Karachi Institute Research Articles

Efficacy and safety profile of Glucagon-Like Peptide-1 Receptor Agonist in obese Type-2 diabetes patients from a private institution in Karachi.

To assess the effectiveness of GLP-1RAs in managing obese T2DM patients. This prospective cohort analysis was conducted at Medicell Institute of Diabetes, Karachi, Pakistan; from July 2019 to July 2021. A total of 97 obese individuals >16 years of age with T2DM and IGT were initially enrolled, and 81 patients who showed up for the follow-up were prescribed one of the three GLP-1RAs available in Pakistan. Out of 81 patients who showed up for the follow-up visit, 43 had received Liraglutide, 25 were taking Dulaglutide, and 13 had been prescribed IDegLira supplemented with oral hypoglycemic medications ± insulin. The mean age of the enrolled patients was 49.21(12.44) years, and there was female predominance (55.6%). Overall, there was a significant weight and BMI reduction among the patients treated with either of the GLP-1RAs (P<.01). Furthermore, significant glycemic control was observed in all three groups after the treatment. The Dulaglutide group demonstrated a more significant reduction of HbA1c compared to Liraglutide group, which showed more pronounced weight and BMI reduction. Nevertheless, this class of medications was well-tolerated, with nausea being the most often reported side effect. GLP-1RAs showed favorable weight and HbA1c reduction among patients of all three treatment groups.

Knowledge, attitude, and perceptions about cancer genetic testing in clinical practice in Karachi, Pakistan.

Healthcare professionals (HCP) play an important role in the practical application of genetic screening tests but often feel inadequately prepared for cancer genetic testing (CGT) in clinical care. As the complexity of gene-related malignancies increases, it demands HCPs' preparedness to cater to patients' needs. Therefore, the aim of our study is to assess the knowledge, attitude, and practices of HCPs in Pakistan regarding the application of cancer genetics. Our cross-sectional survey was conducted from April 2022 to June 2022 amongst HCPs at a private and a governmental institution in Karachi, Pakistan. Non-probability random convenience sampling was used to select the population; however. non-clinical HCPs, as well as Interns, were excluded from our study. A total of 210 HCPs, 56.7% (119) bearing an experience of over 5years of clinical experience, were included in this study. Most respondents from both hospitals deemed their knowledge inadequate, with only 2% (2) and 1.8% (2) being extremely knowledgeable, respectively. 68.6% (144) HCPs displayed a positive attitude towards CGT, with 55.2% (116) participants perceiving CGT in a positive light. As compared to the private sector, significantly more HCPs in the public sector dedicated ≥ 5h/week for CME (P = 0.006), and were better prepared to counsel patients (P = 0.021) and interpret results concerning CGT (P = 0.020). Additionally, screening tests for specific cancer types were popularly considered a worthwhile avenue of investment to improve the current state of CGT in our healthcare system [47.6% (N = 100)]. Demonstrating a lack of knowledge among Pakistani doctors, our results call upon the need for additional training concerning CGT in both the public and private sectors alike. Understanding specific gaps in knowledge may further help enhance post-graduate training programs and eventually lead to effective incorporation of CGT into our healthcare setting.

Abstract #1386026: Outcome of Radioactive Iodine Treatment and its Association with Various Parameters in People Presenting with Hyperthyroidism at Tertiary Care Hospital of Karachi, Pakistan

Hyperthyroidism is a common disorder of thyroid gland with multiple etiologies and radioactive iodine (RAI) is one of the important modalities to treat it. The outcome after RAI treatment is unpredictable as it is influenced by many factors. Successful treatment is determined by development of euthyroidism and / or Hypothyroidism within 6 months of radioactive iodine treatment. The aim of this study was to find out the outcome of RAI treatment and its association with factors like age, gender various etiologies of hyperthyroidism, and baseline TSH, FT4 in our population. This retrospective case series study was conducted at Karachi institute of Radiology and Nuclear Medicine” (KIRAN) from January 2018 to June 2020. Among 537 who were given RAI for hyperthyroidism a total of 199 participants with complete data were recruited in study after IRB approval. Demographic details, age, gender, underlying cause of hyperthyroidism (graves disease, toxic multinodular goitre, solitary toxic nodule etc,) were obtained from medical records along with baseline FT4 & TSH. A fixed dose of 15mci of radioactive iodine was given to all patients and TSH and FT4 were measured at 6 weeks 3, 6, and 12 months to evaluate the outcome of RAI treatment. The data was analyzed by SPSS version 20 to compute mean standard deviation and percentages. A total of 199 participant’s data was analyzed, 77.9% were females and 22.1% males with mean age of 41.32±0.99 years. Seventy-four 74.4% participants had diffuse toxic goiter (Graves’ disease) and 15% had solitary toxic nodule or toxic multinodular goiter. Post RAI TSH target (either normal or high) was achieved earlier at 6 weeks in comparison to FT4 (normal or low) that attained at 3months. Outcome of RAI treatment in patients with Graves’ disease and toxic nodule revealed statistically significant and early result by normalization and or increased TSH at 6 weeks 3, 6 and 12 months (p-value <0.05), and FT4 normalization was only seen in patients with graves’ disease in each measurement compared to other etiologies. Females revealed statistically significant and early improvement in both biochemical markers i-e TSH and FT4 at all point of time (normalization of TSH at 6 weeks, increased TSH / and normalization of FT4 at 3, 6 and 12 months) in comparison to males who showed statistically significant improvement in TSH in all points of measurement. Patients with aged greater than 40 years observed early response after RAI by normalization of FT4 at 6 weeks compared to those aged < 40 years. The treatment failure rate was 24.5% at 6 and 12months whereas successful treatment was noticed in 35%, 56%, 75.6%, 75.6% at 6 weeks, 3,6,12 months respectively. Female Participants with Graves’ disease of age greater than 40 years responds better and early to RAI treatment by achieving successful treatment goals compared to elderly males with underlying diagnosis other than graves for hyperthyroidism.

Role of Absorptive Capacity for E-learning and Organizational Culture on Job Performance: An Empirical Study from Pakistan

Employee job performance is a critical topic of interest and concern for the organization. In order to evaluate the factors that may impact employee job performance in the context of COVID-19 pandemic, this study aims to explore the impact of absorptive capacity for e-Learning on the job performance of teaching faculty. Additionally, the study explored how organizational culture may act as a mediator. The COVID-19 pandemic calls for a transformation in the educational system from the physical to the virtual, which requires teaching faculty to increase their E-learning proficiency. It was necessary to assess each faculty member's effort in this situation. An analytical cross-sectional study design was used to collect data from the teaching faculty of higher education institutions in Karachi, Pakistan. The sample size was 377. Data was collected through reliable and valid self-administered tools. SPSS 23.0 and the PROCESS macro were used to conduct data analysis. Empirical findings from the study demonstrate the significant positive effect of knowledge recognition, assimilation, transformation, and exploitation on job performance. Furthermore, organizational culture significantly mediates the effect of knowledge recognition, assimilation, transformation, and exploitation on job performance. The findings have important implications for managers and policymakers besides employees in creating opportunities for their employees to develop high absorptive capacity and recommend managers to create an appreciative climate within their organizations, which may influence job performance.

Effect of Lifestyle Modification Upon Dysmenorrhea and Pain Severity in University Students of Karachi- Prospective Study

Aim: To evaluate the effect of lifestyle modification upon dysmenorrhea and pain severity in university students of Karachi. Methodology: This is a prospective cohort study, the sample size was 383 participants, and data was collected from the Karachi institute of health sciences. Participants were followed after lifestyle modifications, weight reduction, stress management, physical exercise, and nutrition. Menstruation pain severity was measured by pain visual analog scale score (VAS) score, after 4 weeks and 8 weeks of modification follow-up, participants were asked to fill a validated questionnaire including pain VAS score again to assess the difference in dysmenorrhea and its associated symptoms. Results: Out of 383 study participants, the mean age was 22.2±1.9 years while the mean weight was 72.9±4.7 years, mean age of menarche was 13.4±0.7 years. Pain VAS score was categorized within mild and tolerable, moderate and Uncomfortable, and severe with an immediate need for medical intervention, indicating 82(21.4%), 195(50.9%) and 106(27.6%) frequencies respectively. The effect of lifestyle modification afterthe first menstruation cycle questionnaire was filled again, and results indicated mild, moderate, and severe results as 277(72.3%), 90(23.4%) and 16(4.1%) while on the second cycle 343(89.5%), 34(8.8%) and 6(1.5%) were identified respectively. Conclusion: Lifestyle modification, maintaining a healthy weight, having proper nutrition, and managing stress can sufficiently reduce the chances of dysmenorrhea and decreases the severity of menstrual pain. Keywords:Dysmenorrhea, Pain-vas score, lifestyle modification

Infection Control Practices Followed by Postgraduate Residents of Public and Private Dental Institutions of Karachi During the COVID-19 Pandemic

OBJECTIVE: To gain an insight into cross infection protocols being followed by dental postgraduate residents in the prevention of the spread of coronavirus. METHODOLOGY: A cross-sectional survey-based study was conducted using questionnaires, which were distributed among dental postgraduate residents working in different public and private institutes in Karachi, through social media. Data was analysed using SPSS, version 21.0 with p-value &lt;0.05 to determine significant differences between both sectors. RESULTS: Ninety seven residents from both institutes responded. 60 (93.75%) and 29 (87.87%) residents from the public and private institutes respectively, reported to having the patient's temperature checked with an infrared thermometer. However, a lower compliance was noted in regard to the use of hand sanitization with a hydro alcoholic solution by both institutes with 28 (43.75%) from public and 24 (72.72%) from private institutes. 11 (17.18%) residents from public institutes responding with disposal of PPE after every patient, whereas 1 (3.03%) resident from a private institute responded with disposal after every patient. However, due to a smaller sample size, the differences were not statistically significant. CONCLUSION: The pandemic has exposed numerous shortcomings in the dental healthcare system, regardless of the sector. Since COVID-19 is likely to become an endemic, compliance with cross infection protocols needs to be improved so as to prevent its rapid spread. In a third world country like Pakistan, where resources are already scarce, greater emphasis needs to be placed on funding the dental healthcare system to enhance basic cross infection controls.

Knowledge, Attitude, and Practices of Soft Drinks and its association with gender among Nursing Students, Karachi, Pakistan

It has been recognized that soft drinks have become the third most consumed beverage worldwide. In contrast, it has a detirmental effect on health. Objective: To assess the knowledge, attitude, and practices of soft drink consumption and determine its association with gender among nursing students in Karachi, Pakistan. Methods: This cross-sectional study was accomplished at three nursing institutions in Karachi from 1st January 2018 to 30th June 2018. In this study, there was a total of 369 students of male and female gender were enrolled for the study. Subjects were approached by a non-probability convenient sampling method. Self-structured and pretested questionnaire was used for the collection of data. Results: Among 369 subjects, the majority of 261 (70.7%) were male, and 315 (85.4%) were single. 310 (84%) participants knew the deleterious effects of soft drinks. More than 85% admitted that soft drinks are bad for health. Two knowledge questions heard about soft drinks and the idea of the bad effects of soft drinks showed statistically significant associations with gender variables (p-values &lt; 0.05). Whereas only attitude questions regarding the amount of drink students prefer and one practice question related to favorite drink were found to be significantly associated with gender variable (p-values &lt; 0.05). Conclusion: Most nursing students had a fair knowledge of soft drink and their hazardous effects on their health. Despite knowing the harmful consequences, nursing students consume soft drinks.

Relationship of Emotional Intelligence and Academic Burnout with Mediating Effect of Self-efficacy among University Students

The present study investigated the association between emotional intelligence (EI) and academic burnout with a self-efficacy’s (SE) mediating effect among university students. A cross sectional research design was used in this study which was carried out in Karachi from September 2018 to January 2019. The sample involved 400 full time regular university students from different academic institutions in Karachi, Pakistan. The participants ranged in age from 16 to 25 years (M=21.28, SD=2.12). Participants were given the Schutte Emotional Intelligence Scale, the Academic Self-Efficacy Scale, and the Academic Burnout Scale to investigate the association between a student's emotional intelligence, academic self-efficacy, and academic burnout. The descriptive statistics and linear regression analysis were used to compute the results. The findings show that emotional perception, emotional use, emotional self-management, and managing emotions with others were identified as the significant predictors of academic self-efficacy. It was determined that emotional intelligence and academic self-efficacy played a significant influence in preventing academic burnout among undergraduate students. Students with high levels of emotional stability perform better academically, which is influenced by emotional intelligence. Through developed curricula, trainings, exercises, and awareness sessions, educational institutions may create a variety of strategies to sustain not just students' academic performance but also their ability to operate normally in daily life. Academic administrators can readily manage students' academic burnout if they focus on these factors.

Assessing Resilience in Healthcare Setups of Karachi using Connor Davidson Resilience Scale

Abstract: Background: Healthcare sector of Pakistan is complex and changing rapidly. This complex and transforming phase create more hurdles for employees especially for healthcare managers. During this transition phase, healthcare managers are burdened with more ncertainties and adversities. Managing under these circumstances is not an easy task as this requires frequent adaptations. One of the most important traits that can aid in these adaptations is resilience, which is ignored in healthcare management. Objectives: The first and main objective of the study is to assess the extent to which the healthcare managers are resilient. Secondly, to compare the resilience of public and private sector healthcare managers. At last, to assess the impact of gender, income and other demographic variables like age, socioeconomic status, marital status, education, designation, and work experience etc. Materials and Methods: It was a cross sectional study conducted at 13 different leading healthcare institutes of Karachi. These hospitals and healthcare services were divided broadly according to public and private sector categories. Employees were asked to complete structured questionnaire, a 25 item Connor Davidson Resilience Scale (CD-RISC) and demographic characteristics. Data were collected from 438 healthcare managers working at tertiary care hospitals in Karachi. Results: Health managers at both sectors were found resilient, with mean score of public sector and private sector were 52.55 (SD± 15.05), and 50.74 (SD± 14.15) respectively although the relationship was found insignificant relationship. Income, experience, designation, and worksite variables were significantly associated with resilience while age, gender, working hours, marital &amp; socioeconomic status were insignificant. Conclusion: In conclusion, the healthcare managers working in both public and private sector were found resilient. There was no significant difference found in resilience of male and female healthcare managers. In addition demographic variables like age, marital status, socioeconomic status, and working hours showed no significant relationship with resilience while designation, income, working experience, and worksite variables showed significant relationship with resilience.

Undergraduates’ experiences of the post RN BScN program, Karachi, Pakistan

Introduction: Nursing education has a major responsibility in preparing nurses for clinical practice. In Pakistan, most of the nurses are diploma qualified. Post Registered Nurse Bachelor of Science in Nursing (Post-RN BScN) program plays a substantial role in the transition from diploma to degree. Therefore, it is necessary to explore the experiences of graduates of Post-RN BScN for the successful implementation and quality improvement of the program.&#x0D; Objectives: This study explored the strengths and weaknesses of the Post-RN BScN through experiences of the nurses who completed the BSc N program in 2015 in nursing education institutions in Karachi, Pakistan.&#x0D; Methodology: The qualitative descriptive exploratory study was designed to explore the experiences of the nurses who completed the Post-RN BScN in 2015. Purposive sampling was used for data collection through semi-structured interviews. Data was analyzed through the content analysis method, through which sub-themes and themes emerged.&#x0D; Results: The study participants from a public sector highlighted the strengths of program, such as integration of theoretical knowledge into clinical practice, having graduate qualified faculty, and having appropriate technological and education resources. Whereas, majority of the participants were concerned about the lack of integration of theoretical knowledge into clinical practice, under qualified faculty with unsatisfactory teaching competencies, inaccessibility to and unavailability of resources.&#x0D; Conclusion: The study provided recommendations for stakeholders for improvement in the quality of nursing education by addressing major areas such as integration of theory into practice, competencies and shortage of the faculty members, and provision of technological and educational resources.

Experiences of virtual teaching during COVID-19 in medical institutes of Karachi, Pakistan: teachers' perspective.

To determine the experiences of faculty members related to virtual teaching. The cross-sectional study was conducted from January 15 to March 15, 2021, at undergraduate medical institutions located in Karachi, and comprised all the faculty members. Data was collected using a Google Survey questionnaire, and it was analysed using SPSS 20. Of the 385 subjects, 157(40.78%) were from basic sciences faculty, and 228(59.2%) were from the clinical sciences faculty. The majority had 3-5 years of teaching experience 142(37%). The most common online tool was Zoom 250(65%). The faculty who had prior experience or had received formal training for online teaching was more successful in controlling and engaging students than the rest (p<0.001). Those who had enough computer literacy had a better experience in conducting online teaching sessions (p=0.01). The experienced faculty found the opportunity to focus more on the topic that was to be taught online (p<0.001). Most of the faculty members used online tool Zoom. Faculty members with computer literacy and proper training for online teaching were more successful in controlling and engaging students and conducting online teaching sessions.

Impact of Strategic Ambiguity Tagline on Billboard Advertising on Consumers Attention

It has become difficult for firms to attract and retain customers in the prevailing competitive era. Therefore, they spend considerable resources on advertising mediums, including billboard advertising, apart from other strategies. Given its importance, we have developed a new model that examines the effect of attitudes, perception, brand motives on consumer attention. The study has also examined the effect of tagline ambiguity on consumers' attention and the moderating role of brand image. The study has collected the data from the e leading private business institutes of Karachi, as they are more familiar with the terminologies used in the study. The selected target would reduce variances in the self-administered questionnaire. The study found that consumer attitude is a significant antecedent of consumer attention. And consumers' attitudes, perceptions, and brand motives significantly affect tagline ambiguity. The study has several implications for marketers and practitioners. Deliberate ambiguity significantly affects consumer attention. It promotes cognitive thinking, brand recall, and brand recognition. This allows firms the flexibility of changing value proposition. Many firms have successfully used ambiguity in their taglines. For example, Volkwagen'slogan "Somewhere between tuxedo and birthday suit." This slogan does not communicate anything definite about the products but forces the consumers to form an association. The study has focused on the private business students in Karachi. We recommend others extend this model to other cities and countries. We did not use control variables in this study, which future researchers can incorporate in their studies.

Does Talent Management Strategies Matter for E-recruitment? Empirical Evidence from Higher Education Institutes of Karachi

The aim of this study to examined the impact of talent management strategies on e-recruitment in public and private higher education institutes of Karachi. Yet, in public and private colleges the traditional hiring process is carried out, that results of higher cost, more time and lack of competitive candidates for vacant position is observed. For testing the developed hypothesis, the primary data collected in printed form from potential candidates who wish to apply in future for job in both public and private higher education institutes of Karachi, Pakistan. Questionnaire adopted from past studies and three independent variables such as talent identification, talent development and talent retention and one dependent variable e-recruitment are measured. For analysis reliability analysis and multiple regression analysis were performed. Findings of this revealed all proposed hypothesis accepted and talent identification, talent development and talent retention have significant impact on dependent variable e-recruitment in public and private higher education institutes of Karachi. However, talent identification is higher impact with respect to other variables based on higher beta value. Best of knowledge of us This is first study which gives insights of public and private higher education institutes of Karachi. The policy makers of public and private higher education institutes of Karachi can take these strategies into their future hiring process in order to shift traditional process of hiring to modern one.

Role of COVID-19 pandemic in the academic life and well-being of private sector university students: an exploratory qualitative study

ObjectiveThe advent of the COVID-19 pandemic has caused a drastic impact on students’ life, causing physical and emotional sufferings. Considering the relevance of unprecedented conditions, we explored perceptions and attitudes...

Prolongation of QT Interval as a Result of Combination Therapy of Oral Artemether-Lumefantrine: A Cross-Sectional Study

Aim: To determine the frequency of prolongation of QT interval as a result of combination therapy of oral Artemether-Lumefantrine Study design: A cross-sectional study Place and Duration: This study was conducted at Karachi Institute of Heart Diseases Karachi Pakistan from June 2020 to June 2021. Methodology: The study included a total of 120 participants. Participants were selected by a consecutive sampling method. All the patients were adults and had been diagnosed with malaria by positive blood smear for plasmodium falciparum. The patients had not taken any antimalarial therapy for the last seven days of reporting to the hospital. The treatment was given in six doses of AL combination therapy. The strength of one dose was 80 mg Artemether and 480 mg of Lumefantrine. The QT interval was calculated before and after the therapy administration. Bazett’s formula (Qtc (s) = QT interval / √ RR interval) was used for the calculation of the corrected QT interval (Qtc) Results: The mean age of the patients was 30 ± 2.96 years. A total of 85 (70.83%) were male and 35 (29.17%) were female. According to the age distribution, 31 (25.83%) patients were between the age of 20 years and 30 years. A total of 42 (35%) patients were between the age of 31 and 40 years. 36 (30%) were in the age range of 41 and 50 years. A total of 11 (9.17%) were above the age of 50 years All the patients were analyzed for QT interval prolongation and the QT interval was not prolonged in any of the participants. Conclusion: As QT interval prolongation was not observed in any of the patients, oral AL can be considered a safe combination therapy for the treatment of malaria caused by plasmodium falciparum. Keywords: Artemether, Lumefantrine, QT prolongation, Malaria, Plasmodium Falciparum

Evaluating Knowledge, Attitudes and Practices of Pakistani Dental Professionals Regarding Silver Diamine Fluoride

Objective: The objective of this study was to evaluate the knowledge and attitude regarding Silver Diamine Fluoride (SDF) among Pakistani Dental Professionals worked at various institutes of Karachi.&#x0D; Methodology: This cross-sectional survey-based study was conducted among the house surgeons, general dental practitioners and specialists worked at various institutes of Karachi. Questionnaire was distributed among 375 participants through social media. Questionnaire was kept on google forum and link was sent to all participants through social media including Facebook, WhatsApp by non-probability consecutive sampling. Questionnaire was composed of two portions. Questions in first portion were related to demographic data and in second portion of Questionnaire had 13 closed ended questions regarding Knowledge and Approach towards Silver Diamine Fluoride. Statistical package for social sciences SPSS-25 was used for data entry and analysis with descriptive statistic, which used frequency, percentage, mean, and standard deviation.&#x0D; Results: Out of the total 375 participants, 160(43%) were male and 215 (57%) female. Mean age of participants was 33 + 11.8 years. 191(51%) heard about SDF and only 108(29%) attended lectures/discussions about SDF. 189(50.40%) responded that SDF is used in enamel lesion. 251(67%) participants responded that SDF is used in both anterior and posterior teeth. Only 160(42.66%) of participants responded that SDF is used for both dentitions. 122(32.53%) were agreed that SDF is an alternative to removing dental lesion by a dental drill, while only 118 (31.47%) agreed that many patients would not accept treatment of dental caries with SDF due to the permanent black staining of the carious lesion. 240 (64%) of participants were disagree about the SDF require the use of local anesthesia and more than half of participants responded that the silver is an antimicrobial ingredient in SDF. 237(63.2%) of participants responded that SDF is indicated in Children with High caries rate and most of them responded that black staining of tooth is main disadvantage and barrier to the use of SDF. Majority of participants did not know about reapplication interval for use of SDF.&#x0D; Conclusion: SDF is an appropriate alternative for restoring dental cavities in children. As it doesn’t require local anesthesia, it is the safest way to limit the progression of lesion in patient with high caries index. But there are some barriers related to the use of SDF in their regular dental practice is that, SDF causes permanent staining of tooth and also practitioners had little knowledge about their application protocols and recall or reapplication intervals.

The Moderating Role of Learning Performance on Teaching Competencies and Student Satisfaction

Purpose: The purpose of this study was to investigate the moderating role of the learning performance of the student on the relationship of teacher’s competencies and student satisfaction in higher education institutions of Karachi. Methodology: Three different scales namely SETs, Teaching Competence scale, and learning performance scale were used to measure student satisfaction, teaching competencies, and performance learning of students respectively. A survey method was used to collect firsthand data from tier3 universities of Karachi. Findings: The positive impact of teachers’ competencies on student satisfaction has been observed. The result shows that the learning performance of students is partially moderating the relationship. Conclusion: The study concluded that there is a significant positive impact of teacher’s competencies on student satisfaction. The higher teaching competencies lead to greater student satisfaction. Also Learning performance of students from tier3 universities of Karachi has a significant impact on the relationship between student satisfaction and teacher’s competence.

Current practices of urologists regarding intravesical therapy use for non-muscle-invasive bladder cancer patients.

Background: Leading urology guidelines recommend intravesical chemotherapy and immunotherapy for non-muscle invasive bladder cancer (NMIBC) to reduce the risk of recurrence and progression. This study aims to evaluate the self-reported practices regarding intravesical therapy use for patients with non-muscle-invasive bladder cancer among urologists in Karachi. Methodology: In this cross-sectional study, a proforma-based survey was conducted between January and March 2018, in which printed questionnaires regarding adjuvant treatment options for NMIBC were administered and collected by primary investigators among urologists in leading institutions of Karachi. Results: Overall, 80% of respondents reported routine administration of single instillation of intravesical chemotherapy (SICA) after transurethral resection of bladder tumor (TURBT), and almost one-third of them (37.3%) give SICA within 6 hours inward. A quarter of respondents practice induction therapy routinely in low-risk BC using Mitomycin, whereas 76.5% in high-risk cases use Bacillus Calmette Geurin (BCG) as immunotherapy. Regarding the time duration of intravesical therapy installation, most of the urologists reported for 45 mins (49%) followed by 30 mins (29.4%), 2 hrs (17.6%), and 3 hrs (3.9%). Only 39% reported routinely using maintenance therapy with BCG for high-risk BC. As for BCG failure, 76.5% of participants reported radical cystectomy. Conclusion: Our survey results provide evidence of variation in practices among urologists and poor guideline adherence with the risk of under-treatment of patients with NMIBC. This requires joint efforts of all those involved in the treatment of non-muscle invasive bladder cancer to improve the quality of care.

The Modified Alternate Healthy Eating Index-2010 and Breast Cancer Risk among Women from Karachi, Pakistan.

To determine any relationship of diet with breast cancer risk. The case-control study was conducted at Aga Khan University Hospital and the Karachi Institute of Radiation and Nuclear Medicine, Karachi, from February 2015 to July 2017, and comprised of cases with a confirmed diagnosis of breast cancer and healthy controls. Data was collected using the Alternate Healthy Eating Index 2010, which was modified according to the particular cultural patterns of diet in the Pakistani population. Data was analysed using SPSS 21. Of the 1124 subjects, 374(33.3%) were breast cancer cases and 750(66.7%) were controls. High intake of grains, both whole and refined including white rice, was associated with breast cancer (odds ratio: 2.53; 95% confidence interval: 1.69-3.79; p<0.001). There was no association of breast cancer with Alternate Healthy Eating Index 2010 score (odds ratio: 1.85; 95% confidence interval: 0.61-1.17; p=0.291). There was found a need for awareness of a healthy diet based on more of whole grains and brown rice replacement with refined grains and white rice, respectively. Limiting refined carbohydrate intake might be a useful public health message and may reduce breast cancer incidence in the long term.

Assessment of frequency, risk category and intervention needs in psychoactive drug users by using WHOASSIST Questionnaire among medical students in Karachi.

To determine the frequency of use of various psychoactive drugs among medical students in an urban setting, and to assess the risk category and intervention needs. The descriptive cross-sectional study was conducted from January to June 2018 at four medical education institutions of Karachi; 2 each randomly selected from registered public and private sectors. From the clinical classes of each institution, fourth year was randomly chosen by lottery method. Data was collected using the Alcohol, Smoking and Substance Involvement Screening Test version 3.0. Data was analysed using SPSS 20. Of the 445 respondents, 270(60.7%) were male and 175(39.3%) were females. The overall mean age was 21.3±1.7 years (range: 17-27 years). Of the total, 273(61.3%) had never used any psychoactive substance, 97(21.8%) had used at least one, 34(7.6%) at least two, 23(5.2%) three, while 18(4%) had tried four or more psychoactive drugs in their lifetime. The most commonly used drug was tobacco, reportedly used by 117(26.3%) respondents, and, among them, 40(34%) were in low risk/no intervention category, 71(60.6%) in moderate risk/brief intervention category and 6(5.1%) in high risk/intensive treatment category. The use of psychoactive drug was significantly more in male compared to female students(p<0.05). Tobacco was the most commonly used psychoactive drug among medical students though the use of cocaine, cannabis, alcohol, amphetamine, inhalants and sedatives was also significant. Psychoactive drug use was more common in males compared to females.