Is Ministry of Health fully prepared to implement an effective DOTS program in Pakistan? An operations research on TB control program in the public health sector in Sindh

PURPOSE OF THE STUDY: Pakistan is among the high-burden countries for tuberculosis. One of the fundamental problems in TB control is a high defaulter rate among the registered TB cases in the public sector. In 1999, a cross-sectional study was designed to identify the determinants of low compliance for the TB treatment in two rural districts in Sindh.Methods: Before the actual data collection, a pilot testing was planned in a secondary level care hospital. Fourteen defaulters for TB treatment were identified but none could be contacted due to incomplete addresses. Other alternatives were explored with the health facility team to reach them including a field-based search through Lady Health Workers of the National Health Program but all endeavors went into vain. The pilot testing propelled us to postpone the cross-sectional study but we continued scrutinizing the follow up problem for TB patients in other health facilities. Not surprisingly, more or less a similar picture was found in those health facilities.PRINCIPAL CONCLUSIONS: The study concludes that the public health care system in Pakistan lacks even the basic requirements for an effective TB control program, that is, a viable information system and the functional integration of program with rest of the health care delivery system. A DOTS strategy to control TB was initiated in the public sector in Pakistan just one year prior to this study. The Ministry of Health requires re-visiting the program to ensure that the lacunae identified in this study are being taken care of in the current DOTS strategy

Anorexic behaviour and attitudes among female medical and nursing students at a private university hospital

Objective: To study the anorexic behaviour and attitude among female medical and nursing students in a tertiary care hospital.SUBJECTS AND Methods: A cross-sectional survey to determine the proportion of anorexic behaviour among female medical and nursing students at The Aga Khan University Hospital Karachi was conducted. A multistaged sampling technique was utilized in which our study population was first divided according to field of enrollment (medical or nursing school) and then stratified by class. Within each stratum, we used convenience sampling due to time and availability constraints. We utilized a modified Eating Attitudes Test (EAT-26) to collect data. The Eating Attitude Test is probably the most widely used standardized measure of symptoms characteristic of eating disorders, including anorexia nervosa.Results: A total of 180 female students were interviewed. Ninety-four (52.2%) were medical students and 86 (47.8%) were nursing students. Among the 94 medical students, 26 (27.7%) were from first year, 14 (14.9%) from second year, 15 (16.0%) from third year, 20 (21.3%) from fourth year and 19 (20.2%) from the final year of medical college. Among the 86 nursing students 34 (39.5%) were from first year, 23 (26.7%) from second year, 27 (31.4%) from third year and 2 (2.4%) from fourth year. The proportion of anorexic behaviour among medical students was 8.0%, 7.1% and 20.0% in first, third and fourth years respectively. No individuals with anorexic behaviour were found in second and fifth years. The total proportion of anorexic behaviour among female health care students was 21.7%.CONCLUSION: Results showed a 21.7% prevalence of anorexic behaviour, a figure much higher than that reported in similar studies conducted in Asia. We also found that the proportion was much higher among female nursing students as compared to female medical students. A previous visit to a psychiatrist for reasons other than eating disorders was found to be associated with anorexic behaviour

Breast Diseases: a histopathological analysis of 3279 Cases at a Tertiary Care Center in Pakistan

Objective: To know the frequency of breast diseases in Pakistani females. Methods: A retrospective analysis of 3279 breast specimens received over a period of 4 years (1 993-1996) at the department of pathology, the Aga Khan University Hospital. Results: Out of a total of 3279 breast specimens, common breast lesions included infiltrating duct carcinoma 37%, followed by fibro adenoma 16.95%, fibrocystic change13.96%, mastitis 6.83% and duct ectasia 5.33%. Majority of the cases of infiltrating duct carcinoma were encountered in the 5th and 6th decades of life. Tumour size was 2 or \u3e2 cms. in 93% of cases and 40% of them showed 3 or \u3e3 positive lymph nodes. Grade I tumours were 11.38%, grade 11 59.17% and grade Ill tumours 29.47%. Correlation of grade with lymph node metastases (3 or \u3e3+ve nodes) showed 15 cases (1.53%) of grade 1, 178 cases (18.25%) of grade II and 68(6.97%) cases of grade Ill tumours. Conclusion: This study shows that in Pakistani females, the most commonly encountered lesion in carcinoma of the breast followed by the benign lesions such as fibro adenoma, fibrocystic disease & others. Breast carcinoma occurs at a younger age group with predominance of high-grade lesions and with frequent lymph node metastasis

Comparative analysis of knowledge, attitudes and perceptions about induced abortions among medical and non-medical students of Karachi

Objectve: To determine the knowledge, attitudes and perceptions regarding induced abortions among university students of Karachi and compare these aspects among medical and non-medical students. STUDY Design: Cross sectional opinion survey. Methods: The study is a cross sectional opinion survey of medical and non-medical students from four educational institutions of Karachi using a pretested questionnaire. Results: Of the 381 students interviewed, 201 were medical and 180 were non-medical. More medical students were aware of the correct definition of induced abortion. An encouraging finding was the awareness of our study population about the only legally acceptable circumstance for induced abortion in Pakistan, that is, if conceptus is a risk to maternal health (p \u3c 0.001). More medical students cited complications that were technical like uterine perforation (p \u3c 0.001), cervical trauma (p \u3c 0.001), DIC (p \u3c 0.001), and sepsis (p \u3c 0.001). More medical students thought induced abortion to be a health issue (p=0.001) as compared to non-medical students. Most of the medical students felt the need to modify Pakistan\u27s law regarding abortion (p=0.008) especially for fetal anomalies (13.9%) and rape (7%).CONCLUSION: Though medical students were more knowledgeable about induced abortions as compared to the non-medical population, there is a need to improve awareness regarding induced and unsafe abortions and their consequences

Displacement rate effects on mixed-mode I/II delamination of laminated carbon/epoxy composites

Mixed-mode delamination is one of the common failures of composites which has not been studied under low-impact loading. This paper studies the influence of displacement rate on mixed-mode I/II delamination of unidirectional carbon/epoxy composites. Single leg bending test is performed at displacement rates of 1, 10, 100, and 500 mm/min. Experimental results reveal that the mixed-mode I/II fracture toughness is invariant with the displacement rate. In addition, scanning electron micrographs shows that shear cusps are more obvious at 1, 10, and 100 mm/min. At 500 mm/min, significant matrix debris is noticed. Furthermore, the proposed three-dimensional rate-dependent fracture criterion is found to well predict the fracture toughness. Numerical simulation using cohesive zone model suggests that the lower numerical peak load is due to lower damage dissipated energy. In addition, the theoretical and numerical traction-separation responses show significant differences, which is also reflected in the numerical phase angle. This implies that the local mixed-mode ratio is not constant throughout the simulation process

Effects of local sodium bentonite as aflatoxin binder and its effects on production performance of laying hens

The study was designed to examine the effect of sodium bentonite (SB) as mycotoxin binder in poultry feed and its effects on productions performance of laying hens. A total of forty-five production hens white leghorn aged 34 weeks were caged in a naturally aired laying house into five different groups. Group A was kept as control group, Group B was fed with higher level 170 ppb aflatoxin without binders, and Group C feed contained 170 ppb aflatoxin with 1.5% SB binder, Group D contained 170 ppb aflatoxin with 2% SB and Group E feed contained 170 ppb aflatoxin with 2.5% SB. Aflatoxin contamination adversely affected the egg production and feed consumption. Addition of 2% and 2.5% SB increased (P<0.05) in feed intake and egg productions. SB appears to be useful as toxin binding additive and counteracting the deleterious effects of aflatoxin. However there were no obvious effects observed among groups in respect to egg yolk and albumin content. Significant effect was observed among the groups for feed consumption, egg production, weight, shell weight and thickness and for FCR value. The addition of 2% SB showed better feed and protein utilizations leading an increased egg production and reduced eggs defects in layer hens

Molecular and morphological diversity in locally grown non-commercial (heirloom) mango varieties of North India

Mango (Mangifera indica L.) has been cultivated and conserved in different agro-ecologies including Malihabad region in northern part of India, that is well known for housing diverse types (heirloom and commercial varieties). In the present study, 37 mango types comprising of 27 heirloom varieties from Malihabad region and 10 commercial varieties grown in North and Eastern India were assessed for morphological attributes and molecular diversity. The employed SSR markers amplified 2-13 alleles individually, cumulatively amplifying 124 alleles. These were studied for allelic diversity and genetic dissimilarity ranged from 0.035 to 0.892 arranging the varieties in three major clusters. The results revealed that majority of unique heirloom mangoes from Malihabad were different from the eastern part of the country. It is interesting to note Dashehari, a commercial variety from Malihabad was not aligned with heirloom varieties. Commercial varieties like Gulabkhas and Langra were placed in a separate group including Bombay Green, Himsagar, Dashehari, etc., indicating their dissimilarity with heirloom varieties at molecular level and thus, indicating importance for later from conservation point of view. Furthermore, the hierarchical clustering of varieties based on fruit morphology, assembled these into four groups largely influenced by fruit size. The maximum agreement subtree indicated seemingly good fit as thirteen varieties were arrayed in common grouping pattern. Appreciable dissimilarity among the heirloom varieties demonstrated by molecular analysis, underlines the importance for their on-farm conservation

Prevalence of behavioural and psychological problems in working children

OBJECTIVE: To determine the prevalence and screen the nature and types of behavioural and psychological problems among working children in Karachi. METHODS: A cross sectional study was conducted in three urban squatter settlements of Karachi from May to June 2006, targeting working children aged 11-16 years. Behavioural Problems of these children were estimated by using the self reported Urdu version of the Strengths and Difficulty Questionnaire. The results were cross-tabulated using SPSS 13.0 with the identified risk-factors. RESULTS: Out of a total of 225 respondents, 94.2% (n = 212) males and 5.8% (n = 13) females, the prevalence of Behavioural Problems among working children was found to be 9.8%. Peer problems were most prevalent (16.9%) seconded by Conduct problems (16.7%). Adverse family environment and work environment were closely associated with Behavioural Problems in these children. CONCLUSION: Our study reinforces the need for measures to improve the environment of the children and prevent the psychological and behavioural problems associated with working children. Gradual, long-term policies are required to decrease the need for working children, though sudden abolishment would cause more detrimental effects

Antimicrobial potential of alkaloids and flavonoids extracted from Tamarix aphylla leaves against common human pathogenic bacteria

Background: Alkaloids and flavonoids are secondary metabolites extracted from different medicinal plants. Tamarix aphylla a traditionally valuable medicinal plant; was used for the extraction of alkaloids and flavonoids in order to evaluate their antibacterial activity.Methodology: The leaves of the plant were collected from district Kohat, Pakistan, and their alkaloids and flavonoids were extracted with ethanol and methanol, respectively. Four bacteria i.e. Gram positive (Staphylococcus aureus) and Gram negative (Escherichia coli, Salmonella typhi and Pseudomonas aeruginosa) were selected for the biological screening of these phyto-constituents.Results: The concentration of alkaloids was found to be more in the leaves of Tamarix aphylla than flavonoids. The extracted phytochemicals showed varied inhibition zones against tested bacterial isolates. Alkaloids showed highest inhibitory activity against Staphylococcus aureus (14±0.6 mm) followed by Pseudomonas aeruginosa (13±0.7 mm). Conversely, flavonoids showed the highest inhibitory affect against Salmonella typhi (17±0.7 mm) followed by Staphylococcus aureus (14±0.7 mm). However, both extracts showed the lowest inhibitory effects against Escherichia coli.Conclusions: It was concluded that the alkaloids and flavonoids from Tamarix aphylla leaves have antimicrobial potential against common human bacterial pathogens. However, flavonoids were found to be more active phytochemical against tested bacterial strains as compared to alkaloids.Keywords: Kohat; Medicinal plants; Phytochemical screening; In-vitro activity; Bacterial strains