Search

Objectives: Occupational noise induced hearing loss (ONIHL) is considered an important reason responsible for disability around the world. As industrial workers are frequently exposed to occupational noise, sensorineural hearing loss (SNIHL) is commonly found in this set of population. This study was conducted to determine the frequency of noise induced hearing loss (NIHL) in industrial workers of Multan. Study Design: Descriptive, cross-sectional study. Setting: Department of Otorhinolaryngology, Nishtar Hospital, Multan. Period: 16th April 2018 to 15th October 2018. Material & Methods: A total of 316 industrial workers of age 25-65 years and both genders were included. Audiometric testing was performed in a sound free room where calibrated digital audiometer ALPS AD 2100 was used. Hearing threshold was obtained for both ears at 250-8 kHz. NIHL was noted. Results: Mean age was 45.56 ± 10.95 years. Most patients, 170 (53.80%) were 25-45 years of age. There were 188 (59.49%) male and 128 (40.51%) female. Mean duration of experience was 11.14 ± 5.86 years. NIHL was found in 95 (30.06%) patients. Conclusion: Frequency of NIHL among industrial workers is high. Factory owners and workers should consider adopting preventive and safety measures to control noise induced hearing loss. [ABSTRACT FROM AUTHOR]

Objectives: Hiatus Hernia is one of the leading gastrointestinal problems in Pakistan. Despite the diagnostic challenges, obesity and increasing age are considered significant predictors of hiatus hernia. The study was conducted to establish the association between body mass index (BMI) and hiatus hernia and assess the predictive value of BMI in these patients. Methods: During this descriptive case series 372 patients, presenting with GERD, underwent endoscopy using Olympus CLV-260 series gastroscope and findings were observed for hiatus hernia, grades of gastroesophageal flap valve (GEFV) according to Hill classification and stages of esophagitis according to Savary-Miller classification. BMI was calculated. Chi square test of independence for association between BMI & GEFV and a series of logistic regression analyses for predictive value of BMI were carried out during data analysis. Results: The mean age of the patients was 48 years (SD=14.2). Normal BMI was most prevalent (36.3%) while grade II and III GEFV were the most common findings in 29.8% and 28.5% patients respectively. A chi square test of independence established that the association between BMI & GEFV was significant (p<.01) but no significant association was found between BMI and esophagitis (p=. 14). A series of logistic regression analyses showed that BMI was not a significant predictor of hiatus hernia though age and gender were significant predictors. Conclusion: BMI is not a significant predictor of hiatus hernia, grades of GEFV or esophagitis. However, further studies need to be conducted to establish stronger predictors for hiatus hernia and esophagitis. [ABSTRACT FROM AUTHOR]

The author reflects on β-thalassemia major, an autosomal recessive haemoglobinopathy that is one of common genetic disorders worldwide and is one of the major challenge in Pakistan. He says that β-thalassemia major is one of the major pediatric health challenge as children are dependent upon regular blood transfusion and chelation for survival. He discusses the developments in treatment for β-thalassemia major, such as the introduction of bone marrow transplantation (BMT).

A study was carried out on 391 cases of bronchiolitis and pneumonia from different paediatric units in Rawalpindi/Islamabad, Pakistan. A clear winter spike of respiratory syncytial virus (RSV) was noted. It was found that there was a substantial increase of 30-50% in the positivity of RSV from December to February. [ABSTRACT FROM AUTHOR]

The present study aimed to find out differences in health risk factors of COVID-19 among doctors, nurses and psychologists by determining the relationship of cognitive appraisal, coping styles, stress and fear among health professionals. Cross-sectional research design was used. Sample comprised of 3 groups; doctors, nurses and psychologists ( n  = 145 in each group) working in tertiary care hospitals. Stress appraisal measure, Brief COPE inventory, Perceived stress scale and Fear contracting COVID-19 questionnaire were used to assess cognitive appraisal, coping, stress and fear respectively. Results showed that nurses had high uncontrollable, stressfulness and primary appraisal, used more avoidant emotional and problem focused coping, were more stressed and fearful as compared to doctors and psychologists. Psychologists had a high appraisal of control-self and control-others as compared to doctors and nurses and were more fearful than doctors. Doctors and psychologists used more coping of humor as compared to nurses. Moreover, primary appraisal and avoidant emotional coping positively predicted stress whereas control-self appraisal negatively predicted stress among health professionals. Uncontrollable and stressfulness appraisal positively correlated with fear. This study will direct the administrative authorities to take effective measures to improve psychological wellbeing and to deal with fear and stress of health professionals.

Objectives: The present study aimed to compare the stress experience of employees facing to differentiated types of lockdown situations: total vs. partial. It also aimed to identify the cognitive appraisal, coping, stress, and fear of contracting COVID-19 associated with lock down situations among employees., Method: A cross-sectional research design was employed. The sample comprises two groups (n = 490 in each group), complete lockdown (people working from home) and partial lockdown (people going to workplace), and was drawn from Pakistan using purposive sampling technique. Stress Appraisal Measure, Brief COPE Inventory, Perceived Stress Scale, and Fear of Contracting COVID-19 Questionnaire were used to measure cognitive appraisal, coping, stress, and fear, respectively., Results: Independent sample t-test showed that the threat and uncontrollable appraisal was high in people going to workplace as compared to people working from home. Results of binary logistic regression showed that people going to workplace were more likely to cope with COVID-19 situation through seeking instrumental support, behavior disengagement, acceptance, and religion as compared to people working from home. Moreover, people working from home were 0.84 times more likely to cope through emotional support than people going to workplace. Fear was found to be 1.1 times more likely associated with people going to workplace than people working from home., Conclusion: This study would help administrative authorities and government institutions in designing mental health services for working population. It would help the emergency departments in devising first aid management plan to deal with the psychological needs of the workers under pandemic/lockdown situations.

In this cross-sectional study, 76 consecutive children with autism spectrum disorder (ASD) were studied for the clinical and demographic parameters at Autism Resource Centre in Pakistan. The median age at first consultation was 30 months, 36 months at diagnosis, and 42 months at referral to a specialised centre. Clinical psychologists, therapists and paediatricians were the most frequently involved people in diagnosis. There was an average delay of one year between the first consultation and referral to the specialised centre. The male to female ratio was 4.4:1. Consanguinity was observed in 33 (43.4%) children. Three children had another affected sibling. Half of the children were from the affluent class, while two-thirds of the parents were professionals having good education. The severity of ASD showed that 13 (17%) children had borderline features, 50 (66%) had mild to moderate ASD, while 13 (17%) had severe ASD.

Ellis-van Creveld syndrome (EVC) is a rare developmental disorder characterized by short limbs, short ribs, postaxial polydactyly, dysplastic nails, teeth, oral and cardiac abnormalities. It is caused by biallelic mutations in the EVC or EVC2 gene, separated by 2.6 kb of genomic sequence on chromosome 4p16. In the present study, we have investigated two consanguineous families of Pakistani origin, segregating EVC in autosomal recessive manner. Linkage in the families was established to chromosome 4p16. Subsequently, sequence analysis identified a novel nonsense mutation (p.Trp234*) in exon 8 of the EVC2 gene and 15 bp duplication in exon 14 of the EVC gene in the two families. This further expands the mutations in the EVC or EVC2 genes resulting in the EVC syndrome.

Objective: To evaluate patterns of external injury resulting from bomb blasts in Karachi, and compare the injury profile resulting from explosions in open versus semi-confined blast environments., Methods: The retrospective, cross-sectional study was conducted in Karachi and comprised relevant data from January 2000 to October 2007. Casualty medical records and medico-legal certificates of the victims presented to three large public-sector hospitals were evaluated using a self-designed proforma. SPSS 17 was used for statistical analysis., Results: Of the 1146 victims, data of 481(42%) represented the final study sample. Of these, 306(63.6%) were injured in open spaces and 175(36.4%) in semi-confined spaces. Of the 896 recorded injuries, lacerations were encountered as external injury in 427(47.7%) cases, followed by penetrating wounds in 137(15.3%). Lower and upper extremities were injured in 348(38.8%) and 170(19%) victims respectively. Open and semi-confined blast environments produced specific injury pattern and profile (p<0.001)., Conclusions: External injuries sustained during bomb blast attacks in Karachi demonstrated specific injury patterns and profiles. Further studies are required to account for internal injuries and classification of injuries based on standardised scoring systems.

Objective: To characterise sleep quality and assess degree of daytime sleepiness among medical students of Karachi., Methods: The cross-sectional study was conducted between August and December 2013 and subjects were recruited from five haphazardly selected medical colleges in Karachi. A convenience sample of medical students underwent two validated self-administered questionnaires i.e. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. SPSS 17 was used for statistical analysis., Results: Of the 650 students approached, 504(77.5%) subjects completely filled out the questionnaires. Of them, 300(59.5%) were females and 204(40.5%) were males. Overall mean age was 20±1.4 years. Of them, 199(39.5%) were classified as "Poor Sleepers". Poor sleep quality was associated with female gender (p <0.05), excessive daytime sleepiness (p <0.05), total hours slept (p <0.001) and sleep disturbances (p <0.001). Bed-timing analysis showed 365(72%) students went to bed after midnight., Conclusions: Sleep quality among Pakistani medical students was significantly poor. Efforts must be directed towards proper sleep hygiene education.

Objectives: To investigate whether certain DR alleles might also contribute to the genetic susceptibility among Coeliac disease patients in Pakistan., Methods: The case-control study was conducted at the Military Hospital, Rawalpindi, from October 2011 to January 2012, and analysed 25 children diagnosed to have coeliac disease as per the criteria set by the European Society of Paediatric Gastroenterology and Nutrition, which included histopathological alterations in duodenal biopsies, clinical response to gluten withdrawal, and presence of anti-endomyseal antibodies. Patients were compared with a group of 150 healthy subjects. Dioxyribonucleic acid was extracted from peripheral blood collected in ethylenediaminetetraacetic acid.K3. Human leukocyte antigen DRB1 typing was carried out on allele level (DRB1*01--DRB1*16) using sequence specific primers. Human leukocyte antigen type was determined by agarose gel electrophoresis and results were recorded. Phenotype frequency of various alleles among the patient group and the control group was calculated by direct counting, and significance of their association was determined by Fisher Exact Test., Results: A total of 11 (44%) female paediatric coeliac patients in age range 1-9 (mean 7.2 +/- 4.8 years) and 14 (56%) male paediatric patients in the age range 6-14 (mean 8.6 +/- 5.1 years) were genotyped for HLA-DRB1 loci. A statistically significant positive association of the disease with HLA-DRB1*03 (n = 23; 92% versus n=31; 21% in controls, p < 0.01) was observed., Conclusion: HLA-DRB1*03 is associated with increased risk of developing coeliac disease.

Objective: To analyse various parameters of sepsis screen singly and in combination to formulate a guideline for the diagnosis of neonatal sepsis., Design: A cross-sectional analytical study., Place and Duration of Study: The neonatal intensive care unit at the Paediatric Department, Military Hospital, Rawalpindi, over a period of seven months from 1st June to 31st December 2003., Subjects and Methods: One hundred neonates having clinical features of sepsis and 100 normal asymptomatic neonates were evaluated with a set of investigations. C-reactive protein (CRP), erythrocyte sedimentation rate, total leukocyte count, absolute neutrophil count (ANC), immature neutrophils to total neutrophil count ratio (I/T ratio), thrombocytopenia, degenerative changes in the neutrophils and gastric aspirate cytology (GAC) for polymorphs were used for diagnosis of neonatal sepsis., Results: CRP was positive in 24/28 (85.7%) of group-A (proven sepsis) and 58/72 (80.5%) of group-B (probable sepsis) and had a specificity of 95%. ANC was the second most sensitive test having sensitivity of 71.4 % for group-A and 63.9 % for group-B and 88% specificity. For group-A, sensitivity of GAC for polymorphs and platelet count was 71.4% and 64.3% respectively. The sensitivity, specificity and predictive values (PV) of the individual tests and different tests combination was also calculated for group-A and B., Conclusion: A set of investigations including CRP, TLC, ANC, thrombocytopenia, cytoplasmic vacuolization in the neutrophils and GAC for polymorphs are highly sensitive in detection of culture negative cases of neonatal sepsis. Moreover, a combination of three tests enhances the sensitivity of these tests.

Objective: To determine the incidence of respiratory distress syndrome (RDS) in hospital born babies., Design: A prospective study., Place and Duration of Study: The study was conducted in the neonatal intensive care unit (NICU) at the Pediatric department, in collaboration with the Obstetrics and Gynecology Department, Military Hospital, Rawalpindi, over a period of one year from January to December 2000., Subjects and Methods: All live born infants delivered at the hospital and who fulfilled the diagnostic criteria of respiratory distress syndrome (RDS) were included in the study., Results: Ninety-four neonates developed RDS. Out of these, 88 (93.61%) were preterm and 06 (6.38%) were term infants. There was a male preponderance (65.95%). RDS was documented in 1.72% of total live births, 37.28% of preterm and 0.11% of term neonates born at the hospital. The incidence of RDS was 100% at 26 or less weeks of gestation, 57.14% at 32 weeks, and 3.70% at 36 weeks. The mortality with RDS was 41 (43.61%)., Conclusion: RDS is the commonest cause of respiratory distress in the newborn, particularly, in preterm infants. It carries a high mortality rate and the incidence is more than that documented in the Western world.