Pub Date : 2022-03-31DOI: 10.35845/kmuj.2022.22064
Mahak Memon, H. Ali, F. Ali, Faraz Adil, Urooj Ali, Samia Tasleem
OBJECTIVE: To compare the bleeding control of skin graft donor site between normal saline soaked gauze with adrenaline and conventional technique having no adrenaline. METHODS: This open-label randomized control trial was conducted at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan from October 2020 to March 2021. Seventy-five patients were randomized to interventional (n=36, 48%) and control group (n=39, 52%) through sealed envelopes. Diluted solution was prepared by adding 30cc of Ringer’s lactate and 10cc of lignocaine 2%, with 1cc of adrenaline of 1:200000 with 200 ml of normal saline solution. Solution for control group was containing only normal saline. Following the skin harvesting at donor site, a gauze piece soaked with tumescent solution was applied at the donor site wound. Bleeding severity and epithelialization were assessed. Data was recorded in a pre-designed performa and analyzed through SPSS version-25. RESULTS: There was no significant differences in baseline characteristics like age (p=0.823), gender (p=0.984) and nature of injury (p=0.936) among two groups. Severe, moderate and mild bleeding was noted in 20/39 (51.3%), 15/39 (38.5%) and 4/39 (10.3%) cases in control group as compared to 0/36 (0%); 2/36 (5.6%) and 25/36 (69.4%) cases in interventional group respectively (**<0.001). No bleeding was noted in 9/36 (25%) cases of interventional group. Complete epithelialization was observed in 24/36 (66.7%) & 17/39 (43.6%) cases in adrenaline and control groups respectively (p=0.045). CONCLUSION: Application of adrenaline was more effective in bleeding control and early epithelialization at donor site following the skin harvesting as compared to conventional technique.
{"title":"COMPARISON BETWEEN ADRENALINE AND WITHOUT ADRENALINE SOLUTION ON BLEEDING CONTROL OF SKIN GRAFT DONOR SITE: A RANDOMIZED CONTROLLED TRIAL","authors":"Mahak Memon, H. Ali, F. Ali, Faraz Adil, Urooj Ali, Samia Tasleem","doi":"10.35845/kmuj.2022.22064","DOIUrl":"https://doi.org/10.35845/kmuj.2022.22064","url":null,"abstract":"OBJECTIVE: To compare the bleeding control of skin graft donor site between normal saline soaked gauze with adrenaline and conventional technique having no adrenaline. \u0000METHODS: This open-label randomized control trial was conducted at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, Pakistan from October 2020 to March 2021. Seventy-five patients were randomized to interventional (n=36, 48%) and control group (n=39, 52%) through sealed envelopes. Diluted solution was prepared by adding 30cc of Ringer’s lactate and 10cc of lignocaine 2%, with 1cc of adrenaline of 1:200000 with 200 ml of normal saline solution. Solution for control group was containing only normal saline. Following the skin harvesting at donor site, a gauze piece soaked with tumescent solution was applied at the donor site wound. Bleeding severity and epithelialization were assessed. Data was recorded in a pre-designed performa and analyzed through SPSS version-25. \u0000RESULTS: There was no significant differences in baseline characteristics like age (p=0.823), gender (p=0.984) and nature of injury (p=0.936) among two groups. Severe, moderate and mild bleeding was noted in 20/39 (51.3%), 15/39 (38.5%) and 4/39 (10.3%) cases in control group as compared to 0/36 (0%); 2/36 (5.6%) and 25/36 (69.4%) cases in interventional group respectively (**<0.001). No bleeding was noted in 9/36 (25%) cases of interventional group. Complete epithelialization was observed in 24/36 (66.7%) & 17/39 (43.6%) cases in adrenaline and control groups respectively (p=0.045). \u0000CONCLUSION: Application of adrenaline was more effective in bleeding control and early epithelialization at donor site following the skin harvesting as compared to conventional technique.","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46161835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.35845/kmuj.2022.21481
S. Khan, K. Cresswell, A. Sheikh
OBJECTIVES: To describe the evolution of the Sehat Sahulat Programme (SSP), a large-scale health insurance scheme launched by the provincial government of Khyber Pakhtunkhwa, Pakistan and to contextualise it in the national discourse around Universal Health Coverage (UHC). METHODS: This review was based on peer-reviewed publications and publicly available grey literature over the last five years (2016-2020). We employed a combination of deductive and inductive approaches informed by the World Health Organisation's (WHO) UHC box framework. REVIEW: SSP was launched on 15 December 2015. It has been implemented in four phases, with a gradual expansion in the population, services and cost coverage. In 2015, SSP covered the poorest 21% of the population in four pilot districts. On 20 August 2020, the coverage was expanded to 100% of the population of Khyber Pakhtunkhwa. SSP conferred free access to an expanding list of inpatient, secondary and tertiary care services. The scheme covered all expenditures during hospital admission, with a defined upper ceiling. The ceiling for secondary and tertiary care has improved, with marked changes in tertiary coverage, from PKR 0 in Phase1 – PKR 400,000 in Phase 4. Despite the progress, SSP did not cover key health-related targets under Goal 3 of the Sustainable Development Goals (SDGs) and partially covered Pakistan's UHC benefits package. CONCLUSION: SSP coverage of population, disease and financial protection has expanded over five years. However, SSP coverage was not aligned with the national UHC priorities and the SDGs.
{"title":"CONTEXTUALISING SEHAT SAHULAT PROGRAMME IN THE DRIVE TOWARDS UNIVERSAL HEALTH COVERAGE IN KHYBER PAKHTUNKHWA, PAKISTAN","authors":"S. Khan, K. Cresswell, A. Sheikh","doi":"10.35845/kmuj.2022.21481","DOIUrl":"https://doi.org/10.35845/kmuj.2022.21481","url":null,"abstract":"OBJECTIVES: To describe the evolution of the Sehat Sahulat Programme (SSP), a large-scale health insurance scheme launched by the provincial government of Khyber Pakhtunkhwa, Pakistan and to contextualise it in the national discourse around Universal Health Coverage (UHC). \u0000METHODS: This review was based on peer-reviewed publications and publicly available grey literature over the last five years (2016-2020). We employed a combination of deductive and inductive approaches informed by the World Health Organisation's (WHO) UHC box framework. \u0000REVIEW: SSP was launched on 15 December 2015. It has been implemented in four phases, with a gradual expansion in the population, services and cost coverage. In 2015, SSP covered the poorest 21% of the population in four pilot districts. On 20 August 2020, the coverage was expanded to 100% of the population of Khyber Pakhtunkhwa. SSP conferred free access to an expanding list of inpatient, secondary and tertiary care services. The scheme covered all expenditures during hospital admission, with a defined upper ceiling. The ceiling for secondary and tertiary care has improved, with marked changes in tertiary coverage, from PKR 0 in Phase1 – PKR 400,000 in Phase 4. Despite the progress, SSP did not cover key health-related targets under Goal 3 of the Sustainable Development Goals (SDGs) and partially covered Pakistan's UHC benefits package. \u0000CONCLUSION: SSP coverage of population, disease and financial protection has expanded over five years. However, SSP coverage was not aligned with the national UHC priorities and the SDGs.","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42485187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.35845/kmuj.2022.21984
Noshaba Noor, H. Waseem
INTRODUCTION: Glutaric aciduria type 1 is a neurometabolic disorder occurring due to deficient activity of glutaryl-CoA dehydrogenase. Multiple neurotoxic metabolites start accumulating in plasma, CSF and urine which are detected by mass spectrometry. Early new-born screening plays an important role in early diagnosis whereas typical radiographic features and metabolic workup supports the diagnosis. Treatment guidelines have been constructed to prevent acute encephalopathic crisis and remove neurotoxic metabolites from plasma to prevent brain damage, the goal of treatment. CASE PRESENTATION: An eight month old male patient presented with fever, seizures and altered level of consciousness. He was macrocephalic with examination findings suggestive of upper motor neuron lesion. The typical radiologic features suggestive of glutaric aciduria type 1 were noticed in neuroimaging. Workup for inborn error of metabolism confirmed the same. Early treatment was started keeping a metabolic disease consultant on board. The patient was safely discharged from hospital after stabilization and is well till date. CONCLUSION: This case is being reported to emphasize the importance of early diagnosis, timely management and adherence to proper treatment in paediatric patients presenting with metabolic crisis. This can help prevent irreversible damage in patients especially in the ones diagnosed as glutaric aciduria type 1.
{"title":"GLUTARIC ACIDEMIA TYPE 1: A CASE REPORT FROM PAKISTAN","authors":"Noshaba Noor, H. Waseem","doi":"10.35845/kmuj.2022.21984","DOIUrl":"https://doi.org/10.35845/kmuj.2022.21984","url":null,"abstract":"INTRODUCTION: Glutaric aciduria type 1 is a neurometabolic disorder occurring due to deficient activity of glutaryl-CoA dehydrogenase. Multiple neurotoxic metabolites start accumulating in plasma, CSF and urine which are detected by mass spectrometry. Early new-born screening plays an important role in early diagnosis whereas typical radiographic features and metabolic workup supports the diagnosis. Treatment guidelines have been constructed to prevent acute encephalopathic crisis and remove neurotoxic metabolites from plasma to prevent brain damage, the goal of treatment. \u0000CASE PRESENTATION: An eight month old male patient presented with fever, seizures and altered level of consciousness. He was macrocephalic with examination findings suggestive of upper motor neuron lesion. The typical radiologic features suggestive of glutaric aciduria type 1 were noticed in neuroimaging. Workup for inborn error of metabolism confirmed the same. Early treatment was started keeping a metabolic disease consultant on board. The patient was safely discharged from hospital after stabilization and is well till date. \u0000CONCLUSION: This case is being reported to emphasize the importance of early diagnosis, timely management and adherence to proper treatment in paediatric patients presenting with metabolic crisis. This can help prevent irreversible damage in patients especially in the ones diagnosed as glutaric aciduria type 1.","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45978027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.35845/kmuj.2022.21904
Hassan Sohail Butt, Taimoor Hassan
With the propagation of COVID-19 worldwide, its new strains are also emanating. Consequently, the healthcare workers are persistently monitoring these mutations with grave concern.1 Epsilon variant also called as CAL.20C which is new strain of SARs-COV-2 virus originated and was first detected in California, United States of America (USA) in July 2020 .2,3 Originated from California, this variant is currently in approximately more than 35 countries and was prevalent in the United States.4,5 After processing 23 samples in a reference lab of the Provincial Government, Punjab, it was corroborated by the Health Authority about the existence of the novel variant. Out of 23 samples, five were validated as positive with California Epsilon strain reported in Lahore. According to the medical experts, the patient takes several weeks to recuperate from Epsilon strain in contrast with the other types of infections. Medical pantheons opine that this Epsilon variant found in Lahore is highly contagious and communicable as the Delta variant and this variant is said to be 20 per cent more transmissible. Epsilon strain identified in Lahore, --- city of Pakistan --- was highly contagious and highly communicable as the its counterpart, the Delta variant. Sarah Aslam serving as Secretary Punjab Primary & Secondary Healthcare Department admonished about the menacing situation of the novel California Epsilon strain unearthed in Lahore. Adding her stance, she stated that her department accumulated 23 suspicious samples of which five of them were detected positive for Epsilon. She commended to abide by the SOPs (Standard Operating Procedures) to avert from this strain.6 Though Epsilon is new to South Asia, it is considered to be the second-most dominant variant in New York.5 According to the researchers at the University of Washington it was discovered that this variant is more resistant to vaccines.3 According to peer-reviewed journal Science, Epsilon strain can entirely disappear synthetic antibodies and minimize the potency antibody generates in the plasma of vaccinated people.3 This strain of COVID-19 has five defining variations, one of which incorporates a mutation in spike protein L452R.3 This L452R mutation augments spike strength, viral infectivity, viral fusogenicity, and viral replication.7 Looking at the current scenario and susceptivity of Epsilon variant, the Government of Punjab is working diligently. Primary Health Secretary has released a notice of smart lockdown in various regions of Lahore. All civic vicinities such as market-places, shopping centers, eateries, offices including public and private will remain closed until the situation dwindles. All types of gathering whether social, political or religious shall remain banned.8 In addition, the government has called for moratorium on all intra and inter-city transports.9 According to Punjab Health Minister Dr. Yasmin Rashid, the government has commenced door to door vaccination campaign to
{"title":"EMERGENCY ALARMS IN LAHORE AS EPSILON VARIANT OF COVID-19 IS DETECTED","authors":"Hassan Sohail Butt, Taimoor Hassan","doi":"10.35845/kmuj.2022.21904","DOIUrl":"https://doi.org/10.35845/kmuj.2022.21904","url":null,"abstract":"With the propagation of COVID-19 worldwide, its new strains are also emanating. Consequently, the healthcare workers are persistently monitoring these mutations with grave concern.1 Epsilon variant also called as CAL.20C which is new strain of SARs-COV-2 virus originated and was first detected in California, United States of America (USA) in July 2020 .2,3 Originated from California, this variant is currently in approximately more than 35 countries and was prevalent in the United States.4,5 After processing 23 samples in a reference lab of the Provincial Government, Punjab, it was corroborated by the Health Authority about the existence of the novel variant. Out of 23 samples, five were validated as positive with California Epsilon strain reported in Lahore. According to the medical experts, the patient takes several weeks to recuperate from Epsilon strain in contrast with the other types of infections. Medical pantheons opine that this Epsilon variant found in Lahore is highly contagious and communicable as the Delta variant and this variant is said to be 20 per cent more transmissible. Epsilon strain identified in Lahore, --- city of Pakistan --- was highly contagious and highly communicable as the its counterpart, the Delta variant. Sarah Aslam serving as Secretary Punjab Primary & Secondary Healthcare Department admonished about the menacing situation of the novel California Epsilon strain unearthed in Lahore. Adding her stance, she stated that her department accumulated 23 suspicious samples of which five of them were detected positive for Epsilon. She commended to abide by the SOPs (Standard Operating Procedures) to avert from this strain.6 \u0000Though Epsilon is new to South Asia, it is considered to be the second-most dominant variant in New York.5 According to the researchers at the University of Washington it was discovered that this variant is more resistant to vaccines.3 According to peer-reviewed journal Science, Epsilon strain can entirely disappear synthetic antibodies and minimize the potency antibody generates in the plasma of vaccinated people.3 This strain of COVID-19 has five defining variations, one of which incorporates a mutation in spike protein L452R.3 This L452R mutation augments spike strength, viral infectivity, viral fusogenicity, and viral replication.7 \u0000Looking at the current scenario and susceptivity of Epsilon variant, the Government of Punjab is working diligently. Primary Health Secretary has released a notice of smart lockdown in various regions of Lahore. All civic vicinities such as market-places, shopping centers, eateries, offices including public and private will remain closed until the situation dwindles. All types of gathering whether social, political or religious shall remain banned.8 In addition, the government has called for moratorium on all intra and inter-city transports.9 According to Punjab Health Minister Dr. Yasmin Rashid, the government has commenced door to door vaccination campaign to ","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43633027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-31DOI: 10.35845/kmuj.2022.21719
A. Yousafzai, S. Khan, Shakila Bano, A. Tariq
OBJECTIVES: To assess the patient satisfaction with telepsychiatry consultations, and whether time and money was saved by patients availing the service. METHODS: Anonymous internet survey using Google Form method, was conducted between April 2020 and September 2020 to collect data from patients using teleconsultation in out-patients psychiatry clinic. The google form consisted of patient satisfaction questionnaire, demographic details, and additional questions about the money and time saved by patients using the service. RESULTS: Out of 260 participants, 152, (58.5%) were males, 148 (58.3 %) were married and majority (n=157: 60.4%) of patients were <40 years of age. About 62.7% (n=163) were highly educated. Majority (n=108; 41.5%) of the survey participants were from Khyber Pakhtunkhwa province. The average cost saving was Pakistani Rupees 3000 for the consultation whereas the average time saved was 1.5 days. Patients were happy during communication with doctor including seeing doctor on screen (85.7%), hearing to doctor (90.4%), talking to doctor (84.6%) and discussion of their care plan (81.6%). Majority (79.2%) of the survey participants were happy with the meeting of care needs and 86.5% were happy to avail the service in future. CONCLUSION: The study underscores the importance of telepsychiatry as mode of service delivery during the pandemics. The findings demonstrated a high level of patient satisfaction, considerable amount of time and money saving indicates the effectiveness of telepsychiatry consultation. It needs to expand the telepsychiatry service both in public and private hospitals and also test this model on a representative sample of patients in Pakistan.
{"title":"PATIENT SATISFACTION WITH TELEPSYCHIATRY CONSULTATIONS IN THE TIME OF COVID19: DATA FROM A TERTIARY CARE HOSPITAL IN PAKISTAN","authors":"A. Yousafzai, S. Khan, Shakila Bano, A. Tariq","doi":"10.35845/kmuj.2022.21719","DOIUrl":"https://doi.org/10.35845/kmuj.2022.21719","url":null,"abstract":"OBJECTIVES: To assess the patient satisfaction with telepsychiatry consultations, and whether time and money was saved by patients availing the service. \u0000METHODS: Anonymous internet survey using Google Form method, was conducted between April 2020 and September 2020 to collect data from patients using teleconsultation in out-patients psychiatry clinic. The google form consisted of patient satisfaction questionnaire, demographic details, and additional questions about the money and time saved by patients using the service. \u0000RESULTS: Out of 260 participants, 152, (58.5%) were males, 148 (58.3 %) were married and majority (n=157: 60.4%) of patients were <40 years of age. About 62.7% (n=163) were highly educated. Majority (n=108; 41.5%) of the survey participants were from Khyber Pakhtunkhwa province. The average cost saving was Pakistani Rupees 3000 for the consultation whereas the average time saved was 1.5 days. Patients were happy during communication with doctor including seeing doctor on screen (85.7%), hearing to doctor (90.4%), talking to doctor (84.6%) and discussion of their care plan (81.6%). Majority (79.2%) of the survey participants were happy with the meeting of care needs and 86.5% were happy to avail the service in future. \u0000CONCLUSION: The study underscores the importance of telepsychiatry as mode of service delivery during the pandemics. The findings demonstrated a high level of patient satisfaction, considerable amount of time and money saving indicates the effectiveness of telepsychiatry consultation. It needs to expand the telepsychiatry service both in public and private hospitals and also test this model on a representative sample of patients in Pakistan.","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46747236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.35845/kmuj.2021.19840
Aniqa Khaliq, Shamaila Yaqub, Farooq Islam, A. Raza, Aiman Batool, Sana Jamil
OBJECTIVE: To assess the risk factors associated with upper crossed syndrome (UCS) in females of age 25-50 years. METHODS: This population based case controlled study was conducted from May to August 2019. Total of 210 females including 105 cases (participants who had upper neck pain for at least one month) and 105 controls (participants who didn't had upper neck pain), aging 25-50 years were selected through non-probability convenient sampling technique from the population of Gujrat, Punjab Pakistan. Data was collected through a pre-tested questionnaire and analyzed through SPSS software (version 21.0). Universal goniometer used to assess cervical ranges. Neck disability index (NDI) was used for functional disability and visual analog scale (VAS) was applied to assess the degree of pain. RESULTS: Majority (n=88; 41.90%) of females were in age group of 25-30 years and were housewives (n=147; 70 %). Females who used handheld devices, unsupported back chairs, read, worked, travelled for more than 3 hours had 63.91, 9.127, 3.568, 3.301, 2.068 folds risk of developing UCS respectively as compared to those who did the same for less than 3 hours. Similarly, females who were fetal sleeper had 2.032 times more risk of than front sleeper. All risk factors were statistically significant (p< 0.005). CONCLUSION: Usage of handheld devices while reading, working, and travelling for >3 hours, sleeping with curved spine and in fetal position and unsupported back chair increase the risk of UCS.
{"title":"RISK FACTORS ASSOCIATED WITH UPPER CROSSED SYNDROME IN FEMALES OF AGE 25-50 YEARS: A POPULATION-BASED CASE CONTROL STUDY","authors":"Aniqa Khaliq, Shamaila Yaqub, Farooq Islam, A. Raza, Aiman Batool, Sana Jamil","doi":"10.35845/kmuj.2021.19840","DOIUrl":"https://doi.org/10.35845/kmuj.2021.19840","url":null,"abstract":"OBJECTIVE: To assess the risk factors associated with upper crossed syndrome (UCS) in females of age 25-50 years. \u0000METHODS: This population based case controlled study was conducted from May to August 2019. Total of 210 females including 105 cases (participants who had upper neck pain for at least one month) and 105 controls (participants who didn't had upper neck pain), aging 25-50 years were selected through non-probability convenient sampling technique from the population of Gujrat, Punjab Pakistan. Data was collected through a pre-tested questionnaire and analyzed through SPSS software (version 21.0). Universal goniometer used to assess cervical ranges. Neck disability index (NDI) was used for functional disability and visual analog scale (VAS) was applied to assess the degree of pain. \u0000RESULTS: Majority (n=88; 41.90%) of females were in age group of 25-30 years and were housewives (n=147; 70 %). Females who used handheld devices, unsupported back chairs, read, worked, travelled for more than 3 hours had 63.91, 9.127, 3.568, 3.301, 2.068 folds risk of developing UCS respectively as compared to those who did the same for less than 3 hours. Similarly, females who were fetal sleeper had 2.032 times more risk of than front sleeper. All risk factors were statistically significant (p< 0.005). \u0000CONCLUSION: Usage of handheld devices while reading, working, and travelling for >3 hours, sleeping with curved spine and in fetal position and unsupported back chair increase the risk of UCS.","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49606711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.35845/kmuj.2021.22287
Adil Zareef
On Friday 8th October 2021, the United Nations (UN) Human Rights Council in a “historic breakthrough” declared access to an environment without pollution as a fundamental human right. By recognizing that a healthy environment is a human right, the world body has formally added its support to the global fight against climate change and its devastating consequences. The UN declaration is critical for a world where nine million preventable deaths are caused due to environmental crises yearly. This landmark declaration has firmly established, through research, an association between climate change, environmental degradation and its adverse effects on health. Reversing the level of current greenhouse gas emissions during this decade is crucial to prevent future disasters like extreme heat waves, flooding, tropical storms, rising sea levels supercharged by trapped carbons in the biosphere. As the clock is ticking for the planet's survival, catastrophic health related impacts are equally challenging. The UN Secretary General has termed this emergency as “red code for humanity”.2 The planet’s ecosystem and environment serve as health determinants for the entire humankind. The recent surge in dengue in Pakistan, and COVID 19 pandemic underscore increase of zoonotic diseases, comprising various bacteria, parasites, viruses, fungi proliferating wildly and affecting global populations across continents. Research has established that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) travelled from bats to humans through mutation in intermediate host of an unknown species.3 Unrestrained human activity & climate change figure in the destruction of ecosystems and likelihood of further pandemics. Likewise, dengue transmission is on rise due to unusual global warming, as various vectors like mosquitoes, previously rare in this part of the world, are breeding faster. Consequently, the geographical distribution of vector-borne infectious diseases is likely to proliferate with an incremental increase in the duration and intensity of heat and humidity globally.4 “Humanity is now standing at a crossroads. We must now decide which path we want to take. How do we want the future living conditions for all living species to be like?” remarked Greta Thunberg.5 Reversing these trends would require a herculean effort on part of governments, public health systems and civil society organizations. Whereas, informed policy making is crucial to factor in climate change and public health impacts as a whole, public participation and advocacy campaigns are equally important in creating a critical movement towards a healthier world. Globally, air pollution remains a major public health problem. According to World Health Organization (WHO) estimates, approximately 92 percent of the human population is exposed to unsafe levels of air pollution.6 Air pollution poses a major environmental hazard to human health, alongside climate change.7 Pakistan is no exception to t
{"title":"HEALTH IMPACTS OF AIR POLLUTION AND CLIMATE CHANGE","authors":"Adil Zareef","doi":"10.35845/kmuj.2021.22287","DOIUrl":"https://doi.org/10.35845/kmuj.2021.22287","url":null,"abstract":"On Friday 8th October 2021, the United Nations (UN) Human Rights Council in a “historic breakthrough” declared access to an environment without pollution as a fundamental human right. By recognizing that a healthy environment is a human right, the world body has formally added its support to the global fight against climate change and its devastating consequences. The UN declaration is critical for a world where nine million preventable deaths are caused due to environmental crises yearly. \u0000This landmark declaration has firmly established, through research, an association between climate change, environmental degradation and its adverse effects on health. Reversing the level of current greenhouse gas emissions during this decade is crucial to prevent future disasters like extreme heat waves, flooding, tropical storms, rising sea levels supercharged by trapped carbons in the biosphere. As the clock is ticking for the planet's survival, catastrophic health related impacts are equally challenging. The UN Secretary General has termed this emergency as “red code for humanity”.2 The planet’s ecosystem and environment serve as health determinants for the entire humankind. \u0000The recent surge in dengue in Pakistan, and COVID 19 pandemic underscore increase of zoonotic diseases, comprising various bacteria, parasites, viruses, fungi proliferating wildly and affecting global populations across continents. Research has established that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) travelled from bats to humans through mutation in intermediate host of an unknown species.3 Unrestrained human activity & climate change figure in the destruction of ecosystems and likelihood of further pandemics. \u0000Likewise, dengue transmission is on rise due to unusual global warming, as various vectors like mosquitoes, previously rare in this part of the world, are breeding faster. Consequently, the geographical distribution of vector-borne infectious diseases is likely to proliferate with an incremental increase in the duration and intensity of heat and humidity globally.4 “Humanity is now standing at a crossroads. We must now decide which path we want to take. How do we want the future living conditions for all living species to be like?” remarked Greta Thunberg.5 \u0000Reversing these trends would require a herculean effort on part of governments, public health systems and civil society organizations. Whereas, informed policy making is crucial to factor in climate change and public health impacts as a whole, public participation and advocacy campaigns are equally important in creating a critical movement towards a healthier world. \u0000Globally, air pollution remains a major public health problem. According to World Health Organization (WHO) estimates, approximately 92 percent of the human population is exposed to unsafe levels of air pollution.6 Air pollution poses a major environmental hazard to human health, alongside climate change.7 \u0000Pakistan is no exception to t","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49554909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.35845/kmuj.2021.21913
Kalsoom Tariq, S. Fatima, R. Nazli, S. Habib, M. Shah
OBJECTIVE: To find out the effect of Lipid based nutritional supplement (LNS) on body composition, hematological findings, maternal, birth and infant outcomes in underweight primi-gravidas. METHODS: This single-blinded randomized controlled clinical trial was executed in the tertiary care hospitals of Khyber Pakhtunkhwa province, Pakistan from April 2018 to August 2019. Forty primi-gravidas recruited in the study were randomized into LNS and placebo groups. LNS group received 75 gms of high energy nutritional supplement, named “MAAMTA”, on daily basis from their first antenatal visit till delivery in addition to their conventional antenatal treatment. Fasting blood samples were taken and body composition was measured at baseline visit, 16th week of gestation and post-natally. For the measurement of hematological parameters neonates cord blood was obtained. Data of 36 participants (LNS group n=19; placebo group n=17) were available for final analysis. RESULTS: Majority (n=33/36; 91.7%) had normal vaginal deliveries (n=18/19 in LNS group & n=15/17 in placebo group). Frequency of Cesarean section was 1/19 (5.3%) in LNS group and 2/17 (11.8%) in placebo group. No case of abortion was reported. Mean crown heel length (CHL) was 47.11±2.747 cm in LNS group and 44.24±2.359 cm in placebo group (p=0.002). Mean fronto-occipital circumference was 35.11±1.663 cm and 32.41±7.859 cm in the LNS and placebo groups respectively (p=0.153). No difference was observed between the groups in maternal gestational weight gain per visit, prevalence of maternal anemia, maternal mortality & neonatal birth weight. CONCLUSION: The prenatal use of LNS increases the CHL of the neonates of underweight primi-gravidas.
{"title":"IMPACT OF LIPID-BASED NUTRITIONAL SUPPLEMENTATION IN PRIMI-GRAVIDAS AND ITS EFFECT ON MATERNAL, BIRTH AND INFANT OUTCOMES: A RANDOMIZED CONTROLLED TRIAL","authors":"Kalsoom Tariq, S. Fatima, R. Nazli, S. Habib, M. Shah","doi":"10.35845/kmuj.2021.21913","DOIUrl":"https://doi.org/10.35845/kmuj.2021.21913","url":null,"abstract":"OBJECTIVE: To find out the effect of Lipid based nutritional supplement (LNS) on body composition, hematological findings, maternal, birth and infant outcomes in underweight primi-gravidas. \u0000METHODS: This single-blinded randomized controlled clinical trial was executed in the tertiary care hospitals of Khyber Pakhtunkhwa province, Pakistan from April 2018 to August 2019. Forty primi-gravidas recruited in the study were randomized into LNS and placebo groups. LNS group received 75 gms of high energy nutritional supplement, named “MAAMTA”, on daily basis from their first antenatal visit till delivery in addition to their conventional antenatal treatment. Fasting blood samples were taken and body composition was measured at baseline visit, 16th week of gestation and post-natally. For the measurement of hematological parameters neonates cord blood was obtained. Data of 36 participants (LNS group n=19; placebo group n=17) were available for final analysis. \u0000RESULTS: Majority (n=33/36; 91.7%) had normal vaginal deliveries (n=18/19 in LNS group & n=15/17 in placebo group). Frequency of Cesarean section was 1/19 (5.3%) in LNS group and 2/17 (11.8%) in placebo group. No case of abortion was reported. Mean crown heel length (CHL) was 47.11±2.747 cm in LNS group and 44.24±2.359 cm in placebo group (p=0.002). Mean fronto-occipital circumference was 35.11±1.663 cm and 32.41±7.859 cm in the LNS and placebo groups respectively (p=0.153). No difference was observed between the groups in maternal gestational weight gain per visit, prevalence of maternal anemia, maternal mortality & neonatal birth weight. \u0000CONCLUSION: The prenatal use of LNS increases the CHL of the neonates of underweight primi-gravidas.","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46104116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.35845/kmuj.2021.21782
Syed Fawad Saleem Shah, Nuzhar Noreen, N. Iqbal, Abdul Basit, Faisal Zafar, Erum Afzal
OBJECTIVES: To determine role of folinic acid in improving the adaptive skills and language impairment in autism spectrum disorder (ASD) among children aged 3-14 years. METHODS: This open label randomized controlled trial was conducted at the Out-patient Department of Pediatric Neurology, The Children Hospital & The Institute of Child Health Multan, Pakistan from October-2020 to March-2021. A total of 44 (22 in each group) children of both genders, aged 3-14 years with diagnosis of ASD were included. Children receiving folinic acid (dose of 2mg/kg/day in two divide doses) and behavioral therapy were assigned to Group-A while Group-B received only behavioral therapy. Primary outcome measures were improvement of language and adaptive skills while secondary outcome measures were stereotype movements, verbal communication, hyperactivity, peer relationship and inattention were these parameters measured at baseline, 6-weeks and 12-weeks (final outcome) intervals. RESULTS: Of 44 children, 34 (77.3%) were male and 10 (22.7%) female. Mean age was 4.28±1.57 years. At baseline, outcome measures scores in between both study groups had no statistically significant difference (p>0.05). Regarding final outcome, among children in Group-A, primary outcome measures as gross motor development age (51.41±16.29 months vs. 39.23±51.41 months, p=0.002), self-help (48.64±13.68 months vs. 37.45±6.82 months, p=0.001) and language (18.68±6.34 months vs. 15.15±5.22 months, p=0.050) scores improved significantly when compared to Group-B. Regarding secondary outcome, stereotype movements (p=0.028) improved significantly in Group-A in comparison to Group-B. CONCLUSION: Folinic acid along with behavioral therapy helped improving language and adaptive skills in children with ASD when compared to behavioral therapy alone.
{"title":"ROLE OF FOLINIC ACID IN IMPROVING THE ADAPTIVE SKILLS AND LANGUAGE IMPAIRMENT IN CHILDREN WITH AUTISM SPECTRUM DISORDER","authors":"Syed Fawad Saleem Shah, Nuzhar Noreen, N. Iqbal, Abdul Basit, Faisal Zafar, Erum Afzal","doi":"10.35845/kmuj.2021.21782","DOIUrl":"https://doi.org/10.35845/kmuj.2021.21782","url":null,"abstract":"OBJECTIVES: To determine role of folinic acid in improving the adaptive skills and language impairment in autism spectrum disorder (ASD) among children aged 3-14 years. \u0000METHODS: This open label randomized controlled trial was conducted at the Out-patient Department of Pediatric Neurology, The Children Hospital & The Institute of Child Health Multan, Pakistan from October-2020 to March-2021. A total of 44 (22 in each group) children of both genders, aged 3-14 years with diagnosis of ASD were included. Children receiving folinic acid (dose of 2mg/kg/day in two divide doses) and behavioral therapy were assigned to Group-A while Group-B received only behavioral therapy. Primary outcome measures were improvement of language and adaptive skills while secondary outcome measures were stereotype movements, verbal communication, hyperactivity, peer relationship and inattention were these parameters measured at baseline, 6-weeks and 12-weeks (final outcome) intervals. \u0000RESULTS: Of 44 children, 34 (77.3%) were male and 10 (22.7%) female. Mean age was 4.28±1.57 years. At baseline, outcome measures scores in between both study groups had no statistically significant difference (p>0.05). Regarding final outcome, among children in Group-A, primary outcome measures as gross motor development age (51.41±16.29 months vs. 39.23±51.41 months, p=0.002), self-help (48.64±13.68 months vs. 37.45±6.82 months, p=0.001) and language (18.68±6.34 months vs. 15.15±5.22 months, p=0.050) scores improved significantly when compared to Group-B. Regarding secondary outcome, stereotype movements (p=0.028) improved significantly in Group-A in comparison to Group-B. \u0000CONCLUSION: Folinic acid along with behavioral therapy helped improving language and adaptive skills in children with ASD when compared to behavioral therapy alone.","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46624467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.35845/kmuj.2021.21988
A. Hussain, S. Ali, Ibrar Ahmad, M. Khan, S. Tahir
OBJECTIVE: To screen the females presenting with Polycystic Ovarian Syndrome (PCOS) for underlying pre-diabetes and to correlate pre-diabetes with the various diagnostic criteria of PCOS. METHODS: This descriptive cross-sectional study was conducted at Lady Reading Hospital Peshawar, Pakistan from March, 2020 till December, 2020. One hundred & fifty one cases of PCOS, ranging in age from 17-40 years, were selected through purposive sampling. The Rotterdam criterion was used to diagnose PCOS, the details of history, physical examination and biochemical investigations like luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, thyroid stimulating hormone (TSH), glycosylted hemoglobin (HBA1c), prolactin and pelvic ultrasound were recorded on a structured questionnaire. RESULTS: Mean age of the patients was 23.42±4.88 years. Mean BMI was 33.27±26.98 kg/m2. Pre-diabetes was detected in 19.2% (n=29) and overt diabetes in 4.0% (n=6) of the women with PCOS. Hypertension, dyslipidemia and hypothyroidism were reported by 11 (7.2%), 9 (5.9%) and 4 (2.6%) patients respectively. Delayed menstrual cycle was reported by 44.8% (n=52); 27.6% (n=8) & 33.3% (n=2) cases of normoglycemic, prediabetes and diabetes mellitus respectively. Oligomenorrhoea was present in 69.0% (n=20) of pre-diabetics. Moderate and severe hirsutism was present in 44.8% and 10.3% PCOS patients with pre-diabetes. There was no significant correlation between pre-diabetes and the criteria of PCOS diagnosis. CONCLUSION: Women with PCOS are at increased risk of pre-diabetes and other metabolic complications like obesity, hypertension and dyslipidemia at an earlier age. However, there was no significant correlation between pre-diabetes and the criteria of PCOS diagnosis.
{"title":"SCREENING OF PRE-DIABETES IN PATIENTS PRESENTING WITH POLYCYSTIC OVARIAN SYNDROME: A TERTIARY CARE EXPERIENCE","authors":"A. Hussain, S. Ali, Ibrar Ahmad, M. Khan, S. Tahir","doi":"10.35845/kmuj.2021.21988","DOIUrl":"https://doi.org/10.35845/kmuj.2021.21988","url":null,"abstract":"OBJECTIVE: To screen the females presenting with Polycystic Ovarian Syndrome (PCOS) for underlying pre-diabetes and to correlate pre-diabetes with the various diagnostic criteria of PCOS. METHODS: This descriptive cross-sectional study was conducted at Lady Reading Hospital Peshawar, Pakistan from March, 2020 till December, 2020. One hundred & fifty one cases of PCOS, ranging in age from 17-40 years, were selected through purposive sampling. The Rotterdam criterion was used to diagnose PCOS, the details of history, physical examination and biochemical investigations like luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, thyroid stimulating hormone (TSH), glycosylted hemoglobin (HBA1c), prolactin and pelvic ultrasound were recorded on a structured questionnaire. RESULTS: Mean age of the patients was 23.42±4.88 years. Mean BMI was 33.27±26.98 kg/m2. Pre-diabetes was detected in 19.2% (n=29) and overt diabetes in 4.0% (n=6) of the women with PCOS. Hypertension, dyslipidemia and hypothyroidism were reported by 11 (7.2%), 9 (5.9%) and 4 (2.6%) patients respectively. Delayed menstrual cycle was reported by 44.8% (n=52); 27.6% (n=8) & 33.3% (n=2) cases of normoglycemic, prediabetes and diabetes mellitus respectively. Oligomenorrhoea was present in 69.0% (n=20) of pre-diabetics. Moderate and severe hirsutism was present in 44.8% and 10.3% PCOS patients with pre-diabetes. There was no significant correlation between pre-diabetes and the criteria of PCOS diagnosis. CONCLUSION: Women with PCOS are at increased risk of pre-diabetes and other metabolic complications like obesity, hypertension and dyslipidemia at an earlier age. However, there was no significant correlation between pre-diabetes and the criteria of PCOS diagnosis.","PeriodicalId":42581,"journal":{"name":"Khyber Medical University Journal-KMUJ","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42310585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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