Non-invasive prenatal determination of fetal RhD genotyping from maternal plasma: a preliminary study in Pakistan

Objectives: To determine the accuracy of the non-invasive pre-natal real-time polymerase chain reaction based fetal RhD genotyping from maternal plasma. Study Design: Cross-sectional study. Place And Duration Of Study: Juma Health Sciences Research Laboratory, The Aga Khan University Hospital, Karachi, from July to December 2008. Methodology: Cell-free plasma DNA from 21 D-negative women with D-positive spouse between 20-39 weeks of gestation was tested for the presence of exon 5 region of RhD gene using real-time polymerase chain reaction. b-globin was employed as the house-keeping gene. Sensitivity and specificity of the real-time PCR-based non-invasive fetal RhD genotyping was obtained by calculating proportion of the D-positive fetuses that were D-positive at birth as well. Results: Of the 21 D-negative women 13 and 8 neonates were determined to be D-positive and D-negative, respectively, by serologic studies on cord blood samples at birth. RhD status was correctly determined in 17 of 21 cases. There were three false-positive and one false-negative results. The sensitivity and specificity of the assay was 92.3% (95% CI: 62.1, 99.6) and 62.5% (95% CI: 25.9, 89.8), respectively. The positive and negative predictive value of the assay was 80% (95% CI: 51.4, 94.7) and 83.3% (36.5, 99.1), respectively. Conclusion: These preliminary results demonstrate the feasibility of non-invasive pre-natal diagnosis of fetal RhD status of D-negative mothers in Pakistan

The Approach of Pharmacy Students Towards Communication of Medication Errors in Karachi, Pakistan

Purpose: To assess pharmacy students’ knowledge of communicating medication errors in Karachi, Pakistan.Methods: The study design was cross-sectional and conducted from February to May 2014. A previously validated questionnaire was adopted, modified and distributed to final year pharmacy students in four universities of Karachi. Descriptive statistics were used to present students’ demographic information and their response to the questionnaire items. Pearson chi square test and Logistic regression model were executed to evaluate the association of gender and institution of students with their response.Results: Out of 600 survey questionnaires distributed, only 464 were returned in useable form, giving a response rate of 77.33 %. A majority of the students showed moderately positive attitude towards general communication and training in communicating medication errors. More than 40 % of the respondents were not satisfied with the training they received in communicating and reporting incidence of medication errors. Incorrect drug (14.65 %), incorrect dose (8.40 %) and improper storage of medicines (7.97 %) were the most common errors observed by the students during clerkship.Conclusion: The findings indicate the need for a more standardized approach to improving knowledge of medication errors as well as training in the communication of occurrence of medication errors.Keywords: Communication, Medication error, Pharmacy students, Standardized trainin

Patient-Level Cost Estimation for Health Services at Secondary Hospital, Saudi Arabia

Cost information can help to improve the quality of medical care budgeting, and it can also improve the efficient allocation of resources and patient outcomes. The objective of this study was to estimate the inpatient unit cost of healthcare services in a secondary hospital in Saudi Arabia. A cross-sectional retrospective approach was applied to categorize the inpatients discharged from the hospital from January to December 2018. A top-down costing method for cost estimation was used. We found that the overhead cost center holds 40.17% of the total hospital cost, and intermediate and final care cost centers consumed 25.50% and 34.33%, respectively. Among inpatients wards, the Surgical ward had the highest operational cost (39.27%). Human resources consumed the hospital's highest resources (75%) on salaries. The hospital's cost structure was not remarkable and needs revolutionary changes to adopt the new payment mechanism envisioned in the 2030 Saudi vision

Social Media and Body Dysmorphic Disorder (BDD): Is There Any Link?

To the Editor, Body Dysmorphic Disorder (BDD) is defined as a persistent and intrusive preoccupation with a non-existent or slight imperfection in one’s appearance. Being labelled as one of the obsessive-compulsive and related disorders, it has multifactorial etiology like cognitive deficits, psychological impairment and neurochemical abnormalities. However, a 2020 study has shed light on a  more serious concern- it showed that the use of social media for longer duration, especially Snapchat and Instagram, are associated with increased incidence of BDD distinctly in young participants.1 Other researches have also highlighted this that social media can kindle the negative belief of body image by circulating photos, videos and comments about ideal self-image triggering  insecurities especially in youngsters, about their physical features, body shape,  complexion etc.2,3  Furthermore, social media platforms like Snapchat and Instagram are specialized in photo and video editing features, a behavior that is common in people with BDD.4 Fantasizing the celebrity ideals and social media influencers has promoted body dissatisfaction, disordered eating and other psychological comorbidities resulting in more frequent dermatological and psychiatric consultations.1 According to WHO approximately 24 million people in Pakistan need psychiatric assistance. Mental illness and psychological disorders still face persistent social taboo here. As only one psychiatrist is present for every 10,000 people in the country, BDD can become a big problem for the already feeble health system here by increasing the burden of mental illnesses. People here already consider white complexion the epitome of beauty and success, and promotion of similar mentality through social media either by celebrities or by influencers can be disastrous for the mental health of young individuals. That is why it is mandatory to dictate the proper and constructive use of social media. Facebook and Twitter trends can be set up for awareness and encouraging natural beauty instead of perfectly filtered dummy faces. As celebrities and influencers are followed by many, social media sites should promote people because of their intellect, talent and hard work rather than their appearances. These trivial steps can play a pivotal role in decreasing body dissatisfaction and concerns

Surveillance of Rubella in female students in Medical Colleges

Background: Rubella virus infection is normally not a serious infection in childhood, but if it occurs during pregnancy it can be a very serious threat to the developing fetus. It may lead to Congenital Rubella Syndrome resulting in infant mortality. Methods: This cross sectional study was conducted in Microbiology Department, Benazir Bhutto Hospital (BBH), Rawalpindi.One hundred females with their age group ranging from 17-25 years were included in the study. Twenty female medical students studying in each year of different Medical Colleges were tested. Blood samples were taken and tested for Anti Rubella Antibodies (IgG) by ELISA method. Results: Out of 100 females from Medical Colleges who were studied 54 females were found positive (54%) for IgG Anti Rubella Ab whereas 46 females (46%) were found negative. 4 students (20%) from 1st year, 7 student (35%) from 2nd year, 12 students (60%) from 3rd year, 14 students (70%) from 4th year and 18 students (90%) from final year were found Seropositive for IgG Anti Rubella Antibodies. Conclusion: Female students exposed to hospital environment develop antibodies during exposure to patients. Rubella immunization should be considered for the age group that is not exposed to the hospital environment

Difficulty Index, Discrimination Index and Distractor Efficiency in Multiple Choice Questions

Objective: Our first objective was to evaluate the quality of MCQs by analyzing difficulty index, discrimination index and distractor efficiency. Our second objective was to find out the association of MCQs having good difficulty and discrimination indices with distractor efficiency.Methodology: This cross-sectional study was conducted at department of Pathology, Islamabad medical and dental college. Midterm paper comprising of total 65 MCQs was assessed for difficulty index (DIF), discrimination index (DI) and distractor efficiency (DE). Data was entered in Microsoft Excel 2010 and SPSS 21. Quantitative variables were expressed as mean±SD. Qualitative variables were written as number and percentage. Independent t-test was applied to find out the association of DIF and DI with DE.Results: According to DIF, out of total 65, 53(81%) MCQs were in acceptable category, only 1(2%) MCQ was too difficult and 11(17%) were too easy. Regarding DI, total 34(62%) MCQs showed excellent discrimination tendency to distinguish low and high performer students. While 15(23%), 5(8%) and 11(17%) MCQs demonstrated good, acceptable and poor discrimination ability respectively. Out of total 260 distractors, 72% were functional and only 28% were non-functional. Total 16(25%) MCQs had zero non-functional distractor (NFDs), while 30(46%) and 16(25%) MCQs had 1 and 2 NFDs respectively. Only 3(5%) MCQs were with 3 or more NFDs. DE was significantly more (100%) in 1 difficult item as compared to 11 easy items in which DE was less (36.33%). However, DE in MCQs having poor and good DI was almost same.Conclusion: In this paper of Pathology, large number of MCQs have acceptable level of DIF (81%) and DI (83%). Distractor efficiency related to presence of zero or 1 NFD is 71%. Through item analysis, standardized MCQs having average DIF, high discrimination power with large number of functioning distractors can be developed. Thus it is an effective way to improve the validity of examination and to efficiently assess the student performance