Risk factors of cardiovascular disease and its recommendations in Pakistani context.

Cardiovascular diseases possess a major cause for fatality and disability the world over. Since last several decades, the rates of cardiovascular diseases-related deaths have decreased in a number of high-income countries but increased in low- and middle-income countries with around 80% of the burden. Despite the seriousness of cardiovascular diseases in low- and middle-income countries, minimal attention is given to the prevention of cardiovascular diseases risk factors in South Asia, particularly in Pakistan. In addition, economic and political instability is accelerating the rates of cardiovascular diseases in the country. Practical efforts are required to enhance the understanding of cardiovascular diseases risk factors such as diet, physical activity, and tobacco-control policies to support prevention and control at the population level. This paper reviews the major modifiable risk factors in Pakistan, highlights available preventive services, and presents the most likely ways to promote risk-factor reduction

Recurrent Miscarriage and Associated Factors

The incidence of recurrent pregnancy loss in women of reproductive age group is 0.5%–3%, And idiopathic causes accounts for 50%–60% of recurrent pregnancy losses. Approximately 30%–50% of conceptions end in spontaneous miscarriage before the completion of first trimester. Miscarriages mostly occur at the time of implantation. The causes of recurrent pregnancy loss are many including parental chromosomal abnormalities, maternal thrombophilias, immunologic causes and endocrine disorders. Recurrent pregnancy loss is an extremely distressing clinical problem for women as well as health professinals. According to current studies the decidualized endometrium act as a biosensor of good quality embyos , if it is faulty ,may lead to implantation of embryos resulting in miscarriage. Other factors implicated in the pathophysiology of miscarriage are Systemic and placental oxidative stress. Vascular endothelial damage, abnormal vascularity of placenta and immunologic reactions have been proposed to play some role in causing recurrent miscarriage. The objective of this review is to discuss the causes of recurrent miscarriage, based on the published research articles. Key Words: Recurrent pregnancy loss, Immunology, Miscarriage

CERVICAL CYTOLOGY PATTERNS AT TERTIARY CARE CENTER IN URBAN SETTING OF PAKISTAN

Background: Cervical cancer is regarded as a second most common cancer among women. In developing countries, a disproportionate influence of cervical cancer has accounted approximately 85% of the cases. Identification cytological findings in these women are of utmost importance. Studies reported that proper screening program is not implemented for our population, while the opportunistic contact of women to the doctor can be utilized to screen these females. Methods: This cross-sectional study was carried out at Department of Gynecology and Obstetrics, Ziauddin University and Hospitals from April to September 2016.Total of 370 women age 18-65 years, sexually active were included. Pap smear was taken after taking informed consent. Sample was stored; reports were checked and documented on Performa. Results: The mean age of the patients was 39.54±12.9 years. The mean sexual debut of the patients was 10.02±9.8years. Squamous cell carcinoma and Intraepithelial lesions were observed in none (0%) of the patients. Atypical squamous cell carcinoma-cannot exclude HSIL was observed in 1 (0.3%), low grade squamous intraepithelial lesions in 2 (0.5%), high grade squamous intraepithelial lesions in 1 (0.3%) while atypical glandular cells not otherwise specified was also observed in 1 (0.3%) patients. Conclusion: The finding of this study has revealed positive cytological findings in five patients. In particular, low grade squamous intraepithelial lesions were found higher followed by high grade squamous intraepithelial lesions, atypical squamous cell carcinoma-cannot exclude HSIL and atypical glandular cells not specified

Relationship between Volatility of Economics Variables and Economics Growth

Economic growth of an economy is defined as the steady state path through which the productivity of an economy is improved and increases the levels of national output and income. The government consumption expenditures and investment play a key role in the process of investigating the macroeconomic performance of an economy and determinants of economic growth. The countries which grow quickly, invest a substantial fraction of their GDP for consumption expenditures as well for the sources which encourage private investment. The objective of this study to calculate the volatility in economics growth in Pakistan. The annual time series data are used from 1975 to 2014 from WDI, Economics survey of Pakistan and Hand Book of Statistics. GARCH model has been used to measure volatility of all variables. The empirical results of the study confirmed that the volatility of the different variables (volatility of inflation, volatility of interest rate, volatility of political instability, volatility of GDP, and volatility of foreign direct investment) significant affect the government consumption expenditures and private investment in the economy of Pakistan. The study analyzed data by using the autoregressive distributive lag model which is mainly used in time series data Econometrics to estimate the non-stationary models with mix order of integration. The estimated results of the study evaluated that volatility of the inflation lead to uncertainty which is also suggested by the Able (1980) and negatively affect the economy consumption expenditures as well as private investment in the economy of Pakistan. Because uncertainty directly affects the cost of capital as well as reduce private investor confidence

Ectopic Pregnancy – A 3 Year Analysis Of Different Presentations At Tertiary Care Hospitals Of Karachi.

Background: Ectopic pregnancy is a global problem and is the most common life-threatening emergency in early pregnancy leading to significant morbidity and fetal loss. It occurs in variable presentations. The main objective is to study the prevalence, risk factors and management of cases of ectopic pregnancies at tertiary care hospitals over a three year time period. Methods: This is a retrospective study of cases of ectopic gestations managed in tertiary care Hospital Karachi from July 2013 to July 2016. Information was taken from case notes, theater and labor ward registers, and the cases what we managed. Results: During the study period, we admitted total number of 3113 gynecology cases from 2013 to 2016 out of which 76 pregnancies turned out to be ectopic pregnancies with different presentations. Majority of these presented at the age group of 20-30 years and found more in primigravida. History of infertility was found to be the highest risk factor and tubal pregnancy remained the most common site of ectopic pregnancy. Conclusion: Ectopic pregnancy is a major challenge in gynecological practice and was found more in primigravida. Most of the cases usually present late that makes the tubal conservation treatment inapplicable. Use of modern diagnostic techniques by the clinicians will assist in early diagnosis and treatment prior to tubal rupture which will ultimately lead to reduction in maternal morbidity and mortality associated with the condition Key Words: Ectopic pregnancy, tubal pregnancy, mortality, B- HC

Intrahepatic Cholestasis Of Pregnancy - A Review

Intrahepatic cholestasis of pregnancy (ICP) is a complex disease described by pruritus connected with elevated serum bile acid or amino transferase level. Usually,it occurs to the third trimester of pregnancy and improves itself after delivery.In 1970’s the prevalence was reported highest in Bolivia and Chile, however, the prevalence in United States (US) ranges in between 0.3 to 5.6%, whereas, in Europe it is 0.5 to 1.5%. The awareness campaigns of the disease showed an increase in incidence in the high-incidence regions because of more reporting of the cases.Ursodeoxycholicacid (dose) is the treatment of choice for ICP. This treatment provide improved liver function and relief in pruritus and is considered safe during pregnancy.At the molecular level, it offers cytoprotection against hepatotoxic effects of hydrophobic bile acids, improves hepatobiliary bile acid transport, and decreases plasma bile acids. Moreover, to alleviate the pruritus; hydroxyzine or an aqueous cream with 1% methanol were used.ICP is a unique hepatic disorder in pregnancy with possibly an interaction of genetic, hormonal, and environmental factors in its etiopathogenesis, although the definite etiology still remains obscure

The Sexual, Marital and Fathering Behavior of Men in Sub-Saharan Africa

Understanding men's sexual and reproductive preferences and behaviors as well as their roles as partners in sexual relationships, marriage and family building is essential to address their sexual and reproductive health information and service needs. Identifying and meeting these needs are crucial because the more informed and more effective men are in living safer and more fulfilling reproductive lives, the better it will be for not only them, but for their families as well. The sexual and reproductive behaviors and health needs of men aged 15-54 in 22 Sub-Saharan countries were examined using nationally representative data collected in these countries by the Demographic and Health Surveys (DHS) between 1994 and 2001.The study found that the years between first sex and marriage represent a period of enhanced risk of STIs and premarital pregnancy for many sexually active unmarried men in Sub-Saharan African (SSA). Men in SSA want and have large families. At age 40-54, men have had seven or more children in 14 of 21 countries with data, and about six children in the remaining six countries. However, desired family size is declining: Men 15-24 want fewer children than do men in their early 50s-around 4-6 children compared with 6-10 and more, respectively. Although substantial proportions of sexually active men have more than one partner, the majority are not using condoms to prevent HIV/AIDS and other STI. Men in SSA need targeted information to help them make informed choices in their sexual and reproductive behaviors. Men also need information to help them meet their responsibilities as husbands and fathers. Men, especially those who live in areas with high prevalence of HIV/AIDS and other STIs, need better access to condoms and health services for the prevention, diagnosis and treatment of STIs. If these information and services are put within the reach of men, the gains for them will inevitably be gains for their partners and children

OVARIAN CANCER: MOST FREQUENTLY SEEN GYNAECOLOGICAL MALIGNANCY IN ZIAUDDIN HOSPITAL, NORTH NAZIMABAD

Background: The prevalence of genital tract malignancies is rising worldwide making it one of the most common malignancies in females after breast cancer. Despite cervical cancer being the most commonly occurring cancer globally, a multitude of studies in Pakistan have identified ovarian cancer as the most commonly occurring malignant tumor. The morbidity and mortality rates from genital tract tumors are considerably higher in developing countries. In developed countries, screening tests for early diagnosis of a malignancy followed by effective treatment are readily available. The objective of this study is to study the pattern and relative frequency of the malignancies involving the genital tract among women admitted to Ziauddin Hospital in 2015. Methods: The study is a retrospective, observational analysis of the case files of female patients admitted into Ziauddin University Hospital, North Nazimabad. The patients coming to the OPD have been followed for the last 3 years to check for the suspected presence of a genital tract malignancy. Results: A total of 55 patients over the last three years were confirmed to have some form of genital tract malignancy. Ovarian cancer accounted for 49% of the outcome, with around 23.6% of the cases diagnosed at stages 3 and 4. Endometrial cancer was the second most common cancer, with 27.2% being diagnosed at stage 1. Cancers of the cervix and vulva accounted for 3.6% and 1.8% respectively. No cancer of the vagina was documented. Conclusion: The most common genital tract malignancy in female patients at Ziauddin University Hospital is ovarian cancer, in contrast to the vast majority of developing countries where cervical cancer is the leading cause of genitourinary malignancies

Effect of diabetic counseling based on conversation map as compared to routine counseling on diabetes management self-efficacy and diabetic distress among patients with diabetes in Pakistan: a randomized controlled trial (study protocol)

Background: Novel interactive and pictorial health education tool named Diabetes Conversation Map (DCM) might be effective for the improvement of diabetes management self-efficacy (DMSE) and diabetes distress (DD) among diabetic patients in lower middle-income setting. This study protocol will assess the effectiveness of DCM as compared to routine care (RC) to improve DMSE, decrease DD and glycated hemoglobin (HbA1c) among patients with type 2 diabetes (T2DM). Methods: This will be two arms randomized controlled trial, conducted at national institute of diabetes and endocrinology (NIDE) in Karachi, Pakistan. A sample of 120 T2DM patients of age 30–60 years with suboptimal diabetes control will be screened through eligibility criteria and DD screening tool. Patients who fulfill the eligibility criteria and have diabetes distress will be randomized into interventional and control arm. The intervention arm will receive four education sessions (40 min each) using DCM for 4 weeks duration of enrollment. Controlled arm will receive RC. DMSE and DD will be measured using the validated Likert tools at baseline and after 3 months of enrollment. Latest results of HbA1c will be retrieved from the respective medical record files at baseline and 3 months. Change in DMSE, DD scores and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment will be compared. Multivariable linear regression will be conducted to adjust for any potential confounders. Discussion: In a study in UK, 70% of the patients with diabetes reported DCM had helped them in controlling their diabetes and recommended this method to teach other patients with diabetes also. In China, a study found that patients with diabetes who received DCM based education had significantly lower DD and significantly higher diabetes empowerment score after six months of the intervention as compared to the traditional counselling. A cross sectional study conducted in Pakistan also demonstrated that teaching based on DCM was useful in improving the knowledge, attitude and practices of patients with T2DM. Besides, no other study has evaluated the effectiveness of these novel tools for DMSE and diabetes distress DD in well-designed, sufficiently powered clinical trials. Trial registration: ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018. Version and Date of Protocol: Version 1, IRB Approval date 28 June 2018