Polypharmacy among patients with hypertension attending primary healthcare centres.

Saudi Arabia has several hypertensive patients who require close attention and specialised care for their medications. Polypharmacy is one of the reasons for the failure of patient compliance with antihypertensive medications. Therefore, this study aims to gain a better perspective on polypharmacy in hypertensive patients attending primary healthcare (PHC) centres in Makkah, Saudi Arabia. Methods: This was an observational, cross-sectional, descriptive study of hypertensive patients followed up at 10 PHC centres in Makkah, Saudi Arabia, from 1 July 2019 to 30 June 2022. Frequencies and percentages were used to present categorical data, and Pearson's χ 2 test was used to measure differences. A P value less than 0.05 was considered statistically significant. Results: A total of 506 patients were included in this study. The mean age of the patients was 60 years, and more than half (69%) were females. Regarding antihypertensive medication use, 64% were on antihypertensive combination therapy, 76% on dual therapy, 21% on triple therapy, and 3% on quadruple therapy. Moreover, 21% of the hypertensive patients were exposed to polypharmacy. There was a significant relationship (P<0.001) between the overall number of chronic medications used per day and the duration of hypertension. Conclusion: More clinical research is needed to identify the impact of polypharmacy on the quality of healthcare in PHC centres in general and hypertensive patients specifically in different regions of Saudi Arabia.

Assessment of motivating and demotivating factors to undergo bariatric surgery in high-risk populations with correlation to generalized anxiety disorder and influence of others: a cross-sectional study.

Very few research have looked at the causes and influences that push individuals into bariatric surgery. Although bariatric surgery is effective in boosting self-esteem, little is known about the precise physical characteristics people want to alter. Methods: This study was a descriptive, correlational cross-sectional study to achieve the objectives of the study. All overweight and obese population in Jeddah, Saudi Arabia. Study instrument was designed based on the data present in the latest literature. Study tool consisted of: (1) sociodemographic data, (2) motives of bariatric surgery, (3) concerns about bariatric surgery, (4) people affecting the decision of seeking bariatric surgery, and (5) general anxiety disorder scale. Results: The study included 567 participants. More than half of the study participants were females (n=335, 59.1%). The mean age among study participants was 27.88 years. Most of the participants selected themselves as the main person (n=329). In the second place comes "person who had the surgery" (n=72). A family member was prevalent among 59 participants and a friend among 57 participants. The partner has the least frequency. The most common reason was self-esteem among 26% followed by body image among 20%. The most frequent factor was "I am satisfied with my current weight loss method) among 220 participants followed by "I am afraid of any surgery and will avoid it unless absolutely needed" among 51 participants. Conclusion: Bariatric surgery patients want to improve their health and live longer. Several people are dissatisfied with their bodies and seek cosmetic surgery. Patients desire bariatric surgery for their own and their loved ones', physicians', and peers' reasons. This study supports emphasizing the reasons why Jeddah, Saudi Arabia residents choose bariatric surgery and the demotivating issues.

Choice of medicine program: A single-institution study.

Introduction: The decision to apply for medical school is the first and one of the most important career choices that a physician will ever make and the motives for choosing a career in medicine seem to remain relatively stable during medical school. Our study aimed to investigate what motivated the students, their satisfaction with the PBL curriculum and their plans following graduation. Methods: A cross-sectional descriptive study was carried out from Jan to March 2021 at Batterjee medical college, Jeddah. The data was collected on a questionnaire from undergraduate students of first year till the internship year. Results: Among the 112 students who completed the questionnaire, 85 (75.9%) chose studying medicine to be their own choice, with service to humanity 56 (50%) being the main reason, followed by monetary 20 (18.8%) reasons. Generally 78 (69.6%) of the responders preferred the PBL curriculum over the traditional one. Most of the students 42 (37.5%) planned to undergo the residency program in Saudi Arabia, with general surgery being the specialty preferred by 33 (29.5%) students. Conclusion: The findings in our study suggest that altruism is the most common influencing factor that led students joining a medical college.

Expression of CD10 and CD15 in colorectal mucinous and signet ring adenocarcinomas and its relation to clinicopathological features and prognosis.

BACKGROUND: CD10 and CD15 expression has been reported in several tumors. Whether CD10 and CD15 have a role in colorectal mucinous and signet ring adenocarcinoma (MSA) tumorigenesis is not yet known. OBJECTIVE: We aimed to investigate the role of CD10 and CD15 expression in mucinous colorectal adenoma-carcinoma sequence (ACS) and determine if there is any clinical and prognostic significance associated with their expression. METHODS: Seventy-five cases of colorectal MSA, and 9 cases of adenoma samples were collected. Manual TMA blocks were constructed and immunohistochemistry for CD10 and CD15 was done. RESULTS: Compared to adenomas, CD15 expression was significantly higher in MSA (p= 0.002), in contrast to CD10 expression. CD15 positivity was significantly associated with microsatellite stable (MSS) tumors (p= 0.018). The association between CD10 positivity and fungating tumor growth showed marginal significance. Unlike CD10, CD15 positivity showed significant association with overall survival of colorectal MSA patients. CONCLUSIONS: CD15 expression seems to have a role in mucinous colorectal ACS, with significant impact on the survival of MSA patients. Further studies are suggested to identify any genetic alterations that may underlie a potential association with disease progression.

Frequency of transfusion transmissible infections among blood donors of Rawalpindi District, Pakistan.

Background: Transmissible Infections (TTI's) are a cause of significant burden on health care facilities by imposing a threat of infection transmission through disease reservoirs in asymptomatic donors. This eventually leads to a serious challenge in acquiring blood bags in a country like Pakistan where transfusion dependent disease are of high prevalence. The objective of this study is to determine the seroprevalence of TTI's in blood donors in Rawalpindi District through a multi-center approach. Materials and Methods: This is an observational descriptive retrospective study based on 6 transfusion centers in the Rawalpindi District. The time frame of the study was from January 2015 to December 2018. A total of 223,242 donors were consecutively included and data on donor type, the purpose of transfusion, and seroprevalence (HBV, HCV, HIV, Syphilis, and Malaria) were collected through a structured questionnaire and laboratory investigation results. The collected data were entered in SPSS version 21.0 for analysis. Results: The seroprevalence of blood borne infections was 7,897 (3.537%) of which HBV, HCV, HIV, Syphilis and Malaria accounted for 2410 (1.080%), 3105(1.391%), 0(0.000%), 2017 (0.933%) and 365 (0.171%), respectively. Reactive samples reduced from 4.850% to 3.537% over 4 years, while there was a rise of 37.478% of blood donors from 2015 to 2018. The total number of voluntary donors and replacement donors was 22079 (9.890%) and 201156 (90.107%), with a rising incidence in voluntary donors from 2015 to 2018. A considerable number of donor bags were transfused to Thalassemia, Anemia, Leukemia and Hemophilia patients, 28156 (12.612%). This number also showed increasing rates from 11.654% to 14.017%. Conclusion: In conclusion, our study suggests that the risk of transmission through transfusion is still considerable. Targeting donors with a low-risk profile, a screening questionnaire, an ample supply of quality screening tests, and awareness campaigns for the diseases in question must be carried to further decrease the risk of transmission of TTIs in Pakistan.

The complex role of post-operative magnesium on the long term serum calcium and parathyroid hormone levels in patients undergoing total and near-total thyroidectomy.

Objective: To assess the role of hypomagnesaemia in the development of permanent hypocalcaemia following thyroidectomy. METHODS: The prospective cohort study was conducted from April 3, 2017, to January 2, 2020, at Surgical Unit 1, Benazir Bhutto Hospital, Rawalpindi, Pakistan, and comprised of patients of both genders undergoing total and near total thyroidectomy. Post-operative calcium and magnesium levels were noted, and the patients were followed up after 6 months and fasting serum calcium, magnesium and parathyroid hormone levels were checked. Signs and symptoms of hypocalcaemia were noted. Data was analysed using SPSS 22. RESULTS: Out of the 62 patients followed up, 57 (91.9%) were females and 5 (8.1%) males. The overall mean age was 38.5 ± 12.1 years Post-operative hypomagnesaemia was seen in 6(9.8%) patients and none developed follow-up hypocalcaemia. Post-operative magnesium levels were significantly negatively correlated with follow-up parathyroid hormone level (p=0.006). Fall in magnesium post-operatively and follow-up magnesium were positively correlated with follow-up parathyroid hormone (p<0.05). Permanent hypocalcaemia was seen in 7(11.4%) patients and it was significantly associated with pre-operative and post-operative calcium levels, post-operative symptoms of hypocalcaemia and readmission for hypocalcaemia after discharge (p<0.05). Follow-up hypomagnesaemia was significantly associated with follow-up hypocalcaemia (p=0.024) and follow-up symptoms of hypocalcaemia (p=0.031). Conclusion: Acute development of mild hypomagnesaemia post-operatively may be beneficial in early positive feedback for parathyroid hormone secretion. Hypomagnesemia 6 months after surgery may be involved in PTH organ resistance. The complex role of hypomagnesemia on PTH levels must be further explored.

Frequency of Hypomagnesaemia following Total and Near-total Thyroidectomy and its relationship with Hypocalcaemia.

OBJECTIVE: To determine the frequency of hypomagnesaemia in patients undergoing thyroidectomy and evaluate its relationship with postoperative hypocalcaemia. STUDY DESIGN: Observational, cross-sectional study. PLACE AND DURATION OF STUDY: Surgical Unit 1, Benazir Bhutto Hospital, Rawalpindi, Pakistan from April 2017 to May 2019. METHODOLOGY: Preoperative and 24-hour postoperative samples for serum calcium and magnesium of 75 patients undergoing total and near-total thyroidectomy were taken.  Postoperative signs and symptoms of hypocalcaemia were documented. Data was analysed on SPSS version 22, using independent and paired t-test, Pearson correlation, linear regression, Chi-square test and Fisher's Exact test. RESULTS: Postoperatively 49 (65.3%) patients developed hypocalcaemia and 8 (10.7%) developed hypomagnesaemia. Postoperative hypocalcaemia was significantly associated with hypomagnesaemia (p=0.03) with a significant positive linear correlation. Ten patients (13.3%) developed symptomatic hypocalcaemia; however, it was not associated with postoperative hypomagnesaemia. Postoperative hypocalcaemia and hypomagnesaemia were significantly associated with preoperative calcium level (p = 0.03 and 0.04, respectively). There was significantly lower calcium level in patients with hypomagnesaemia (p = 0.002) and a significant fall in magnesium level in patients developing hypocalcaemia (p = 0.044). CONCLUSION: Postoperatively hypocalcaemia was prevalent following thyroidectomy, while hypomagnesaemia was not common.  Hypomagnesaemia and a fall in magnesium level after surgery was associated with hypocalcaemia; but not with symptomatic hypocalcaemia. Monitoring of magnesium levels in severe or persistent hypocalcaemia is recommended. While this study proves a relationship between calcium and magnesium, its clinical implication must be further studied. Key Words: Calcium, Magnesium, Postoperative, Hypocalcaemia, Hypomagnesaemia, Thyroidectomy.

Spinal Versus Intracranial Meningioma: Aberrant Expression of CD10 and Inhibin with Relation to Clinicopathological Features and Prognosis.

CD10 and inhibin are used mainly in CNS pathology to distinguish hemangioblastoma from metastatic clear cell renal cell carcinoma. Some meningiomas can mimic both tumors and so we aimed at this study to investigate the expression of both markers in a large number of meningioma cases. One hundred thirty-four meningioma samples were collected, 14 of them were spinal and 120 were intracranial. Manual TMA blocks were constructed using modified mechanical pencil tip method and immunohistochemistry for CD10 and inhibin was done. Intracranial meningioma occurred in significantly younger age than spinal ones. Most of spinal meningiomas were of transitional histology. CD10 was expressed in 14% of cases with significant positivity in spinal rather than intracranial cases. Transitional meningiomas showed the highest positivity for CD10 expression, while the least positive was the meningiotheliomatous type. Inhibin was expressed in 6% of cases with no significant relation to clinicopathological and histological features. There was no significant relationship between the expression of CD10 and inhibin expression in meningiomas. In conclusion, spinal meningiomas differ than intracranial ones in many clinicopathological and biological aspects. Among these differences is CD10 expression being more expressed in spinal meningiomas. However CD10 and inhibin are aberrantly expressed in a proportion of meningiomas, both have no relations to poor prognostic factors but more caution should be exerted during usage of these markers in diagnosis of hemangioblastoma and metastatic RCC. Further studies are suggested for exploring more biological differences between spinal and intracranial meningiomas.

Spinal versus intracranial meningioma: Expression of E-cadherin and Fascin with relation to clinicopathological features.

BACKGROUND: E-cadherin and Fascin are adhesive proteins that are expressed in many tumors. It was supposed that loss of expression of these proteins is associated with increased aggressiveness of the tumor. Whether spinal and intracranial meningiomas express adhesion proteins in different rates is not yet known. OBJECTIVE: We aimed to investigate the expression of E-cadherin and Fascin in a large number of meningioma specimens and determine if clinical and prognostic significance existsMETHODS: One hundred and thirty-four spinal and intracranial meningioma samples were collected. Manual TMA blocks were constructed and immunohistochemistry for E-cadherin and Fascin was done. Focal or diffuse staining was considered positive. RESULTS: Intracranial meningioma occurred in significantly younger age than spinal ones. Most of spinal meningiomas were of transitional histology. E-cadherin was expressed in 38.8% of cases. Spinal meningiomas showed statistically significant negative expression of E-cadherin than intracranial tumors. All atypical meningiomas showed negative E-cadherin expression. Fascin was expressed in 9% of cases with significant expression in atypical cases. CONCLUSIONS: Aggressive behavior of meningioma could be explained in part by loss of E-cadherin and overexpression of Fascin especially in spinal meningiomas. Further studies are suggested to explore the biological aspects of spinal and intracranial meningiomas for constructing tailored targeted therapies.

Diagnosis, Management And Prevention Of Hepatitis C In Pakistan 2017.

AIMS AND OBJECTIVES: Since the advent of direct acting antiviral agents, there is a revolutionary change in the management of HCV infection. Newer drugs with different mechanism of action are being introduced and are expected to be available in coming few months in Pakistan as well. The main purpose of the guideline is to review and induct the latest research in field of HCV infection in Pakistani perspective so that our healthcare professionals can apply the new recommendations in timely and judicial manner. Target groups of guidelines are general physicians treating hepatitis C, hepatologists and gastroenterologists. Other beneficiaries of these guidelines are public health institutions of Pakistan, which provide free treatment to deserving patients under National Hepatitis Prevention and Control Program and Pakistan Bait-ul- Mal Program. METHODOLOGY: These guidelines are based on the review of National consensus practice guidelines: Diagnosis, Management and Prevention of Hepatitis C Pakistan 2009. Published data in National and International Journals searched with the help of Google search and pub med, and 2015-16 guidelines of HCV by AASLD, EASL, APASL and WHO. Local studies are preferably added with references to enhance the Pakistani perspective. Evidence was also taken from published studies. Recommendations have been based upon evidence from national publications on the subject and scientific presentations at national liver meeting as well from experts' personal experience and opinion.

HIV/AIDS outbreak investigation in Jalalpur Jattan (JPJ), Gujrat, Pakistan.

BACKGROUND: In June-July 2008 a non-governmental organization (NGO) in Jalalpur Jattan (JPJ), Gujrat, Pakistan arranged two voluntary HIV screening camps after numerous HIV-infected persons reported to their treatment center in Lahore; 88 (35.8%) of 246 persons screened in those camps were positive by rapid test. Intense media coverage made the residents of JPJ hostile to further inquiries. The Pakistan Field Epidemiology Training and Laboratory Training Program (FELTP) was requested by the Provincial AIDS Control Program to carry out an epidemiological investigation. METHODS: HIV-positive persons or family members of patients who died of AIDS and consented to be interviewed during the period 15 December 2008 to 2 January 2009 were investigated. Enhanced contact tracing was done to identify additional cases. A structured questionnaire was used to collect data regarding clinical history, risk factors, and HIV knowledge and practices. The national HIV/STI Referral Laboratory collected blood samples for HIV serology and molecular studies independently following pre- and post-counseling. RESULTS: A total of 53 HIV-infected persons were investigated. Out of these, 47 (88.7%) were alive at the time of investigation and 27 (50.9%) of the cases were female with 6 children aged 10years or less. Median age was 35years (mean 34.7, range 3-70). Most frequent symptoms were unexplained fever 42 (79.2%), diarrhea 34 (64.15%) and skin infections 27 (50.9%); 13 (24.5%) had co-infection with tuberculosis (TB) and 10 (18.9%) with hepatitis (B or C). Use of injections 51 (96.2%), dental procedures 21 (40%) and barber shop visits among males 18 (72%) were common risk factors. Extramarital sex was reported by 4 (9.4%). Only 19 (35.8%) were aware that HIV can be sexually transmitted and 18 (34%) were aware of HIV transmission by blood transfusion. Phylogenetic analysis revealed HIV infection in this group was HIV-1 Subtype A, transmitted over a decade, and the situation is endemic rather than an outbreak. CONCLUSION: The investigation indicates high rates of HIV infection in JPJ. Unlike other studies from Pakistan, a high proportion of cases in females and children less than 10years of age were observed. Socio-cultural norms and stigmatization limited in-depth investigation of sexual and behavioral practices and history of drug abuse. A shift of HIV infection from high-risk groups to the general population was seen and requires vigilant surveillance besides targeted health education, clinical management, lab facilities for diagnosis and monitoring, and voluntary counseling and testing services to limit disease spread.

False positive HIV test in low prevalence region: Pakistan.

The prevalence of HIV in Pakistan is less than 0.1%, but is feared to be spreading among the general population rapidly. Screening tests for HIV is based on antibody detection. There seems to be little knowledge regarding the interpretation of HIV results among the population. Most often the patients are being issued a positive HIV report based on single screening test when in fact it should be confirmed before issuing a positive HIV result. There is a lot of stigma associated with the disease in Pakistan, on the other hand the test is done mostly without counselling services hence causing physical and mental trauma to the patients.

Migrant workers: a risk factor for HIV transmission.

BACKGROUND: HIV continues to be a threat in both developed and developing countries. Pakistan has entered concentrated epidemic from low epidemic stage. The prevalence of HIV is more in at risk population particularly intravenous drug users (IDUs). Studies are required to find out other risk factors contributing to spread of the disease in the general population in order to prevent the spread of disease among general population. METHODS: A cross-sectional study was carried out on patients reporting for HIV testing at National HIV/STI Referral Lab, National AIDS Control Program (NACP) from January to December 2011. RESULTS: A total of 345 patients reported to the lab during the study period. The detailed histories of 271 patients were available out of which 131 (48.3%) patients were found to be positive for HIV. Minimum age of patient with HIV was 2 years while maximum age was 64 years. HIV affected those more significantly who had visited abroad (p = 0.000) or were IDUs (p = 0.000). Extramarital sexual activity, blood transfusion, or any surgical procedure in the past was not found to be significant (p = 0.574, p = 0.243, p = 0.252 respectively). Most of the affected males were drivers (16, 12.2%) by profession. Among them 9 had visited gulf countries and 4 of them were deported from the gulf countries having HIV. CONCLUSION: Migrant workers are a risk factor for HIV transmission. Policy may be developed to focus on this population who continues to spread HIV among their spouses and children as a result of unawareness about their HIV status and its modes of transmission.