Journal of Shifa Tameer-e-Millat University

Sociocultural dimensions of research on public health roles for community pharmacists in tuberculosis disease control in a developing country

Waseem Ullah — 2024-08-01

Developing countries often have healthcare system fragmentation because of either limited administrative healthcare organization or partial engagement of healthcare team members operating in private operations. Community pharmacies (also known as retail pharmacies) remain one of the most accessible venues for initial health-seeking for infectious diseases by populations living in these countries. Although community pharmacies are well established for the sale and dispensing of medications prescribed for infectious diseases to patients, their roles in infectious disease prevention, health promotion, and active/passive case detection have not been well elaborated. In fact, community pharmacies' engagement in public health roles is largely limited by the sociocultural barriers and challenges prevailing in these countries. In an attempt to address the aforementioned barriers, this study builds upon a large-scale national implementation (case-detection) trial conducted in a developing nation (such as Pakistan) with a high burden of Tuberculosis disease and provides a way forward for designing and scaling-up similar interventions for Tuberculosis control in the Pakistani healthcare system through public health pharmacy services.

Influence of smoking and other factors in development of cataracts in urban and rural areas. A cross-sectional study from Pakistan

Yasir Nawaz — 2024-08-02

Introduction: Cataract is characterized by the clouding of the crystalline lens fibers in the eyes. Smoking has been identified as risk factor for several common and serious eye diseases, including age-related macular degeneration, glaucoma, and cataracts, all of which can lead to irreversible blindness. This study aimed to examine the relationship between tobacco smoking and non-smoking with the prevalence of cataracts in both urban and rural populations in Pakistan.

Methodology: This epidemiological study was conducted in Okara, involving approximately 2000 patients. Some participants did not provide information, resulting in a total of 1992 confirmed cases from both genders. Data was collected using a questionnaire-based form after obtaining informed consent from patients.

Results: Of the 1992 subjects, 46.13% were male and 53.87% were female. The age distribution of both groups showed a significant difference. A total of 24.60% of patients were from urban areas, while 75.40% were from rural areas, showing no significant difference. The marital status of age groups 20 to 60 and 61 to 100 showed no significant differences. For cigarette smokers aged 20 to 60, the OR / 95% CI was 10.41/2.34, while for the age group 61 to 100, it was 6.63 / 1.89, indicating a significant difference. Huqa smokers aged 20 to 60 also showed a significant difference, as did the age group 61 to 100.

Conclusion: Smoking, whether cigarettes or huqa, is strongly associated with the development of cataracts. Other factors, such as the use of pan, niswar, and marital status, also play a role.

Comparison of intermittent compression-decompression with glides and conventional physical therapy protocol for knee osteoarthritis

Jamal Tariq — 2024-08-02

Introduction: Osteoarthritis (OA) is among the most prevalent types of arthritis and a fundamental cause of disability in people around the globe. Elderly population particularly females over the age of 65 years, patients with uncontrolled obesity have the highest risk of developing OA. To compare the effects of intermittent compression-decompression with glides and conventional physical therapy on pain, range of motion, and functional status in knee osteoarthritis.

Methodology: A randomized controlled trial was conducted with 60 participants having knee Osteoarthritis. The subjects were randomly allocated to Group A (intermittent compression-decompression with glides), Group B (conventional physical therapy), and Group C (intermittent compression-decompression with glides and conventional physical therapy) using a lottery method. The treatment was provided for 3 days per week alternatively and continued for 4 weeks. The assessment was done at the baseline and post-12th treatment day using NPRS, range of motion, WOMAC scale, and KOOS scale as outcome measures.

Results: Based on the results attained through the Kruskal Wallis test, there was a statistically significant effect (p<0.05) on scores of NPRS, Flexion, WOMAC, and KOOS, while extension showed no superlative effects after the application of the novel technique. More significant results were obtained in Group C (p<0.05) as compared to Groups A and B respectively.

Conclusion The application of compression and decompression with glides supplemented with conventional treatment protocol resulted in a massive reduction in pain and related symptoms, and improvement in range of motion with enhanced functional proficiency of patients affected with knee osteoarthritis.

Clinical pharmacist’s role in identification and management of medication errors in different wards of a hospital in Karachi

Anum Sattar — 2024-08-02

Introduction: Medication errors are a frequent issue within healthcare facilities. The ratio of patients who suffer harm due to these errors, in contrast to those who do not, is a concerning 100:1. The research aimed to ascertain the prevalence and categories of medication errors, as well as the function of pharmacists in identifying and addressing these errors across different wards of a private tertiary care facility located in Karachi, Pakistan.

Methodology: A cross-sectional case study, conducted in a private hospital in Karachi and including 200 patients, was assumed to explore drug therapy errors and evaluate the pharmacist's contribution to their detection.

Results: Through the meticulous efforts of clinical pharmacists, an extensive assessment encompassing 200 patients was conducted with a gender distribution of 110 females (55%) and 90 males (45%). Within this cohort, a cumulative total of 250 errors (averaging 1.25 per patient) were detected and appropriately addressed. The observed frequencies of error categories were as follows: above therapeutic dose (2.8%), sub-therapeutic dose (3.2%), dose adjustment (30%), drug-drug/drug-food interaction (3.6%), duplication of drug class (4.0%), dose Rounded off (3.6%), intravenous to per oral switch (3.2%), incomplete drug order (4.8%), transcribing error (4.8%), wrong medication (22%), wrong frequency (8%), wrong route (3.6%), wrong dilution/incompatibility (3.6%), wrong infusion rate (1.6%), and miscellaneous (1.2%).

Conclusion This research highlighted the pervasive problem of medication errors and highlighted the critical role clinical pharmacists played in identifying and correcting errors to improve patient safety and streamline healthcare procedures.

Assessment of risk factors associated with sociodemographic status of hepatitis. A cross-sectional study from Pakistani population

Jaweria Ismail — 2024-08-02

Introduction: One of the most urgent health concerns in Pakistan is the high prevalence of hepatitis C virus infection. Despite the availability of potent antiviral medications, the overall burden of the illness has not diminished, possibly due to the asymptomatic nature of the infection, leading to delayed diagnosis. This study was conducted to assess risk factors associated with the sociodemographic status of Hepatitis C disease in Pakistani patients.

Methodology: This study adopts a cross-sectional design, employing a questionnaire-based Performa to collect data from the Pakpattan district. This hospital-based, study was conducted in Pakpattan, the largest district in Punjab province, Pakistan, and collected data of 500 patients.

Results: The study reveals a higher frequency of male patients than females, with more individuals belonging to nuclear families than joint families. Unmarried individuals face greater risk than married multiple times, and more people reside in rural areas than urban areas. The average family size does not differ between cases and controls, and the prevalence of uneducated individuals is higher than educated individuals. Gender, family status, and residence exhibit non-significant results, age, marital status, family size, and education status show significant associations. The multivariate analysis indicates p-values below the significance threshold, reinforcing the reliability of the results.

Conclusion: Hepatitis C infections are more prevalent in males, and socioeconomic status significantly influences its distribution in both genders. Education emerges as a crucial factor in the spread of this disease. Establishing Hepatitis-related societies for awareness campaigns is essential to facilitate early detection and treatment.

Estimation of body fat mass percentage as measure of obesity among undergraduate medical students and its correlation with clinical markers of obesity

Abhishek Ghose — 2024-08-02

Introduction: This study was conducted to assess the burden of overweight and obesity among UG medical students by measurement of body fat mass percentage and to evaluate its validity as a clinical marker of obesity by its correlation with BMI.

Methodology: The research was conducted as a cross-sectional, observational study using the principle of Bioelectric Impedance Analysis for the measurement of body fat.

Results: A total of 420 students were enrolled out of which 233 were males (55.4%) and 187 females (44.5 %). The burden of overweight and obesity among the students was found to be 26% and 9.8 % respectively according to WHO global BMI criteria. This abnormality was pervasive across all four years of UG MBBS students. The startling finding is that students who were labeled as ‘Normal’ using the BMI criterion were found to be obese by BF% assessment (43%) and even ‘Underweight’ students were found to have more than normal levels of BF% (15.2%). Measurement of waist circumference (WC) showed that 146 (34.8%) of the students had WC higher than normal. Likewise, 145 (34.5%) of the students had Waist-Hip Ratio higher than normal. Abnormalities of all the above parameters put the students at risk of NCDs(Non-Communicable diseases).

Conclusion: The study shows a high burden of overweight and obesity in medical students. Using body fat percentage as a clinical marker of adiposity is more desirable than using BMI only to screen for clinical obesity

Incidence of hyperoxia and excess of oxygen use in critically ill pediatric patients

Fatima Gul — 2024-08-02

Introduction: Oxygen therapy is a crucial aspect of quality care in the pediatric Intensive Care unit. It is not only necessary for preventing hypoxia but also important for reducing the burden of labored breathing in a child maintaining saturation at the cost of a higher basal metabolic rate. To determine the incidence of hyperoxia in patients receiving supplemental oxygen therapy in a pediatric intensive care setting.

Methodology: A cross-sectional prospective study was conducted at the pediatric intensive care unit of Shifa International Hospital from November 2022 to October 2023. A total of 137 patients were included in the study. Consecutive non-probability sampling was used for patients who matched the inclusion and exclusion criteria. Data regarding demographic and clinical factors was collected and evaluated using SPSS 23. The incidence of hyperoxia and its relationship to mortality, organ dysfunction, mode of ventilation, and length of stay was determined.

Results: The mean age of the patients participating in the study was 4.97 ± 4.35 years and 101 (73.7%) were males. Mean fractional inspired oxygen, saturation, and partial pressure of oxygen were 0.37 ±0.19, 94.58 ±3.20, and 102.77 ±21.95 mmHg respectively. The overall incidence of hyperoxia was 9.5%. There was no statistically significant difference in mode of ventilation, organ dysfunction, and length of stay when compared between those who had hyperoxia and those who did not.

Conclusion: The study concludes that the overall incidence of hyperoxia remains low at 9.5% as only 13 out of 137 patients experienced it.

Ultrasonographic assessment of hydronephrosis in adults and children: Experience from a tertiary care hospital

Smeera Ahmed — 2024-08-02

Introduction: Hydronephrosis (HN) refers to the dilation of the pelvicalyceal system. The current study aims to evaluate various presentations and causes of HN in children and adults with the help of ultrasound (US) as the primary diagnostic modality.

Methodology: This cross-sectional prospective study was conducted in a tertiary care hospital in Lahore, Pakistan on patients between 0-70 years of age, who were diagnosed with HN in the US. Data was collected using self-designed proforma including gender, age, symptomatology, and anthropometry. Percentages and frequencies were calculated for categorical data. chi-square test was applied to compare urinary calculi in gender, age, BMI, and side.

Results: The total number of patients was 73. The mean age was 31 years. Adults were 74% (54) while 26% (19) were of the pediatric age group. Males were 67.6% (50) and 31.5%(23) were females. Lumbar pain was the commonest presenting complaint. Hydronephrosis was bilateral in 20.5%(15), 43.8% (32) in the left and in the right kidney (35.6%) 26. In adult patients, renal calculi were the commonest cause of 69.9%(51) of HN. In the case of children, PUJ obstruction and renal calculi were equally common 31.6%(6) each. The ureter was the most common site of calculi 35.6% (26). A significant association was found between HN with side of involvement (p-value < 0.001) and age of the patient (0.041).

Conclusion: Ultrasound imaging is helpful in the diagnosis, determination of etiology, and grading of hydronephrosis. Ureteric calculi is the most frequent cause of hydronephrosis followed by pelvic ureteric junction obstruction.

Prevalence of antibiotic resistance in patients with urinary tract infections

Fatima Khurshid — 2024-08-02

Introduction: Antibiotic resistance is a significant threat to the effective treatment of urinary tract infections (UTIs). The frequency of antibiotic-resistant UTIs is becoming increasingly concerning due to the possible consequences for patient health and healthcare expenses.

Methodology: A retrospective research at DHQ Hospital Mirpur AJK examined 225 patients with febrile UTIs from Dec 2023 to Feb 2024. Urine samples were collected and antibiotic testing were performed in accordance with Clinical and Laboratory Standards Institute standards.

Results: The study revealed alarming antibiotic resistance rates in urine isolates. Klebsiella spp. showed high resistance to Ceftriaxone (54%), Colistin (57%), and Cefuroxime (86%). Staphylococcus aureus exhibited significant resistance to Erythromycin (64%) and Doxycycline (81%). Escherichia coli displayed resistance to Ceftriaxone (23%) and Amoxicillin (25%). Notably, all species were susceptible to Vancomycin, with no observed resistance.

Conclusion: This study demonstrates significant antibiotic resistance among bacterial species that cause urinary tract infections (UTIs), with Klebsiella pneumoniae showing the highest resistance rates. Effective antibiotic stewardship are urgently required to address this issue and enhance UTI care.

A cross-sectional study to explore depression in postmenopausal women

Fatima Khurshid — 2024-08-02

Introduction: The impact of depression on postmenopausal women is a significant public health concern but remains largely unknown. Menopause signifies the cessation of a woman’s reproductive ability, indicating the halt of ovarian activity and leading to permanent amenorrhea. This organic change is associated with various symptoms including physical, vasomotor, sexual, and psychological elements. This cross-sectional survey was conducted to investigate the severity of depression in postmenopausal women and the factors that influence that depression.

Methodology: This study examined 240 women from the Gynae department of DHQ Hospital Mirpur, AJK, Pakistan. Data on menopausal symptoms and demographic traits was collected via structured interviews and Menopausal Rating Scale (MRS) questionnaires.

Results: The study revealed that 57% of participants experienced physiological symptoms such as hot flashes, sweating, heart discomfort, insomnia, and sleep problems. Psychologically, 39% experienced depressive mood, irritability, anxiety, and exhaustion. Urogenital, 60% experienced sexual problems, bladder issues, and vagina dryness. The severity of symptoms varied, with 5% reporting no symptoms, 77% reporting mild to moderate symptoms, and 18% reporting severe to extremely severe symptoms.

Conclusion: The study reveals that postmenopausal women often experience mild to moderate depression symptoms, emphasizing the need for personalized support and interventions to enhance their overall well-being.

Exploring the knowledge, attitude, and practice of family planning services among healthcare workers in Khyber Pakhtunkhwa: Cross-sectional online survey-based research

Syeda Seher Iqbal — 2024-08-02

Introduction: Family planning services have a pivotal role in encouraging reproductive health and ensuring the well-being of individuals, families, and communities worldwide. This current research aims to investigate the knowledge, attitudes, and practices (KAP) regarding family planning services.

Methodology: An online survey among female health workers was conducted in Khyber Pakhtunkhwa from March 1st to July 31st, 2023, for 5 months. The survey questionnaire was designed to assess KAP regarding family planning methods, implementation, and associated variables.

Results: Among the 319 participants, 15% had primary education, 21% were diploma holders, and 64% were graduates. Most participants (65.5%) had a monthly household income of less than Rs. 50,000, and 71.2% were married. Regarding family size, 61.3% had two or more children. All participants were familiar with family planning methods, with 89.5% receiving information from trainers and 9.5% through self-study. Over 85% provided correct information on family planning methods, with high accuracy across different types of contraceptive methods. Regarding attitudes, 80% of participants had a positive attitude towards family planning, 82% reported regular practice, and 94.3% advocated for an appropriate gap between childbirth. Additionally, 77.3% encouraged others to use family planning, and 82.6% believed it improved living standards.

Conclusion: The study concludes that attitudes and practices are influenced by knowledge of family planning methods. While awareness and positive attitudes were evident, utilization remained lower than desired. Factors such as education level, income, marital status, family size, and participation in training were highly associated with knowledge, attitude, and practice scores.

The association between maternal anemia and preterm birth: A case-control study

Zulfiqar Ali Khan — 2024-08-02

Introduction: Preterm birth (PTB), defined as birth before 37 weeks of gestation, remains a global public health challenge associated with neonatal morbidity and mortality. Maternal anemia, characterized by low hemoglobin levels, is prevalent in many low- and middle-income countries, including Pakistan.

Methodology: A case-control study was conducted at Swat Medical College and Women Hospital Mardan, Pakistan, from June 2022 to June 2023. Medical records of 1000 pregnant women (500 cases of PTB and 500 controls of term births) were reviewed. Maternal anemia, defined as hemoglobin levels below 11 g/dL, was assessed along with demographic variables, pregnancy history, and maternal complications. Logistic regression analysis adjusted for potential confounders was performed to determine the association between maternal anemia and PTB.

Results: Maternal anemia was significantly associated with an increased risk of PTB (adjusted odds ratio [OR] = 2.50; 95% confidence interval [CI]: 1.80-3.50; p < 0.001). Other significant risk factors included previous PTB (adjusted OR = 2.20; 95% CI: 1.50-3.20; p < 0.001), multiparity (adjusted OR = 1.50; 95% CI: 1.10-2.00; p = 0.01), preeclampsia (adjusted OR = 3.00; 95% CI: 2.20-4.20; p<0.001), and gestational diabetes (adjusted OR = 2.00; 95% CI: 1.50-2.70; p<0.001). Demographic factors such as maternal age, education, residence, and pre-pregnancy BMI did not show significant associations with PTB.

Conclusion: Maternal anemia emerges as a significant risk factor for PTB in Pakistan. Early detection and management of anemia during pregnancy are crucial to reducing the burden of PTB and its associated adverse outcomes.

Prevalence and risk factors of gestational diabetes mellitus in pregnant women at a tertiary health centre, Mardan, Pakistan

Zulfiqar Ali Khan — 2024-08-02

Introduction: Gestational diabetes mellitus (GDM) is characterized as impaired glucose tolerance that first occurs during pregnancy. GDM can lead to serious complications for both mother and fetus if undiagnosed or untreated. This study investigates the prevalence and risk factors of GDM among pregnant women at a tertiary health center in Mardan, Pakistan.

Methodology: A cross-sectional study was conducted from January 9, 2023, to December 8, 2023, at Swat Medical College and Women's Hospital Mardan. A total of 320 pregnant women were screened using glucose challenge tests followed by oral glucose tolerance tests if initial results were abnormal. Data on socio-demographic factors, BMI, gravida status, and clinical history were collected and analyzed using SPSS version 23.0.

Results: The prevalence of GDM in the study population was 24%. Advanced maternal age, higher BMI, and multigravida status were significant risk factors for GDM. Women aged over 35 years had the highest prevalence (48%). Overweight and obese women had prevalences of 30% and 32%, respectively. Multigravida women had a GDM prevalence of 32% compared to 22% in primigravida women. Family history of diabetes mellitus and history of GDM were the most common risk factors among GDM patients.

Conclusion: The high prevalence of disease and its association with factors such as age, BMI, gravida status, and family history underscores the need for targeted screening and prevention strategies. Health education and lifestyle interventions should be prioritized to mitigate the impact of GDM on maternal and fetal health.

Antidepressants and ocular health: Addressing dry eye syndrome

Ayesha Mansoor — 2024-08-02

Dry eye syndrome (DES) is a common and multifactorial eye disease that can lead to visual disturbance if left untreated. DES arises from various factors such as reduced tear production and inflammation, affects the quality of vision, and can potentially lead to other eye diseases such as pterygium, pseudo pterygium, conjunctivitis, keratitis, corneal ulcers, and corneal dystrophy. Notably, there is an intriguing link between DES and depression, a commonly diagnosed psychiatric disorder characterized by decreased levels of neurotransmitters such as serotonin, dopamine, and norepinephrine. Antidepressants prescribed to treat depression work by increasing serotonin levels but paradoxically can lead to DES and other ocular side effects. In particular, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are known to contribute to DES development. This article unveils the factors that trigger DES and sheds light on the interconnected casual web. By explaining the intricacies of DES, this article aims to provide physicians and patients with a deeper understanding of the condition, enabling better management and treatment outcomes.

Development of clinical reasoning skills through strategic questioning

Shumaila Yasir — 2024-08-02

Introduction: The ability of healthcare professionals to use clinical reasoning skills effectively is essential for making decisions in clinical settings. It is a general observation that nursing graduates possess adequate knowledge, but they lack clinical reasoning skills. This study aimed to assess the effectiveness of strategic questioning in improving the clinical reasoning skills of nursing students.

Methodology: A quasi-experimental study was conducted at a private-sector university in Islamabad, Pakistan. In total, 24 students were included in the study who were enrolled in the Medical and Surgical Nursing course in the undergraduate nursing program. The students were allocated to an experimental (12) and a control (12) group. The experimental group was provided with strategic questioning developed based on Bloom’s taxonomy and the comparison group was taught through traditional questioning methods. The intervention was done for two weeks and post-intervention scores of clinical reasoning were compared in both groups.

Results: After the intervention, the mean score on the Nurse Clinical Reasoning Scale (NCRS) for the experimental group was 63.50 to the comparison group which had a mean score of 57.25 and the mean difference was statistically significant.

Conclusion: Strategic questioning is an effective teaching-learning strategy that improves the clinical reasoning skills of nursing students in the clinical areas.