowfrom the study due to difference in studysetting21.

a transport mechanism and conduction of healtheducation session with pregnant mother as wellas other family member such as mother in law &husband. Financial restrains was the next reasonfor poor use of ANC reported by 33%respondents this finding is high from the studyconducted in Military hospital Rawalpindi where10%women didn't utilize the ANC services16due to this reason. This may be good socioeconomiccondition of army employees. Samestudy which was conducted in army setup alsoaccount that 26% respondents have beliefs ontraditional practices (Dai) which is higher fromour study where belief was 12.3%. Out of 430Multigravida mothers 74.4 % (n=320) mentioned thatthey received ANC services during last Pregnancy inthis 23% (n=73) from LHW or Dais and 77%(n=247) from the health facilities. Doctors 54.6%(n=135), Nurse 21% (n=53), LHVI Midwife 23%, (n=59), was the most frequent source ofANC services in health facilities. 74.4 % % samplestate that they received ANC during last Pregnancy inthis 23% at home from LHW or Dais and 77% fromthe health facilities by Doctors 54.6%, Nurse 21%,LHVI Midwife 23 %. This result is slightly lowfrom the study conducted In Islamabad17 whichmay difference in socio economic status education.According to PHOS 2006-07, 61% of mothersreceive ANC from skilled health providers, from adoctor, nurse, midwife or Lady Health Visitor. Only3 percent of women receive prenatal care from atraditional birth attendant (Dai). Other study carriedout in Karachi13shows 51% women who received ANC, in this33% from an untrained care provider(specifically a dai), 20.4%midwife, 20.4%nurse, 19.1% doctor and 7% from Lady HealthVisitor. In this study 40.6% respondents madefour or more prenatal care visits during their lastpregnancy which was slightly high reported inPHOS 06-07, 28% & low 48.0% from studyconducted in Northwest Ethiopia18 and closed to(36%) finding of a study conducted inxiengkhouang provincel9. Comparative Reportsof Demographic Household Survey of differentcountries shows the percentage of women attend4 ormore ANC visit Bangladesh 20%,Cambodia 27%, India 37%, Indonesia 81%,Nepal 29.%, Philippines 77%, Vietnam 200230.1%20. 63% state that last baby was deliver athome, 22.4% public hospitals and 14.1% privatehospitals nearest result were reported in studyconducted in Islamabad17 where 59%, babydeliver at Home 27.5% Government hospital11%Private cliniclhospital. The other study

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18. Tura, Gurmesa. "Antenatal care service utilizationand associated factors inMetekel zone, northwestEthiopia." Ethiopian Journal of Health Sciences 19,no. 2 (2009).19. Ye, Yang, Yoshitoku Yoshida, and JunichiSakamoto Junichi. "Factors affecting the utilizationof antenatal care services among women inKhamdistrict, Xiengkhouang province, Lao PDR" Nagoyajournal of medical science72, no. 1-2 (2010): 23-33.20. Bicego, George T., and J. Ties Boerma."Maternal education and child survival: acomparative study of survey data from 17

10. Celik, Yusuf, and David R Hotchkiss. "Thesocio-economic determinants of maternal health careutilization in Turkey." Social Science &Medicine 50,no. 12 (2000): 1797-1806.11. Adamu, Y. M., and H. M. Salihu. "Barriers to theuse of antenatal and obstetric care services inruralKano, Nigeria." Journal of Obstetrics &Gynecology 22, no. 6 (2002): 600-603.12. Chompikul, J., and S. Isaranurug. "Factors relatedto the utilization of antenatal care services amongpregnant women at health centers in Aceh BesarDistrict, Nanggroe Aceh Darussalam Province,Indonesia." J Public Health Dev 6 (2008): 99-108.13. NISar,N., and F. White. "Factors affectingutilization of antenatal care among reproductive agegroup women (1549 years) in an urban squatter

settlement of Karachi." JOURNAL-PAKISTANMEDICAL ASSOCIATION 53, no. 2 (2003): 47-53.14. Titaley, Christiana R,Michael J. Dibley, andChristine L.Roberts. "Factors associated withunderutilization of antenatal care services inIndonesia: results of Indonesia Demographic andHealth Survey 200212003 and 2007." BMC PublicHealth 10, no. 1(2010): 485.15. Titaley, Christiana R, Cynthia L. Hunter, PeterHeywood, and Michael J. Dibley. ''Why don't somewomen attend antenatal and postnatal care services?:a qualitative study of community members'perspectives in Garut, Sukabumi and Ciamis districtsof West Java Province, Indonesia." BMC pregnancyand childbirth 10, no. 1(2010): 61.16. Y.Tehreem, lAliya, N.Ghazala, H. Talat,M.Mamoona ; Social Factors Involved In WomenAvoiding Early Antenatal Booking In Army Setup:Pakistan Armed force Medical Journal Vol 4December 2008.17. Alam, Ali Yawar, Akhtar Ali Qureshi, MalikMuhammad Adil, and Hasan Ali. "Factors affectingutilization of antenatal care among women inurbanslum areas of Islamabad." Rawal Med J 29 (2004):71-75.

8. Wang, Wenjuan, Soumya Alva, Shanxiao Wang,and Alfredo Fort. "Levels and trends in the use ofmaternal health services in developing countries. "(2011).9. Hafez, M. A, M. A. Ullah, H. A Begum, A. T.Alam, and M. A Haque. "Extent of utilization andfactors influencing antenatal care in ruralRajshahi." JOPSOM. JOURNAL OF PREVENTIVEAND SOCIAL MEDICINE 18, no. 1(1999): 1-6.

References: 1. Chou, D., M. Inoue, C. Mathers, M.Oestergaard.L, Say, S. Mills, E. Suzuki, and J.Wilmoth. "Trends in maternal mortality: 1990 to2008. Estimates developed by WHO UNICEFUNFPA and The World Bank." (2010).2. Maternal mortality: Fact sheet: Number 348; May,2012, Geneva, World Health Organization3. PDHS, National Institute of Population Studies &Demographic and Health Surveys. PakistanDemographic and Health Survey. 2006-2007.4. The Millennium Development Goals Report 2007.United Nations, New York 2007.5. Glei, Dana A., Noreen Goldman, and GermanRodriguez. "Utilization of care during pregnancy inrural Guatemala: does obstetrical needmatter?" Social Science &Medicine 57, no. 12(2003): ~7-2Ak53.6. Overbosch G., Nsowah-nuamah J., Vanden B., andDamnyag L. Determinants of antenatal care use inGhana. Center for world food studies. Staff workingpaper workshop, 02- 13,Novermbe 20027. Gerein, N., S. Mayhew, and M. Lubben. "Aframework for a new approach to antenatalcare." International Journal of Gynecology &Obstetrics 80, no. 2 (2003): 175-182.

Acknowledgements: Authors would like to thank allthe staffmembers of Department of Gynecology andobstetrician at District hospital Mirputkhas,Sindh for their genuine assistance during datacollection.

Authors' Contributions:MA was the primary researcher, conceived thestudy, designed, participated in data collection,conducted data analysis and drafted themanuscript for publication. MFB and GMYassisted indata collection and preparation offirst draft of manuscript. All authors interpretedthe results, and reviewed the initial and finaldrafts of the manuscript.

Conflict of Interest: The author(s) declare that theyhave no conflict of interest.

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Introduction: Tuberculosis (TB) is a major publichealth problem, attributed to huge burden ofmorbidities and mortalities worldwide. In 2013,an estimated 9 million incident cases with 1.5million deaths (1,140,000 in HIV-negative and360,000 in HIV-positive peoples) reported fromthe mycobacterium tuberculosisl.Geographically, more than 95% of new TBcases and deaths occur in low and middleincomecountries2. The 83% of total incidentcases were reported from the three regions i.e.South-East, Western Pacific and African region,among them the highest rates of incident casesand deaths per capita were reported from theAfrican region3. The case fatality rate hasexceeded 50% in some African countries whereHIV prevalence rate are highAPakistan ranks fifth amongst TB high-burdencountries imposing 61% of the TB burden in theEastern Mediterranean Region, Approximately273,097 new TB cases emerge every year with

Key Words: Tuberculosis, Treatment, directlyobserved treatment-short course

Conclusion: Treatment success rate amongtuberculosis patients was fairly satisfactorilywith high defaulter rate, which may be corrected byenhance supervision, improvedcounseling activities and implementation of defaulttracing and home visit by healthworker.

Results: Among 641 patients, n=542 (84.5%) hadpulmonary and n=99 (15.4%) hadextrapulmonary tuberculosis, mean age was 27.7years (range: 7-80), n=343 (53.5%) weremale. Persons aged 25-34 years were highly affectedn=174 (27.1 %). Of all patients,treatment outcome was classified as treatmentsuccess (cure and treatment completed) inn=396 (61.7%), defaulted n=l66 (25.8 %), treatmentfailed n=24 (3.7%) and transferredout n=51 (7.8%), death n=4 (0.6%) patients. Femalesn=93 (14.5%) and rural populationn=98 (15.2%) were more likely to experience defaultthan males n=73 (11.3 %) and urbanpopulation n=68 (10.6%).

were followed-up during their course of treatment toassess treatment outcome inaccordance of World Health Organization (WHO)guideline as: cure, treatment completed,default, treatment failure, death or other. Data wereanalyzed by using EpiIofo version 3.2.

Methods: A descriptive study was conducted inDOTS center of private teaching hospital,District Mirpurkhas, province Sindh from January­December, 2012. All registered patients

Abstract:Background: Upsurge of multidrug resistancetuberculosis is an emerging public healthproblem in developing countries, associated withpoor compliance with anti-tuberculosistherapy (Am. Directly observed treatment-shortcourse strategy (DOTS) has been widelyreported to improve the compliance and treatmentoutcome among the patients reported inall level of health care system. Current study wasconducted with objective to evaluatetreatment outcome among tuberculosis patientsregistered under DOTS.

Published: 4 October 2014Received: 1May 2014Accepted: 2 October 2014

Email: MuhammadAsif*-asif.mph@gmail.com* Corresponding author

Address: 1, 3Department of Community MedicineMuhammad Medical College, Mirpurkhas, Pakistan2Department of Medicine Muhammad MedicalCollege, Mirpurkhas, Pakistan

Author: Muhammad Asif-i, Gohar Rath01'2,Allah Bachayo Rajars

Treatment Outcome of Tuberculosis PatientsRegistered at TB Centre in aPrivate Teaching Hospital, Sindh

countries." Social science & medicine 36, no. 9(1993): 1207-1227.21. Sadiq, Namrah, Quratulain Waheed, MehreenHussain, Ali Tahir Rana, Zareen Yousaf, ZunashChaudry, Saad Salman, and Saima Iqbal. "Factorsaffecting the utilization of antenatal care amongwomen of reproductive age in NurpurShahan." JPMA The Journal of the Pakistan MedicalAssociation 61, no. 6 (2011): 616-618.22. Nisar, Nighat, and Raheela Amjad "Pattern ofantenatal care provided at a public sector hospitalHyderabad Sindh." Journal of Ayub Medical CollegeAbbottabad 19, no. 4 (2007): 11-3.

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Treatment Failure: A TB patient who wasinitially sputum smearlculture positive andremained smear positive at month 5 or laterduring treatmentDied: A TB patient who dies for any reasonduring the course of treatmentTransferred out: A Category IV patient whohas been transferred to another reporting andrecording unit and whose treatment outcome isunknownSuccessfolly Treated: A TB patient who curedor completed treatmentUnsuccessful Treatment: A TB patients whosetreatments were interrupted, transferred out orfailed on treatment.All collected data collected were entered andanalyzed by using SPSS version 16 aftercleaning. Validity of data ensure throughrandom checks and double entry. Indescriptive

Defaulted: A patient whose treatment wasinterrupted for two consecutive months or morefor any reason

Completed Treatment: A pulmonary 1extrapulmonary TB patient who completed treatmentbut did not meet the criteria of failure or cure(negative sputum smear or culture results in thelast month of treatment and on at least oneprevious occasion

type of tuberculosis were collected from eachpatient by face to face interview. Disease relatedinformation including form of tuberculosis(pulmonary or extra pulmonary tuberculosis),type of tuberculosis (smear positive or smearnegative), type one category of tuberculosis(new cases) and type 2 category (defaulter,failure, relapse) and treatment outcome wereevaluated by World Health Organization (WHO)guidelinel9. We used following definitionCured: A pulmonary TB patient who wassputum smear-positive at the beginning oftreatment and become sputum smear-negative inthe last month of treatment and on at least oneprevious occasion

DOTS clinic of Muhammad Medical TeachingHospital, Mirpurkhas. It is an only tertiaryhospital providing health services to 1.5 millionpopulation of rural Sindh. All registered patientswere followed up periodically until completionof their medication with objective to evaluate thetreatment outcome. Information on age, sex,address, education. socioeconomic status and

Methods: A cross sectional descriptive study wasconducted among 641 TB patients registeredfrom 1st January to 31st December 2013 in

incidence rate of 410/100,000 and mortality rate0.66/100,0005. Possible cause of this highnumbers are rapid increase in number ofpeoples living below the poverty line,overcrowding, poor living conditions,malnutrition. war, inadequate availability ofanti-tuberculosis therapy (Am in health caresetting, poor compliance with ATI,underfunding of National Tuberculosis controlProgrammes (NTCPs), and non-adherence toprogramme policies.6 The National TB ControlProgram of Pakistan is accountable fordeveloping national guidelines, outlining thepolicies and engendering resources for executionof TB control measures at Provincial and districtlevel.For the early diagnosis and adequate treatmentof TB infectious Directly Observed TreatmentShort Course strategy (DOTS) strategy wasadopted as National Strategy in 2000 andexpanded to all level of health care system? InDOTS strategy at least the 2 initial months oftreatment, patients take drugs directly under theobservation of health care providers, as guidedby international tuberculosis authorities8-9,which ensure high successful treatment rate(from 86% to 96.5%)10, major reductions in drugresistance, and relapsel l. Jasmer et al observedthat DOTS strategy was significantly associatedwith a higher treatment success rate thanselfadministeredtherapy (97.8% VS. 88.6%) and alower tuberculosis-related mortality rate (0% VS.5.5%)12.Despite the availability of free anti-tuberculosisdrugs in all level of health care setting, manypatients are not successfully treatedl3, resulted inan extended period of infection, resistance todrugs, increase morbidity andmortalityl4. Ideally, treatment outcome in allpatients should be routinely monitored by theepidemiological surveillance system, whichserves as a proxy indicator for the quality of TBtreatment15. So far, very few studies havedocumented the treatment outcomes of DOTS inPakistanI6-17-18, but never conducted in thissetting. To fill the existing gap of the knowledgecurrent study was conducted with objective toevaluate the treatment outcome of TB patientsenrolled in DOTS clinic of a private teachinghospital located in rural area of Sindh.

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A detailed summary of treatment outcomes ofthe TB patients is presented in Table 3 & Table4. A total of 641 tuberculosis patients wereanalyzed: n=71 (11%) cured, n=321 (50%)completed treatment, n=168 (26.2%) defaulted,

pulmonary tuberculosis patients, n=397(73%)were smear positive patients and n=145(26.7%)were smear negative. Most of the patients n=583(91%) were belongs to category one (new cases)and remaining n=58 (9%) were fall in categorytwo including relapse n=I4(2.1 %), return afterdefaulter n;::29(4.5%) and treatment failure casesn=15(2.3%) (Table 2)

Table 1: Demograpluc characteristics

Cha racterisricsFrequency

%ageX=641

SexMale 343 53.5%

Female 298 46.4%Address

Urban 405 63°'0Rural 236 37°'0

Age group0-14 84 13%14-24 117 18.2%25-34 137 21.3%35-44 174 27.1%45-54 59 9.2%55-64 32 4.9%>65 38 5.9%

Educationilliterate 367 57.2%Primary 140 21.8%Matrie 99 15.4%College 35 5.4%

OccupationUnskilled 392 61%

Skilled 103 16%Semi-skilled 146 22.7%

Tablel: Demographic characteristics

Results: A total of 641 tuberculosis patients wereregistered at Muhammad Medical CollegeTeaching hospital between January-December2013. Of these, n;::343(53.5%) were male andn;::298 (46.5%) were female with the mean ageof 27.7 years. N;::405 (63%) of the patients werebelongs to urban area. Among total n=537(83.7%) were belong from low socio-economicstatus. Over half n=367 (57.2%) were illiteratewhile only n=35 (5.4%) had college education.Regarding occupational status, 392 patients(61%) were unskilled and 103 (16%) wereskilled and the rest were semi-skilled workers.(Table 1)Among total n;::542 (84.5%) patients hadpulmonary tuberculosis and n=99 (15.4%)extrapulmonarytuberculosis (Table 2). Among

Ethical Considerations:Ethical clearance for the current study wasobtained from the Research Ethics ReviewCommittee of Muhammad Medical College withregistration number of MMC/RERcn13. Aninformed consent was obtained from eachpatient before collection of relevant information.Inorder to ensure confidentiality, names oridentification numbers of TB patients were notincluded in the data sheet.

statistics frequency tables and charts weregenerated. Cross tabu1ati.onof variables wasdone to find out association between variables.A p-valne of less than 0.05 was considered asstatistically significant.

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responsible factor for this difference is duration,current study based on one year while Ethiopianstudy reviews data of two and three year of TBcases. Obionu31 noted that less than 20% cases

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Discussion: In Low and Middle countriesTuberculosis is consider as a one of the leadingcauses of morbidities and mortalities amonginfectious diseases. For effective control oftuberculosis infection, it is a pre-requisite to detectthe cases as early as possible, ensure completetreatment with good compliance and get cured20. Toachieve this objective DOTS strategy has beenwelcome as an effective meth0d21. In currentstudy tuberculosis was observed more in male ascompared to females. Similar results werereported in studies conducted in Nigeria22,Zimbabwe23 Ethiopia24 India 21and Pakistan16while Mir Azam Khan et al, reported equalnumber of cases in both sex25. Most of thetuberculosis cases occur in population of agegroup 15-59 years, which coincidently are themost productive age in term of economic andreproduction26. Similar trend was observed inthe current study more than 80% of the caseswere belongs to age less than 60 years. This is inline with local and international. studies 27-28-29Current study shows that pulmonary TBaccounted for 542 cases (84.5%) of the totalburden of the disease in the study population,while the extra-pulmonary tuberculosisattributed to 99 (15.4%) cases. This is atvariance with the finding of studies conducted inEthiopia where extra-polmonary TB was foundin 56.2%24 and 22%30 of respondents.

Characteristks Frequency N=641Cured7111% Treatment Treatment

Completed Failure 2532150% 3.9%

Dead 4 0.6 Defaulted 168 Transferred26.2% out528.1%

Cured 7111% Treatment TreatmentCompleted Failure 2532150% 3.9%

Dead40.6 Defaulted 168 Transferred26.2% out 528.1%

Cured 7111% Treatment TreatmentCompleted Failure 2532150% 3.9%

Dead4 0.6 Defaulted 168 Transferred26.2% out 52 8.1%

Table 3: OutcomeOfTuberculosis Treatment

n=52 (8.1%) transferred out, 25 (3.9%) weretreatment failure, n=4 (0.6%) were die. Amongextra pulmonary tuberculosis patients, lymphnode tuberculosis was most frequently reportedn=41 (41.4%) followed by pleural tuberculosisn=22 (22.2%)

Table 2: Form & Type ofTB

Form & Type Mall' Female Total~=343 N=298 N=641

Types ofTBPulmonary 301 241 542

Extra-pulmonary 42 57 99Form of Pulmonary TB

Smear positive 295 102 39-

Smear Negative 81 64 145

Category 1

l\ew 309 274 583

Category 2

Relapse 8 6 14

Return after16 13 29

defaulterFailure 10 5 15

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References: 1 World Health Organization, GGlobal Tuberculosis Report 2012, WHO, Geneva,Switzerland, 2014. 2 Vasankarl, Tuula, PekkaHolmstrom. Jukka Ollgren, Karl Liippo, MaaritKokki, and Petri Ruutu. "Risk factors for poortuberculosis treatment outcome in Finland: a cohortstudy." BMC Public Health 7, no. 1 (2007): 291.3World Health Organization, G Global Tuberculosis

Acknowledgements:Authors would like to thank all the staffmembers of DOTS clinic, Muhammad MedicalCollege for the proper documentation ofpatient's information and their genuineassistance during data collection.

Authors •Contributions:MA was the primary researcher, conceived thestudy, designed, participated in data collection,conducted data analysis and drafted themanuscript for publication. MR and MNSassisted in data collection and preparation offirst draft of manuscript. All authors interpretedthe results, and reviewed the initial and finaldrafts of the manuscript.

Conflict of Interest: The author(s) declare that theyhave no conflict of interest.

Conclusion: The treatment success rate wasunsatisfactorily i,e. 60.4% among pulmonary and64.6% in extra-pulmonary tuberculosis patients. Itwas also lower in patients of rural area 43% and infemale population 55.9%. A high proportion ofpatients defaulted (26.2%) transferred out 8.1%and treatment failed 3.9%, which is a seriouspublic health problem that needs to be addressedurgently. To improve treatment success rate oftuberculosis patients we recommend constantsupportive follow-up and supervision ofTBpatients by health workers and family duringintensive and continuous phase of therapy, fordefaulters home visits and motivation ofdefaulter patients (defaulter tracing) healtheducation to reduce treatment interruption, andcommunity mobilization for early detection andtreatment of TB cases.

information on co-infection with HIV was notcollected and current study only conducted inone teaching hospital which might affect itsgeneralizability. Finally, inadequate financialresources constraints played a limiting role inextending this study beyond one hospital.

of extra-pulmonary tuberculosis and affectsvarious organs including lymph nodes, pleura,bones and joints, meninges, the intestine etc.which is similar to our finding.The treatment success rate (completed + cured)was 61%, which is lower from study conductedamong 494 patients by Menke B et a132observed76.1% success rate. High treatment success rate80.3% was also reported by Diel R et a133 in 518cultures positive TB patients. In line of thisobservation Chennaveerappa PK et a134noted84.2% success rate among 181 patients. Thedifference in success rate may be due to increasedefaulter and transfer out rate among currentstudy population patients.In agreement with the studies carried out atnationa135 and intemationa1361evel, the our studyreported the higher treatment success rate amongmale TB patients as compared to female TBpatients, increase number of defaulter and deathswere also observed among male patients.However, the proportion of female patientsenrolled for AU were relatively low comparedto male patients, which may be due to culturaland religious barriers.In this study the treatment success rate washigher in patients living in urban area than inrural living patients (54% vs. 43%), which maybe due to poor access to health facilities,or nonavailabilityof health care facility, drugs andstaff in the rural settings. These findings aresame line the study carried out in three districtsin Burkina Paso where geographical distancewas observed as a major challenge for ruralpatients in access to health facilities37.The default rate in this study was high 26% ascompare to study conducted in Nigeria22 andIndia38, which may be due to low poor access tohealth facility or lack of motivation. Our studysuggests that there is a need to take urgent actionto low the default rates in our TB controlprogrammes. Intervention like, counseling39,home visits and motivation40, and healtheducation41 supposed to be strengthened andimplemented in our health care setting to reducedefault rates in tuberculosis patients. The TBtreatment failure rate of this study was 3.9%,which was higher from the study conducted inIndia reported 1.6% treatment failure rate42. Onthe contrary side study from Nigeria39 andEthiopia43reported 8.3% and 18.6% respectivelyFirst limitation of this study is that no attemptwas made to visit the defaulted patients to findout reason. Second limitations is that

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University of Gondar Teaching Hospital, NorthwestEthiopia." Virology journal 10, no. 1 (2013): 171.16Soomro, Munawar Hussain, Ejaz Qadeer,Muhammad Amir Khan, and Odd Morkve."Treatment Supporters and Their Impact onTreatment Outcomes In Routine TuberculosisProgram Conditions In District Rawalpindi,Pakistan."Journal of Medicine 14, no. 1 (2013): 40-46.17Mohammad, Wazir, Ani1a Basit, MohammadTahir, 1Rahman, A. Wajid, and A. Javaid."TREATMENT OUTCOME OF PATIENTS WIIHPULMONARY TUBERCULOSIS FROM ADISTRICT GENERAL HOSPITAL INVOL YEO INTB CONTROL PROGRAMME IN NWFP." Pale JChest Med 10, no. 3 (2004): 25-30.18Khan,Mit Azam, Ani1a Basit, Zia Ullah, andArshad Javaid. "Outcome of tuberculosis patientsregistered during 2007 in major teaching hospitals ofPeshawar." Journal of Postgraduate Medical Institute(Peshawar-Pakistan) 23, no. 4 (2011).19World Health Organization. Global tuberculosisreport 2013. World Health Organization, 2013.20Getahun, Belete, Gobena Ameni, Girmay Medhin,and Sibhatu Biadgilign. "Treatment outcome oftuberculosis patients under directly observedtreatment in Addis Ababa, Ethiopia." TheBrazilianJournal of Infectious Diseases 17, no. 5 (2013): 521-528.21Rajarao, P., and P. Anjanamma. "Genderdifference in treatment outcome of tuberculosispatients under the Revised National TuberculosisControl Programme." Int J Pharm Biomed Sci 4, no.2 (2013): 66-8.22Babatunde, Oluwole Adeyemi, E. O. Elegbede,Majekodunmi Ayodele, Joseph Olusesan Fadare,Ayodeji Olusola Isinjaye, Demilade OlusolaIbirongbe, and Juwon Akinyandenu. "Factorsaffecting treatment outcomes of tuberculosis in atertiary health center in Southwestern Nigeria." InsRev Soc Sci Hum 4 (2013): 209-18.23Takarinda, Kudakwashe C., Anthony D. Harries,Tsitsi Mutasa-Apollo, Charles Sandy, and OwenMugurungi. "Characteristics and treatment outcomesof tuberculosis patients who "transfer-in" to healthfacilities inHarare City, Zimbabwe: a descriptivecross-sectional study." BMC public health 12, no. 1(2012): 981.24Biadglegne, Fantahun, Berhanu Anagaw,Tewodros Debebe, Belay Anagaw, Woghata Tesfaye,Belay Tessema, Arne C. Rodloff, and Ulrich Sack."A retrospective study on the outcomes oftuberculosis treatment in Felege Hiwot ReferralHospital, Northwest Ethiopia." 1m JMed Med Sci 5,no. 2 (2013): 85-91.

Report 2012, WHO, Geneva, Switzerland, 20134Tessema, Belay, Abebe Muche, Assegedech Bekele,Dieter Reissig, Prank Emmrich, and Ulrich Sack."Treatment outcome of tuberculosis patients atGondar University Teaching Hospital, NorthwestEthiopia. A five-year retrospective study." BMCpublic Health 9, no. 1 (2009): 371.sWorld Health Organization, G Global TuberculosisReport 2012, WHO, Geneva, Switzerland, 20136World Health Organization. Global tuberculosiscontrol: epidemiology, strategy, financing: WHOreport 2009. World Health Organization, 2009.7 Vermund, Sten H., Arshad Altaf, Rab Nawaz Samo,Rafiq Khanani, Noor Baloch, Ejaz Qadeer, andSharaf Ali Shah. "Tuberculosis in Pakistan: A decadeof progress, a future of challenge." J Pale MedAssoc 59, no. 4 (2009): 1-8.8Enarson, Donald A., Hans L. Rieder, ThuridurArnadottir, and Arnaud Trehucq.Management oftuberculosis: a guide for low income countries. No.Ed. 5. International Union Against Tuberculosis andLung Disease (IUATLD), 2000.9World Health Organization. Treatment oftuberculosis: guidelines. World Health Organization,2010.10. Chaulk, C. Patrick, and Vahe A. Kazandjian."Directly observed therapy for treatment completionof pulmonary tuberculosis: Consensus Statement ofthe Public Health Tuberculosis GuidelinesPanel" Jama 279, no. 12 (1998): 943-948.11Weis, Stephen E., Philip C. Slocum, Francis X.Blais, Barbara King, MaryNunn, G. Burgis Matney,Enriqueta Gomez, and Brian H. Foresman. "Theeffect of directly observed therapy on the rates ofdrug resistance and relapse in tuberculosis." NewEngland journal of medicine 330, no. 17 (1994):1179-1184.izSumartojo, Esther. "When tuberculosis treatmentfails. A social behavioral account of patientadherence." The American review of respiratorydisease 147, no. 5 (1993): 1311-1320.ISZellweger, J. P., and P. Coulon. "Outcome ofpatients treated for tuberculosis in Vaud County,Switzerland." The International Journal ofTuberculosis and Lung Disease 2, no. 5 (1998): 372-377.14Dye, Christopher, Suzanne Scheele, Paul Dolin,Vikram Pathania, and Mario C. Raviglione. "Globalburden of tuberculosis: estimated incidence,prevalence, and mortality by country." Jama 282, no.7 (1999): 677-686.ISWondimeneh, Yitayih, Meseret Alem, FanayeAsfaw, and YeshambelBelyhun. "HBVandHCVseroprevalence and their correlation with CD4 cellsand liver enzymes among mv positive individuals at

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tuberculosislhuman immunodeficiency co-infectedcases treated under directly observed treatment ofshort course in Western Ethiopia."JournaZ of AIDSand HW Research 6, no. 8 (2014): 164-171.37 Sanou, Armande, M. Dembele, S. Theobald, andJean Macq. "Access and adhering to tuberculosistreatment barriers faced by patients and communitiesin Burkina Faso." The international journal oftuberculosis and lung disease 8, no. 12 (2004): 1479-1483.38Babatunde, Oluwole Adeyemi, E. O. Elegbede,Majekodunmi Ayodele, Joseph Olusesan Fadare,Ayodeji Olusola Isinjaye, Demilade OlusolaIbirongbe, and Juwon Akinyandeno. "Factorsaffecting treatment outcomes of tuberculosis in atertiary health center in Southwestern Nigeria." IntRev Soc Sci Hum 4 (2013): 209-18.ssLiefooghe, R., C. Suetens, H. Meulemans, M-B.Moran, and A. De Muynck. "A randomised trial ofthe impact of counselling on treatment adherence oftuberculosis patients in Sialkot, Pakistan." TheInternational Journal of Tuberculosis and LungDisease 3, no. 12 (1999): 1073-1080.40White, A. J., C. M. Robinson-White, and H. Lnitel,"A report on home visiting practices conducted inremote districts of Nepal in an NOO-run tuberculosiscontrol programme [Notes from the Field]." TheInternational Journal of Tuberculosis and LungDisease 3, no. 6 (1999): 534-536.41Dick, L, and C. Lombard. "Shared vision-a healtheducation project designed to enhance adherence toanti-tuberculosis treatment [planning andPractice]."The International Journal of Tuberculosisand Lung Disease I, no. 2 (1997): 181-186.4zChadha, S. L., and R. P. Bhagi. "Treatmentoutcome in Tuberculosis patients placed underDirectly Observed Treatment Short course (DOTS)-Acohort study." Indian Journal of Tuberculosis 47. no.3 (2000): 155-158.43Berhe, Gebretsadik, Fikre Enquselassie, andAbraham Aseffa. "Treatment outcome ofsmearpositivepulmonary tuberculosis patients inTigrayRegion, Northern Ethiopia. ItBMC Public Health 12,no. 1 (2012): 537.

25Khan, MitAzam., Anila Basit, Zia Ullah, andAtshad Javaid. "Outcome of tuberculosis patientsregistered during 2007 in major teaching hospitals ofPeshawar." Journal of Postgraduate Medical Institute(Peshawar-Pakistan) 23, no. 4 (2011).26World Health Organization. Global tuberculosisreport 2012 World Health Organization, 2012.nNaing, Nyi Nyi, Catherine D'Este, Abdul RahmanIsa,Rosemi Salleh, Noraini Bakar, and Mohd RobiMahmod. "Factors contributing to poor compliancewith anti-TB treatment among tuberculosispatients." Southeast Asian journal of tropicalmedicine andpublic health 32, no. 2 (2001): 369-382.28World Health Organization. Global tuberculosiscontrol: epidemiology, strategy, financing: WHOreport 2009. World Health Organization, 2009.Z9 Getahun, Belete, Gobena Ameni, Girmay Medhin,and Sibhatu Biadgilign. "Treatment outcome oftuberculosis patients under directly observedtreatment in Addis Ababa, Ethiopia." The BrazilianJournal of Infectious Diseases 17, no. 5 (2013): 521-528.30 Sintayehu, Wegderese, Abebe Abera, TeklemichaelGebru, and Temesgen Fiseha, "Trends ofTuberculosis Treatment Outcomes at Mizan-AmanGeneral Hospital, Southwest Ethiopia: ARetrospective Study." International Journal ofImmunology 2, no. 2 (2014): 11-15.31Faustini, A., A. J. Hall, and C. A. Perucci."Tuberculosis treatment outcomes in Europe: asystematic review." European RespiratoryJournal 26, no. 3 (2005): 503-510.nMenke, B., D. Sommerwerck, and T. Schaberg."[Results of therapy in pulmonary tuberculosis:outcome monitoring in northern LowerSaxony]."Pneumologie (Stuttgart, Germany} 54, no.2 (2000): 92-96.33Diel, R., and S. Niemann. "Outcome oftuberculosis treatment in Hamburg: a survey, 1997-2001." The International Journal of Tuberculosis andLung Disease 7, no. 2 (2003): 124-131.34 Floyd, Katherine, David Wilkinson, and CharlesGilks. "Comparison of cost effectiveness of directlyobserved treatment (DOT) and conventionallydelivered treatment for tuberculosis: experience fromrural South Africa," Bmj315, no. 7120 (1997): 1407-1411.ssWalley, John D., M. Amir Khan, James N. Newell,and M. Hussain Khan. "Effectiveness of the directobservation component of DOTS for tuberculosis: arandomised controlled trial in Pakistan. fI TheLancet 357, no. 9257 (2001): 664-669.36Ejeta, Eyasu, Tadesse Birhanu, and TsedekeWolde. "Tuberculosis treatment outcomes among

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Case Study Three 'let us ten':Seventy-seven years old ex-teacher Maureen wassuffering from cancer of the pancreas. When she wasdiagnosed, she was also told of the poor prognosis.Maureen had four children and nine grand childrenwith age ranging from 15 to 4. Maureen spoke to thegrandchildren openly and they kept visiting theirgranny with no hesitation. When Maureen died, hereight years old grand daughter Jade drew a picture ofher understanding of Maureen's death and was happyto share it with hospice staff.

Case Study One 'Not to teli':Eighty years old Ian was a farmer and was sufferingfrom peritoneal secondaries from unknown primary.He had a very hard earned estate where he lived withhis wife Nora, sons Graham and Geoff. WhilstGraham had no children of his own, all the familyenjoyed Geoff's young children Josh aged 9 andAmy aged 7. Nora very much enjoyed being theorganiser of the family. After successive admissionsto the hospice for aspiration of recurrent Ascites, Iandeteriorated and died with his wife and daughter-in­law Jane in attendance. Nora had made the decisionfor the family that Amy and Josh would not visit Ianduring the terminal stages. Following his death, therewas a huge argument between Nora and Jane aboutthe children coming to see Ian. Jane stated thatchildren loved their grandfather and had made theirwishes known that they wanted to see Ian. While Ianwas alive, she respected Ian's wish, not to bring inthe children in to see him, but now, Jane felt thatchildren had a right to see their much lovedGranddad. Nora argued that the children would neverbe able to understand what was going on and theywere better left alone. She felt if the children areallowed to see Ian after his dying, it will be a horribleexperience and will leave them scarred emotionally.She suggested that children are told after the funeralthat Ian had died.Case Study Two 'How to teQ':Pauline had colorectaI carcinoma and wasundergoing palliative treatment only. She had adaughter Lorna who was divorced and had twochildren Hannah aged 12 and Connor aged 8. AsPauline was in her terminal stage, she wished to seethe children. Lorna approached the hospice staff andsaid that she could not face telling the children and'was it appropriate to tell them as they will notunderstand it anyway?' Hospice staff supportedLorna and Pauline and called the Child BereavementCounsellor, who helped Lorna speak to the children.Pauline died after the children had been in to see herand left.

Introduction: Hea1thcarebas multiple roles to offer.Caring for death and dying remains a pivotal role fordoctors and other hea1thcare professionals.Bereavement support or preparation for families isalso a role, doctors should have understanding of.Over the last decade, there has been a growingacknowledgement among the healthcareprofessionals about the needs of bereaved children.Hospices, in particular, and palliative care providers,in general, have developed programmes of skills andresources to meet this demand'. However, it is also ofconcern that at times, children are excluded from thegrieving process as there is not enough appreciationin the wider community that children of a very youngage could go through same emotions. The notion of'protection' can sometimes be overused. At the sametime, the published data, agreed standard orguidelines are sparse and although totallysympathetic, even palliative care workers find itconfusing to guide families through this difficulttime.Here we will discuss three rea1life case studies withdifferent scenarios dealing with people's assumptionabout Children's perception of death.

Abstract: Childhood bereavement bas been a matterof intense discussion among the Palliative careproviders. Yet, there is little evidence base behind thenotions, which are prevalent among the population ingeneral, and Palliative Medicine providers inparticular. Among the masses, there is stillprevalence of 'protecting the child' phenomenon.Beliefs, like this, create confusion among theproviders while recommending the strategy whiledealing with the bereaved children. There is definiteneed to develop plans to deal with this difficultproblem, while recognising some other issues likeculture and spiritual mechanisms.

Corresponding author Email:Oamar.abbas@stclacehomice.org.uk:Published: 4 October 2014 Received: 20 July 2014Accepted: lit October 2014

Address: Deputy Medical Director & Consultant inPalliative Medicine, St Clare Hospice, Hastingwood,Essex, United Kingdom

Author: Syed Qamar Abbas

ASSUMPTIONS AND ATrITUDES TOWARDSCHILDHOOD BEREAVEMENT

REVIEW ARTICLE

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Conclnsion:Though, there is very little written evidence basedmaterial on the childhood bereavement, there are stillvery good grounds to support the theory of 'beingopen to children of young age' . It also corresponds tothe ethos of holistic care and honesty. It is notuncommon to find perplexed children where the truthwas hidden. Children, if not told, find the situationdifficult and unstable and often imagine the situationto be worse than it really is1Z. Inthe United Kingdom,Personal, Social and Health Education (pSHE)programme was introduced in 1999, which enables11 to 14 years old children to learn to recogniseemotional stages of grieving process and how toadapt in these circumstances 13. Although someteachers are undergoing training to help children dealwith dying, there is till a gap in the service as it willtake time and also often palliative care services haveto deal with children younger than that age group.Another important factor to influence the decisions,like any other issue in palliative care, is the culturaland spiritual background. In Pakistan, communitiesrely on family support or other community networks.This can suit the model but further research is neededto find out if it does".We suggest that:• There is need to recognise the fact that therestill is the notion of 'protecting the child' whileactually what is happening is the 'harm to the child'by being dishonest and making them unable to openup.• We also need to find more evidence to helpus channel the resources in the right way, whether itis to support the parents or to set up support groups.It is without doubt that all of these may have theirown role. Given the confusion we have, due to lackof data about the childhood bereavement, it is hard tosupport one strategy over the other.• We also need more evidence to knowwhether there are any long terms psychologicalinfluences left with the bereaved children. Itwill helpus plan our programmes as well as provideinformation to the family, although it needs to beemphasized, in a very sympathetic manner.

Another argument among the healthcareprofessionals is that of the level of interventionprovided to the children to help them cope with thebereavement. Some providers believe that providingintervention can make it difficult for the children andtheir families to use their own resources in thecommunity around them, making them dependant onprotessionals".

There is no national collection of statisticalinformation of the number of children and youngpeople bereaved in United Kingdom. However, anunadvertised telephone service from St Christopher'sHospice in London experienced what was describedas 'the tip of an iceberg regarding an unmet need forbasic advice, support and resources", There isanother interesting conflict of opinion among thehealthcare professionals, where some papers suggestthat the death of a parent causes children to be at riskof developing psychiatric problems", other paperssuggest that these concerns are probably complicatedwith the methodological problems as well as theexperiences which went on along side bereavemente.g., lack of adequate parenting", Some authors haveeven identified that in fact bereaved children, in factshow resilience and have coped remarkably wellunder this severe form of trauma i.e., bereavement',Another paper actively looked at the two theories blinterviewing adults who were bereaved as children .The debriefing interviews showed that there werefour distinct types of experience: appreciation,frustration, enmeshment, and ambivalence.Depression was not found to be an inevitableoutcome.It is though agreed that children require time to cometo terms with their loss and mar need externalsupport to be allowed to grieve. Whether this'external support' is from the family or friends orprofessionals, it is open for discussion. Althoughmany people still believe that children do not havefull understanding of death, but it was found manyyears ago by Lansdown and Benjamin that 59% of 5years old and 73% of 6 years old had an almostcomplete understanding of the concept and process ofdeaths. Their reactions vary from acting strange andshowing physical signs to keeping their feelings andexperience of bereavement of a parent to themselves,which can hinder the process of coming to terms withtheir loss". Systemic controlled studies of bereavedchildren have been few but data suggests thatmajority of children do not show serious symptomsor dysfunctional behaviour'", It is also suggested thatas compared to adults, the episode of intense grief isshorter but the total grieving period may last longer.

Discussion: The case histories described reflectdifferent attitudes among the society towardschildhood grief. While in the case history one, theelderly lady had a notion of 'protection' of the child,lady in case history two, though agreed to tell thechildren but found it hard. Both of these attitudescome from the background that putting childrenthrough grief may cause them more 'harm thangood'.

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References:1. Monroe B. Social work in Palliative care. InD Doyle et al (Eds) Oxford Textbook of PalliativeMedicine 867-880: Oxford University Press 19992. Stokes, Pennington, Monroe et al.Developing services for bereaved children: adiscussion of the theoretical and practical issuesinvolved.Mortality 1999; 4: 291-3063. Weller RA, Weller EB, Fristad MA, BoweslM. Depression in recently bereaved prepubertalchildren.Am JPsychiatry 1991; 148: 153~ 15404. Quinton D. Adult consequences of earlyparental loss. BMJ 1989; 299: 694-55. Harrington R, Harrison L. Unprovenassumptions about the impact of bereavement onchildren. Journal of Royal Society of Medicine. 1999;92: 230-2336. Hurd RC. Adults view their childhoodbereavement experiences. Death Stud; 1999: 23: 17-417. Hurd RC. Adults view their childhoodbereavement experiences. Death Stud; 1999: 23: 17-418. Lansdown R. and Benjamin G. Thedevelopment of the concept of death in children aged5-9. Child care and Health Development; 1985: 11:13-209. Fell M, Helping older children grieve: agroup therapy approach: Health visit; 1994Mar 67:92-410. Silverman PR, Worden JW. Children'sreactions in the early months after the death of aparent Am JOrthopsychiatry 1992; 62: 93-10411. McCord 1. A thirty years follow-up oftreatment effects. American Psychologist 1978; 33:284-912. Landry-Dattee N, Dalaigue-Cosset MF.Support Groups for Children. European Journal ofPalliative Care 2001; 8: 107-11013. Department of Education and Skills. ATeacher's guide to personal; social and healtheducation. London: The Stationary Office, 1999.14. Gatrad AR, Sheikh A. Palliative care formuslims and issues before death. InternationalJournal of Palliative Nursing 2002; 11: 526-531

• We also need to recognise the fact thatbereavement is influenced directly by social, spiritualand cultural issues, while setting up any suchprogramme, we will have to consider the localimplications based around the needs of the particularsituation.

• ISSN: 2075-9983-APR 20 14"()CT2014 1 2811 _

Ab8tractI.ntrocIndIoo.: Progrees evaluatioo of a medical student ia as impoI1an.t asasses&ing knowledge aDd bu.lc sk:Illa. LIke medical schools use a globalepproacb called 360 ? evaluation? , to evaluate medical students' edncaIionaDd skills, performance may be enluated by diversity of iDdividuals whointeract with students. The evaluation gives rtlber panoramic view ofmedical students.

The deparUnent of CommoDity Medicine and Health Sciences basdeveloped an easy and practical method of evaluating medical Studentsperformance. The evaluation instrument is single pago document listingparameters of progress &:perfODlWlCeon basis of rating COD.fideIItial codeson their actual acquired achievements. The use of this progress cord greatlyfacilitates the evaluation of medioal students in basic CommoDil)' Medicine&: Health Sciences educational studies, practical, clipping file , continnedacademic tests • semest« results and research project study &: over allperformanoe of the students.Abn:StrengtheD internal mdoatioo prOOllS.Objectivall..Determine attendance rate-Establish test rating-Develop field visits scale-Pormat practical joumal &: clipping file skills scale.. Determine participation rating in research project studies*Fomwlate over all performance gradingStudy Df8Ip: Descriptive observational cross sectional study wasconductM on 93 students at Departmentof Community Medicine & HealthSciences Mohammad Medical College Mirpurkbas.Material UId MedIoda: At Muhemmad Medical College developed.approached, tinal.ized and pre tested performance evaluation instrument i-eProgress Olart Record { peR} at department of Community Medicine &Health Sclnces 00 medical students of fourth year MBBS batch 2010. Thisprogress chart reeced {PeR} includes edncaIion seetm artendance ,continued academic tests results .semester scores , carried field visits ,performance of practical journals .formation of olipping file. &participation in research project studies efforts and over all performanceacbi.evemenlS .BIbically coofidertri ality was kept through coding and scoresrating categorized. MODi.toring was used to confirm improvement instudents' performance. Like 360 evaluation reflects rating as 0 or 1 = Bad •2 = Poor , 3 = Fair. 4 = Good , 5 = Excellent " after that one is able toobtain or show clear view I picmre of a medical student in a year. Or as aclass we see the annual performance in a glance.

Anthon: Ohulam Ra8oo1Bhurgd. Ohulam Mustafa DahIiMohammad AliQazi, .Hussain Bux KorcjoAbstradObjectivall To evaluate the safety of antipsychotic ugs in psychoticpatients at SJr. CJ Institute of Psychiatry. Sindh (Sontbem Province ofPaldstan).Method: Patients were selected from OPD, male and female wards of Sir,Cowasjee lebangir Institute of Psychiatry, Hyderabad. Total two hundredpatients were enroned in the study, out of them 192 patients continnedthroughout study and eight lost follow-up the study. The side effects werenoticed according to UKU (side effect scale). Same criteria was fonowedfor both drugs in the study, assessment was done on 07, 14, 28, and 42days.lleIults: AdV«Be effects of two drugs presented. rigidil)' and tremors werethe DlO8t common adverse effect, in haloperidol 14.6% aDd 12.5% and inResperidone 4.2% and 4.2% respectively. Overall Resperidone in onr studyproved efficacious and economical drug in psychotic patients. On the otherhandhaloperidol was also effective and cost effective but produced moreside effects.Conclusion: The results of our study are also in accordance with Borton(2005) where the target behaviors of psychosis improved in 94% of patientsgiven Resperidone, 6S%given HaloperidoL Extra pyramidal symptoms were reported in 7% ofpatients on Resperidone, 22% taking Haloperidol, safe effective doses oftencause unacceptable side effects. 'Ibis study showed rigidil)' and the tremorsthe most common adverse effect in Haloperidol 14.6% an 12.5%respectively and in Resperidono 4.2% and 4.2% respectively.

Evaluation at departme.nt of ~ mecIkiDe aDd health IJcieDcesof foorth yeD' MBBS medicalltodmfl batch 2010

NOOI'Alis.- loPDOCBS MMC MPX.

toxic effects. At therapeutic level, sodium tungstate causes noIOOIpbological changes in kidneys and livers of the e.xperimental rabbits,

ToDcoIoekal proftie of typical and atypical drup in psydaodccHsorden

• The blood glucose level of Group C became near normal withtreatment as compared to Group B without treatment

• There is decrease in weights of rabbits in Group B at the end of 4·week and gain in weights of rabbits in Group A & C and differencewas significant was significant statistically statistically.

• Regarding weight and size of liver and kidney of rabbits, non­significant results are seen in diabecic rabbits without (B) and with (C)sodium tungstate therapy.

• The microscopic features of liver revealed comparable difference inGroup B &:C with control group (A)

• Regarding NAS Score of liver no diagnosis of NASH.• Fibrosis staging of liver showed non significance results in diabetic

rabbib without (B) andwith (C) sodium tungstate therapy.• The microscopic feltures of kidney in all groups revealed non

significant cbAnges as compared to thecontrol Group (A).

Hence on the basis of these findings, it is concluded that sodinm tungstateis a good anti-diabetic agent when administered oraDy without significant

Study DesIp: It was an experimentalinterventiooai study in rabbits.Place and duration of study: The animaI8 were kept inthe animal houseof Postgraduate Medical Institute (PGMQ, 6-Abdul Rehman Qrugtai Road,Labore and fwtber processed in tile pathology department of PGMI. Thestudy was carded ont for 04-weeb, after iDduclng the DM in rabbits withSTZPatiftID aDd Method8: For this purpose. 30 rabbits of 30 rabbits of 30weeki ago with aveqge veitbt of 1.5 kg were selected aDd divided intothree groop8of teo animals each with equalllUlllber of males and females.Twenty animals were given a single intrtperltoneal injection ofsttepCOZOCOcln (STZ) (SOmgIka body weight) in 0.9% NaCl withlOOmmoUl lIOdium citrate. These animals were monitored forhyperglycemia 24-48 hours after injection of STZ The blood glucose levelsof all the rabbits were divided into 2 groups. T'bese groups were identifiedby placing small tattoo mark in the noo-vasoular space of Wt pinna of theear as follows, two marb for diabecic animals with S1Z treaIDlIent GroupA included ten healthy rabbil3 receiving normal diet Group B included tendiabetic rabbits fed on normal diet and distilled water. Group C includedten diabetic rabbits fed on normal diet and solution of 2mgIml of STL indistilled water orally.Renltll: The trealme.o.twas carried out for 04weeks. Blood glucose levelwas measured every third day. After the end of 4 week animals weresacrificed according to protocol and liver and kidneys were dissected outand put in 10% buffered formalin solution. Gross examination of liver andlddney were done and sections were taken. The sections were furtherprocessed in automatic processo(. Histological examination was done on H& , Tciculin silver stains. So following conclusions were drawn from thestudy.

Sodium tungstate bas been found to correct hyperglycemia in insulin- andnon insulin depeo.dentmodels of diabetes when administ«ed in drinkingflu.Id with a low degree of toncil)'. Thus it provides a potential treatmen.tfor diabetes.

The aim of the study was to study the morphological effects of sodiamtungstate administration on liver and kidney of 8treptozotocin (STZ)induced diabed.c rabbit •.

Morpholoikal study of BOdlmn tuDptate effects on liver and Idclney of~ induced dJabetk rabbits.

AudIors: Afra Samad, Mobam.mad Tayyib, InstitutioD:Post GraduateMedical Institute, Lahore.Ab8tract: Diabetes mellitus (DM) is major health problem, which isrecognized by WHO to reaclling epidemic proportion. Pakistan is a 80UIhAsian country with population of approximately 160 million andprevalence of the disease is high. In a study it bas been seen that 12% ofpeople. Above age of 2S are suffering from DM and an additional 10%have impaired gIuco.!e toleranco test (lGT). The development of newthenpies that are able to improve glycemia ~ement and even to CU1ediabeces is obviously of gre.r interest. A drug, which can restore pancreaticbec.a cell funaion. will be a lJ(eakthrough in the lWIDagement of thisdisease. Reaearch is going on for the last century but a nee-toxic BUbstanoeadminlst«ed oraDy, which can restore bec.a cell function, is yet a dream.Previous studies hAve shoWD sodium Tungstate (S1') to be an effective oralanti- diabetic agent, in boch sbon- and long term treaIn:ierIts, in severalanimal diabetes mel.Utus models.

Abstrat Presented in9thAnnual MedicalSymposium 2011

29 .

Author: Mahesh Kumar, Associate Professor Plastic SurgeryL.U.MH.SJamshorol HyderabadAbstractIub:oducliOD: Management of comp1icatedwounds with exposed bones,joints, fractures , or implant is challenging for plastic surgeon. complicatedwounds needs to be covered with vascularized flaps, such as fascio­cutaneous flap, muscle or myo-cuteous or free flap.Patimts aDdMethod: This is fonr year study done at Liaquat Univer&ityOf Medical And Health Sciences larnshorolHyderabad between 2008 and2011. Majority of cases were referred from orthopaedic surgeon or done incolloboration with orthopaedic surgeonResult: .Total 82 cases were seen 4 years, among them 63 were male and19 were females, . 30 to 50 year patients was the major affected groupVmoos types fasci-cateaous flaps was done for complicated woundes suchas ponten flap retrograde peorneal flap, islaDd and pedicled fascio-cutepusflap , sural flap.Results will beproduced with photographs.Condnsioru FASCIO-CtTI'ENEOUS flap iscomperatively simple and cancover expose bone at any level ofleg.sural flap is ideal for lower leg, hee complicated wounds

Authors: Abdul Ghani Soomro, Faisal Ghani Siddiqui, Arshad HussainAbro, Shahnawaz Abro, Noshad Ahmed Shaikh, and Abdul SattarMemonAbstractObjective: Acute appendicitis is one of the commonest surgicalemergency. There are different scoring systems in use to diagnose theappendicitis. Aim of this study was to document the diagnostic accuracy byapplication of Alvarado Scoring System in clinical practice for acuteappendicitis.DesIgn: Descriptive case series.Setting: Surgical Unit-n, Liaquat University Hospital Hyderabad, Sindh -Pakistan; from January 2003 to September 2004.Methods: All the patients with suspected appendicitis were admitted in theward. A profroma was designed and relevant findings were docnmented.These were observed regarding the increase or decrease in severity ofsymptoms and hence the change in the initial score according to AlvaradoScoring System was documented at the time of admission. Decisionregarding surgical intervention was made on the basis of change in thescore.Results: A total of 227 patients with clinical features suggestiDg acuteappendicitis was admitted in the ward. Among them. 150 (66.07%) weremales and 77 (33.92%) were females. Age ranged from 10-62 years. Mainsymptoms at presentation included pain in right iliac fossa 67.8%, fever66.9% and.nausea and vomiting 49.7%. Thirty two patients were receivedwith Alvarado Score of 1-4 aDd three out of them required surgery. Thirtyfive patients were in the score of S, twenty three out of them requiredsurgery. One hundred sixty patients were in the score of 6 and above, all ofthem required surgery. Out of 185 patients who underwent surgery, 178patients had appendicitis. The negative appendicectomy rate was 3.78%.Condusion: It is concluded that according to Alvarado file patients withscore up to 4 probably do not require surgery and among the patients withscore up to 5, most of them need surgery while the patients with the scoreof 6 and above will require surgery.Key Words: Appendicitis. Appendicectomy. Alvarado scoring system,

Oakome of 8Z cases of Fasdo-Cutaoeous flap for complicatedwoandleg with exposed bont'8

Tide: Diagnostic Accuracy of Alvarado Sc:oriDgSystan InAcute Appendicitis

1. "Evaluate the frequency of fungal involvement in patientspresenting with nasalpolyposis"

2. "Determine the most common symptoms in Allergic fungalIhinosinusitis patients"

Methods: This Descrlptive study was carried out in EN.T. department atMuhammad Medical College MiIpuIkhas from November 2010 to August2011. All the Patients of any age and sex presenting with nasal polyposiswere included except malignant conditions of nose and paranasal sinuses,immunOCOlllplOlllise patients or on immunosuppressant drugs and any co­morbidity like diabetes, chronic renal failure, chronic liver:diseases etc.Results: Out of 23 patient (13 males & 10 Females) 14 were fungal stainpositive, out of 14 cases 11 had Aspergillosis (6 female & 5 male) whileother three fungal stain had Rhizopus, Blastomyces and tricbphytosis inleach. The mean age was 28.83 years (Range 7- 75 years) in the patientspresented with nasal polyposis. Nasal obstruction, post nasal drip andhyposmia I anosmia were the most common presenting symptoms.Condusion: All«gic Fungal Rhinusinusitis usually presents in youngindividuals, having nasal obstruction, post nasal drip and hyposmia Ianosmia. Aspergillosis was found as most common fungal organism Inthese patients.Key Words: Rhinusinusitis, Allergic, Aspergillus, Nasal polyposis.

• ISSN: 2075-99B3-0CT 20 13-APR2014 _

Authors: Arsalan Ahmed, Noor Ahmed, Salman Matiullah Shaikh,Muhammad Saleem MarfaniAbstractObjedive:The objectives of my study are to:

AutboI:: BajiMuhammadAslam Cbanna, ShaukatAwanAnatomyAbstnid: Administration of quinolone Therapy is controversial duringgrowing age as stated by earlier wOl:kers.1be flouroqainolones are currentlynot indicated for yonng children because of aJ.1bropathy & adverse effect asnew boee shown by studies. However the effects of ciproflox.acln&ZnCl2onpre-natal conceptus has remained undocumented.I'ropo6e of study: The present study is therefore design to compare theeffects on coneepms after matemal ingestion of cip:ofloxacin and ZnCl2 byprospectiveexperimt-mal auimal study model U&iDg wistar albino rats.Medaods: Qprotloxacin &ZnC12 was administtated topregnant female albinorats.CiproftoxaciD with a dose of 20 mglkg bodyweight & ZnC12 120flgllOOgmbodyweight two times therapeotic dose for 10 days.(from day -8 today 18 of pregoancy.)Eachauimal was weighted on day l,day 8& day -18 ofpregnancy. Abo.rti.onresultedon day 1Sllof pregnancy. Earo group ofpreguantauimals were sacrificed on day -18 of geststion by avet dose of eilber~ alxIomen opened, uterus & both canua containing concept usideartified, removed, there weight recorded, crown rump length was measured& was compared with Bimilar value of conttol aoimals.The resulIs wereSI3I:istically analysed to find out !besignificance.RtBUIt: The clprofloxacin induces a mordanting effect as obviated byincreased basophillia.Oor study reveals that ciprofloxacin administered inmatt:mal, decreased matemal body weight to 38..a<>.9gm. Howe~simoltaneous ZnCIz maintained the body weight to 41..a<>.7glI1,whlleZnOzincreased the body weight to 46.5±2.25gm.1be body weight & crown romplength (CR Length) in CODCqltus decreased by 4S~.1Ogm & 3.06:t0.09cmrespectively.That ciprofloxacin&ZIlCh administration maintained the bodyweight &CR lengthby S.46:tO.09gm&3.79:t!l.13cm respectively.That ZoClzadministration increased !be body weight aDdCR length by 6.71±O.05gmand4.15±O.08cmrespectively.Condusion: The ciprofloxacin& ZnCl2 pre-natal administration affected themean body weight & CR leogth reduction Inbody weight & length of ratconcepros&ZIlCh maintained body Weight&CR length leading to growthofflle ratconceptus.Keywords: Cipro:floxacio,ZnCJ2, body weight of animal, crown rnmp length(CRLength), rat conoeptus.

Frequency & Presentation of Allergk Fungal RldnOllinositis InMnbannnad MedIcal College Mirpurkbas

10 determIae morphology afte&- dprotIoDdn & DDc ddoride In adultalbino atpr&-Datal period.

Resull8 :A quality improvement process was seem aDd showed the outcomes tbrough systemic review of progress record of 93 students in whichmales were 49 i.e. 52.68 % & females 44 i.e, 47.31 % , conducted lecturesclasses218, determined attendance rating as, Bad: 7.52 % Poor; 25.8% Fair. 31.1 % Good: 20.4 % ExceD.em: 15.05 %, establ.i8hed testscoring, Bad: 2.15 % Poor; 21.5 % Fair; 34.4 % Good: 39.7 %Excenent 2.15 %, established semester scoring, Bad: 1.07 % Poor:4.30 % Fair: 47.31 % Good: 40.86 % Excellent 6.45 %,Developedfield visits scale: Bad : 8.60 % Poor: 36.5 % Fair: 0 % Good: 54.8% Excellent: 0 %, formatted practical journal & clipping file skills scale :Bad : 6.45 % Poor: 12.9 % Fair: 13.9 % Good: 62.3 % Excellent:4.30 %, determined participation in research project study work ; Bad :10.74 % Poor: 9.67 % Fair: 45.5 % Good: 17.2 % Bxcellent; 18.2 %,formulated over all pedoanance grading: Bad: 7.52 % Poor: 39.7 %Fair: 3333 % Good: 13.9 % Excellent 5.37 %, with average 19.2 ,range maximum 27 minimum 3, while annual result reflected 86% success.CoodasioruStudents need improvement to attend the classes withregularity andpunctuality.Students need improvement to actively participate in continued academictests & semester examination.'"Determine attendance rate 66 %*Establish test rating 73 %"Acquired semester scoring 94 %·Develop field visits scale 94%·Format practical journal & clipping file skills scale 81%.. Determine participation in research project studies 81%*Fonnu1ate over allperformance grading 53%RecommendatiOll8:Process identifies areas of improvement, develop & C3lCYout action.

• Assigmneut activity should be added to play part I internalevaluation

• Ensure lectures eutry in departmental register

_______ ISSN: 2075-9983-APR 20 14-0 CT2014.30

AbstractObjective: To evaluate Blood Ordering and Transfusion ratios for electivesurgical procedure.Study Design, SeUing &Duration: This was a prospective study carriedout at Muhammad Medical College Hospital Mnpurkhas form January2007 to December 2007.Patients &Methods: A total of 1032 patients were incladed, both male &female. Allpatients who underwent elective surgical procedures in SurgicalUnit, Muhammad Medical College lIoopital, Mirpurkhas from January2007 to December 2007 were included in this study. Blood units crossmatched and units transfused intra-operatively and post~peratively wererecorded apart from patient demography and hepatitis,profile.Results: A total of 1032 patieuts underwent elective surgical proceduresduring the study period. Total 1500 blood units arranged, among these only74 units of blood were transfused. This means only 4.9% of blood wasutilized while 95.1% of blood was not utilized. Cross-match to transfusionration (CIf) = 20.27. Transfusion probability (Tp) = 7.1 and Transfusionindex (Ti) =om.CoDdosion: For elective surgical procedures, there is no need for routinecross matching of blood. However, on must confirm the availability ofblood for Hepatitis B and Hepatitis C reactive patients, and for cases, wherethe bleeding is inevitable like transvesical 1 ttangurethral removal ofprostate.

Blood Transfusion arrangements and lISe of blood in electivesurgicalproced1ll'e

AuthorsRehmatnIlah Soomro (Associate Profes8O.tof Surgery)SaraAhmedAli, Muhammad Rizwan JavedThis paper has been published in Professional Med J Apr-Jun 2011; 18(2):212-214.

Fistula in ano: our experienceat a rural based teadIiDg.

Authors: Muhammad Jawaid Rajput (Professor of Surgery)Rehmatullah Soomro (Associate Professor of Surgery)Shabnam Rani,Naseer AhmedThis paper has been publiahed inPak J Snrg 2010; 26(4): 297-300

AbstractObjective: To observe the outcome of conventional techniques for thetreattnent of Fistulae in Ano, both low and hi.gh types at rural basedhospitalPatients and Method: It was a prospective study carried out at theDepartment of General Surgery and Urology, Muhammad Medical CollegeHospital, Milpmkhas from August 2006 to July 2008. During these twoyears 47 cases were admitted and operated for fistula in Ano. Patients of allage group were included in the series. Swprisingly no female patientreportedduring the study. Result were analyzed.Results: Total patient dealt with were 47. All were males. Fistulae of lowtype were found in 36 (76.59%) whereas that of high type was found in 11(23.04%). Among the low (n-11) type 30 were single (8333%) and 6 weremultiple (9.52%). Among the high (n-11) type 7 were single (63.6%) and 4were multiple (36.3%) Age group varied from 2 years to 54 years (mode:32-38). Histopathology performed in all cases, which revealed tubetculosisin 2 cases (4.2%). No malignancy was found All low type fistulas in Anowere dealt with by Fistulotomy. The cure rate was found to be 100%. Allcases healed successfullyCoDdosioo: For low type fistula in anofistulotomy is a simple tuethod withsatisfactory therapentic results. For high type fistula in ano cutting Seton isa well-accept method with high rate of success.Key Words: Fistula in ano, Fistulatomy, Hihg fistula in ano

Results: A total of 501 patieuts were admitted during the study period.Total 411 surgeries were performed. 258 (62.8%) were elective and 153(37.2%) were emergency procedures. Hernia repair was the most commonsurgery performed in 92 (22.4%) patients, followed by appendicectomy in64 (15.6%) and cholecystectomy in 54 (13.2%) patients. Complicationswere documeated in 122 (29.6%) patients. Most common complicationobserved was post-operative pyrexia in 75 (18.2%) patients, followed bypostoperative nausea and vomiting (PONY) in 48 (11.6%), wound infectionin 47 (11.4%), respiratory tract infection in29 (7.0%) patients. During thestudy period 4 patieuts (0.9%) died in the postoperative period.CoDdosion: This study revealed that the commonest postoperativecolIIPlication was fever followed by PONY, wound infection andrespiratory tract infection. It is important that the resident staff should beaware of these complications and how to manage them because these arebetter yardstick:tomeasure the quality of care.Key words:Herniorrapphy, appendicectomy, cholecystectomy,postoperative nausea, postoperative pyrexia, sound infection.

Authors:RehmatullahSoom, Jawaid Rajput, Ahmed AliLagbari (Prof of Surgery)This paper has been published in Ann HarndUni 2010; 1(1): 23-27AbstractObjective: To find out post-operative complications during hospital stay ofpatieuts in a general surgical ward at a tertiary care teaching hospital ofKarachi.DtsJgn: Descriptive retrospective analysis.Duration: Six months, from January 1, 2008 to June 30, 2008.Patients and Methods; The records of all patients who underwent surgerybetween January 2008 to June 2008 were reviewed regarding postoperativecomplications developed dming hospital stay. The following data werecollected: age, sex, presentation at time of surgery (emergency or elective),surgery performed, complications during postoperative period andoutcome, All data was analyzed with the help of SPSS-lO software.Main Outcome Measures: Surgery performed, post-operativecomplications.

Post-operative compJicatioos,observed Inour ward; a recent six monthreview.

Authors: Javed Rajput, (Professor of SurgeryMMCH)RehmatnIlahSoomro (Associate Professor of Surgery, MMCH)GhularnAkbar Arain. (S. RegistrarofSurgeey,MMCH)This paperhas been published in Pak J Surg.2010; 26(2): 138-141

AbstractObjective: To evaluate the influence of the urologist's experience on thesurgical results and complications of transurethral resection of the prostate(TURF).Patients and Methods: This was a prospective study done between May2008 to May 2009. Sixty-seven patients undergoing transurethral resectionof the prostate without the use of a video camera were randomly allocatedinto two groups according to the urologist' 8 experience: a junior urologistwith moderate experience of transurethral resections of the prostate (GroupI - 34 patients), a senior urologist with vast transurethral resection of theprostate experience (Group IT - 33 patients); The following parameterswere recorded: the weight of resected tissue, the duration of the resectionprocedure and how many patients IIIDDIIg each group needed a secondTURP.Results: The weight of resected tissue per minute was approJtimately fourtimes higher in group IT than in groups I. Also the resection time wassignificantly low in group IT. Significant number of patients needed asecond TUPR in group 1.CoDdosion: The senior urologist was capable of resecting four times moretissue per time unit than the more inexperienced surgeons. Therefore, asurgeon's experience may be important to reduce the risk. of secondaryTURP due to recurring adenomas or adenomas that were incompletelyresected.Key Words: Transurethral resection of prostate, BPH, prosteti.cadenoma.

Can an experienced Urologist is do a better TURP

AbstractObjective: There are specific licensed indications for the use of ProtonPump Inlnllitors (PPIs). However it is over-prescribed globally. Wepedormed a study to find out the uses and misuses of this expensive drug inour rural and financially poor population.Methodology: Prospective survey of patients successively admittedpatients over a tuOnthwere interviewed. Of them 144 (58%) were females.Mean age was 42 years (range = 10 -100 years). Nmety (36%) were usingPPIs for which there was a licensed clinical indication in 44 (49%), whtteas 46 (51%) had no definite indications. Fifty three patients (59%) whowere taking PPIs were either self prescribing or were prescribed by anunqualified medical practitioner. Of these, 34 (64%) did not appear to havea valid indication. Of the remaining, 15 patients were prescribed PPI by aspecialist, and 22 by a qua1i.fiedgeneral practitioner.Cooelosion: Over half of patients (51%) in our setting are using PPIs withno definite indication. Over 2/3 (64%) of those were prescribed either byunqualified practitioner or bought over-the-counter, had no licensedindication.Key Word: Proton Pump Inhibitors, Dyspepsia, Indications.

This paper has been published in Pak J Med Sci April- June 2011 Vol. 27No.2 300- 302

Authors: Syed Zafar Abbas (Professor of MedicineGastroenterology, MMCH)Rehmatullah Soomro (Associate Professor of Surgeey,MMCH)Sadaf Shaffi

Proton pump iDbibitors - over - pre8C1'ibed in a rural colllll1llllity?

A1Jthors: Arslan Ali, Abdullah Bangwar, lasim Gull, Usman Ghani,Khawar Zaman AliFiaqNaqvi, Zeesban Ahmed, (Final year MBBS)

./SSN:2075-9983-APR 2014-OCT 2014 1 311 _

An audit of bladder outflow obstruction at MMCR

Oesophageal maIlpancy Is common amona wo_ presenting withDysphapa.

Authors: AbdulObaffar (F'malYear)Syed Zafar Abbas (Prof. of Medicine 1Gastroenterology).Section of Gastroenterology, department of media MMCH.AbstractBackgrowJd: Dysphagia is a sinister symptom, as also shown by anotherpaper presented by our group in this symposium. However, it is a commonsymptom and when presented by a young fewale patient, many believe it tobe a likely "functional" problem..Aims: To determine the association of dysphagia with malignancy and todetermine various demographic and clinical features of oesophageal cancer.Patieots &: methods: Retrospective analysis of endoscopy records of 105patients consecutively presenting with dysphagia and to further analyse therecords of patients found to have oesophageal malignancy. HospitalResearch Ethics Committee approval was obtained to conduct this study(No. 1009111RECI 0(9).Results: Out of a total of 105 patients (72 females [ 68.5%) presentingwith dysphagia 42 (40%) were found to have oesophageal malignancy thereaverage age was 45 years (range 22-65) out of these 42,31 (74%) werefemales with average age of 40 years (range =22 to 60) of them 23 (74%)were ~ 45 years of age the average age of 11wales patients was 54 years(range 40 to 80 of which 3 (27%) were ~ 45 years of age. Histologicalfindings records were available for 35 patients. Commonest histologicalfinding was squamous cell carcinoma and high grade dysplasia.Conclusion: Dysphagia is a sinister symptom in both sex groups, infemales, including young age group this symptom MUST be investigated asa large proportion of this group turns to have malignancy.

Upp« GI BleedAudit

Authors: Abdul Obaffar (Final Year)Syed Zafar Abbas (Prof. of Medicine 1Gastroenterology).Section of Gastroenterology, Department of Medicine, MMCH.AbstractBackground I Acute upper or bleed (AOlB) is a COllllllOl1emergency. Itrepulres specific treatment of which upper GI endoscopy (UGIB) basedtreatment can be life saving..Aims: To perform an audit of our practice at eIlSOSCOpyunit of MMCH forthis problem.Patieots &:Medlods: Retrospective analysis of endoscopy record of all 74patients who presented with AOIB over last year. Hospital Research ethicscommittee approval was taken (No.l2091lIRecI012).Results: Out of 74, there were 34 women and 40 men. Average age was 44years(range 19-70). ThIs was 42(range 19-67) for women and 50(range 24-70) for men. Bleeding esophageal varices (BOy) was the commonestfinding (40170;54%), followed by no abnormality round (11=12;16%),bleeding duodenal ulcer and bleeding gastric varices(no:4each;5%each).Endoscopic variceal band ligation (EVBL) was the commonest procedureperformed (n=34). ID.stoacrylugection was used for Bleeding Gastric Varixin 3 patients 3 patients had Ethanolamine oleate injected in BOV and 1patient bad adrenaline 1:10,000 unit injected in Bleeding DU.ConclusIou: Acute uom is a common 01 _gency. BOV is thecommonest cause and BVBL is the commonest form of endoscopictreatment used in our setting.

AbstractBackgroond: Over 50% of all upper GI endoscopies referred in thewestern countries prove normal. In another study being presented in drissymposium by onr group, we have shown that 47.5% of all endoscopyrefemls show a normal finding. However, some presentations, includingdysphagia, are described as « sinister" and are recommended to have lowthreshold to investigate..Aims: To determine the .. yield» of endoscopy for patients presenting withdysphagia.Patieots &:Metbods:Retrospective study of our endoscopy records of 105 patients consecutivelypresenting with dysphagia hospital Ethics Committee approved this project(No. 1009111REC/OO8).Results: Out of lOS patients who presented with dysphagia, 72 werewomen. Average age of all patients was 51 years (range = 16 to 80). A totalof 69 patients (66%) were found to have abnormalities of which 42 (40%)were found to have oesophageal malignancy.Conclusion: Dysphagia is a sinister symptom and a large propot1ion of ilBsuffetelll turn out to have pathology, including malignancy.

Symptom of dysphasia bas high probability of signilkmt pathology.

Anthors: Abdul Ghaffar (Final Year).Syed Zafar Abbas (Prof. of Medicine 1Gastroenterology).Section of Gastroenterology, Department of Medicine, MMCH.

AbstractBadgrouDII: Colonoscopy is an important investigation in GI prance,Itisa highly skilled procedure. At MMCH this is performed regularly but n9data is available as yet on its various issues.AhDs: To perform an audit of colonoscopy done at MMCHPatieuts &: Methods: Retrospective stndy of 93 diagnoatic colonoscopyprocedures consecutively performed at MMCh. Approval of Hospital'sEthics Committee was obtained (No. l009111Rec1(10).Results: Out of 93, there were 57(61%) male patients. Average age was 39years (range 9 to 78 years). Commonest 3 indications ware Bleed PerRecmm (n =31;33%), Bloody Diaahea (n = 15;16%) and AbdominalMass (n = 9;10%) Olympus Videocolonoscope CL 100 was used for allcolonoscopies. Success in completing the examination (Caecal intubationrate) was 83/93 (89%). Out of those where examination could not becompleted, 6 were found to have impassable obstruction making perprotocol analysis for competition rate 83/87 (95%). Further 4193 patientsbad poor bowel preparations. Commonest 3 colonoscopic diagnosis werecolorectal cancer (11=13;14%),procto colltis (11=12;13%)and bemoahoids(11=7,7.5%).In addition 3/93 patients (3%) bad colonic polyps and 1patienteach had fissure in ano, fistula in ano and diverticulosis 40 patients (43%)bad a normal examination.Conclusion: Colonoscopy is an important investigation for lower OI and alarge proportion turn out to show a significant pathology.

An Audit of Col_py at MMCR

Authon: Abdul Obaffar (Final Year)Syed Zafar Abbas ( Prof. of Medicinal Oas1roenterologist)

Authors: Abdul Ghaffar (Final Year)Syed Zafar Abbas (Professor of Medicinal Gastroenterologist)Section of Gastroenterology, Department of Medicine, MMCHAbstractBadgrou.ocl: 01Endoscopies, partico.larl.y upper 01 is a common 01investigation. Both Gl and Non OI physicians and Surgeons refer patientsfor this test. Some doctors feel that a GI consultant is more likely to arrangedris test becanse of a lower threshold for doing investigations in their ownfield. This should result in more "negative" (nonna!) endoscopies if theywere arranged by GI physiciansAhDs: To deteanine the "yield" of endoscopies arranged by 01consultantsVs non-OI consultants.Patients &: Methods: Rttrospective study of the endoscopy record ofconaecuti.ve 100 patients referred by 01consultants and comparison of theproportion of positive findings with those patients referred by non-OIdoctors. Hospit8l Ethics Committee gave approval to crary out this study(No.1009111REC1OO7).Results: Out of 100 consecutive endoscopies refeaed by 01consultants, 38proved normal compared to 571 100 of endoscopies referred by non-OIdoctors. The patients in both groups were sex matched (52 % VS 51%wales in both groups respectively) but non age-marched (40 years VS 30.5years).Condnsion: Significantly larger proportion of endoscopies referred by 01consultants show a pathology - showing a « low threshold" for arrangingthis test by them is just a myth, and the reality is quite the opposite.

Yield of G-I CIOII8Ultant referred end08COpies is higher than non-GIconsaItant reterrers.

Allthor: Prof. Ghulam Ali Memon, Prof. & Principal, MuhammadMedical College, MiIpurkhas.

Introduction, Material &:Medlod: I am reproducing two Ca8eS of (R.N)One on the upper track: on Rt Side which under went Malignant changewhich was Very aggressive & finally the young man died due tosecondaries and second case involving the scalp & face, she has Ulld«gonemultiple surgical procedures since 1985, But the Tumor is recurring again& agaIn infiltrating the deeper structures & causing considerable deformity.Condosion: This Disease is a rare entity with high rates of Recurrence,complications & transformation into malignancy.

PlexIform neu.roftbromatcJ8is

.Key Words: Blood U'aII8fu8ion, Bleaive surg«y, Cross match, Cross­march to transfosion ratio, Hepatitis B & C, Transfusion probability,Transfusion index.

Autbers:Hafsa Shaikh (Hospital Pharmacist)Syed Zafar Abbas (Prof. of Medicine / GastroenterologyMMC)AbstractBackground: Diuretics is the main stay of drug treatment of ascites whichhas several causes. Unfortunately some of the side effects or otherintolerance of diuretics produced its usage either completely or does notallow physicians to use it in full doses. However, some feel that despite the1ac1.of theserestrictive factor, these drngs are not prescribed as needed.Aims: To determine whether diuretic are prescribed in maxinmm requireddoses in hospital admitted in patients.Patients & Methods: Retrospective analysis of case notes of 100consecutively admitted patients, Hospital Research Ethic Commiteeapproval was obtsined (No. 13091lJRec / 017) to conduct this study. IfSpironaclatone was used at a doses of less than 400mgl day or Puresmideat less than 160 mglday with ascites still present, it was defined as underdosing.Results: Out of 100 patiants, 51 were men and 49 women , with theaverage 52 years (rang 10 to 90) .57 patients were givea a diuretic. 30 (53%were given Spironolactone alone, 13 (29%) Furesmide alone, 8 (14%)Spiromide (conbination tablet.of Spironolactone and Furesmide) and 6(11%) were given a combination of above.No patient was given diuretics at maximum recommended doses. 4 (7%) ofthem were clinically judged not to need a higher than prescribed dose, 45_______ ISSN: 2075-9983-APR 20 14-0 CT2014.32

Dowe under UDderpresttibe or under dosediureCicsIn88dtes ?

Aldhers:Hafsa Shaikh (Hospitall'batmacist)Syed Zafar Abbas (Prof. of Medicine IGastroentology, MMC)AbstractBad: ground: B-blockers are known to lower portal blood pressure, whichcan prevent complication such as upper GIbleed (tram) in cirtbotics.Unfortunately some of their side effects or intolerance sometime restricts itsusage. Some believe that despite no such problems. B-blockers are oftenunderotili.sed / underdosed.Aims: To detemdne the adequate usage of B-block.en in portalhypertension.Patients & Methods: Retrospective analysis of case ootes of 100consecutively admitted patients With a complication of portal hypert.eusion.Propranlol was defined as underdosed if used at <16Omg1day andCarvedilol ifused <5Omg/day.Approval to conduct this srudywas obtsinedfrom Hospital Researuch Btbic Committee (No. 1309111Rec/018)Results: Out of 100 patiants,54 were men and 46 women. Their averageage was 50 year (20 to 85), 26 were given Propranolol and 2 Carvedilol,Nitartes ooly was given to 1 patient and Nitartes With Carvedllol to 1patient. No patient was given these drngs at maximum recommended doses,70 were not prescribed any such drug at all, of the 30which were not giventhese medicine at full recomended doses, 8 (27%) , had a side effect torestrict dose wheras 22 (73%) , did not have any reason me:otioned. Out of70 patients who were not prescribed aB-blocker , no reason was describedin SO(71%) other bad a clinical reason.Conclusions: Only a minority of Portal hypertensive patients areprescribed a B-blocker and a majority are either not prescribed at all. or areunderdosed.

Do we onder use or onder prescribe })'blocbrs In dnilotic:s withportal hypertension?

Type of Study: Cross sectionalResults and Conclusion: of 100 studeats, 67 were resident of Punjab,31sindbi, 2 Khaber PaIdrton and non from Balochistan . 48 girls declaredPunjabi as there mother tongue, 16 each sindbi and siraiki, 14Urdu, 4posb.to and 2 Bloch.i . 40 girls were from I" Professional MBBS (I" &ryear), 17 from2nd Profession MBBS (31<l> Year) ,22 from 301professional(4" year), 21from final year Profession (5year). We found that 7 girls weremarried , 19 Engaged and 57 bad a proposal under process17 girls wereUJIIIlaIIiedand unengaged who bad no proposal yet . 44 girls consideredthat this highnumber of girl student having manied , engaged or a proposalwas done to their having Medical student s where as 56 did not think so .However 57 girls thought that the proposal , engagemeat or lWIIriagewouldstill be there even if they where not Medical student s, 43 did not share thisview Among these married or engaged (26 in no) half were engaged!Married to Doctors i.e (SO) , 3(11.5% ) to Business man ;2 eacl!(7.7%) toarmy officer , engineee and Landlord , where 3 (11.5%) wereengagedlmaoied to menwith other profession. When asked if the chancesof proposals andmarriage were higher for Medical students , 85% said yesand 15%no . However 54% thought this was unfair practice (46% did nor). Interestingly , 68% of girls said that if they were Men, they would choosea Medical student I lady doctor as there wife . 73% of girls surveyedthought that the long duration of Medical students may have detrimentaleffects on proposal

Author: Ayesba Mokbtar, Rabia Ali, Kbadija Safdar, Sbafqat Abbas (FinalYearMBBS)Syed Razi Muhammad (Professor of Surgery MMC)ln1rodoctIon: It is a common practice that gkls admitted in a medicalcollege are more in demand when it comes to proposals. We selected 100female students (out of roogbly 250 female students )of MuhammadMedical College to see how many of them are married ,engaged or bad aproposal under processSelection Criteria: Random

Does admission in a medic:al sdIooI has an affect on proposals of Girlstudents?

AbstractBackground: Loadshedding has been a prevalent problem in Pakistan formany years now. It has affected people of all ages, profession and socialstams. This study has been conducted to assess the effects of loadsheddingon students ofMllhammad Medical CoDege.Aims and Objectives:To assess the difficulties faced by medical student due to the excess ofloadsbedding and to get suggestion for solving/copingWith these problems.Study Design: Descriptive cross-sectional. Convenient sample of 4Sstudents of Mohammad Medical College. Approval of this project wasobtsined from Research Ethics Committee (130911/REC1024)Results: Our study received 21 Male participation and 24 Ferualeparticipation out of 45 total. The data showed that work of 91% students isdistuIbed, 86.5% students feel dehydrated, 84% are in:ilated, Sleep of77.7% students is disturbed, 82% feel suffocation and 75.5% students feelanxiety due to loadsbedding.Conclusion: Almost ifnot quite all students are distw:bed by loadsbeddingand therefore it is a problem that mnst be solved in order to acheive bettereavironment for education.Recommendation: Some students suggested the constroction of Kala-BaghDam to combat the shortage of electricity some suggested that we mustsave electricity by switching off extra lights, fans and other appliances thatuse electricity. Few suggested that theremust be a proper system to controlthe theft of electricity and the culprits must be punished. Constroction ofwind mills was also stated as an option.

Autbcml: Asi.mHussain, M.Zohaib Azbar Buzdat, M.Mateen MuzaffarImranHasbmi,M ShoaibAfzal. (4<1t.YearMBBS)NoorAliS8IllOOn.(AP. Community Medicine, MMC)

Effects of LoadsbeddiDg on medical students at a private medicalooDtge.

Methodology: A retrospective review of pali.erl.tsrecords of all pali.erl.t'8admitted With BOO over one year period. Approval to carry out the studywas given by Hospital's research ethics committee (No. 13091IJRec/OI9).Results: Prom July 2010 -Iune 2011,96 patients were admitted inMMCHwith bladder outflow obs1raction out of which 91(94.79%) were male and5(5.20%) were female, There age range was 3-103 year. Average age was61 years. Main causes were BPH 55/96 (57.29%), Vesical calcali14196(14.58%),Ca prostrate 10/96(10.41%), Ured!raJ.stricture 7/96(7.29%)U.TraIUWl5196(5.2O%), Urethral stone 3196(3.12%) and Bladderatony2I96(2.08%). The mean ages with causes are 68 years for BPR, 54years for vesicle calculi 62 years for Ca prostate, 38 years for urethralstricture 23 years for urethral trauma, 21 years for urethral stone, 45 yearsfor Bladder atony. There was an overlap of symptoms inmany patients,However; the main symptoms WC%e hesitancy of urine in 67 pali.erl.ts(69.79%), poor stream in 53 patients (55.20%),buming micturation in 45patients (46.87%) and Dribbling of urine in 31 patients (32.29%).Treatment performed at MMCH were TURF 42196(43.75), Conservative30196(31.25%), cystoscopy (± optical urethrotomy) 9196(9.35%), TVP8/96(8.33%) and cystolithotomy 7196(7.29%). Outcome was DC 48/96(50%), DOR 33196(34.37%), LAMA 15196(15.62), Referral 0196(0%) andDeaIhOI96(O%).CoDdusion: Study concluded that most common cause of BOO is BPHwith average age 68 years. Main symptoms was hesitancy of urine. Thecommonest treatment option chosen was TURF. 50% patients were safelyDC, and a further 34.4% were discharged on request.Key Words: Bladder Outflow Obstraction, Benign Prostate Hyperplasia,Retrospec1ivesStudy

Syed Razi Muhammad (Professor of surgery MMC)Department of surgery Muhammad Medical College, Mirpwtbas.AbstractBackground: Bladder outflow obs1raction (BOO) is a common Medicalproblem. We perlODDCd an audit of BOO find out different aspects of thisdisease at MMCH, MPS.ObjectiTe: To find out the causes, main symptom, treatment and outcomeof bladder outflow obstruction (BOO).

.ISSN: 2075-9983-APR 2014-OCT 2014 1 331 _

Authors: Naila Noor, Sanam Rasool Bux, Ponam. Final YearProf. S. Zafar Abbas (Prof. ofMedicine 1Gastroenterology MMCAbstractBKkgroUDd: Hepatitis B infection is common in our part of the world.Our group has previously shown its prevalence to be % of all people tested( ) in our region (Pjms;(23(5):713-716). Anecdotally, delta virus is alsoprevaleut in our region, which has treatmeut and outcome implications.However, there is no data on this, partly because of the non-availability of

Hepatitis D - how big Is tbis a problem in our bepatitis B infectedpatients?

AbstractIntroduction: Sexual harassment is auy unwelcome or physical condnct ofthe bases of gender, Sexual harassmeut may be verbal or physical or visual.BackgrouDd: Sexual harassment is a growing problem in the medicalinstitutes of Pakistan. Sexual harassment is known to affect IIUi:Dber offemale medical students in medical Institutes.Objectives: To find out prevalence and knowledge about the sexualharassment in female medical students.Study Deoiip: A cross section study of sample size of lOO.thequestionnaire was self administrated. The study was carried out in 3medical colleges of Pakistan including student's from I" to sa year.Research ethic committee approval was obtained (No:1409111RBC102S)Results: 59% female students of medical institutes claimed to undetstandthe meaning of sexual harassment, while 41% students admitted that theydid not know the meaning of sexual harassment. 54% had personalexperience of sexual harassment, while 46% did not face it The commonestculprit were teachers.29 (53.7%) and fellow male students 21(38.8%) while3(5%) did not name the culprit Among teachers the commonest time ofharassment was during viva exams, 19 (65.5%) where as 10(34.5%) faced itduring teaching.14 (25.9%) of the affected students informed someoneabout it, where 40(74%) did not inform about it Among them 8(57%)infouued this to fellow students,2(14.2%)info.r:med it to theirmothers,4(28.5%)informed this some other family member.43students(77%)claImed to have sever adverse effect of this. among them27(62.7%)were depressed,I4(32.55%)felt thresteoed, while2(4.65%)developed serious suicidal thoughts,25%students claimed toknow abour the harassment laws, while 75%did not mow.Conclusion: Much awareness is required in female studeut about tbis.matter and administration must take serious steps to overcome thissituation.Keywords: Female Sexual harassment, crossectionalstudy,

Authors: Khawar Zaman, Usman Ghani, Zeeshan Ahmed (Final year)Anbreen Rehman, Saroman Butt, Maimoona Bilal (2*1 year), BakhtawarHassan (1" year), Syed Razi Muhammad (Professor of Surgery, MMC)

Assessment of girls students fadllg se:mal harassment in medicalinstitutes

An audit of neurolotlY admis8ions

Anthors:Khalid Hussain AbbasiS. Zafar Abbas (Prof. of Medicine 1Gastroenterology MMCAbstractBacqroo:oo: A 10 bededed ward dedicated to Neurologjcal patients wasopened at MMCH about a year ago. The case-mix of this ward is not yetanalysed.AIm: To evaluate the case-mix of patients admitted inNeurology ward overlast one year.Methods:Retrospective study of the case notes of all 100 patients consecutivelyadmitted to Neurology ward. Approval of Hospitals Research & EthicsCommittee was obtained (No. 250811!REC/002).

Resalts:out of 100 patients, 61 were males. Average age of all patients was 55 years(range 8 years to 100 years). Commonest 3 diagnosis were

1. Ce:rebrovascnlarAccidents (n =31) ,2. Epilepsy (n= 12),3. meningitis (n=10).

Twelve (12) patients died during admission of which 9 had CVA 2 hadmeningitis and 1 hadepilepsy.Condosioo: CVA is the commonest cense of admission in Neurologyward, but other diagnoses are also not uncommon. There is a mortality of12% among all neurology patients of which CVA contributed most (9).

Condusioos: CVA is a devastating illness which affect order age groupaud carries a significant mortality.

Authors:Muhammad AzamKamboh. (Final Year)Syed Zafar Abbas (Prof. of Medicine 1Gastroenterology MMCAbstractBackground: Cerebrovascular accideur (CVA) is a common problem. Inan audit done and presented last year (8" Annual Medical Symposium,MMC), it stood sa Commonest diagnosis among admitted patient (15%) atMMCH, and 31<1commonest cause of all - cause mortality in anydepartment (10%) we at need to andit our patients at MMCH.Abns: To find out the demographic and clinical details of all patientsadmitted atMMCH in 12 month.Methods: Retrospective audit of file notes of all patients admitted in 2010.This study was approved by Hospital's Research &EthiC3Committee (No.240811!REC1OO1.Results: 39 patients (24 males, 15 females) were admitted with diagnosisof CVA in study period. There average age was 57 years (range 14 to 90).cr Scan confirmed had infarction 'l:1 (69%) whereas 12 (31%) hadbaemardJage.

An audit of CVA atMuhammad Medical College Hospital

A cnsHeCtionai study of medical ethics insurgicallIDd medical wardsAutbon:Hassan Shoaib, Ishfaque .Ahmad, HumaiIa Aslam, Nadia Ambreen (Finalyear)IDstitntion :1. Lahore General Hospital, Lahore2. Services lwItimte of Medical Sciences, Lahore3. Dhq Hospital, Chiniot(STUDY PERFORMED BY STUDENTS OF MMC)AbstractAbns and Methods : A survey was undertaken to assess the knowledge,attitude and practice of medical ethics among both surgical and medicalresidents & interns in three Govetnment sector hospitals of Punjab,Pakistan. 2 of them being regular teaching institutes.115 participants were approached & filled the questionnaires, out of which100 were included in the study, 15 qoestiollJlaires were excluded as theinfODDationprovided was either incomplete or incomprehenS1ble.74 of the100 respondents were male. 84were residents, registrars and specialists and16 were intetns.Results : 78 respondents hadheard about the code of ethiC3formulated byPMDC. Only 44 out of 100 had read the code either partially or folly. 46out of 100 respondents reported that they took consent from patients beforesurgery or examination. Only 14 respondents reported having been taughtethics in medical college & ooly 3 respondents did not feel the need forhaving ethics taught at undergraduate level31 out of 100 gave correct answers on questions about patient's autonomy.Only 16 respondents gave positive answers on questions based on non­malificence.73 respondents were surrounded by uncertainty over decision making.51 respondents our of 100 thought that Euthanasia should be accepted asstandard medical practice despite religions taboos. 84 practitioners weremore prone to obtain better results, than to rule out the hmn the treatmentmight cause to that patient48 practitioners believe that conflict of interests should be allowed to haveinfluence on judgmentThere was no significant difference in responses between male & femalemedical & surgical team members respectively.CondusioD: Knowledge of medical ethics & its application on surgical &medical floors is extremely poor. Overall, this study reflects the currentsituation of ethics by doctors in Pakistan where ethics is not taught as asubject at undetgraduate level Though the PMDC guidelines clearly statethat medical students most be taught ethics & evaluated, most of medicalcolleges have not made it a mandatory part of their curricula The onlyguidance our students & clinicians get on ethics is through seminars &workshops.

(79%) suffeted a side effect or intolerauce, whereas 8 (14%) hadno cliuicalreason mentioned for nnderdosing. Out of 43 patients who were not given adirectic a clinical reason was mentioned in 30 (70%) patients, no clinicalreason was identifiable in remaining patients.CoDdusioos: 57/100 of all patient with ascites were given a diuretic ondischarge, but only 7% of them were thought to have reached maximumbenefit on the presribed doses 70% of pateints who were not precribed adioreetic hada clinical reason mentioned.

Authors: Mebreen, Saif-ur-rab, Salah ud Din Khan, Ayesha khan, AyeshakhaI.il Sana Mehree:n, Xenab syed, Fatima Akbar, Rameez haider, SohaibMushtaq (4tt.YearMBBS) Prof. Abdur Rahim Siyal, Noor Ali SamoonAbstractIntroductioD: Families with couples having no chilen is one of alarmingfamily issues around the world Especially in80IIthAsia.The couples havingno chilen tend to face several problems within and outside the family. Theysuffer from different psychological issues and attitude of family andcommunity around them.AimslObject1v~ To determine the artitudes of the childless couples andtheir comnmDityStudy Design: Cross sectional-the sampling was convenient random typeof 100 couples.Result: There were 37% males and 63% females parlicipants.34%werebetween ages 20 and 30,41% between 16% between 40 and 50,5% 50 and60 and 4% over 60 years of age.Among the Males Businessman 37%,job holders 56%,others are 7%Females-honsewives 69%,working women 31%Couples nothaving child for 10 years-74%_______ ISSN: 2075-9983-APR 20 14-0 CT2014.34

To detenDiDe the attitudes of ehilcJless couples and their colllDlDllityaround them

Authors:Romanamehwish, Aneeqaishtiaq, Farzanabatool, Uroojhab:ib(Final Year)Supervisor:- Syed Razi Muhammad, MMC.Back groUDCI: Daily calorie reqDirment is essential unit of balnce diet forboth sex.Aims: To assess the knoweledge about the daily calorie requirent amongdoctors at mmchMethodoIgy: Cr088 sectional study done from angust lOll-sop 2011 atMMCH. Semi structured questionaire were distributed to the 60 doctors,response was obtained from 50(83%). Among them male 34(68%),female 16(32%).IncidentIy all were married. Ethical approval was takenfrom Hospital's ResearchEthics COmmittee(ref no. 14091l1REC1031).Results: Among respondent, 70% have knoweledge about daily calorierequinnent,and 58% of them tske food according to the daily calorierequirment. 84% prefer to take bleak fast daily but 12% don't takebleakfast 4 % took break fast every now and then. 62% tske vegetable and fruitsin luncb, 48% of them prefer white meat while 30% of the reponent preferto hoding less then once a tnonth, 30% once a month , 24 % prefer hotlingonce a week while 16% were favour in hoding more then once a week.CoDdnsion: Although doctors are believed to instruct the patient aboutbalance diet but our study show some of them are I!IiIlhave no idea aboutdaily calorie reqo.ianenlB.Remarks: There should be seminar, wod: shops about awareness ofbalanced calorie diet among doctors as well as society.

Knowledge aboot usage of Daily calorie reqJrements among doctors.

Authors:Saif-ur-Rab, Mehreen , salah uddin khan, Ayesha Khan, Ayesha Khalil,Sana Mehreen, Rameez haider Xenab Syed, Fatima Akbar, SohaibMushtaq(4" Year MBBS).Noor Ali Samoon, Prof: Abdur Raheem SiyalAbstractIntroduction: Over a billion people worldwide, live in a region a wheremost of marriages are consangenions, first cousin marriages specially arepopular.Discussion of this phenomenon is confused by its facts that itscauses are social and economic while its outcome tend to be measured interm of child health,internalional variation in infants motility and varyinggenetic factor within given communities. Second cousin marriages are atgreater risk of birth defects.Genetic screening can be done to prevent theproblems later in life.AJmIobject1ves: To determine diseasepattem in cousin marriagesStudy design: Cross sectional-conveDientsampling of 250 subjects.Results: There were 105 (42 %) males and 145(58 %) femalesparticipants.They reported the presence of diseases as follows amongcousin marriages in their fami1ies.Hyperten.sion(n=98;39.2%),diabetes(n=77;30.8%), cancer(n=24;9.6%),heart diseases(n=22; 8.8%),blood disease (=18;7.2%), others (n=11;4.4%), students in favour ofcousin marriages(n=1l5; 46% )& students against of cousin marriages(=135;54%).CoDdusIon: Hypertension, diabetes, cancer, heart diseases rates arealarmingprevalant among cousin marriages.Recommendatiou.: Pre marriage health counselling should be encouragedto ensure healthy communiti.es.Prior to wedding if possible & socially ac«ptable,genelic screening maydone to avoid genetic problems.

Pattern of health diseases InconsIn marriages among the families ofmedical stu.denf&

301560 (5%) patients admitted died during the admission. The commonestcanso of death was Renal Failure (n=10).Conclusion: Urological diseases continue to consti.tute the largest group(over 1/3 of all) of diseases, whereas cholelithiasis is the single commonestdisease reqDiring admission in this rural teatiary care hospital. This isret1ected in the number of surgical procedures performed. Hospitals likeours therefore require more resources and teams trained in these areas thanothers. However, there is a significant proportion of other surgical problemsthat need attention on a regular basis.

Iperformed were:Sr. No. Procedure Number ofpati.ents (%)1 Chol 972 TURP 703 Pyelolithotomy 614 Cysto!ithotomy 575 A 446 Throidectomy 387 Pistulectomy 368 HerDiorraplly 289 Nephrectomy 2010 Amputation 15

Median duration of stsy was 10 days (range 0 - 31). Commonest surgical

ommonest aznoses were as ows:Sr. Diagnosis Number of Men WomenNo. patients (%)1 Cholelithiasis 97 (17%) 15% 85%2 BPH 70(12.5%) 100% -3 Renal Calculi 61 (11%) 30% 70%

4 Vesicle Calculi 57 (10%) 84% 16%5 Appendicitis 44(9%) 82% 18%6 Goitre 38 (7%) 8% 92%7 Fistula IFISSurein ano 36 (6%) 91% 9%8 Inguinal Hernia (all 28(5%) 78% 22%

Right sided)9 RTA 20(4%) 85% 15%10 Perforation 15 (3%) 60% 40%

Mtthods: Retrospective study of the case notes of all consecutivelyadmitted patients to the department of Surgery over 6 months (1anuary2011 to JUDe 2011). Approval for this project was obtained from HospitalResearch Ethics Committee (No. 07091l1RECJOO4)Results: 560 patimts were admitted during the study period. 343 (61%)were males and 217 (39%) females. Their median age was 30 years.C 10di fun

Anthors: Naila NoorSupervisor: Prof. S. R.azi Muhammad, MMCAbstractBackgronDd: In the environment of limited resources, it is of obviousimportance to know the disease borden in any department. In the field ofmedicine, the situation can change quite significantly in this regard andevery institution needs toupdate its data.Aims: To determine the current disease burden and activity in thedepartment of Surgery at Muhammad Medical COllegeHospital, inclodingmortality.

An cause surgical admisskIos atMuhammad Medical Conege Hospital

its testing locally and because the otheI: out of city labs charge sigDificant1yheavily for this investigation.Aims: To determine the prevalence of delta virus in patients chronicallyinfected with hepatitis B (CHB) as shown by a positive HBsAg test.Mtthods: Retrospedive study of the laboratory records of consecutivelypresenting patients with CHB who were tested for delta virus antibodies(Anti-HDV) by ELISA in our laboratory. Approval for this study wasobtained from Hospital Research Ethics COmmittee (No.0709lllREClOll).Results: 26 patients (22 males, 4 females) were tested forAnti-HDV. Theirmean age was 36 years (range 22 to 71). 3 (11.5%) were tested positive­all of them were males. The mean age of those testing positive was 49years.ConcJasion: In this small study (which will be continued in the future), asignificant proportion (11.5%) of patients were found to be Anti-HOVpositive.

35

Autbors: Tahir Ahmed, Watan Yar, Abdul.Ghaffar, Bilal Hassan, M. UmarYaqoob Saqib Baloch, Mr. Wabid Pehalwani (Senior 10umaJist Press ClubMPK), S. Zafar Abbas(Professor of Medicine 1Gastroenterology).Department of Medical Education MMC.AbstractBaekgrowuI: Last few years have seen many adverse media reports ofmedicallncidenccs over ~ of all doctors surveyed by our group, reportedseparately in this symposium, feet the media reporting was fair. Alsoreported separately in this symposinm by our group is the survey whichshowed that despite a small decline, doctors are stiJl the most trostedprofessionals in our society. However, views of joumalist on this is notknown.ADDs: To determine the views of journalists of Mirpurkhas on whether ornot the tlUst of doctors has decline in our society.Sobject & Methods: Cross sectional survey of members of press clubMirpurkhas. Hospital Research Ethics Committee's approval was obtained(No. 1209111RECJ016).RA!suJts: 16 responses were received. All (100%) journalists felt thatdoctors image among people has declined significantly. Among them 9Unlu media reporters and 7 were Sindhi media reporters. All respondentsfelt that perception among people is that Ihere is a significant element ofgreed which has created in doctors community, which has resulted in thisdecline of trust.

What does mediathink of doctors?

Authors: Muhammad Shahzad. Mahmood, Alman Ilyas (Final YearM.B.B.S), Maimoona Bilal (zaoi Year), Anam Liaqat (I" Year), Syed RaziMuhammad , (Department of Medical Education., MMC)Abstract.AimsIBackground: This study is designed for medical. students ofMuhammad Medical College to self-evaluate their progress made inMMCand to rate their satisfaction with all aspects of the learning envirODJlleJlt.To gain better undetstanding of total experience of students at MMC.Toprovide evidence based information to assist the process of continuousimprovement, with objective of enriching the quality of student experience.Methods: Cross-sectional survey. Approval of Hospital ResearchCommittee was obtained to conduct the srudy. (lOO911/RECIOO6).RfIl1Ilts: 100 students were surveyed. Majority of the students fe1t,therewas a significant personal improvement at MMC. Overall students weresatisfied with learning environment as shown in the talkin our poster.Condasiou.: Majority of MMC stndents satisfied with learningenvironment, although a significant minority feels there is a room forimprovement.

Assesmerlt of personality progress and experience about study & llfe atMMC as a medkaI student

Assessment of cb.aIJ.engesI Issues faced by MMC students and DODmedical yODtb.

Autbors: Muhammad shahzad Mahmood, Syed Ahmad Raza, MuhammadAmanu1lab Khan,Jam Kasif .Imtan,AlmanDyas (Final Year MBBS)Syed Razi Muhammad, (Department of Surgery)Ah8tractBackground: Youth an over the world have a certain view of life and itschallenges. It however varies from community to community, And alsowithin a community depending upon a number of factocs such as level ofeducation and socioeconomic condition of a community.Alms: To determine the challenges faced by our youth. Approval ofHospital Research Committee was obtained to conduct the study.(10091llRECJ013).Subject & Methods: A cross-sectional survey of MMC Youth (n=145)andNon-medical youth (n=75) performed, They were asked to identify Top3 challenges they feel are the most important for them.Results: Out of total 220 respondent 1181220 (54%) felt lad: of jobs is themost important problem faced by youth. Other two problems are poverty(981220; 44.5%) and mobile phone misuse (841220; 38%).Out of total 145 respondent of MMC student 761145(52%) felt mobilemisuse is most important problem faced by youth. Other two problems arejobs (51/145; 35%) and t=orism(33/145; 23 %).Out of total 75 respondent of Non-medical youth 67n5(89%) felt jobs ismost important problem faced by youth. Other two problems are poverty(66fT5; 88 %) and prize hikes (26175; 35 %).Many respondent 731l18( 62 %) said jobs opportunity must be increasedwith good salaries. Moat of respondents of MMC students 53n6(70%) whosuggest mobile phone misuse is one of top most important problem andsuggest night packages and SMS packages should be taken away.Condasiou.: Oar youth is concerned about lad: of adequate job facilities,Lad of salaries and misuse of mobile phone as the most important youthissue.

• ISSN: 2075-99B3-APR 2014-OCT 2014 _

An audit of Paediatric patients at MMCH.(JULY 2010 TO JUNE 2011)

Anthors: Mllhammad shahzad Mahmood, Syed Ahmad Raza, MuhammadAmanuIlah Khan, Alman nyas (Final Year M.B.B.s)Ah8tractBackground; Medicine is an ever changing field. Requirement keepschanging in terms of resources accordingly. It is therefore important to keepthe needs (clinical and otherwise) of every department up to dare.ADDs: To detenni:ne the disease burden of patients requiring admission inthe department of pediatrics.Patients &Methods: Retrospective study of the case notes of 151 patientssuccessively admitted in paeds ward at MMCH. Approval of HospUaJ.Research Committee was obtained to conduct the study.(lOO9ll1REC1OO5) •Results: Out of the total of 151 patients, there were 93 Male, 58 Female ofvarying ages up to 12yesrs. Commonest age group was under 1 month(8=59; 39%),Commonest 5 diagnosis were AcuteG-d8trOenteritis(n=36;24%), pre-term delivery (8=32 ;21%) ,ARI(n=14;9%), Sepsis(n=11;7% )And Birth Asphyxia(n=9;6% ).There were4 deaths (3%) during the admission.Conclusion: Acute Gastroenteritis is the commonest cause of admission inthis financially deprived community .3% of patients admitted died due topre-term delivery and sepsis.

PrevaleDce of a di8ease amou.g parents of stu.dmts ofMMC.

Authors: M. shahzad mahmood (Final), Zohaib Hassan, Junaid Ramzan ,Jibran Khalil, Aqsa kiran , (3Myear MBBS)Prof. Syed Razi Muhammad (Depattment of surgery, MMe)Ah8tract.Baekground:Many illnesses are inherited and othm; are not. Healthy lifeis the aimof all humans. However suffering from disease is inevitable.ADDs: To determine the prevalence of any illness IID:lOIlg parents ofstndents ofMMC.Subjects and Methods: Cross sectional survey of 111 randomly selectedstndents attending their classes at MMC on 13·Sep. 2011. Approval ofundertaking this survey was obtained from MMC's research ethicscolDlllittee.(No.I309111tec102O).Resolts: Average age of parents was 46 yesrs. (Range40-65). Out of 222parents of 111 stndents 159(71%) has a long term (chronic) illness.Commonest 4 diseases are Hypertension (n= 67; 30%), Diabetes MeUiIUS(n=47; 21%), Asthma (8=31;14%) Ischemic heart disease (n=27;12%) anda combination of HI'NIDM is (n=11;5%). Out of 159 patients, 148(93%)are on some treatment for their illness.Conclusion: 71% of an parents have a chronic illness and 93% of them areon treatment.

ConclusioD: Oar stndy shows majority of child less couples are jobless47% had taken medical treatment.Disease prevalance inchildless couples were hypertension, T.B. DM.34% inlaws behavior is iIretative87% Couples are not in favor of second marriage.29% to 38 % couples are stiJl in desire of child

Couples not having child for 20 years-2O%Others-6%No. of miscarriges-l9%The form of treatment they were taking wereMedical 47%H~c8%Hibnat5%Religious-5%No treatment 3%Other8-32%Contraception used 14%Genital problem 10%Th5%Diabetes meUiIUS1%Hypertension 7%13%want second marriage11% have adopted childBehavior supportive desire for child emotional stress careless divorceHusband 19% 29% 30% 2%7%Wife 20% 38% 22% 7%nill34% inlaws behavior is iIretative

Prevalenceof the depression aJIlOIIg the medical practitioner.

Authors: Abdul Sattar, YahyaAbduI Hanan, MariaZahid, ZubairTehseen,Ammara Khalid, Shaista Fatima, Huma Ameer Awan, HashmatuIlah,Ameer Khan, (4'" year), Noor Ali Sumoon, ABiCAli, MMCHBackgroond: Medicine is a stressful profession. Depression, which existsin our COIllDlIlDity,is also Iike1y to be prevalent among the medicalpractitioners likeDoctors, Dentists and Nurses.Ahns and objectives: To find out the prevalence of depression among themedical practitioners.lDdusion Criteria: All the doctors, dentists and nurses who are wotking invarious private hospitals and clinics of 6 different cities were included.Methodology: Cross-sectional interview (survey) of 94 MedicalPractitioners both male and female of age ranging from27 to 61 residing in6 different cities in Pakistan. Approval to perfocn this study was obtainedfrom Hospital's Research Ethics Committee (No. 14091l1RBCJ034)Results: Out of 94 Medical Practitioners 8% said that they felt sad, 12%were nsing the anti depressants, 12% could not sleep properly. 6% felt that_______ ISSN: 2075-9983-APR 20 14-0 CT2014.36

Authors: Zeeshan Ahmad Malik, Arslan Ali, Usman Ghani, RomanaMehwish (final year MBBS). Department Of Medicine, MMCHAbstractBackground: Pulmonary tuberculosis (PI'B) is a common and seriouscommunicable disease in our country. It is curable although multi ngresistant TB is getting comeover. To combat this disease communityawareness regarding its various aspects isa very important.Aims:To find out awareness about TB among TB patients.Methodology: K.AP study done at Nlshter Medical Hospital. Multan from(July -2011 to September 2011). Among the 100 patients of TB attendingTBOPD.Result: Among the 100 patients of TB, Male/Female ralio was (70:30),mean age was 43 year, 50% said that TB spreads through oplets, 40% viasharing utensils, 10% via handshake. 76% knew that TB could be cured and24% do not knew TB can be cured. 53% were smoker, 47% non smoker.62% said TB can be prevented by vaccination, 38% can not be preventedby vaccination. Regarding Medication 34% said it should be in single dose,42% in divided dose, 24% before breakfast. 48% having family history and52% do not 54% were vaccinated 46% do notCoadusion: KAP of TB among suffers is not adequate. Mass educationprograms are needed to raise awareness and ensure SlICCe88 in fight againstthis horrible Communicable illness.

Knowledge audpractice regardiDg 1'8patients atteDding 1'8OPD.

Frequency of Irondefidency inlWcrocytieAnaemia

Anthol'S: Waseem Zaidi (House Doctor),.Rabia Hameed, Kiran MebmoodSyed Zafar Abbas (Prof) Department of Medicine, MMCH.Introduction! Background: There are many causes of anaemia Inour partof the world, Iron deficiency anaemia (IDA) and Bera -1balIasemia minotare two important causes of mirocytic anaemia (MA). It has beenanecdotally reported that most doctors prescdbe Iron supplements fot allMAs. However this practice may not be in best interest of patients if theydo not have IDA.Objective: To determine the prevalence of IDA in patients with MA.Methods and Subjects: Retrospective review of all reports of serumferritin tests done on samples of patients with MA, received consecutivelybetween January 2010 & July 2011. Hospital's Research Ethic CommitteeHospital gave approval for study (No. 0210101REC 1025).RfB1Ilts: 114 patientS had serum ferritin level cheeked as they were foundto have MA. 'Their average age was 29.5 years (range 6 month - 80 year).70 (61 %) of them were women. Oat of the total, 68 [(60 %): average age25.5 (19-45) years], were found to have a low fettitin level confirming Irondeficiency. 45nO [(64 %): average age 27.5 years] WOIllflll tested werefound to have IDA, whereas 23/41 [(56 %) : average age 22 (12-50) years]men tested had IDA.CoDdnsioDs: Only 60% of all patients with MA tumed out to have IDA,Chances of being iron deficiency were almost equal (64% VS 56%), but ata younger age (22 V8 27.S years) MA was found in males. Clinicianstherefore must investigate further instead of prescribing Iron suppletnentsto all MA patients.

Results: 11 Men and 22 WOlDl2l underwent this procedure. Average agewas 4S years (range 16 to 75). Commonest 3 presenting symptoms wereNausea 1 vomiting (n= 12), abdominal discomfort 1 pain (n=12) an allpatients had pte-prooedure ultrasound scan showing gall stones. At surgery,33/33 confiJmed the presence of gall stones. Although 3 also hadadhesions, 2 were acutely inflatned and Ihad empyema. Average dlJllllionof stay in hospital after procednre was 9 Days (range 3 to 20). Nocomplication was recorded and no mortality was seen.CondusioDs: Laproscopic cholecystectomy is a safe· procedure fotgallstones disease.

An aodit of laparo!l('Opie eboleeystectolnY

Authors: S. Waseem Ali Zaidi, S. Zafar Abbas, MMCH.KhalilBabbar , Rozina Khatoon , Rashid Shamsi ,Fozia (Final Year)AbstractBackgroUDd: Gallstones is a common problem, particularly amongwomen. Inmodem tnedicine, un complicated gall stones are usually treatedwith Laparoscopic Cholecystecomy - U Key- hole Surge:ry". It caniessignificantly lower morbidity and mortality as compared to open surgery.At Muhammad Medical College Hospital we have not yet analysed theresults of this procedure.Aims:To look in to various demographic and clinic aspects of Lap chole.Methods: Retrospective study of last consecutive 33 Lap Chole records atMuhammad Medical College Hospital Research Ethics Committeeapproval was obtained (No. 2508111RBCJOO3).

Authors:Tahir Ahmed, Watan Yar, AbdnI Ghaffar, Bilal Hassan, M. Umar Yaqoob,(Fmal Year), SaqibBaloch, RMOMMCH,S. Zafar Abbas (Professor of Medicine 1Gastroenterology)Departtnent of Medical Education MMC,AbstnctBackground: Over past 2 year SOtDe high people adverse medicalincidence have been reported in the media in Pakistan. A number of othermedia reportshave also emerged portraying negative image of doctors bothlocally and nationally. Doctors and their associations have at times reactedstrongly against SOtDe reports as 1I1lfaitor based against them.Ahns: To detennine the perception of doctors of media reports of adversemedical incidences as a whole.SnbjedB &Methods: Cross- sectional survey of 144 doctors of differentlevels in their careers. Hospital's Research Ethics Committee's approvalwas obtained (No. 1209111RBC1(15)Result: Oat of 144, there were 95 male doctors (66%). Average age was 39years (range 24-75). ~OIity 1061144 (74%) felt that media does not reponmedical incidences fairly. Of 38/144 (26%) who felt media reportedincidences fairly, 25/38 (66%) were males, 9123 (39%) were GPs, 18/35(51%) worked in private hospital and 5127(19%) were consultant, 141106who felt media reportswere biased commented that this was because of U

Yellow Journalism".Condasion: Nearly % of all doctors in this survey felt that adverse medicalincidences were not reported fairly by the media. Among those who offereda reason for this all doctors felt that this was done to sell the papers orincrease the viewers rather than potttay the right picture.

CondasioDS: Doctors still enjoy the trU8t of most people although there hasbeen a slight decline form 41% 2 years ago to 39% now. Trust in Armyshow up form less than 1% to 18%. Alarmingly back of trust in anyprofession has gone up frQJll15%to 21% in our survey.

Does media reportadv_ medkaIindd_ fairly?

Authors: Tahir Ahmed, Abdul Ghaffar, M. Umar Yaqoob, Bilal Hassan ,Watan Yar, (Final Year), Saqib Baloch, Syed Zafar Abbas (Professor ofMedicine 1Gastroenterology) Department of Medical Education, MMC.AbstnctBackground: There is perceived general attitude of lack of trust in oursociety. Even the historically most trusted professions are perhaps facing adistrust by the general population. AB per recurrently published data andsurveys from the west. including royal college of physicians of London'srecruited famous firm MORl's report, physicians are still the most trustedprofessionals. Our groap did a survey in 2009 (Astlact book which alsoshowed doctors as the most trusted profession in Mirpw:khas (vote by41%). However, many say that medical profession has seen negative pressbecause of SOtDe high prome adverse medical incidences- locally andnationally.Ahns:To detetmine the most trusted professions in our society.Material and methods: 206 people from different walks of life, indifferent location of MiIpurkhas were randomly selected and interviewed..No more than 10% people from a specific profession were interviewed..Average age of respondents was 32 years (range 22 to 67). They included41 (20%) women. Hospital's Research Ethics Committee approved conductof this study (No.I209111RBCJ014).Result: 5 most commooly trusted professions were doctors (39%), No one(21%), Army (18%) and teachers (13%). 'Those professions who weretrusted by less than 1% included lawyers, Land Lords, Media, Bnsinesslllfllland Engineers.

Doctors-still themost trustworthy profession in PakIstanI

CoDdusioos: According to this short survey, jow:ualists are UIIIIIIimoU8intheir opinion that the trust of medical profession among common peoplehas declined in the recent past.

37

Authors:Aorangzab, Mllbammad lawad, MJlbarmnad lr.aran,Zaigatn Ismail, HasanShams, lees Sotnro, MuhatntnadWaqas, IftikharKhan, (46Year)Prof. Noor Ali Samoon, Asif Ali Shah, , MMC, Pir Muqaddas IanSarbandi, (Senior Lecturer Community Medicine, MMC)AbstractOur research is about the Smart cell phones usage inour coDllIlllIlity.Introduction:Smart cell phone: A smart cell phone is a high-end cell phone that offersmore advanced computing ability and connectivity than a contemporaryfeature phone. A smart phone combines the functions of a personal digitalassistant and a cell phone. Today's models typically also 8('ZVeas portablemedia players and camera phones with high-resolution touchscreen, GPSnavigation, Wi-Fi and cell broadband access.Aim of study: Our aim is to study the usage & harmfull effects of smartcell phone in Muhammad Medical Olllege,Mb.pur khas.Methodology: Cross-sectional study through questionare of 100 medicalstudents of Muhammad Medical college.Approved by college research committee with reference number140911IMC(040)Smart !'bones & Students: Students spends most of the time on theirpbones using SMS,GPRS,social sites,media players & camera.According to the UIrited Nations-ron organization, a whopping 6.1 trilliontext messages bas been sent by the end of 2010, means people around theglobe are sending 200,000 text messages every second.And Pakistan is the (/A largest country for sending messages.Diseases CaDSed By Cell Phones: It's a known fact in these days that cellphones are cause of a lot of chronic diseases. So.me of them are shown.Kidney DIseases: Cell phones can canse kidney failure & kidney stones.European research institute for electronic components in Bucharest foundthat cell phones may lead to kidney stones.The study found tbat cell phones emit radiation which causes red bloodcells to leak haemoglobin.'Ihen the haemoglobin accwnu1ates in the bodywhich can lead to health complications of kidney stones.Heart: A report suggests that cell phones can interface with the function ofheart pacemaker.'The pacemaker interference by the cell phones was foundto be significant when the phones are held over that pacemaker means infront pocket.Study shows that cell phone radiation can also cause multiple sclerosis.brain damage: Researchers at Sweden's Lund university found thatexposure to cell phone radiation could cause proteins & toxins to leak intothe brain & can lead to alzhiemer diseas & parkinsonism.Research have found that microwave radiations from. cell phone handsetsdamages areas of the brains associated with learning,memory, movement.Itis also brain tumor risLOther Diseases: Research fromEngland Institute shows that cell phonescan canse damage to the genes & genetic distwbance & cancer.

Smart cell phone usage& it's hannfoJl effect.

Results:Amongst 93participants (mean age 22.8 years), 55.1%said that theyhave had thought of dieting where as 38.8% said that they did diet. Amongthose who diet, 13.3% (40% male, 37.5% females) were overweight, 24%(30.7% males, 57.1% females) were nonnal, while amongst alreadyunderweight students 2.4% were on diet (1 male and 1 female). Majoritysaid tbat they diet ooly to look slim (19.4%).Amongst the motivating factorsfriends were on top (33.4%). Those who said that they wish to continuedieting were 68.1%.In ordec to lose weigbt, 52.8% of the dieters nsed to skipmeals, 16.6% nsed to eat less, 13.7% used low fat diet and 5.8% usedmedicines (herbal and others). Amongst harmful effects of dieting, 17.2%suffered lethargy, 8.6% had vertigo, 6.4% had fiwigue and 2.1%had dizzIDess.CoDdusion: Our study showed that many medical studnets lack basic00IlCqIt of dieting. Thdr dieting habits Ipractice is often not as pel' scientificguidelines.Remarks: Seminars should be conducted so that there may be properconcept of dieting among medical students and to help them avoid thebanns of improper ways of dieting.

andpractice of dieting 8IIIOIIgundeIgraduate medicalstudents.Methodology: The study was descriptive and cross-sectional in nature, thequestioonaire was self- administered semi-structured and was pilot testedon a sample of 5 students from Muhammad Medical Olllege before thofinal administration on students from different colleges. 'The study wascarded out in 4 different colleges ~ab Medical College, Quaid-e­Azam Medical College, Nistbar Medical College and Muhammad MedicalCollege) of two provinces ~ab and Sindh) of Pakistan. The sample size

taken was 200, response rate was (46.5%).Data analysis was <be usingSPSS17.Btbical approval was taken from our Hospita1s ~ EdIics ComtnitteeNo. 14091~3.

• ISSN: 2075-99B3-APR 2014-OCT 2014 _

Do you dietn? dietthe right way

Authors: Aneela Amber, NUtnanMajeed, Sabat Khalid ,Manzoor HussainAhsau. Rasheed (FinalYear, MMC)AhstractBadIgroaDd: Proper nutrition plays a key role in disease prevention andtreatment The increasing phenomenon of dieting and weight loss especiallyin teens and twenties. many of the people especially females suffer from anumber of nutrition rdated issues. People have diffcmlt approaches towardsdieting.Aims: The aim of this study is to access the knowledge, attitude, behavior

Use of c:outraapCiveiu malepatiaJts c:omiDg to MMCH MJrpurkhas.

Authors: Aimanllyas, AbubakarRiaz, Sheharyar Ajmal, Goharlanjua,AnmaRi.az, Madiha Shah, MahrukhAbbas, Sonia Zafar, (FinalYear,MMC)Abstracthdrodnction: This study aims to assess the use of contraceptives amongmale patients that come to MuhatntnadMedical College Hospital.Aim: To assess the knowledge, atti1XJde and practice regarding use ofCODttacepti.vein male patients coming toMMCH.Methodology: It was a KAP study conducted among 50 patients randomlyselected in OPD of Mnhammad Medical College Hospital, MirpIlrkbas.Hospital Research Ethics Committee approved this project (No.140911JRECJ037).ResulU: 50 subjects (average age;=.37years) answered the qnestiOllllaire.35(70%) knew about contraception and condom was the COtntnOnest (59%)form of contraception used. 57% encouraged their wives to visit familyplanning center and thought it was useful. Among those who did not usecontraceptive, 54% did not go becanse of lack of awareness and 36%because of religions belief. All those who used condom believed in itseffectiveness and 68% of all encouraged otber-s to use a futm ofcontraception.Condusion:. 30% of all male OPD attendees had no awareness regardingconttaception. Among those who use contraception, Jlll!iority (59%) usedcondoms.

Authors: AhsanRasheed, Aneela Amber, Numan Majeed,ManzoorHussain, Sabat Khalid (Final Year)BackgroUDd: Internet inc.reasingly being used globally in imparting anddelivering medical education.Not only for heallh care training ofprofessionals but also the material available there for medical students islading in developing countries.Aims: To evaluate tho access, pattem of use in geueral and for professionalpurposes by medical students.Methodology:'The stIldy was descriptive and cross-sectional innature, thequestionnaire was self-administered semi-structured and was pilot tested ona sample of 5 students from Mnbammad Medical College before the finaladministration on students from different colleges. 'The study was carriedont in4different colleges (Punjab Medical College, Quaid-e-Azam MedicalCollege, N'JStbar Medical College and Muhammad Medical College) of twoprovinces (Punjab and Sindh) of Pakistan. The sample size taken was 200students from 3m year to Final year, response rate was n (48.6%). Dataanalysis was done UBing SPSS 17. Ethical approval was taken from ourHospitals Research Ethics Committee No. 1409111REC1042Results: Amongst the n respondent, 59 (60.8%) were males and 38(39.2%) were female users of internet, majority studems started UBinginternet in last two years (~35.1%),Majority students (36.2%) spent up to5 hours weekly on internet, while 26.6% spent more than 10 hours perweek. 91,7% said that they used internet for non-acadetnic use whereasonly 13.4% used for academic purpose. Innon-academic use, 20.1% usedto play games, 12.8% on watching movies and 32.3% on non-academicstudy. For academic purposes majority (32.9%) used intenlet to get betterunderstanding of subjects, 24.7% for research purposes, 30.9% for makingpresentations and 24.7% for making assignments. Regarding academicbenefit of internet 48.8% said it was useful while 50.5% said it was of nouse. Among all nsers 48.4% (61% males and 39% females) said that theyhave miss-used internet (eg. Watching porn, chatting with opposite sex,hacking etc.).Condusiou: Our study shows that most students do not use intemet foracademic purposes as much as they do for other activitiesNegative use ofinternet is common practice..Retnarb: Steps should be taken to encourage students to use internet inmore positive and discourage negative use.

Evaluation ofJntemet use by m.edkaI stu.dents

they were underestimated, and almost all of them had a memoty of tbeirbeloved which made them feel sad.CondusiODS: It is concluded that 13.5% of the subjects bad symptoms ofdepression in them.

_________________ 138 I .ISSN: 2075-9983-APR2014-OCT2014.

College's research edrics C01IIIIIlttee approved this prOject (No.14091URECm8)Ile!ioJt: 796 medical students were included in die survey (male 391.female 405). 766 students (96%) respondedto die questionnaire(OJAle375,females 391). Among them 670 (87.46%) Students reported no mentaldisnubance. 96 (12.54%) medical students reported symptoms of meataldisnubance intheir academic life.Among these 96 (12.54%) students, 39 students (40.6%) (13 Males, 16Females) reported positive Anxiety Symptoms. 33 students (34.37%) (18Males, 15 Females) reported positive Pbohla Symptoms. 24 Studarts (25%)(9 Males, 15 Females) reported positive Depression SymptoJD8. Whilesymptoms of Bipolar Disorder and Schizophreuia were not reported by anystudent.CoDdosioo: Our study shows that 12.54% of medical students havesympcoms of anxiety, depression aod phobia.

Study type: Cioss-secIi.onal~veStudy too); QuestionnaireSample size: RandoIJIly selection 796 individuals in 6 different

medical colleges of PakistanSampling Convenient random probability samplingtcc.bnique:Sampling area; MuhaomJadMedical College, Mirpod:has (Sindh)

BolanMedical College, Quetta (Balochistan)Khyber Medical College, Peshawar (KhyberPakhtunkhwa)Qoaid-o-Azam Medical College, Babawalpur(Punjab)Islamabad Medical andDental College, Islamabad(Federal)Ni8htar Medical Colle,& MultanJ.I'Ill!iab_l

Anal~ Data analysis is done by MS Excel

Authors: Fatimah Hameed, Zain Sharif, Farah Sattar, .Maria Mazhar, YasirAlam Khan, Sbahnawaz, Naveed Waitoo, Muhammad BiJal, MuhammadShahid, Zain Ali RazaSopenIsorl Sir.Noor All Sarnoon, MMCAbstractIntrocluctioo:Psychiatric disorders or mental illness isa psychological oe behaviO£al pattem generally associated withsubjective distress or disability that occurs in an individual, andwhich isnot apart of normal developmmt or culture.Medical education is perceived as stressful. Bi,gh levels of stress have beendocumented in medical students in varioo.s studies doe to academicdemands, exams, inability to cope, hopelessness, increased psychologicalpressure and too much woO:: load.Stress during medical college can lead to prohlems ~ in profC88ionallives COlDPromising the patient care.The study therefore carried out to determine the prevalence of psychiatricsymptoQlS atDQIlg the medical students.Objective: To find out Prevalence of Psychiatric symptoms amongMedical Studenl3 of different Medical colleges of PakistanMaterial aDd Mtthod:

College's research14091lJRECJ(39):a-It: 760 medical students were included in the survey (Male 373(49%), Fem.ale 387 (51%). All students responded to die qnestionn.aire(100%). Among them 554 (72.89%) Students felt there was no genderbased discrimi nation. 206 (27.11%) medical 5tuden13 reported gender baseddisaimination.Amoog these 206 students, 134 Stodents (65%) (86 (64%)Males,48 (36%)Females) felt that there was a gender discrimination inprovision of healthopportunities. 134 students (65%) (93(69%) Males, 41 (31%)Females) feltthat there was a gender discrimination regarding educatioual opportunities.156 students (76%) (135 (87%) Males, 21 (13%) Females) felt that therewas a gender discrimination regarding job opportunities. 6S students (32%)felt that there was a Differentiation in celebrating birth of baby girl or babyboy. 43 (66%) (37 (86%) Males, 6 (14%) FeOJAles)celebrate birth of babyboy and 22(34%) (9 (40%) Males, 13 (60%) Fetuales) celebrate birth ofbaby girl.CoodasioD: Our study shows that Women in Pakistan are moredisadvantaged and have less opportunity for beabh, education and job.

Anthon: Fatimah Hameed, Zain Sharif, Farah Sattar, .Maria Mazhar, YasirAlam Khan. Shalmawaz, Naveed Wattoo, Mohwnmad 'aUal. MuhaounadSbahid, Zain All Raza, MMC, MiJpurkhas.Abs01Id~ Gend« based discrimination or sexism is unequal treatmentof a person based solely OIl otheu person sex mainly due to social andcultural conditions. Women in.Pakistan are more disadvantaged as compareto !be women in modem Western democratic societies.ObjecdTe: To find out prevalence of gender based discrimination amongmedical students of di1femlt Medical Colleges of Paki&tan.Method aDd MattriIl:

CoaIIDoII8It drects of mood swiQp duriDa DlftJIIitnJatio OIl academicperfOJ1ll8llCe of fftllllle medkaI stodaIfa at MMC.

Autbon: ~ Mad:iha Shah , Mabxukh Abbas, Sonia Zafar.ADeeqalshtiaq, SbeharyarAjInal Aimanllyas. Abuba.k.adijaz (Final Year )Yasmeen Kobaro (Assistant Professoc DepGneoI of Gynaecology,MMC)AhsCnctlDtrodadioo: MenstroaIion is a physiological phenomenon but hasvarious physical andpsychological effect on a woman.Aim: To assess 00IIlIII0Ile6t effects of mood swings during menstroaIion onacademic pedoonance of femalemedical students at MMC.Me6ocIoIocY: It was a ceoss-secdonal study oonducted atDQIlg30female medical students at Muhanmlad Medical College,MiJpurkhas.College Research Ethics Committee approved conduct of this study(No. 1409111RECJ027)R.esulU: The smdy yield that 86% of die females oxpetialced mood swingsduring mcmttuaIion. 70% of the femalessaid that theiracademic pedormance was affected by mood swings. 53% experiena>.dmentalfatigoe. Social8lld personal life of 60%subjects was affected. 76% of the subjects6tated that they use ugs to relieve thepain.CGDcIusioD' 1bc study concloded that female medical students experieoce alot of problems doe to menstrual mood swings and it exerts alot of effect on their academic pedormance.

PrevIleDce of &eu.der based dIscrimiDatioIl amoua medkal studeuts ofPakistaD.

Hence smart cell phones are health risk.Reeult: Acoording to ow: research:67% students of Mbammad Medical college are smart cell phone USCIll.

33% student are simple featnre phone users,69% of students are using a cell phone in ranging from 3-6 years.While 25% stode:nts using a cell pbonoe from 6-9 years..Rest of die 6% user from 1-3 years.57% student are the USCIll of Samsung cell pbonoe.23% students are using nokia phones.4% students are using iPhooe.12% studenta are using odler smart p~ ie Blackberry,lITC or chinamade.43% students recharge their credit inbetween 1-2days.27% students recharge their credit inbetween 2..4 days.While 14% from4-6 days.Rest of die 16% recharge in aweek.81% students have no sidb-effect because of cell phone usage.While 19% shows some disorders such aslnsomnia9.Ear disorder 3.Eye problems 5.Poor c:oo<:artration 2-76% slUdents have no sleeping distwbance becauseof cell phone.While 24% stode:nts are disturbed becauseof phone.11% stode:nts are aware of 8idcH:ffects of cell phone usage.89% students are not aware of any sidb-effec1:scaused by cell phones.96% students cannot spend a day without their cell pbone.While 4% students can.

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Audlt of IrIguiDO saotal sweIIIDg InslllJellcal department of MMCBbetween July ZOlO-juIy2011

ADthon: Shamasud Din, WaqasNaseem, lameel Ahmed, OhulamMunaza,SajidYarKhan,Ahmed Abba<;(Pinal Year MBBS )Syed RaziMubamJDd (Professor of Surgery).Place IDd cluratioo: Department of surgery Mnbammad Medical CollegeHospital, MirpuddJ.asSindb, fromJoly 201~July 2011.

Authors: Sajida Zafar, Sia Noureen, Sumba Javaria, Nosheen Bano, Afrozoen,Nwnan Majeed (FmalYeu MBBS)Bacqroaod: Communication skills play vital role in personalitydevelopment, interaction with the community, to understand other peopleand to convey one's message. It is especially important for doctors whohave to deal with patients, where conversation has prime significance Inpatient cue and provision of proper health cue. For this reason,COIIIlXlIIniclltionskills is taught as a compulsory subject in many westernoountti.es and some medical colleges within Pakistan.Aims: The aim of this study is to access the knowledge, attitude, behaviorand practice of lUldergradnate medical students regarding communiclltionskills.MeChocJoIoI)': The study was de3aipCive and cross-aectional in DaIure, thequestionnaire was self~ 8eDli-structured and was pilot tested ona sample of 6 sIOdents from Muhammad Medical College before fOllDailyconducting the study on the students of Muhammad Medical College,Mixpurkhas, Sindb. The sample size taken was 150 students from secondyear to Final year, Response rate was 941150 (62.6%). The assessment wasdone by IlSing modified Portland Community College CommuniclltionSkills Self-assessment Exercise. Data analysis was done using SPSS 17.Ethical approval was taken from one hospitals Research Ethics Committee(No. 14091l/REC1030).ResaI1J: Oot of 94 students 40 were males and 54 were females. 36%people said they knew whU communiclltion stiIls arc. Most of theparticipants (55%) said there should be wOlbbop6 on development ofcommnniclltioo skills, 40% said that bad language probkm3, 46% said thatby better comlJlDlricationskills, there will be rcdoction in clinical eeroes,The result of the exercise is presented in the graph.Cood........ : There is an acute need to develop better COIIIIDIIJlication skillsin furore doctors, Le medical smdeat, Proper measures should be taken toenhance communication skills in students.Remarks: Workshops should be conducted on regular basis on personalitydevelopment and commenicanon skills, in order to get better clinicians.

AbstractBaclqp:oand: It is a common thinking in some sections of society withinPakistan that bijab is a hinance inthe way of progress and acquiring properskills. These are very littler work done regarding this issue•AD: The aim of this study is to access the effect of bijab onundergraduate medical studenIs.MethocIoIogy: The study was descriptive and cross-sectional in DaIure, thequestiODllllirc was self-administered semi-sttucIlIl:ed and was pilot tested ona sample of 5 female students (both bijab observing and UOD-bijabobserving) from Mohammad Medical College before the finaladministration on slOdenll> from different colleges. The study was carriedout in 3 different colleges (Punjab Medical College, Quaid-o-AzamMedical College, and Muhammad Medical College) of two provinces(Punjab and Sindb) of Pakistan, The sample size taken was 100 femalestudents from 3114 year to Final year, who observe IDjab. Response rate was61%. Data analysis was done using SPSS 17. Ethical approval was takenfrom our Hospitals Researcb Ethics Committee (No. 1409111REC1044).RtiIaIta: Out of 61 respondents, 61.7% students stuted bijab after enteringthe medical college. Most of the females wear bijab dne to religiousobligatioD (35%) while 24% for self-protectioo. A small amount (15%)reportcd that they feel hijab has affected their study and 16.7% stated thatbijab bad atIected their glades inexams among these gil:!&. 22.9% said thatthe behavior of teachers became harsh 19.7% of the students said that theattitude of teachers was politer. The difficulCie8 faced by these stndents are,lab wad:: and dissec1ion 6.5%, cIiffirolty inexam ball and during gcmeralphysical exam 3.2%. Whereas using stethosoope was reported by majority(48%). 59% girb said that after they started wearing bijab, they got more:respect from male class fellows, while 3.3% said that they were called uponIIlIIIlllS.Conclusion: Majority of our survey respondents felt that wearing bijab haslittle effect on the academic life of medical students but is not a condition tobe called a hinance.Remarks: Observing bijab is a good socia1 and religious practice, sospecial attention should be paid to resolve the issues that the girb wearingbijab face.

KDowIecJ&e attitude prac&e & bebmor of medica1 st8daIts regard:iDgcollllDlJllicatiostms.

IsBijab a hiDaaee inprogxessiDg inmedical coDece

ADthon: Sabu Kbalid, Aneela Amber, Numan Majeed, Ahsan Rasheed,ManzootHussain (FiDal Year MBBS)

Study of ca_ of deprailivestate of mectical8lDdeDfll1llDOllg Pds

Autbon: Sadia I8mail, Sumaya giI1, Hilla Arif. lffa1 Safdar (FilIal YearMBBS), Syed Razi Muhammad (Prof. of Surgery, MMC)AhItnIdBacqroaDd: Depression is psychological disord« that can lead to varioospsychological ~ inmedical studeots. Depression can atIect theacademic life as well as the bealth of the students. There are several factorsthat may lead to depressive state in studeots.Abu 8Dd objective: Aim of the study was to determine the cause ofdeplC88ioninmedical students.MetbocIoIogy: The study design was descdpdve c:.roS8 sectional, pilot testingwas done on 5 students before administration on sample populalioo. Samplesize was SO female student of MMC. Approval to cooduct this study wasgiven by Hospital's ResearchEthics Committee (No. 140911JRECm6)Results: AD of the sample was aware of depression. Major trigger ofdepJession was home sickness 64%, behaviour of parents was reported by24%, serious iIJness in family was trigger in16%, death of relative in.doceddepJession in 18%, and in 8% it was dne to failure in an examination.Depressive episode lasted for one day in28% of affected girls, a week in12% ,a 0100111 in 8 % and fornon specific period in 38%. Maj« manifestationof depression were irritaIion (36 %), crying (34%), sadness (29%), overeating (18%), 8118« and sleep distw:bance in16 % each.CondusioD: We conclude that almo6t all the st1Idents bad episode ofdepressionone timeor the other, a.Imo$tin213mcdicalhelp.Rsurb: rd of girls due to bome sickness, where as only minority seekedAppropri.ate measures shonld be taken to avoid psychological emergencies infemale studeot and coonseIling sessious shonld be aaangcd.

Ambon: Rabia Ali ,Aneela cbaodio Khadija Safdu .AmIm Aywz. (FiDalY_MBBS), SyedRmM1lhammad(Prof. ofSUrgery,MMC}BacqroaDd: Medical profession is ID06t desiIeable profession inPakistanand rest of the world.Many studeots make their own choice, where as otherare made to taU medical fidd by pareotS, other rdalives and fdeuds. Manystudents contimle to enjoy their studies where as some find that medical fieldis not acoording to their aptitude and wish some other professions.MeCbocIoIoJY: we conducted a survey on 100 students (46 boys,54 girb) ofM1JHAMMBD medical college (MMC) to find the answers of abovequestion. Research Ethics Committee approved this SlU'Vety (No.140911/RECA)5()Results: 79 students (33 boys,46 girls) accepted that they chose medicalprofesaion themselves where as 21 (11 boys,10 girls) mallioned that it wastheir pueots choice which they accepted.1bey 21 students wanted to go tothere professiooa (fashion de8iguing 7,business person 3).OveraIl41 (17boys,24 girls) students mentioned that the choice was entirely theirs,whereas59 students who claim to make their own choice,accepted that some.influenced from pamIts was present When asbd that if a relative seebd anadvice for choosing bisIber carrier 83 (85 boys,48 girls) said that theywould suggest medical. When they were asked if they could go back in timeand made mother choice,78 (33 boysA5 girls) reiteI:ated ttu. they would joinmedical again,where as 22 wanted to leave it for some other profe88ion(fasbion dcsignillg 11,bussine$s 9,EngDCCIing 2,othen 7).65 students (25boys,4O girls) had a doctor intheir immediate family,whereas 35 did not.CoodDsioD:Most medical students of MMC chose their profession by themselves and.remained slltisfiedwith their professioo.

salaries and social accq>taoce. I>ata was analyzed usingSPSS 17.Results: Satisfaction with patient dealing was 57%, with salaries and privateclinic chaeges was 59% and with social acceptance was 74%. The main.reason cited for lower satisfaction in dealing with the poor patientcompliance (65%) Le, Palieots feels i.nsoIt in going to a psycbiatrist8 andthe Irearmeot is U81IaIly loog term (38%) and &bowslimited im{xov=t insym{l(Oms resulIing in frequeot visits by the patieots (52%). Majority(59.3%) said that it was difIicolt to deal with extreme cases. Whendemographics were COIllp8Rld, it was fouDd that semor psychiattisls weremore satis&dCOIIIp8ftd to the newer generation of consultants.CoodosIm~It is petlinent that the govemment should realize the impottanceof psychiatty as a major specia1ty and incauivize the specialty so that theyounger generlltionof physicians is atIracted to and satiafiedwith this field.

• ISSN: 2075-9983-APR 2014-OCT 2014 1 411 _

Authors: Sumera Bibi, Shazia Parveen, Rabia Aham, Khawar Abbas.(Final Year)Syed Razi Muhammad: MuhammadMedical College HostdsAlDIs UId bKkground: To assess the scope for improvement in Hostelfaciljties by residents of MMC host.eIsMethod: It is Cf088 sectional desaiptive study done at MMC hostels fromaugwt 2011- sep 2011. Sample size was taken 9O.seniormedical studentscollected data !tom individual residents about the problems faced. HospitalResearch Ethics Committee approval No. 14091~9,llIsaIts: out of respondent 90( female 66.6%, male 33.3~). Average age20-24 year, participant from each hostel were 30. Residents suggest thatthey considered following area bad problems and requirement, residentssatisfied !tom qualities of food MMC city hostel(16.6%),MMC collegegirls bostel(~),MMC boys hostel (S9.9%). saIisfaction from watersupply MMC city hostel (20%). MMC college hostels both girls andboys(13.3%). satisfaction from cleanliness MMC hostel city(43,2%). MMCcollege bostel for girls( 59.9%), MMC boys hostel (39.6~). quality ofmobile network at MMC city hostel(76~), MMC hostel for girls at college(16.6~). and MMC boys hostel(46.6%). sanitation satisf1Iction at MMCCity bosteI(36.9%),MMC college glrlJ bosteI (36.3%). and MMC boyshoatel(26.6~) while transport satisfaction arIIOIIi the students i3(76.9%)Cooda8loD: It is fOWld that among city hostels and college hostels,improvements should be made especially to improve mess, water supplyand~ .

To __ the scope for Improvement ill bostd IadIWee by resideots ofMMChosteis

'lbe prevalence of Low Back pain IIIDOD& medical students, doctors andsupportJDa staff at MMC.

Authors: Darakhshan Rehman, Saba Ilyas, Sia Khan, Adnan Khalil,(Final Year) Syed Razi Muhanunad. (Professor of Surgery,MMC)A.hIItractBacqroaud: Low back pain(LBP) affe« both old and young. Medicalcolleges tend to have time consuming curricula possibly perpetuating asedentary life style, a bad posture during prolon~ study and a highprevalence of low backpain among medical wOfhrs.Aim.: To determine prevalence of low back pain among medical students ,doctors and supporting staff atMMC.Method: A survey was done on 133 participants using a questionnaire in10 days duration. The questionnaire was self-administered and semistructured. The study was carried out on medical students , doctors andsupporting staff of MMC with Research Ethics Committee with RECNo.I40911/RECf048.llfsuIt: Tota1133 participants were chosen randomly. .Among them therewere 92 Medical students (41 males and 51 females) • 16 DoctOllI and 25SUpportingstaff members. A total of 78 (5S.64~) members suffered fromlow back pain. Among these 31 (60.79%) were female smdents , 26(63.41%) were male smdents,4 (25%) were doctors , 17 (68%) weresupporting stafU7 (54.83~) female students, 12 (46.1S~) male students,2(50%) doctors and 6 (3S.29%) suppotting staff members were sufferingfrom 1-2 years. 24 (63.15~) female students, 11(37.93%) male stndentsand 3 (SO%) doctors declared prolonged sitting wod: as possible causativefactor. Whereas 8 (44.44%) of supporting staff members declaredprolonged standing while at work as the causative facto.r. 22 (62.SS%)female students, 14 (SO%)male students, 2 (50%) doctors and 16 (66.66%)suppordng staff members revealed that bed rest relieved the pain. 11(35.48%) female students, 6 (23.07%) male students, 2 (50%) doctors andS (47.0S~)8UppOlting staff members used medicine to relieve pain. 17(54.S3%) female students, 21 (80.76%) male students • 10 (58.82%)supporting staff members said low back pain affect little on routine lifewhereas 3 (7S%) doctors said low back pain ~ some routine life. 2S(80.64~) female students, 4 (IS.3S%) male students, 4 (1~) doctors, 12(70.SS%)supporting staff consulted doctor for low back pain.Cooda8loD: PrevlIlence of low back pain among Medical workers is highin MMC because of their hectic routine.

supplementary eumination although only 2 (05%) were expecting it 06(16%) did not.inform their parents. 13 (3S~) of them showed a discouraging~ 23 (62%) feel the failure in annna1 exam a fault of ex.aminer.13(35~) faced difficulty in ooocenIraIingintheir SUJd.iesas a result of failure. 37(l~) said that their frialds were 8UppO{t live. 17 (46%) felt londiness inlife. 3 (08~) bad suicidal ihooghts and 20 (54~) suffied iDsomoia. 18(49%) nociced a cbauge inbehavior of teacbers with them after result and 08(21~) were coofident !bey were ronsidtring 1lSingunfair means 10pass thesesuppItmenIary exam.CoodasIoo: Failing annual examinalion is a major psychologicalseCback formedical studenrs.many of which have negative dlou.ghIs fOt failure. Supportand counse1ing from paralI$ and II:lICbm to guide them 10 positive life mayhelp.

Autborr.Sheharyar Ajmal,Aimanllyas,AOObabr Riaz, Gohat Janjua(Final year)Prof. Razi MuluuDmad: l)cpaItment of Medical Educatioo, MuhammadMedicalCollege,M'irpuddIas.AhIIC:ractIntrodudIon: This study aims to assess the effects medical students undergowhen they faoe supplt!lllmlalyexaminaIioo.ObjectivtlAlm: To assess the etfecIs of supp1ementacy examinaIion onmedical students.~: It was a cross-sectional study ooodoc:ted among medicalstudents at Muhammad Medical College, MlrpuIkhas. Research dhicsOOIJlIIliIteeof college approvedthis project (No. 140911JREO)25)BsJlIa: 37 8IIldent8 of all cI&'l8e8 of a medical coI.Iege (24 boys and 13 gir:ls)respooded to a quesIionnaire. 33 (89%) bad firlIt expeDmce of facing

Motivator aDd harden for blood cloaatioD -oa the stodmts ofMnlPnnnad MecIk:al 0JBege MirpuIthas.

Authors: Syeda TalW:aShenzi, Fahad Riaz Warraich, 'IUbaKhan, SajjadSarwar, FarahNureen, Zahid Mushtaq, Hamid Saleem. Saba Faiz,(411lYear)Muhammad Asif AliShah (Assistant Professor CommtmityMedicine,)

AbstractBactpoUDd: An adequate blood supply depeuds on voluu.leel: blooddonors who continuously save the life of millions of peoples. In manydeveloping countries people are still dying due to inadequate supply ofblood and blood product. A reliable supply of safe blood is essential forscaling of health care service level The objective of this study is to find outspecific motivarors and ban:ieo of blood donaIion among the medicalstudent!. The results from this study will aid in the creation of int.e:rvmtions&will improve the blood donation rate.Methods: A cross sectional descriptive study was conducted from J1II1&­August 2011 in Muhammad Medical CoUege Mitpurthas. 100 studentswere selected by syatemic random sampling, interviewed were conductedby using a pre-tested, closed ended questionnaire. The variables assessedwere motivators and barriers of blood donation. 60% recognized hospital asa D.IOIltCODveniem place for blood donation. College' 8 Research EthicsCommlttee approved conduct of this study (No. 140911/RECf041).Re80hB100 students were approsched for interviewed in tbe6e 42% were femaleand remaining were male. In this 13~ belong to first year, 22% secondyear. 21%. third year, 28~ fourth year and 16~ from final year. 47% (male73%, female 27%) has history of blood donation. The main rea90IIS wereidentify for blood donation were 49% saving the life, 13% self satisfaction11~ right thing to do, 10% friend motivation & 17~ other. Unknownpatients 72% was the most frequent person for blood donation. Among thenon donor group the main reasons were low Bb level 35~, never thoughtregarding blood donation 19%, afraid of needles 11~, harmful for health11%& ocher 24%. 75% of student said that they donate blood one time inayear inthese 47% feel weakness for one day. 92% (male S5%, female lS%)student ahowprepared for blood donation incme&'gencysituation.CoudosiODSMale student practices for blood donation were good and highly motivatedto blood donation in emergency situation. Edncational campaigns regardingimportance of blood donation supposed to be conducted among medicalstudent! to change the behaviour toward blood donation.

Methodology: Data of patients regarding preaeadng complaint. diagnosisand treatment was collected from the patients' medical record files. Theresult was analyzed using MS Excel and expressed in percentages.Approval to conducr this study was obtained from H06pira1' S ResearchEthics Committee (No. 140911.1REC103S)a-Jts:A total of 25 patients. (record of 2 patients was missing) withinguiDo-scroW swelling, the complaints of patients were inguinal pain 14(60.8~), inguinal swelling 12 (S2.1~). scroW swelling 8 (34.7~). scrotalpain 5 (21.7~). inguino-scrotal swelling 3 (13~), vomiting 3 (13~) urinaryretention 2 (8.7~). 0Cben 11 (47.S~). The diagnosis was made on clioicalassessment. other than base line investigations (RSE, CBC). chest X-rayand ultrasound were performed. The final diagnosis were right inguinalbernia 13 (56.2%),left inguinal bemia 5 (21.7%). bi1ateral. hernia 2 (S.7%),strangulated hernia were 2 (8.7%). obstructed hernia in 1 (4.3%).Additional diagnosis of BPH 2 (8.7%) and hyocele 2 (8.7%) wasmade in4patients. Tceatment given given to these patients werebemiotomy (right 26%, left 17.3~, bilateral S.6%). and hemiorrhapy47.8%).For othercomplaints, additioual procedures of orchidopexy 8.7% andcyctosoopy4.4% were done . All patients were discharged on compledng the treatmentexcept 2, who were d.iscluagedon request.

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Having had a pre-SyooposiumSeminar the day before, the stage for holdingthe SytupOsiumwas already nicely set. The morniIIg of 6th October, wassllocated to the presentations (free papers) by clinical medical students.First free paper was presented by Mr. Siu/arym' of Fourth Year MBBSMuhammad Medical College. He presented the findings of the work doneby his group on Infection Control Practices among General Practitioners.He explained that despite clear guidelines and obvious risks. a significantnumber of OPs was not practicing adequate infection control practices andsuggested proper ttaioing and wodshops for them. Min TayyabaNlllInenof Final Year MuhammadMedical College presented her group's paper on

Keeping up its reputation of holding Scientific Programs of higheststandards, Mulwnmad Medical College, Mirpurthas, held its 8th AnnualMedical Symposium on 6th and 7th October 2010 at its campus. The themeof the Symposium was "Medical Diaasters following Natural Calamities inPakistan". It was very well attended by doctors and clinical medicalsrudents from within Mirpurldias and othez cities of Pakistan.

Muhammad Medical College holds 8th Amwal Medical Sympo!Iium,aDd inaugnrates its ownSc:ientifIc Joumal

Authors: Saba Jacob ,(House Offocer),Syed Zafar Abbas (Professor ofMedicine)AbstractBac:kgromuI: Malignancy is an important diagnosis but unfortnnately isdiagnosed quite late in its course.Aims: To look at varions aspects of malignancy in patients admitted toMMCH.Patients &Methods: Rettospective analysis of case notes of 35 patientsadmitted consecutively toMMCH. Hospital's Research Ethics Committee'sapprovalwas obtained (No. 1209111RECJ017).Results: 26 (74%) men and 9 (26%) women were admitted with variousmalignant diseases with ages ranging 55-65 years. 3 most commonpresenting complains were abdominal pain, weight was and severe malaise.Bronchogenic carcinoma was the commonest cancer diagnosed in 9/35(26%) patients, followed by Hepatoma (n=5; 14%) and urina:cy bladdercancer (n=3; 8.5%). Most patients (11=20; 57%) were treated for palliation,whereas 8(23%) were given surgical treatment. 2 (6%) died during hospitaladmission, whereas 5 (14%) were tefeaed to another centre for furthertrealDlent.CODCIusions:Bronchogenic carcinoma is the commonestmalignant diseaseamong our admitted patients and palliation is the commonest form oftreatment offered to them.

Au audit of maligDant disease at MMCB

46% of the males said that they use the faimess creams, 40% of the males&aidthat they had facials, 28.8% of the males &aidthat they use the ShowerGel, 14.1% of the males said that they use Wax, 51% of the males said thatthey use Hair 001. 78% of the males seid that they use Perfume, 38% usePowder, 9% Skin Toner. 6% Nail Shiner. 9.3% use Bleaching, 3.3% useBlush on, 32.6% use deodorant, 22.6% use the Hair Straighter. 48% use theConditioner, 1.13% use the Eye Lashes, 31.3% use the StIIISCl'eeIl(snnblock). 3.3% did the pedicure and 4% did the manicure.Tbere were also 2,3% men who did not mow about all the cosmeticproductsused in the survey.CODdusion: We found that all the males regularly use some sort ofcosmetic products, and many of them also think that they havedisadvantages.

Authors: Zubair tehseea, Yahya Abdul Hanam:n, Abdul sauar. MariaZahid, Ammara Khalid, Shaista Fatima, HnmaA= Awan,Hashmatullah,Ameer Khan, (4· year)Noor Ali Sumoon ,Asif Ali, MMC.AbstractBackground: Not only females but the males are also using the cosmetics.When do they use and why do theyuse them?Aims aDd objectives: To assess the use of the cosmetics in males in oursocietyIndusion Criteria: Convenient sample of sll the males in 6 different ciliesof Panjab and SJndhin Pakistan of all the ages were inclnded.Metbodology: Cross-sectional interview (survey) of 296 males of ageranging from 15 to 45 residing in 6 different cities in Pakistan. Awrovalfrom College's Research Ethics Commirtee was obtained (no.140911/REC1032)Results: Out of 296 males we found that all subjects used different types ofcosmetic products.Out of 296 males:

Prevalence or cosmetic:use in males

lndusiOD Criteria: A11296males of the ages 15-60years, who admitted touse cosmetics were included.Methodology: Cross-sectional interview (survey) of 296 males of ageranging from 15 to 45 residing in 6 different cities in Pakistan whoadmitted to use cosmetics. Approval to carry out this study was given byCollege's Research Ethics Committee (No. 1409U/RECI033).Results: Outof 296 males:52% weee using cosmetics for Face, 24% for the Hands, 8% for the Feetand 18%for the Hair.We found that 45% of the males were suffering from the diseaselskinproblems.Out of these 45% we found that 21.3% were suffering from Acne, 14.4%had Itching. 15.7% had dermatitis. 31% were allergic to some cosmeticproducts and 17.6%were having other skin related problems.CoDclusioa: A significant proportion of tho male cosmetic users reportSOIlIIl skin oondilion, which mayor may not be directly related to their useof cosmetics.

'IJpes ~ sleep ~ IDDOIIgmecIkal students ofMMC

Anthers: Sia Maq:sood, Rabia Saleem, Sutnaira Nazeet. Waheed Ahmad,NanmanAhmad, NabeelAshraf ClJandoor, Faisa! Nawaz, MalikAhmadM.Usman,(4I11YearMBBS), NoorAliSamoo, AsifAliSbah,MMC.AbstractBad:grooDI1 : Almost everybody suffen sleeping problem at IlOIIIe stage oftheir lives. Sleep disorder are group of synome cbaracterized by distutbaoce8in the indivi<kJals lime of sk:cp and quality of sk:cp On ibe otllc% band Joogsk:cp duralionmaybe associ.ated witbmatbidity and J:IIOOa1lIy.Objectives : 1.1b ddermine the frequency of sleeping disorden among ibemedical stodeots. 2.1bknow some associ.ated factors with sk:cpdistmbanceSIudy DeQgn : Observational(descriptive)cross sectional,convenient sampleof 200 stodeots of MMC who had suffered sleeping di8tu.tbance at SOIlIIl

stage of their lives. Approval of this ptIject was obtaiDed from ResearchEthicsColllllleltee(130911/Reom3)Reiult: Oar study determined that (66) 33% of subject had more than onesleeping disorder, Among 1bem insomnia 56% is more prevabent thandyssomnia (47.5%) ,hypa:soomia 45.5% or Parasomnia 25%. Amongstudent average hours of sleep was 6 to 8 hours (55%),3 to 5 hours (40.5%), 9 to 11hours (3.50%), above 11hours (1%),Averagetime to go 11>bed 10PMto 12AM(11.5O%),12AM11>2AM (56.50%), 2AMto4 AM(32%), Factorscausing interIuption in sleep when examination Stress 15% , noise 11.5%,thoughts 18% , disease 1.5% , TV 16.5% , anxiety 9.5% , pain 2.5%

,prickling SensaIions 35%. frequeDcy of disorder is more among sudeI's 75%.Coodusion : Oar study revealed that the frequency of insomnia (56%) wasmore then dyssonmia 47.5% • parasomoia (25%) ,.Hypersomnia 45% in thestudent of Muhsmmad MedicalCollegeMiIpuI:kbas.

Prevalellce of the skiD problems IDIseases in the eosmettc users

Authors: Yahya AbdulHanan, Abdul Sauar, Maria Zahid, ZOOairTebseen,Ammara Khalid, Shaista Fatima, Huma A= Awan Hashmatullah,AJDee.r Khan, (Fourth Year)Noor Ali Sumoon , Asif Ali, MMC.AbstractBadrgrouad: Skin disease is not a common problem. In a:notbfa'presentation by our group in this sytupOsiutu we have shown that theproportion of male sex using cosmetics is significant.Aims aDd Objectives: To find out the Prevalence of the skin diseases inthe males who use cosmetics.

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Audience chen gathered again in the main symposiom hall. Formal themesession tben started. S"_1llArt"" KllIIII perlollllled the duties of StageSccretaty. Met recitation from Holy Quran. Prof. S,ed RIIDMuhammtJd.Managing Trustee of the Trost, gave a welcome and theme speech. Hedcsodbed the devastating effects of recent 1100ds and mentioned SODl.C ofthe efforts made by Muhammad Medical College & Hospital in reducingthe suffering of the victims. He also expanded on the future plans inhelpingthe rehabilitation of the victims and urged the audience to perlOfll1 theirroles in this big problem. Chief Guest and all the seolor profC68Q[Sthenjointly inaugurated the first evea- editioo of HJournal of MuhammDdMtdiool O11kge".They described this event as a milestone in scieotificbistory of this region. Prof_or s,«l Zlqar .Abba, <llairman ScientificCOmmittee of the Symposium tbcn gave the statistics of an thepresentations done in the symposium. He told the audience that in total 84papers were presented in the symposium. Out of them there were 70 freepapers, of which 43 were produced by students and doctors of MMCH.Remaining were invited !alb on .key topics by eminent experts fromdifferent parts of the country. Chief Guest Qad M~ KDm4l in hisspeech praised the efforts of foonders and runners of MuhammadFoundation Trust in establishing such great institutions in this remoteareaof Pakistan. He appreciated the high quality of the papers displayed aspostel$ by the stodents and doctors of MMC&H and expressed his pleasantsurprise 00 that. He offered all out sopport 10 tbe college 00 his part in all

After this session. Chief Guest (la:J M~ 1f.tuMI, Federal DeputyDirector General. Health, fJ.ank:edwith senior professors of MuhammadMedical College, LUMHS and Nawabshah opened the Etbibition Hall bycutting the ribbon at the entrance. He then vislted all the stalls andbospitality rooms and was informed on the sea-vices offered by all thephaaDaceutical and ochea- companies. He then opened the Scientific PosterPreaeDtation Hall.He visited an the 43 po6tm prcaatted by the S1Udeotsand doctors of MMC&H, and showed intetest in the work done by stndeotsand doctors by asking the details of the studies.

Second day of the symposium started with a Scientific Session. QcurtanmNiMl was the stage secretary. JtI'IHIid Il4Jp1d preaented his pap« OIl

"Operatioo Tbeaters, an inside story". AbtbIl QodlrDdrt presented resultsof his study done 00&dof 'I'reatmeot Response in hepatitis C infection.Prof. Mu..- MIJIW" presented a slDdy on Upid disotdera in cardiacdiaeases and Prof.NoorM~ MIJIW"on DeogueFever.

Profn.or SII_ M~of Community Health Sciences in HamdardUnivea-alty presented a talk OIl Nuttltional Status in patients withTuberculosis. All the presenters were presented with Symposium sbiel4sand bags.

• AMuI All Toq, of final year presented 00 Surgical Safety practices. Mil,BnuII BIIIIIMl00 Nuttitioo assessment in eWen, Mr. M~ u,_SM_ on Hospital waste manage:mcnl at Tea-tiary Care Hospitals inK.Itaclli, Mr. AlIdld RlIJIrwm NablrlHwlt on factors ~ with ugaddiction, andMr.DaUltHnrry on Depreeslon in old age.

In another auditorium. Society of Surgeons, Mitpwthas Chapter ran aseminar at the same time. A team from Hamdard University also held a"Hamdard Hoar" in Symposium.. Mr

Aftet the above _ion, 2 diffea-ent sessions weee nm simultaneously. Inone auditodum. physic.i.an8 session went on. A1ttI'"' M4I~ MQWIII ofLiaqut University presented a paper on frequency of malaria in patieotswith splenomegaly and IlOIlIlOC)'tic anaemia. SNUlItIMIJIW" updatedaudience on management of heart failure. AbAl Rlult4edDum, Head ofcardiology dcpartmenI, Abbasi Shaheed Hospital preaeoted a lecture onbow to improve ug compliance inpatients with bypertension.

the Audit of Neck Swel1i.ngpresented to surgi.caldepartment inMuharmnadMedical College Hospital. She showed that the commonest cause of thispresentation was tuberculous lymphadenitis followed by goiter. Mr. AbaiIlUT lWr_ presented on audit of Upper OI Bleed at Muhammad MedicalCollege Hospital. Over 70% were caused by bleeding oesophageal varices.of which 94% were treated eudoIloopically by baod ligation. No immrdjatein- bospital mortality was recorded in patients treated as such ovea-last 121llOQlhs. Mr. W4qG1' KJIOIfi of Ftnal Year Muhammad Medical Collegepresented his audit on CVA. He showed that majority (94%) of CVA3 wascaused by nee- baemoahagic infucts and carried a high mortality ofapproxi.mJtely 30%. Mr.Burium JlJulued,Final Year student MuhammadMedical College. presented his study 011 evaluation of abdominal painpresenting to the hospital and showed that lllI\jodty of patients in recentpast bas been presenting to department of medicine with complications ofcin:hosis such as tense ascites, hepatoma and spontaneous bacterialpea-itonitis.MII,ll4bi4 H_ed of Fmal Year Muhammad Medical Collegepresented bel" group' 8 paper on frequency of iron deficiency anaemia inpatients with microcytic anaemia. She showed that only 59% of patientswith microcytic anaemia proved 10have a low fcoitin level oonfinning irondc1icieocy. She raised conccms that doctors have been presa:ibing ironsupplemeots Indiscriml.nately to all patienCBwith microcytic anaemia whomay nOCneed It and aucy develop iron over- load with its potentialcompUcations. Mr. MIll All MI,,"," of Dow Unlvea-sity of HealthSciences (DUHS) presented his group's findings on malaria. He showedthat plaanwdium vlvax infection was 86% of all malaria patients. Mr.Hamdmt Ahnud also of DUHS presented on anti- HCV seropositivity inKarachi and discussed the po6sibility that this dlscasc may infact be on thelise despite an campaign against unsafe blood trana.t\J&ionand reuse ofdiJpouble syringes. Mr. H_ Nad44",of finalyear Muhammad MedicalCollege presented his paper 00 lIlOI1alityin patieots with decompensatedciIrllosia and showed that. Mortality with a sinale decompeIIsaIion featmewas approximately 10% and climbed to 20% with 2 and 30% with 3features in present in such patienl$. Mill SalM J®Ob of final yearpresented bee paper on Reproductive and Sexual compUcations of DiabetesMellitus. She showed that an such problems weee significantly higher inpatients with DM and abortion rate was around 42%. Mr. Ak1ItGr Abbas offinal year presented the finding of flood relief activities of Ooverrunent andUNlCBP in District Kot Addu. He said that particularly nonspecific feverand skin diaeasu were quite high in flood victima. Mr. YaN ArtifaJ ofFinal year Muhammad Medical College preearted a study of one yearhospital admisslOO8 inMuhammad Medical College. 17% of an admissiooin IIIdepartments was caused by problema from chronic Uvea-diaease andnearly 30% of all deaths in bospital were cau.ted by them. Mr. SaIul IqbGIof DUHS presented his data collected from VadOll8 Labs in Katachi 00prevalence of Typhoid fovea-and pattem of anJibiotics susceptibility amongSalmorulla isolates. He showed that SOlIliC of the previously commonlyused medications have now developed resistance, such as amoxicillln andco-Crimoxazolebut cephalosporins and quinoloncs arc doing quite well.

SpedIl Welcome Nole for Sympoeium 2011As Chal.rman Scientific CoIIllllittee for the last 7 Annual MedIcal Symposiaof Muhammad Medical College, MiIpw::ldw, r bave mixed feelings on theoccasion of holding ~ AnnualMedical Symposium.Holding and organizing all the previous symposia is a wondetful SlICCe8Sstory. Scientific Symposia are extremely important for any modem medicalcollege who believes in imparting upeo date knowledge, with a particularemphasis 00 local medical problema and their solutions. It hdp6 de3igl1medical curriculum appropriate to the requirements of a nation. MedicalStudents and 1unior Doctors inparticular get expedence of doing researchwork and pregeIllaliODB in front of audience which comes to attend thesesymposia from all over Pakistan. At the same time, it allows medicalprofessionals to share the latest k:nowledge and information relevant to theirspecialities with each other. Yet very few medical colleges (in public andprivate sectors) in Pakistan have been organizing scientific symposia forthiB long on such a regular basis. We at Muhammad Medical College &Hospital MiIpur.k:has take pride in the fact that we have been holding highquality symposia every year for the last 9 years. In fact, we startedorganizing these symposia even when our first batch was still in the collegeand not a single batch had passed out yet. Organising such high qualitysymposia has been made possible only with tbo help of our medicalstudents and junior doctors. Of course tbo guidance and support of seniorteachers has been of paramount importaDce in this respect. OrganisingCo:mmittee of these symposia and Administration of the College have been-----------------144 I- .ISSN: 2075-9983-APR2014-OCT2014.

ProfCSiOrSyed Zafar Abbas thanked all the audience, speabrs, doctors,organizers, wotk«s and Getz Pharma for spons«ing thiB se.m1nat.The seminar ended on scheduled time of 2 pm when all the participantswere served lunch.

Batlier, shields, publication set of the College and Slndh's trlldilional gift ofAjraJ:. were presented to all speabrs by Professor Ohulam AU Momon,Professor Noor Muhammad Memon, ProfCS9OtCaptain Rasheed, ProfessorAbdul Rahim Siyal, Qamat Habib, Abdullah Memon and Professor SyedR.azi Muhammad. Professor R.azi Muhammad aLto distributed shields ofHonour among many distinguisbed goesIJ including presidents of PMA ofnearoy cities.

and its role in causing various diseases, especially peptic ulcer. Hedescribed various treatment regimens and their success rates, ProfessorAmir Obafoor Khan of PGMI, Peshawar then gave an interactive talk on "Inflammatory Bowel Disease". He talked on epidemiology, diff«encesbetween UlC«alive Coliti8 and Crohns Disease and their extta- iDtestinalmanifestations. He discussed investigations and treatment - both to induceremission and furmaintenance of remission. Tea Break followed this talk.Although tbore were Questions and Answ« Sessions after every talk,participants continued their discussion with speakers at the tea- break also.Aft« the break, Lubna Kamani of Uaquat National Hospital Karachipresented on " Hepatitis C - past • present and futare·,. She tookaudience through history of treatment of this deadl.y virus and talked aboutthe cwreut treatment options and discussed VariOU8possibilities ofimprovement in treatment success, with the help of potential newmedications in the future. With the help of various clinical trials, shecompared the practical issnes among the currently available treatment.Professor Syed Zafar Abbas of MuhamJrJad Medical College Mirpurkhasthen talked on "Olronic Hepad.tis B- Basic ConceptS in understanding andManaging the Disease". He discussed the intemalional and nationalepidemiology and with the help of locally held studies, said that thepteValence of this illness in this region was signi&mt.ly higher than thenational avenge. He said it was a major caase ofmorbidity and monality inMlrpw:Idlas. He discussed the IIalUra.l history, varioua issues SUIroUIIdingthe investigations and treatment of the disease and the treatment of specialgroups.Last lecture of the day was the "10· S. All Muhammad Memorial SpecialLecture". This special Lecture Series has been going on for several yearsand every now and again, an expert in any field ot life is invited to talk on atopic which is nOD-medical, yet related to medical students and doctors ashuman. This year, Professor Amir Ohafoor Khan of POM! Peshawar wasselected to talk on "My life, My Teacher". Professor .Khan praised theservices of S. AliMuhammad in the field of medicine and social sector. Heexplained to the audience the main issues that mate a person legend andqUOCCdS. All Muhammad's personality as a glare example of that. He thenfocused 011 the i.mportance of the qualities of Usceo.ing and talking amongdoctors. By giving Ufe examples, he explalned why It was so important tolisten and talk to tbo palients. The described the art of history taking as oneof the most important part of medical edocation and practice.

Professor Syed R.azi Muhammad then gavo his concluding remarks andpraised those who made this seminar a suocess. He recalled Mirpurkhasseminars in Oastroenterology of previous years and hoped that the future01le6 would also be as much of education 8UccesS as always.

1tDrparthuStmIDarID ~Fourth Nalional Annual Mirpw:kbas Seminar in Oastroenterology andHepatology was held at Professor Hassan Memon Memorial Auditoliom ofMuhammad MedIcal College, MUputkhas on .l~ May 2011. Itwas verywell attended by a large nnmbet of doctors from College's attachedhospital, senior and junior faculty, final year swdents, and a large numberof doctors from widlin Mirpud:has and nearby cities including Mithi,Umet:kot,Digri. Nawabshah and Tando Allahyar.The Seminar started with recitation of Holy Qu,t:an. Shamsul Arfeen Khan,Vice Principal of the College recited fronl Holy Book and presented itatraDllalion. Professor Syed Zafar Abbas introduoed the speakers to theandience and described the sdleduled event. Professor Noor MuhammadMemon, Head of Department of Medicine at Muhammad Medical College.welcomed tbo guests and threw light on the lmportallCC of holding suchseminars of Nalional level at remote areas. Professor Sobail Al.mani ofUaquat University of Medical & Health Sciences. Presented on "Oastro­Oe8opbageal Reflux Disease". He de6cr:ibed the caoaative factors of thisdlsease and educated the audience OD the impact of too much of modem lifefast food and spicy or Oily food. With the help of video clips, he explainedthe patbo- physiology of this disease. He also discussed in detail the variousinvestigations and treatment options. Aat:nit Obouri of Isra MedicalUniversity di8cussed "Coeliac Disease". He said that tb«e was an acuteneed to raise the awatalellS regarding it among masses as well as medicalprofessionals. He described the screening and diagnostic tests andemphasized upon tbo need fur life- long strict gluten- free diet for thesuffezus. ProfeIJ8(XNoor Muhammad Memon of Muhammad MedicalCollege discussed "Helicobacter Pyleri re1ated diseases". He discussed there1a1ion of the pteValence of this infection and tbo socio-economicconditions of the society. He described the ways to investigate the infection

Following thiB award e«emony was held. Syed AliMuhammad MemorlalFirst prize for C8SC reporta was awarded toMil, S4baIt ltM:obet al, Secondpdz.e to MIl, M,lI""''' S~, et al and 1b1rd prize to Mu, SolMlau,."lI; et al. For the category of poster p:esentatlon, orl,ginal report, Firstprize was awarded to Mr. 51tJd WGftII'Ali If:.avttJ et 01, Second to MissAMl14 AmHr (fourth year) et al, and 1blrd to MUI AMM Riaz (fourthyear) et of. P'1t8l pdze for oral presentalion went toMil,SDW JtM:Ob et al,Secood to Mr. YW Artiftlt et al and 'Ibitd to !lUI RIIbiGa__, ttal.

Scientific Session V started iDUDedlately after thiB session. PrO/lUOTs,.d1-.,/ HuMiitof LUMHS presented a 8tUdy on Psycbiatric issue amongflood victims. Pro/lUOT IlII/i AlI",M Gilourl, 0Wrman Department ofMedicine. LUMHS presented on Recent Advances of Diabetes MelliwsType n. Pro/fUM Abdal s-.M_", Counselor CPSP and DeanSurguy LUMHS,gave a lecture on BrJdo8«)py in Tbe new MjllenninmLat« all tbo dl.sti.nguWIed speU«a w«c pre8CIIced.ymposium shields andbags. All the participants w«c also given a copy of Symposium Ab6trtctBook and Journal qJ Muhorttmad Medical CQlltge.

area including furth« improvement in educational and health care facilitiesand in relief efforts to the flood victims. Prof. Ghulam Ali Memoli,Pl:inclpal MMC, then offered Votes Of 'I'hanb to all panicipants,pre3eaters, workers, pbal:maceutical compaoies, organizing committee,scientific committee, guMs and stage secretaries.

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It was followed by Mubarak Hu.ssain, the neurosurgeon from MuhammadMedical College Hospital who described surgical treatment of prolapsedlumber intervertebral disc.Hem Lara from the department of ~ Obs Muhammad MedicalCollege Hospital discussed about the urinary problems in pregnancy.Later Bllal Fazal from LUMHS Presented Surgery of the Scalp defect.Prof. Faiz Muhammad Halepoto from the department of OphthaImology,Muhammad Medical College presented his paper on Tensilon test in ocularMystheniagravis.

Finally the chairman thanked the audience for participat

Vas Dev from the department of neurosurgery described the Dilemma ofoccipital extra dural hematoma.

Next speaker was Prof. Javed Rajput who shared his three years experienceon extram.ucosalinteo:opted s.inglelayer of gut anastomosis.

Next speaker was Meash Kumar from LUMHS who talked about theReptir of Scalp Defects.

Next speaker was Muhammad Ali from LUMHS who presented a casestudy of dog bite.

Qamar Un Niaa. was third speaker who presented an audit of Hysterectomyat Muhammad Medical College Hospital After her Nand La! Kala fromLUMH be gave a presentation of the bleomycin Scelrotherapy in thetteatment of Peripberal Lymphangioma.

He was asked question from Prof. Amna Memon and Prof. FaizMuhammad Halepoto. This speech was followed by a presentarl.on by Prof.Aftab Qureshi a neurosurgeons from LUMHS. He spoken onneuroendoscopy. This paper was followed by presentation by RehmatullahSoomro on Histopathological Evaluaeion of Appendices to find out the rateof negative appendicectomies and found it was 25%.

The next speaker was Prof. Amna Memon who described thecomplications of Diabetic mellitus in pregnancy.

The first speaker was Zainul Abdeen from LUMHS. He spoke on reviewof published work from UK on simulated endoscopy.

The session was hosted byProf. Javed Rajput and Rehmstullah Soomro.The session started by recitation of Holy Quran offered by Prof.Muhammad Arif.

Professor Syed R.aziMuhammad, President Society of Surgeon MirpurkbasChapter welcomed the Guests and Thanked every body for participation inthe event which is held regularly for last several years.

The session was chaired by Prof. Ghulam AliMemon, Co- Chairman wasProf. Amna Memon.

The meeting was attended by large number of surgeons from Mirputkbas.Nawabshah and Karachi.

3'" Annnal Meeting of Society of Surgeons Pakistan Mlrpurkhas Chapterwas held at Prof. Hassan Memon Memorial HaIl, Muhammad MedicalCollegeMirpurkbas 06-10-2010.

3111)ANNUAL MEETING OF SOCIETY OF SURGEONS PAKISTANMIRPURKHAS CHAPTER

Professor Syed Zafar AbbasChairman Scientific Committee

CoDege's Academic Calendar also did not allow us to hold it at abovementioned times.But much more troubling than all these factors has been the terribleweather in Mirpurkbas in particular and rest of the province in general.Tortaltial rains have bro.Un all the records this year. Floods have uprootedeven weDbuilt houses in many localities. A large number of villages havewiped off tbe surface and do not exist any more. AD kinds of cultivation inthis furtile soil have been totally destroyed. Farmers are struggling to keeptheir cattle alive. Infact, they have been struggling to keep their own livesand those of their families intact. To date, baoks of several canals havebroken or over-spilled, resulting in worsening of the already terriblesituation. Further rainfalls have been forecasted over next many days. Asalways, Muhammad Medical College &Hospi.tal bas been working day andnight to help the victims of the floods. We have done a. number of camps,mainly to look after the medioal side of the problems, but have alsodistributed food rations, cloths and cash to as many flood victims as wecould reacll. Our dynamic leadership and hard-working workers havereached out to most difficult areas of the region where people had seen theirlivelihood washed away in the rains. Professor Syed Rm Muhammad andMr. Syed Taqi MnabatutuM personally supervised and carried out reliefactivities. However, despite our best efforts under difficult condition anddespite the generous support from our friends - bothwithin and outside thecountry, the suffering has continued, and is likely to go on unul MotherNature decides to provide some relief.Undec these circumstances, we had 3 options - cancel symposium this year,postpone it and re-schedule it when the weather gets better and stabil.lze8,and stick to the already announced dates which have been widely circulatednationally and internationally. We pondered over all these options anddiscussed them with all, including students and junior doctors who havebeen involved in their projectll for the symposium. It was thought thatcancelling the programme was not an acceptable option at alll Majority feltthat postponing the symposium would also actually risk cancelling it as theAcademic activities, including tests and exams dates would approach andmay preclude holding the symposium. The bard-working and enthusiasticstudents and junior doctors therefore mostly favoured organizing it on theannounced schedule to ensure continuation of this important scientific andacademic activity without break.We are therefore holding this symposium as planned. However, we aredoing so with simplicity and in a professional manner. Our thoughts arewith the victims of the flood, and our prayers are with them.We also praythat Almighty Allah provides the people maximum relief and furtherenhance the thirst of scientific knowledge and humanitarian work: inourstudents and workers.ion in the meeting .

iIIstromental in sotting out all problems. Organising sucb bigh qualitysymposia even in the big cities with all the facilities is not an easy task,particularly on a regular annual basis. Doing this for many years without abreak in the remote area of Mirpurkhas with little interms of intra-structurewas many folds mare difficult. However, with the help of all concerned,including support of phaJ:maceuticalcompanies, we have beat successful indoing this for the benefit of our students and that of all doctors, particularlythose who reside in and around MirpIn:k:has with little or no access to theprograms like these in bigger cities and institutions. These symposia, andother seminars which we have beat holding here, have meant that for tbefirst time in the history of this region, these doctors bad the opportunity tohear the s~-art lectures on hot medical topics from speakers of nationaland intemational reputation here at their door-steps.So, in view of all above, organi.zation of these symposia has not beat easy.However. this year bas been particularly difficult We have been boldingthese annnal symposia every year in August I September or occasionally inOctober, after students have come back from their summer vacations andhad ample time to prepare their projects without clashing with their otheracademic activities. However, the Lunar CaI.eadar and Gregorian Caleadarhave overlapped this year such that Rarnadban and Bid festivals did notallow us to bold symposium in August or early September this. Moreover,

• ISSN: 2075-9983-APR 2014-OCT 2014 1 461 _

The covering letter should be signed in original by all authors. It should state that the article is not under consideration forpublication elsewhere, that the authors are responsible for the accuracy of references cited, and consent to be coauthors in thesequence indicated on the title page.

Covering Letter:

References from a chapter Ina boo~Bhatia, MT (1990): Practical palliative care: cancer pain program for developing countries. In: Lipton S, Tunks E, Zoppi M, Ed. Advances inpain research and therapy, Vo1.13,New York, Raven Press, p. 303 - 307.

References from books:Randall F, Downie RS (1999) Palliative care ethics: A companion for all specialities. 2nd edition, Oxford, Oxford University Press, pp 52-55.

References from JoornaJs:Thomas, DW and Owen, H (1988): Patient controlled analgesia: the need for caution. Anaesthesia, 43:770, 2002.

References:References should be listed in alphabetical order without numbering (Harvard style referencing). Anthors are responsible for the accuracy ofallreferences. Lengthy direct quotations, tables or figures from previously published sources must be accompanied by the written permissionof the copyright holder. The list of references mnst be typed double spaced. The type and punctuation of references are illustrated as follows:

Tables:Each table should be typed double-spaced on a separate sheet of paper without vertlcallines Tables should be numbered by the Arabic system,and must include a clear and concise title at the top. Explanatory footnotes may beused ifneeded and should define all abbreviations used.Sufficient information must be included so that the table can be understood by itself, Tables should not be substituted for data that can bedescribed adequately in two or three sentences in the text.Figures and Legends: Figures should not be substituted for tables unless understanding is significantly enhanced by the use of a figure. Figuresare numbered by the Arabic system. Legends should define any abbreviatious or symbols found in the :figures.

Text:Inresearch articles the introduction must state the purpose or objective of the study. A detailed literature review should beavoided in theintroduction. Methods of statistical analysis should be identified in the materials and methods section. Any statistical software programs usedshould be mentioned. The text should comment on, but not repeat, the details in tables or captions. The discussion should include references toliteramre and be used to raise inlplications of the results. Unfounded conclusions should beavoided.

KeyWords:Three to five key words for indexing should be listed in alphabetical order,

Abstract:An original research report should be accompanied by a stIUctured abstract of 250 words or less, having the following headings: Aim, Methods(study design, participants, outcome measures), Results (measurements and level of statistical significance when appropriate), and Conclusions(directly supported by data, along with any clinical implications). For case reports, a structured abstract of less than 125 words should beprepared using the following headings: Background (importance of the subject matter and specific purpose of the report), Case (Summary ofpertinent features of the clinical features, treatment and outcome) and Conclusion. For all other types of articles, the abstract should be a singleparagraph of no more than 250words.

Electronic submissions are welcome and IWIIUJSCripts can be submitted at jmmc@lDIIlC.edu.pkIfarticle is submitted electronically, there is no need to send a hard copy. However, the copyright form should be sent within two weeks ofsubmission of the article. Articles can, alternatively, be sent as hard copy to:Editor JMMC, Muhammad Medical College, Hyderabad Road, Mirpurk:has 69000. Sindh

Specifications:The entire manuscript must be typewritten double-spaced on A4 paper with margins of at least one inch on each side. The font size should be12. Each page should be numbered consecutively, in the following order: title page, abstract and key words, main text, tables, references andfigure legends. The manuscript should be accompanied by a disc.

Title Page:The first page should have the title of the article, authors' names, designations, departments, institution and degree(s) (maximum of two).Financial support mnst be acknowledged. The name, address, telephone and FAX numbers, and email address of the coaesponding authorshould be listed on the title page. A short running title of no more than 30 characters and spaces should be provided at the bottom of the titlepage.

The Journal of Muhammad Medical College (JMMC) is an interdisciplinary, peer reviewed journal published biannually. The journalwelcomes contributions in the following sections: original articles on clinical research, psycho social, ethical, medical education, medicalstudents and paramedical issues; review articles, clinical guidelines, case reports, case discussions, narratives, reports on important meetings,book reviews, short reports and letters to the editor.Published articles are the property of the Journal of Muhammad Medical College.

INSTRUCTION TO AUTHORS

47 ...• /SSN: 2075-9983-APR 2014-OCT 2014 _

NOTE: Pkase sign and return this Letter of Untkrlaking immediately.

As per ICMJE guide lines the anthorship should be based on the following criteria:1. Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data.2. Drafting the article or revising itcritically for important intellectual content.3. Final approval of the version to be published. All those who meet the above three conditions are eligible tobe included as Authors in

the manuscript.When a large multi center group has conducted the work. the group should identify the individuals who accept direct responsibility for themanuscript. These individuals should fully meet the criteria for authorship contributor ship defined above. Acquisition of funding,collection of data, general supervision of the research group does not qualify any one to bean author. All contributors who do not meetthe criteria for authorship should belisted in the acknowledgment section. Those who provide technical support, writing assistance, ordepartment chair who provided just general support should also bementioned in acknowledgment. Itis also important the all those whosenames appear in acknowledgement must have given permission to beacknowledged.

Authorship Criteria

Note: T1u!manuscript mustcontain a paragraph tUscribing the contributWn of each autlwr otherwise the first three autlwrs will beretomed and aUothers listed as aut/wrs will be shifted to the Aclawwkdgtmumt section.

Name: Sing~-------Name: Sing. _

Name: Sing~ _Name: Sing. _

Name: Sin,&- _Name: Sing. _

FullName of Authors: (Use Capital letters)

This is to confirm that the Manuscript entitled submitted for publication in Biannual "Journal ofMuhammad Medical College" has been read and approved by all authors, has not been published inany other journal, is being exclusivelycontributed to Journal of Muhammad Medical College and if accepted for Publication, itwill not be published in any other medical periodicalin Pakistan or Overseas. We also transfer all copyrights of this manuscript to Journal of Muhammad Medical College.Please also note that there is no publication charge for articles.(This letter must be signed by all authors).

DearSh,

The Editor in Chief,Journal of Muhammad Medical College,Hyderabad RoadMirpurkhas. 69000Pakistan.

Date: _

LEITER OF UNDERTAKING

8,969,383

40,5004,989,8(,2

GRAND TOTAL FOR 2012-2014

66,9393,979,521

FREE CAMPS'

6.206355.750

TOTAL

Medicines routinely given free of chargeatOPD