Information Seeking Practices and Availability of Smart Devices Among Healthcare Professionals in a Lower-Middle-Income Country: An Analysis From Pakistan.

Introduction Evidence-based medicine (EBM) is a principle that integrates clinical experience with relevant information available to provide adequate healthcare. It requires access to current medical literature. This paper analyzes the information requirements of a lower-middle-income country (LMIC) and the resources available and preferred by medical professionals. Methods A survey-based cross-sectional study was carried out among 160 participants, ranging in expertise from students to attending physicians in Karachi, Pakistan. The survey comprised questions to assess the clinical background, technology access, need for health-related information, and the preference for resources to obtain that information in different scenarios. They were also asked if they use PubMed and their recommended methods to improve information access. Statistical Package for the Social Sciences (SPSS; IBM, NY, USA) software was used for all analyses. Results A basic mobile phone (with limited internet connectivity) was the most common device used at home (n=159; 99.4%) and work (n=141; 88.1%). No smart devices were available to 28 (17.5%) participants at work. Internet connectivity was available for 155 (96.9%) participants at home but only for 118 (73.7%) participants at work. About one-third (n=49; 30.6%) experienced questions arising in practice two to four times a day, and half of the participants (n=80; 50%) were very likely to look up a reference. The most common resource for the majority of given clinical scenarios was a senior colleague. At the same time, medical websites (Medscape, Up-to-Date, WebMD) were the first choice for a non-specific general medical query. About 68.75% (n=110) of participants claimed to use PubMed in daily practice. The most common reason for not using PubMed was the ease of using other search engines (like Google). Conclusions Improved access to the internet and well-reputed journals can enhance the practice of EBM in Pakistan. Limitations of technological access must be considered while designing information resources in lower-middle-income countries.

Frequency and Predictors of Pacifier Use in the Low Socioeconomic Group of Karachi, Pakistan: A Cross-Sectional Study.

Background Pacifier use has been popular for ages. They are prevalent all over the world because of their various perceived benefits. On the other hand, there is a common belief that they do carry health risks as well. Due to these contradicting belief systems, the frequency of their use, and the factors that determine them, need to be thoroughly evaluated. Since Pakistan is a developing country with a low literacy rate, it can be implied that a vast majority of the country's population may lack awareness regarding the advantages and disadvantages of pacifier use, making them incapable of weighing associated risks versus benefits. The data evaluating these factors in this region are however scarce in the published literature. We, therefore, aimed to highlight the frequency and predictors of pacifier use in the low socioeconomic group of Karachi, Pakistan. Materials and methods A descriptive, cross-sectional study was conducted on a sample of 300 mothers visiting a tertiary care hospital in Karachi, Pakistan. We included mothers who had at least one child under the age of two years, and whose child did not have any oro-nasal anomaly that could prevent them from sucking a pacifier. Data were collected using pre-tested questionnaires and analyzed using the Statistical Package for Social Sciences (SPSS version 23.0, IBM Corp., Armonk, NY, US). Frequencies were calculated and presented in the form of tables. The chi-square test was used to determine the significance of all categorical variables. A P-value of <0.05 was considered to be statistically significant. Results Almost half of our respondents (49%) gave pacifiers to their children. A significant number (59%) of these mothers were uneducated. Almost all (97%) of the users had annual household income less than 15,000 Pakistani rupees (PKR); 34% were primiparous and more than two-thirds (71%) had a normal vaginal delivery. Out of all the factors, maternal age less than 20, annual household income less than 15,000 PKR, and primiparity were significantly associated with pacifier use in mothers (P<0.05). Only a half of the users (51%) cleaned the pacifiers by boiling; one-fourth (25%) washed it with water only; while 18% washed it with soap and water. The majority (84%) of the mothers used the pacifier to soothe the baby when upset. Among mothers who did not use a pacifier, about a third (30%) did not do so as they believed it's a bad practice. About one-fourth (27%) believed it was unhygienic. Conclusions Our study highlights the gap in the awareness of mothers regarding pacifier use. Using this data, we can target to disseminate specific information to this population to integrate safe and healthy child care habits in society.

Comparison between blood pressure readings using a mercury versus an aneroid sphygmomanometer.

OBJECTIVE: For more than a century since its introduction, mercury sphygmomanometer (HgS) had been the mainstay for office measurement of blood pressure (BP). In light of the environmental and health hazards associated with mercury, there is a need to replace it with mercury-free alternatives all over the world. We aimed to validate the widely used aneroid sphygmomanometer (AnS) by comparing its BP readings against BP readings taken with an HgS. METHODS: We compared the BP readings using AnS vs. HgS on a sample of 300 patients of 18 years or older age admitted to a tertiary care hospital in Karachi, Pakistan. RESULTS: The differences between mean HgS and AnS BP readings were found to be statistically significant (P-value <0.01). The mean systolic blood pressure (SBP) readings of the two devices were still significantly correlated (r = 0.989; P < 0.01). Similarly, the mean diastolic blood pressure (DBP) readings were also significantly correlated (r = 0.988; P < 0.01). The aneroid device identified a higher proportion of hypertensive participants compared to the mercury device. CONCLUSION: The difference in the two devices used was found to be significant; however, the readings were correlated with each other. The AnS significantly overestimated BP readings, thereby identifying a higher proportion of hypertensives as compared to the HgS. There is a considerable room for improvement in the accuracy of the AnS, only then an accurate and a well-calibrated AnS could provide an acceptable alternative to the use of the HgS.

Vomiting in Neuromyelitis Optica: An Atypical Presentation.

Neuromyelitis Optica (NMO), also known as Devic's disease, is a demyelinating disorder of the central nervous system (CNS) that majorly involves the optic nerves and the spinal cord. It is an idiopathic and an autoimmune disorder. The patient typically presents with symptoms pertaining to the eye or spinal cord, such as a decrease in visual acuity, visual field defects, pain in the eyes, loss of vision, numbness, and weakness of the limbs with or without bladder dysfunction. Vomiting, however, is an atypical presentation of this disorder. We report here a case of an 18-year-old female who presented to our tertiary care set-up with a one-month history of intractable non-bilious vomiting and dull epigastric pain. After going through several initial investigations and being discharged home, she returned after five days with complaints of intractable vomiting, double vision and inability to stand or walk. Later, the presence of anti-NMO antibodies led to the diagnosis of Neuromyelitis Optica Spectrum Disorder (NMOSD). Through this case, we highlight the importance of considering NMO in a patient presenting with intractable vomiting to enable prompt diagnosis and treatment of the disease, thus preventing further disability.

Awareness of Hazards of X-Ray Imaging and Perception Regarding Necessary Safety Measures to be Taken During X-Ray Imaging Procedures Among Patients in Public Sector Tertiary Hospitals of Karachi, Pakistan.

Background X-ray imaging is a common procedure performed on a regular basis for diagnostic purposes all over the world. The use of X-rays is increasing rapidly with the introduction of new radiation-oriented therapeutic practices. Although it carries significant diagnostic benefits, extensive exposure to X-ray imaging has been shown to be associated with multiple dose-dependent health risks. Awareness and knowledge among patients regarding the effects of X-ray imaging, therefore, becomes important. Through this study, we aimed to assess the knowledge and awareness of the hazards of X-ray imaging among different groups of patients visiting two of the public sector tertiary hospitals in Karachi, Pakistan. We also aimed to evaluate the necessary safety measures undertaken during X-ray imaging in these hospitals, and the perception of patients regarding the importance of these measures. Materials and methods A cross-sectional study was conducted in October and November 2018 at two well-known public sector tertiary care hospitals, Dr. Ruth KM Pfau Civil Hospital, Karachi and Jinnah Postgraduate Medical Centre, Karachi. A non-probability convenience sampling technique was adapted to recruit 200 participants for the study. A pretested questionnaire was used to assess the knowledge of radiation among patients and their perception regarding the necessary safety measures required to be undertaken during the X-ray imaging procedure. Data were entered and analyzed using the IBM Statistical Package for the Social Sciences 17.0 (IBM Corp., New York, USA). Frequencies were calculated for individual variables. Chi-square test was employed to measure the relationship between categorical variables. A p-value of <0.05 was considered to be significant. Results Out of 200 participants, 58% knew what radiation was, 42% did not. The relationship between the level of education of patients and the awareness of the term 'radiation' was found to be statistically significant (p-value = 0.003). Television was the most common source of information (65.5%). One participant (0.5%) thought that it was possible for X-ray imaging to cause cancer. Similarly, only one participant (0.5%) thought that it could cause decreased fertility, five participants (2.5%) thought it could cause burns, seven (3.5%) thought it could cause cataract, and 20 (10%) were of the view that anemia could be caused. The majority of the participants (80.5%) thought that a lead sheet was important during the X-ray procedure for safety and protection. Most participants (71.5%) said that they were never provided with any such lead sheets. When asked if the participants requested for a lead sheet if not provided, the majority (71%) denied requesting for it. On analyzing, we found that a higher percentage of uneducated participants denied requesting a sheet compared to the educated ones. The relationship between the level of education and the choice of requesting for a lead sheet was found to be statistically significant (p-value =0.012). Conclusions The patients visiting the public sector tertiary care hospitals of Karachi seem to lack the knowledge and awareness regarding the hazards of ionizing radiations and the necessary safety measures required to be undertaken during X-ray imaging. More awareness programs should be conducted to increase the level of patients' awareness to protect them from unnecessary health risks.

Back Pain: A Rare Presentation of Takayasu Arteritis.

Takayasu arteritis (TA) is a chronic inflammatory large-vessel vasculitis of the aorta and its major branches. It is a relatively rare disease, which presents with a wide spectrum of clinical features. Back pain is, however, rarely described to be a presenting symptom of TA. We report a case of a 28-year-old female with no known co-morbidity, who presented with back pain along with intermittent fever, dry cough, and significant weight loss. After an extensive inpatient workup, a computed tomography (CT) scan with contrast of chest and abdomen revealed evidence of vasculitis involving aorta, common carotid arteries, renal arteries, common iliac arteries as well as external and internal iliac arteries. A confirmatory CT abdominal aortography established the diagnosis of TA. The patient was treated with long-term oral corticosteroid therapy. Our case highlights that while assessing nonspecific back pain with elevated inflammatory parameters, particularly in young women, TA should be considered as one of the differential diagnoses.

Frequency and Nature of Road Traffic Injuries: Data of More than 10,000 Patients from Ha'il, Saudi Arabia.

Background Road traffic accidents (RTAs) have become a major issue in today's world. They have caused the loss of more than a million lives in the last decade and are substantially increasing every day. Injuries due to RTAs can cause significant morbidity and mortality. These injuries can be sorted by the type, body region, gender, and age group. We aimed to highlight the frequency and nature of road traffic injuries (RTIs) according to these variables in Ha'il, the Kingdom of Saudi Arabia. Methods A retrospective study was conducted in King Khalid Hospital, Ha'il. Data on the cases of RTIs were collected, which presented to the hospital emergency department from January 1, 2016, to December 31, 2017. Data analysis was then performed using IBM Statistical Package for the Social Sciences 17.0 (SPSS, IBM, NY, USA). Frequencies were calculated using descriptive statistics, and graphs were generated. Results A total of 10,855 patients with RTIs were encountered at the hospital emergency department. Out of these, 8035 patients were males (74.02%) while 2820 were females (25.97%). Fractures of one or more sites were the most common type of injury, encountered in 5173 patients (47.66%). Lacerations occurred in 3487 patients (32.12%). Crush injuries were encountered in 1190 patients (10.96%) while penetrating injuries occurred in 844 patients (7.78%). Abdominal and pelvic visceral injuries were present in 103 patients (0.95%) while thoracic visceral injuries were present in 39 patients (0.36%). Amputations occurred in 19 patients (0.18%). Conclusion Our study highlights the frequency and nature of road traffic injuries that present in the emergency department. As suggested by the high frequency of specific types of injuries, special training should be provided to healthcare professionals to address and treat fractures, head and neck injuries, and serious lacerations effectively.

Factors Affecting the Choice of a Career in the Field of Surgery Among Medical Students of Karachi.

Introduction Medical students choose to pursue their careers based on multiple internal and external factors. These factors, in turn, not only affect their personal future but the overall status of the health care system of their country. A recent decline in the interest of medical students towards the surgical career is being observed and, therefore, the factors influencing their choice need to be evaluated. We aimed to identify these factors in medical students of a public sector university of Karachi. Methods A cross-sectional study was conducted at Dow Medical College from April 2018 to May 2018. A pre-tested questionnaire was administered to a sample of 250 students. Besides sociodemographic factors, the choice of career was identified and the factors that influenced it were assessed. Students' opinions were collected using a Likert scale. Data were entered and analyzed using the IBM Statistical Package for the Social Sciences 23.0 (IBM, NY, USA). Frequencies were calculated for individual variables. The chi-square test was used to measure statistical differences between categorical variables and a p-value of <0.05 was considered to be significant. Results In this study, 224 out of 250 questionnaires were returned with complete data, yielding a response rate of 89.6%. We found that 48.2% of students reported a desire to pursue a career in surgery. Students whose fathers were more qualified and belonged to the field of health care were more likely to pick a surgical career (p-value of 0.034 and 0.039, respectively). Students who were willing to pursue a path in surgery more often thought that the social standing of surgeons had its importance (p=0.037). These students also agreed that high salary has a role to play in affecting the choice of career (p=0.023). The most common factors that encouraged students for the choice of a surgical career included the practical implication of skills (57.4%) followed by an academic interest in the field (53.7%), and high income (42.6%). The most common discouraging factors included lifestyle and long working hours (56.9%), followed by less academic interest (31%). Conclusion Our study provides a valuable insight into the factors that influence the choice of medical students for pursuing a career in surgery. We also identified the factors that demotivated them from doing so. In our opinion, better incorporation of surgery into the curriculum, proper attention given to students during their surgical rotation and restructuring of the surgical training program are some of the ways that may improve the interest of students in the field of surgery.