Impact of Flood on Breastfeeding Practices at Flood Relief Camps of Pakistan.

Objective: To explore impact of flood on breastfeeding practices and identify barriers in continuation of breastfeeding among mothers residing in flood relief camps. Methods: This exploratory observational study was conducted during visit of medical team of The University of Child Health Sciences, Children's Hospital at flood relief camps of Sindh (7th September to 12th September, 2022) and south-west of Punjab province (18th November to 20th November, 2022). The data was collected on structured questionnaire from 40 lactating mothers residing in flood relief camps. Purposive sampling technique was used in this regard. Results: The mean age of breastfed children was 16.1±7.811 months. There was negative impact on breastfeeding practices (n=21, 52.5%) as frequency decreased in 18(45%) mothers and 3(7.5%) totally stopped breastfeeding. There was significant relation between pre-flood breastfeeding status and impact of flood on breastfeeding practices (p=0.001). The major barriers to appropriate breastfeeding were mother's perception of insufficient breast milk due to inadequate diet (n=6, 15%) or depression and anxiety (n=4, 10%), mother's illness (n=3, 7.5%), constant displacement (n=2, 5%) and provision of breast milk substitutes (n=2, 5%). Conclusion: There has been significant negative impact of flood on breastfeeding practices among lactating mothers residing in flood relief camps. Perception of decreased milk production due to inadequate diet and stress are major barriers in continuation of breastfeeding. Breastfeeding supportive services need to be integral component of flood crisis management.

What do medical faculty students think about telehealth?

Objective: We aimed to evaluate medical school students' knowledge and approaches regarding telehealth. Method: In this descriptive study, an electronic survey was conducted among students attending the Faculties of Medicine at Health Sciences University. The first part of the Form included questions evaluating individual characteristics and telehealth approaches, and the second part included opinions and suggestions regarding telehealth usage topics. Results: Of 698 participants, 435 (64.9%) students were in the preclinical period. One hundred nine (15.6%) believed they had sufficient knowledge about telehealth while 399 (57.2%) believed that telehealth should be included in medical education. When asked about their opinions on using telehealth in their professional careers, 298 (42.7%) stated that they considered using them. Those who perceived themselves as having sufficient knowledge about telehealth were more inclined to consider using it more in their professional careers (p=0.000). Participants who believed that healthcare services could be provided through telehealth were more likely to think that disease monitoring would be better, patient follow-up quality would improve, unnecessary hospital admissions would decrease (p<0.05). Conclusions: The majority of medical faculty students lack sufficient knowledge about telemedicine and believe that education on this topic should be included in the medical curriculum. It is suggested that incorporating pre-clinical courses on telemedicine and providing internship opportunities in practical settings would effectively address this gap.

The current outbreak of Monkeypox virus (MPXV); what strategies can be adopted to control its transmission?

As the world is still under the grip of COVID-19, "WHO" has started alerting about the new global emergency due to a surge in cases of the Monkeypox virus (MPXV) disease (MPXD). MPXD is a rare viral zoonotic disease, caused by the monkeypox virus, which results in multiple centrifugal rashes similar to smallpox. The current unusual high frequency of transmission has lead to the WHO alert because, human-to-human transmission has been observed in Europe, without a history of travel to endemic areas. So, further spread of the virus can be anticipated through close contact, being a threat for its transmission. It is thus necessary for our government to prepare itself for handling this new situation which could spread fast due to globalization.

Third International Conference on Medical Education and Medical writing, University of Karbala College of Medicine, Karbala, Iraq.

University of Karbala College of Medicine (UKCM), Iraq, conducted a three days' workshop on Medical Education and medical writing. The UKCM is now transforming to conform with the latest trends of modern education. This will help to re-shape the future of medical education and produce capable doctors. This requires a strong faculty, which is sound in teaching, training, learning improvement, research capacity building, and leadership development. The capacity building of faculty at UKCM has been initiated in collaboration with Medics International at a local and government level and includes a series of workshops and online symposia. This educational activity was conducted after a delay of three years due to COVID-19. A three -day refresher course was conducted in the first week of August, 2022. Medical writing is another important feature which has been continuously covered by UKMM since many years with the collaboration of Al-Sadiq International Virtual University (SIVU) and Imamia Medics International (IM).

The new criteria for a COVID19 patient for the clinical practice to determine the need for an early therapeutic regimen and to decrease mortality.

A new predictive criterion is being proposed for the determination of cytokine storm (CS) in COVID-19 (COVID-CS). It is comprised of results of laboratory that associate the pro-inflammatory status, systemic cell death, multi-organ tissue damage, and pre-renal electrolyte imbalance. The data identifies the patients' stay in hospitals and their mortality with the relevance of hyper-inflammation and tissue damage during the CS. The criteria can be readily used in clinical practice to determine the need for an early therapeutic regimen, block the hyper-immune response and possibly decrease mortality. It helps to understand the nature of the virus by following a specific criterion to predict the disease. The SARS-CoV-2 tells us in few days what nature has decided for the patient i.e., recovery, death or permanent disability.

Evaluating the effect of Ramadan Fasting on patients with chronic diseases.

OBJECTIVE: The study aimed to investigate the effect of Ramadan Fasting on Patients with Chronic Diseases and their experience during fasting. METHODS: This study was a descriptive research that used a researcher-designed questionnaire in face-to-face interviews with individuals who have at least one chronic disease and visit, for any reason, the Istanbul Sisli Etfal Training and Research Hospital polyclinics. We first asked each participant about fasting during Ramadan. If the participant was not fasting, we asked only the reason(s) and collected socio-demographic data. If a participant was fasting, we administered a researcher-designed questionnaire in face-to-face interviews. Our survey consisted of 19 questions that were designed to evaluate the fasting behaviors, current chronic disease and treatment status of individuals, encountered complications during fasting and their socio-demographic data. RESULTS: The study participants were 253 people (168 females [66.4%]; mean age: 58.06 ± 11,13) with non-infectious diseases. One hundred sixty (63.2%) participants were fasting during Ramadan and 33 of them (20.6%) had consulted a doctor before fasting, 62.5% (n = 100) said they never faced any symptoms during fasting. Most experienced symptom during fasting was fatigue (56.7%; n = 34). A significant relationship occurred between experiencing symptoms while fasting and gender (p = 0.023) and waking regularly for sahur (p = 0.029). CONCLUSIONS: Many people with chronic diseases fast and experience symptoms while fasting. Being woman and not waking up for sahur was related with the symptoms during Ramadan fasting. Most participants with NIDs fasted during Ramadan without consulting their doctors.

Evaluation of pre-malignant cervical lesions in females presenting with abnormal pelvic complaints.

OBJECTIVE: To evaluate premalignant cervical lesions by using Papanicolaou smears in females presenting with abnormal pelvic complaints. METHODS: The descriptive cross-sectional study was conducted from June to November 2013 at the Department of Histopathology, Mayo Hospital, Lahore, and comprised female patients aged 25-70 years presenting with abnormal pelvic complaints with no cause in the uterus checked through ultrasonography who were undergoing cervical Papanicolaou smear. The smears were spray-fixed and placed in 95% reagent alcohol and was then stained with haematoxylin and eosin stain. The cytological examination was carried out under light microscope. SPSS 16 was used for data analysis. RESULTS: There were 210 women with a mean age of 39.51±8.32 years. Vaginal discharge was present in 89(42.4%) women; postcoital bleeding in 12(5.7%), and intermenstrual bleeding was present in 21(10%) women. Dyspareunia was present in 33(15.7%) women, and pelvic pain in 60(28.6%). Overall, premalignant cervical cancer was noted in 17(8.1%) patients. Atypical squamous cells of unknown significance was present in 5(2.4%) women, low-grade squamous intraepithelial lesion (LSIL) in 8(3.8%), and high-grade squamous intraepithelial lesion in 4(1.9%) patients of cervical cancer. CONCLUSIONS: The frequency of premalignant cervical lesions in symptomatic patients was high enough to highlight the importance of early detection of cervical cancer.

Conference Report on First Certificate Course in Health Professions Educationat College of Medicine, University of Kerbala, Iraq.(September 2019).

The current status of medical education in Iraq requires complete transformation to conform to the latest trends of modern education. Presently it is compromised due to the influence of political factors, finances, weakness or fragility of planning and security. It has to be re-shaped for the future of medical education to produce good and efficient medical professionals. It is necessary to reform and revise the curriculum as accreditation in accordance with international medical universities. The initial requirement is faculty development in areas including but not limited to, curriculum development, teaching and learning improvement, research capacity building, and leadership development. The capacity building of faculty at College of Medicine, University of Kerbala (CMUCK) has been initiated in collaboration with Medics International at a local and the government level. Medics International conducted the current Course on Certificate in Health Professions Education (CHPE) programme in September, 2019 to facilitate the faculty to revise their curriculum and improve their current educational practices. Further steps will be taken to develop the faculty for Masters in Medical Education (MME), PhD, and fellowship programmes. To face the on-going challenges in the medical and health care system, continous efforts are required for faculty education. Medics International has volunteered to begin a series of Webinars through its global faculty to reach out to the Iraqi Board followed by engagement of the Arab Board covering 18 countries.

Clinicopathologic analysis of primary gastroenteropancreatic poorly differentiated neuroendocrine carcinoma; A ten year retrospective study of 68 cases at Moffit Cancer Center.

OBJECTIVE: To assess clinicopathological characteristics of primary gastro-entero-pancreatic poorly differentiated neuroendocrine carcinomas (GEP-PDNECAs) and evaluate overall survival in patients treated with systemic platinum and etoposide therapy. METHODS: A detailed retrospective review of clinico-pathologic data (1999-2009) on 68 consecutive adult patients with primary GEP-PDNECAs was carried out, from H Lee Moffit Cancer Center and Research Institute, Tampa, Florida; USA, based on electronic patient records, specialty consultation files, tumor registry, social security index and pathology archives. All available tumor slides were reviewed and subtyped by neuro-endocrine pathologists. Clinicopathologic data and patient survival were analyzed. RESULTS: Of 68 patients 41 were males and 27 females with a mean age of 42 years (range: 25-76 years). Regarding the site of origin, 39 patients were of the colorectal location, 19 from the pancreas, 04 from small intestines, 03 from stomach and 03 were multi-focal from colon, small intestine and pancreas. Sixty three of 68 (93%) patients presented with lymph node/distant metastases. Of 68 tumors 37 (54%) were classified as small cell carcinoma (SCCA), 16 (24%) large cell carcinoma (LCCA), 5 (7%) mixed small and large cell (MSLCCA) and 10 (15%) poorly differentiated carcinoma with neuroendocrine features (PDCA-NEF). Neuroendocrine differentiation was confirmed by positivity for chromogranin in 38/65 (55%), synaptophysin in 62/67 (92%) and CD56 in 17/21 (81%) cases. One neuroendocrine marker was positive in 22/68 (32%), 2 in 40/68 (59%) and all 3 were positive in 9/68 (13%) cases. Fifty-eight of 68 (85%) patients were treated with platinum and etoposide. Overall patient survival at 1, 3 5 and 10 years was 85%, 40%, 16% and 1.5% respectively. Patient survival was independent of age (r= 0.1022), sex (r= -0.909) and histologic tumor subtype (r=0.1028) (p= 0.128) but was related to distant metastases (r=0.306; p=0.0383). CONCLUSIONS: GEP-PDNECA occurred in many part of the GI tract, most commonly in the colorectal region. Positivity of neuroendocrine markers was variable, which helped to confirm neuro-endocrine differentiation and to avoid under-diagnosis of GEP-PDNECA, especially in metastatic setting. Overall prognosis of GEP-PDNECA patients following platinum and etoposide therapy in our series was relatively favorable but remained poor in the presence of distant metastases.

Microalbuminuria (Moderate Albumin Excretion) and its relationship with Silent myocardial ischemia in treatment naïve type II diabetic patients.

OBJECTIVE: To determine the frequency of microalbuminuria (MAU) or Moderate Albumin Excretion (MAE) in treatment naïve type II diabetic patients and to compare the frequency of silent myocardial ischemia in treatment naive Type-II diabetic patients with and without microalbuminuria. METHODS: It was a cross sectional survey conducted in the outpatient Department, Jinnah Hospital Lahore, from 30th May 2015 to 29th November 2015. There were 227 patients, (consecutive treatment naïve type II diabetic patients), presenting to outpatient department were enrolled in the study. MAU/MAE, silent myocardial ischemia and effect modifiers like HbA1C > 7%, smoking pack years and dyslipidemia was determined. MAU/MAE was determined by urinary albumin excretion rate of 30-300 mg/24 hours and included patients underwent exercise tolerance test to diagnose silent myocardial ischemia. RESULTS: Out of total 165 patients (72.7%) were male and remaining 62 patients (27.3%) were female. The 54 patients (23.8%) had MAU/MAE. The 44 patients (19.4%) had silent myocardial infarction. When we cross tabulated microalbuminuria with silent myocardial infarction, result were significant. Out of 54 patients with MAU/MAE, 16 cases had silent myocardial infarction. CONCLUSION: The frequency of microalbuminuria/ Moderate Albumin Excretion in treatment naïve type II diabetic patients was high and associated with the frequency of silent myocardial ischemia in treatment naïve type II diabetic patients with and without MAU MAU/MAE.

Over view for the truth of COVID -19 pandemic: A guide for the Pathologists, Health care workers and community'.

Pakistan is in the grip of COVID-19, due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) since 26 February 2020, and the number of infected people and mortality is rising gradually. The health workers, doctors, pathologists and laboratory staff are front line fighters who are facing the risk. Few things are important for public and health workers, human behavior is at the core of preparedness and response i.e, personal protective measures, (handwashing, face masks, respiratory etiquette, surface and objects cleansing), social distancing and travel measures because the virus spreads through the respiratory channels, eyes, nose and mouth. While working in the Pathology labs, use the personal protection equipment (PPE), during the work in the duty. Avoiding the over duties and long shifts. It is good to keep the immune system healthy by taking a healthy balanced diet, vitamin supplements, and a night of proper sleep. It is also important to avoid taking food during duties and avoid making close contact without wearing safety dress.

Clinicopathological study of ameloblastoma and detection of human papilloma virus by immunohistochemistry.

OBJECTIVE: To study the clinocopathological factors and presence of Human Pappiloma Virus in ameloblastoma by immnohistochemistry. METHODS: It was a cross sectional study on 50 surgical specimens of ameloblastoma, completed in six months. These were selected and processed for initial screening by H&E and then by immunohistochemistry (IHC) for detection of Human Papilloma Virus (HPV). The questionnaire was designed to study the clinicopathological factors associated in these patients. Sections of 4µm were cut, placed on special positive charged glass slides in the Department of Pathology, King Edward Medical University. It was then examined by the histopathologists for grading and scoring of these lesions. Chi Square test was used to assess the differences found in types of ameloblastomas. The p-value was smaller than 0.05 (p < 0.05). RESULTS: The mean age of the patients (12-80 years old) was 38.6±15.1 years, with male-female ratio 2.84: 1. HPV was positive in 9 (18%), whereas negative in of 41 (82%) patients. Among the positive, reactive HPV with score-1 was 8 and score-2 was 1. According to histological variant, follicular was present in 78%, Plexiform pattern in 8%, Conventional and Desmoplastic variants in one patient each; and Cystic and Acanthomatous were seen in two and three patients respectively. The mandible was involved in 39 patients, maxilla and right maxilla involved in 4 patients each, right retromolar, cheek and angle of mandible was seen in one patient each. About 16% patients had anterior, 66% had posterior and 18% had both anterior and posterior regions involved. Among the HPV positive reactive statistically, no significant difference was found with smoking, Paan and exposure to pesticides, factory or mine (p-value > 0.05). Among HPV positive reactive patients, eight had ameloblastoma whereas, 1 had ameloblastomic fibroma. There was no statistical significance of type, location and region of tumor in HPV positivity. CONCLUSION: Mandible and posterior region was more commonly involved. Follicular pattern was most common. There was no effect of exposure to pesticides, factory or mine, smoke and human papilloma virus in the etiology of ameloblastoma because only 18% of patients showed the association of HPV16.

Levels of serum thyroxine, triidothyronine and thyrotropin in patients with acute myocardial infarction.

OBJECTIVE: To determine the levels of serum thyroxine (T3, T4), triiodothyronine and thyrotropin in patients with acute myocardial infarction (AMI). METHODS: It was an observational prospective study and 60 patients (both males and females) of AMI, (diagnosed by ECG & cardiac enzymes.) were included. Serum thyroid stimulating hormone (TSH), Free T3 and Free T4 were measured and relevant data was entered into a predesigned proforma. RESULTS: FT3 levels were below the reference range in 56.7% cases while both the FT4 and TSH values were found to be the lower limit of normal range. When the decrease in FT3 was correlated with the duration of illness, it was found that significant inverse correlation existed between FT3 value and the duration of illness and linear regression line was obtained. No such correlation existed between FT4 and TSH values. CONCLUSION: Thyroid hormone levels (FT3) decreases in AMI and this change is associated with the duration of illness.

A study of Galactin-3 on fine needle aspiration as a diagnostic marker differentiating benign from malignant thyroid neoplasm.

BACKGROUND & OBJECTIVE: Thyroid nodules are very common in our setup and their diagnosis on fine needle aspiration is not easy and is a taxing affair. It is a challenge to differentiate between follicular adenoma and follicular carcinoma without histology. Our objective was to investigate the role of Galectin-3 in fine needle aspirates of thyroid nodules as a prospective diagnostic marker and consequently its ability to differentiate benign from malignant neoplasms. METHODS: The research was conducted at the department of Pathology, King Edward Medical University, in association with other teaching institutions of Lahore from June 2012 to July 2014.. Sixty cases of solitary thyroid nodules were included in the study. Haematoxylin and eosin staining of the fixed smears and Galectin-3 immunohistochemical staining of the sections prepared from the cell block was performed. RESULTS: There were 60 patients in our study with a mean age of 33.35 years. The Bethesda system for reporting thyroid cytopathology was used to classify the smears and only categories IV, V and VI were included. On histological examination of the resected nodules there were 38.3% (23/60) cases of follicular adenoma, 46.6% (28/60) were of papillary carcinoma and follicular carcinoma made up to 15% (9/60) of all cases. Galectin-3 was negative in 100% (23/23) cases of follicular adenomas. Out of 37 malignant cases 65% lesions showed positivity, while 35% showed negativity for this immunomarker. Considering the malignant lesions, 75% cases of papillary carcinomas showed a positive reaction while only 33% of follicular carcinomas were positive for the immunomarker. This showed that the positive expression was more common in papillary as compared to follicular carcinomas. CONCLUSION: Galectin-3immunomarker is considerably expressed in malignant tumors, but it is not expressed in benign follicular lesions.

Smoking Cessation with Medication and Behaviour Therapy.

BACKGROUND AND OBJECTIVE: Smoking Cessation Clinics (SCCs) involve the use of cognitive behavior therapy and effective medications provided by specialists. Our objective was to report socio-demographic data, investigative services provided, and determine the smoking cessation success. METHODS: Data from all hospitals affiliated with the Beyoglu Public Hospitals Union were obtained between January 1, 2015 and December 31, 2015. Data from Sisli Hamidiye Etfal Training and Research Hospital were reviewed via retrospective chart review in the same period. Frequency and average values were determined using statistical software. In the evaluation of related factors, chi-square and student t tests were applied; p ≤ 0.05 was considered statistically significant. RESULTS: The mean admission age was 38.72 ± 12.20 years (min 13; max 94). Women tended to be older than men at the time of admission but men started smoking younger than women. Less than the high school educated subjects started smoking at early ages. The smoking cessation rate was 39.3% (n = 219) when treated with medication and behavioral therapy. CONCLUSION: About 48% smokers stopped smoking after treatment with medications and behaviour therapy. Most of the smokers were between 30-50 years of age. More Smoking Cessation Clinics should be established to allow access to more highly educated patients to smoking cessation resources.

Association between body mass index and activities of daily living in homecare patients.

OBJECTIVE: Overweight or obesity may cause many chronic illnesses. Furthermore, several studies have shown that high body mass index is associated with mortality and morbidity among the elderly. Therefore, obesity or being overweight could adversely affect the performance of activities of daily living. In this study our aim was to investigate the association between Body Mass Index and Activity of Daily Living in Homecare Patients. METHOD: The records of 2016 from the homecare unit of Sisli Hamidiye Etfal Training and Research Hospital were retrospectively reviewed. During this period, 1105 patients visited this facility. Unconscious or bedridden patients (hemiplegia, hemiparesia, and tetraparesis) and patients with incomplete data were excluded from the study. Therefore, the survey was completed with 250 files, which included all the data needed for our research. Age, gender, Body Mass Index and Barthel Index scores were recorded to the statistical program; p≤0.05 was considered as statistically significant. RESULTS: One hundred fifty one (60.4%) were women, and 99 (39.6%) were men. The relations between gender and age, weight, and Barthel index scores were not statistically significant. There was a significant positive correlation between weight and Barthel index scores as well as between Body Mass Index and Barthel index scores (r = 0.190; p = 0.003). The patients were divided into two groups: Group-I (underweight and normal weight) and Group-II (overweight and obese). Group-II exhibited a much higher ability to perform Activity of Daily Living than Group-I (p = 0.002). CONCLUSION: Some studies report that obesity is protective against Activity of Daily Living, but the opposite is reported in some others. Our study showed increased values of Body Mass Index and Activity of Daily Living ability, which are indicative of protective effects. The relationship between Body Mass Index and physical disability is not yet proven to be linear.