Stimulation of Erythrocyte Membrane Blebbing by Bifenthrin Induced Oxidative Stress.

Background: Bifenthrin is an insecticide and anti-estrogenic compound primarily used to control residential pests by depolarizing sodium gated voltage channels in the nervous system. Eryptosis, the suicidal death of erythrocytes, featured by PS exposure, membrane blebbing and cell shrinkage. Anemia is an outcome of uncontrolled eryptosis. Research Design: In this study, erythrocytes were treated with different concentrations (.5-1-1.5 µM) of bifenthrin over a period of 48 hours. In order to investigate the oxidative stress induced by bifenthrin, catalase, superoxide dismutase, and glutathione peroxidase activities were investigated. Results: Obtained data indicated the decrease in the enzymes (superoxide dismutase, glutathione peroxidase, and catalase) activities in bifenthrin treated cells at 1 µM concentration. In addition, measurement of cell size and confirmation of the role of calcium in the stimulation of the eryptotic activity of bifenthrin were performed. A significant increase in mean cell volume was found in the presence of bifenthrin and a decrease in mean cell volume in the presence of calcium channel blocker was observed. Similarly, there was also a significant increase in the percentage of hemolysis indicating the necrotic activity of bifenthrin. Conclusions: It is concluded that the indicated doses of bifenthrin triggered oxidative stress which may lead to early cell death by eryptosis and hemolysis.

Coronavirus (COVID-19): Let's Prevent Not Panic.

It was on 31st December 2019, that a cluster of pneumonia cases was reported to the World Health Organization (WHO) by China. The initial investigations revealed the cases to be due to a previously unknown "never before seen strain of coronavirus". Coronaviruses are a group of viruses, which are normally present among animals such as cows, bats, camels and cats. The disease was officially named COVID-19 by WHO on 11th February 2020. The International Committee on Taxonomy of Viruses named the virus as SARS-CoV-2 due to its resemblance to SARS coronavirus. According to WHO's Situation Report-28 as of 17th February 2020, globally there were 71,429 confirmed cases, which included both laboratories confirmed and clinically diagnosed cases (applicable only to Hubei province of China). Cases are clinically diagnosed based on their signs and symptoms and chest x-rays without laboratory testing. More than 99% of these are in China i.e. 70,635 and 794 are outside China. The cases reported outside of China belong to 25 countries in various regions of WHO: China having the epicenter of the disease bears the greatest brunt, with 1772 deaths. The three deaths outside China have been reported in Philippines, Japan and France. The case fatality rate of COVID-19 ranges between 2-3% A wide spectrum of disease, ranging from mild to severe, has been reported in confirmed cases of COVID-19. Respiratory symptoms, fever, cough, dyspnoea, myalgia, fatigue, breathing difficulties and bilateral lung infiltrates on C.T are common findings. Pakistan so far has not reported any confirmed case of COVID-19. Government is showing its commitment towards the threat of importation. This novel coronavirus, called as a "devil" by Chinese Prime Minister, Xi Ping is really an enigma.

Empathy among medical students: A cross-sectional survey.

BACKGROUND: Empathy is regarded as one of the leading elements of good physician-patient relationships, having a strong association with improved patient outcomes. It is an aspect of personality, which is considered to be an essential component in the development of interpersonal understanding and in assisting proficiency in communication. Developing empathy among medical students who are going to become tomorrow's physicians is an important part of medical education. The objective of this study was to measure the mean empathy score of medical students at a private medical college and identify associated factors. METHODS: This cross-sectional study was conducted from January to June 2018 among 569 medical students at a private medical college in Lahore. Toronto empathy questionnaire (TEQ) was used to determine empathy levels among students. Data was analysed in IBM SPSS-20. Mean TEQ scores were calculated. Independent sample t-test and one-way ANOVA were used to determine association between mean Toronto empathy score and socio-demographic variables, significant at a p-value of <0.05. RESULTS: The age of 569 respondents ranged from 17 to 27 years with a mean of 20.82±1.757. There were 317 (55.71%) females; and 312 (54.8%) were residing at home with parents. The overall mean TEQ score was calculated to be 42.57±7.513. The Cronbach's alpha was 0.710. There was a significant association between empathy levels and year of study of the respondents (p<0.001), gender (p<0.001) and students' permanent area of residence (p=0.018). CONCLUSION: Overall mean TEQ score was found to be 42.57±7.513. Statistically significant difference was found between gender, place of residence, year of study and mean empathy scores.

Risk of adverse treatment outcomes among new pulmonary TB patients co-infected with diabetes in Pakistan: A prospective cohort study.

PURPOSE: The escalating burden of diabetes in countries tackling high burden of tuberculosis (TB) has adverse implications for co-infected individuals and National TB control efforts. We aimed to study whether there was a difference in treatment outcome among diabetic and non-diabetic pulmonary TB patients and identify the determinants of treatment outcome among the two groups. MATERIALS AND METHODS: This prospective cohort study recruited new patients of pulmonary tuberculosis (PTB) aged 15 years and above who were diagnosed at and registered with Gulab Devi Chest Hospital, Lahore, Pakistan for anti-tuberculosis treatment (ATT). PTB patients were screened for diabetes using random and fasting blood glucose tests. Diabetic and non-diabetic PTB patients were followed up at second, fifth and sixth month of ATT and 6 months after ATT completion to determine treatment outcome. Multivariate logistic regression analysis was conducted to assess association between various factors and treatment outcome. RESULTS: Of 614 PTB patients, (n = 113 [18%]) were diabetic and (n = 501 [82%]) non-diabetic. Final model showed that diabetics were more likely to experience an unfavorable outcome as compared to non-diabetics (adjusted odds ratio [aOR] = 2.70, 95% Confidence Interval [CI] = 1.30 to 5.59). Other predictors of unfavorable outcome included rural residence (aOR = 1.98, 95% CI = 1.14 to 3.47), body mass index less than 18.50 (aOR = 1.89, 95% CI = 1.03 to 3.47) and being a smoker (aOR = 2.03, 95%CI = 1.04 to 3.94). CONCLUSION: Our study shows unfavorable treatment outcome among diabetic PTB patients. Integrated models of care with screening/testing and management for diabetes and TB could improve TB treatment outcomes.

Establishing a cohort in a developing country: Experiences of the diabetes-tuberculosis treatment outcome cohort study.

BACKGROUND: Prospective cohort studies are instrumental in generating valid scientific evidence based on identifying temporal associations between cause and effect. Researchers in a developing country like Pakistan seldom undertake cohort studies hence little is known about the challenges encountered while conducting them. We describe the retention rates among tuberculosis patients with and without diabetes, look at factors associated with loss to follow up among the cohort and assess operational factors that contributed to retention of cohort. METHODS: A prospective cohort study was initiated in October 2013 at the Gulab Devi Chest Hospital, Lahore, Pakistan. We recruited 614 new adult cases of pulmonary tuberculosis, whose diabetic status was ascertained by conducting random and fasting blood glucose tests. The cohort was followed up at the 2nd, 5th and 6th month while on anti-tuberculosis therapy (ATT) and 6months after ATT completion to determine treatment outcomes among the two groups i.e. patients with diabetes and patients without diabetes. RESULTS: The overall retention rate was 81.9% (n=503), with 82.3% (93/113) among patients with diabetes and 81.8% (410/501) among patients without diabetes (p=0.91). Age (p=0.001), area of residence (p=0.029), marital status (p=0.001), educational qualification (p=<0.001) and smoking (p=0.026) were significantly associated with loss to follow up. Respondents were lost to follow up due to inability of research team to contact them as either contact numbers provided were incorrect or switched off (44/111, 39.6%). CONCLUSION: We were able to retain 81.9% of PTB patients in the diabetes tuberculosis treatment outcome (DITTO) study for 12months. Retention rates among people with and without diabetes were similar. Older age, rural residence, illiteracy and smoking were associated with loss to follow up. The study employed gender matched data collectors, had a 24-h helpline for patients and sent follow up reminders through telephone calls rather than short messaging service, which might have contributed to retention of cohort.

Depression And Associated Factors: A Cross-Sectional Study Using Beck Depression Inventory.

BACKGROUND: Mental health disorders are becoming an increasingly common occurrence worldwide and present a major public health concern. Depression has been recognized as a major contributor in mental health disability burden. This study aims to determine the frequency of depression among individuals presenting at a rural health facility in Lahore and to identify the risk factors associated with it.. METHODS: A cross sectional study was conducted at Rural Health Centre Kahna Nau, Lahore from January to April 2017. A sample of 384 consenting individuals presenting at the rural health facility were selected through consecutive sampling technique. Beck Depression Inventory (BDI), was used to assess the level of depression amongst the respondents. We categorized the BDI score for this study into BDI ≥20 as "depressed" and BDI <20 as "non-depressed". Data was entered and analysed by using SPSS 16.0. Chi-square test was carried out to identify factors associated with depression, significant at a p-value of ≤0.05. RESULTS: Out of total, 258 (69.5%) respondents were males with 197 (53%) in age category of 25-44 years. BDI scale showed 84 (23%) respondents to be suffering from depression. Age (p=0.002), income (p=0.003), marital status (p=0.023), educational status (0.011), family structure (p=0.041), history of hospitalization (p=0.003), smoking status (0.012) and co-morbidity (p=0.001) were significantly associated with depression. CONCLUSIONS: Our study found a substantial proportion of patients' who were suffering from depression. Age, income, marital status, educational qualification, family structure, co-morbidity and smoking status were significantly associated with depression.

Cohort profile: the diabetes-tuberculosis treatment outcome (DITTO) study in Pakistan.

PURPOSE: Pakistan is faced with an increasing prevalence of diabetes in addition to its existing high burden of tuberculosis (TB). Diabetes has a detrimental effect on treatment outcomes of patients with TB, which may hinder achieving the goals of the End-TB strategy by 2030. We conducted a prospective cohort study to determine difference between treatment outcomes among patients with diabetes and new pulmonary tuberculosis (PTB) and patients without diabetes and new PTB. This would help generate contextual and valid scientific evidence from a developing country like Pakistan with its unique interplay of sociocultural, economic and health system factors to inform policy and practice. PARTICIPANTS: This paper outlines the baseline characteristics of 614 new cases of PTB, aged 15 years and older, which were followed up prospectively at 2nd, 5th and 6th months while on antituberculosis treatment and at 6 months after treatment completion. FINDINGS TO DATE: We ascertained patients' diabetic status by conducting random and fasting blood glucose tests and their glycaemic control by determining glycosylated haemoglobin. Treatment outcomes were established using standardised definitions provided by WHO. The assessment of 614 respondents' diabetic status revealed that 113 (18%) were diabetic and 501 (82%) were non-diabetic. A greater proportion of patients with diabetes and PTB were illiterate (n=74/113, 65.5%) as compared to patients without diabetes and PTB (n=249/501, 50%) (p=0.035). More patients with diabetes and PTB gave a history of heart disease (n=14/113, 12%) and hypertension (n=26/113, 23%) as compared to patients without diabetes and PTB (n=2/501, 0.4% (heart disease) and n=13 501, 3% (hypertension)) (p<0.001). Unfavourable treatment outcome was more likely among patients with diabetes and PTB (n=23/93, 25%) as opposed to patients without diabetes and PTB (n=46/410, 11%) (p=0.001). FUTURE PLANS: We are negotiating with the government regarding funding for a further 2-year follow-up of the cohort to ascertain death and relapse in the post-treatment period and also differentiate between re-infection and recurrence among these patients with respect to their diabetic status.

Tackling The Co-Epidemic Of Diabetes And Tuberculosis: From Evidence To Policy And Practice.

With the global increase in the diabetic population there is a resurgence of interest in the dual epidemic of diabetes mellitus (DM) and tuberculosis (TB), which has a bidirectional detrimental relationship with negative consequences for co-infected patients. Pakistan is feared to be hit the hardest, occupying fifth position amidst the 22 high burden TB countries, and ranking seventh in the global diabetic burden. The diabetes tuberculosis treatment outcome (DITTO) study was undertaken to determine the impact of diabetes on tuberculosis treatment outcome in Pakistan. The generation of such scientific evidence is useless if it is not utilized for policy making and practice, especially in a developing country like ours with a dearth of resources. In this paper, we have developed a framework for the transfer of scientific evidence regarding the impact of diabetes on TB treatment outcomes into policy and practice. The framework is divided into three components namely; generation of scientific evidence harnessing international and national efforts, informing health policy and practice and addressing other concerns such as social protection, health education and future research.

NAEGLARIA FOWLERI: THE BRAIN EATING AMOEBA OR AN ENIGMA?

Naeglaria fowleri (N. fowleri), popularly known as the brain eating amoeba is the causative agent of the fulminant disease, primary amoebic meningoencephalitis (PAM). Although a rare disease, it is a threat to human health with a case fatality rate ranging from 95-99%. PAM cases have been reported from the United States of America, Australia, Europe and Asia. From 1962 to 2014, 133 people have been infected by N. fowleri in the USA, out of which only three have survived. None of the PAM cases reported in Pakistan so far has survived. This underscores the importance to identify factors, which have led to the failure in decreasing case fatality associated with N. fowleri despite major advances in medical technology, health care; and prevention and control strategies since the first reported case in 1965. We need to focus on eliciting risk factors of the disease prevalent in our part of the world, which are at variance with the developed world. A predominant number. of PAM cases in the West are reported in young males who had participated in recreational activities. However, majority of cases reported in Pakistan are also among young males but they were linked with the religious practice of ablution. What is required to better understand and hence manage this enigma is further research. Further research is to be conducted to discover potent antimicrobials, to test the effectiveness of the new transcribial device in managing PAM, and to identify host factors, which make an individual susceptible to N. fowleri. Investigation of environmental factors related to N. fowleri also needs to be done. Doing so is of paramount importance, as it will help identify the preventive strategies to be employed against N. fowleri.

The health workforce crisis in Pakistan: a critical review and the way forward.

Today, the developing world suffers due to the health "workforce crisis." The World Health Report 2006 uses this term to study the current scenario in the developing countries. Human resource planning is a critical activity within the broader sectoral planning, especially when it comes to the health sector. Pakistan faces an acute shortage of different cadres of healthcare workers, which is bound to escalate further because of the high population growth rate, inequitable distribution and out-migration of the healthcare workforce. In the wake of ongoing reforms in the health sector of Pakistan, it is suggested that for the strengthening of health systems, there ought to be a serious thought process involved for developing a human resource plan for the health sector that responds to the needs of the population and the disease burden. A national strategy is imperative to retain, train and incentivize the health workforce.

Medical students' perspective about role-plays as a teaching strategy in community medicine.

OBJECTIVE: To assess the students' perspective about role-plays conducted as a teaching methodology in community medicine. STUDY DESIGN: A quasi-experimental study. PLACE AND DURATION OF STUDY: Department of Community Medicine at Fatima Memorial College of Medicine and Dentistry from July to November 2010. METHODOLOGY: A probability technique of simple random sampling was used to collect 63 students from the third and fourth year MBBS who were randomly distributed in five sub-groups. They were variously ascribed the roles of obsceners, participants and helpers. A questionnaire was distributed to collect student's responses. The data was analyzed on SPSS version 17 to compare the responses. Chi-square test was applied and p-value was fixed at < 0.05 as significant. RESULTS: Sixty-three students were selected as participants of this study in which 46 belonged to the fourth year MBBS class (73%) and 17 were third year MBBS students (27%). There were 13 male (20.6%) and 50 female (79.4%) students. Role-plays were identified as most effective method of teaching (n = 25, 37.9%) followed by lectures (n = 17, 25.8%, p = 0.054). Fifty-two students (78.5%) admitted that role-plays improved their knowledge of the subject, 55 (84.6%) said that it will help them in their clinical performance. Fifty-nine participants (89.4%) found role-plays interesting and 49 (74.2%) wanted to incorporate role-plays as a part of curriculum. Fifty-six of the participants (88.9%) agreed that role-plays improved their communication skills. Twenty-one participants (31.8%) believed that it helped them in making acquaintance with the local situation. Forty-six students (76.7%) identified role-plays as a feasible way of andragogy (p = 0.005) and 48 (76.2%) said that it provoked critical thinking about the subject (p = 0.038). Fifty-four students (85.7%) admitted that their attention span was better in role-plays as compared to lectures (p = 0.047). CONCLUSION: Role-plays were well accepted by the students as an effective teaching methodology and can be incorporated as a part of teaching strategies in Community Medicine.

Outbreak of dengue fever in Lahore: study of risk factors.

BACKGROUND: Dengue fever is a rapidly emerging arthropod born viral disease threatening to become an international public health problem. Approximately 500,000 people suffer from dengue haemorrhagic fever and dengue shock syndrome with 20,000 deaths annually. Objective of this study was to look into the risk factors associated with the development of dengue fever. METHODS: This cross-sectional descriptive study was conducted on patients admitted in various hospitals of Lahore with suspected Dengue fever. Data was collected on a questionnaire from 109 conveniently selected patients. RESULTS: Mean age of the patients was 34 +/- 16.5 years, and majority (80, 73.4%) were male. Seropositivity for dengue was found in 78 (71.5%). The study did not find significant statistical association of seropositivity with demographic variables. However, source of water supply was found associated with dengue seropositivity (p = 0.002). CONCLUSION: Source of water is a determinant of contracting dengue fever owing to it a breeding media for mosquitoes. All other phenomena associated with use of water and sanitation needs to be part of long term control of dengue that will also contribute to controlling other diseases with the same determinants.

Medico-legal aspects of alleged rape victims in Lahore.

OBJECTIVE: To describe the socio-demographic along with the medico-legal characteristics of rape victims reporting to a female police station of Lahore. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Female Police Station in Shadman, Lahore, from, June 1995 to January 2009. METHODOLOGY: A total of 74 cases of alleged rape victims were identified while reviewing all available police files concerning reported rapes and attempted rapes from 1995 to 2008. The data was gathered on preformed questionnaires after conducting the pilot study. All information about victims and alleged offenders were extracted from the police files including socio-demographic profile of the accused and victim both. Use of weapon, evidence of physical and genital trauma, assailant identification and his relationship with the victim, number of accused persons and location of rape was noted in each case. Examination by doctor and obtaining the specimens were also identified and was related to the outcome of the court case. Chi-square test was applied to determine the association of rape with age and educational status of the victim and the accused. RESULTS: A total of 74 cases of alleged rape were reported in the study period at Shadman Female Police Station. Maximum number of victims was reported in the age group 10-19 years (n=46, 62.2%). Majority of the accused belonged to 20-39 years' age group constituting 64.8% of the total. Regarding educational status 45 (60.8%) of the victims and 51 (68.9%) of the accused were illiterate. Significant association was found between the educational status of rape victims and accused (p = 0.016) but not between their ages (p = 0.862). The maximum incidence of rape was reported in unmarried (n = 55, 74.3%) and unemployed (n =61, 82.4%) women. In 14 cases (19%) use of weapon was reported. Physical trauma was reported in 29 (39%) and genital trauma in 14 (19%) cases. The accused were identified as family friends (25%) and neighbours (23%) respectively. Only 21% of the victims were examined by doctor and specimens were obtained in only 14.9% of the cases. Acquittal of the accused was observed in 43% of the cases while 34% cases were still pending; conviction of the accused was observed in only 5% of the cases. CONCLUSION: Rape victims usually belong to young age group between 10-19 years majority of being unmarried and unemployed. Only a smaller fraction of the victims were examined by doctor and specimens were obtained in only few of the cases.

Bullying of medical students.

OBJECTIVE: To assess the frequency and forms of bullying experienced by medical students, and the associated factors. STUDY DESIGN: Cross-sectional questionnaire-based survey. PLACE AND DURATION OF STUDY: The study was conducted at a private Medical College of Lahore, from January to February 2010. METHODOLOGY: All the students of first and fourth year classes were included in the study with voluntary and anonymous participation. Self administered-questionnaires were given to the students which were completed by them in the presence of the surveyor. A modified version of the British Medical Associations (BMA) medical student's welfare and education survey form was used for data collection. The data was recorded and analyzed using the statistical package for social sciences version 16.0. Data was described in the form of frequencies and percentages. Chi-square test and Fisher exact test were used to test statistical significance between categorical variables at p < 0.05. RESULTS: More than half the students 70 (66%) had experienced some form of bullying in the past 6 months at the Medical College. It was found that 70% (49) of the students who were bullied were females. Sixty-seven percent of students reported experiencing a bullying episode at least once in a month, 26% less than once in a month and 7% at least once in a week. The most common forms were verbal abuse (n=44, 63%) and behavioural gestures i.e. making faces (n=36, 51%), followed by having been ignored or excluded (n=20, 29%). The common perpetrators of all types of bullying were fellow students followed by Professors. Feeling lonely or sad (p=0.024), not having a close friend (p=0.049) and knowledge amongst respondents regarding the availability of support services in their college (p=0.019) were significantly associated with being bullied. CONCLUSION: Most medical students reported of having been bullied in the last 6 months at the College, with verbal abuse being the commonest form of maltreatment and fellow students followed by Professors being the frequent perpetrators. A history of feeling lonely or sad, not having a close friend and knowledge amongst respondents regarding the availability of support services in their college were significantly associated with these experiences.

Faculty development in medical institutions: where do we stand in Pakistan?

BACKGROUND: The term 'Faculty Development' encompasses all those activities which help faculty members enhance their academic competencies. It comprises three domains: personal development, professional development, and instructional and course development. The objectives of this study were to determine the proportion of medical colleges involved in faculty development activities, to assess the types of faculty development activities, and to identify the factors influencing such activities, along with formulating recommendations for faculty development. METHODS: A cross-sectional study was conducted in the medical colleges (public and private) of Pakistan from September to December 2010. A questionnaire was designed through literature review, was pre-tested and then sent via mail to principals of the institutions outside Lahore. Questionnaires were self-administered to respondents within Lahore. Apart from describing the data, Chi-square and Fisher's exact tests were applied to determine statistical association between categorical variables at p < or = 0.05. RESULTS: All the 65 public and private sector medical colleges recognised by the Pakistan Medical and Dental Council (PMDC) at that time were included in the study. Responses were received from 45 medical institutions, of which 37 (82%) were involved in faculty development activities. Training on communication skills were provided by 31 (84%), and teaching skills by 30 (81%) institutes. Stress management was the topic addressed by 15 (40%) institutes. Most institutes conducted such activities once a month (43%), followed by once every six months (30%). Faculty at all levels was equally involved in training activities, except senior registrars involved by 5 (14%). The presence of Medical Education Department (DME) in the college (p < 0.01), the respondent's designation (p = 0.0038) and the provincial location of the college (p = 0.036) were significantly associated with faculty development activities. The barriers to faculty training were identified as: lack of incentives 20 (54%), lack of faculty interest 15 (40%), and dearth of trained facilitators 15 (40%). CONCLUSION: Majority of the medical institutes were involved in faculty development activities imparting training regarding communication and teaching skills. Presence of DME in the college, the respondent's designation, and the provincial location of the college positively influenced faculty development activities. Lack of incentives, lack of faculty interest and a shortage of trained faculty were identified as barriers.

Brucellosis in a high risk occupational group: seroprevalence and analysis of risk factors.

OBJECTIVES: To estimate Brucella seropositivity among slaughterhouse workers of Lahore district and to elucidate risk factors associated with seropositivity to Brucella. METHOD: During the year 2008, a cross-sectional study was conducted in four slaughterhouses of Lahore district. A sample of 360 workers was selected from these slaughterhouses through stratified random sampling on proportional basis. Workers were interviewed using a structured questionnaire to obtain risk factor information and their blood samples were collected to be screened for the presence of anti-Brucella IgG using Enzyme Linked Immunosorbent Assay (ELISA) technique. Data management and analysis were performed using SPSS (statistical package for social sciences) version 16. Risk factors associated with seropositivity to anti-Brucella IgG were identified by constructing a logistic regression model. RESULTS: Of the 360 serum samples tested, 21.7% (95% CI 17.44% - 25.96%) were positive by ELISA test. The logistic regression model identified age (OR 0.96, 95% CI 0.94-0.99), assistance in parturition of animal (OR 0.47, 95% CI 0.23-0.96), consuming raw milk (OR 2.25, 95% CI 1.04-4.87) and handling sheep (OR 0.30, 95% CI 0.09- 0.92) as risk factors for Brucella seropositivity among slaughterhouse workers of Lahore district. CONCLUSION: To reduce the burden of brucellosis, a national brucellosis control programme should be initiated with special emphasis on the high risk population of slaughterhouse workers.

Determinants and pattern of health care services utilisation in post graduate students.

BACKGROUND: The health care utilisation of a population is dependent on their health seeking behaviour which is determined by their physical, political, socio-economic and socio-cultural aspects. OBJECTIVES: This particular study is conducted to identify the determinants and the patterns of health services utilisation by the postgraduate students of Allama Iqbal Open University in Pakistan. It was a cross-sectional study and conducted from December 2008 to April 2009 in Allama Iqbal Open University Islamabad. METHODS: A non-probability convenience sampling was done in post graduate students who were enrolled for Masters Degree at Allama Iqbal Open University Islamabad. Data was collected on a self administered, pre-tested questionnaire to identify the pattern of utilisation of health care services by this educated class. Data was labelled and entered in SPSS version 16. Chi-square test is applied as a test of significance with fixing the p value at 0.05 as significant. RESULTS: Only 129 students 32 males, 97 females) out of 250 responded to the questionnaire with the response rate of only 51.6%. The sociodemographic profile of the participants shows that 71 (55%) belong to age group 20-29 years, followed by 43 (33.3%) in age group 30-39 years. The marital status of the participants had a significant association with selection of health care services (p = 0.04). Twenty-four (75%) of the males and 67 (65%) of the females were using private sector facilities. Age, marital status and income of the study subjects had significant association with selection of the provider with p values of 0.000, 0.047 and 0.051 respectively. CONCLUSION: The health care system in Pakistan comprises the public as well as private health facilities. In Pakistan vast majority of doctors resides in urban area and attracts the educated class towards private sector. Utilisation of public health care facility is not the main priority of the educated class of the country. Government officials should pay attention to make it more convenient for general public.

Brucella serology in abattoir workers.

BACKGROUND: Brucellosis is an occupational hazard with those particularly at risk either living in close proximity with animals or handling them. It is a public health problem in developing countries with adverse health implications both for animals and human beings as well as economic implications for individuals and communities. The Objectives were to estimate the seroprevalence of brucellosis among abattoir workers of Lahore District and to determine the association of brucellosis with nature of job of the workers. METHODS: Data was collected in April 2008. It was a cross-sectional study in which four main slaughterhouses in Lahore were included. The slaughterhouse workers were divided into seven strata based on their nature of job: meat sellers, slaughterers, animal keepers, drivers, cleaners, loaders and vets/paravets. A total of 360 such workers were selected using stratified random sampling technique. Sampling frames for different strata were prepared and from each frame, proportionate numbers, were selected through simple random method using random number tables. Data was obtained using a questionnaire. Additionally blood samples were collected and analyzed for anti-Brucella Immunoglobulin G (IgG) using enzyme-linked immunosorbent assay (ELISA) technique. RESULTS: The seroprevalence of anti-Brucella IgG was found to be 21.7%. A statistically significant difference was observed between the immune status of the respondents and their nature of job (p = 0.005), age groups (p = 0.013), and duration of job (p = 0.003). CONCLUSION: The disease is an important public health problem in Pakistan. The disease can be prevented in the slaughterhouse workers through the use of personal protective devices. Public health authorities should educate the general public regarding prevention of the disease with specific emphasis on people working in slaughterhouses.