Safety Profile of Methotrexate Therapy in Patients With Rheumatoid Arthritis.

Objective The objective of this study was to determine the safety profile of methotrexate (MTX) therapy in patients with rheumatoid arthritis Study design This was a cross-sectional observational study. Place and duration of the study The study took place in the Division of Rheumatology, Lady Reading Hospital Peshawar, from May 2020 to August 2021. Methodology A total of 411 patients with rheumatoid arthritis and receiving MTX in the dose of 10-20 mg/week for at least four months were included by consecutive sampling. All patients were followed for four months for the development of cytopenias, deranged liver function tests, renal function tests, fever, and gastrointestinal upsets. Data were recorded on a pro forma. Results There were 237 (57.6%) females and 174 (42.4%) males. The female to male ratio was 1.4: 1. The average age of patients was 43.01 years + 17.1 SD with a range of 18-72 years. Gastrointestinal side effects were the most common, found in 49 patients (11.9%), followed by mucocutaneous side effects in 35 patients (8.5%) and fever (34 patients, 8.3%). Conclusion Every one in three patients developed some adverse effect within six months of methotrexate therapy. Moreover, we conclude that gastrointestinal side effects were the most common side effects seen.

Career Aspirations Of Junior Doctors In Pakistan: Exploring Reasons Behind The Brain Drain.

BACKGROUND: Mass medical migration from Pakistan to more developed counties pose a threat to the professional resources of Pakistan. The aim of our study is to assess magnitude of the brain drain and to assess reasons behind it. METHODS: A Cross-sectional study, using convenience non-probability sampling, with sample of 201 Ayub Medical College graduates. A simple questionnaire was designed on Google Forms, comprising of three sections including bio data, intentions to emigrate and the last part evaluating work environment, training and personal factors associated with the desire to train abroad. Data was analysed using SPSS version 20.0, descriptive statistics were calculated and Chi square test was used to determine association between various groups of push and pull factors and the intention to train abroad. A significance level (p-value) of less than 0.05 was used. RESULTS: Over half (63.68%) of our participants wanted to emigrate, and out of the remaining 71.6% would consider it in the future if given the opportunity. Overall, more males wanted to train overseas as compared to females, and the United Kingdom was the most popular destination. The leading factor push factors behind wanting to move abroad were quality of training and a poor work environment. While family commitments and costly examinations were the main reasons to stay in Pakistan. CONCLUSIONS: A significant number of young doctors are planning on pursue training/careers abroad. If this large-scale brain drain is not addressed on time, it can have various implications in the future. Hence the Government and Medical authorities must take action in order to prevent further loss.

The Association Between Refractive Errors and Breastfeeding in Pakistani Children: A Case-Control Study.

Objective The aim of this study was to determine the association between breastfeeding and the occurrence of refractive errors (REs) among children. Methodology This was a (retrospective) case-control study carried out between December 1, 2021, and March 30, 2022, at the Basheeran Umar Eye Hospital in Islamabad, Pakistan, and Sheikh Khalifa bin Zayed Al Nayhan Combined Military Hospital in Rawalakot in Kashmir, Pakistan. A total of 200 participants between the ages of five and 16 years (106 cases with REs and 94 controls without REs) were included in this study. After obtaining informed consent from the parent accompanying the participant, the parent was further interviewed to extract information regarding biodata, breastfeeding, and other parameters including parental myopia, the number of hours spent on outdoor activities, on gadgets, and doing near work; this data was entered into a questionnaire. The participant's visual acuity was then checked using the Snellen chart. Data were analyzed using SPSS Statistics version 20.0 (IBM Corp., Armonk, NY) and statistical tests such as multivariate regression analysis and chi-square were carried out and odds ratios (OR) were calculated. Results There were 74 (37%) females and 126 (63%) males, with 67.5% residing in urban localities and only 32.5% hailing from rural areas. Testing revealed no significant association between REs and area of residence (p=0.97) or the gender of the participant (p=0.74). Hypermetropia was the most common RE among our participants (59.4%). Breastfeeding was significantly associated with errors of refraction (OR: 27.852, 95% CI: 3.686-210.45, χ2=21.680, p<0.001, degrees of freedom: 1), and we observed a lower risk of REs in children who had been breastfed. There was no association between REs and the number of hours spent outdoors per week or the number of hours spent using gadgets per week. However, there was a significant association between the development of REs and the duration of breastfeeding and the number of hours spent on near work. Conclusion This study demonstrates that breastfeeding plays a protective role in the prevention of REs. The type of breastfeeding also had a significant effect on the development of REs, i.e., children exclusively breastfed (regardless of the duration of breastfeeding) were less likely to develop errors of refraction in the future.