Determinants of Non-Adherence to Anti-Retroviral Therapy in HIV/AIDS Patients of HIV Centre Jinnah Hospital

Introduction: Human immunodeficiency virus is very harmful to human’s immune system. This virus can further cause specific contaminations and tumors in humans. The HIV-contaminated populace is at a higher danger of AIDS-characterizing tumors, for example, Kaposi sarcoma, non-Hodgkin lymphoma, and cervical malignant growth. Since the coming of exceptionally dynamic antiretroviral treatment (HAART) in 1996, the endurance of HIV-tainted populace in the United States has expanded significantly (Shiels et al., 2011).Methods: A descriptive study conducted at HIV centre Jinnah Hospital Allama Iqbal Medical College Lahore. Data was collected through questionnaire from patients of HIV clinic. Data was analysed by SPSS version 21.0, frequency, percentage and standard deviation was found with statistics of pie charts and histogram.Results: From one hundred participants 100(100%) shows forgetfulness , 29(29%) shows missing appointments, 33(33%) shows run out of medication, 11(11%) shows depression, anger, despair. 78(78%) don’t think that ART helps ,only 4(4%) shows side effects of ART and 1(1%) shows other reason for non-adherence. Conclusions:  The outcomes gave basic and valuable data that will help in decreasing the factors that are causing non-adherence to ART. Keywords: Antiretroviral therapy, Adherence, Determinants, Lahore, Pakistan DOI: 10.7176/JHMN/101-05 Publication date:June 30th 202

Lisinopril, an angiotensin converting enzyme inhibitor for the treatment of idiopathic oligospermia: a randomized controlled trial

Background: Oligospermia or low concentration of sperm is a common finding in male infertility. Alterations in the expression of angiotensin converting enzyme (ACE) may be one of the mechanisms underlying male infertility and ACE inhibitors may improve the sperm count. The objective was to compare the effects of lisinopril and zinc-folic acid with zinc-folic acid alone on idiopathic oligospermia in infertile males.Methods: This randomized controlled trial was conducted in the Department of Reproductive Endocrinology & Infertility of a medical university from March 2021 to February 2022. A total 78 diagnosed cases of infertile males with idiopathic oligospermia were selected for this study. Eligible men who gave their informed consent were randomly allocated to receive either a combination of low dose lisinopril (2.5 mg) and zinc-folic acid or zinc-folic acid alone for 12 weeks. Pretreatment and post treatment semen parameters, including sperm concentration, sperm motility and total motile sperm count were assessed.Results: There was significant rise in sperm concentration and total motile sperm count in both groups but the mean difference in sperm concentration (2.36±2.04 vs 1.53±1.8 million/ml) and total motile sperm count (11.64±8.28 vs 9.95±6.11 million) were higher in those receiving Lisinopril in addition to zinc folic acid. The percentage increase of sperm count was higher (22.65 vs 16.70 million) in this group. Normalization of sperm count (sperm count ≥15 million/ml) was also higher in this group (18.4% vs 8.3%) with relative risk 2.21, 95% CI (0.648-4.56 %).Conclusions: Lisinopril given orally at the dosage of 2.5 mg/day with zinc-folic acid for 12 weeks appears to be well tolerated among men with oligospermia and improves sperm count by a small margin when compared to zinc folic acid only

Coenzyme q10 and letrozole versus letrozole alone for ovulation induction in polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is the largest single cause of anovulatory infertility. PCOS is associated with oxidative stress. Coenzyme q10 (Coq10) is an antioxidant that protects the mitochondria from damage caused by either insulin resistance or oxidative free radicals. The objective of the study was to compare the effect of combined Coq10 and letrozole than of letrozole alone for ovulation induction in women with PCOS.Methods: This open label parallel design randomized controlled trial study was conducted on 80 infertile women with PCOS selected for ovulation induction. Eligible women were randomized either to combined Coq10 and letrozole (40 patients, 83 cycles) or letrozole alone (38 patients, 91 cycles). The outcome measures were mature follicles, adequate endometrial thickness, ovulation and pregnancy.Results: Mature follicles (≥18-25 mm) were significantly higher in women given Coq10 at 2nd (74.2% vs 31.3%) and 3rd cycles (83.3% vs 28.6%). Adequate endometrial thickness was significantly higher in women given Coq10 in second (90.3% vs 56.3%) and third cycle (94.4% vs 47.6%). When Coq10 was added to letrozole, ovulation rates were significantly higher (87.1% vs 53.1% in second cycle), (83.3% vs 38.1%, in third cycle). Cumulative pregnancy was 2.37 times (95% CI 1.03-5.48) higher in women having Coq10 in addition to letrozole for ovulation induction. Conclusions: Coq10, as an adjuvant to ovulation induction with letrozole improves ovarian response, ovulation and pregnancy in PCOS women. Combination of Coq10 and letrozole can be tried successfully before a more complicated and expensive treatment such as gonadotrophins and laparoscopic ovarian drilling

Vitamin D Supplementation in women with Diminished Ovarian Reserve: A Randomized Controlled Trial

Background: Diminished ovarian reserve (DOR) predicts decreased ovarian response to stimulation. Low serum anti-Mullerian hormone (AMH) is associated with DOR. AMH is a marker of ovarian reserve and acts as a predictor of ovarian response to ovarian stimulation protocol. The AMH is up regulated by vitamin D via vitamin D response elements that bind the vitamin D receptor. Vitamin D supplementation has a role in increasing serum AMH. The objective was to compare the combined effect of vitamin D and DHEA vs DHEA alone on serum AMH in DOR.  Methods: This randomized controlled trial was conducted in the Department of Reproductive Endocrinology and Infertility, Bangabandhu Sheikh Mujib medical University (BSMMU), Dhaka, from March 2021 to February 2022. A total of 44 infertile women with DOR, 20 to 39 years were allocated into two groups, one received vitamin D plus DHEA for 8 weeks and the other received DHEA alone for the same duration. After 8 weeks of treatment, both groups had repeat assessment of AMH, FSH and transvaginal sonography for AFC. Results: There was no significant difference in serum AMH after vitamin D supplementation in women with DOR. But the spontaneous pregnancy during intervention was 2.57 times more in those given vitamin D supplementations in addition to dehydroepiandrosterone (DHEA).Conclusions: Short term vitamin D supplementation adds little to the effect of increasing AMH but favors spontaneous pregnancy in women with DOR

Letrozole versus dienogest in endometrioma recurrent after surgery: a randomized controlled trial

Background: Letrozole is a third-generation aromatase inhibitor. As there is aberrant aromatase production by endometriotic stromal cells and the growth and regression of endometriosis is estrogen-dependent, the use of letrozole to reduce the size and symptoms of endometrioma especially in recurrent cases is a promising medical intervention. Dienogest is a fourth-generation progestin which is being used for the treatment of endometriosis due to its antiproliferative and antiangiogenic properties on endometrial tissue. The present study was conducted to compare the effects of letrozole and dienogest on endometrioma recurrent after surgery.Methods: This randomized controlled study was conducted on 38 women having recurrence of endometrioma after surgery. They were randomly assigned to receive either letrozole (2.5 mg daily) or dienogest (2 mg once daily) for 6 months. Size of the endometrioma was measured by transvaginal ultrasound and the pain (dysmenorrhoea) was measured on a visual analog scale (VAS) of 0-10, prior to treatment and after 3 and 6 months of treatment.Results: The mean size of endometrioma was reduced from a baseline of 6.06±2.40 cm to 5.23±1.37 cm and to 4.59±1.25 cm after 3 and 6 months of treatment with letrozole. While with dienogest the reduction was from a baseline of 6.67±1.31 cm to 4.83±1.50 cm and to 3.80±1.34 cm after 3 and 6 months of treatment. The difference between the two groups was not statistically significant but dienogest yielded better result in terms of effect size. Decrease in pain (dysmenorrhoea) was highly significant with both the drugs.Conclusions: In terms of reduction of the size of endometrioma, dienogest yields better results than letrozole. Both the drugs are highly effective in alleviating pain (dysmenorrhoea)

Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients’ experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU

Bleeding disorders in the tribe: result of consanguineous in breeding

<p>Abstract</p> <p>Objective</p> <p>To determine the frequency and clinical features of bleeding disorders in the tribe as a result of consanguineous marriages.</p> <p>Design</p> <p>Cross Sectional Study</p> <p>Introduction</p> <p>Countries in which consanguinity is a normal practice, these rare autosomal recessive disorders run in close families and tribes. Here we describe a family, living in village Ali Murad Chandio, District Badin, labeled as haemophilia.</p> <p>Patients & Methods</p> <p>Our team visited the village & developed the pedigree of the whole extended family, up to seven generations. Performa was filled by incorporating patients, family history of bleeding, signs & symptoms, and bleeding from any site. From them 144 individuals were screened with CBC, bleeding time, platelet aggregation studies & RiCoF. While for PT, APTT, VWF assay and Factor VIII assay, samples were kept frozen at -70 degrees C until tested.</p> <p>Results</p> <p>The family tree of the seven generations comprises of 533 individuals, 63 subjects died over a period of 20 years and 470 were alive. Out of all those 144 subjects were selected on the basis of the bleeding history. Among them 98(68.1%) were diagnosed to have a bleeding disorder; 44.9% patients were male and 55.1% patients were female. Median age of all the patients was 20.81, range (4 months- 80 yrs). The results of bleeding have shown that majority had gum bleeding, epistaxis and menorrhagia. Most common bleeding disorder was Von Willebrand disease and Platelet functional disorders.</p> <p>Conclusion</p> <p>Consanguineous marriages keep all the beneficial and adversely affecting recessive genes within the family; in homozygous states. These genes express themselves and result in life threatening diseases. Awareness, education & genetic counseling will be needed to prevent the spread of such common occurrence of these bleeding disorders in the community.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Relationship of Nurse Manager’s Practices with Nurse’s Retention and Quality of Care Among Registered Nurses in Public Hospital Lahore

Back ground of the study: Nurse Manager’s practices play a vital role in nursing retention and promotion of best care in nursing. Improved the nursing retention will prompt reserve the organization, which may additionally be allocated to activities, for example preparing and mentorship to help nurse managers in making these imperative management capabilities. Approaches also want to be set up to ensure that nurse managers accomplish adequate organizational support from nursing administrators (C. M. Duffield, Roche, Blay, &amp; Stasa, 2011). In Pakistan, the nursing profession has been experiencing a workforce shortage staff in recent years, making nurses a precious resource. The substantial low retention of nurses is mainly due to their intent to leave, absenteeism. The work-life issues threatening retention of nurses and quality of care are serious concern for health administrators (Hamid, Malik, Kamran, &amp; Ramzan, 2014). Objectives: To assess the Relationship of Nurse manager’s practices with nurse’s retention and quality of care in Public Hospital of Lahore. Methodology: A quantitative descriptive cross sectional study was conducted to assess the relationship of nurse manager’s practices with nurse’s retention and quality of care. The instrument use for the data collection was adopted questioner and convenient sampling technique was used. Conclusion: The present study is considered as a cornerstone that gives strong support towards understanding of nurses’ manager’s practices and their retention. It highlighted that a significant difference was found between management practices with nurse’ retention and patient care. These results substantiate the belief that aspects of the practice environment affect staff nurse retention, and most importantly, the quality of care delivered on hospital nursing units. Keywords: Quality; Care; Retention; Nurse Manager.. DOI: 10.7176/JHMN/94-02 Publication date:October 31st 202

An empirical investigation of the relationship between consanguineous marriage and prevalence of β-thalassemia in Punjab, Pakistan: A cross-sectional study

It is a striking fact that β-thalassemia has become a common single gene disorder among the children. Among the contributing factors, overwhelmed practice of consanguineous marriage is one of the most prominent reason of the high rate prevalence of β-thalassemia in Pakistan. Therefore, the present research was conducted to investigate the relationship between consanguineous marriage and prevalence of β-thalassemia in Punjab, Pakistan. The nature of study was cross-sectional and quantitative. The study was conducted in the Children’s Hospital, Lahore and Multan. Purposive sampling technique was used and sample of 300 parents was drawn. A well-structured research questionnaire was used to collect the data from the parents. The results indicate that rate of β –Thalassemia is significantly higher (76.7%) in first cousin marriage as compared to the second cousin marriage (23.3%). The trend of thalassemia major among male patients is higher (76.31%) in first cousin marriage as compared to the second cousin marriage (23.69%). Similarly, the prevalence of thalassemia Intermedia is significantly prevalent higher (67.5%) among male patients in first cousin marriage as compared to the second cousin marriage. The above findings can be concluded that there was a strong relationship between consanguineous marriage and prevalence of β-thalassemia in Punjab, Pakistan.&nbsp