Knowledge and Attitude of Cervical Cancer Screening and Vaccination in Patients Attending Gynecology Outpatient Clinic at a Tertiary Care Hospital in Pakistan.

Shamaila ShamaunBackground Cervical cancer is the third most prevalent female cancer in Pakistan; nearly 70% present at a very advanced stage of malignancy due to lack of awareness, proper screening, and vaccination. Therefore, we aimed to assess the knowledge and attitude toward screening, vaccination, and risk factors of cervical cancer in sexually active women of Pakistan. Methods This cross-sectional study was conducted at the gynecology outpatient clinic of a public sector hospital in Karachi, Pakistan, from December 2021 to March 2022. We included sexually active women with exception of diagnosed cases of cervical cancer, pregnancy, vaginal bleeding, and psychological disorder. Collected data were regarding demographic characteristics, awareness regarding cervical cancer, screening, human papillomavirus (HPV) vaccine, and risk factors, history of cervical screening, and wiliness to opt-in for cervical screening. Results We included 226 women with a mean age of 41.25 ± 10.54 years. The mean parity level was observed to be 3.8 ± 1.95. A majority of women were housewives by profession (88.9%) and uneducated (61.9%). Only 41.2% (93) of women were aware of cervical cancer, 33.6% (76) were aware of cervical screening, and only 15.9% (36) had a history of cervical screening. Only four women (1.8%) were aware of the HPV vaccine and 31% (70) showed intention to opt-in for cervical screening. A vast majority of women (96.9%) were not aware of the risk factors of cervical cancer. Conclusion(s) We have observed poor awareness regarding cervical cancer, HPV vaccination, and cervical screening among women in our population. Lack of awareness was not restricted to a certain segment but it prevails all across the demographic in our population.

Contact tracing along with epidemiological and clinical characteristics of Novel corona virus 2019 in prisoners of Camp Jail, Lahore - A prospective case ascertaining study.

Background & Objectives: Prisons are reported as hub for communicable disease, as the closed environment, overcrowding, poor hygienic conditions facilitate the disease transmission. This study was conducted to describe contact tracing to identify, educate and manage COVID-19 in camp jail Lahore and to describe clinical and epidemiological features of disease in prisoners. Methods: After diagnosis of primary case of COVID-19 on 24th March, 2020 in camp jail, 527 suspected cases were identified through contact tracing. The health department-initiated case identification through contact tracing, isolation of confirmed and suspected cases, and quarantine of exposed persons and establishment of 100 bedded hospital in jail for infection prevention and control and treatment. Baseline characteristics of primary case and secondary cases were described along with the secondary attack rate of infection. Results: Mean age of secondary cases was 36.9(11.5) years with mean stay of 14.9(13.6) months. Two third of the prisoners were from Punjab. 11 % were illiterate and almost half were under metric. 527 prisoners were labelled as suspected cases through contact tracing and 59 out of 527 suspected prisoners tested COVID positive through RT-PCR with few reporting mild respiratory symptoms. Fifty five out of 59 tested negatives on day-5 and all have uneventful recovery by day-21. Secondary attack rate was 11%. Conclusions: In order to prevent Covid-19 outbreaks, proactive containment and comprehensive contact tracing to identify monitor and manage cases and contacts, in incarcerated facilities like prisons is a public health solution to prevent and control large scale epidemic. Active monitoring for infected patients, and implementing timely infection prevention and control measures are mandatory for highly infectious Covid-19 in this vulnerable population.

Preparedness of Public Hospitals for the Coronavirus (COVID-19) Pandemic in Lahore District, Pakistan.

Background Pakistan reported more than a million cases during the coronavirus disease 2019 (COVID-19) pandemic, shuffling the already resource-constrained health system that is known for its high vulnerability and lack of adaption. Objective To find out the level of preparedness of public hospitals for the novel COVID-19 pandemic in Lahore district. Methods A descriptive cross-sectional study was conducted from April to July 2021 among all 18 public hospitals under Specialized Health Care and Medical Education (SHC&ME) in Lahore by administering World Health Organization (WHO) and SHC&ME modified and pre-tested interviewer based and observation checklist. The level of preparedness was assessed for 11 domains, and each domain was scored as a dichotomous variable (Yes and No). Hospital preparedness was labeled as 'acceptable,' 'insufficient,' and 'unacceptable.' Descriptive statistics were run by using SPSS version 26 (IBM Corp., Armonk, NY), and data are presented in the form of tables and bar graphs. Results Out of 18 hospitals, only three (17%) had an acceptable level of preparedness for COVID-19 (>70%). An unacceptable level of preparedness (<35%) was seen in one hospital (5%). Fourteen hospitals (78%) were insufficiently prepared (35-70%). Conclusion The study highlights the suboptimal preparedness in 83% of the public hospitals with a consistent pattern of deficiencies in surge capacity, logistics and resource management, essential services, including diagnostics, infection prevention, and control.

Comparison of Chest X-rays findings in COVID-19 suspected and confirmed cases at a university teaching hospital: A retrospective comparative study.

OBJECTIVES: To compare Chest X-rays findings in COVID -19 suspected and confirmed patients on RT-PCR, presented at corona filtration center, Benazir Bhutto hospital Rawalpindi. METHODS: In this study, Chest radiographs of 100 COVID-19 RT-PCR positive confirmed patients were compared with 100 RT-PCR negative suspected COVID-19 patients screened at corona filtration center, Benazir Bhutto Hospital Rawalpindi from November 2020 to December 2020. Data on demographics, presenting complaints, co-morbid, lesion characteristic, distribution and attenuation, lobar involvement, pleural effusion and lymphadenopathy were collected. Associations between imaging characteristics and COVID-19 pneumonia were analyzed with univariate and multivariate logistic regression modals. RESULTS: Chest X-rays findings revealed bilateral lung consolidation with peripheral and diffuse distribution, involving middle and lower lobe to be statistically significant (p<0.05) between RT-PCR positives and negative patients. Peripheral distribution was associated with an 11.08-fold risk in COVID-19 positive patients than diffuse distribution. Middle lobe involvement had four folds risk and lower lobe involvement had 11.04 folds risk in COVID-19 cases as compared to upper lobe involvement. Consolidation had 2.6 folds risk in COVID-19 positive cases. CONCLUSIONS: Bilateral, peripheral distribution of middle and lower lobes ground glass haze or consolidation with no pleural effusion is significantly related to COVID-19 pneumonia. Overlapping imaging features of the infectious and non-infectious COVID mimickers can be further excluded by detailed clinical evaluation and further radiological workup.

Noise Induced Hearing Loss among an Occupational Group of Textile Workers in Karachi, Pakistan.

A cross sectional survey was conducted among textile workers of six textile factories of different industrial areas of Karachi to determine the frequency of hearing loss. A total of 264 workers were assessed for frequency of hearing loss with audiometric and otoscopic examination conducted by audiologist. About 79% workers had hearing impairment on audiometric assessment having hearing loss ≥25 dB. Of these, 19% of the workers had conductive deafness while 71% had mixed hearing loss. Otoscopic examination revealed that 38% had wax, 41.8 % had ear discharge and 1.6 % had perforation. The multiple logistic regression model shows sound level more than 25 dB aOR: 1.15; 95%CI: 1.10, 1.30 and ear discharge aOR: 2.23; 95%CI: 1.27, 3.92, was found as a strong risk factor of hearing loss (p<0.05). Hearing impairment affects a large proportion of the workers in Pakistan. There is a need for screening of workers exposed to occupational noise. Efforts should be made by the health care system to prevent the problem from an early stage and require effective management of ear-related diseases.

Anxiety And Depression In Medical Students Of A Private Medical College.

BACKGROUND: Depression and anxiety are the common mental disorders with a prevalence of 10-44% in developing countries and is the fourth leading cause of morbidity. Undergraduate medical studies are generally perceived to be more stressful for the students as compared to other undergraduate programs as students have to undergo strenuous curriculum and evaluation which may lead to many emotional stresses that may end with psychiatric disorders like depression and anxiety. This study aimed to determine the frequency of anxiety and depression in medical students of Foundation University Medical College (FUMC), Islamabad. METHODS: In this cross-sectional study, Beck Depressive Inventory and Beck Anxiety Scales were used to assess anxiety and depression at three different times of the Academic year. All five-year students were included in the study. RESULTS: Out of a sample of 150 students, mild depression was seen in 37.46% and moderate to severe depression was observed in 14% students. About 19% of the students had moderate to severe anxiety. In Second year students time of assessment was significantly related to depression and anxiety (p-0.000). Females had higher association with depression in final year (p-0.037). CONCLUSIONS: High Psychiatric morbidity found needs to be identified and treated at the earliest; otherwise it can lead to serious consequences such as suicidal ideation and burnout.

Burden of asthma among children in a developing megacity: childhood asthma study, Pakistan.

OBJECTIVES: Global burden of childhood asthma has increased in the past few decades, particularly in low-income countries. In Pakistan, there is a lack of community-based epidemiological studies estimating the burden of asthma among children. This study determined the prevalence and predictors of asthma among children 3-17 years of age in Karachi, Pakistan. METHODS: A two-stage community-based representative cross-sectional survey was conducted in Karachi from March 2012 to April 2013 comprising 1046 children aged 3-17 years. Of 7500 clusters, 80 were randomly selected, and of these, 15 children per cluster were enrolled randomly. A translated and pre-tested version of International Study of Asthma and Allergies in Children questionnaire was administered. RESULTS: The overall prevalence of asthma among study participants was 10.2% (95% CI: 8.4-12.0). Asthma was more likely to occur among boys (adj. OR: 2.5, 95% CI: 1.6-4.0), children in the younger age group (3-7 years) (adj. OR: 2.9, 95% CI: 1.7-4.8), those living in households with ill-ventilated kitchens (adj. OR: 1.8, 95% CI: 1.1-3.1), having family history of asthma (adj. OR: 2.3, 95% CI: 1.3-3.9) and those of the Sindhi ethnicity (adj. OR: 2.2, 95% CI: 1.1-4.4). CONCLUSION: This study is the first robust evidence regarding asthma among children in Pakistan, reporting a high burden in this group. Family history, male gender, Sindhi ethnicity and ill-ventilated kitchen were identified as important predictors of asthma. Targeted preventive measures and intervention studies are required to better understand and reduce the burden of asthma among children in Pakistan.

Frequency of depression and anxiety in patients attending a diabetes clinic.

BACKGROUND: Depression is very common among people with type-2 diabetes and is associated with poor treatment compliance and outcome. This study was done to see the frequency of depression in patients with established type-2 diabetes attending a diabetes clinic in a tertiary care hospital. METHODS: One hundred and ten patients with chronic type-2 diabetes were included in this cross sectional study, excluding type-1 diabetics, patients with severe co-morbid illness with type-2 diabetes and patients with some psychiatric illness. Hospital Anxiety and Depression Scale was used to assess depression and anxiety in these patients. RESULTS: Almost 50% of patients were found to have anxiety and depression in our study. Female gender, lack of education and housewives were found to be ffected'more -hile duration of diabetes, treatment and control of diabetes have little effect on anxiety and depression in patients with chronic type-2 diabetes patients. CONCLUSION: There is a high incidence of depression and anxiety in patients with chronic type-2 diabetes and clinicians must screen regularly for better care of these patients.

Tranexamic acid in decreasing blood loss during and after caesarean section.

OBJECTIVE: To determine the effectiveness of tranexamic acid (TXA) in reducing blood loss during and after caesarean section (CS), as well as its safety. STUDY DESIGN: A randomized double-blind placebo controlled study. PLACE AND DURATION OF STUDY: The Lyari General Hospital, Karachi, from March 2009 till April 2011. METHODOLOGY: Women undergoing lower segment caesarean section (LSCS) were enrolled. The patients were randomized to receive either injection TXA or distilled water just before the surgery. Blood loss was collected and measured. First from the time of placental delivery to the end of LSCS and later from the end of LSCS to two hours postpartum. Haemoglobin, urine analysis, liver and renal functions were tested in both the groups. Mean values blood loss were compared using t-test with significance at p < 0.05. RESULTS: Tranexamic acid significantly reduced the quantity of blood loss from placental delivery to the end of LSCS which was 356.44 ± 143.2 ml in the TXA group versus 710.22 ± 216.72 ml in the placebo group (p < 0.001). It also reduced the quantity of blood loss from the end of LSCS to 2 hours postpartum which was 35.68 ± 23.29 ml in the TXA group versus 43.63 ± 28.04 ml in the placebo group (p = 0.188), was not significant. No complications or side effects were reported in either group. CONCLUSION: Tranexamic acid significantly reduced the amount of blood loss during the LSCS, but it did not reduce the blood loss significantly after the caesarean section. Its use was not associated with any side effects or complication like thrombosis. TXA can be used safely and effectively in women undergoing LSCS to reduce intraoperative blood loss.

Change in action: using positive deviance to improve student clinical performance.

At our medical college many students have lower ratings in their clinical performance once they start their clinical years (third year). This is contrary to their results in other written exams. Some students demonstrate better clinical performance. We used the six-step Positive Deviance (PD) Conceptual Framework to identify and disseminate the strategies employed by the successful students to improve group clinical performance. Fifty 3rd year students (of a 5-year MBBS program) rotating through internal medicine were assessed mid-rotation with mini-CEX and 360° evaluations. Twenty students (40%) who performed well were invited for in depth interviews in order to identify positive deviant behavior in their clinical skills learning practices. The seven students (14%) who reported novel behaviors were asked to develop strategies for dissemination of their learning behavior in their peers. They decided to work in small groups with their peers, using the identified PD behaviors to encourage learning of history taking and examining skills in their peers. Group performance was assessed at the end of rotation, using mini-CEX and 360° evaluation in comparison to a subsequent group of students in the same year that did not work in PD peer learning groups. For the 360° evaluation the EP(2) (generalizability coefficient) was 0.92 and for the mini-CEX the EP(2) was 0.95, taking into account the variances between participants, groups, time and the interactions effects; thus indicating good reliability of both the assessment methods. A statistically significant difference (p < 0.05) was seen for improvement in medical interviewing skills and clinical judgment on the mini-CEX exam and 360 evaluation (p < 0.0001) in the PD group. Positive Deviance approach can help highlight behaviors among medical students, which contribute to success but may go unnoticed. Learning strategies based on the PD framework can improve student's group performance.

Promoting healthy workplaces--health pledges initiative at North Kirklees Primary Care Trust, NHS, England.

OBJECTIVE: To evaluate the effectiveness of health promotion activities targeting physical activity, healthy eating, smoking and stress management as a part of healthy workplace initiative at North Kirklees Primary Care Trust, England. METHODS: The quasi-experimental interventional study was conducted from April 2005 to March 2006 and involved all the employees of the North Kirklees Primary Care Trust, England, who were willing to participate. Main interventions were; lunch-time walk, motivational interviews, counselling and support sessions from qualified dieticians, physical activity and smoking cessation advisors. Free occupational therapy sessions were provided at the workplace. Incentives like discounted vouchers for sports club and the gymnasium were also given. Pre- and post-intervention data was collected and analysed using SPSS version 17. RESULTS: Of the total, 57 (42%) pledged to undertake physical activity; 50 (37%) healthy eating; 20 (15%) mental and emotional well-being; and 8 (6%) to quit smoking. Statistically significant associations were found between different health promotion activities like physical activity (p = 0.004), healthy eating (p = 0.003), stress management and stop smoking (p = 0.001) at the workplace. CONCLUSION: Workplace is a potentially valuable setting for health promotional activities for primary prevention and may facilitate lifestyle modification.