A young man with hoarseness of voice

A 45 year-old driver presented with a two months history of hoarseness, fever, productive cough, anorexia and weight loss. He chewed tobacco. He was previously seen and treated without benefit by a family Physician and two ear, nose and throat consultants. Crackles were heard in the left scapular region. An X-Ray of the chest showed a right apical cavity, perihilar infiltrates and blunting of left costophrenic angle. His sputum smear showed acid fast bacilli. A high index of suspicion for tuberculosis is recommended while dealing with such cases. Complete recovery of patient\u27s voice with anti-tubercular therapy confirmed it was a case of laryngeal tuberculosis

An Investigation on Disease Diagnosis and Prediction by Using Modified K-Mean clustering and Combined CNN and ELM Classification Techniques

Data analysis is important for managing a lot of knowledge in the healthcare industry. The older medical study favored prediction over processing and assimilating a massive volume of hospital data. The precise research of health data becomes advantageous for early disease identification and patient treatment as a result of the tremendous knowledge expansion in the biological and healthcare fields. But when there are gaps in the medical data, the accuracy suffers. The use of K-means algorithm is modest and efficient to perform. It is appropriate for processing vast quantities of continuous, high-dimensional numerical data. However, the number of clusters in the given dataset must be predetermined for this technique, and choosing the right K is frequently challenging. The cluster centers chosen in the first phase have an impact on the clustering results as well. To overcome this drawback in k-means to modify the initialization and centroid steps in classification technique with combining (Convolutional neural network) CNN and ELM (extreme learning machine) technique is used. To increase this work, disease risk prediction using repository dataset is proposed. We use different types of machine learning algorithm for predicting disease using structured data. The prediction accuracy of using proposed hybrid model is 99.8% which is more than SVM (support vector machine), KNN (k-nearest neighbors), AB (AdaBoost algorithm) and CKN-CNN (consensus K-nearest neighbor algorithm and convolution neural network)

Isolated entrapment of the brachialis branch of the musculocutaneous nerve: a case report

Non peer reviewe

Healing during physician-patient consultation

OBJECTIVE: To determine the patient perceptions regarding healing during a physician-patient consultation. DESIGN: A questionnaire-based survey. PLACE AND DURATION OF STUDY: Family Practice Center of the Aga Khan University Hospital, Karachi, Pakistan, in June 2004. PATIENTS AND METHODS: A questionnaire was designed that included the demographic profile of patients comprising age, gender, education and occupation as well as questions in line with the study objective. It was administered to 111 patients, visiting outpatient department of the hospital. Participants were explained the study objective, a written consent was taken and full confidentiality was assured. RESULTS: The mean age of the study population was 27.86 years. Majority of the subjects were males with 68% having graduate or more education. A physician-patient consultation has healing properties for patients and physicians, according to 99 (89%) and 67 (65%) respondents respectively, with 65 (58%) having had experienced healing during the consultation process. The competence of a physician, individual attention given by a physician and a cool and calm attitude of a physician, were reported to increase healing in a physician-patient consultation according to 34 (30%), 32 (29%) and 13 (11%) respondents respectively. The unhelpful physician behavior, incorrect diagnosis and physician\u27s rude and arrogant attitude were reported to decrease healing according to 42 (37%), 15 (14%) and 14 (13%) respondents respectively. CONCLUSION: The study shows that a majority of the patients believe a physician-patient consultation has healing properties on its own, based on healing potential in the consultation process itself. Physicians must try to find ways to improve their ability to act as healers during consultation with patients

The utilization of services of health care providers among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan

Objective: To study the utilization of services of Health care providers among patients presenting to Family Physicians in a teaching hospital in Karachi.Methodology: It was a cross sectional study. A questionnaire was developed to collect patient’s utilization of services of health care providers. The investigators administered the questionnaire to 387 patients, after purpose of the study was explained, written consent was taken and confidentiality was assured. Results: The study population included more females than males, with average age of 32.6 years. The majority were married, well educated, in private and government service, were students or housewives. We found that 383(99%), 141(36.4%), 88(22.7%) and 45(11.6%) of the respondents had used services of allopaths, homeopaths, hakims and spiritual healers respectively. It is important to consider that these patients had come for allopathic treatment, thus exhibiting preference for it. The five main ailments for consulting health care providers differed, suggesting the perception in the mind of patients that certain ailments are better treated by particular system of treatment than the others. Studies are needed to explore this area further. The main reasons for consultation with particular health care provider were the recommendation of others or the perceived effectiveness of the practitioners. The reasons cited for non-consultation with health care providers were the lack of belief in them or lack of effectiveness of their treatment. Three hundred seventy nine (98%), 259 (67%), 174 (45%) and 249 (64.4%) of patients were willing to consult allopaths, homeopaths, hakims and spiritual healers again respectively, if unwell in future Conclusion: We found a substantial utilization of services of complimentary medicine practitioners among the utilization and organization of services offered by patients seeking allopathic treatment. Further study on health care providers is required (JPMA 52:269; 2002)

Patient expectations from an emergency medical service

BACKGROUND: Patient expectation survey at the Emergency Medical Services can improve patient satisfaction. A need was established to conduct such a survey in order to recommend its use as a quality improvement tool. METHODS: The study was conducted on patients visiting the Emergency Medical Services, Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and expectations of patients. The ethical requirements for conducting the study were met. RESULTS: A hundred patients were surveyed. The majority was relatively young, married men and women, well educated and better socio-economically placed. The majority of the patients expected a waiting time and a consultation time of less than 30 minutes and 20 minutes, respectively. The majority of respondents expected and agreed to be examined by a trainee but there were reluctant to be examined by the students. There was an expectation that the consultant will examine patients and not advice the attending team over the phone. The majority of the patients expected intravenous fluid therapy. There was a desire to have patient attendant present during the consultation process. The majority of the patients expected to pay less than three thousand rupees for the visit. An expectation exists for investigations and hospitalization. Involvement of patients in decisions concerning their treatment and written feedback on their visit was expected. CONCLUSIONS: We have documented the need and value of patient expectation survey at the Emergency Medical Services department. The use of such a tool is recommended in order to improve the satisfaction levels of patients visiting such facilities

Perception about family physicians: results of a survey of patients visiting specialist clinics for treatment

Objective: To study the perceptions about Family Medicine among patients visiting Specialist Physicians for treatment. Methods: A questionnaire based survey was conducted at the Specialist Clinic, Aga Khan University Hospital, Karachi, Pakistan, in June 2004. Trained volunteers administered the questionnaire among patients visiting Specialist Physicians for treatment. Confidentiality was ensured to all patients and written informed consent was taken as part of the ethical requirements for the conduct of the study. SPSS computer software and Microsoft Excel were used for data management. Results: A total of 100 patients visiting the Specialist Clinic were interviewed, of which fifty four (54%) were women and forty six (46%) were men. The mean age was 36.3 years. Twenty four (24%) respondents had graduate education. Being well-mannered, being familiar with a family\u27s medical history and possessing the abilities to conduct proper checkups were quoted as main characteristics of Family Physicians by thirty eight (38%), seventeen (17%) and twenty five (25%) respondents respectively. If they had a chest pain, fifty six (56%), forty three (43%) and one (1%) respondents would consult a Family Physician, Cardiologist and Chest Specialist, respectively. Conclusion: We have documented perceptions regarding family medicine among patient\u27s visiting Specialist Physicians for treatment. It is recommended that programs highlighting role and functions of family medicine should be started for the publi

Physician assisted suicide perceptions among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan

Objective: To study the perceptions on physician assisted suicide, among patients presenting to family physicians, at a teaching hospital in Karachi, Pakistan. Method: The study was carried out at the Community Health Center of The Aga Khan University Hospital, Karachi, between December 1999 and May 2000. The principal and co-investigators filled a pre-coded and pre­tested questionnaire consisting of important demographic characteristics and bio-medical ethics issues. A system of convenience sampling was used and a written consent was taken from respondents over the age of 16 years, who agreed to participate. The data were managed by using the Epi Info (version 6.0) program. Results: Four hundred twenty respondents were interviewed against an estimated sample size of 385. Majority (88%) were males between 25 and 34 years of age, and were self employed or in private service. Overall 9%respondents were advocated of physician assisted suicide. advocates was 9%. Those who advocated the Physician assisted suicide were more likely to be female, elderly, married and educated amongst the total respondents. Those who support Physician assisted suicide were less likely to attach divine qualities to physicians and were more bold, courageous and tolerant towards broader biomedical ethics issues. Conclusion: We have found a substantial acceptability to the idea of Physician assisted suicide in a Muslim society and have identified characteristics of those who support it (JPMA 51 :233;2001)