Pakistan Medical Research Articles

Pakistan Medical Missions: An Extension of Our Skills as Emergency Room Nurses

When you hear the phrase “medical mission trip” what comes to mind? Is it flying to remote parts of the world and feeding starving children? Maybe it's being part of a surgical team that sets up in a third world hospital to assist with much needed surgeries. The term could conjure up visions of trekking into remote jungles to bring medical attention to uncivilized tribes. Possibly, you do not have any preconceived ideas about what is involved in medical missions. You may be asking yourself what is a medical missions trip, who goes, and how do you decide where to go and with whom.

The association of complex liver disorders with HBV genotypes prevalent in Pakistan

BackgroundGenotyping of HBV is generally used for determining the epidemiological relationship between various virus strains and origin of infection mostly in research studies. The utility of genotyping for clinical applications is only beginning to gain importance. Whether HBV genotyping will constitute part of the clinical evaluation of Hepatitis B patients depends largely on the availability of the relevance of the evidence based information. Since Pakistan has a HBV genotype distribution which has been considered less virulent as investigated by earlier studies from south East Asian countries, a study on correlation between HBV genotypes and risk of progression to further complex hepatic infection was much neededMethodsA total of 295 patients with HBsAg positive were selected from the Pakistan Medical Research Council's (PMRC) out patient clinics. Two hundred and twenty six (77%) were males, sixty nine (23%) were females (M to F ratio 3.3:1).ResultsOut of 295 patients, 156 (53.2%) had Acute(CAH), 71 (24.2%) were HBV Carriers, 54 (18.4%) had Chronic liver disease (CLD) Hepatitis. 14 (4.7%) were Cirrhosis and HCC patients. Genotype D was the most prevalent genotype in all categories of HBV patients, Acute (108), Chronic (39), and Carrier (53).Cirrhosis/HCC (7) were HBV/D positive. Genotype A was the second most prevalent with 28 (13%) in acute cases, 12 (22.2%) in chronics, 14 (19.7%) in carriers and 5 (41.7) in Cirrhosis/HCC patients. Mixed genotype (A/D) was found in 20 (12.8%) of Acute patients, 3 (5.6%) of Chronic and 4 (5.6%) of carriers, none in case of severe liver conditions.ConclusionMixed HBV genotypes A, D and A/D combination were present in all categories of patients except that no A/D combination was detected in severe conditions. Genotype D was the dominant genotype. However, genotype A was found to be more strongly associated with severe liver disease. Mixed genotype (A/D) did not significantly appear to influence the clinical outcome.

Development of the community-oriented medical education curriculum of Pakistan: A case report on the national initiative on curriculum development

The medical curriculum in Pakistan includes the following courses: anatomy,physiology, and biochemistry. These courses are offered in the first two yearsusing lectures, tutorials and laboratory work. In the last three years, pathology,pharmacology, forensics and community medicine courses are taught by usingclerkships in medicine, surgery, pediatrics, gynecology, obstetrics, and associ-ated health-related disciplines.The general objective of the undergraduate medical curriculum as specifiedby the Pakistan Medical and Dental Council (PMDC) is to provide com-passionate,generalpractice,community-orienteddoctorswhoarecommittedtomanage common health problems of the people in a scientifically sound andcost-effective manner while using appropriate technology and a holisticapproach. It also states that the doctor should be able to assume leadership ina health care team, function and communicate effectively as a manager inaccordance with the code of medical ethics prescribed by the PMDC.

Medical ethics in surgical wards: knowledge, attitude and practice of surgical team members in Karachi

A survey was undertaken to assess the knowledge, attitude and practice of medical ethics among surgical residents and interns in three teaching hospitals of Karachi, Pakistan. 101 out of 120 completed responses were included in the study. Fifty-one respondents had heard about the Code of Ethics formulated by the Pakistan Medical and Dental Council. Forty-four had read the code. Seven had no knowledge about it. Forty-seven reported taking consent for procedures. Forty-two respondents gave correct answers on questions of confidentiality and knowledge of law pertaining to trauma victims. Only 11 reported having been taught ethics as students. Four did not feel the need of its teaching at an undergraduate level. Doctors graduating within the last 10 years gave fewer correct answers than those graduating earlier. Knowledge of medical ethics and its application on the surgical floors is extremely poor. The survey results support the view that medical ethics should be part of the undergraduate medical curriculum.

Doctors in Pakistan protest at killing of colleagues

More than 50 prominent Karachi doctors staged a six hour hunger strike on Saturday 30 March in protest at the targeted killing of fellow doctors in Pakistan. And the Pakistan Medical Association, angered by the government's apparently uncaring attitude towards the killings, called for a countrywide strike on 8 April. Doctors have been calling for adequate security for some time. This year, 13 doctors, most of them of the Shiite …

Adult non-Hodgkin's lymphoma

Adult Non-Hodgkin’s Lymphoma (NHL) is a diverse group of lymphoid malignancies, with an increasing annual trend world over. NHL has shGwn an increase by 39% in Caucasians and 46% in black population and is at least three times more frequent than Hodgkin’s disease, as shown by the SEER study.Intermediate grade lymphoma still constitutes the largest proportion of NHL. Increased incidenceof NHL is largely because of large share from NHL in older age groups. Increased incidence rates of NHL in younger age grouj are attributed to its association with AIDS in recent times and also to classify a large number of cases as NHL which previously used to be labeled as unspecified malignant lymphoma. NHL is more common in developing world and shows a wide geographic variation in its pathobiological characteristics. Extranodal lyinphoina is reportedly 26% of all lymphomas and has increased by 4%, with most frequent sites being stomach, skin, oral cavity, pharynx, small intestine and brain in that orde?. Some of the sub-types like diffuse large cell NHL, large cell immunoblastic NHL and small non-cleaved cell NHL are increasing. NHL can be aB cell or T cell type as cell of ongin. In a local population based study malignant lymphorna are 5.7-8.7% in males and 1.2-1.7% in females. The national cancer database organized by Pakistan Medical Research Council indicates that 6.3% of all male tumors and 1.9% of all females tumors are lymphoma. About 14.8% male lymphoma is NHIL, while 18.4% of female lymphoma are NHL. Inununogenetic sub-typing, flow cytornetty and gene re-arrangement studies and molecular biology tecimiques are increasingly being incorporated in lymphoma management and diagnosis and have changed over concepts tremendously. Hair dyes and herbicides are currently new entities in addition to genetic and envimmnental factors inetiology of NHL. Viruses (HTLV-1, HIVandEBV), congenital immunodeficiency, organ transplantation and autoimmune disorders are otherprecipitating factors. The treatment options are surgety, radiotherapy, chemotherapy (CHOP, M-BACOD, m-BACOD, ProMACE/cytaBOM, MACOP-B), with PBST/BMT9. The clinical presentation is vague with symptoms like decreased appetite, loss of weight, excessive night sweats, tiredness, itching, insomnia, discomfortorpain. Excision biopsy is preferred over FNAB where possible. Other tests are complete physical evaluation, CBC with ESR, biochemistry, XR, CT/MRI, bone marrow biopsy, Gallium scan of nodes, lymphangiogram, biopsy/exploration, endoscopy and biopsy. NHL usually shows centrifugal nodal involvement. Overall median survival is 8-9 years and increasing condition to early diagnosis combined withprompt and effective treatment. Currently REAL (Revised European American classification of lymphoid neoplasm) is widely used and accepted. The prognosis and overall survival in good in NHL, with early diagnosis and prompt treatment. The same can be achieved in our local lymphoma patients with improvement in diagnostic and therapeutic approach. There is an immense need for impfovement in histopathology training, incorporation of new diagnostic modalities and evaluation of cost effective treatment protocols for our population of patients. There is no reason not to achieve the same level of life expectancy and quality of life in our patients, if these above-mentioned considerations are given the due attention.

Impact of health service provision on mothers and infants in a rural village in North West Frontier Province, Pakistan.

The objective of this paper is to examine the impact of the Health Service Research Project of the Pakistan Medical Research Council (PMRC) on mothers and infants in Budhni village, North West Frontier Province (NWFP), Pakistan. Information from the PMRC records on the socioeconomic and demographic situation over the last 10 years and anthropometric measurements made on all infants from 1986-96 were collected and analysed. The demographic data showed a number of changes, namely a reduction in birth rate and improvements in perinatal, neonatal, infant and child mortality rates. Literacy in the village was poor (27 and 39% literate in 1986 and 1996, respectively) and female literacy showed no improvement (14%). Improvements in sanitation and in the water supply introduced by the PMRC had limited success, as clean water was subsequently contaminated by unclean hands and utensils, and 50% of the population continued to use open fields for sanitation. In 1986 only 27% of children 0-5 years were vaccinated, but by 1996, 96% of children had completed polio, diphtheria/pertussis/tetanus (DPT) and bacille Calmette-Guérin (BCG) vaccination programmes and 95% of women of child-bearing age were vaccinated against tetanus. Protection against tetanus reduced neonatal deaths and from 1993 onwards there have been no further cases. Anthropometric data for the period 1986-96 for infants (0-24 months) showed that at birth the majority of infants were close to the 50th National Centre for Health Statistics (NCHS) centile for weight and length, and only 5% of birth-weights were less than 2.5 kg. Growth charts showed faltering in length and weight and by 24-months length in both boys and girls was below the 3rd NCHS centile and weights were just above. Reductions in child mortality have occurred over the period 1986-96. However, the slow progress in adopting hygienic practices, despite health education, and the low literacy rates, particularly in women, may hamper continued improvement.

Pakistan Medical Research Council Cancer Study Group

Pakistan Medical Research Council Cancer Study Group

Male determining factor on chromosome 3 in the mosquito, Culex tritaeniorhynchus.

Recent experiments indicate that the sex allele M in different populations of Culex tritaeniorhynchus may be present in different linkage groups. In some laboratory wild-type and mutant stocks, M was found to be unlinked to the mutants of linkage group I. Further experiments have demonstrated that in these stocks M is linked to the mutants in linkage group III. Thus, M may be associated with either linkage group I or III. All other markers within a linkage group appear to remain linked to each other and the recombination frequencies among linked markers remain unaltered irrespective of whether or not the M allele was present. The females behave as the homogametic sex in crosses with both types of males. The M allele when associated with linkage group I has been designated M1, when associated with linkage group III it is designated M3. The gene order when M3 is present in linkage group III is Lp-M3-Adh-bw-ae.

COMPARISON OF TOTAL LEUCOCYTE AND EOSINOPHIL COUNT IN MALE SMOKERS AND HEROIN ADDICTS IN PESHAWAR

Background: The harmful components of tobacco smoke nicotine, tar and carbon monoxide affectsdifferent haematological parameters. Heroin affects almost every system of the body including blood and itscomponents. The present study was conducted in Physiology department; Khyber Medical CollegePeshawar from Jan 2006 to Dec 2007. The objective of the present study was to compare the affects ofcigarette smoking and heroin abuse on haematological parameters especially total leukocyte count andeosinophil count.Subject and Methods: The study was conducted on hundred age and sex matched subjects. The subjectswere divided into three groups i.e. forty cigarette smokers and forty heroin addicts and with twenty normal(Control). Laboratory tests were performed at Pakistan Medical Research Council (P.M.R.C) KhyberMedical College, Peshawar. Data was statistically analysed by computer using SPSS 10 software.Results: Total leukocyte and eosinophil counts were raised in both cigarette smokers and heroin abusers ascompared to normal individuals. Total Leukocyte count (TLC) was found significantly higher (P<0.001) incigarette smokers as compared to heroin addicts whereas there was no statistically significant difference ineosinophil count of cigarette smokers and heroin addicts. Neutrophil and lymphocyte percentages werelower and monocyte percentage higher in both cigarette smokers and heroin addicts as compared to controlgroup.Conclusion: Haematological parameters vary with cigarette smoking and heroin abuse. Therefore history of smokingand heroin abuse should be considered while interpreting the investigation in such patients.Key words: Leukocyte count, Eosinophil, Heroin addiction, Smoking.

Joint Meeting of B.M.A and Pakistan Medical Association

Joint Meeting of B.M.A and Pakistan Medical Association

Joint Annual Meeting, Karachi

Sir,?The British Medical Association is holding its 134th Annual Scientific Meeting at Karachi between 29 November and 3 December jointly with the 11th Biennial Meeting of the Pakistan Medical Association. The Pakistan Medical Association is affiliated to the British Medical Association and the two are joined together with close bonds of friendship and brotherhood. The purpose of the Joint Meeting is further to strengthen these ties, and this can be achieved only if a large number of members of both Associa tions get a chance to meet and know each other better and also exchange each others' ideas. For the last two years I had the privilege of addressing the Representative Body of the British Medical Association and to extend to its members a personal invita tion. Now again I have the pleasure to renew the same invitation through the columns of the British Medical Journal. The Karachi climate will be at its best at the time of the Meeting and my committee have drawn up a very interesting scientific and social programme. I sincerely hope that a large number of members of the British Medical Association will be able to attend this Joint Meeting, and I assure them of a warm and cordial welcome. I also hope that a good number of them will be accompanied by their wives, for whom also my Ladies Committee has drawn up a very interesting programme.?I am, etc., Hamid Ali Khan, President-Elect, Pakistan Medical Association Karachi. and British Medical Association.

Diabetes in East Pakistan.

Since the advent of oral hypoglycaemic agents in diabetic therapy newer vistas have been opened up in research on diabetes mellitus in regard not only to its management but also to its aetiology and pathogenesis. Peculiarities in the character of diabetes in tropical regions were noted in the early part of this century, and various authors discussed their observations in a symposium in the Section of Tropical Medicine of the British Medical Association's Annual Meeting in 1907 (British Medical Journal, 1907). The most significant of these peculiarities were rarity of juvenile diabetes, infrequency of ketosis, and diabetic coma. During the last decade clinical studies by DeZoysa (1951), Hugh-Jones (1955), and Cosnett (1959) clearly showed that diabetes in the tropics differs widely from that in temperate climates. Different authorities have described various types of diabetes, such as type 1 and type 2 (Lawrence, 1951) and type J (Hugh-Jones, 1955). In a stimulating leading article in the British Medical Journal (1959) the types of diabetes were discussed and the need for further studies in the tropics was stressed, concluding with the remark of Sir Harold Himsworth that a primary deficiency of insulin is only one, and then not the commonest, cause of the diabetic syndrome. The present paper records the result of a study of 894 cases of diabetes in East Pakistan. As there was no special clinic in the country to deal with these cases, and as illiteracy, poverty, and superstition often made dietary control and insulin treatment difficult or uncer tain, a Diabetic Association was organized in the early part of 1956 and arrangements were made to contact as many diabetics as possible by newspapers, seminars, and conferences. A research section was started under the auspices of the Pakistan Medical Research Council in the Medical Research Centre at Dacca, where all the examinations, including repeated glucose-tolerance tests and other relevant biochemical procedures, were done free of cost. Method and Materials.-The period covers the 28 months from August, 1957, to December, 1959. All the 894 patients were studied in the Medical Research Centre and arrangements were made to call them at regular intervals, fortnightly or monthly, for assessment and glucose-tolerance tests. The procedure of examina tions has been fully described (Ibrahim, 1959).