Menstrual Hygiene Practices among Adolescent School Girls in Pakistan

Objectives: To evaluate menstrual hygiene practices among teenage girls and to compare menstrual hygiene practices among secondary and higher secondary school girls in Pakistan Methodology: A cross-sectional study of adolescent girls (grades 9 to 12) from different secondary and higher secondary schools across Pakistan was conducted between November 2017 and September 2018. A pre-tested and standardized questionnaire was administered using a non-probability sampling technique. The menstrual hygiene practices were evaluated and comparisons were made between secondary and higher secondary school girls about these practices. Data was analysed using SPSS version 22. P-value < 0.05 was set for being statistically significant. Results: Out of a total of 2,000 adolescent girls, an equal number of adolescent girls (n=1,000) were chosen from secondary and higher secondary schools. The mean menarchal age was 12.5 ± 1.2 years. Majority of the participants (63.6%) belonged to public sector schools and (71.3%) responded that menstrual blood comes from the womb. One in five (19.3%) girls missed 2 days/month of school due to pain (54.5%). Two-thirds (68.6%) of the participants were using sanitary pads and one of three changed their pads three times/day, and forty-six percent of the girls were unable to carry out daily activities due to menstrual period. Statistically significant (P < 0.05) association was observed between knowledge of menstruation among secondary and higher secondary school girls. Conclusion: The study showed that menstrual hygiene was understood well among young girls. However, a substantial association was noted between secondary and higher secondary school girls’ hygiene practices.

Arsenic: A Cause of Cardiometabolic Syndromes

Objective: The objective of the study is to identify major pathological biomarkers and their possible mechanisms in arsenic-induced cardiometabolic syndrome. Methodology: The present review summarizes the data and literature taken from previously done studies from Research Gate, Science Direct, PubMed, PubMed Central, Medline, and some other scientific databases emphasizing the role of arsenic in cardiometabolic syndrome. The results obtained through this database were assembled, composed, critically elucidated and presented in explanatory and tabular form. Results: The major pathological target of arsenic is antioxidant defense system and increase in Reactive Oxygen Species reduces the Nitric oxide production, reduction in vascular permeability, increases adhesion and production of inflammatory mediators (IL-6, TNF-á,), TCs, TGs, LDL-C, lipid peroxidation, â-cells dysfunction. The persistent accumulation and generation of these pathological biomarkers in blood vessels can induce hyperlipidemias, dyslipidemias, atherosclerosis, hypertension and diabetes. Conclusion: There is a need to propose natural antioxidant with minimum side effects in the treatment of CMTs.

Knowledge, Attitude and Practices of Pharmaceutical Waste Disposal in Community Pharmacies of Karachi

Objectives: The aim of the study was to assess the knowledge of community pharmacies about recommended methods of drug disposal and hazardous effects of improper disposal of pharmaceutical waste and to determine the attitude as well as practice of community pharmacies about the proper disposal of pharmaceutical waste. Methods: A cross-sectional study was performed with 139 community pharmacies in Karachi, Pakistan by using non-probability convenient sampling technique. Predesigned structured questionnaire was distributed to different community pharmacies in Karachi and filled questionnaires were collected after one day. Data was analyzed using SPSS 22.0 Results: About 65 (46.8%) of the participants reported to have a system for regularly removing the expired or unused drugs by returning them to contractors/distributors. More than half 86 (61.9%) of the participants disposed of solid, liquid, semi-solid, controlled, and p-listed drugs in the rubbish bin. Approximately half of the participants believed that standard method for disposal of solid, liquid, semi-solid, controlled, and p-listed drugs is by flushing them down the toilet/sink. Conclusion: Our study showed that knowledge and practices of community pharmacies regarding disposal of unused and expired medicines were not satisfactory. However, most of the participants were well aware of the harmful effects caused by improper disposal of pharmaceutical waste on environment and showed positive attitude towards learning safe methods of management and disposal of unused and expired drugs.

Frequency of ABO Blood Groups and RhD Factor in Donors of District Nowshera

To screen the donors for the frequency of different blood groups, reason for deferral and comparative analysis of the donation in two consecutive years in the blood bank of Qazi Hussian Ahmed Medical Complex Nowshera, a cross sectional study was carried out from April 25, 2017 to May 5, 2019. A total of 3,429 donors were included in the study. The mean age of donors with standard deviation was 35+ 3.24 years. Three thousand eighteen (88%) of the donors were males. The distribution of RhD+ and RhD- blood groups was 89.90% and 10.09% respectively. The frequency of ‘RhD+ blood groups in target population’ was B: 1226 (35.75%), O: 807 (23.53%), A: 754 (22%) and AB: 296 (8.63%). The frequency of ‘Rh Negative blood groups’ was: B: 139 (4.05%), O: 95 (2.77%), A:84 (2.45%) and AB: 28 (0.82%). The packed cell wastage rate in our blood bank was 185 (5.4%). The donor deferral rate was 0.7%. Hepatitis B Virus was the major cause of deferral that was reported in 14 cases followed by HCV Virus in 13 cases. It was concluded that the frequency of ‘Rh-positive blood group’ was B,O,A and AB respectively. Blood Group B was noted in 35% of the donors that counted to be the major prevalent Rh positive blood group in our population. Regarding the Rh Negative blood group, again the frequency was B,O,A and AB. Blood group B- was prevalent as a major negative blood group in our population that was recorded in 4.05% cases. The seroprevalence of hepatitis in the donors was 0.7%.

Knowledge, Attitude and Practices of Undergraduate Medical and Nursing Students Regarding Basic Life Support Training

Objective: To assess and compare the Knowledge, Attitude, and Practices of Medical and Nursing Students regarding Basic Life Support Training Methodology: This cross-sectional study was done at the Shalamar Institute of Health Sciences, Lahore in a period of three months. Students from all years of MBBS and BS Nursing were taken as subjects. Participants satisfying inclusion criteria were requested to fill out a self-structured pre-tested questionnaire after informed consent. Data was analyzed using SPSS v.21. Results: There were 330 participants from MBBS and BS Nursing (50 from each class of MBBS and 20 from each class of BS Nursing). The age of participants ranged from 18 to 30 (Figure 1). Only 250 subjects had heard about BLS. Out of 330 participants, only 204 had good knowledge about BLS (Table 2) and 126 had poor knowledge of BLS where score of higher than 3 out of 7 was considered as good. Knowledge of Medical and Nursing students was compared and the p-value came out to be 0.088, which was considered insignificant. Only 34.5% of the participants had learned BLS by training and only 13.3% of the participants (Table 3) had practically done BLS. Most of the people gave no reason for not attending a training session for BLS. Conclusion: It was concluded that medical and nursing students had satisfactory knowledge of BLS and more attention was needed towards this important life-saving skill.

Effectiveness of Educational Training related to Disaster Preparedness among Nursing Students

Objective: To evaluate the effectiveness of educational training related to disaster preparedness among nursing students at Karachi Methodology: This quasi-experimental study was performed in Indus College of Nursing and Midwifery in Karachi. The study was carried out from June to November 2019 over a period of six months. Total sample size was 40. Both male and female final year nursing students were included. The participants were approached by using non-probability purposive sampling method. Validated questionnaire was used to collect the data. Data was entered and analyzed using SPSS version 22.0. Results: Out of total 40 subjects, 19 (47.5%) were males. A large number 23 (57.5%) of respondents’ ages lied between 23 and 27 years. Nearly half 21 (52.5%) of the participants’ educational qualifications were Matriculation. Majority 34 (85%) of participants did not have any formal education of disaster management. On the other hand, few 6 (15%) study participants had training of disaster management. Significance difference was found between pre and post knowledge score of disaster, burns, flood and earthquake practices among study participant and it is also statistically significant. Conclusion: It is concluded that there is an effect of educational intervention on pre and post knowledge of disaster, burns, flood and earthquake practices among study participants.

Association of Vitamin D and its Receptor (VDR) Gene Single Nucleotide Polymorphism (ApaI and TaqI) with Risk of Psoriasis

Introduction: Psoriasis is one of the skin related inflammatory diseases that affects a low percentage of population around the globe. Vitamin D through Vitamin D Receptor (VDR) also regulates the function of white blood cells in psoriasis. Mutations in VDR gene have shown abnormalities in immune responses like psoriatic arthritis. To determine the possible association between Vitamin D Receptor (ApaI and TaqI) gene polymorphism and psoriasis, a case-control study was designed and conducted at the Institute of Basic Medical Sciences (IBMS), Khyber Medical University (KMU) Peshawar and health units of Peshawar. Method: This multi-centre study included 220 samples (110 cases of psoriatic disease and 110 healthy controls). DNA was extracted using modified salting out protocol. VDR gene polymorphisms (TaqI and ApaI) were genotyped using amplification refractory mutation system using polymerase chain reaction (ARMSPCR) method. Results were statistically analyzed. Result: Our study showed significant association between VDR gene (TaqI, ApaI) polymorphisms and psoriasis with p-value of 0.009 (0.0019 and 0.0162) and odds ratios (95% confidence interval) for psoriasis of CC vs CT (TaqI) and AA vs AC (ApaI) were 2.963 (95% CI: 1.508-5.743) and 2.293 (95% CI:1.22-4.246) respectively. Conclusion: Findings indicate that VDR gene polymorphisms (TaqI, ApaI) are significantly associated with onset and progression of psoriasis, and mutations in these loci are risk factors for development of psoriasis. Key words: Psoriasis, VDR polymorphism, TaqI, ApaI, South Asia, Pakistan

Do Family Wishes Trump Verbal Advance Directive? An Ethics Case Report Amidst COVID-19

Covid 19 pandemic brought many challenges for public and healthcare workers. Healthcare workers all around the world are at the heart of this dreadful situation. While providing critical care to Covid 19 patients, they have faced many clinical as well as ethical dilemmas. The novelty and profound uncertainty associated with the clinical course of the disease introduced a dimension to the context of ethical dilemmas faced in clinical practice.

Importance of Face Masks during COVID-19

Corona virus disease also known as COVID-19 is a respiratory infection that is caused by the virus SARSCoV- 2, that spreads among the people by respiratory droplets usually produced by sneeze and cough, and by touching an object or surface used by an infected person. As COVID-19 pandemic is increasing, the best way to limit the outbreak is the use of face masks1,2 which helps in preventing transmission of the virus from a person to another by creating a barrier between the oral cavity and the nose of the wearer with the potential contaminants in the surroundings.3