Characteristics of Patients Presenting with COVID-19 from Balochistan Province and Lessons Learnt.

OBJECTIVE: With the spread of COVID-19 in Pakistan, Balochistan province with its unique problems of lowest literacy rates in the country, limited resources and a flail health care system is reporting an increasing number of cases of COVID-19. This study discusses the epidemiological and clinical characteristics of COVID-19 patients from the Balochistan province. STUDY DESIGN: Situation report Place and Duration of Study: The study was conducted in Balochistan province of Pakistan. The completion date for the study was April 30, 2020. METHODOLOGY: The data was retrieved from the daily situation report from the Health Department, Government of Balochistan. Descriptive statistics (proportions, mean ± SD) were used for data analysis. RESULTS: A total of 1136 patients were confirmed to have COVID-19. The highest rate was found in cases with ages >60 years. About 78% of COVID-19 cases were males and majority of the cases (78.56%)were asymptomatic. Out of these, 183 recovered and 16 died. The case fatality rate was 1.3%. CONCLUSION: COVID-19 cases and case fatality ratio is low in Balochistan. Whether this is due to inability to carry out more tests is still to be ascertained. Males and elderly are more affected and fatalities were higher in cases with co-morbid conditions. Balochistan having a weak healthcare system and with the majority of cases being asymptomatic, needs more stringent actions to practice social distancing to avoid further spread of COVID-19.

Sleep and its relation with academic performance among adolescents: An analytical cross sectional study in Gulshan Town, Karachi.

OBJECTIVE: To determine the prevalence of sleep patterns and their relationship with academic performance among adolescents. METHODS: The analytical cross-sectional study was conducted from March to August 2015 in Gulshan Town of Karachi and comprised students in grades 6 to 8 who were selected from six government and private schools. Data was collected regarding their sleeping time, wake-up time, sleep latency and total sleep duration. Paediatric Daytime Sleepiness Scale was administered to calculate daytime sleepiness. Academic performance of students was taken from school academic records. Data was analysed using SPSS 22. RESULTS: Of the 440 subjects, 234 (53.2%) were boys and 206 (46.8%) were girls. The overall age range was 11-16 years. A total of 280 (63.6%) students had abnormal sleep patterns, 182(41.4%) suffered from daytime sleepiness, 41 (9.3%) had abnormal sleep latency and 201 (45.7%) scored below 60% in their exams. Among poor sleepers, 157 (56.1%) scored below 60% in their exams. CONCLUSIONS: More than half the subjects were found to be sleeping less than required, which eventually affected their academic performance.

Frequency and features of nocturnal enuresis in Pakistani children aged 5 to 16 years based on ICCS criteria: a multi-center cross-sectional study from Karachi, Pakistan.

BACKGROUND: Nocturnal enuresis (NE) is a common symptom in children worldwide. International Children's Continence Society (ICCS) defines enuresis as either mono-symptomatic, NE with lower urinary tract symptoms and NE with co-morbid conditions. The objectives of this study were to determine the frequencies and types of NE and associated symptoms and conditions in children aged 5 to 16 years based on ICCS criteria. METHODS: A multi-center cross sectional study was conducted between November 2012 and December 2013 in the primary care clinics of four hospitals in Karachi. Children aged five to fifteen years were included through consecutive sampling. Informed consent was obtained from the parents and a pre-coded semi-structured questionnaire was used to obtain the information. Data was entered on SPSS version 20.0 and multivariable logistic regression analysis was used for data analysis. RESULTS: Out of 429 children aged between five and sixteen years, 243(56.9%) were boys and the remaining 186(43.1%) were girls. One hundred and eighty three children (43%) had nocturnal enuresis (NE). Forty four (10.3%), had mono-symptomatic NE, 57(31.1%) had associated lower urinary tract symptoms (NE-LUTS), whereas 30 (16.3%) had NE with a co-morbid condition. Fifty two (28.4%) NE's had at least one of both LUTS and a co-morbid condition. Out of the 246(57%) non-enuretic's, 31(12.6%) had a LUTS, 95(38.6%) had a co-morbid condition and 57(23.2%) had at least one of both LUTS and a co-morbid condition. The remaining 63 (25.6%) were symptom free. Increased voiding frequency, urgency, dysuria, suprapubic pain and daytime incontinence were the LUTS significantly associated with NE. Co-morbid conditions significantly associated with NE included constipation, congenital defects, developmental delay, and learning and sleep problems. CONCLUSION: Although NE can be an only symptom, it is often associated with lower urinary tract symptoms like dysuria, urgency, suprapubic pain, and daytime incontinence. Children presenting with NE often have co-morbid conditions like constipation, urinary tract infection, sleep disorders, and developmental delay. Many children presenting with these conditions as the primary complaint may also have NE. It should be addressed as unrecognized and untreated NE can cause additional morbidity and distress.

Effect of faculty personality, rating styles, and learner traits on student assessment in medical education: A mixed-method study from the Aga Khan University, Karachi.

Background: Medical colleges invest considerable effort in developing assessment programs to effectively evaluate students across attributes of knowledge, skills, and behavior. While assessment by direct observation is designed to be objective, "soft characteristics" such as personality, demeanor of student, and assessor may make assessment more subjective. The effect of such attributes in medical education remains unclear and needs exploration. The objective of this study was to explore non-cognitive traits of assessor and learner to understand their roles in student assessment. Methods: A mixed-method study was conducted during March to June 2015. All clinical faculty members at the Aga Khan University were invited to participate in this study. A questionnaire was designed and completed by the study participants. Two focus group discussions (FGDs) with faculty members explored teacher and learner traits influencing student assessment. A documentary analysis of the yearly student feedback report with a focus on the section on assessment was also utilized. Data triangulation was achieved by combining three sets of data. Results: Fifty-four (28%) clinical faculty members completed the questionnaire and 11 participated in the FGDs. About 68% reported rating students leniently. More than 50% reported their personality as a factor influencing assessment and 76% reported student appearance influencing assessment. The documentary analysis identified faculty personality and rating styles as key issues affecting the validity of student assessment during ongoing observation. In the FGDs, traits such as eagerness, intuition in students, and body language were reported to influence faculty members during the assessment. Discussion: Softer attributes of trainer and trainee increase the subjectivity of student assessment. Ongoing faculty training and rater feedback are required for a robust and objective assessment.

Risk of Type 2 Diabetes Among the Pakistani Population: Results of a Cross-sectional Survey.

Introduction Diabetes is a global issue. The aim of this study was to identify the high-risk population and factors associated with the future development of type 2 diabetes mellitus (T2DM). Methods A cross-sectional study was conducted in the Family Medicine clinics of a tertiary care hospital in Karachi, Pakistan, from July 2016 to February 2017. Patients or patient care attendants aged 21 to 85 years visiting the clinics were included. Individuals with known diabetes or with serious comorbid conditions were excluded. A total of 600 participants were consecutively approached. QDiabetes (an online diabetes risk calculator) was used to measure the risk of developing T2DM. IBM SPSS Statistics for Windows, Version 19.0 (IBM Corp., Armonk, NY) was used for data analysis. Results Information from a total of 522 participants was included in the final analysis. Roughly 53% of them were between 25 and 44 years of age. There was a predominance of females (63%). Thirty-eight percent of patients were at high-risk. The factors associated with high risk of T2DM were as follows: age 65 years or greater (Relative risk [RR]: 5.81; 95% confidence interval [CI]: 2.01 to 16.76); female (RR: 1.86; 95% CI: 1.05 to 3.28, p = 0.03); a past history of hypertension (RR: 5.11; 95% CI: 2.49 to 10.49); a family history of diabetes (RR: 9.76; 95% CI: 5.49 to 13.35). Conclusion Controlling glucose levels and preventing hyperglycemia is a challenging task due to the increasing trend of a sedentary lifestyle and changes in dietary patterns. Counseling should be provided to caregivers and high-risk patients on the prevention of T2DM including lifestyle modifications.

Depression and its Associated Factors among Patients with Chronic Obstructive Pulmonary Disease in Karachi, Pakistan.

Introduction Depression in patients with chronic obstructive pulmonary disease (COPD) can be an incapacitating health problem that negatively affects the quality of life. If the depression is not treated, it is associated with increased morbidity and mortality. The goal of this study was to determine the frequency of depression in patients with COPD and examine the factors contributing to depression in these patients. Methods This cross-sectional study was conducted using a sample of 556 patients with COPD visiting the Pulmonology Clinic of the Aga Khan University Hospital in Karachi, Pakistan, from March 2010 to March 2011. A pretested structured questionnaire was used for data collection. The Hospital Anxiety and Depression Scale (HADS) was used to screen for depression. SPSS Statistics for Windows, Version 19.0. (IBM Corp, Armonk, NY) was used to enter and analyze data. Results Out of the total 556 participants, majority 62.9% were between 60 and 79 years of age and 70.1% of the participants were males. The frequency of depression in COPD patients was 57.2%, and multiple logistic regression analyses indicated being over 59 years (Adjusted odds ratio (ORadj), 2.750; 95% confidence interval [CI]: 1.25 to 6.05, p = 0.039), being male (ORadj, 2.28; 95% CI: 0.89 to 5.14), being retired or unemployed (ORadj, 1.041; 95% CI: 0.41 to 2.62, p = 0.000), using inhaled steroids (ORadj, 3.929; 95% CI: 2.59 to 5.97, p = 0.000), and living alone were significantly associated with depression in COPD patients. Conclusion Several risk factors for depression in patients with COPD were identified. Patients with COPD who are elderly, male, retired or unemployed, use inhaled steroids, and patients who live alone have characteristics significantly associated with depression. These factors should be considered by practicing family physicians, pulmonologists, and healthcare workers.

Influence of supportive care on chemotherapy patients' self-care behaviour and satisfaction: A pilot study conducted in Karachi, Pakistan.

BACKGROUND AND AIM: Cancer is a daunting illness affecting a vast number of people globally. During the illness trajectory, cancer patients suffer from physical and/or psychosocial issues. These physical and psychosocial issues demand conscious actions by patients to maintain their well-being. Hence, the objective of the pilot study was to evaluate the level of self-care behaviors and satisfaction in women suffering from cancer after exposure to supportive care (education and mind diversion activities) delivered via a patient help group program. METHODS: The study was conducted at the chemotherapy day care unit of one of the tertiary care hospitals located in Karachi, Pakistan. In this study, supportive care interventions were offered via the patient help group program over a 5-week period, and in the 6th week, data were collected. The total sample size of this pilot study was n = 17. Female cancer patients receiving weekly chemotherapy regimen and diagnosed with breast or gynecological cancers were a part of the study. Outcome variables, self-care behavior and satisfaction, were assessed via a self-developed questionnaire. Content validity index of the questionnaire was calculated on the basis of expert review and was found to be 96% for relevancy and 94% for clarity. Frequencies were calculated to evaluate outcome variables. Outcome variable satisfaction was also assessed via few open-ended questions. RESULTS: Participants reported moderate-to-high self-care behaviors and satisfaction after exposure to supportive care interventions delivered via the patient help group program. CONCLUSION: Counseling and mind diversion activities are effective in producing a positive change in chemotherapy patients' self-care behaviors and satisfaction. Therefore, oncology nurses must utilize them in chemotherapy patient care. Future studies should evaluate the effectiveness of these interventions with larger sample size and comparative analysis.

Relationship of Nutritional Status and Functional Capacity in Elderly Patients Visiting Outpatient Clinics of a Tertiary Care Hospital.

OBJECTIVE: To determine the correlation of functional and nutritional status of elderly patients (equal to and more than 60 years of age) visiting family medicine clinics of tertiary care hospital in Karachi. STUDY DESIGN: Cross-sectional, descriptive study. PLACE AND DURATION OF STUDY: Family medicine clinics of Aga Khan University Hospital, in Karachi, from August 2014 to February 2015. METHODOLOGY: A total of 200 participants (60 years and above), Family medicine outpatient clinics, were recruited via non-probability consecutive sampling. Katz scoring and MNA scale were used for the evaluation of functional and nutritional status, respectively. Spearman's rank correlation coefficient was applied to assess the correlation between nutritional status and functional status of elderly. RESULTS: Out of 200 participants, 35 % (n=70) were of 60-64 years of age. Most of them (54%, n=109) were males as compared to 46% (n=91) females; 33.5% were at risk of malnutrition and 35.5% were dependent. Spearmen correlation between functional and nutritional status was rho = -0.675, with p-value of p<0.001. CONCLUSION: There is a negative correlation between nutritional and functional status. As good nutritional status is essential for older persons to become functionally active; hence, this issue needs to be dealt in a developing country like Pakistan.

Physical activity levels and their correlates among secondary school adolescents in a township of Karachi, Pakistan.

OBJECTIVE: To determine physical activity level and its correlational factors among secondary school adolescents. METHODS: This cross-sectional study was conducted in two public and two private schools in Jamshed Town, Karachi, from March 2012 to June 2013, comprising students aged 10-17 years. The subjects, selected by simple random sampling were students of grades VI, VII, VIII. Physical activity was measured using the Physical Activity Questionnaire for older children. Socio-demographic data was also collected. SPSS 19 was used to analyse the data. RESULTS: Of the total 216 students, 131(60.6%) were girls and 85(39.5%) were boys, with an overall mean age of 13±1.4 years. Of the total, 151(70%) subjects had moderate and 65(30%) had low physical activity levels. Boys educated in public schools and those with parental support for sports were more physically active (p<0.05). CONCLUSIONS: Private school without playgrounds, female gender and lack of parental support for sports were correlates of physical inactivity among the students..

Frequency and Factors Associated with Adult Immunization in Patients Visiting Family Medicine Clinics at a Tertiary Care Hospital, Karachi.

Objective The goal of this study was to determine the frequency and factors associated with adult immunization in patients visiting family medicine clinics at a tertiary care hospital in Karachi. Methods A cross-sectional study was conducted from March 2014 to March 2015 in a tertiary care hospital in Karachi, Pakistan. Participants more than 18 years were invited to participate in the study. A pretested questionnaire was used to collect information. Data were entered and analyzed using IBM SPSS Statistics for Windows, version 19.0 (Armonk, NY: IBM Corp). Results A total of 340 patients were surveyed. The majority of patients were female (69.5%) with a mean age of 35.47 years. The majority were married (61.1%), and 30% of the participants had completed graduation or postgraduate education (20%). Most of the patients believed that vaccines can be used in adults to prevent disease (62.2%). Patients believed that the hepatitis B vaccine, influenza vaccine, and hepatitis A vaccine can be administered to adults (58.1%, 29.9%, 33.8%, respectively). The major sources of their information regarding vaccination in adults were friends or relatives (25%) and media (23.2%). Regarding availability of vaccines, 71.3% thought a hepatitis B vaccine is available, 54.9% thought a tuberculosis vaccine is available, and 49.3% thought a tetanus toxoid vaccine is available. Only 36.4% respondents received any vaccine in adulthood. The majority of patients (62.2%) received the hepatitis B vaccine in adulthood. The major reason given for not receiving vaccines was lack of awareness (62.4%). Conclusion Low adult vaccination coverage rates and awareness, as highlighted by the results of this study, show the dire need to address this major preventive strategy. This information can be utilized to conduct larger community-based surveys, to conduct health awareness sessions in the community, and to educate our doctors regarding the availability and benefits of adult vaccines.

Health Care in Gulf Cooperation Council Countries: A Review of Challenges and Opportunities.

This study was undertaken to review the health care status in the Gulf Cooperation Council (GCC) member states, and explore current challenges and future opportunities. Available data was acquired using databases including PubMed, Embase, and Cochrane Library. The data gathered was then combined and the expert authors in the field discussed and propose strategies to overcome the challenges. There is an increase in both population and health care needs of GCC States citizens and migrant workers. The huge emigrant population challenges the capability of the already limited available health care resources. The region is faced with a quadruple disease burden that includes communicable and non-communicable diseases, mental health issues and accidental injuries. Recent advances in technology have made breakthroughs in diagnosis and treatment modalities but with an increase in overall health care cost. Innovative and cost-effective strategies are required to cater the health care needs of people living in the GCC states. Policy makers should emphasize the need to prioritize and strengthen primary care as a matter of urgency.

A Review on the Role of Vitamin D in Asthma.

Asthma, a major public health issue, is one of the most common diseases affecting millions of population globally. It is a chronic respiratory disease characterized by increased airway inflammation and hyper-responsiveness. Vitamin D is of particular interest in asthma due to its immunomodulatory effects. Serum 25-hydroxyvitamin D is found to be associated with a wide range of pulmonary diseases, including viral and bacterial respiratory infections, asthma, and cancer. Several researches have reported positive associations between vitamin D and asthma. On the other hand, others have reported contrasting effects of vitamin D on asthma. This review provides an examination of current epidemiologic and experimental evidence of a causal association between vitamin D status and asthma or asthma exacerbations, including its probable protective mechanism. Most of the evidence regarding vitamin D and asthma is reported by observational studies. Therefore, results from the experimental trials of vitamin D supplementation are important as they can provide evidence for future recommendations about the significance of vitamin D for asthma. Moreover, the trials can be effective in assessing the correct dosage and safety of vitamin D supplementation when given in diverse age groups such as children, teenagers, and adults for prevention and treatment of asthma.

Mimicking rashes: Use of moulage technique in undergraduate assessment at the aga khan university, Karachi.

BACKGROUND: The use of simulated patients in student assessment is supported by the Best Evidence Medical Education and U.S. Agency for Healthcare Research and Quality, and it provides a safe and effective alternative to real patients in many situations. To assess the validity and feasibility of moulage technique-where a cosmetically constructed rash is used on simulated patients-two dermatologic rashes were developed using moulage simulation on standardized patients at Aga Khan University Hospital for 3rd year medical summative Objective Structured Clinical Examination (OSCE). METHODS: Checklists for cases that focused on history taking of a skin rash were developed. These also included a description and identification of lesions, differential diagnosis, and basic management. Cases were first reviewed and approved by the Educational Committee and a dermatologist content expert. Stations were piloted to assess validity and feasibility. Simple nontoxic materials were used to develop the rash by faculty familiar with moulage simulation. RESULTS: Sixty-four students were assessed on a Herpes Zoster case and 32 students on a Herpes Simplex case in morning and afternoon sessions. The total mean score obtained at all OSCE stations was 64.82 ± 10.22. Mean scores on the morning and afternoon dermatology stations were 62.72 ± 9.74 and 69.03 ± 9.98, respectively. Face validity for both stations was established through input of content experts. The internal reliability as measured by Cronbach's alpha between the checklist items on the morning and afternoon stations was acceptable at 0.60 (20 items) and 0.65 (18 items), respectively. DISCUSSION: The use of moulage technique to develop dermatologic lesions on simulated patients may be utilized for student assessment.

Impact of Caregiving on Various Aspects of the Lives of Caregivers.

OBJECTIVE: This study was designed to assess the impact of caregiving on the lives of the caregivers. METHODS: A cross-sectional study was conducted between July and September 2015 at a teaching hospital in Karachi, Pakistan. Participants who were more than 18 years old and were involved in caregiving (former or current) of a family member were invited to participate in the study. The participants were recruited through consecutive sampling technique. A total of 400 caregivers were interviewed. Written informed consent was obtained from all the participants. A pretest structured questionnaire was used for data collection and included sections on demographic details and impact of caregiving on various aspects of the lives of caregivers. The data was analyzed using SPSS version 19 (IBM, NY, USA). RESULTS: Information about a total of 400 caregivers (215 men and 185 women) was included in the final analysis. The majority (57.0%) of the participants were aged between 18 and 30 years. About three-fifths (60%) of the participants were single and the majority of the participants were students. Approximately 64% of the participants were currently involved in caregiving and about 48% of the participants responded that caregiving has an overall negative impact on various aspects, such as physical (40.8%), psychological (47.8%), and professional aspects (51.8%) of their lives. CONCLUSION: Negative impact of caregiving was observed among caregivers due to extensive demands of caregiving and limited resources. Therefore, it is imperative for health care providers to explore, identify and support caregivers to cope in a better way to the challenging task of caregiving.

Patient education and mind diversion in supportive care.

Cancer is a growing health problem worldwide. Common treatments include surgery, chemotherapy and radiation therapy. Systemic anti-cancer medications often result in an array of physical and psychological side effects. Supportive care assists patients with cancer in managing multidimensional symptoms that result from treatment or the illness itself. This review discusses supportive care and examines patient counselling and mind-diversion activities, which are safe and cost-effective strategies. Improving cancer patients' health and wellbeing should be encouraged in oncology nursing practice and by teaching students the knowledge and skills needed to provide supportive care.

Knowledge regarding calcium contained in food amongst secondary school going adolescents in Karachi.

OBJECTIVE: To determine the knowledge regarding calcium contained in food among secondary school-going children. METHODS: The cross-sectional study was conducted from February to May 2013 in two public and two private schools of Jamshed Town, Karachi. Stratified random sampling was used to raise the study sample. A pre-coded, piloted questionnaire was used for data collection. Data was analysed using SPSS 19. RESULTS: Of the 153 participants, 27(18.3%) had adequate knowledge while 126(81.7%) had inadequate knowledge about calcium contained in food. The mean age of the participants was 13.52±1.725 years. Statistically significant association was present between knowledge regarding calcium and mother's and father's educational level (p=0.039 and p=0.012, respectively), mother's and father's working status (p=0.002 and p=0.015, respectively) and acquisition of knowledge from parents (p=0.020), teachers (p=0.039) and via television (p=0.034). CONCLUSIONS: Most adolescents did not have knowledge about calcium contained in food.

Magnitude and factors associated with child abuse in a mega city of developing country pakistan.

OBJECTIVE: Child abuse is one of the major challenges for health care providers. This study was conducted to determine the burden of child abuse (physical & emotional) and the factors associated with it in an urban city of Pakistan. METHODS: This cross-sectional study was conducted in primary care clinics affiliated with a tertiary care hospital in Karachi, Pakistan between March to December 2010. Mothers with children aged between 6 and 12 years were included in the study. Those mothers' suffering from any acute illness like high grade fever, were excluded. A total of 412 mothers were recruited through consecutive sampling and written informed consent was taken. A pre-tested questionnaire was used to seek information about child abuse. Data was analyzed using SPSS version 19 and multivariable logistic regression was used to identify the factors (age, gender of child, family structure, educational status of parents, and mother's perception of her home environment) associated with child abuse. FINDINGS: Of the total 412 mothers, final analysis was conducted on 379 mothers. In all, 32.5% of children had been abused, 25.5% physically and 17.9% emotionally. Abuse was reported more among children whose mothers had minimal or no schooling (P=0.02), who were abused by their husbands (P<0.001), not satisfied with their marital life (P<0.001), and stressful home environment (P=0.02). In the multivariate analysis, the factors found to be independently associated with child abuse were mothers abused by their husbands (AOR=4.2; 95%CI: 2.2-7.9) and child being a girl (AOR=8.7; 95%CI: 4.5-16.8). CONCLUSION: The prevention of child abuse can be achieved through comprehensive, multifaceted and integrated approaches requiring joint efforts by the government, policy makers, stake holders, social workers, educationists, and public health practitioners.

Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study.

BACKGROUND: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, "concurrent use of five or more different prescription medication". Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center. METHODS: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University Hospital April 2012 to March 2013. One thousand geriatrics patients (age ≥ 65 years) visiting ambulatory clinics were identified. They were divided on the basis of exposure (polypharmacy vs. no polypharmacy). We followed them from the time of their enrollment (day zero) to six weeks, checking up on them once a week. Incidence was calculated and Cox Proportional Hazard Model estimates were used. RESULTS: The final analysis was performed on 1000 elderly patients. The occurrence of polypharmacy was 70% and the incidence of ADRs was 10.5% among the study cohort. The majority (30%) of patients were unable to read or write. The use of herbal medicine was reported by 3.2% of the patients and homeopathic by 3%. Our Cox adjusted model shows that polypharmacy was 2.3 times more associated with ADRs, con-current complementary and alternative medicine (CAM) was 7.4 times and those who cannot read and write were 1.5 times more associated with ADRs. CONCLUSION: The incidence of ADRs due to poly pharmacy is alarmingly high. The factors associated with ADRs are modifiable. Policies are needed to design and strengthen the prescription pattern.

Patient Attitudes towards Physician Nonverbal Behaviors during Consultancy: Result from a Developing Country.

Background. Nonverbal behaviors have a significant impact on patients during consultations. This study was undertaken to find out the attitudes and preferences of the patients regarding nonverbal communication during consultations with physicians, in a tertiary care hospital. Methods. A questionnaire based cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, Pakistan, during the months of January to March 2012. All patients (>18 years of age) coming for consultancy in the family medicine clinics were approached; out of 133, 120 agreed to participate. The subjects were asked questions regarding physician's comforting touch and eye contact and their responses were noted. The data were analyzed using SPSS and chi-square test was used to identify corelations. Results. Overall, 120 patients were enrolled. About 58.3% were men and 41.7% were women with a mean age of 34.9 ± 10.9 years. 95.8% were Muslims and 57.6% had more than 12 years of education. Among females 74% wanted supportive touch from doctors, used to comfort the patient (45%) or to show respect (27.5%) or as healing (30%). 86.1% of the respondents believe that establishing eye contact with the patient shows that the doctor is attentive towards his/her patient. The eye contact should be brief but regular (54.1%) and prolonged staring (36.7%) makes them uncomfortable. Conclusion. Nonverbal communication helps to strengthen the doctor-patient relation as patients do appreciate positive touch and eye contact from their physicians.