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Background: Global Health Estimates 2015 has shown IHD as second leading global cause of death and 3rd leading global cause for DALYs for 2015. The objectives of this study were to determine frequency, distribution and determinants of DM in adult acute coronary syndrome (ACS) population of D.I.Khan Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in Departments of Ophthalmology & Community Medicine, Gomal Medical College, D.I.Khan, from February 1, 2017 to April 30, 2017. 331 cases were selected with margin of error 4.511%, 90%CL and 25% prevalence of DM in 73,438 adults assumed to have IHD. All indoor adult patients of ACS were eligible. Sex, age groups, and residence and presence of DM were variables. Frequency and distribution were analyzed by count and percentage. Hypotheses for distribution were substantiated by chisquare goodness-of-fit and of association by chi-square test of association. Results: Out of 331 patients with ACS, 225 (68.0%) were men and 106 (32.0%) women, 221 (66.8%) =60 years and 110 (33.2%) >60 years, and 210 (63.4%) urban and 121 (35.6%) rural. Frequency of DM was 79/331 (23.87%). Out of 79 patients with DM, men were 44 (13.29%), women 35 (10.57%), age group =60 years 57 (17.22%), >60 years 22 (6.65%), urban 53 (16.01%) and rural 60 (7.85%). Our prevalence of DM was lower than expected (p=.00214), our distribution by sex was similar to expected (p=.4993) while our distribution for age groups (p=.01209) and residence (p=.00005) were not similar to expected. Presence of DM was associated to sex (p=.011) but not to age groups (p=.0304) and residence (p=.5241). Conclusion: Prevalence of DM in adult ACS population of D.I.Khan Division, Pakistan was found lower than expected. The prevalence was more in men than women, more in younger age group (=60 years) than older age group (>60 years) and more in urban than rural population. Our prevalence of DM was lower than expected, our distribution by sex was similar to expected while our distribution for age groups and residence were not similar to expected. The presence of DM was associated to sex but not to age groups and residence. [ABSTRACT FROM AUTHOR]

Background: Pediatric cataracts cause significant visual disability worldwide. The objectives of this study were to determine the distribution of pediatric cataracts by sex, age groups, laterality, type and presentation in population of D.I.Khan District, Pakistan. Materials & Methods: This descriptive study was carried out at Department of Ophthalmology, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2015. Sample was collected from Eye unit, DHQ Teaching Hospital, D.I.Khan. Pediatric cataract patients under 14 years of age were included in the study. Demographic variables were sex and age groups. Research variables were laterality, type and presentation. All variables being nominal were analyzed through frequency and percentages. The observed and expected distribution of pediatric cataract by sex, age groups, laterality, type and presentation were respectively tested by chi-square goodness of fit test. Results: Out of a sample of 47 patients, 29 (61.7%) were boys and 18 (38.3%) girls, 22 (46.81%) were <5 years and 25 (53.19%) 5-14 years of age. Thirty three (70.21%) had unilateral and 14 (29.79%) bilateral cataracts. Type was congenital/developmental in 27 (57.45%) patients and traumatic in 20 (42.55%). Presentation was by defective vision in 23 (48.94%), leukocoria 14 (29.79%), strabismus 7 (14.89%) and screening in 3 (6.38%) cases. The observed distribution of pediatric cataract by sex (p=.0158), age groups (p=.00002), laterally (p=<.00001) and type (p=.00001) was similar to expected, while for presentation, it was different than expected (p=.1033). Conclusion: The prevalence of pediatric cataract was higher for boys than girls and higher for older children (5-14 years) than younger (<5 years) children. Unilateral were more common than bilateral cataracts and the congenital/developmental were more common than traumatic cataracts. Defective vision was the most common presentation of pediatric cataracts. [ABSTRACT FROM AUTHOR]

Previous evidence suggests that Occupational Health & Safety (OHS) is linked with Employee Performance (EP), whereas according to other studies EP is based on Job Satisfaction (JS). This study attempts to explore whether independent variable (OHS) predicts the dependent variable (EP) directly or through mediating variable (JS) indirectly. Besides what is the role of demographic attributes of the respondents in this framework of relationships. OHS (variable X) has three attributes; legislative, medical & engineering measures. Dependent variable (variable Y) has been expressed into four attributes; effectiveness, efficiency, responsiveness & innovativeness. JS as mediating variable (M) has pay, promotion, supervision, colleagues, work & work environment as attributes. The objective of the study was to investigate existing literature in order to explore the relationship between perceptions of OHS, EP & JS in the workplace, thereby extracting a conceptual framework regarding the topic for future application in the upcoming empirical study. This review study was conducted at Department of Community Medicine, Gomal Medical College, Dera Ismail Khan from October, 2016 to November, 2016. Data collection method was literature search. Data type was qualitative & secondary. We searched the databases of MEDLINE (PubMed), Google scholar, Pakmedinet, Cochrane reviews and relevant web sites, over the period 2006-2017, using keywords as searching mechanism. Data was organized, summarized, analyzed and interpreted. [ABSTRACT FROM AUTHOR]

Current global workforce stands at about 2.8 billion. Workers spend about one third of their lifetime at workplace. Workers expect safe working environment as their fundamental human right. However there are still poor working conditions especially in developing countries due to lack of practicing simple preventive measures. The standard of Occupational health and safety available at any work place is the main determinant of workers' health. Workers all over the world, face dual occupational hazards, the traditional as well as novel in the complex work settings due to rapid industrialization, technological advancement and globalization, over the last few years. An equally wide variety of chemical, physical and psychological hazards in production. Occupational health issues affect individuals, families and communities, as well as the citizens of the world. All the stake holders including the state, the manager, the employer and the worker have certain responsibilities to take up medical, engineering and legislative interventions to make work environment safer. This review study was conducted at Department of Community Medicine, Gomal Medical College, D.I.Khan from October 9, 2016 to November 30, 2016. Qualitative, secondary data was collected through literature search. MEDLINE (PubMed), Google scholar and Pakmedinet were searched out employing relevant keywords from 2000 onwards until January 2017. Data was organized, summarized, analyzed & interpreted. The objective of the study was to identify existing gaps on occupational health and safety in industries in developing countries and propose future research areas. [ABSTRACT FROM AUTHOR]

Background: Asthma is a chronic allergic respiratory disease. The frequency and severity of asthma is rising in the developing countries. Severe asthma causes great morbidity and mortality affecting the quality of life of patients and their families. The objective of this study was to find the risk factors of asthma and their frequency and distribution in adults in District Dera Ismail Khan. Material & Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D. I. Khan, Pakistan from March 16, 2015 to August 15, 2015. A sample of 200 subjects was selected by consecutive non probability technique. Results: Among 200 patients 123(61%) were males and 67 (39%) were females. Total number of asthmatics in age group of 20-29 years were 94 ( 47%), 30-39years were 40(20%), 40-49 years were 20(10%), 50-59 years were 23(11%), 60-69 years were 11(6%), 70-80 years were 12(6%)asthmatic. Further regarding residence 114(57%) were from urban areas and 86(43%) were from rural areas. Conclusions: As it is clear from our results that asthma is mainly found in the age group of 20-29 years. Most of our respondents are students. Males are more vulnerable to get asthma than female. So health care planners should focus on adult asthma patients generally and this vulnerable group especially. [ABSTRACT FROM AUTHOR]

Background: Dengue fever is a mosquito-borne infection that in recent decades have become an important global public health issue. It can be fatal but preventable. Public awareness, perception and behaviour play important role in its prevention and this KAP survey was done to asses this. Material & Methods: This descriptive cross-sectional survey was carried out in Department of Community Medicine, Gomal Medical College, D.I.Khan from January 1, 2015 to April 30, 2015. A total of 100 respondents (patients/ attendants) were selected by convenient sampling technique. Data was collected on a self administered questionnaire having nominal scale. Data was collected from local population at medical OPD of DHQ Teaching Hospital, D.I.Khan. Informed consent was taken from all respondents. Socio-demographic variables were age groups, gender, education, income of family, residence, language. Research variables were knowledge, attitude and practice. Scale used was nominal. Data was expressed in frequency, percentages and overall mean percentage. SPSS version 19 was used for descriptive data analysis. Results: All 100 respondents were interviewed and there was no missing data. Among 100 respondents 32% were males and 68% were females, 14% were illiterate, attended school 32%, college 24%, university 30%. Urbans were 68%, 32% were rural. 46%, 34% and 20% were Saraiki, Pushto and Urdu speaking respectively. 38%, 40% and 22% belonged to poor, middle and high income group. Overall knowledge about dengue disease was 60%, positive attitude was 92% and overall practice was 90%. Conclusion: Key findings of this study are that knowledge is low. Public be educated about dengue disease and its prevention utilizing all sources of information employing mass media, print as well as electronic. Health department must assume a leadership role in this regard. [ABSTRACT FROM AUTHOR]

Evaluating strategies for reducing health disparities by addressing the social determinants of health. The impact of unemployment on mental and physical health, access to health care and health risk behaviors. 1,2 The attention of the public health community, during the past two decades, has changed to the social determinants of health to shape health through public policies. [Extracted from the article]

The author stresses the need for more research to clarify the health benefits and risks of fasting during Ramadan for patients with diabetes.

The author reflects on prevention of infections caused by protist Naegleria fowleri which causes primary amoebic meningoencephalitis (PAM), by chlorination of water. Topics discussed include symptoms of infection include headache, hallucinations and lack of attention, therapeutic use of drugs Amphotericin B and Chlorpromazine against N. fowleri, and increase in incidence of infection with rise in temperature through climate changes.

The authors present insights on the threat of swine flu outbreak. Topics discussed include the emergence swine flu in Mexico in 2009 and its spread in more the 195 countries, the mode of transmission of swine flu and the clinical spectrum of the disease. Also mentioned are the effort of the World Health Organization to monitor the cases of swine flu worldwide, the estimated fatality rate of the disease and the outbreak of swine flu in India.

The authors reflect on the failure of Pakistan to eradicate poliomyelitis, a communicable disease that can lead to severe disability but is preventable by vaccination and improved standards of living. Topics discussed include the disease's high incidence in Pakistan, the resolution for polio eradication by the year 2000 passed by the World Health Assembly (WHA) and Saudi Arabia's special travel advisory for Pakistanin pilgrims. Also mentioned are recommendations for eradicating the disease.

The authors reflect on the threat posed by Ebola virus disease (EVD) to public health in Pakistan. Particular focus is given to the symptoms associated with EVD, as well as its fatality rate. Topics discussed include high risk groups, incubation period, EVD outbreaks in West African countries and precautionary measures against EVD.

An image of severe ophthalmic injury due to high pressure water jet is presented.

Background: Dyspnea is a common symptom in patients presenting to emergency departments worldwide. The objective of the study was to determine the pattern of spirometry findings in subjects presenting with dyspnea in Bannu, KP, Pakistan. Materials & Methods: This descriptive cross-sectional study was conducted in Bannu Medical College, Bannu, KP, Pakistan from 1st December 2015 to 31st march 2018. Sample size was 4300 selected through convenient sampling technique. All patients with acute and chronic dyspnea were included. Any patient unable to perform spirometry, recently diagnosed smear positive pulmonary tuberculosis (PTB), recent myocardial infarction and any infectious disease patient were excluded. A self-administered proforma was used for data collection. The demographic variables were sex and age groups. The research variables were type of lung pathology, severity of obstructive lung pathology, severity of restrictive lung pathology, causes of obstructive lung pathology and causes of restrictive lung pathology. All variables being categorical were analyzed through count and percentages using SPSS version17. Results: Out of 4300 subjects, (55.72%) were males and (44.28%) were females. Two thousands four hundred and forty five (52.32%) had obstructive, (22.49%) restrictive, (12.9%) with mixed pattern and (4.3%) had normal spirometry. In obstructive patients bronchial asthma were (35.13%), COPD 741(30.3%) asthma-COPD overlap syndrome (ACOS) (9.48%), acute bronchitis (05.64%), bronchiectasis 173(7.07%) and unclear diagnosis (04.17%). In restrictive patients post pulmonary tuberculous fibrosis (PTB) were (33.77%), cardiovascular disorders (28.35%), interstitial lung diseases (17.79%), chest wall disorders (6.47%) and unclear diagnosis in 143(13.6%). Conclusion: Ninety five percent of individuals were having an abnormal spirometeric pattern. mostly old males were having bronchial asthma & COPD as obstructive and PTB & CVDs as restrictive lung disease. [ABSTRACT FROM AUTHOR]

The work related stress, occupational stress and job stress are used synonymously. Stress has now become the universal issue. Present era is known as the era of stress. Everyone has the right to spend his life more happily. How? Is the question that arises here. Everyone experiences stressful situations, though people react to them in different ways. The objective of this study was to identify the main sources of occupational stress affecting different occupational settings in the developing countries. This study utilized qualitative research methods of theoretical Network Approach (TNA). Various papers were studied to get the final conclusion. Respondents identified the most frequent sources of stress, their outcomes and the information about the types of stress on their places of work. It provides an opportunity to the employers & employees to take various steps to reduce stress among employees. [ABSTRACT FROM AUTHOR]

Brucellosis is the most common zoonotic bacterial infection in the world. The causative organism is Brucella spp. and the incubation of period is 5 days to 5 months. Although immunological tests are widely used for the diagnosis but cultures of the blood or other clinical specimens is the gold standard for the diagnosis. Outbreaks of brucellosis occur from time to time. It spreads mostly in the communities having close contact with the sheep and cattle, like farmers, cattle grazers, veterinary workers, and butchers. In the urban situation the outbreaks usually occur due to consumption of unpasteurized milk or its products. The clinical features of brucellosis are protean but the major one is a prolonged fever. Infected animals are the reservoirs and the sources of infection. Antibiotics have a major role in the management of brucellosis. Although a single antibiotic may be effective but a combination is preferred to prevent the chances of development of resistance and recurrence of disease. Antibiotics commonly used in the management of brucellosis are doxycycline, rifampicin, streptomycin, fluoroquinolones, cotrimoxazole, and chloramphenicol. Resistance to one or the other antibiotic have been reported from time to time. Dual therapy is commonly prescribed and triple therapy is used in serious conditions like neuro-brucellosis, endocarditis, or recurrence. The objective of this review was to evaluate the effects of various antibiotic regimens in the management of brucellosis. Antibiotic resistance is a problem which can aggravate the situation in future. We suggest that antibiotics' use should be rationalized to prevent future drug resistance. At least dual therapy should be used to prevent the chances of recurrence and triple therapy for complicated cases and in cases of relapse. There should be no compromise on the optimal doses and duration of therapy. [ABSTRACT FROM AUTHOR]

Background: Global Health Estimates 2015 has shown the stroke as second leading global cause of death and 3rd leading global cause for DALYs for year 2015. The objectives of this study were to determine the frequency, distribution and determinants of hypertension in adult stroke population of D.I.Khan Division, Pakistan. Materials & Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from February 1, 2017 to April 30, 2017. A sample 217 was selected with margin of error 5.59%, 90%CL and 50% prevalence of hypertension in 200,000 adults at risk of stroke population through consecutive sampling. All indoor adult patients of stroke were eligible. Sex, age groups, and residence and presence of hypertension were variables. Frequency and distribution of hypertension were analyzed by count and percentage. Hypotheses for distribution were substantiated by chi-square goodness-of-fit and of association by chi-square test of association. Results: Out of 217 patients with stroke, 123 (56.7%) were men and 94 (43.3%) were women, 86 (39.6%) were=60 years and 131 (60.4%) were>60 years, and 105 (48.4%) were urban and 112 (51.6%) were rural. Frequency of hypertension was 132/217 (60.83%). Out of 132 patients with hypertension, men were 74 (34.10%), women 58 (26.73%), age group=60 years 46 (21.20%), >60 years 86 (39.63%), urban 72 (33.18%) and rural 60 (27.65%). Presence of hypertension was associated to residence (p=.023) but not to sex (p=.817) and age groups (p=.072). Conclusion: Frequency of hypertension in adult stroke population of D.I.Khan Division, Pakistan was found to be similar as expected. Frequency was more in men, in older age group (of>60years) and in urban population. The presence of hypertension in adult stroke population of D.I.Khan Division was associated to residence but not to sex and age groups. [ABSTRACT FROM AUTHOR]

Background: Thyroid disorders are a commonly encountered problem in hilly areas of Pakistan. The objectives of the study were to determine the frequency and distribution of thyroid disorders among patients presenting with suggestive signs & symptoms of thyroid disorders in Hazara Division, Pakistan. Material and Methods: This cross-sectional study was conducted in Departments of Medicine and Pediatrics & Neonatology, Ayub Medical College, Abbottabad, KP, Pakistan from January, 2017 to January, 2018. Exclusion criteria was patients taking medicines such as Lithium and Cordarone. Sample size was 55 selected using consecutive sampling technique. Reference values were taken as follows; serum TSH=0.4-4.0 µIU/L, serum T3=100-200 ng/dL), serum T4=5-13.5 µgm/dL. Demographic variables were sex and age. Research variables were thyroid status (euthyroid/hyperthyroid/hypothyroid) and levels of thyroid function tests (TFT). Categorical variables such as sex and thyroid status were calculated by frequency and percentages whereas numeric variables such as age and TFT by Mean and SD. Descriptive statistics were calculated using SPSS Version 20. Results: Out of the total 55 patients, 11 patients were males and 44 patients were females. The minimum age was 20 years, maximum age was 90 years. Mean age was 43.24 years±15.118. Out of the total 55 patients, 14 (25.5%) were euthyroid, 30 patients (54.5%) were hyperthyroid and 11 (20%) patients were hypothyroid. Out of the 14 patients that were euthyroid, seven were males and seven were females. Out of the 30 hyperthyroid patients 26 were females and only 4 were males. All 11 hypothyroid were females. Conclusions: Hyperthyroidism is more common thyroid disorder in Hazara Division specially in adult females. [ABSTRACT FROM AUTHOR]

Background: Contaminated food is an important cause of human morbidity and mortality. One of the risk factors of food contamination is poor personal hygiene of the food handler. The objective of the study was to assess the positive knowledge and practice regarding personal hygiene of domestic food handlers. Material & Methods: This descriptive cross sectional study was conducted in Gomal Medical College, D.I.Khan from 1st Sep 2014 to 30th Dec 2014. A total of 100 respondents were chosen by purposive sampling technique. Data collecting tool was questionnaire. Our socio-demographic variables were age, education, income, residence and language. Our research variable was positive knowledge and practice, having attributes of hygiene of hands, personal attire, health of food handler and habits of respondents. SPSS version 20 was used for descriptive statistics. Data being categorical was expressed in frequency and percentages. Results: All the 100 respondents answered all the questions, so there was no missing data. The frequency of young age group was 46(46%), middle age 44(44%) & old age 10(10%). The frequency of literates was 76(76%) and illiterate 24(24%). The frequency of urban population was 82(82%)and rural 18(18%). Saraiki speaking were 65(65%), pushto speaking were 20(20%) and urdu speaking were 15(15%). Respondents of middle income status were 62(62%), 20(20%) were of low income status and 18(18%) were of high income status. The overall score of positive knowledge and practice about personal hygiene was 71% & 54.5% respectively. Conclusion: There is a gap between knowledge and practice of the female domestic food handlers. [ABSTRACT FROM AUTHOR]

Background: Body Mass Index (BMI) gives information about the relative weight for a given height based upon age and sex. The objective of this study was to assess BMI among medical students and to determine the related risk factors including diet and lifestyle. Material and methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan from March 15, 2015 to May 15, 2015. A sample of 100 subjects was selected by consecutive technique. Study instrument was a questionnaire. The demographic variables were gender, age groups, dietary habits and stress effect on diet whereas research variable was BMI. Frequencies and percentages were calculated. Data were analyzed by descriptive analysis plan. Results: Out of 100 subjects, 69(69%) were in normal range, 22(22%) were overweight and 3(3%) obese and 6(6%) were underweight. Males were 50(50%) and females 50(50%). Sixty four(64%) males were normal, 32(32%) were overweight, 4(4%) were obese and none was underweight. Seventy four (74%) of female respondents were normal, 12(12%) were overweight, 2(2%) were obese and 12(12%) were underweight. In the age group 18-20 years, 20(20%) were normal, 4(4%) were overweight and 1(1%) was obese and 3(3%) were underweight. Among the respondents that had no serving per day of fatty food, 44(44%) were normal, 7(7%) were overweight, 3(3%) were obese and 3(3%) were underweight. Among respondents whose diet was not affected during stress 2(2%) were underweight, 12(12%) were normal, none were obese and 5(5%) were overweight. Conclusion: Female students 21-23 years, having no serving of fatty food per day & whose diet decreased during strees showed better BMI. This study reflects the general trend of weight gain especially in male students. [ABSTRACT FROM AUTHOR]

Background: Paraphenylenediamine (kala pathar) poisoning is an emerging way of self-harm in developing countries. The objective of this study was to explore the clinical course and outcome of patients with this poisoning. Material & Methods: This case series was observed at Medical Unit B, DHQ Teaching Hospital, D.I.Khan, Pakistan over a period of two years from September 2013 to August 2015. Demographic details, clinical manifestations, complications, and outcome of patients with paraphenylenediamine poisoning were noted. Results: Thirty-eight patients were observed during the study period with male to female ratio of 1:18 and mean age of 22.08±6.42 years. Among 38 patients 27(71.1%) were unmarried, 27(71.1%) of low socioeconomic class, 28(73.7%) illiterate, and 23(60.5%) rural dwellers. Suicidal intention was identified in 36(94.74%) cases. Dysphagia was noted in 38(100%), cervicofacial oedema in 36(94.7%), dysponea in 36(94.7%), haematuria in 8(21.1%) and stridor in 7(18.4%) cases. Rhabdomyolysis was observed in 22(57.9%), acute renal failure in 15(39.5%), and shock in 10(26.3%) cases. The mortality rate was 47.4%. Conclusion: Paraphenylenediamine (kala pathar) poisoning is more common in poor, illiterate, unmarried females of younger age group living in rural areas in our set-up and is associated with very high mortality. [ABSTRACT FROM AUTHOR]