Assessing the Mental Health Status and Sleep Quality among House Officers in Peshawar

OBJECTIVES The aim of this study was to assess the mental health status and quality of sleep among house officers in Peshawar and to determine the correlation between their mental health status and quality of sleep.METHODOLOGY This was a cross-sectional study, conducted on house officers of four tertiary care hospitals in Peshawar. Data was collected through a self-administered questionnaire using convenience sampling technique. Pittsburgh sleep quality index (PSQI) scale was used for assessing the sleep quality and Warwick Edinburgh mental wellbeing scale (WEMWBS) was used for assessing the mental health status of the respondents.RESULTSAmong the 276 house officers, the mean mental health score was 48.13±9.17, and mean sleep quality score was 6.39±3.27. In comparison, female House officers had poor mental health status (female: 45.72±9.32, male: 49.83±8.70, p<0.05) and sleep quality (female: 6.91±3.77, male: 6.03±2.82, p<0.05.  The hospital status showed no significant association between sleep quality (p value: 0.778) and mental health score (p value: 0.573). Furthermore, quality of sleep had a positive correlation with mental health status of house officers (p<0.01).CONCLUSIONMental health status and quality of sleep among house officers was poor. Female house officers had a poor mental well-being and a poor sleep quality compared to male house officers. There was no significant difference between the mental health status and quality of sleep, of house officers working in public hospitals and those working in private hospitals. House officers having a poor sleep quality also had a poor mental health status showing a positive correlation between the tw

The functional outcome of direct lateral approach for fixation of proximal humeral fractures: A case series from a tertiary care hospital

Displaced proximal humeral fractures warrant surgical fixation for early rehabilitation and better functional outcome. These fractures are traditionally fixed by delto pectoral surgical approach. Direct lateral approach has recently gained interest as it involves less soft tissue dissection and is particularly helpful in certain fracture patterns. However, there have been concerns of axillary nerve damage with this approach. We report a case series of proximal humerus fractures fixed by direct lateral approach from our institution. All displaced Type 2 and 3 fractures were included in our study. Pathological and comminuted Type 4 fractures and fractures with ipsilateral clavicle or elbow fractures were excluded. Oxford Shoulder Score was done at regular intervals for assessment of functional outcome. We did not observe any axillary nerve damage in our case series and the outcomes of 70.5% of our patients were excellent while in 29.5% it was good. We recommend direct lateral approach for specific pattern of proximal humerus fractures

Diagnostic accuracy of ultrasonography in differentiating benign and malignant thyroid nodules using fine needle aspiration cytology as the reference standard

Background: In Pakistan thyroid cancer is responsible for 1.2% cases of all malignant tumors. Ultrasonography (US) is helpful in detecting cancerous thyroid nodules on basis of different features like echogenicity, margins, microcalcifications, size, shape and abnormal neck lymph nodes. We therefore aimed to calculate diagnostic accuracy of ultrasound in detection of carcinoma in thyroid nodules taking fine needle aspiration cytology as the reference standard.MATERIALS AND Methods: A cross-sectional analytical study was designed to prospectively collect data from December 2010 till December 2012 from the Department of Radiology in Aga Khan University Hospital, Karachi, Pakistan. A total of 100 patients of both genders were enrolled after informed consent via applying non-probability consecutive sampling technique. Patients referred to Radiology department of Aga Khan University to perform thyroid ultrasound followed by fine-needle aspiration cytology of thyroid nodules were included. They were excluded if proven for thyroid malignancy or if their US or FNAC was conducted outside our institution.Results: The subjects comprised 76 (76%) females and 24 males. Mean age was 41.8±SD 12.3 years. Sensitivity and specificity with 95%CI of ultrasound in differentiating malignant thyroid nodule from benign thyroid nodule calculated to be 91.7% (95%CI, 0.72-0.98) and 78.94% (0.68-0.87) respectively. Reported positive predictive value and negative PV were 57.9% (0.41-0.73) and 96.8% (0.88-0.99) and overall accuracy was 82%. Likelihood ratio (LR) positive was computed to be 4.3 and LR negative was 0.1.CONCLUSIONS: Ultrasonography has a high diagnostic accuracy in detecting malignancy in thyroid nodules on the basis of features like echogenicity, margins, micro calcifications and shape

Optimal energy management of a campus microgrid considering financial and economic analysis with demand response strategies

An energy management system (EMS) was proposed for a campus microgrid (µG) with the incorporation of renewable energy resources to reduce the operational expenses and costs. Many uncertainties have created problems for microgrids that limit the generation of photovoltaics, causing an upsurge in the energy market prices, where regulating the voltage or frequency is a challenging task among several microgrid systems, and in the present era, it is an extremely important research area. This type of difficulty may be mitigated in the distribution system by utilizing the optimal demand response (DR) planning strategy and a distributed generator (DG). The goal of this article was to present a strategy proposal for the EMS structure for a campus microgrid to reduce the operational costs while increasing the self-consumption from green DGs. For this reason, a real-time-based institutional campus was investigated here, which aimed to get all of its power from the utility grid. In the proposed scenario, solar panels and wind turbines were considered as non-dispatchable DGs, whereas a diesel generator was considered as a dispatchable DG, with the inclusion of an energy storage system (ESS) to deal with solar radiation disruptions and high utility grid running expenses. The resulting linear mathematical problem was validated and plotted in MATLAB with mixed-integer linear programming (MILP). The simulation findings demonstrated that the proposed model of the EMS reduced the grid electricity costs by 38% for the campus microgrid. The environmental effects, economic effects, and the financial comparison of installed capacity of the PV system were also investigated here, and it was discovered that installing 1000 kW and 2000 kW rooftop solar reduced the GHG generation by up to 365.34 kg CO2/day and 700.68 kg CO2/day, respectively. The significant economic and environmental advantages based on the current scenario encourage campus owners to invest in DGs and to implement the installation of energy storage systems with advanced concepts

Career goals of trainee physicians in internal medicine

OBJECTIVE: To survey Internal Medicine trainees\u27 future career choices and factors influencing their decision-making. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from November 2006 to January 2007. SUBJECTS AND METHODS: A standard questionnaire was administered to the residents and Interns working in the Department of Internal Medicine of The Aga Khan University Hospital. The questionnaire covered demographic details, specialty choice, work-time distribution and factors influencing career choice. Descriptive statistics were applied. RESULTS: A total of 49 doctors participated with 57% females; and 43% males, having 33% interns and 67% residents. A minority (22%) opted for internal medicine, while 78% selected sub-specialties with cardiology (20%) being the most sought- after sub-specialty. Majority (69%) wanted to spend more time in clinical activities compared to administration (18%) or research (13%). Majority (92%) wanted to work in an academic setting. Availability of a structured training program (61%), ability to practice broad area of medicine (41%) and prestige of the specialty (41%) highly influenced their career choices. Forty one (82%) wanted to proceed abroad for further training and 80% wanted to eventually practice in Pakistan. CONCLUSION: Most of the interviewed under-training physicians wanted to pursue sub-specialty. Clinical work was more attractive compared to research. A structured training program was detrimental in affecting their choices. Majority wanted further training abroad but eventual settlement in Pakistan. The study results can help us create the basis for reforming the current training programs

Detection of BCR-ABL kinase domain mutations in CD34+ cells from newly diagnosed chronic phase CML patients and their association with imatinib resistance

BCR-ABL kinase domain (KD) mutations, the most common cause of imatinib resistance, are infrequently detected in newly diagnosed chronic-phase chronic myeloid leukemia (CP-CML) patients. Recent studies indicate pre-existing mutations (PEMs) can be detected in a higher percentage of CML patients using CD34+ stem/progenitor cells, and these mutations may correlate with imatinib resistance. We investigated KD mutations in CD34+ stem cells from 100 CP-CML patients by multiplex ASO-PCR and sequencing ASO-PCR products at the time of diagnosis. PEMs were detected in 32/100 patients and included F311L, M351T, and T315I. After a median follow-up of 30 months (range 8-48), all patients with PEMs exhibited imatinib resistance. Of 68 patients without PEMs, 24 developed imatinib resistance. Mutations were detected in 21 of these patients by ASO-PCR and KD sequencing. All 32 patients with PEMs had the same mutations. In imatinib-resistant patients without PEMs, we detected F311L, M351T, Y253F, and T315I mutations. All imatinib-resistant patients without T315I and Y253F mutations responded to imatinib dose escalation. In conclusion, BCR-ABL PEMs can be detected in a substantial number of CP-CML patients when investigated using CD34+ stem/progenitor cells. These mutations are associated with imatinib resistance, and mutation testing using CD34+ cells may facilitate improved, patient-tailored treatment

Papillary Renal Cell Carcinoma: Demographics, Survival Analysis, Racial Disparities, and Genomic Landscape

Papillary renal cell carcinoma (PRCC) is the second most common histological subtype of renal cell cancer. This research aims to present a large database study highlighting the demographic, clinical, and pathological factors, racial disparities, prognosis, and survival of PRCC. The clinical and demographic data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and molecular data was cured from the Catalogue Of Somatic Mutations in Cancer (COSMIC) database. PRCC had a median age of diagnosis at 64 years, with a higher incidence in men (77%), and Whites (68%). 70.3% of cases were Grades I–IV (13, 53, 31, and 3%, respectively). In patients with known data, 85% were localized to the kidney, and 84% of cases were 7 cm in size. No metastasis occurred in 97% of the known data. The most common treatment offered was surgical resection (9%). The 5-year overall survival was 79%, with patients undergoing surgery having a 90.6% 5-year survival. Multivariable analysis revealed age > 60 years, Black race, poor histologic differentiation, distant metastases, and tumor size > 10 cm as independent risk factors for mortality. The most common mutations identified from the COSMIC database were MET, KMT2D, KMT2C, ARID1A, and SPEN. PRCC affects male individuals in the sixth decade of life. Increased age, Black race, distant metastases, and tumors > 10 cm are associated with a worse prognosis. Surgical resection offers a favorable survival outcome. Next-generation sequencing (NGS) could identify potentially targetable alterations and future personalized therapeutic approaches

A Comprehensive Review on Impact of Microorganisms on Soil and Plant

Soils have the most diversified microbial communities of any environment on the planet. Bacteria, fungi, algae, and protozoa are all found in abundance in soil. Maintaining a healthy environment for crops requires a strong link between plants and soil microorganisms that are essential for good crop development. Soil bacteria are key regulators of the nutrient cycle. Mineralization, legume nitrogen fixation, and ammonia conversion to plant-available nitrate would all be impossible without bacteria. Effective microorganisms have the ability to boost crop growth and yield. When used in conjunction with organic amendments, these bacteria performs better than to the sole application. It also contributes to soil health and provides a variety of ecological services. They also help in the cleaning of the environment, landfill disinfection, and the development and implementation of sustainable, closed-cycle organic waste treatment processes across the globe. The whole study remarks a conclusion that the application or presence of effective microbes to soil not only enhance the nutritional capacity, fertility and productivity of soils but also helps to remediate soil problems cost effectively