Different Hospitals Of Lahore Research Articles

Self-Silencing and Marital Adjustment in Women With and Without Depression

This study compared women with and without depression on self-silencing, marital adjustment, and depression. The study also investigated the predictive role of self-silencing and marital adjustment for depression. Two samples were recruited from various Psychiatric units and General Medical wards of different hospitals of Lahore, Pakistan including 80 women diagnosed with depression (Mage= 37.16 years, SD = 8.5) and 80 women without depression (Mage= 36.64 years, SD = 7.7). Using Urdu versions of Silencing the Self Scale (Jack & Dill, 1991), Dyadic Adjustment Scale (Spanier, 1976) and DSM-5 Cross-cutting Measure for Depression and Severity Checklist for Depression (American Psychological Association, 2013), the results revealed that self-silencing was significantly higher in women with depression than the other group while marital adjustment was better in women without depression than the women with depression. Depression was positively correlated with self-silencing and negatively correlated with marital adjustment for the sample of women with depression. Regression analysis revealed Externalized Self-Perception subscale of Silencing the Self Scale appeared to be a positive predictor while Dyadic Satisfaction and Dyadic Cohesion subscales of Dyadic Adjustment were negative predictors of depression. The study implied that psychologists especially couple/marriage counselors may need to focus on the communication patterns of spouses for decreased chances of depression.

Methylglyoxal: Antimicrobial activity against blood culture isolates of Salmonella Typhi and other Gram negative rods.

Objectives:To evaluate the activity of Methylglyoxal against the blood culture isolates of Salmonella Typhi and various Gram negative rods and to compare the activity of Methylglyoxal against S. Typhi and other Gram negative rods.Methods:It was an experimental study conducted at the Department of Microbiology, University of Health Sciences (UHS), Lahore-Pakistan in collaboration with the Department of Microbiology, CMH Lahore, from July 2011 to June 2012. Recent blood culture isolates of S. Typhi and other Gram negative rods were collected from different hospitals of Lahore and kept stored at -80°C. As per the latest CLSI guidelines, morphological, biochemical and serological identification was carried out and antimicrobial susceptibility was tested. A multi-point inoculator was used to carry out agar dilution for determination of MICs of MGO. Results were determined after compilation of data using latest SPSS version.Results:MIC90 of MGO against the clinical isolates of S. Typhi was 0.20 mg/mL (2.8 mM) and against Gram negative rods it was 0.21 mg/mL (3.0 mM). The p-value of MICs of MGO against the isolates of S. Typhi was 0.023 when compared with Gram negative rods (p<0.05; statistically significant).Conclusion:MGO has a scientifically proven in vitro antimicrobial activity against blood culture isolates of S. Typhi and various Gram negative rods.

COMPARISON OF PORE SIZE ANALYSIS OF EXISTING AND EXPERIMENTAL SURGICAL GOWNS

… Majority of the public and private sector hospitals are using reusable gowns andscrubs whereas only a few hospitals are using disposable ones. Protection during surgery is veryimportant both for the patient as well as for the surgeon. The reasons are not only hygienic butalso creating a barrier so that the bacteria and the viruses do not transfer from patient to doctorand vice versa. The surgical gowns have been in use for many decades. With the advancementsin the field of manufacturing (weaving and finishing), the quality of gowns has been improvingover the period of time. In Pakistan, there is no awareness yet regarding the construction ofsurgical apparels viz. surgical gowns and scrubs so no standards are being followed as suchduring the manufacturing (weaving &amp; finishing) of surgical apparels. For effective barrier functionof surgical gowns and scrubs, it is necessary for them to comply with certain standards in terms ofphysical characteristics viz. mass per unit area, number of threads per unit length, tensilestrength etc. The idea behind this study was to evaluate the physical characteristics of surgicalgowns and scrubs currently being used in different public sector hospitals of Lahore. Objectives:(1) To evaluate the pore size of existing and experimental surgical gowns being used in differenthospitals of Lahore. (2) To compare the pore size analysis of existing surgical gowns withexperimental surgical gowns. Study Design: Experimental study design was used. Duration:January 2014- April 2014. Materials and Methods: Samples of fabric used for making surgicalgowns and scrubs were collected from different hospitals of Lahore and evaluated for pore sizewith the help of optic microscope. For experimental gowns the fabric was developed according tothe international standards. Pore size of surgical gowns was measured with the help of scanningelectron microscope. Results: The results showed large pores in existing surgical gown. Nolength or width wise pores in the experimental surgical gowns fabric except there are tiny holes of0.5 after 20 launderings. The existing reusable surgical gowns did not offer any resistance againstbacterial penetration because of large pores. Conclusions: The fabric used for the existingsurgical gowns was not up to the mark and did show large pores under microscope. Theexperimental surgical gown showed no pores in the fabric structure when subjected to scanningelectron microscope. The functional ability of resistance against bacterial penetration of thesurgical gowns is important because the risk of SSI. If the patient develops SSI weather it isgrades 1, 2 or 3, the cost is significant. The cost effectiveness of the existing reusable surgicalgowns becomes insignificant as none of the existing surgical gowns offer any resistance againstbacterial penetration and the risk of SSI with subsequent treatment cost. Necessary guidelinescan be formulated and proposed to the concerned departments of various hospitals, in the lightof which they can design some specifications and select appropriate materials for surgicalapparels in future.

Prevalence of anemia and associated risk factors among pregnant women in Lahore, Pakistan

ABSTRACTMaternal anemia is a frequent problem during pregnancy, especially in developing countries, such as Pakistan. In this context, the present study was conducted to determine factors associated with maternal anemia prevalent among women of different age groups visiting different hospitals in Lahore from February to April 2017. The current study used a cross-sectional design involving 390 pregnant women. Data related to demographic area, maternal age, gestational age/period, educational and income level, as well as socioeconomic status of all the participants were collected. Also, hemoglobin levels of the participants were obtained for assessment of maternal anemia. A total of 57.7% of participants were anemic (34.4 % mild and 23.3% moderate anemia). Bivariate analysis showed that less education (p = 0.01), occupation as housewife (p = 0.03), lower income (p = 0.001), rural residence (p = 0.028), and greater number of house members (p = 0.04) were significantly associated with maternal anemia. Results of multivariable logistic regression showed that low income was the only significant factor independently associated with maternal anemia. These results suggest that interventions, such as the Nutrition Support Program, to improve nutritional status of pregnant women by providing free food supplements with focus on the poor and marginalized communities are recommended to prevent anemia.

The therapeutic effectiveness of sitagliptin with niacin and chromium picolinate on glycosylated hemoglobin in type 2 diabetes mellitus patients

Purpose: The purpose of this study was to evaluate the effectiveness of niacin (B3) on glycosylated hemoglobin (HbA1c), alone and as adjunct therapy, with chromium picolinate (CrPlt) and sitagliptin. In the present study, we have evaluated the effects of niacin and chromium picolinate supplementation with sitagliptin in Type 2 diabetes mellitus (T2DM) patients.&#x0D; Methods: A randomized controlled trial was conducted on 600 patients suffering from T2DM from four different hospitals in Lahore, Punjab, Pakistan; patients were divided into three groups (n=200 per group). Group A was given sitagliptin (100 mg), Group B received niacin (14 mg/d) along with sitagliptin, and Group C received chromium picolinate (200 mcg/d) and niacin (14 mg/d) along with sitagliptin, for a duration of 6 months. Analysis of variance (ANOVA) was used to compare the efficacy of all treatment groups, and statistical significance was set at p≤0.05.&#x0D; Results: The data indicated that all defined therapies have a significant influence with respect to fasting blood sugar (FBS) (p&lt;0.0001), random blood sugar (RBS) (p&lt;0.0001) and glycosylated hemoglobin (p&lt;0.0001).&#x0D; Conclusion: Our study demonstrated that low doses of niacin and chromium picolinate supplementation with sitagliptin helps in maintaining glycemic control in patients with T2DM, and provides the best treatment option among those considered.

Assessment of prescribing potentially inappropriate medications listed in Beers criteria and its association with the unplanned hospitalization: a cross-sectional study in Lahore, Pakistan.

Background and objectivesDue to physiological and pharmacological variations, geriatrics are at high risk of experiencing life-threatening outcomes related to the use of potentially inappropriate medications (PIMs). Thus, the present study aims to evaluate prescribing practices of PIMs among elderly patients who may lead to unplanned hospitalization and associated risk factors.MethodsA cross-sectional study was conducted in different hospitals of Lahore, Pakistan. The study population consisted of geriatric patients aged ≥65 years. Data were collected from the medical records of geriatric patients, who attended these selected hospitals between December 1, 2017, and February 28, 2018. Data were analyzed using SPSS (IBM SPSS Statistics for Windows, Version 21.0) and Microsoft Excel (MS Office 2010).ResultsThe records of 385 geriatric patients were investigated. More than half (60.8%) of the patients were subjected to polypharmacy, which can be defined as the utilization of 5–9 drugs by the patient at the same time, whereas 36.4% were prescribed with one PIM and 56.4% were hospitalized due to PIMs. Majority of them were prescribed with PIMs including N02BA01 (aspirin, 32.4%), A02BC01 (omeprazole, 23.6%), A10AB02 (insulin, 17.4%), A02BC05 (esomeprazole, 8.5%), C08CA01 (amlodipine, 8.3%), and R06AA02 (diphenhydramine, 5.9%). Results of regression analysis revealed that patients exposed to polypharmacy (OR=2.556, 95% CI=1.579–4.135, P-value≤0.001) and excessive polypharmacy (OR=37.828, 95% CI=4.754–300.9, P-value≤0.001) were significantly associated with unplanned hospitalization, whereas factors such as age 75–84 years (OR=0.343, 95% CI=0.156–0.756, P-value=0.008) and polypharmacy (OR=2.480, 95% CI=1.219–5.048, P-value=0.012) were significantly correlated with PIMs.ConclusionThe utilization of PIMs listed in Beers criteria among geriatric population can cause unplanned hospitalization. As the patients receiving polypharmacy are at high risk of unplanned hospitalization, so caution must be exercised in prescribing PIMs for elderly people.

Evaluation of Recent Medication Therapies of Asthma in Different Hospitals of Lahore City, Pakistan

Asthma is the episodic and most chronic disease that exists worldwide. Factors that trigger asthma are allergens, pollens, cigarette smoke, dust, mites, and animal dander, cockroaches and food. A increased knowledge of asthma, its causes and prevention influence the researchers to find out new and improved medication therapies for future to serve asthma patients is a great opportunity for ambulatory care pharmacists. A questionnaire based, cross-sectional study was planned for this research. Questionnaires were standardized based on common research or they can be customized to meet the specific data gathering need. The study was conducted at five different hospitals of Lahore, Children hospital Lahore, Jinnah hospital Lahore, General hospital Lahore, Social security hospital Lahore and Chaudhary Muhammad Akram teaching and research hospital Lahore. The results indicated that 85% of population is suffering from asthma. 91.5% of population is any taking medication for asthma. Most recently used medication for asthma are inhalers i.e. 80% and inhaled corticosteroids i.e. 82%.Patients are taking medication therapies for asthma but most commonly used are inhalers and steroids. Education provided by pharmacist about asthma was an integral part of health maintenance services its management to control or prevent further attacks because of his knowledge in pathophysiology pharmacology and medication techniques of asthma. Pharmacist driven medication therapy management services were economically stabilized.

Effect of Company during Academic Years on Habit of Cigarette Smoking among Doctors

Abstract&#x0D; Objective: To assess the effect of company during academic years on the habit of cigarette smoking.&#x0D; Materials and Methods: This Cross-sectional descriptive study was conducted in130 doctors from three different hospitals of Lahore. Written consent was taken; participants were questioned about smoking habit. Data was analyzed using SPSS20.&#x0D; Result: Doctors (all smokers) were questioned about smoking habits. Response rate was 100%. The greatest percentage of Doctors started smoking due to influence of friends and family (65%). Majority of them stayed in private hostels (58%) and flats (29%) during their academic years. These doctors showed greater tendency towards smoking than the doctors that stayed with their family/children (15%).&#x0D; Conclusion: Our results showed a marked tendency of tobacco smoking in doctors living without their families/children in Lahore. Majorities have the smokers in their friend’s circle and had started smoking under influence of them. Doctors who lived in private&#x0D; flats/hostels showed increase in tobacco use than who lived in the houses.&#x0D; Key words: Cigarette smoking, Hostelites, Smokers in friends and family.

Effect of Company during Academic Years on Habit of Cigarette Smoking among Doctors

&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;To assess the effect of company during academic years on the habit of cigarette smoking.&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and Methods:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;This Cross-sectional descriptive study was conducted in 130 doctors from three different hospitals of Lahore. Written consent was taken; participants were questioned about smoking habit. Data was analyzed using SPSS20.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;Doctors (all smokers) were questioned about smoking habits. Response rate was 100%. The greatest percentage of Doctors started smoking due to influence of friends and family (65%). Majority of them stayed in private hostels (58%) and flats (29%) during their academic years. These doctors showed greater tendency towards smoking than the doctors that stayed with their family/children (15%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;Our results showed a marked tendency of tobacco smoking in doctors living without their families/children in Lahore. Majorities have the smokers in their friend’s circle and had started smoking under influence of them. Doctors who lived in private flats/ hostels showed increase in tobacco use than who lived in the houses.&lt;/p&gt;

Identification of the Risk Factors Associated with Helicobacter pylori Infection in Lahore, Pakistan

In this study, significant risk factors of Helicobacter pylori infection in Lahore are investigated through a case-control study by using descriptive and analytical approaches. A sample of 362 subjects was selected from the Gastroenterology Departments and OPDs of different hospitals of Lahore. About 25 risk factors with sub categories were included in the study. For bivariate analysis, the chi-square, phi/v statistics and Kendall’s tau-b are used. From descriptive analysis, it was found that the persons who eat from restaurants have more risk of infection as compare to persons who eat homemade food. By the descriptive analysis, it was also observed that risk of Helicobacter pylori infection increases with an increase in the number of family members per house and in the number of persons living per room. Furthermore, similar results were observed in the bivariate analysis. In the analysis, the five risk factors including age, food eat, food liked, dental complains and number of persons living per room are found to be positively significant having the odds ratios and 95% confidence intervals of odds ratios (1.025; 1.003-1.047), (9.596; 4.767-19.314), (3.500; 1.509-8.119), (3.204; 1.685-6.094) and (2.772; 1.496-5.139), respectively. While the three risk factors including usage of tea, educational level and sewerage system are found to be negatively significant having odds ratios and 95% confidence intervals for the odds ratios (0.221; 0.119-0.411), (0.216; 0.115-0.404) and (0.401; 0.218-0.738), respectively, which indicates that these three risk factors are protective factors against Helicobacter pylori infection. According to this study, the subjects who eat from restaurants have higher risk of Helicobacter pylori infection as compared to all other risk factors.

Gender differences in resilience and psychological distress of patients with burns

This research explored the gender differences in resilience and psychological distress of patients with burns. In Pakistan, psychological states of patients with burns have not been widely studied, women making up as the neglected section of society lag far behind in availing the needful health facilities. It was hypothesized that there would be significant gender differences in resilience and psychological distress of patients with burns. The sample of the study consisted of 50 patients with burns, obtained from four different hospitals of Lahore. In order to investigate resilience and psychological distress, the State Trait Resilience Scales (Hiew, 2007) and Kessler Psychological Distress Scale (Kessler, 2001) were used. In addition to these, self-constructed demographic questionnaire was administered. The data was analyzed using SPSS version 16.0. Independent sample t-test was conducted to find gender differences in resilience and psychological distress. The findings from the current research revealed that there were significant gender differences in resilience and psychological distress of patients with burns. The insightful findings from the current research carry strong implications for the clinicians, psychologists and policy makers who can help to develop and implement the rehabilitation programs for the affected population and can launch resilience promoting programs that would help them in coping with burns in effective manner.

English

Dengue fever is a vector-borne viral disease which is now endemic in more than 100 countries affecting more than 2.5 billion people worldwide. In recent years, dengue fever has become a major threat to public health in Pakistan. In this paper, we derived an explicit formula for reproduction number R0 (the most important epidemiological parameter) and then used real data of dengue fever cases of different hospitals of Lahore (Pakistan) on R0. Conditions for local stability of equilibrium points are discussed. In the end, simulations are carried out for different situations.

Sequence variants on 17q21 are associated with the susceptibility of asthma in the population of Lahore, Pakistan

Objective: Single nucleotide polymorphisms (SNPs) on 17q21 are known to be associated with asthma disease in multiple populations. This study was designed to know whether this region is associated with asthma in Lahore region population or not. Methods: A total of 200 asthma patients and 100 healthy controls were enrolled from different hospitals of Lahore, Pakistan. Twelve SNPs from chromosomal region 17q21 were analyzed in cases and controls by single base extension method and capillary-based genetic analyzers. Associations with asthma were checked using basic allelic model, genotypic model, and results were adjusted by logistic regression analysis using PLINK v1.9. Pair-wise linkage disequilibrium among the SNPs was analyzed by using Haploview software. Results: SNP rs3816470 showed a strong association (p = 8.89 × 10−5, Odd Ratio = 3.082 [1.755-5.41]) with asthma, whereas rs3859192 and rs6503525 also showed a significant association with the development of asthma, especially in the case of positive family history. In LD block1 (93 kb) consisting of six SNPs (rs12936231, rs7216389, rs7216558, rs9894164, rs1007654 and rs7212938), none of the haplotypes show any significant association with asthma except the haplotype “CCTCAG”, which is a significant protective factor against asthma having frequency 0.051 in controls while 0.017 in cases (p = 3.56 × 10−2, χ2 = 4.415). Conclusion: The present study reports that the polymorphic genomic variant rs3816470 is significantly and independently associated with asthma in the studied population, while the variants, rs6503525 and rs3859192, also indicate a significant association with asthma in this population when family history of the disease is taken as a covariate.

ALTERNATIVE MEDICINE;

From ancient times, humankind has used self-created traditional methods for handling the illnesses and continues to use them along with modern medicine. Even today, more than 70% of the world’s population still depends on the complementary and alternative systems of medicine (CAM). The objective of this study is to create awareness of health hazards with the use of CAM therapies and to find out its utility among Pakistani population. Comprehensive questionnaire was developed for the study on the use of CAM and was distributed to 470 patients/attendants in different hospitals of Lahore as well as major hospitals and clinical setups in the peripheral regions of Lahore, Pakistan. Over all, the response rate of the study was 81.7% while 78.1 % population found as CAM user. The most common type of alternative medicine used by patients is from Hakeem (Natural Therapist) which is about 17% and the most frequent disease for which patients often go for CAM therapy is liver diseases (19%). Respondents found inclined towards CAM only due to its marketed false benefits and not because of their dissatisfaction with conventional therapy. Conclusions: A noteworthy population of Pakistan is using CAM therapies from different practitioners, irrespective of any education and awareness about their disease and long-term drawbacks because of improper treatment of the disease. Though adverse events due to the use of CAM therapy are not unusual still a delay in the proper treatment usually ends up in serious consequences and even loss of lives.

Comparison of awareness about nephrology and kidney diseases amongst doctors in institutes with and without nephrology departments.

To compare the awareness about nephrology and kidney diseases in medical officers and postgraduate trainee doctors working in institutes with and without nephrology departments. This cross sectional study was conducted at Nephrology Department, Shalamar Hospital Lahore from 1(st) Jan to 31(st) Mar 2013. Doctors working on medical floor with more than one year experience after house job were included in the study. Each doctor was given questionnaire comprising of 28 questions. Two hundred and eleven doctors fulfilling the criteria were included in the study. Most of the doctors were male 150(71.1%). Knowledge had strong correlation with practice (p= 0.001). Knowledge regarding nephrology and chronic kidney disease (CKD) was found significantly different among doctors of different hospitals [(F=36.09, p=0.000). Practice regarding nephrology and chronic kidney disease (CKD) was found significantly different (F= 7.222, p=0.000)] among doctors of different hospitals of Lahore. Doctors working in the Shaikh Zayed Hospital (SZH), Lahore were having maximum score in the components of the knowledge and practice than other hospitals. Awareness of the Medical Officers and postgraduate doctors is poor regarding nephrology and kidney diseases. Doctors working in institutes with established nephrology services have better knowledge than other units. Working experience of doctors improve the practice significantly.

PIH69 - Adverse Drug Reaction Reporting System At Different Hospitals Of Lahore - An Evaluation And Patient Outcome Analysis

Adverse drugs reactions (ADRs) are known to be a major cause of morbidity and mortality. However, only a very little proportion is reported. ADRs contribute to the incidence of adverse events, resulting in increased health care costs. An increase in the number and quality of reports by improving ADR reporting system in hospitals, highlight the importance of ADR including general awareness could improve patient outcome and save healthcare costs. Ministry of Health (MOH) has done some work but still major requirements are needed to run a proper ADR program. The first part of this project was to review the ADR reporting system in Pakistani hospitals, to determine the factors contributing to the ADR reporting rate and benchmark with developed countries. Data was collected by self-administered questionnaire. The response rate was 83.3%. 24 (80%) hospitals have no proper ADR system; five (16.7%) hospitals are targeting few of the drugs for ADR reporting while only one (3.3%) hospital has a proper ADR policy including online reporting system as well. Only seven (23.3%) hospitals have a policy of ADR reporting which is running under Pharmacy Department.

KNOWLEDGE ATTITUDE AND PRACTICE (KAP)OF CHRONIC KIDNEYS DISEASE AMONG MEDICAL OFFICERS OF TEACHING HOSPITALS OF LAHORE

BSTRACT Objective: This study was conducted to determine the knowledge, attitude and practice (KAP) about kidney diseases among medical officers working in different hospitals of Lahore. Study Design: Cross sectional Study. Place and Duration of the study: Department of Nephrology, King Edward Medical University, Mayo Hospital, Lahore from 1st Jan 2013 to 31st March 2013. Methodology: Doctors working on the medical floors of different tertiary care teaching hospitals [Mayo Hospital (MH), Sir Ganga Ram Hospital (SGRH), Service Institute of Medical Sciences (SIMS), Fatima Memoral Hospitals (FMH), Lahore General Hospitals (LGH), Shalamar Hospital (SH), Jinnah hospital (JH)] of Lahore were included in the study. Each doctor was given a questionnaire comprising of 28 questions. Each participant was given 10-15 minutes for completing the questionnaire at the spot. Categorization of doctors according to the KAP score was done as poor ( 70%). Results: One hundred eighty five doctors participated in the study who fulfilled the criteria. In this study majority 134 (62.6%) of the doctors were not taught about nephrology during their graduation which was statistically significant. Most of the doctors either had some knowledge or didn't know about procedures done in nephrology. Majority of the doctors 208(97.2%) know that nephrology deals with medical diseases of the kidney which was statistically significant. Most of the doctors 138(64.5) feel that nephrology services are insufficient in their hospital. More than 90% doctors want that kidney diseases should be taught during MBBS curriculum and separate nephrology department should be established which was statistically significant. Most of the doctors don't know the management of hyperkalemia very well. About 90% of the doctors know that there are five stages of CKD. Majority of the doctors know that ACE inhibitors are used in hypertension and diabetic nephropathy. They also know that urine complete examination help in early detection of diabetic nephropathy which was statistically significant. Conclusion: Most of the doctors have poor to average knowledge and practice about kidney diseases. Most of the doctors think that nephrology services are insufficient in their hospitals and it must be taught during graduation. Separate nephrology department should be established for creating awareness about kidney diseases Key words: Kidney diseases, Knowledge, Attitude, Practice, Nephrology, Doctors.

English

Extended spectrum beta lactamase (ESBL) producing members of the family Enterobacteriaceae are a major health problem in the hospitals and community. These enzymes confer bacterial resistance to penicillins, first, second and third generation cephalosporins and aztreonam. The prevalence of ESBLs varies from organism to organism and is increasing day by day. The study was designed to test typhoidal salmonellae for production of ESBL. One hundred and fifty eight (158) isolates of typhoidal salmonellae; Salmonella Typhi (n=126), Salmonella Paratyphi A (n=26) and Salmonella Paratyphi B (n=6) were collected from different hospitals of Lahore and Gujranwala. The isolates were identified morphologically, biochemically (API-20E) and serologically (BD Difco, USA). ESBL production has been tested by three methods; CLSI screening method, double disk diffusion synergistic method and CLSI phenotypic confirmatory method. CLSI screening method detected twenty two (22) strains as ESBL producers. However, when tested by the CLSI confirmatory method and by disk diffusion synergistic method, none proved to be ESBL producer. Based on our study, we concluded that the extended spectrum beta lactamase enzyme does not exist in tested clinical isolates of typhoidal salmonellae, however the isolates suspected to be ESBL by phenotypic methods must be subjected further for molecular analysis. Key words: ESBL, typhoidal salmonellae, isolate.

RISK FACTORS LEADING TO HIGH PREVALENCE OF BREAST CANCER

Breast cancer in women causes psychological and physical distress. It is the most commonly diagnosed female cancer in all cancers. Breast cancer is among the top 20 causes of deaths in Pakistan. It is believed that various factors such as gender, age, socioeconomic status, family history, physical activity, smoking, breastfeeding/lactation, no. of full term and incomplete pregnancies, hormonal and reproductive factors influence the incidence of breast cancer. A prospective as well as retrospective study was conducted on 100 patients in different hospitals of Lahore, aiming to evaluate risk factors leading to high prevalence of breast cancer in women. A questionnaire was designed to obtain patient history, patient complaint and management regarding disease. Females of all age groups were included in the study. The data collected was analyzed and presented in the form of graphs and tables. The results were derived and conclusion presented. Women with advanced age, having middle class family background, higher body mass index and a high ratio of incomplete pregnancies were at significantly increased risk of breast cancer. Obesity and the use of oral contraceptives are minor whereas family history, employment status, physical activity and smoking don’t serve as risk factors. The protective role of breastfeeding/lactation and full term pregnancies is suppressed and not very significant.

EMOTIVE EFFORT AMONG MEDICAL PROFESSIONALS IN PAKISTAN

The aim of this paper is to investigate the relationship between work complexity, emotive effort and its effects on job satisfaction and Emotion Management related stress among medical professionals; as in accordance with ‘The Managed Heart’ by Arlie Hochschild, it is asserted that emotive toil is carried out by medical professionals. Correspondence among work complexity, emotive toil and job satisfaction are ascertained by circulating questionnaires among medical personnel. This correspondence is investigated by the use of regression analysis. Conclusions drawn on the basis of analysis disclose that emotive struggle was considerably negatively associated to job satisfaction and work complexity. The research verdicts are only restricted to the medical professionals working in different hospitals in Lahore, Pakistan.