Reasons for seeking orthodontic treatment in Lahore population: A cross-sectional survey in a low-income country

ABSTRACT Introduction: Poor esthetics, dysfunction and discomfort are the key reasons for seeking orthodontic treatment across the world as reported by many researchers. This paper presents the causative factor for seeking orthodontic treatment in the patients who are visiting Punjab Dental Hospital of a populous city Lahore (de\u27 Montmorency College of Dentistry) in local settings and associating these reasons with demographic characteristics. Objective: Aim of this cross-sectional survey was to explore the reasons for seeking orthodontic treatment among individuals who are visiting PDH. Materials and methods: This study was carried out in Punjab Dental Hospital (PDH) after the approval of the Institutional Review Board (IRB) on a sample of 98 individuals having malocclusion assessed with Angle\u27s classification of the malocclusion. We chose simple random sampling. A self-structure questionnaire was designed to get data by the principal investigator after taking verbal and written consent. Descriptive statistics were calculated using SPSS 21. Chi-square test of association was applied to associate reasons with different demographic variables. P-value <0.05 was taken as significant. Results: Female respondents were more in number than males. Around one-third of respondents (30.6 %) had a monthly income of less than 25000 PKR ($ 170). Esthetics was the primary reason for seeking orthodontic treatment. The most common type of malocclusion was the Class II malocclusion. Statistically significant factors that emerged in this study that turned into reasons for seeking orthodontic treatment were hurdles in marriage, referral by a general dentist, motivation by parents, self-esteem and speech problems. Conclusion: In conclusion, patients seek orthodontic treatment mainly to enhance facial esthetics and self-confidence, motivation by the parents, and social acceptability

Utilization and impact of electronic and print media on the patients’ health status: physicians’ perspectives

Aims: Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors’ opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients. Setting and Design: The current research is a cross-sectional study conducted from January 2015 to July 2015. The study population comprised physicians rendering their services in different hospitals of Karachi, Pakistan, selected by the nonprobability convenience sampling technique. In this study, 500 questionnaires were distributed through email or direct correspondence. Methods and Materials: Physicians’ perception toward the impact of electronic and print media on the health status of patients was assessed with a 20-item questionnaire. Different demographic characteristics, such as age, gender, institution, position, and experience of respondents, were recorded. Quantitative data were analyzed with the use of Statistical Package for Social Sciences, version 20.0 (SPSS, Chicago, IL). The association of the demographic characteristics of the responses of physicians was determined by one-way ANOVA using 0.05 level of significance. Results: In this study, 254 physicians provided consent to show their responses for research purposes. A response rate of 50.8% was obtained. Nearly one-third of the respondents negated that patients get health benefit using electronic and print media. The majority did not consider electronic and print media as lifestyle-modifying factors. Physicians thought that patients particularly do not rely on mass media for acquiring health information and consider healthcare professionals as unswerving information resource. Conclusions: Mass media can be productive resources to augment awareness among patients, although physicians seem unconvinced about the extended usage of print/electronic media

Development and validation of a novel general medication adherence scale (GMAS) for chronic illness patients in Pakistan

Objective: This study aimed to develop and validate a self-reporting adherence tool termed as General Medication Adherence Scale (GMAS) in Urdu language for measuring adherence toward medication use among Pakistani patients with a chronic disease. Methods: A month-long study (December 2017) was conducted in three tertiary health care settings of Karachi, Pakistan. The tool underwent content and face validity as well as factor analyses, i.e., exploratory, partial confirmatory and confirmatory factor analyses. Random sampling was conducted, and sample size was calculated using item response theory. The item-to-respondent ratio was 1:15. Fit indices namely normed fit index (NFI), Tucker Lewis index (TLI), comparative fit index (CFI), goodness of fit index (GFI), absolute goodness of fit (AGFI), parsimony goodness of fit index (PGFI), root mean square error of approximation (RMSEA), and standard root mean square residual (SRMR) were calculated. Additionally, estimation of the convergent, discriminant and known group validities, was conducted. Internal consistency was analyzed by testretest reliability, McDonald’s and Pearson correlation coefficient. The factor analyses were conducted using IBM SPSS version 22 and IBM SPSS AMOS version 25. Results: Content validity index (CVI) was reported at 0.8 (SD 0.147) and the tool was content validated with three hypothetical constructs. Factor analyses highlighted a 3- factor structure. The fit indices were calculated with satisfactory results, i.e., PGFI, GFI, AGFI, NFI, TLI, and CFI were greater than 0.9 and PGFI > 0.5. The values of RMSEA and SRMR were less than 0.07. A Cronbach’s alpha value of 0.84 was obtained in reliability analysis. The test-retest Pearson’s correlation coefficient value was reported at 0.996 (p-value < 0.01). Convergent and discriminant validities for all constructs and, known group validity for two constructs, were established. A high response rate of 91% was achieved in respondents. Patients without insurance coverage appeared to be low adherent compared to those with insurance coverage (p-value < 0.05). Non-comorbid patients were more likely to be highly adherent as compared to comorbid patients (pvalue < 0.01). Conclusion: A novel tool GMAS was developed in Urdu language and was subsequently validated in patients with chronic diseases

DIRECT COST OF TREATMENT OF DIABETES MELLITUS TYPE 2 IN PAKISTAN

Objective: Diabetes is a serious illness. It is a key and growing threat to the health of the global world. The prime concern of this research was to estimate the cost-of-illness of type 2 diabetes in Karachi, a major metropolitan city of Pakistan. This study was performed on the basis a community perspective to calculate the economic burden of diabetes mellitus type 2 in Pakistan. Methods: This study was conducted in all districts of Karachi, the patients were taken from all economic segment of society from low income group, average revenue and high revenue group. A preliminary test questionnaire was used to collect the data directly from patients and in some locations conducted interviews with patients due to lack of understanding and un-educated patients. The total of 885diabetes patients was selected with convenient random sampling. Results: The average direct cost of all these expense bear by diabetic patient in Pakistan is Pak Rupees Rs.5542 per month. The cost range starts from Rs. 650/month to 20000 per month on the basis of patient economic condition and disease state. The average appointment fee of a physician, laboratory test and medicines came to Rs. 700/visit, 400/test, and 1100/visit precisely. The average travel and food spent was Rs.200/visit and 1000/month. Medicine accounted for largest cost followed by consultation with the physician. Conclusion: This is clearly indicated by this study that considerable cost is amounted by diabetes, it is suggested that a huge amount of resources could be prevented by taking care, initial understanding of the disease and a decrease in diabetes co-morbidities and complications through better diabetes mellitus treatment. Very extensive and cost-effective programs should be started to maximize health benefits and to diminish the prevalence of this epidemic

Fasting headache, a cross-sectional study

Headache is a predominant disorder in general population and is classified into primary and secondary forms by the International Headache Society. Fasting headache is currently classified in Group 10 of ICHD-III as “Headache attributed to disorders of homeostasis”. In spite of continuing research, there is still indistinctness regarding the exact cause of fasting headache. Hypoglycaemia, previous history of headache, stress, caffeine withdrawal, lack of sleep and female gender have been speculated as causative factors. Our rationale for this study is to find out what percentage of the population experiences fasting headache and to find out any link between the occurrence of this phenomenon and any associated factors

SURVEY BASE STUDY ON CURRENT TREND OF TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN KARACHI

Objective: Community-acquired pneumonia (CAP) is a potentially serious infection that results in various general physicians (GP) visits and hospital admission every year. The prime objective of this research was to find the current trend of treatment of community-acquired pneumonia in Karachi.Methods: It was a prospective survey conducted in all districts of Karachi. A Questionnaire was filled by distinctive specialities of doctors in an outpatient setting in Karachi. A preliminary test questionnaire was used to collect the data directly from distinctive specialities of doctors in outpatient setting in Karachi. Total 500 doctors were selected from distinct districts of Karachi with convenient random sampling.Results: Majority (33.8%) of the respondents recommended complete blood count and chest x-ray for diagnosis of community-acquired pneumonia in an outpatient setting. Most (76%) of the respondents recommended nebulization for the management of community-acquired pneumonia in an outpatient setting. 31% and 25.4% of the physicians recommended clarithromycin as 1st line antibiotic therapy in adults and children for the management of a community-acquired pneumonia patients in outpatient setting.55.6% of the physicians recommended two-week duration of antibiotic therapy for the management of CAP in outpatient setting.Conclusion: This is clearly indicated by this study that deviation from the standard guideline is observed in the management of community-acquired pneumonia in Karachi. These deviations from the highly recommended guideline can results excess cost and inappropriateness of the management of the disease of community-acquired pneumonia. There is a need that the physician should take a decision of therapy according to the standard guidelines for the treatment of CAP in an outpatient setting.Â

Development and Validation of a Novel General Medication Adherence Scale (GMAS) for Chronic Illness Patients in Pakistan

Objective: This study aimed to develop and validate a self-reporting adherence tool termed as General Medication Adherence Scale (GMAS) in Urdu language for measuring adherence toward medication use among Pakistani patients with a chronic disease.Methods: A month-long study (December 2017) was conducted in three tertiary health care settings of Karachi, Pakistan. The tool underwent content and face validity as well as factor analyses, i.e., exploratory, partial confirmatory and confirmatory factor analyses. Random sampling was conducted, and sample size was calculated using item response theory. The item-to-respondent ratio was 1:15. Fit indices namely normed fit index (NFI), Tucker Lewis index (TLI), comparative fit index (CFI), goodness of fit index (GFI), absolute goodness of fit (AGFI), parsimony goodness of fit index (PGFI), root mean square error of approximation (RMSEA), and standard root mean square residual (SRMR) were calculated. Additionally, estimation of the convergent, discriminant and known group validities, was conducted. Internal consistency was analyzed by test-retest reliability, McDonald’s and Pearson correlation coefficient. The factor analyses were conducted using IBM SPSS version 22 and IBM SPSS AMOS version 25.Results: Content validity index (CVI) was reported at 0.8 (SD 0.147) and the tool was content validated with three hypothetical constructs. Factor analyses highlighted a 3-factor structure. The fit indices were calculated with satisfactory results, i.e., PGFI, GFI, AGFI, NFI, TLI, and CFI were greater than 0.9 and PGFI &gt; 0.5. The values of RMSEA and SRMR were less than 0.07. A Cronbach’s alpha value of 0.84 was obtained in reliability analysis. The test-retest Pearson’s correlation coefficient value was reported at 0.996 (p-value &lt; 0.01). Convergent and discriminant validities for all constructs and, known group validity for two constructs, were established. A high response rate of 91% was achieved in respondents. Patients without insurance coverage appeared to be low adherent compared to those with insurance coverage (p-value &lt; 0.05). Non-comorbid patients were more likely to be highly adherent as compared to comorbid patients (p-value &lt; 0.01).Conclusion: A novel tool GMAS was developed in Urdu language and was subsequently validated in patients with chronic diseases

RESPONSE OF SUNFLOWER TO VARIOUS PRE-GERMINATION TECHNIQUES FOR BREAKING SEED DORMANCY

Abstract Seed dormancy is considered to be a serious constraint in sunflower seed production. Viable seeds sometimes do not germinate even in the presence of favorable environmental conditions. Such seeds are suspected to be dormant. The study was conducted under controlled/laboratory conditions during spring 2010 at National Agricultural Research Centre, Islamabad. The objective of the study was to evaluate some techniques to convert a seed from dormant to non-dormant germinable state. Dormant seeds of 21 sunflower hybrids were treated with three hot water treatments (100°/80°C) and four chemicals potassium nitrate, 0.2%, thiourea, 0.5%, ethanol, 25%, acetone, 25% for breaking seed dormancy .The untreated seed was taken as control. Soaking seeds in hot water (80°C) for 15 minutes followed by one day dry and seed treatment with acetone were found to be the most effective and successful techniques in converting the seed from dormant to nondormant state

A case report of male infertility and gynecomastia in high altitude area: Clinical evaluation and management

Gynecomastiais a common abnormality of breast tissue among men. Itis the benign enlargement of male breast glandular tissue.In this report anarrative approachwasfollowed for the qualitative inquiry of three men from the high altitude areas of Pakistan. They presented with gynecomastia and infertility. These men were approached for clinical examination, lab investigations,and further management.Thesemenfindings ofthese patients showed oligospermia, azoospermia ornecrospermia. Serum Prolactin was found to be high and they were overweight with increasedbreast development. The Serum Prolactin, FSH, LH levels,andTestosteronelevels were measured in these patients with infertility.The laboratory investigations of our patients showed highprolactin and estrogen levels.All these men were reported stress due to erectile dysfunctionand infertility. The reasons of male infertility in the high-altitudeareas of Pakistan need to be explored further

Knowledge, attitude, and perceptions about polycystic ovarian syndrome, and its determinants among Pakistani undergraduate students.

ObjectiveThe aim of the study was to evaluate knowledge, attitude, perception, and assess the determinants of polycystic ovarian syndrome (PCOS) among undergraduate students.MethodsA cross-sectional study was conducted among female undergraduate students in Pakistan using a survey. The questionnaire was formulated in English language by a review of literature and expert consensus. The sampling approach was convenient, and survey was available as electronic as well as hardcopy. Data were analyzed using IBM SPSS v23. Descriptive statistics namely mean ([Formula: see text]), standard deviation (SD), or median ([Formula: see text]) and interquartile range (IQR) were used dependent upon data distribution. In addition, range (R) was also utilized to express the results. The logistic and linear regression analyses were also conducted. Study received ethical clearance from ethics committees.ResultsA total of 646 responses were analyzed. The average PCOS knowledge score was 11.58 ± 4.99 (overall), 12.02 ± 4.73 (medical students), 9.36 ± 5.65 (non-medical students) (α = 0.861). 68.6% participants did not feel embarrassed while discussing PCOS in the society, but 67.3% never discussed it with a doctor. Lack of self-knowledge (31.6%) and shyness/reluctance (21.4%) were identified as barriers by most students. Further, obesity, irregular menstrual periods, family history, hirsutism and contraceptive use were observed to be determinants for having PCOS (AOR > 2, pConclusionThe disease knowledge among undergraduates was inadequate. However, there is greater acknowledgement of PCOS as a problem for Pakistani women and barriers have been identified in the study. Conducting awareness campaigns within academic institutions which include promoting disease education, arranging talks, distributing merchandise with disease awareness signage, would greatly help in raising awareness of the disease and lowering stigma and hesitancy