Adherence to growth hormone therapy in children with growth hormone deficiency: Experience at a public sector tertiary care hospital

Objective: To determine the adherence rate of recombinant human Growth Hormone therapy (rhGH) in children suffering from growth hormone deficiency and parent’s perspectives regarding reasons for non-compliance. Materials and Methods: This study was conducted at District Headquarters Hospital, Rawalpindi from January 2020 to June 2021. All children already diagnosed with Growth hormone deficiency were included in the study. Children with less than one-year duration of treatment were excluded. Demographic details were recorded on a predesigned proforma. Adherence to treatment was assessed using a combination of methods based on previous studies. The proportion of days covered >80% was taken as good adherence. Data was entered and analyzed in SPSS 25. Qualitative variables such as gender, socioeconomic status, source of growth hormone injections, and adherence were presented as frequency and percentages. Self-reported reasons for non-adherence were presented as frequency and percentage. Results: A total of 38 patients meeting the inclusion criteria were included in the study. Both genders were equal in number. The mean age at diagnosis was 8.2 ± 3.6 years. Socioeconomic status was the middle (upper or lower) in 55% of the cases while 45% belonged to the lower socioeconomic group. Adherence was good in 44% of the patients while suboptimal in 56%. The cost of treatment was the main reason for non-adherence in all the cases. Conclusion: Non-adherence to rhGH therapy is common in our setup. Clinicians should be aware of different factors affecting adherence and all efforts should be made to ensure good adherence so that optimal targets may be achieved. Keywords: Adherence, Growth hormone therapy, socioeconomic statu

Presentation And Diagnosis: Pregnancy Induce Diabetes And Hypertension In Medical Doctors At Hospital And Clinics

OBJECTIVES The aim of this study was to assess pregnancy induce diabetes and hypertension in medical doctors. METHODOLOGY This case-control study was conducted after approval by the ethics committee. A total of 72 physicians who were pregnant and diagnosed with pregnancies causing hypertension or diabetes participated in the study. Daily details of hourly blood glucose levels were recorded at the beginning and end of the day. Use SPSS version 24.0 to analyze the results. RESULTS Out of the 33 patients, 23 remained hypertensive at the end of the day, while 10 had normal hypertension at the beginning of the day. Hypotension appeared from the 39th day of which 24 of her ended high, 15 were normal and 10 were diet controlled. The maximum number of pregnancies was 40 in high-care controls and 32 in low-care controls. Out of 30(16) had high FBS at the beginning of the day and 17 of the 42 who had the highest at the end of the day had low FBS. The highest score of 17(42) was presented at the beginning of the day with low FBS and 17 at end of the day with a high ratio and high count of 42.   CONCLUSION   Health care is important for all patients, whether they are health workers or not. Daily Record helps patients and providers understand patient disease management and take appropriate action.

2MASS Studies of Differential Reddening Across Three Massive Globular Clusters

J, H, and K_S band data from the Two Micron All-Sky Survey (2MASS) are used to study the effects of differential reddening across the three massive Galactic globular clusters Omega Centauri, NGC 6388, and NGC 6441. Evidence is found that variable extinction may produce false detections of tidal tails around Omega Centauri. We also investigate what appears to be relatively strong differential reddening towards NGC 6388 and NGC 6441, and find that differential extinction may be exaggerating the need for a metallicity spread to explain the width of the red giant branches for these two clusters. Finally, we consider the implications of these results for the connection between unusual, multipopulation globular clusters and the cores of dwarf spheroidal galaxies (dSph).Comment: 40 pages, 14 figures. Accepted for publication in Oct. 2003 A

Prevalence of Oral Manifestations of Systemic Diseases in Patients Visiting the Dental Outpatient Department of Sindh, Pakistan

OBJECTIVES The purpose of the study was to evaluate the awareness of oral health workers in identifying the prevalence of oral manifestations of systemic diseases in patients visiting the Dental Out-Patient Department of Sindh, Pakistan. METHODOLOGY A descriptive, cross-sectional survey-based study was conducted in Karachi, Pakistan, from October to December 2021. The study was conducted in various institutes from all over Sindh, Pakistan. An online, well-structured questionnaire was designed using Google Forms and distributed to the participants through social media platforms in the dental community. Using the Open-Epi software regarding a parent article, the sample size of this study was calculated. Keeping the confidence interval at 95% and the desired percentile at 50, the total sample size was calculated to be 100. Around 175 questionnaires were given out to the candidates. RESULTSThe results showed that  81% male and 19% female participated, including 45% postgraduate trainees, 30% house officers, and 25% general dentists. 80% detected 2-3 systemic diseases in a patient, with 75% observing oral manifestations preceding systemic illness diagnosis. The majority favoured treating underlying ailments (75%), and prevalent conditions included hypertension (90%), diabetes (80%), anaemia (75%), and lichen planus (40.7%). CONCLUSION Oral health workers play a vital role in the initial and early identification and multidisciplinary medical management of various systemic diseases. A coordinated approach between physicians and dentists in diagnosing and managing these conditions is necessary to achieve optimal clinical outcomes

Effects of different acetylsalicylic acid doses on body organs, histopathology, and serum biochemical parameters in broiler birds

A indústria avícola é afetada por diversas doenças ou estresses. Particularmente devido às aves serem antipiréticas. O ácido acetilsalicílico (AAS) é largamente utilizado com diferentes objetivos que incluem o controle do estresse calórico, bem como a atividade respiratória e digestiva. O propósito deste estudo foi a avaliação dos efeitos benéficos e tóxicos do emprego de diferentes dosagens do AAS em frangos de corte. As variáveis analisadas foram: exame físico, parâmetros bioquímicos, bem como as alterações histopatológicas em seções de tecidos colhidas das aves em um ensaio experimental. O estudo foi conduzido em 60 frangos de corte com um dia de idade adquiridos em um mercado local de Faisalabad que foram recriados nos primeiros 14 dias em idênticas condições. Então no 15º dia as aves foram distribuídas randomicamente em quatro grupos identificados pelos números 1 a 4, com 15 aves em cada grupo. O grupo 4 foi mantido como grupo controle e os grupos 1, 2 e 3 foram tratados com AAS, respectivamente, nas doses de 300, 600 e 1200 mg/L de água de bebida, durante 21 dias. Foram realizadas três amostragens nos dias 21, 28 e 35 pós-tratamento. O peso vivo corpóreo e da carcaça foi registrado em cada amostragem. Em todos os órgãos viscerais foi analisada a presença de alterações patológicas. As amostras de soro sanguíneo foram colhidas para a avaliação bioquímica. O exame histopatológico de todos os órgãos viscerais foi realizado para a observação de alterações microscópicas. A partir da segunda amostragem foi observado um aumento significante (p<0,05) no peso corpóreo na dosagem de 300mg/L. Um significante aumento no peso relativo dos órgãos foi registrado na dosagem de 1200 mg/L. Os grupos tratados com dosagens de 600 e 1200 mg/L de AAS, apresentaram aumento significante dos níveis de AST, ALT e de creatinina quando comparados ao grupo controle. O grupo tratado com 1200 mg/L de AAS apresentou um aumento significante (P,0,05) de uréia, proteína sérica total e de albumina em todas as amostragens. No grupo de alta dosagem foram observados alterações histopatológicas constituídas por aumento dos hepatócitos, aumento dos espaços sinusoidais no fígado, congestão e anormalidades nos espaços glomerulares nos rins, congestão e ruptura alveolar nos pulmões, degeneração das vilosidades e celular nos intestinos A conclusão obtida foi que em frangos de corte uma baixa dosagem do AAS pode ser utilizada por um período de longa duração, apresentando um efeito promotor do crescimento, contudo as doses elevadas determinam toxicidade hepática e renal.The poultry industry suffers from various diseases or stresses. In poultry, apart from being antipyretic, acetylsalicylic acid (ASA) is widely used to cope with different issues including heat stress, and respiratory and digestive orders. This study evaluated the beneficial and toxic effects of ASA at different dose levels in broiler birds. To evaluate these toxic and beneficial effects it is necessary to examine the physical and serum biochemical parameters as well as the histopathological changes with tissue sections taken from broiler birds under experimental trial. This study was conducted on 60 one-day-old broiler chicks purchased from a local market in Faisalabad. Chicks were reared for the first 14 days under similar conditions. On the 15th day, birds were randomly divided into 4 groups (1-4) with 15 birds in each group. Group 4 was kept as control, while groups 1, 2, and 3 were treated with ASA at the dose of 300, 600, and 1200 mg/L of drinking water for 21 days. There were 3 samplings performed at 21, 28, and 35 days post-treatment. The live body weight and carcass weight were noted on each sampling. All the visceral organs were recorded for gross pathological changes. The serum samples were collected for biochemical evaluation. Histopathology of all the visceral organs was performed to observe the microscopic changes. A significant (P<0.05) increase in live body weight at a 300mg/L dose was noted after the first 2 samplings. A significant (P<0.05) increase in the relative organ weight was recorded at 1200 mg/L. The groups treated with ASA 600 and 1200 mg/L showed increased (P<0.05) AST, ALT, and creatinine levels from that of the control group. The group treated with 1200 mg/L of ASA showed increased (P<0.05) urea, serum total protein, and albumin level in all the samplings. Histopathological changes revealed swollen hepatocytes, increased sinusoidal spaces in the liver, congestion and abnormal glomerular spaces in the kidney, congestion and alveolar disruption in the lungs, and generation of villi and cellular degeneration in the intestine in a high-dose group. The study concluded that ASA at a low dose can be used for a long time in broilers and has a growth promontory role, while high-level doses cause hepatorenal toxicity

Suicide Associated with Risk Factors in Patients Suffering from Depression

OBJECTIVES: The purpose of this study was to assess suicide and their relationship with risk factors i.e. degree of hopelessness, severity of depression and suicidal ideations. METHODOLOGY: It was a cross sectional study conducted in Psychiatry unit Khyber Teaching Hospital Peshawar. The total sample of this study was forty-eight admitted patients. Those patients were included in the study that scored moderate to high in Hamilton Depression Rating Scale (HDRS), Hopelessness Scale and Reasons for Living Inventory (RLI). The collected data were analysed using SPSS version 22. RESULTS: Study showed that reasons for living as well as the subscales of reasons for living inventory i.e. responsibility towards family, hope of improvement and surviving and coping beliefs have significant inverse correlation with score on Hopelessness Scale and suicidal ideations. The score on subscale religious beliefs had significant correlation only with score on hopelessness. Married individuals’ responses were different on total reasons for living to a significant extent. The patients with past psychiatric history had significantly greater fear of suicide. The three different social groups did not differ to a significant extent in scoring on reasons for living. CONCLUSION: The reasons for living as a whole and some of the subscales of Reasons for Living Inventory have significant inverse relationship with suicidal risk factors showing the modulatory effect of these reasons on suicidal risk. Moreover, these reasons are not equally distributed among some of the sociodemographic and clinical groups

Postnatal Depression: Frequency, Demographic Characteristics and Risk Factors

OBJECTIVES: The iobjective iof ithe istudy iwas ito iestimate ithe iprevalence iof postpartum idepression iand iits iassociated irisk ifactors iamong imothers.   METHODOLOGY: This icross-sectional istudy iwas icarried iout iin ithe iDepartment of iObstetrics i& iGynecology,iand iDepartment iof iPsychiatry, iKhyber Teaching Hospital iPeshawar 1st April 2018 till 31st March 2019. iA itotal i750 ipost-natal imothers iwere iscreened irandomly ifor ipostnatal idepression ifor ifirst i1-2 weeks ifollowing idelivery iby iusing iEdinburgh iPostnatal iDepression iScale (EPDS). 680 iaccepted ito iparticipate, i70 irefused ito iparticipate iand i504 ifulfill ithe inclusion icriteria. iA iscore iof i≥13 iwas iconsidered ihaving Ipostpartum depression.   RESULTS: A itotal iof i168 iwomen ihad ian iEPDS iscore i10, iyielding ia icrude prevalence irate iof i34%. iThe iprevalence iof isuicidal iideation iwas i14 iout iof 504 (3%), iamong iwhich i11 i(79%) ihad iEPDS iscore iof i10. iWe ifitted multiple ilinear iregression imodels ito ievaluate ithe ipredictors iof ivariables measured ion ithe iEPDS. iThis imodel iwas istatistically isignificant p<0.0001 iin ipredicting ithe itotal iEPDS iscore. iWomen's iemployment istatus, domestic iviolence iand imarital iconflict iwere istatistically isignificant predictors.   CONCLUSION: Thisistudy ireflected ithe ifacts ithat imany iof ithe ipostnatal mothers iof iour icircumstances isuffer ifrom ipostpartum idepression iand ineeds medical iattention. iScreening iof ipostpartum idepression ishould ibe iconsidered as ia iroutine ipart iof ipostpartum icare. KEYWORDS: IPostpartum IDepression, Risk IFactors, Socio-Demographic IFactors, Pakista

Ecological Aerobic Ammonia and Methane Oxidation Involved Key Metal Compounds, Fe and Cu

Interactions between metals and microbes are critical in geomicrobiology and vital in microbial ecophysiological processes. Methane-oxidizing bacteria (MOB) and ammonia-oxidizing microorganisms (AOM) are key members in aerobic environments to start the C and N cycles. Ammonia and methane are firstly oxidized by copper-binding metalloproteins, monooxygenases, and diverse iron and copper-containing enzymes that contribute to electron transportation in the energy gain pathway, which is evolutionally connected between MOB and AOM. In this review, we summarized recently updated insight into the diverse physiological pathway of aerobic ammonia and methane oxidation of different MOB and AOM groups and compared the metabolic diversity mediated by different metalloenzymes. The elevation of iron and copper concentrations in ecosystems would be critical in the activity and growth of MOB and AOM, the outcome of which can eventually influence the global C and N cycles. Therefore, we also described the impact of various concentrations of metal compounds on the physiology of MOB and AOM. This review study could give a fundamental strategy to control MOB and AOM in diverse ecosystems because they are significantly related to climate change, eutrophication, and the remediation of contaminated sites for detoxifying pollutants

Perception Of E-Learning In Medical Students Of Fatima Jinnah Medical University

Introduction: In the modern era, advancing information technology is leaving an impact on the educational system as well wherein classroom learning is being replaced by e-learning. This type of learning is a part of formal educational system in many institutions around the globe. HEC is emphasizing the implementation of e- learning in formal education, thus perception of students about e learning need to be known. Aims & Objectives: To determine the perception of medical students of FJMU regarding e-learning. All institutions throughout world had to shift to online learning during COVID- 19 pandemic. This new online system is challenging for many students. The current study was planned to know the perception of medical students of FJMU about e- learning. Place and Duration of Study: This was a descriptive cross-sectional study that took place in FJMU, Lahore and duration of study was 2 weeks in August 2021. Material & Methods: The study was conducted on 377 medical students of 1st and 2nd year MBBS. Nonprobability purposive sampling technique was employed. A predesigned and pretested questionnaire was administered to the students in August 2021. Data was analyzed by SPSS 23 and frequency % was calculated for quantitative variables as perceived usefulness, perceived ease of use and e learning stressors were calculated. Results: Mean age of students were 19.4 years, with range of 18-22 years and all were females. Majority (85%) used mobile phones for e-learning. 72.6% of the students preferred face to face learning over e-learning. Major stressors included inadequate IT skills, lack of motivation and poor internet connections. Conclusion: Medical students of FJMU didn’t prefer e- learning over face to face learning