Empty follicle syndrome: Frequency and probable causes in Pakistani Population.

OBJECTIVE: To determine the frequency of empty follicle syndrome in in-vitro fertilization-stimulated cycles and to evaluate the causes associated with this phenomenon. METHODS: The retrospective study was conducted at the Baqai Institute of Reproduction and Developmental Sciences, Karachi, and comprised data related to period from January 2012 to December 2016. Other than demographic information, laboratory investigations, ultrasound findings and treatment protocols were noted and evaluated. Data was statistically analysed using SPSS 21. RESULTS: Of the 1120 cycles studied, empty follicle syndrome was found in 72 (6.4%). The possible leading causes included advanced age in 64 (88.8%) patients, longer duration of infertility in 56 (77.7%), higher baseline follicle stimulating hormone in 56 (77.7%), and lower oestradiol level before human chorionic gonadotrophin injection in 58 (80%). Empty follicles were significantly correlated with age of the patient, years of infertility, serum follicle stimulating hormone level and stimulation length (p<0.05). CONCLUSIONS: Empty follicle syndrome is a rare occurrence. Screening of patients for risk factors before considering IVF cycles is mandatory. The patients should be counseled for possible EFS even in first cycle.

Impact of wellness indicators on intellectual dimensions of medical teachers of Karachi: Findings from cross sectional study.

OBJECTIVE: To measure impact of social, spiritual, occupational, physical, financial and emotional wellness on intellectual wellness of medical teachers. METHODS: The cross-sectional study was conducted at 8 medical universities in the Sindh province of Pakistan from January 2012 to December 2014, and comprised faculty members. Using a self-administered questionnaire, teachers' responses on physical, emotional, social, spiritual, intellectual, occupational and financial spokes of the wellness wheel that were graded on a 4-point Likert scale. Generalised linear models were executed to find the best predictive scores for intellectual wellness. RESULTS: Out of 300 subjects approached, 261(87%) returned the questionnaire fully completed. Of them, 86(33%) were males and 175(67%) were females. Occupational wellness followed by spiritual, financial and emotional wellness depicted significantly high correlation with IW (p<0.05). Adjusted analysis revealed significant effects of spiritual, financial and occupational wellness (p<0.05). Findings of Models 1 and 2 suggested that holding the effect of other wellness subscales, intellectual wellness increased up to 0.485 score and 0.245 score due to occupational and spiritual wellness (p<0.05) respectively, while financial wellness was not significant (p>0.05). In the final model, occupational wellness effect increased to 0.504 score and spiritual wellness effect projected to 0.273 score for intellectual wellness (p<0.05). CONCLUSIONS: Amongst all the spokes of the wellness wheel, occupational, financial, social, emotional and spiritual wellness improved mental capabilities of medical teachers to overcome the challenges for acquiring intellectual wellness. However, wellness at workplace played the major role in enhancing intellectual proficiencies.

Peritoneal dialysis related infections in a tertiary care hospital in Riyadh, Saudi Arabia.

OBJECTIVES: To detect the incidence of and risk factors for infections among patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD). METHODS: A retrospective cohort study was conducted at the PD unit of King Fahad Medical City. End-stage renal disease patients above the age of 12 years who were undergoing PD management between January 2006 and March 2016 were included. RESULTS: One hundred PD patients were enrolled in the study and examined over a total observation period of 2,553 patient-months. The leading ESRD etiology was hypertension (26.3%). The mean duration of PD was 28.05 months. A total of 45 patients developed 101 episodes of technique-related infections (TRIs). Peritonitis represented the majority of these episodes (90 episodes), with an overall rate of one episode per 28.3 patient-months. TRIs were mostly caused by coagulase-negative staphylococci. A total of 12 patients developed non-technique related infections (NTRIs). There was a statistically significant difference between patients with TRI and non-infected patients regarding the presence of diabetes and duration of dialysis. No peritonitis-related deaths were noted. In total, 21 patients continued on PD and 18 patients were shifted to hemodialysis (HD). Conclusion: In our setting, ESRD patients undergoing PD are more susceptible to TRIs than NTRIs. Diabetes increases the risk of developing TRIs. The high incidence of coagulase-negative staphylococcal TRI suggests touch contamination.

Assessment of knowledge and attitude toward organ donation among the Saudi population in Riyadh City.

We aimed to assess the knowledge and attitude of the Saudi population and students of health science colleges as well as healthcare workers in Riyadh city about organ donation (OD). Data of this study were collected from 648 Saudi residents of Riyadh city using interviewer-administered questionnaires and online surveys. The participants included 503 from the general population and 145 health science professionals. The subjects included 252 males and 396 females with mean age of 27.09 ± 9 years. Majority of the participants (60%) were aware of OD from media as the main source of information, while only 30% had knowledge about Saudi center for organ transplantation (SCOT). It was found that 47.7% of the population agreed to donate both organs and tissue and 26% of them accepted the idea of OD to please Allah. The most important barrier (13%) was the belief that their bodies should be kept intact after death followed by ignorance about OD. Among health science professionals, 63% thought that everyone should be automatically registered as an organ donor while 15% believed that the donated organs could be misused. The majority of Riyadh's population knew the concept and procedure of OD; however, there was a lack of awareness of the presence of SCOT. Religion is not a barrier for OD in the Saudi population. Awareness programs are urgently needed to emphasize the importance of donation as well as clarification of wrong beliefs.

Interprofessional learning experiences: Exploring the perception and attitudes of Saudi Arabian medical and dental students.

OBJECTIVE: The objective of this study is to evaluate the awareness and attitudes of medical and dental students regarding interprofessional learning (IPL). METHODS: A cross-sectional study was conducted with 278 female undergraduate Medical and Dental students from Princess Nourah bint Abdulrahman University, Riyadh. These students undertook IPL in the Foundation block, in basic science teaching, clinical skills' laboratories and in professionalism and learning skills' modules. A modified, validated RIPLS questionnaire with four subscales and 29 items was used to collect data regarding their perception and attitudes towards shared learning. A five-point Likert scale was used with a value ranging from 1 (strongly disagree) to 5 (strongly agree) for each item. Factor analysis was done using Varimox rotation. Student's t test was applied to detect difference between mean scores of medical and dental student's responses Results: The mean age of respondents was 19.8 ± 1.7 years with the majority in the second year of each program. There was no difference in mean responses of the medical and dental students. The respondents favored shared learning in the areas of professional skills and patient care. They agreed that IPL helps to develop respect, trust and appreciation for other professions; however, both groups preferred to learn uni-professionally with regard to developing discrete professional identities and roles. CONCLUSIONS: There is an overall positive response towards IPL and the value of team work; however, more attention needs to be paid to enabling students to learn about the specific roles of each profession in the healthcare team.

Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life.

Stress urinary incontinnce (SUI) is a common condition among women. The usual approach to treatment of SUI is a stepwise plan from conservative to surgical procedures. A vaginal pessary is one of the commonly used conservative treatments that offer symptomatic improvement for women with incontinence. This review provides a critical analysis of the benefits and shortcomings offered by vaginal pessaries to patients affected by SUI, with a particular focus on indications, advantages, quality of life, patient satisfaction, and potential complications. To obtain the required information, an extensive search of PubMed and Cochrane databases was performed, covering the time frame from January 2000 to December 2016. We also surveyed the published guidelines of American Urological Association, Canadian Urological Association, American Urogynecological Society, National Institutes of Health (USA), and National Institute for Health and Care Excellence (UK). A total of 192 original research papers, review articles, and clinical trials were identified. The analysis of retrieved data provides evidence that vaginal pessaries constitute an effective nonsurgical option for SUI. The satisfaction rate with pessary use is high and only minor complications, if any, occur, vaginal discharge being the most common. The reviewed studies document that vaginal pessaries provide an adequate control of SUI if they are fit properly and managed by frequent replacements and regular checkups. They should be considered among the first line of treatment for SUI associated with exercise and increased intra-abdominal pressure.

Intellectual wellness in medical university teachers: Gender based comparison.

A cross section, questionnaire based study was carried out from January 2012 till December 2014 to compare intellectual wellness (IW) awareness on the basis of gender in teachers of basic sciences at medical universities of Karachi, Pakistan. Data was collected from 3 public and 5 private medical universities of Karachi, Pakistan. Questionnaire was tailored from "Wellness Wheel" and responses were aggregated for eight questions in the dimension of IW to obtain aggregate IW score. Reliability of the questionnaire was measured using Cronbach's alpha. The average intellectual score was 24.99 ± 3.93 with a minimum score of 8 and maximum 32.The frequency of keeping informed about research updates was significantly higher in males (p = 0.043) that emphasized significantly better IW awareness of male medical teachers involved in teaching of medical sciences in both public and private medical universities of Pakistan.

Effectiveness of health education programme: Level of knowledge about prevention of cervical cancer among Saudi female healthcare students.

OBJECTIVE: To evaluate the effectiveness of health education programme on the knowledge of human papilloma virus among female medical students. METHODS: This quasi-experimental study was conducted in 2014 at the Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia, and comprised female medical students. An intervention programme was implemented in the form of lectures, videos, posters, etc. on human papillomavirus. SPSS 20 was used for data analysis. RESULTS: There were 535 participants in the study. There mean age was 20.3±1.3 years. After the intervention, there was a significant increase in the level of knowledge. Of all, 495(92%) students recognised avoidance of sexually transmitted disease, vaccination and screening as effective preventive measures. In comparison to pre-intervention results, significantly higher percentage of students defined risk factors: sexually transmitted disease 392(73.3%) versus 329(61.8%), and human papillomavirus 293(54.8%) versus 151(28.4%). Knowledge regarding sensitivity, 280(52.3%) after the campaign versus 160(30.1%)before, and time to perform Pap smear,229(42.8%) versus 113(21.1%),increased significantly (p<0.05). CONCLUSIONS: Health education programme was effective in improving the level of knowledge on human papillomavirus.

Association of ovarian reserve with age, BMI and serum FSH level in subfertile women.

OBJECTIVE: To examine the association of age, body mass index, serum follicle stimulating hormone levels and antral follicular count with fertility outcomes in terms of conception and delivery. METHODS: The prospective cohort study was conducted at Baqai Institute of Reproductive and Developmental Sciences, Karachi, from January to December 2012.and comprised women undergoing the first cycle of in-vitro fertilisation who were categorised into groups A and B depending upon age. Group A consisted of women below 35 years of age, while Group B had women over 35 years of age. Age body mass index (BMI), basal level of serum follicle stimulating hormone and antral follicular count were determined in all subjects. Intracytoplasmic sperm injection was dispensed, and all subjects were followed up prospectively and their cycle outcomes were recorded. SPSS 20 was used for statistical analysis. RESULTS: Of the 148 women in the study, 98(66%) were in Group A and 50(44%) in Group B. In Group A, 15(38.5%) women with body mass index < 25 and 24(61.5%) with >25with normal follicle stimulating hormone levels showed positive outcome. Moreover, 20(51.3%) women with normal ovarian reserve and 19(48.7%) with higher reserves showed positive pregnancy test and outcome. Group B showed < 7 follicular count on ultrasonic examination, < 5 eggs were retrieved in 36(72%) women and all of them (100%) had negative outcome. CONCLUSIONS: Sub-fertile women at age 35 years and above and body mass index over 33 had reduced fertility potential compared to younger women, and ultimately had lower success rate of fertility treatment, including in-vitro fertilisation.

Faculty development programs improve the quality of Multiple Choice Questions items' writing.

The aim of this study was to assess the utility of long term faculty development programs (FDPs) in order to improve the quality of multiple choice questions (MCQs) items' writing. This was a quasi-experimental study, conducted with newly joined faculty members. The MCQ items were analyzed for difficulty index, discriminating index, reliability, Bloom's cognitive levels, item writing flaws (IWFs) and MCQs' nonfunctioning distractors (NFDs) based test courses of respiratory, cardiovascular and renal blocks. Significant improvement was found in the difficulty index values of pre- to post-training (p = 0.003). MCQs with moderate difficulty and higher discrimination were found to be more in the post-training tests in all three courses. Easy questions were decreased from 36.7 to 22.5%. Significant improvement was also reported in the discriminating indices from 92.1 to 95.4% after training (p = 0.132). More number of higher cognitive level of Bloom's taxonomy was reported in the post-training test items (p<0.0001). Also, NFDs and IWFs were reported less in the post-training items (p<0.02). The MCQs written by the faculties without participating in FDPs are usually of low quality. This study suggests that newly joined faculties need active participation in FDPs as these programs are supportive in improving the quality of MCQs' items writing.

Knowledge of Saudi female university students regarding cervical cancer and acceptance of the human papilloma virus vaccine.

OBJECTIVES: To assess the level of knowledge regarding cervical cancer and the acceptance of the human papilloma virus (HPV) vaccine among Saudi female students in health colleges. METHODS: This cross-sectional study of a convenient sample encompassed 1400 students in Health Colleges at Princess Nora Bint Abdul Rahman University, Riyadh, Saudi Arabia was conducted between December 2013 and February 2014. A self-administrated questionnaire was distributed to all participants. Data collected included socio-demographic data, knowledge of cervical cancer risk factors and clinical presentation, Pap smear, and HPV vaccine acceptance. The questionnaire reliability as tested by Cronbach's alpha was 0.82. RESULTS: The response rate was 89.9%, and data analysis revealed that 95.7% of students had poor knowledge level. The Pap smear was poorly recognized as a screening tool, with 46.7% of students having heard of the test. Senior and medical students had a significantly higher knowledge score. Father's health profession, high monthly income, and presence of cervical cancer among family members or friends increased the level of knowledge. Vaccine acceptance is influenced by its price, approximately 80% of students thought that an affordable vaccine price should not exceed 300 Saudi Riyals. Perceived barriers to the vaccine were fear of injections and vaccine side effects. CONCLUSION: There is a lack of knowledge and misinformation regarding cervical cancer, Pap smear, and HPV as a major risk factor for cancer of the cervix. These data can be used as a benchmark to formulate effective awareness programs. 

Health and spirituality 'walk along' in wellness journey of medical students.

OBJECTIVE: To assess and compare knowledge, attitudes and practices of male and female medical students of Karachi in the context of physical, emotional and spiritual wellness. METHODS: The cross-sectional questionnaire-based survey was conducted from January to December 2010, comprising randomly selected 800 male/female medical students in eight medical colleges of Karachi. The responses--'never,' 'sometimes,' 'mostly' and 'always' (numbered 0-4 )--were analysed in terms of frequency, proportion and percentages by Predictive Analysis Software (PASW) version 18. Chi-square test was applied for comparison of categorical aspects of wellness, and results were declared significant at p < 0.05. RESULTS: Of the 800 questionnaires, 736 (92%) fully-completed questionnaires comprised the study universe. According to the survey, 503 (68.37%), 504 (68.45%) and 658 (89.35%) medical students were aware of the concept of physical, emotional and spiritual wellness respectively. Males had greater involvement in physical activity (p < 0.001), while females selected healthy diet (p < 0.03). The dimensions of physical and emotional wellness on an aggregate did not differ significantly in both genders, but knowledge and practices of spiritual wellness in females gave them direction to face episodes of anxiety for which males had to take help from mentors and psychologists (p < 0.034, p < 0.0001). CONCLUSION: Spirituality, the key success factor in better wellness management, was found to be greater among female medical students.

Association of aldosterone and cortisol with cardiovascular risk factors in prehypertension stage.

Background. The Pakistani population has higher incidence of cardiovascular (CV) diseases at younger ages, due to undiagnosed, uncontrolled hypertension (HTN). A variety of associated HTN stressors is also reported. The study plans to understand the variables associated with initiation of HTN in this population. Objective. To find plasma aldosterone and cortisol relationship with some CV risk factors (obesity, dyslipidemia, hyperglycemia, sodium and potassium) in different stages of HTN particularly prehypertension. Subjects and Methods. The study conducted on 276 subjects (25-60 years), classified into prehypertensive (n = 55), HTN stage-1 (n = 70) and II (n = 76) according to 7th JNC report and compared with normotensive controls (n = 75). The anthropometric profiles (height, weight, waist circumference, Body Mass index) and BP recorded. Serum cortisol, aldosterone, total cholesterol, Low density lipoproteins, blood glucose, Na(+) and K(+), using standard laboratory techniques, were determined in fasting blood samples. Results. Subjects were mostly overweight and obese (80%, 90%, and 76% in pre-HTN, stage-I and II versus 69% in controls). The aldosterone level (ng/dl) was in higher normal range (9.17-12.41) and significantly correlated to BMI (0.587) in controls, and to TC (0.726) and LDL (0.620) in pre-HTN stage-I. The cortisol level was positively correlated (P < 0.01) to BMI (0.538), Na(+) (0.690) and K(+) (0.578) in control, and to BMI (0.628) and WC (0.679) in pre-HTN group, showing its association with BMI > 25. Conclusion. Pre-HTN stage among Pakistani population with successive increase in various risk factors of HTN in relation to aldosterone and cortisol has been identified. Interaction of the risk factors with endogenous levels of these hormones may initiate stages of HTN.

Impact of alterations in teaching methodologies on learning capabilities.

OBJECTIVE: To compare the role of new approaches and methods in the development of understanding and learning capabilities of undergraduate medical students in the module of respiratory physiology. METHODS: A comparative cross sectional study was conducted in Bahria Univiersity Medical & Dental College using a sample size of 198 students from February till May 2010. Difficulties in understanding the concepts of respiratory physiology was analyzed in groups A (Batch 2008-2013) and assessed through test performance. In group B (Batch 2009-2014) "integrated learner-and teacher-centered" approach was implemented by introduction of problem based learning, case based sessions, students seminar, quizzes and structured assignments. Response of group B students was evaluated in terms of concepts and performance by identical feedback form and assessment test. The data was analyzed using SPSS version 15.0 and applying the Chi-square test. RESULTS: The mean age of Karachi students of Groups A and B was 20 +/- 2 years. Statistically significant improvement in conceptual understanding of Group B (84%) was noticed compared to Group A (42%). Conceptual understanding of Group B (84%) was observed, as compared to Group A (42%) CONCLUSION: Supplementation of teaching methodologies with augmented interaction improved significant learning, performance and satisfaction among group B students.

Relationship of life style choices on body fat mass in young adults.

BACKGROUND: Healthy diets and regular, adequate physical activity are major factors in the promotion and maintenance of good health throughout entire life course. Accumulation of fat occurs whenever energy consumed by food and drinks exceeds that which can be utilised by an individual's metabolism and physical activity. The objective of this study was to estimate the effect of lifestyle characteristics of a representative segment of medical students in terms of fast food preferences and participation in physical activity with respect to Body Mass Index (BMI). METHODS: This cross-sectional study was carried out in Physiology Department, Bahria University Medical & Dental College, Karachi on 192 students of 1st and 2nd year MBBS. Body Mass index of students was calculated. They were classified into 4 groups with BMI < or = 18.5, 18.6-23, 23.1-25 and > or = 25 respectively. A life style questionnaire, based on preferences for healthy/unhealthy food, dietary habits and participation in physical activity was filled. RESULTS: Most of medical students (65%) had BMI less than 23. It was because of selection of healthy dietary pattern with nutritious food (p < 0.09) and participation in outdoor games (p < 0.03). Males who had high BMI showed a tendency to daily intake of fast food (p < 0.03). Walking in both the sexes had a positive impact in maintaining normal BMI (p = Males < 0.04, females < 0.001). CONCLUSION: Obesity can be prevented by innovative approaches, easiest of which is to promote active life styles with intake of healthy diet and involvement in physical activity.

Overweight and obesity in students of a dental college of Karachi: lifestyle influence and measurement by an appropriate anthropometric index.

OBJECTIVE: To compare body mass index (BMI), waist circumference (WC), and body fat percentage (%BF), as index of overweight and obesity in young adults. We also intended to find an association between lifestyle behaviours and obesity. METHODS: A cross-sectional study was conducted at Fatima Jinnah Dental College, Karachi, during 2007 to 2008, with 192 first year dental students, (18-21years) of high socioeconomic class. All were questioned regarding lifestyle behaviours. Overweight and obesity were estimated by measuring %BF, BMI, and WC. For %BF, skinfold thickness was measured using skinfold calipers. BMI > or = 23.0-24.9 kg/m2 was taken as overweight and > or = 25.0 kg/m2 as obese (Asians criteria proposed by Western Pacific Regional Office of World Health Organization). WC using Asian cutoff values for overweight and obesity were: males > or = 78 cm and > or = 90 cm; females > or = 72 cm and > or = 80 cm, respectively. Body fat percentage used to define overweight and obesity was: males 22.1-27.0 and > 27.1; females 27.1-32.0 and > 32.1, respectively. Pearson's correlation was done between the BMI, WC and %BF with statistical significance taken at P < 0.01. RESULTS: BMI (Expressed as mean +/- SD) in males and females was 23.82 +/- 3.88 and 20.98 +/- 4.12 respectively. WC was 83.63 +/- 10.20 cm in males and 70.22 +/- 9.36 cm in females. %BF was 22.32 +/- 6.27 in males and 28.73 +/- 6.65 in females, with an overall 60.8% females and 44.4% males found to be overweight or obese. Obesity was underpredicted by BMI when compared to skinfold calipers method. The obese were seen to skip breakfast more often [odds ratio (OR): 2.39], take frequent snacks (OR: 1.58), watch television more (OR: 1.58), and were physically less active than their non-obese counterparts. CONCLUSION: Body fat percentage using skinfold caliper is a reliable index of obesity. Lack of sleep and skipping of breakfast, are prominent promoters of obesity, in addition to other lifestyle behaviours.

Anthropometric and metabolic indicators in hypertensive patients.

OBJECTIVE: To determine the relationship between anthropometric variables with blood glucose and lipid concentrations in different stages of hypertension and evaluate the risk factors involved in progression of pre-hypertension stage in to clinical hypertension stage-1. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: National Institute of Cardiovascular Disease and General Practitioner's Clinics, Karachi, from 2005 to 2007. METHODOLOGY: The study was conducted on 276 participants aged 25-65 years and classified into four categories of control, prehypertension (pre-HTN), hypertension (HTN) stage I and II, according to 7th JNC report. Anthropometric measurements and blood chemistry were obtained. The relationship between obesity indices (Body Mass Index [BMI], Waist Circumference [WC], Waist Hip Ratio [WHpR], Waist Height Ratio [WHtR], Basal Metabolic Rate [BMR] and Cardiovascular Disease [CVD] risk factors [blood pressure, serum lipids and glucose levels]) were investigated. The analysis of variance and test of Pearson's coefficient correlation were applied to assess relationship of all the variables. RESULTS: The mean WHR had significant correlation with both systolic and diastolic BP in all groups of HTN, as well as with blood glucose level in control and pre-HTN groups. BMI was positively correlated with cholesterol (r=0.29) and triglyceride (r=0.25) in HTN stage-1. Impaired and high blood glucose levels were found in pre-HTN group; all lipid parameters except triglycerides were higher in HTN stage I. CONCLUSION: WHR was positively and independently related to occurrence of arterial hypertension. Elevated levels of WHR, BMI, fasting blood glucose, total cholesterol and triglycerides were responsible for progression of pre-HTN stage in to HTN stage-1.

Changes in blood pressure, BMI and ECG Patterns in women using low-dose contraceptives.

OBJECTIVE: To determine the cardiovascular risk factors in users of second generation contraceptives by recording changes in body mass index, blood pressure and electrocardiogram. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The National Institute of Fertility Research Centers at Jinnah Postgraduate Medical Center and PIB Maternity Home Karachi, from July 1997 to 1999. MATERIALS AND METHODS: Sixty four women volunteered for this study (age range 20-35 years), belonging to low-income group with similar socio-cultural background. The Body Mass Index (BMI) was calculated by measuring height and weight of the subjects; systolic and diastolic blood pressure and ECG recording by standard method. The group means, standard deviations and coefficient correlation for interrelationship among variables in respective groups of subjects were calculated using relevant statistical method and software program. RESULTS: There was no significant difference between BMI of two types of contraceptive users as compared to non users; but BMI was significantly correlated with both systolic and diastolic blood pressures in injectable users as compared to controls. ECG alterations frequently observed in contraceptive users (40%) as compared to controls were normal findings. CONCLUSION: It was observed that women aged < 30 years and using contraceptives for more than three years had a tendency to gain weight and developed a mild increase in systolic and diastolic blood pressures.

Role of exercise in osteoporosis prevention--current concepts.

Osteoporosis is a metabolic disorder of the bones due to loss of both bone mineral and bone matrix in equal proportions resulting in a bone that is weak and unable to support the body. This becomes a problem in the elderly who are then at risk of frequent fractures increasing the morbidity and mortality. Measures taken early in life in the form of calcium and exercise go far in preventing the development of this disorder. The primary purpose of this narrative review is to evaluate the current literature and to provide insight into the role of exercise relating to osteoporosis. Emphasis is given to the importance of the specific types of exercises needed to increase bone strength and muscle power, keeping in view the age and general physical condition of the person.

Presentation, staging and diagnosis of lymphoma: a clinical perspective.

BACKGROUND: Due to lack of awareness among health professionals, lymphoma is often misdiagnosed. This study was done to evaluate the clinical features and histopathologic subtypes of lymphoma. METHODS: Sixty diagnosed cases of lymphoma were selected (aged 12-65 years) from medical units of Civil Hospital Karachi, during 1993 to 1998. Clinical history, physical examination and basic laboratory investigations including imaging procedures were done in all the patients. The diagnosis of lymphoma was based on histology, following the International Working Formulation classification system. This included lymph node biopsy and in some cases, biopsy of the bone marrow. The Ann Arbor Staging Classification was used to classify the extent of disease. RESULTS: Out of 60 cases of lymphoma, 81.6% (49 cases) were diagnosed as non-Hodgkin's lymphoma and 18.3% (11 cases) as Hodgkin's disease, with an overall male predominance. Both categories exhibited a bimodal age distribution. Lymphadenopathy was the commonest presenting features in both the types of lymphomas; however, patients with Hodgkin's disease had a prominence of 'B' symptoms, whereas abdominal signs and symptoms were more common in non-Hodgkin's lymphoma. On histopathology, majority of non-Hodgkin's lymphomas (91.8%) showed a diffuse pattern, while mixed cellularity was the commonest type seen in Hodgkin's disease (81.8%). CONCLUSION: Non-Hodgkin's lymphoma was 4 times more common than Hodgkin's disease. The vast clinical spectrum of lymphoma sometimes delays its diagnosis, leading to its eventual presentation in late stages. A general awareness is hence required among the health professionals regarding its varied clinical presentations.