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PubMed2003

Anti-tuberculous drug prescribing: doctors' compliance at a private teaching hospital in Pakistan.

An adequate and appropriate anti-TB drug prescription is of crucial importance in order to "cure" a TB patient of his or her disease. This study looked at the prescribing habits of doctors working in a private teaching hospital of Pakistan. The results showed that the majority of doctors (79%) were choosing the correct four-drug regiment of RHZE in the intensive phase, as recommended in the National Guidelines. However, the dosage of some drugs were below the recommended ranges (43% of prescriptions for Pyraizinamide and 48% for Ethambutol). Regular audit of doctors' prescriptions is necessary in order to ensure that the National TB Guidelines are fully implemented by physicians working in the private sector of Pakistan.

Adult↗
PubMed2004

Smoking habits amongst house physicians working at Jinnah Postgraduate Medical Center, Karachi, Pakistan.

The objective of this study was to estimate the prevalence of smoking among house physicians working at Jinnah Postgraduate Medical Center, Karachi, Pakistan. Sixty-four (32%) of the 200 house physicians were smokers; 50% (36) had started smoking in their twenties and 44% (28) in their teens. Seventy-five per cent (48) of the smokers were influenced by friends, 20% (13) by cigarette commercials and the remainder by their parents. Ninety-five per cent (61) smoked during duty hours. The frequency of smoking among young doctors was higher than the overall prevalence of smoking in Pakistan.

Attitude of Health Personnel↗
PubMed2005

Patient assessment of effectiveness and satisfaction with traditional medicine, globalized complementary and alternative medicines, and allopathic medicines for cancer in Pakistan.

BACKGROUND: Virtually no research has been conducted on patient assessments of traditional medicines and allopathic medicines for cancer care in poorer countries marked by pluralistic medical environments. Pakistan represents an excellent case for such a study because of the coexistence of culturally and historically specific indigenous traditional medicine, the strong presence of allopathic medicine, and, to a lesser extent, the availability of some globalized complementary and alternative medicines. AIM: To gain a preliminary understanding of cancer patients' perceptions of effectiveness and satisfaction with traditional medicine, globalized complementary and alternative medicine, and allopathy in the context of a pluralistic medical environment. STUDY DESIGN: Structured survey of 362 cancer patients, from diverse regions in the Punjab province and Northwest Frontier province, who were being treated in 4 different hospitals in Lahore, Pakistan. RESULTS: Use of traditional medicine remains high among cancer patients, with traditional healers used by the majority of those surveyed. Although patients' perceptions of the overall effectiveness of traditional medicines for treating cancer are low, those patients who do use traditional medicines still have high levels of satisfaction with these modalities. This is distinct from levels of satisfaction with, and perceptions of effectiveness of, Western cancer treatments, which were synonymous in this group of patients. Important differences in patient perceptions were found within groups (eg, between different forms of traditional healers) as well as between them. CONCLUSION: This study showed considerable support for complementary and alternative medicine/traditional medicine but also significant variation in usage of and perceptions of local traditional medicines. More research needs to be done to explore the social processes underlying this variation in cancer patients' preferences for particular traditional medicines.

Complementary Therapies↗
PubMed2004

Lysine fortification of wheat flour improves selected indices of the nutritional status of predominantly cereal-eating families in Pakistan.

Wheat provides more than 50% of the protein and calorie intake of the population of Pakistan. Legumes and animal protein that could complement the amino acid pattern of wheat, in which lysine is the first limiting amino acid for utilization of protein, are not affordable by members of lower socioeconomic groups in developing countries. The purpose of the study was to determine whether lysine fortification of wheat flour would have a positive impact on populations consuming a predominantly wheat-based diet. A double-blind study was carried out for three months on the outskirts of Peshawar, Pakistan. Forty families received wheat flour fortified with lysine, and 40 families received wheat flour without lysine. Wheat provided 59% of the protein for men, 65% for women, and 58% for children. The weight and height of the children in both groups increased during the study, but the increase was significantly greater in the lysine group. Hemoglobin increased significantly in the women receiving lysine-fortified flour. Transferrin levels increased significantly in men, women, and children in the lysine group as compared with those in the control group. Prealbumin increased significantly in adults receiving additional lysine but decreased in children. Men, women, and children in the lysine-supplemented families had significant increases in CD4, CD8, and complement C3 as compared with controls. These results indicate that lysine fortification of wheat flour can significantly improve sensitive indicators of nutritional status in a population consuming a diet in which 58% to 65% of the protein, depending on age and sex, is supplied by wheat.

Adult↗
PubMed2004

Survival of patients treated with intra-aortic balloon counterpulsation at a tertiary care center in Pakistan - patient characteristics and predictors of in-hospital mortality.

BACKGROUND: Intra-aortic balloon counterpulsation (IABC) has an established role in the treatment of patients presenting with critical cardiac illnesses, including cardiogenic shock, refractory ischemia and for prophylaxis and treatment of complications of percutaneous coronary interventions (PCI). Patients requiring IABC represent a high-risk subset with an expected high mortality. There are virtually no data on usage patterns as well as outcomes of patients in the Indo-Pakistan subcontinent who require IABC. This is the first report on a sizeable experience with IABC from Pakistan. METHODS: Hospital charts of 95 patients (mean age 58.8 (+/- 10.4) years; 78.9% male) undergoing IABC between 2000-2002 were reviewed. Logistic regression was used to determine univariate and multivariate predictors of in-hospital mortality. RESULTS: The most frequent indications for IABC were cardiogenic shock (48.4%) and refractory ischemia (24.2%). Revascularization (surgical or PCI) was performed in 74 patients (77.9%). The overall in-hospital mortality rate was 34.7%. Univariate predictors of in-hospital mortality included (odds ratio [95% CI]) age (OR 1.06 [1.01-1.11] for every year increase in age); diabetes (OR 3.68 [1.51-8.92]) and cardiogenic shock at presentation (OR 4.85 [1.92-12.2]). Furthermore, prior CABG (OR 0.12 [0.04-0.34]), and in-hospital revascularization (OR 0.05 [0.01-0.189]) was protective against mortality. In the multivariate analysis, independent predictors of in-hospital mortality were age (OR 1.13 [1.05-1.22] for every year increase in age); diabetes (OR 6.35 [1.61-24.97]) and cardiogenic shock at presentation (OR 10.0 [2.33-42.95]). Again, revascularization during hospitalization (OR 0.02 [0.003-0.12]) conferred a protective effect. The overall complication rate was low (8.5%). CONCLUSIONS: Patients requiring IABC represent a high-risk group with substantial in-hospital mortality. Despite this high mortality, over two-thirds of patients do leave the hospital alive, suggesting that IABC is a feasible therapeutic device, even in a developing country.

Aged↗
PubMed2004

Characterization of a new full length TMPRSS3 isoform and identification of mutant alleles responsible for nonsyndromic recessive deafness in Newfoundland and Pakistan.

BACKGROUND: Mutant alleles of TMPRSS3 are associated with nonsyndromic recessive deafness (DFNB8/B10). TMPRSS3 encodes a predicted secreted serine protease, although the deduced amino acid sequence has no signal peptide. In this study, we searched for mutant alleles of TMPRSS3 in families from Pakistan and Newfoundland with recessive deafness co-segregating with DFNB8/B10 linked haplotypes and also more thoroughly characterized the genomic structure of TMPRSS3. METHODS: We enrolled families segregating recessive hearing loss from Pakistan and Newfoundland. Microsatellite markers flanking the TMPRSS3 locus were used for linkage analysis. DNA samples from participating individuals were sequenced for TMPRSS3. The structure of TMPRSS3 was characterized bioinformatically and experimentally by sequencing novel cDNA clones of TMPRSS3. RESULTS: We identified mutations in TMPRSS3 in four Pakistani families with recessive, nonsyndromic congenital deafness. We also identified two recessive mutations, one of which is novel, of TMPRSS3 segregating in a six-generation extended family from Newfoundland. The spectrum of TMPRSS3 mutations is reviewed in the context of a genotype-phenotype correlation. Our study also revealed a longer isoform of TMPRSS3 with a hitherto unidentified exon encoding a signal peptide, which is expressed in several tissues. CONCLUSION: Mutations of TMPRSS3 contribute to hearing loss in many communities worldwide and account for 1.8% (8 of 449) of Pakistani families segregating congenital deafness as an autosomal recessive trait. The newly identified TMPRSS3 isoform e will be helpful in the functional characterization of the full length protein.

Alleles↗
PubMed2006

Prevalence and determinants of asthma in adult male leather tannery workers in Karachi, Pakistan: a cross sectional study.

BACKGROUND: This study aimed to estimate the prevalence and to identify some risk factors of adult asthma in male leather tannery workers in Karachi, Pakistan. METHODS: A cross sectional study was conducted from August 2003 to March 2004 on leather tannery workers of Karachi, Pakistan. Data were collected from 641 workers engaged in 95 different tanneries in Korangi industrial area selected as sample of convenience. Face to face interviews were performed using a structured pre-tested questionnaire by trained data collectors. RESULTS: Prevalence of adult asthma was 10.8% (69/641) in this study population. The prevalence of perceived work-related asthma was 5.3% (34/641). Multivariable logistic regression model showed that after taking into account the age effect, the leather tannery worker were more likely to be asthmatic, if they were illiterate (adjusted OR = 2.13, 95% CI: 1.17-3.88), of Pathan ethnicity (adjusted OR = 2.69; 95% CI: 1.35-5.36), ever-smoked (adjusted OR = 2.22, 95% CI: 1.16-4.26), reportedly never used gloves during different tanning tasks (OR = 3.28; 95% CI : 1.72-6.26). Also, the final model showed a significant interaction between perceived allergy and duration of work. Those who perceived to have allergy were more likely to have asthma if their duration of work was 8 years (adjusted OR = 2.26; 95% CI: 1.19 - 4.29) and this relationship was even stronger if duration was 13 years (adjusted OR = 3.67; 95% CI: 1.98-6.79). CONCLUSION: Prevalence of asthma in leather tannery workers appears to be high and is associated with educational status, ethnicity, smoking, glove use, perceived to have allergy and duration of work.

Adolescent↗
PubMed2004

Systemic lupus erythematosus in Pakistan.

Clinical features of systemic lupus erythematosus (SLE) have been described from different geographical regions in the world, with some clinical differences among different racial groups. Although data on the characteristics of SLE in Pakistan is scarce, it is not uncommon in the South East Asian region. The purpose of this study was, therefore, to delineate the clinical pattern and disease course in Pakistani patients with SLE and to compare it with international data on lupus patients. A total of 196 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatism Association admitted to the hospital between 1986 and 2001 were studied by means of a retrospective review of their records. Demographically, it was seen that SLE is a disease predominantly of females in their third decade, which is consistent with worldwide data. The mean age of presentation was 31 years (range 14-76) and the mean duration of follow up was 34 (4-179) months. Generally, there was less cutaneous (46%), arthritic (38%), serositis (22%) and renal involvement (33%) but more neuropsychiatric symptoms (26%) in our population. Eighty-six percent of patients were ANA positive, whereas anti dsDNA was positive in 74% of patients. Infections, renal involvement, seizures and thrombocytopenia were associated with poor prognosis (P < 0.05). This study is the first of its kind in Pakistan. The clinical and laboratory characteristics of SLE patients in our study place our population in the middle of a spectrum between the Caucasians and other Asian populations. It has shown that the clinical characteristics of SLE patients in this country may be different to those of its neighbors.

Adolescent↗
PubMed1991

The Bradford Somatic Inventory. A multi-ethnic inventory of somatic symptoms reported by anxious and depressed patients in Britain and the Indo-Pakistan subcontinent.

In the development and evaluation of a multi-ethnic inventory (the BSI) of somatic symptoms associated with anxiety and depression, symptoms were derived from psychiatric case notes of Pakistani and indigenous British patients with a clinical diagnosis of anxiety, depression, hysteria or hypochondriasis. The inventory was constructed simultaneously in Urdu and English. A pilot version of the BSI was checked against psychiatric case notes in north and south India, and Nepal. The revised BSI achieved over 90% coverage of all somatic symptoms recorded in each centre. The linguistic equivalence of the Urdu and the English versions was established in a bilingual student population in Pakistan. Conceptual equivalence of the BSI was explored using factor analysis of responses by functional patients presenting to medical clinics in Britain and Pakistan. Four principal factors (head, chest, abdomen, fatigue) were similar in both populations.

Adult↗
PubMed2007

Life stress and depression in a tribal area of Pakistan.

BACKGROUND: Depression is common in Pakistan but no research on this subject has been reported from the North West Frontier Province (NWFP), host to numerous Afghan refugees. AIMS: To measure depressive symptoms and associated features in a population-based sample. METHOD: A Pushto translation of the Self Reporting Questionnaire (SRQ) was administered to 471 adults living in a village in one of the federally administered tribal areas. Respondents were also assessed with a life events checklist for social problems, a social support questionnaire and the Brief Disability Questionnaire. RESULTS: Sixty per cent (95/158) of women and 45% (140/313) of men scored 9 or more on the SRQ. High SRQ score was associated with few years of education, higher social problem score, less social support and greater disability. High social problem score was the strongest correlate. CONCLUSIONS: This population reports more depressive symptoms than other communities in Pakistan and this probably reflects the very high degree of social stress experienced in the NWFP, which has been affected by years of turmoilin neighbouring Afghanistan.

Adolescent↗
PubMed1999

Seroprevalence of HIV, HBV, and syphilis and associated risk behaviours in male transvestites (Hijras) in Karachi, Pakistan.

In Pakistan, male sex workers are predominantly transvestites and transsexuals known as Hijras. In 1998 in Karachi, Pakistan, we studied the seroprevalence of HIV, HBsAg and syphilis and associated risk factors in Hijras. Study subjects were verbally administered a structured questionnaire that determined risk behaviours for sexually transmitted and blood-borne diseases and knowledge of AIDS/STDs. After pre-test counselling, verbal consent was taken for serological testing. The results were provided on a one-on-one post-test counselling session. Three hundred male transvestites were approached; all agreed to answer the questionnaire, 208 consented to blood testing. Of 300, 81% acknowledged commercial sex with men. Of 208, prevalence of syphilis was 37%; HBsAg 3.4%; HIV 0%. The prevalence of HIV and hepatitis B virus (HBV) is low in transvestite sex workers but that of syphilis is high. Intervention programmes implemented at this stage can have an impact on HIV and STD prevention.

Adolescent↗
PubMed2002

Assessment of a new approach to family planning services in rural Pakistan.

OBJECTIVES: In 1993, the government of Pakistan started a new approach to the delivery of contraceptive services by training literate married women to provide doorstep advice and supplies in their own and neighboring communities. This report assesses whether this community-based approach is starting to have an impact on contraceptive use in rural areas. METHODS: A clustered nationally representative survey was used to collect data on contraceptive use and access to services in each cluster. Two-level logistic regression was applied to assess the effects of service access, after potential confounders were taken into account. RESULTS: Married women living within 5 km of 2 community-based workers were significantly more likely to be using a modern, reversible method of contraception than those with no access (odds ratio = 1.74; 95% confidence interval = 1.11, 2.71). CONCLUSIONS: After decades of failure, the managers of the family planning program have designed a way of presenting modern contraceptives that is appropriate to the conditions of rural Pakistan. The new community-based approach should be steadily expanded.

Birth Rate↗
PubMed2004

Developing nursing leaders through graduate education in Pakistan.

Advanced practice is the conceptual focus for the first Master's of Science in Nursing (MScN) program in Pakistan. Initiated at the Aga Khan University School of Nursing (AKUSON) in October 2001, this full time two-year program aims to prepare nurses who are leaders in nursing practice with advanced knowledge and skills for their roles in either urban, rural, tertiary-care or community settings. The significance of the progress must be emphasized in a country where most nursing education takes place at diploma level and relatively few opportunities exist for nurses seeking a baccalaureate degree. Other countries developing graduate nursing programs may benefit from the expereince in Pakistan.

Developing Countries↗
PubMed1998

Is the Barthel Scale appropriate in non-industrialized countries? A view of rural Pakistan.

PURPOSE: To determine if the Barthel Index, a conventional scale for assessing disability, is appropriate for stroke patients in rural Pakistan, rather than an observational study by visiting stroke patients in their homes. METHOD: Stroke patients attending hospital out patient clinics in Islamabad, together with others identified in local villages, were assessed to test the validity of the Barthel Activities of Daily Living Scale. RESULT: For each item on the disability scale, differences in local customs, lifestyle and architecture meant that the Barthel Scale was not appropriate in rural Pakistan. CONCLUSIONS: There is unlikely to be a disability scale which can be applicable universally. Care must be taken when standard scales are used for international comparisons of stroke disability.

Activities of Daily Living↗
PubMed1994

Risk factors for drug misuse in Pakistan.

While a number of risk factors have been identified for drug misuse in the United States, little evidence is available about such factors in other societies. This study attempted to identify risk factors in Pakistan. Ten of 11 sociodemographic variables which had previously been identified as predictors in the United States successfully differentiated groups of addicts and controls in Pakistan. About 97% of the 60 addicts studied were at risk on four or more factors; 100% of controls were at risk on four or fewer factors. It appears that the precursors for misuse cut across cultural lines.

Adolescent↗
PubMed2004

Elevated blood lead levels among children living in a fishing community, Karachi, Pakistan.

Lead is a widespread environmental contaminant worldwide and is associated with adverse outcomes in children, including impaired neurobehavioral development and learning difficulties. A cross-sectional survey of 53 young children was conducted in a fishing village on an island adjacent to Karachi, Pakistan. Whole blood from each individual was tested for lead levels. Also tested were samples of cooked food, house dust, and drinking water from 36 households. Laboratory determinations were made by the Pakistan Council for Scientific and Industrial Research with quality control by the United States Centers for Disease Control and Prevention. Fifty-two subjects (98%) had blood lead levels above 10 microg/dl (mean 21.60 microg/dl), an internationally recognized threshold for potential neurotoxicity. The mean concentration was 3.90 microg/g in cooked food, 4.02 microg/l in drinking water, and 91.30 microg/g in house dust. These findings indicate possible major health concerns and suggest significant environmental contamination in this community as well as the need to identify locally relevant early childhood exposures.

Animals↗
PubMed1979

Host selection patterns of some Pakistan mosquitoes.

The host selection patterns of 18 species of Pakistan mosquitoes are described, emphasizing the presumed malaria vectors, Anopheles culicifacies, An. fluviatilis, and An. stephensi, and the probable vectors of West Nile virus, Culex pipiens fatigans and Cx. tritaeniorhynchus. All species tested, with the exception of Cx, p. fatigans, were considered to be essentially zoophilic. Few human feeds were recorded for An. annularis (0.7%), An. culicifacies (0.5%), An. fluviatilis (1.1%), An. nigerrimus (14.3%), and Cx. bitaeniorhynchus (2.8%), while Cx. p. fatigans (37.6%) commonly fed on man. No human positive feeds were recorded for An. stephensi. Temporal or spatial changes in host selection patterns were not discerned with the exception of Cx. p. fatigans, whose feeding patterns varied opportunistically with host availability. Cx. p. fatigans females collected from houses fed more commonly on man than those resting in cattle sheds or in agricultural fields. Cx. p. fatigans resting in cattle sheds during winter fed mostly on birds and bovids, changing to man and bovids during the spring and then to man and birds during summer. The relationships between these results and vector-borne disease transmission in Pakistan are discussed.

Animals↗
PubMed1986

Effects of Fansidar on chloroquine-resistant Plasmodium falciparum in Pakistan.

Fansidar (SP), a combination of sulfadoxine and pyrimethamine, was evaluated for its usefulness as a curative agent for treating individual malaria patients and for reducing the community reservoir of Plasmodium falciparum in 4 villages near Lahore, Pakistan, where resistance of 4-aminoquinolines has recently been reported. Following the end of the major malaria transmission season, we carried out a month-long mass treatment campaign during which SP was given to all available villagers who had parasitemias detected during a concurrent house-to-house malaria blood film survey. Of the 82 falciparum patients followed for 14 days after SP treatment, 80 (97.5%) had parasites sensitive to the investigated drug. Parasitemia clearance time after SP was remarkedly short (1.25 +/- 0.53 days; mean +/- SD). However, we were unable to reduce the parasite reservoir of P. falciparum and P. vivax in these villages, probably because we treated only 337, about one-third, of the parasitemic patients. We conclude that SP is an effective drug for treating individual malaria patients from areas in Pakistan where 4-aminoquinoline-resistant parasites are present, but that more research is needed for assessing its usefulness in reducing community reservoirs of malaria.

Disease Reservoirs↗