DIABETES AS A PREDICTOR OF MORTALITY IN CIRRHOTIC PATIENTS PRESENTING WITH VARICEAL BLEED

Background; A major cause of cirrhosis-related morbidity and mortality is the development of variceal bleeding, a direct consequence of portal hypertension. Each episode of active variceal bleeding is associated with 30 percent mortality. This study was planned to determine frequency of variceal bleeding in patients with liver cirrhosis and frequency of in-hospital mortality of these patients in our population. Objective; To determine association of diabetes with mortality in patients with liver cirrhosis presenting with of variceal bleed. Material and Methods; Consecutive 139 Patient diagnosed with cirrhosis of liver were included in this cross-sectional study from department of Medicine, Nishtar hospital Multan. Complete history and physical examination was assessed to document duration of duration of liver disease, ascites, Hepatic encephalopathy, Previous GI bleed and systemic coagulopathy. All the patients had undergone diagnostic upper GI endoscopic examination to document varices. Results; Of these 139 study cases, 77 (55.4 %) were male and 62 (44.6 %) were female. Mean age of our study cases was 45.50 ± 10.81 years. Mean duration of disease (liver cirrhosis) was 3.25 ± 2.32 years. Majority of our study cases i.e. 94 (67.6%) were having liver cirrhosis for the duration of less than 5 years. Child-Pugh class C was more prevalent i.e. 77 (55.4%) of our study cases. Variceal bleeding was observed in 100 (71.9 %) of our study cases. Frequency of diabetes in cirrhotic patients with variceal bleed was 47 (33.81%) and mortality in these diabetics was 26 (55.31%) (p = 0.001). Conclusion; Diabetes was found to be significantly associated with mortality in cirrhotic patients presenting with variceal bleeding. Healthcare professionals should anticipate adverse outcomes in diabetic patients of liver cirrhosis presenting with variceal bleeding and should educate them regarding glycemic control at early stages of diagnosis. Keywords; Liver Cirrhosis, Variceal bleeding, Mortality. DOI: 10.7176/JMPB/58-01 Publication date: August 31st 201

ASOCIATION OF URINARY TRACT INFECTION AND PNEUMONIA AMONG PATIENTS WITH ISCHEMIC STROKE AT A TERTIARY CARE HOSPITAL.

Objective; To determine the association of urinary tract infections and pneumonia among patients with ischemic stroke at a tertiary care hospital. Material and Methods; All the cases of ischemic stroke (181), fulfilling inclusion criteria were recruited in this cross – sectional study. Once registered these study cases was assessed for different complications (UTI, shoulder pain, arrhythmia, pneumonia and hyponatremia) after undergoing baseline investigations like urine test, blood tests and ECG. Data was entered and analyzed by computer program SPSS-18. Results; Of these 181 study cases, 101 (55.8%) were male patients while 80 (44.2%) were female patients. Mean age of our study cases was 50.68± 7.18 years. Of these 181 study cases, 80 (44.2%) were from rural area while 101 (55.8%) from urban areas, 43 (23.8%) were diabetic and 118 (65.2%) were hypertensive. Mean body mass index (BMI) of our study cases was 23.58 ± 3.29 kg/m2 and obesity was present in 29 (16%). History of smoking was present in 43 (23.8%) of our study cases. Previous history of stroke was present in 21 (11.6%) while family history of stroke was noted in 37 (20.4%) of our study cases and 130 (71.8 %) were illiterate and 51 (28.2%) were literate. Mean serum sodium level was noted to 136.29 ± 2.01 mEq/L, urinary tract infection (UTI) was noted in 87 (48.1%), shoulder pain in 72 (39.8%), pneumonia in 43 (23.8%), arrhythmia in 58 (32 %) and hyponatremia in 51 (28.2%) of our study cases. Conclusion; Our study results indicate high proportion of medical complications in patients with ischemic stroke. Urinary tract infection was the most commonest complication followed by shoulder pain, arrhythmia, pneumonia and hyponatremia. All clinicians treating such patients should carefully monitor such patients to take preventive measure against these complications, this will decrease disease morbidity and hospitalizations in these patients. Keywords; Ischemic stroke, medical complications, Frequency. DOI: 10.7176/JMPB/58-02 Publication date: August 31st 201

Food preferences and eating behavior among children with autism spectrum disorder: A causal-comparative study in Lahore

This study aims to compare the eating behaviors, food preferences, and body mass index of children with and without Autism residing in Lahore, Pakistan. The study participants were aged 5-12 years, and were divided into two groups: 60 children with Autism spectrum disorder (ASD), and 120 typically developing (TD) school children. The sample was drawn from three Autism schools and three private schools through the purposive sampling technique. Data regarding the participants’ basic personal history, food preferences, and eating behavior were obtained from their parents using a self- administered structured questionnaire. BMI for age percentiles of the children was obtained from standard charts, based on their height and weight measurements. Among participants with Autism, 46.7% were obese, compared to 23.3% of the participants without Autism. Children with Autism exhibited a significantly greater degree of limited variety (U= 2797.000, p= 0.009) and food refusal (U= 1586.000, p= 0.000) as compared to children without Autism. Greater preference for food in the vegetable group was related to a higher BMI for the age percentile, for children with Autism (r = 0.327, p = 0.011). A p-value < 0.05 was considered to be statistically significant. Children with Autism exhibited selective eating and food refusal to a greater degree than children without Autism

Experiences of frontline Pakistani emigrant physicians combating COVID-19 in the United Kingdom: a qualitative phenomenological analysis

Background: This study aims to explore the experiences, beliefs, feelings, and challenges faced by Pakistani migrant doctors working in the United Kingdom in times of the COVID-19 pandemic. The qualitative study aims to explore the lived experiences, beliefs, feelings, and challenges faced by Pakistani migrant physicians working in the United Kingdom during the COVID-19 pandemic. Methods: An exploratory phenomenological approach was used to collate data on experiences expressed during the COVID-19 pandemic. Purposive and snowball sampling was used to target participants, which were doctors of Pakistani origin involved in the direct care and management of COVID-19 patients in different NHS hospitals of the United Kingdom. Semi-structured, in-depth telephonic interviews were conducted with study participants in May 2020. Data analysis was done parallel with data collection by using an inductive qualitative approach. Results: We recruited ten frontline physicians. Four theme categories emerged from the data analysis: 1) Working across borders and cultures, 2) Role of beliefs for coping with stress and fear, 3) Passion and profession, and 4) Scaffolding the Pakistani health system. Overall, the results show that the participants received limited professional support, in terms of counseling and psychological rehabilitation. Instead, they had to use self-management strategies to cope with the situation. Conclusion: The intensive work exhausted participants physically and emotionally. They were holding a lot of grief and hurt inside, but still, healthcare professionals showed the spirit of professional dedication to overcome difficulties. Although currently coping with their emotional problems, comprehensive professional support should be made available to cater to the wellbeing of frontline physicians

Comparative analysis of developmental profile between normal and severe acute malnourished under-five children in Pakistan: a multicentre cross-sectional study

Objectives: This study aims to compare the developmental profile of severe acute malnourished (SAM) and normal under-five children and to find sociodemographic determinants accountable for their developmental disabilities. Setting: We conducted a multi-centre cross-sectional study in three basic health units and one rural health centre in Pakistan. Participants: 200 children (SAM and healthy) aged 6-59 months. Primary and secondary measures: We screened for nutritional status and clinical complications. Children underwent for developmental assessment by Denver Development Screening Tool II. A pretested structured questionnaire on sociodemographic characteristics and nutrition was used for collecting data about determinants of developmental delay. Results: We observed statistically significant differences in anthropometric measurements among SAM compared with normal nourished in weight, height, mid-upper arm circumference and weight-for-height z-scores. SAM serves as a significant risk factors (p<0.001) for delayed personal or social development (69% vs 11%; OR (95% CI)=18.01 (8.45 to 38.37)), delayed fine motor development (39% vs 8%; OR (95% CI)=7.35 (3.22 to 16.81)), delayed language development (32% vs 8%; OR (95% CI)=5.41 (2.35 to 12.48)), delayed gross motor development (34% vs 10%; OR (95% CI)=4.64 (2.14 to 10.05)) and delayed global development (66% vs 20%; OR (95% CI)=7.77 (4.09 to 14.74)). Applying logistic regression, personal or social development (p<0.001) and language development (p<0.05), under-five siblings was a risk factor, while among gross motor development, mother's educational status (p<0.05) was a significant risk factor for developmental delay. Conclusions Our analysis indicates that children with malnutrition have a high frequency of developmental delays. Missing maternal education and a higher number of under-five siblings are also potential risk factors for developmental delay

Developmental delay and its predictors among children under five years of age with uncomplicated severe acute malnutrition: a cross-sectional study in rural Pakistan

Background: In developing countries, malnutrition in children and developmental delays are two major challenges for public health. To achieve the vision of the Sustainable Development Goals from the broader perspective of child health, early identification of developmental delays and timely intervention are crucial. The aim of this study is to assess the prevalence of suspected developmental delay and their predictors in children under the age of 5 years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Methods: A multicentre cross-sectional study was conducted among 185 children with uncomplicated severe acute malnutrition. We screened children aged 6-59months for their nutritional status and clinical complications. Children fulfilling the inclusion criteria underwent the Denver Development Screening Tool II (DDST-II). The children's global developmental profile was calculated according to the established protocols of DDST-II, which are based on four important domains of development: personal and social behaviour, language, gross motor adaptive skills and fine motor adaptive skills. A pretested questionnaire was used to collect data on socio-demographic and nutritional factors for assessing predictors of developmental delay, which were analysed using a multivariate logistic regression model. Results: Out of 177 children with severe acute malnutrition, 69 (38.9%) had normal global development and 108 (61.1%) had delayed global development. Significant associations were found between global developmental delay and younger children (6-24months vs. 25-59months; AOR=4.53, 95% CI: 1.56-13.10, p<0.01), children who were not exclusively breastfed (AOR=3.07, 95% CI: 1.24-7.56, p=0.01), and a history of contact with a tuberculosis smear-positive adult (AOR=2.67, 95% CI: 1.30-5.49, p<0.01). Conclusion: About two thirds of the study participants showed delayed or unstable global development. Thus, according to DDST-II-established protocols, there is a high prevalence of suspected developmental delay among children under the age of five years with uncomplicated severe acute malnutrition in rural areas of Pakistan. Children in their first 2 years of life were at particularly high risk due to insufficient breastfeeding. This emphasizes the need to provide adequate infrastructure and information to parents for the prevention of developmental delay in remote areas

The Impact of Idiosyncratic Risk and Macroeconomic Uncertainty on Firms’ Leverage and Investment: Evidence from the Different Industries of Pakistan

The main purpose of this study is to empirically examine the impact of idiosyncratic risk and macroeconomic uncertainty on firm leverage and investment. The analysis is carried out for a large panel data which is obtained from different industries of Pakistan comprising textile, auto and allied, cement, fuel and energy and sugar over the period of 2008-2018. Our investigation provides evidence that firm use less debt during periods of high risk. It also shows that as macroeconomic uncertainty and idiosyncratic risk increases, firms reduce their degrees of leverage. This study shows that idiosyncratic risk has an indirect and statistically significant effect on the Pakistan target firms’ leverage. However, highly profitable firms’ leverage is more sensitive to macroeconomic uncertainty and less sensitive to idiosyncratic risk. The result related to firm characteristics suggests that the firm specific variables such as firm size, tangibility, debt to asset ratio, growth of sales and cash flow to assets ratio are important in the determination of different firms’ investment. The finding also reveals that firm’s investment is more sensitive during periods of heightened firm idiosyncratic risk.  The outcome of the paper is useful for firms’ investment decision and authorities in designing of effective fiscal and monetary policies

The Impact of Idiosyncratic Risk and Macroeconomic Uncertainty on Firms’ Leverage and Investment: Evidence from the Different Industries of Pakistan

The main purpose of this study is to empirically examine the impact of idiosyncratic risk and macroeconomic uncertainty on firm leverage and investment. The analysis is carried out for a large panel data which is obtained from different industries of Pakistan comprising textile, auto and allied, cement, fuel and energy and sugar over the period of 2008-2018. Our investigation provides evidence that firm use less debt during periods of high risk. It also shows that as macroeconomic uncertainty and idiosyncratic risk increases, firms reduce their degrees of leverage. This study shows that idiosyncratic risk has an indirect and statistically significant effect on the Pakistan target firms’ leverage. However, highly profitable firms’ leverage is more sensitive to macroeconomic uncertainty and less sensitive to idiosyncratic risk. The result related to firm characteristics suggests that the firm specific variables such as firm size, tangibility, debt to asset ratio, growth of sales and cash flow to assets ratio are important in the determination of different firms’ investment. The finding also reveals that firm’s investment is more sensitive during periods of heightened firm idiosyncratic risk.  The outcome of the paper is useful for firms’ investment decision and authorities in designing of effective fiscal and monetary policies

Effects of the COVID-19 pandemic on perceived stress levels of employees working in private organizations during lockdown

Background: Worldwide, office employees have experienced two novel phenomena during the COVID-19 pandemic and lockdown: working from home and reductions in their salaries. These phenomena have majorly impacted the lives of individuals as well as their families. The present study aims to measure the perceived stress levels among employees during the COVID-19 pandemic lockdown in Pakistan.Methodology: A cross-sectional approach was used to collect data from a sample of 385 employees working in three different IT-oriented private organizations. A semi-structured, Likert-scale questionnaire was used, containing the 10-item inventory from the Perceived Stress Scale (PSS). A sociodemographic profile, working parameters, and frequency of PSS inventory were presented in the descriptive analysis. Binary logistic regression analysis was made to compare the stress levels of the two groups resulting from their workloads and reductions in salary.Results: An elevated perceived stress level (50.9%) was observed among the employees, showing a significant relationship with salary reduction and home work engagement (p&lt;0.005). A strong negative correlation was observed (-0.860) for the salary reduction with PSS.Conclusion: Working from home and reductions in salary caused increased perceived stress levels of the employees working in private organizations. Salary reductions proved to be a strong stressor, causing economic disruption and inability to cope with financial burdens during the COVID-19 pandemic

Benefits of physical activity on reproductive health functions among polycystic ovarian syndrome women: a systematic review

BackgroundPolycystic ovary syndrome (PCOS) is among the predominant endocrine disorders of reproductive-aged women. The prevalence of PCOS has been estimated at approximately 6–26%, affecting 105 million people worldwide. This systematic review aimed to synthesize the evidence on the effects of physical activity on reproductive health functions among PCOS women.MethodsThe systematic review includes randomization-controlled trials (RCTs) on physical exercise and reproductive functions among women with PCOS. Studies in the English language published between January 2010 and December 2022 were identified via PubMed. A combination of medical subject headings in terms of physical activity, exercise, menstrual cycle, hyperandrogenism, reproductive hormone, hirsutism, and PCOS was used.ResultsOverall, seven RCTs were included in this systematic review. The studies investigated interventions of physical activity of any intensity and volume and measured reproductive functions and hormonal and menstrual improvement. The inclusion of physical activity alone or in combination with other therapeutic interventions improved reproductive outcomes.ConclusionThe reproductive functions of women with PCOS can be improved with physical activity. Furthermore, physical activity can also reduce infertility, as well as social and psychological stress among women