Life style related risk factors for cardiovascular disease among patients at a teaching hospital in Karachi

BACKGROUND: Cardiovascular disease is a leading cause for morbidity and mortality all over the world. It is important to study life style related, modifiable cardiovascular risk factors among patients, in order to devise preventive strategies. METHODS: We surveyed family practice patients visiting the out-patient clinics of Aga Khan University Hospital, Karachi. The interview was questionnaire-based and recorded the demographic profile of the patients, in addition to information on life style related cardiovascular risk factors. The ethical requirements for the study were met. SPSS computer software was used for data management. RESULTS: Fifty patients were surveyed and included 28 (56%) men and 22 (44%) women. Thirty seven (74%) respondents were married, nineteen (38%) had graduate education, twenty five (50%) were in private service, and twelve (24%) were housewives. Twenty six (52%) respondents were overweight or obese. Butter, cream, margarine and red meat was consumed by 17 (34%) and 32 (64%) respondents respectively. White meat, fresh fruits and vegetables were consumed by 30 (60%), 29 (58%) and 38 (76%) respondents respectively. Oil from vegetable sources was used by 49 (98%) respondents. Addition of table salt was found occasionally and always in 18 (36%) and 09 (18%) respondents respectively. Twenty seven (54%) respondents exercised at least twenty minutes, three times a week, while eleven (22%) were current smokers. CONCLUSIONS: Life style related modifiable risk factors are prevalent in patients reporting to our hospital. This offers an opportunity for preventive strategies, to prevent cardiovascular disease. Such surveys, followed by interventional strategies, are recommended to be followed by all Primary care facilities

Understanding the link between trafficking in persons and HIV and AIDS risk in Tanzania

The magnitude of trafficking in persons in Tanzania is unknown. Consequently, available information on health risks of persons trafficked for different forms of exploitation is extremely scanty. We conducted a baseline study in eight administrative regions of Tanzania using both qualitative and quantitative methods to generate data on the health conditions of trafficked persons to inform trafficking in persons control measures through HIV and AIDS interventions. Study participants included the national, regional and district community development officers, district medical officers, local government leaders, managers or representatives of non-governmental organizations involved in anti-trafficking in persons activities, members of the community and victims. Findings indicated that common forms of labour into which persons are trafficked include domestic services, agriculture (farming), construction, mining/quarrying, fishing, lumbering and manufacturing. Trafficked persons are reported to be exposed to risks like overcrowding, long working hours, psychological problems, physical injuries, impotence, breathing problems and sexually transmitted infections including HIV. It is concluded that the reported occupational hazards in industries where trafficked persons are forced into are not specific to trafficked persons as they affect all labourers. However, the underground nature of the trafficking in persons process increases health problems and risks, including the vulnerability to HIV infection. More tailored research is needed, especially to find means of how to reach out and provide services to this particular vulnerable population, validate labour forms of exploitation into which persons are trafficked to enable the integration or mainstreaming of HIV and AIDS and trafficking in persons at the policy and programmatic levels. In addition, findings would facilitate the understanding of the link between increased risk of HIV and trafficking in persons

Postoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting

ntroduction Postoperative atrial fibrillation (AF) is the commonest of all the known cardiac arrhythmias after cardiac surgery. The postoperative AF has both short- and long-term adverse impacts on patients, like prolonged intensive care unit (ICU) stay, increased frequency of reoperations, myocardial infarction, increased use of inotropes, and intra-aortic balloon pump (IABP). There is a paucity of data regarding the postoperative AF after isolated coronary artery bypass grafting (CABG) and its risk factors in our geographic location. Therefore, the aim of this study was to determine the frequency of postoperative atrial fibrillation among patients undergoing isolated CABG at a tertiary care hospital of Karachi, Pakistan. Methods This prospective observational study was conducted on 163 consecutively selected patients undergoing first time isolated CABG at the Department of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi. Patients with redo-sternotomy, preoperative atrial fibrillation and with other cardiac pathology were excluded from the study. Postoperative AF was defined in the patients with postoperative 12-lead electrocardiographic (ECG) finding of absence of P waves, replaced by unorganized electrical activity and irregular R-R intervals. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). Results A total of 163 patients were enrolled with the mean age of 58.66 ± 9.77 years ranging between 40 and 85 years with male predominance of 81% (132). The most common comorbidity was hypertension in about 68.1% (111), followed by diabetes mellitus in 54.6% (89) patients. Postoperative AF was observed in 42 (25.8%) patients. Most of the patients who developed postoperative AF, were overweight with mean body mass index (BMI) of 27.04 ± 4.85 kg/m2, 76.2% (32) had a history of hypertension, diabetes mellitus was associated with 33.3% (14) patients with postoperative AF and 50.0% (21) of them were smokers. Distribution of coronary artery disease in patients with postoperative AF was observed as three vessels coronary artery disease (3VCAD) in 83.3% (35), two-vessel coronary artery disease (2VCAD) was present in 7.1% (three), and rest of 9.5% (four) patients had single-vessel coronary artery disease (SVCAD). Conclusion The frequency of postoperative atrial fibrillation in our study was found to be 25.9% which is comparable to world literature. An important finding that comes through this study is a younger population undergoing CABG, which raises the possibility of early manifestation of ischemic heart disease in our region. This, however, needs further investigation. We were unable to point out the factors predictive of postoperative AF; studies with larger sample size would help in that regard

Conventional Weight-Based versus Low-Dose Regimen of Heparin Administration to Achieve Target Activated Clotting Time on Cardiopulmonary Bypass in Pakistani Population

Objective: A weight-based dose of heparin is calculated to achieve target ACT (Activated clotting time) for establishing CPB (cardiopulmonary bypass). Whether a target ACT can be achieved with lower dose of heparin in Pakistani population was the aim of this study. Methodology: The cross-sectional comparative study was conducted at Rawalpindi Institute of Cardiology, Department of Cardiac Surgery from 1st January 2019 to 1st January 2020. Three hundred thirty-six (336) patients undergoing elective open-heart surgeries on CPB were included in this study. Patients receiving weight-based heparin dose were placed in Group-A, while those on low-dose heparin were placed in Group-B. ACT was considered to have reached the target value in range of 400-480 seconds, values between 481-1500 seconds were considered excessive, whereas ACT of >1500 was regarded as potentially high-risk for peri-operative bleeding . Results: 14.1% (n= 28) of Group-A patients achieved target ACT, whereas 58.3% (n=116) exceeded the target of 480. In 25.1% (n=50), ACT values were beyond the measuring capacity of the assay machine i.e. >1500. Only 2.5% (n=5) required additional dosage of heparin. Target ACT in Group B was achieved in 19.7% (n= 27), 55.5% (n=76) had excessive ACT values, whereas in 16.8% (n= 23), it was >1500. 9.5% (n=13) required an additional dosage of Heparin. Conclusion: In Pakistani population, a target ACT can be achieved with significantly lower dose than the conventional weight-based heparin dose. Larger studies, preferably randomized controlled trials are needed to determine the optimal heparin dose calculation for safe anti-coagulation during CPB

Predictors of condom use among unmarried sexually active women of Reproductive age in Tanzania

Background: Condom is one of the methods for prevention against Human Immunodeficiency Virus and other Sexually Transmitted Infections. It is also considered an effective method for preventing unwanted pregnancies. Despite the several interventions that have been put to promote condom use, still a large proportion of women do not use condom during sexual intercourse. Objectives: This study aimed at determining predictors of condom use among unmarried sexually active women of reproductive age in Tanzania. Methods: This study used secondary data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS). It involved unmarried sexually active women aged 15-49 years. Multiple binary logistic regression was used to determine predictors for condom use at last sexual intercourse. Results: Overall, lower proportion (31.1%) of unmarried sexually active women used condom at last sexual intercourse. The odds of using condom during last sexual intercourse was lower aOR=0.67 and aOR=0.65 for women aged 20-24 and 25+ years respectively). Women who reported higher age (18+ years) at first sex had higher odds (aOR=1.65) of using condom compared to those started sex before 15 years old. Women owning telephone had higher odds (aOR=1.44) compared to women without telephone. Also, higher odds of using condom were observed for women in the Southern, South West highlands, and Eastern zones compared to the Central zone. Discussion: Age, marital union, parity, wealth, ownership of; mobile phone, television, access to newspapers, and radio significantly predicts condom use among unmarried sexually active women of reproductive age in Tanzania. Conclusion: The level of condom use among unmarried women in Tanzania is very low and varies by age, age at sex intercourse, ownership of phone and zones. Targeted interventions are needed to promote the condom use among unmarried women in order to mitigate the risk of HIV and un-intended pregnancies

Factors associated with child sexual abuse in Tanzania: a qualitative study

Background: Child sexual abuse (CSA) is one of the most pervasive occurrences which are reported all over the world. It often goes unnoticed and undocumented due to surrounding taboos; its sensitivity in nature and affects the less powerful population. Anecdote information is available on the nature and extent of sexual abuse among children in Tanzania. The aim of this study was to explore factors, forms, context of abuse and perpetrators of child sex abuse in selected regions of Tanzania.Methods: Key informant interviews were conducted among adults including parents of the victims to explore factors associated with sexual abuse of children under 10 years old in Tanzania. The interview guide centred on factors for child sexual abuse, the type of perpetrators and the context into which these abuses take place.Results: There were incidences of child sexual abuse in Tanzania and the major forms were anal and vaginal penetration, and the most affected were girls. The abuses were rarely reported due to shame and embarrassment faced by the affected children and parents. The causes of child sexual abuse were poverty, ambitions and moral degradation, myths and beliefs, urbanization, foreign culture and poor parental care. Incidents of CSA were reported to occur in perpetrators’ homes and in semi-finished housing structures, madrassa and recreational venues where children can freely access entertainment by watching movies. These acts were committed by people in position of power, close relationship and trusted by the children. Contexts where child sexual abuses occur included overcrowded living spaces and social activities that go on late into the night.Conclusion: We recommend for strengthened interventions at different levels within the society to address the root causes and different contexts in which child sex abuse occurs. Increased awareness of the root causes should go hand in hand with measures to encourage parents and survivors to report incidents to relevant authorities timely as they occur