BACKGROUND: Implementation of the Charter to protect patients' rights is an important criterion to achieve patient-centered approach and receive financial support from the Global Fund. Our study aims to explore the knowledge of tuberculosis (TB) patients about their rights and responsibilities at the Chest Disease Unit of the Bahawal Victoria Hospital, Bahawalpur, Pakistan.
METHODS: This was a qualitative study. The data from purposefully selected TB patients was collected by in-depth interviews. Eligibility criteria included confirmed diagnosis of TB and enrollment in the TB program. A pilot tested interview protocol was based upon the objectives of the study, and was used uniformly in each interview to maintain the consistency. The sample size was limited by applying the saturation criteria. All interviews were audiotaped and transcribed verbatim. Inductive thematic content analysis was applied to analyze the data and draw conclusions.
RESULTS: Out of the total 16 patients, four were female, and seven were illiterate. Eight patients were known cases of multi-drug resistant TB. Analysis of the data yielded seven themes; tuberculosis care services, moral support and stigmatization, dignity and privacy, complaints, fear of losing job, information sharing and compliance to the treatment plan, and contribution to eradicate TB. First five represented the rights section while latter two were related to the responsibilities section of the Charter.
CONCLUSION: Discriminatory access to TB care services and the right to privacy were two major concerns identified in this study. However, the respondents recognized their responsibilities as a TB patient. To ensure uninterrupted investment from the Global Fund, there is a need to implement fair TB care policies which support human rights-based approach.
OBJECTIVE: Patient education is a key element in the treatment of diabetes. Assessment of diabetes knowledge is important for optimum treatment. For the assessment of diabetes knowledge, validated tool is essential. None of such validated tool is available in Urdu language. Therefore, the aim of this study was to translate and examine the psychometric properties of the 24-item Urdu version of Diabetes Knowledge Questionnaire (DKQ) among type 2 diabetes patients.
METHODS: Standard "forward-backward" process was used to translate DKQ into Urdu language. Later, it was validated on a convenience sample of 130 patients with type 2 diabetes, between July and September 2016. Internal consistency was assessed by reliability analysis, one-way analysis of variance was applied for known group validity and multivariate linear logistic regression was applied for identifying significant predictors for patients' DKQ score.
RESULTS: Good internal consistency was observed for DKQ (Cronbach's α = 0.702). The mean HbA1c of the patients was 8.55% (±1.91). DKQ scores of patients' with "good glycemic control" (14.22 ± 2.4) were observed significantly higher (P Pakistan.
In this study, we proposed integrated tools to evaluate the wind power potential, economic viability, and prioritize 15 proposed sites for the installation of wind farms. Initially, we used modified Weibull distribution model coupled with power law to assess the wind power potential. Secondly, we employed value cost method to estimate per unit cost ($/kWh) of proposed sites. Lastly, we used Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (F-TOPSIS) to rank the best alternatives. The results indicate that Pakistan has enormous wind power potential that cost varies from 0.06 $/kWh to 0.58 $/kWh; thus, sites S12, S13, S14, and S15 are considered as the most economic viable locations for the installation of wind power project, while remaining sites are considered to be less important, due to other complexities. The further analysis using Fuzzy-TOPSIS method reveals that site S13 is the most optimal location followed by S12, S14, and S14 for the development of wind power project. We proposed that government should formulate wind power policy for the implementation of wind power projects in order to meet energy demand of the country.
Identifying the abnormally high-risk regions in a spatiotemporal space that contains an unexpected disease count is helpful to conduct surveillance and implement control strategies. The EigenSpot algorithm has been recently proposed for detecting space-time disease clusters of arbitrary shapes with no restriction on the distribution and quality of the data, and has shown some promising advantages over the state-of-the-art methods. However, the main problem with the EigenSpot method is that it cannot be adapted to detect more than one spatiotemporal hotspot. This is an important limitation, since, in reality, we may have multiple hotspots, sometimes at the same level of importance. We propose an extension of the EigenSpot algorithm, called Multi-EigenSpot that is able to handle multiple hotspots by iteratively removing previously detected hotspots and re-running the algorithm until no more hotspots are found. In addition, a visualization tool (heatmap) has been linked to the proposed algorithm to visualize multiple clusters with different colors. We evaluated the proposed method using the monthly data on measles cases in Khyber-Pakhtunkhwa, Pakistan (Jan 2016- Dec 2016), and the efficiency was compared with the state-of-the-art methods: EigenSpot and Space-time scan statistic (SaTScan). The results showed the effectiveness of the proposed method for detecting multiple clusters in a spatiotemporal space.
World Health Organization (WHO) measles surveillance data report a reduction in cases of measles globally from 67,524 cases in 2015 to 16,846 in 2016, and a reduction in deaths from 546,800 to 114,900 during period of 2000-14. Pakistan is among the five nations where almost a million children did not receive their first dose of measles vaccination, and outbreaks of the disease resulted in 4386 cases in 2011, 14,687 cases in 2012 with 310 deaths. In 2013, about 25,401 cases of measles were reported and 321 affected children died. The measles vaccination coverage is very low in Pakistan for both 1st dose and booster dose. To prevent outbreaks of measles in Pakistan a national vaccination program should be launched side by side with a polio eradication program in each district and township and a campaign should be launched to educate parents on measles vaccination for childrens to reduce the measles case fatality rate.
The study is aimed to explore the perceptions and experiences of hypertensive patients toward medication use and adherence. The study was qualitative in nature conducted at Sandamen Provisional Hospital of Quetta city, Pakistan; a public hospital catering to the health needs of about 40% of the population. A qualitative approach was used to gain an in-depth knowledge of the issues. Sixteen patients were interviewed, and the saturation point was achieved after the 14(th) interview. All interviews were audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis framework. Thematic content analysis yielded five major themes. (1) Perceived benefits and risks of medications, (2) physician's interaction with patients, (3) perception toward traditional remedies, (4) layman concept toward medications, and (5) beliefs toward hypertension and its control. The majority of the patients carried specific unrealistic beliefs regarding the long-term use of medication; yet these beliefs were heavily accepted and practiced by the society. The study indicated a number of key themes that can be used in changing the beliefs and experiences of hypertensive patients. Physician's attitude, patient's past experiences, and knowledge related to hypertension were noted as major contributing factors thus resulting in nonadherence to therapy prescribed.
Objective: The purpose of the present study was to identify reverse culture shock among returnee high school students. Methods: It was an observational study conducted at an International High School of Islamabad, Pakistan on overseas-experienced returnee Pakistani students. A 15 statements questionnaire was used to measure reverse culture shock. Results: Mean index score on survey questionnaire was 4 indicative that these returnees were experiencing high reverse culture shock. Conclusion: For being feeling different in own cultural set up the returnees usually suffer from reverse culture shock and develop personal problems associated with it.
OBJECTIVE: To estimate the percentage of children with low, moderate and high caries risk; and to determine the predictors of caries risk amongst 11-12 year old Pakistani school children.
METHODS: Subjects' caries risk was assessed using the Cariogram programme. The survey was done among school children in Bhakkar district of Punjab, Pakistan. Caries and plaque level were assessed using the DMFT and Sillnes and Loe indices respectively, while diet content and frequency were assessed using a three-day diet diary.
RESULTS: A total of 226 children participated in this study, giving a response rate of 75%. Most subjects (39.8%) were in the low risk category with DMFT score of 0. The overall mean DMFT score was 1.49 (±0.63). Linear and multiple regressions were performed to evaluate the predictability of caries risk. Previous experience of dental caries was found to be the most relevant predictor of caries risk (40%).
CONCLUSION: The levels of caries risk amongst Pakistani 11-12 year old school children were generally low. Past caries experience was the most significant factor in predicting future caries lesion in this sample population.
Air heating by solar collectors is renewable technology providing hot air for different purposes. The present research
emphasizes on analysis of energy, exergy and efficiency of a flat plate solar air heater. The analysis model was tested
on five different air mass flow rates of 0.5 (Natural), 1.31, 2.11, 2.72 and 3.03 kgs-1 under three different tilt angles of
25, 35 (Recommended) and 50o
. The data was replicated three times making a total of 45 treatments. A two factorial
completely randomized design was used to find if there is any significant difference among the treatments. The results
showed that the solar collector gave better performance at air mass flow of 3.03 kgs-1 under tilt of 35o
. At maximum
air mass flow rate of 3.03 kgs-1and optimum tilt angle of 35o
the maximum energetic efficiency of 51%, while minimum
exergetic efficiency of 24% and maximum overall efficiency of 71% were recorded. It was concluded that to get maximum
thermal efficiencies of 71% from flat plate solar collector used as an air heater must be operated at high air mass flow
rates of 3.03 kgs-1under 35o
tilt angle at Peshawar, Pakistan.
Dengue fever is a vector-borne viral disease which is now endemic in more than 100 countries affecting more than 2.5 billion people worldwide. In recent years, dengue fever has become a major threat to public health in Pakistan. In this paper, we derived an explicit formula for reproduction number R0 (the most important epidemiological parameter) and then used real data of dengue fever cases of different hospitals of Lahore (Pakistan) on R0. Conditions for local stability of equilibrium points are discussed. In the end, simulations are carried out for different situations.
Recently, cultivation of high-yielding hybrid maize varieties has revolutionized maize production in Pakistan. Analyses of nutritional traits and aflatoxin (AF) contamination in these varieties can aid in the identification of susceptible and resistant varieties, particularly for cultivation in the Pakistani agro-climatic environment. Five spring maize varieties-Pioneer, Neelam, DK-919, Desi, and Hi-maize-were selected for analyses of their nutritional, tocopherol, and AF contents. Protein, carbohydrate, oil, ash, fiber, and moisture contents ranged between 8.7 and 10.8%, 68 and 71%, 3.72 and 5.56%, 1.09 and 1.81%, 1.1 and 3.1%, and 11.7 and 14.2%, respectively. Tocopherol levels in selected varieties were in the range of 461 to 1,430 μg/g. Hi-maize exhibited significantly higher protein and tocopherol contents than the other varieties, indicating its better suitability for feed and silage applications. The highest mean level of total AFs, 14.5 ± 0.12 μg/kg, was found in Desi, and results showed that the most dominant AF found in the maize varieties was AFB1. Furthermore, the results showed that the higher the level of tocopherol, the lower the concentration of total AFs and vice versa in maize varieties. The results can be used to investigate additional susceptible maize varieties that are resistant to fungal attack.
The incidence of thyroid cancer is increasing in several countries. The main objective of this retrospective study was to find and describe province-specific estimates of incidence in males and females by age groups for differentiated thyroid cancer (DTC). This study reports on 87 cases of DTC from Baluchistan province of Pakistan treated with post operative radioiodine at the Center for Nuclear Medicine and Radiotherapy (CENAR) Quetta from January 2003 to December 2009. The patient data has been collected from CENAR Quetta. Patients with DTC were confirmed by clinical examination, thyroid scintigraphy (Thyroid scan), blood tests (T3, T4, TSH) and histopathalogy tests and then treated with radioiodine. The Median age of the patients was 35.5 years (Range 12-70 years). The final histological diagnosis was papillary carcinoma in 71 (81.6 %) cases, follicular carcinoma in 6 (6.9%) cases while 10 (11.5%) cases presented with mixed papillary and follicular carcinoma. About 53 % cases were found in females with age 21-40 years. No strike predominance was observed in any age group for males. Four patients presented with recurrence while six patients showed metastasis in cervical lymph nodes. The small annual incidence did not follow any definite pattern. DTC has a small incidence in Baluchistan due to lack of education and health care facilities. The incidence of DTC is higher in females when compared with males as per this study. This preliminary study will provide an insight to incidence of DTC, its treatment facilities and future planning strategies in Baluchistan, Pakistan.
Although neglected, the mite Sarcoptes scabiei is an unpredictable emerging parasite, threatening human and animal health globally. In this paper we report the first fatal outbreak of sarcoptic mange in the endangered Himalayan lynx (Lynx lynx isabellinus) from Pakistan. A 10-year-old male Himalayan lynx was found in a miserable condition with severe crusted lesions in Chitral District, and immediately died. Post-mortem examination determined high S. scabiei density (1309 mites/cm(2) skin). It is most probably a genuine emergence, resulting from a new incidence due to the host-taxon derived or prey-to-predator cross-infestation hypotheses, and less probable to be apparent emergence resulting from increased infection in the Himalayan lynx population. This is an alarming situation for the conservation of this already threatened population, which demands surveillance for early detection and eventually rescue and treatment of the affected Himalayan lynx.
BACKGROUND: Fluoroquinolones are the backbone of multidrug resistant tuberculosis treatment regimens. Despite the high burden of multidrug resistant tuberculosis in the country, little is known about drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance among multidrug resistant tuberculosis patients from Pakistan.
OBJECTIVE: To evaluate drug resistance patterns, prevalence, and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients.
METHODS: This was a cross-sectional study conducted at a programmatic management unit of drug resistant tuberculosis, Lady Reading Hospital Peshawar, Pakistan. Two hundred and forty-three newly diagnosed multidrug resistant tuberculosis patients consecutively enrolled for treatment at study site from January 1, 2012 to July 28, 2013 were included in the study. A standardized data collection form was used to collect patients' socio-demographic, microbiological, and clinical data. SPSS 16 was used for data analysis.
RESULTS: High degree of drug resistance (median 5 drugs, range 2-8) was observed. High proportion of patients was resistant to all five first-line anti-tuberculosis drugs (62.6%), and more than half were resistant to second line drugs (55.1%). The majority of the patients were ofloxacin resistant (52.7%). Upon multivariate analysis previous tuberculosis treatment at private (OR=1.953, p=0.034) and public private mix (OR=2.824, p=0.046) sectors were predictors of ofloxacin resistance.
CONCLUSION: The high degree of drug resistance observed, particularly to fluoroquinolones, is alarming. We recommend the adoption of more restrictive policies to control non-prescription sale of fluoroquinolones, its rational use by physicians, and training doctors in both private and public-private mix sectors to prevent further increase in fluoroquinolones resistant Mycobacterium tuberculosis strains.
KEYWORDS: Fluoroquinolones; MDR-TB; Private; Resistance
The current study aims to explore the factors associated with outcome among patients with severe sepsis and septic shock admitted to the intensive care unit, Northwest General Hospital and Research Centre, Peshawar, Pakistan.
The aim of review was to find the recent evidence for the management of conversion disorder. The study was conducted at the Psychiatry Unit of Govt. Lady Reading Hospital, Peshawar, Pakistan. A systematic literature search was done using Medline and Extra Medline. A total of 10 articles fulfilled the inclusion criteria. In the literature reviewed hypnosis and self hypnosis, psychoanalytical intervention, behavioral intervention, paradoxical intervention, treatment by strong suggestion and trans-cranial magnetic stimulation were the treatments used by the clinicians for the management of conversion disorder. Conclusion: The literature review did not give details concerning the treatment used for conversion disorders adequately. Behavioral interventions were in general found to be more successful treatment course for the management of conversion disorders.