Factors associated with poor CD4 and viral load outcomes in patients with HIV/AIDS.

Suboptimal viral suppression and CD4 response to antiretroviral treatment (HAART) is known to cause poor outcomes with the increase cost of treatment. We aimed to assess factors associated with such control among HIV/AIDS patients in Malaysia. Four hundred and six HIV/AIDS patients, using Antiretroviral Therapy (ART) for at least the past three months, treated as outpatients at medication therapy adherence clinics (MTAC) were recruited. CD4 cell counts, viral load readings along with co-variants such as socio-demographic factors, adverse drug reactions, comorbidities, and medication record were obtained. Statistical Package for Social Sciences (SPSS(®)) version 18 and STATA IC(®) version 12 were used for data analysis. CD4 counts were found highest among those within the age category 41-50 years (390.43 ± 272.28), female (402.64 ± 276.14), other ethnicities (400.20 ± 278.04), and participants with no formal education (414.87 ± 290.90). Patients experiencing adverse effects had a 2.28 (95%CI:1.25-4.18) fold greater risk of poor CD4 control, while patients with comorbidities had 2.46 (95%CI:1.02-5.91) fold greater risk of mild viral suppression. Adverse drug reactions, co-morbidities were found to be significantly associated with poor immunological and virological outcomes in HIV/AIDS patients. However, a comprehensive evaluation is needed to better understand other confounders.

A qualitative insight of HIV/AIDS patients' perspective on disease and disclosure.

BACKGROUND: Understanding patients' knowledge and belief towards disease could play a vital role from an outcome perspective of disease management and HIV/AIDS patients are not exception to that. METHODS: Qualitative methodology was used to explore Malaysian HIV/AIDS patients' perspectives on disease and status disclosure. A semi structured interview guide was used to interview the patients and a saturation point was reached after the 13th interview. All interviews were audio-recorded and subjected to a standard content analysis framework. RESULTS: Understandings and beliefs towards HIV/AIDS and Perspective on disease disclosures were two main themes derived from patients' data. Beliefs towards causes and cure emerged as sub-themes under disease understandings while reasons for disclosure and non-disclosure were resulted as main sub-themes under disease disclosure. Majority of patients apprehended HIV/AIDS and its causes to acceptable extent, there were elements of spirituality and lack of education involved with such understandings. Though beliefs existed that knowing status is better than being ignorant, fear of stigma and discrimination, social consequences and family emotions were found important elements linked to disease non-disclosure. CONCLUSIONS: The outcomes provided basic information about patients' perceptions towards disease and status disclosure among HIV/AIDS patients which can help in the designing and improvising existing strategies to enhance disease awareness and acceptance and will also serve as baseline data for future research further focusing on this subject.

Assessing HIV and AIDS treatment safety and health-related quality of life among cohort of Malaysian patients: a discussion on methodological approach.

BACKGROUND: Health-related quality of life (HRQoL) is increasingly recognized as an important outcome and as a complement to traditional biological end points of diseases such as mortality. Unless there is a complete cure available for HIV/AIDS, development and implementation of a reliable and valid cross cultural quality of life measure is necessary to assess not only the physical and medical needs of HIV/AIDS people, but their psychological, social, environmental, and spiritual areas of life. METHODS: A qualitative exploration of HIV/AIDS patients' understanding, perceptions and expectations will be carried out with the help of semi structured interview guide by in depth interviews, while quantitative assessment of patient reported adverse drug reactions and their impact on health related quality of life will be carried out by using data collection tool comprising patient demographics, SF-12, Naranjo scale, and a clinical data sheet. RESULTS/OUTCOMES: The findings may serve as baseline QOL data of people living with HIV/AIDS in Malaysia and also a source data to aid construction of management plan to improve HIV/AIDS patients' QOL. It will also provide basic information about HIV/AIDS patients' perceptions, expectations and believes towards HIV/AIDS and its treatment which may help in designing strategies to enhance patients' awareness which in turn can help in addressing issues related to compliance and adherence.

Comparing the effects of osteoporosis prevention exercise protocol [OPEP] versus walking in the prevention of osteoporosis in younger females

The aim of this work was to evaluate the effectiveness of Osteoporosis Prevention Exercise Protocol [OPEP] in younger females. One hundred young female volunteers aged 20-30 were selected from IPM and R Dow University of Health Sciences. This was a comparative study in which 64 females participants were randomly assigned into two groups [32 in OPEP exercise group and 32 in walking group]. The exercise session had three components 1] stretching 2] strengthening 3] high impact weight bearing exercises. Both interventional programs consisted of 3 sessions per week for twelve weeks under the supervision of physiotherapist. Pre and post intervention bone mass density [BMD] was measured on the lumbar spine [L1-L4], hip, femur, and distal forearm by using Dual-Energy X-ray Absorptiometry [DEXA] scan. After twelve weeks of intervention BMD was found to be statistically insignificant at hip, femur, lumbar spine and wrist [p > 0.05] comparing the post results in the OPEP and exercise group. Moreover BMD at hip, femur, lumbar spine and wrist was unaltered in both groups comparing the results of pre and post intervention. Though significant changes were observed in BMI in the OPEP exercise group [p value =0.010] mean +/- standard deviation pre and post found to be 20.2578 +/- 3.11123 and 21.0942 +/- 3.64203 but no variations in anthropometrics in walking group were found. The present study highlights the burden of osteopenia in younger females. The Osteoporosis Prevention Exercise Protocol formulated by author was not useful to bring any significant changes in BMD moreover it had no significant effects in comparison to walking group. However additional studies are needed to evaluate the efficacy of Osteoporosis Prevention Exercise Protocol on bone quality with long term effects

Diabetes mellitus and limb loss: an analysis from a tertiary care center

To compare the frequency and determinants of prosthesis fitting [artificial limbs] in diabetic and non-diabetic amputees at a tertiary care center. Cross Sectional Comparative Study This study was conducted at Institute of Physical Medicine and Rehabilitation [IPM and R] at Dow University of Health Sciences, Karachi during Oct 2007- Sep 2010. Data was collected from amputee records files seeking carefor prosthetic fitting. There were 1469 prosthesis fitted in both diabetic and non-diabetics patients. The data from both groups were compared for frequency of amputation in diabetic and non-diabetics. The data was entered and analysis was performed on SPSS windows version 16. The analysis of data was performed for patients who were provided prosthesis fitting at IPM and R. Diabetic males were 327[73.6%] female were 117 [26.4%].About a third of amputees had primary, secondary and tertiary health care services for control of diabetes. About 60% of all diabetics were not able to seek medical care for control of diabetes. The use of primary, secondary and tertiary health care services to control diabetes were also recorded to correlate with health seeking facilities among diabetics. The prosthesis fitting was given to one third of diabetic patients after lower limb amputation. The major determinants of diabetic amputees were old age, man uneducated, low socioeconomic status. The facilities for primary, secondary and tertiary health care services to control diabetes are available only to one third of diabetic patients. Diabetic control, education of foot care and accessibility to diabetic and prosthesis centre can markedly improve functional integration of diabetic amputees in community

Obstetrics determinants of cerebral palsy in children from birth to five years

To determine obstetrics risk factors for cerebral palsy from birth to 5 years children. A hospital based cross sectional survey. This study was conducted in outpatient department, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences Karachi, Pakistan during October 2007 to October 2010. Children with cerebral palsy between births to 5 years of age were included in the study. The Sampling technique was non probability purposive. Data was analyzed as frequency and association by chi-square in SPSS version 15. Children enrolled in this study were 300 their Mean age +/- SD was age 4.9 +/- SD 3.6 yrs. Mean maternal age +/- SD was 30.8 +/- 6.5 years. Mostly mothers had secondary level of education 110 [36.7]. Father's Mean income +/- SD was 11587 +/- SD. During assessment the pregnancy risk factors were mostly hypertension 55 [18.3%], diabetes mellitus 28 [9.3%] seizures 11 [3.7%] placenta previa 4 [1.3%]. The commonest risk factor was birth asphyxia in one third of children and two third of the deliveries were conducted in institutions as spontaneous vaginal deliveries. Birth asphyxia is the major obstetrics risk factors for cerebral palsy from birth to 5 years children. The obstetrics practices require revisiting and reprogramming to reduce cerebral palsy

Determinants of lower extremity amputations: an institutional experience

To determine the determinants of lower extremity amputations in diabetics and non-diabetics in a tertiary care institute. Cross-sectional, analytical study. Outpatients Department of the Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, from January 2007 to December 2010. All patients with amputations reporting at the study centre for prosthesis fitting were included in the study. Patient's age, level of amputation, stump complications and associated risk factors of amputation were recorded on a structured proforma. Prosthesis and orthotic assessment were carried out. The frequency and determinants were collected to compare diabetic and non-diabetic amputees. The data was analyzed in SPSS windows version 16. A total of 1091 subjects were provided prosthesis, including 847 males [77.6%]. Mean age in diabetic and nondiabetics being 49.6 +/- 15.2 and 26.6 +/- 17.9 years respectively which is significant at [p < 0.001]. Socioeconomic status and educational levels were significantly associated with diabetic status [p < 0.001]. Amputation was more common in non-diabetic 858 [78.6%] compared to diabetics 233 [21.4%]. This study has identified that most common and significant predictors were gender, low social status and educational levels. Other significant predictors of amputation identified were type of lesion, [infections and ischaemia], initial diagnosis acute/chronic arterial insufficiency and diabetic foot

Epidemiology of amputation; low resource community: Sindh province, Pakistan [October 2007- june2012]

Amputation is stated to be a foremost but preventable community health problem causing intense financial, social and emotional effects on the patient and family particularly in developing countries where the prosthetic services are limited. The purpose of this study was to identify the causes and levels of amputation in low resource community, Sindh Pakistan. This was a retrospective chart review study that was carried out at first civilian Institute of physical medicine and rehabilitation-Dow University of health sciences from October 2007 to June 2012. After verbal informed consent all patients, who underwent major or minor amputation were enrolled for the study. Data was collected using a pre-tested, coded questionnaire and analysed using SPSS version 16. A total of 1115 patients were enrolled into the study. Their ages were ranged between 2-95 years [mean 38.40 +/- 17.38]. Among total population of amputees 83.58% were males. The most common cause for major limb amputation was road Traffic accident 38.38%, followed by Diabetes 15.42%, infection 14.26% and trauma 12.37%. Lower limbs [trans-tibial] amputations were in 47.35% of cases and transfemoral in 27.98% of cases. While for the upper limb trans-radial amputation [7.4%] were found to be more common than trans-humeral [5.56%]. Other amputations were for shoulder, hip and knee disarticulations. Road traffic accidents, complications of diabetic foot ulcers, infections and trauma were the most common causes for major limb amputations found in low resource community, Sindh Pakistan. The majority of these amputations are preventable by endowment of traffic rules, health education, early preventions and appropriate management of the common infections

Determinants of upper limb amputations in a tertiary care center, Pakistan

To determine the frequency and causes of accidental upper limb amputations seeking rehabilitation [prosthesis] care in a tertiary care center. Observational Descriptive Study. This study was carried out at outpatients Department of Institute of Physical Medicine and Rehabilitation at Dow University of Health Sciences, Karachi from Jan 2007 to Dec 2010. The Sampling Technique was non Probability Purposive sampling. A study specific Performa was prepared which included patient age, stump complications, level of amputation and associated risk factors. The data was analyzed in SPSS version 15. The Mean+/-SD age of ULA was 28.56 +/- SD 11.97 [years]. Most ULA were reported from Karachi 65 [67.7%]. Labourers were the most commonly affected groups 33 [34.4%].Accidents leading to ULA were reported in 89 [92.70] and machine injury [chaff cutting] was responsible in one third of the ULA. Quarter of the ULA had leading cause electric injury. Only, 16 [16.7%] amputees had road traffic accidents. The study concluded that majority of upper limb amputation were caused by machine accidents affecting mostly labourers. Therefore, machine safety protocols for labourers, farmers and workers should be implemented in their local language and through pictoral messages and inbuilt safety measures machines should be sold by company representatives

Recognizing the sensory abilities in cerebral palsy children

To evaluate the sensory abilities in different type of cerebral palsy [CP]children. Retrospective, chart review This study was conducted at the Institute of Physical Medicine and Rehabilitation, Dow University of Health sciences from January 22, 2011 to March 23, 2011 in a period of 2 month. 60 CP children already diagnosed with required categories [hemiplegia, diplegia and quadriplegia] without mental retardation between the ages from 4-8 years were included in this study after seeking consent from their parents, while CP children [Athetoid, ataxic, dystonic] below 4 years and above 8 years of age and other developmental disorders were excluded. Convenient sampling was used. A standardized questionnaire was developed to assess parent's perception of their children's sensory profile. It was a self-reporting questionnaire with five point scoring system. Trained Occupational Therapist assisted parents in filling out the form for the collection of data. Data was analyzed by analysis of variance [ANOVA]. The mean age was 5.47Results show that8 out of 38 items have significant value [p 0.05] on Item analysis. Mean value was calculated for each subtypes of CP, therefore classified them according to Dunn criterion on components of short sensory profile. On gender difference significant difference was found on tactile sensitivity, taste/smell sensitivity, under responsive/seek sensation and visual/auditory sensitivity. The differences of classification in each subtypes on seven components along with significant differences on 8 items on short sensory profile indicates that CP children suffer from sensory processing disorder that interferes with their performance. Thus it draws an attention towards a neglected side of palsy so that more accurate assessment and intervention planning could be implemented for effective rehabilitation program of cerebral palsy children