An indirect evaluation of medical residents' research writing skills by research synopsis review.

OBJECTIVE: To scrutinise the research proposals of medical residents fo inadequacies in writing dissertation synopsis. METHODS: The analytical cross-sectional study was conducted at the regional centre of the College of Physicians and Surgeon Pakistan, Islamabad, Pakistan, and comprised synopsis from January t June 2020 of postgraduate residents attached wit different hospitals in Rawalpindi and Islamabad. For evaluation purposes, an institutional checklist was used that had domains: general, epidemiological, statistical, and bibliographical review. These were assessed by a single epidemiologist Data was analysed using SPSS 21. RESULTS: Of the 400 research proposals, 224(56%) were submitted by male and 176(44%) by female residents. Also, 208(52% proposals were submitted by residents at public-sector hospitals, a 114(28.5%) by those at private-sector hospitals, while 78(19.5%) were from military hospitals. Significant association of errors was found with training institutions, speciality an duration of training (p<0.05). No gender difference was seen (p>0.05). CONCLUSIONS: Majority of the research proposals lacke correcunderstanding of all the concepts related to research. Difference in research writing skills across specialties and trainin institutions may be related to the lack of availability o research assistance and good mentorship.

Impact of pharmacist-led interventions on diabetes management at a community pharmacy in Pakistan: A quasi-experimental study.

OBJECTIVE: To determine the impact of pharmacist-led interventions on satisfaction, disease state knowledge and perception of self-management of diabetes patients. METHODS: The interventional, quasi-experimental study was conducted in Bahawalpur, Pakistan, from December 1, 2018, to June 30, 2019, and comprised data data from a community pharmacy of patients who had diagnosed type 2 diabetes for at least one year. Both non-pharmacological and pharmacological interventional tools were used as part of a care package administered by pharmacists. The modified version of the Diabetes Disease State Management Questionnaire was used to assess patient satisfaction, disease state knowledge and perception of self-management. Data was analysed using SPSS 20. RESULTS: Of the 100 patients initially enrolled, 80(80%) completed the follow-up. The mean age of the sample was 49.33±8.31 years. Of the total, 63(78.8%) patients had diabetes for <10 years. A significant improvement was seen in patient satisfaction (p=0.04), disease state knowledge (p=0.009) and self-management of diabetes (p=0.02) scores after the intervention. CONCLUSIONS: Interventions by pharmacists in a community pharmacy resulted in significant improvement in patient satisfaction, disease state knowledge and perception of self-management among type 2 diabetes patients.

General practitioner's (GP) home management guidelines for COVID-19 patients: Guidelines.

Carefully developed guidelines for clinical practice serve as an important tool for desirable changes in health care of a country. They act as an important source of information for physicians as well as policy makers and educational institutions thereby improving the quality of care of patients. The outbreak of Novel Coronavirus Disease (COVID-19) in 2019 has placed a huge burden on health care system globally. The first line health care provider bears the brunt of this disease with limited and varying sources of information as most of the patients present to them. Varied presentation of disease along with limited hospital facilities for admission is a huge challenge for appropriate management and referral of these patients. These guidelines, prepared after reviewing the interim guidelines in literature, will serve as a source of guidance for GPs to manage mild cases at home and refer those with moderate and severe disease to tertiary care hospitals.

Knowledge and perception about bioethics: A comparative study of private and government medical college students of Karachi Pakistan.

INTRODUCTION: Ethics plays an elementary role in current medical practice. Recent advancement in medical technology and its implications have raised many ethical issues and dilemmas in clinical practice, requiring dire needs for incorporation of bioethics into medical curriculum. AIM: The objective of this study is to assess the base line knowledge and perception of medical students regarding bioethical issues in clinical practice based on exposure to formal bioethics teaching in their medical curriculum. SETTING AND DESIGN: This cross sectional study was conducted among medical students of a private and government medical college who were currently enrolled into third to fifth year MBBS. METHODS AND MATERIAL: A pretested questionnaire was used to collect data. A structured questionnaire consisting of 27 questions was used for this study. An Ethics Review Committee approval was taken. ANALYSIS: Data analysis was done under SPSS version 17 and frequencies were calculated. RESULTS: A total of 285 medical students, 145 from private and 140 from government medical college participated in this study. Private college medical students (57%) had slightly better knowledge of bioethics as compared to the government students 43%. CONCLUSION: The study clearly signifies the need of teaching bioethics in the both the medical colleges. Our findings provide strong evidence for major educational initiatives related to bioethics education in medical curriculum.

Effect of dietary supplementation of black seed (N. Sativa L.) on lipid profile of patients suffering from diabetes.

Diabetes is a chronic metabolic problem closely related to cardiovascular disease leading to premature death. Dyslipidemia is an important risk factor responsible for cardiovascular disease in patients with diabetes. This paper is based on review of articles published to observe the effect of N. Sativa (black seed) on lipid levels in patients suffering from Diabetes Mellitus. A search of indexed papers and clinical trials was done using MEDLINE and PubMed and Cochrane search engine. All studies assessing the effect of N. Sativa ingestion on lipid levels among diabetics (animal or human) were included. A total of 12 trials (6 human studies and 6 animal studies) fulfilling the inclusion criteria were reviewed. Majority of human and animal trials done among humans and animals with diabetes or metabolic syndrome demonstrated reduction in weight and improvement in serum lipid levels including decrease total lipids, triglycerides, LDL levels. However, increase in HDL level showed questionable results. N. Sativa L and its different preparations can be used as an adjuvant with lipid lowering drugs for control of lipids however its role as a main therapeutic agent cannot be recommended and more metanalysis using standardized preparations with a close watch on methodological short falls is suggested to prove its role.

Role of garlic usage in cardiovascular disease prevention: an evidence-based approach.

Introduction. Rapidly growing prevalence of cardiovascular disease is a major threat for the developed as well as developing world warranting urgent need of intervention. Complementary and alternative medicines are gaining popularity among general population because of their safety profile and easy administration. Garlic, in particular, is considered to be one of the best disease-preventive foods because of its potent and widespread effects. This study was done to find out the role of garlic usage in cardiovascular disease prevention. Methodology. Major databases including Google, PubMed, MEDLINE, and Cochrane library view were used for the literature search. Clinical trials conducted on humans assessing role of garlic usage in cardiovascular disease prevention and the possible mechanisms responsible for such therapeutic actions were assessed. Results. Various clinical trials and meta-analyses conducted have shown positive impact of garlic in cardiovascular-disease prevention especially its effects on lipid levels; however, some contradictory results are also reported. Similarly, its effects on hypertension control, and platelet are also mild with limited data availability. The possible reason for these inconsistent results is the difference in preparations with diverse composition, variations in sulphur content present in different garlic preparations used, and methodological variations in subject recruitment, duration of study, dietary control and so forth. Conclusion. Garlic can be used as an adjuvant with lipid-lowering drugs for control of lipids, however, its role as a main therapeutic agent cannot be recommended and it is suggested that more meta-analyses using standardized preparations with a close watch on methodological shortfalls should be conducted to prove its role.

Frequency and associated factors for care giving among elderly patients visiting a teaching hospital in Karachi, Pakistan.

OBJECTIVE: To study frequency and associated factors for care giving among elderly patients visiting a teaching hospital in Karachi, Pakistan. METHODOLOGY: A cross sectional questionnaire-based study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital (AKUH) Karachi, Pakistan from September to November 2009. All individuals, visiting the CHC and aged 65 years or above were interviewed after taking written informed consent. RESULTS: A total of 400 elderly completed the interview. Majority were females, 65-69 years age, More than half of the individuals ie: 227 (85%) had received Care Giver experience for assistance and among these 195(72%) had care provided by an immediate family member. A large proportion of them stated that their Care Givers managed to provide less than four hours in a day for care giving. Around 37% showed substantial improvement in their relationship with the care givers. About 70% of the respondents stated that the care provided by the Care Giver improved their quality of life. CONCLUSION: Elderly care is provided by majority of the family members resulting in increased satisfaction level, however small number still not satisfied due to unfulfilled need of these older people. This demands that efforts should be made to strengthen the family support by increasing awareness regarding elderly care and arranging support system by the government.

Frequency and risk factors for intestinal parasitic infection in children under five years age at a tertiary care hospital in Karachi.

OBJECTIVE: To assess the frequency and risk factors for intestinal parasitic infection in children under five years age at a tertiary care hospital, Karachi. METHODS: A cross sectional survey of 269 children under five years was conducted at a tertiary care hospital on a pretested self-administered questionnaire. Stool smears were examined under light microscope with direct saline smear and lugol's iodine solution. Parasitic detection was confirmed by formalin ethyl acetate concentration method. RESULTS: Stool test positive for parasites was found in 185 (68.8%) children. Majority of children 144 (53.5%) were among 4-5 years of age. Less than one third (20.4%) showed moderate malnutrition (p = 0.05) while 44.6% were found to have mild anaemia (p < 0.001). Giardia lamblia was the most common parasite (25.3%) identified. Only 40% of children were found to wash hands with soap after using the toilet (p < 0.001). Eating mud/pica was present in 36% children (p < 0.001). Less than half (48%) of the mothers said that they do not purify drinking water (p < 0.001). CONCLUSION: The frequency of intestinal parasitic infection was found to be high among children under five years. Major contributory factors were lack of hand washing and drinking unpurified water along with habit of eating mud/pica. This study identifies at-risk population of less than five years of age who could benefit from health education of parents.

Knowledge of medical students regarding diabetes mellitus at Ziauddin University, Karachi.

OBJECTIVE: To assess knowledge among medical students of Ziauddin University regarding Diabetes Mellitus. METHODS: A cross sectional survey of medical students from first year to final year at the medical college was conducted on a pretested self-administered questionnaire. Students were divided into preclinical and clinical years for analysis. RESULTS: A total of 366 students participated, with 145 (39.6%) from the preclinical group and 221 (60.4%) from the clinical group. Overall 89% students knew that diabetes is a metabolic disorder, 78% knew that pancreas is the site of insulin production and 77% students correctly identified main target organ of insulin. Regarding presentation, 67% said polyphagia, 50% said weight loss while only 18% claimed pruritus vulvae to be the presenting symptom. Majority from the clinical group (95%) while 86% of preclinical group knew about risk factors for diabetes (p = 0.003). Regarding prevention, 89% of clinical group knew that diabetes is preventable but 49% preclinical students did not have an idea of prevention (p < 0.001). A large number from clinical group (87%) said that there is some criteria of screening for diabetes while only 30% of preclinical group knew about screening (p < 0.001). Correct diagnostic criteria for diabetes according to WHO was identified by 55% clinical and only 6% of preclinical students (p < 0.001). Over two-third (78%) of clinical while only 50% of preclinical students said that diabetes should not always be treated with drugs (p < 0.001). CONCLUSION: The knowledge of students about diabetes was more in the clinical group as compared to the preclinical group, whereas, overall knowledge of the students was adequate. Medical students are the future physicians, therefore the medical curriculum should lay emphasis on educating students, patient based clinically oriented approaches for dealing with this epidemiologically important disease.

Knowledge, attitude and perception of water pipe smoking (Shisha) among adolescents aged 14-19 years.

OBJECTIVE: To study the impact of educational intervention on knowledge, attitude and practices with regard to water pipe smoking among adolescents (14-19 years old) in Karachi. METHODS: A cross-sectional survey of adolescents aged 14-19 years studying at different educational institutions of Karachi, Pakistan was conducted through multistage sampling on a pre-tested self-administered questionnaire. They were divided into high, middle and lower socioeconomic strata on the basis of monthly fee structure. The impact of health messages was assessed two months after education sessions through post-test of only high and middle socioeconomic strata. RESULTS: A total of 646 students were surveyed for the pre test and 250 students for the post test. A significant association was found for water pipe smoking among the socioeconomic class (p < 0.001). Water pipe is more addictive as compared to cigarettes was marked by more students after the sessions (54% vs 68%; p < 0.001). A significant difference was seen for water pipe being more socially acceptable (58% vs 80%; p < 0.001), it is part of our cultural heritage (29% vs 58%; p < 0.001). CONCLUSION: Shisha smoking was more prevalent among the high socio economic group, which might be because of the cost, accessibility and availability. The knowledge of the students regarding water pipe smoking improved after the health awareness sessions.

Knowledge regarding breastfeeding practices among medical students of Ziauddin University Karachi.

OBJECTIVE: To assess knowledge among medical students of a private medical college regarding breast-feeding practices. METHODS: A cross sectional survey of medical students from first year to final year at a private medical college was conducted on a pretested self-administered questionnaire. Students were divided into preclinical and clinical years for analysis. RESULTS: A total of 344 students participated with 159 (47.6%) from the preclinical group and 185 (53.7%) from the clinical group. The mean age of respondents was 22 +/- 1.5 years. Overall 69% students knew that breastfeeding should be initiated immediately after birth, 42% said that exclusive breastfeeding should be continued for 4-6 months and 33% said that weaning should be started between 4-6 months. Regarding giving colostrum to the newborn, 14% students felt that it should be discarded and 12% from both groups thought that colostrum was harmful. Over two-third (76%) from clinical group and 61% from preclinical group were of the opinion that breastfeeding should be started immediately after birth (p = 0.009). Correct age to start weaning was identified by 71% of the clinical group, whereas, the preclinical group stated it to be 7-9 months of age (p < 0.001). CONCLUSION: The knowledge of students regarding breastfeeding was more in the clinical group as compared to the preclinical group, whereas, overall knowledge of the students regarding breastfeeding was low. Medical students being the future physicians will be the first line in dealing with mothers and breastfeeding related problems. The medical curriculum should lay emphasis on counseling regarding maternal and child nutrition.

Awareness of hypertension among patients attending primary health care centre and outpatient department of tertiary care hospital of Karachi.

OBJECTIVE: To compare awareness of hypertension among patients attending Primary Health Care Centre (PHC) and outpatient department (OPD) of a tertiary care hospital of Karachi. METHODS: Cross sectional survey of patients more than 18 years of age without any complication of hypertension in a squatter settlement of Karachi through non-probability convenient sampling. RESULTS: A total 202 patients were approached, 49 (24%) were males and 153 (76%) were females. Majority of the patients attending tertiary care OPD (80%) and 56% from PHC group believed that hypertension could lead to cardiovascular disease (CVD). On inquiring the duration of taking antihypertensive drugs, 61% from tertiary care OPD group and 31% of PHC group said they are taken only for few months (p < 0.001). Over two-third (77%) of patient of tertiary OPD were not doing exercise and not avoiding oily and heavy food to keep their weight under control. Large number of OPD patients (91%) used oil for cooking in comparison to PHC group (78%) who utilized ghee (p < 0.001). CONCLUSION: This study showed a marked difference in awareness regarding hypertension in urban slum and middle class community, which can be attributed to the level of education. This outcome reveals need for more awareness campaigns especially in the squatter settlement with special emphasis on lifestyle modifications along with pharmacological therapy for the better control of hypertension.

Risk factors assessment for hypertension in a squatter settlement of Karachi.

OBJECTIVE: To assess the risk factors for hypertension in adults (age more than 15 years) in a squatter settlement of Karachi. METHODS: Cross-sectional survey of adults more than 15 years old in a squatter settlement of Karachi through random sampling method. RESULTS: A total of 327 adults were approached, 165 (50.5%) were males and 162 (49.5%) females. Blood pressure was measured in 63 (38%) males and 135 (83%) females. Out of which, 11 (17.5%) males and 19 (14%) females were screened hypertensive. Hypertensives were older as compared to normotensives (p < 0.001). The mean BMI of hypertensives (25.6 +/- 4.5 kg/m2) was significantly higher (p = 0.008) than normotensives (22.9 +/- 5.0 kg/m2). Hypertensives were 9.7 times more likely to be diabetic as compared to normotensives in this study (p < 0.001). On analyzing the relationship of hypertension with other variables, no significant difference was noticed for education (p = 0.68), smoking status (p = 0.46), family history (p = 0.31) and occupation (p = 0.27). CONCLUSION: Prevention and control of hypertension is essential as the life expectancy is increasing in developing countries as well. The main emphasis according to this study, should be on controlling the BMI through weight reduction and regular exercise. Awareness about the risk factors for hypertension among the population is required to decrease the double burden on the society.