Pakistan Journal of Medical & Health Sciences

Mitochondrial Genetics and Human Health: Implications and Insights

HAMZA ALI — 2024-11-23

Mitochondrial genetics is a crucial area of research with major implications for human health. Mitochondria are cellular organelles essential for energy production but also play vital roles in other cellular processes like calcium regulation and redox balance. Certain unique characteristics of the mitochondrial DNA (mt-DNA) including its high mutation rate, maternal inheritance and heteroplasmy make it central to understanding the wide range of genetic and complex diseases. This review examines the bridge between mt-DNA mutations and various diseases such as mitochondrial myopathies, neurodegenerative disorders and complex diseases like type 2 diabetes and cardiovascular disorders. Mutations in the mt-DNA lead to generation of reactive oxygen species (ROS) which leads to cellular damage and disease progression. The review explores different epigenetic factors such as environment. Lifestyle, aging impact the mitochondrial function with focus on the susceptibility of mt-DNA to oxidative damage due to its proximity to ROS generation sites
The review also highlights the importance of mitochondrial genetics in reproductive health and provides insights on maternal transfer of mt-DNA and inherited mitochondrial disorders. These findings offer foundation for advancement in diagnosing, treating and preventing mitochondrial diseases, ultimately increasing our understanding of human biology and disease mechanism.
Keywords: Mitochondrial genetics, Mitochondrial DNA (mt-DNA,) Mitochondria Genetic diseases, Mitochondrial myopathies, Neurodegenerative disorders, Type 2 diabetes, Cardiovascular disorder

Diagnostic Accuracy of Quantitative Washout Calculated on Triphasic CT Scan for Diagnosis of Hepatocellular Carcinoma keeping Histopathology as Gold Standard

MARYAM SAMAD — 2024-11-23

Aim: To find out how accurate the quantitative washout is at diagnosing hepatocellular carcinoma on a triphasic CT scan compared to the histopathology, which is the gold standard. It can be used as a supplement to the subjective visual analysis of washout to help the radiologist diagnose hepatocellular carcinoma.
Methods: From the OPD and indoor database, 150 patients of both sexes were included who had abnormal lesions confirmed by ultrasound. In order to quantify washout during the delayed phase, CT scans were performed in three phases on all patients. On delayed phase, a region of interest between normal liver parenchyma and lesions was obtained. Those lesions having a percent attenuation ratio greater than 107 were identified as hepatocellular carcinoma.
Results: The ages of 150 patients who met the inclusion criteria ranged from 15 to 85. There were 93(62%) males and 57(38%) females, for a total gender ratio of 2:1. Of the 105 patients who tested positive for HCC on a CT scan, 96 actually had HCC. Among 45 patients who tested negative for HCC on a triphasic CT scan, 8 were erroneously labelled as negative. Quantitative washout on Triphasic CT scan has an overall sensitivity of 92.30%, a specificity of 80.40%, a positive predictive value of 82.20%, a negative predictive value of 88.66% and a diagnostic accuracy of 88.66% for identifying hepatocellular cancer.
Conclusion: Based on our findings, quantitative washout assessment for hepatocellular carcinoma is an easy, highly sensitive, and objective way that can be used as an adjunct to qualitative washout for hepatocellular carcinoma diagnosis.
Keywords: Hepatocellular carcinoma HCC, Percentage attenuation ratio, Washout, Delayed phase

Guardians under Fire: Unveiling Violence on Emergency Healthcare Professionals: A Multicenter Questionnaire Based Cross Sectional Survey

HUMA NASIR — 2024-11-23

Background: It focuses to identify the factors related to workplace violence who, what and where and to evaluate the knowledge of reporting among healthcare staff.
Aim: To establish the common types of workplace violence that health care workers in emergency departments of tertiary care
hospitals in Pakistan are vulnerable to.
Methodology: Cross-sectional research study methodology was adopted in this study in assessing the proportion of healthcare practitioners who encounter workplace violence. The study was carried out in the emergency facilities in tertiary care hospitals in Pakistan, from March 2023 to August 2023. The 383 emergency department healthcare professionals who had worked for at least 6 months were surveyed for the study. Due to the pilot nature of the study and to increase participation, the questionnaire was made available online, though participants orally assented to the study. Mean scores and standard deviations were used to describe the variables while independent samples t-tests, one-way analysis of variance (ANOVA) and logistic regression analysis were used to determine the differences, relationships and risk factors respectively.
Results: The survey revealed that 87.5% of doctors, nurses and other healthcare personnel accounting to workplace violence stated that had suffered verbal abuse at the workplace. Physical assault was 5.0%, bullying or mobbing 5.2% and sexual harassment only 0.5%. Similarly, health care workers that are male and those with more than a decade of practice in the profession were more vulnerable to violence with odds ratios of 1.37 and 2.25 respectively. As for the reporting behavior, it was not very high – 28.7% of participants reported actual incidents of violence at work.
Conclusion: Emergency staff experience workplace violence in the workplace and verbal aggression is the most prevalent type of violence. Experience for more than five years, work place setting and male gender emerged as antecedents to predicting workplace violence. The safety of the health care professional and increased safety for the patient requires attempts to be made to better a situation and to enrich a reportage process.
Keywords: Workplace violence, emergency healthcare, verbal abuse, cross-sectional survey, reporting behavior.

Facilitators and Barriers Related to Complementary Feeding Practices among Mothers of Children Under 2 Years of Age in Karachi

TUBA RASHEED — 2024-11-23

Aim: To identify the underlying Facilitators and Barriers influencing Complementary feeding practices among mothers of children under 2 years of age in Karachi and to determine the level of Knowledge, attitudes and practices of Complementary feeding practices among mothers of children under 2 years of age in Karachi.
Methods: A cross-sectional study was conducted in Karachi, Pakistan, from September 2022 to February 2023, focusing on complementary feeding practices among mothers of under-two-year-olds. A self-administered questionnaire was administered to
participants, identifying facilitators and barriers. The study included mothers and children under 24 months old, lactating or non lactating, who have delivered a child or have children up to 2 years old. Data was analyzed using SPSS and Chi-square test to determine associations between variables.
Results: The majority of the mothers displayed poor knowledge and the practices regarding complementary feeding were found to be fair. With regards to barriers and facilitators of complementary feeding practices, mother’s and father’s education were significant facilitators while level of attitude was found to be a significant barrier which influenced feeding practices among mothers.
Conclusion: Mothers of children under 2 years old, especially non-literate ones, have poor complementary feeding knowledge
and practices. Global health goals include reducing child malnutrition through supplemental feeding. Reduce child morbidity and
death with complementary feeding education that changes behavior.
Key words: Complementary feeding practices, Facilitator, Barriers

Assessment of knowledge, attitude and practices towards research; the perspectives of dental graduates

MUHAMMAD ABUBAKAR — 2024-11-23

Background: Research is a systematic approach to reasoning and documenting clinical observations and problems that we encounter in clinical settings. It is a prerequisite for developing new skills and knowledge by all medical and dental professionals, which is beneficial for society.
Aim: To assess research related knowledge, attitude, and practices among dental undergraduate and graduate students of a private dental college in Lahore city.
Methods: Cross sectional with survey design was used in Dental College of Lahore Medical and Dental College, Lahore. The study took place between April 1st and July 1st, 2024. A total of 180 graduates and undergraduates of the college were selected. Data collection was done using a self-administered, structured, validated questionnaire. The questionnaire was divided into sections including sociodemographic factors, research knowledge, attitude, and research experience questions. For assessing knowledge, 10 dichotomous questions of true and false statements were used. A 5-point Likert scale (strongly disagreed, disagreed, neutral, agreed, and strongly agreed) was used to assess the attitude towards research; 7 positive and 7 negative questions were asked.
Results: A total of 180 participants 31.3% males and 68.9% females—were selected. 69.4% were graduates, and 30.6% were undergraduates. One-way ANOVA significance was found for knowledge and practices towards research with respect to age groups p<0.05; however, an insignificant result was found with respect to attitude. Independent sample t test for gender and knowledge was insignificant p > 0.05. Insignificant result found for gender and practice; however, for attitude, significant result obtained; p<0.05. Statistically significant results obtained for knowledge, attitude, and practices towards research with graduates and undergraduates, i.e., p<0.05.
Conclusion: The dental undergraduates and graduates’ students demonstrated good research knowledge and a positive attitude towards scientific research conduct, but the research practices were very low. Students should be actively engaged in research by making system-based reforms with respect to basic research knowledge and guidance to promote research culture.
Keywords: House Officers, Research, Knowledge, Assessment, graduates,

Is the classification of Ventilator-Associated Pneumonia as early and late- onset useful? A comparison of Microbial Profile, Antibiotic Susceptibility and Mortality

SAMI UR REHMAN — 2024-11-23

Aim: To see the microbial profile of early and late-onset ventilator-associated pneumonia, antibiotic susceptibility and mortality rate.
Methods: Retrospective cross-sectional study in 18-month period from 1st January 2023 to 31st June 2024 in Surgical ICU of Doctors Hospital and Medical Centre, Lahore, Pakistan. Data was analyzed using the IBM SPSS 29.0 software, and an Excel sheet was used to make a table of isolates and their sensitivity to antibiotics. Descriptive statistics like standard deviation and mean are used. One sample t-test was applied. SPSS and Excel sheet files are provided with the text. The P-value was set at <0.05, and a confidence interval of 95% is taken.
Results: A total of 46 ventilator associated pneumonia (VAP) were recorded during our study period of 18 months. Out of 46 cases, 13 (28.2%) were early-onset VAP and 33 (71.7%) were late-onset VAP. Males being more admitted in our surgical ICU, their number of VAP is also high, that is, 31(67.3%), while females constitute 15 (32.6%) cases. Among the early-onset VAP, the most common isolates were Pseudomonas aeruginosa 4(30.7%), Candida albicans 4(30.7%), Klebsiella pneumonia 2(15.38%), followed by each one of the Acinetobacter, Burkholderia, and E. coli. While in the late-onset VAP, isolates that appeared on tracheal cultures were Acinetobacter 8(24.2%), Klebsiella 8(24.2%), Pseudomonas 7(21.2%), Staphyloccus aureus 3(9.09%), Burkholderia 2(6.06%), Candida 2(6.02%), Proteus mirabilis 1(3.03%), E. coli 1(3.03%) and Enterobacter cloacae 1(3.03%). Almost all gram-negative organisms were sensitive to colistin except one E. coli. All Pseudomonas and Acinetobacter isolates were resistant to carbapenems (100% resistance), while Klebsiella is only 40% (4 out of 10) sensitive to carbapenems, E. coli 50% (1 out of 2), Burkholderia 66.6% (2 out of 3) and Proteus mirabilis was 100% sensitive. Klebsiella is 70% sensitive to chloramphenicol. Minocycline has 100% susceptibility for Acinetobacter, Enterobacter, and Staphylococcus aureus, while it has 60% susceptibility to Klebsiella and 33.3% for Burkholderia.
Conclusion: At the end of this study period of 18 months, we conclude that VAP is mainly caused by MDR bacteria, especially Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter Baumanni, in our settings, irrespective of the duration of onset. We suggest that broad spectrum MDR cover, including colistin, along with gram positive cover like vancomycin, linezolid, or teicoplanin, should be started as an empirical therapy to prevent the onset of early or late VAP.
Keywords: Ventilator associated pneumonia (VAP), Intensive Care Unit (ICU), Mechanical ventilation, Early Onset VAP, Late Onset VAP, Antimicrobial resistance

Factors Contributing to Increased Stress among Bedside Nurses Working in Tertiary Care Hospitals in Karachi, Pakistan

2025-01-21

Introduction: Nurses are facing stress due to work related factors which highly impacting their career by suffering from heavy workloads, insufficient staffing, turnover, limited resources, and the prolong duties hours which elevated their stress respectively into their profession.

Objective: To determine the factors contributing to increased stress amongst bedside nurses working in public and private tertiary care hospitals at Karachi, Pakistan.

Methodology: An analytical Cross-sectional study was conducted in both Public Dr. Ruth K. M. Pfau, Civil Hospital Karachi, and Private Kharadar General Hospital (KGH) where data were collected amongst 200 nurses, from June to August, 2024, and Convenient sampling technique was used to assess the self-structured questionnaire from RN, BSN, MSN whereas, RM, CMW, CHN, LHV, and nursing students were not included in this study setting.

Results: The results revealed that, stress amongst nurses were identified more on female 126 (63%), unmarried124 (62%) women whose age between 20-30 86(43%), residing in urban 172(86%) Muslim 127(63.5), Punjabi 84(42.5%), had BSN degree 64(32%) mainly were from 40(20%) from medical department than other units, were suffering more stress from; clinical environment 133 (66.5%), lack of support from nursing administration 140(70%), miscommunication between health care provider (colleagues or doctors) 151(75.5%), making mistake in treating patient153(76.5%), doctors commanding 141(70.5%),shortage of healthcare provider in emergency situation163(81.5%), pressure from unit managers, doctors and supervisors 113(56.5%), by working constantly doing night shift duties 128(64%), having additional responsibility and long working hours by the management 138(69%), ineffective or unsupportive may create a negative work environment 160(80%), lack of professional development opportunities; training, educational facilities, promotion 155(77.5%), lack of safety and security139(69.5%), busy by the paper work and documentation 152(76%). Herein, X²test also used to evaluate the association between the factors and the socio demographic variables in which hospitals, age, gender, religion and ethnicity were highly significantly associated as (P-value< 0.05)

Conclusion: The nursing profession is comprises the stress of bedside nurses which directly impacts on nurse’s health, patient-care, and health system of the country.

Keywords: Nurses, Stress, Workload, Lack of Support from Nursing Administration, Shortage of HealthCare Provider.

Frequency of Errors in Factors Affecting Complete Denture Satisfaction - A Tertiary Care Hospital Study

2024-09-30

Aim: To find out the frequency of errors made by dental undergraduate students in factors affecting denture satisfaction (retention, stability, support and esthetics) and find out the association of errors with patient age and gender.

Study design: Cross sectional Observational study

Place and duration: Prosthodontic Dept. of Lahore Medical & Dental College, Lahore, From March 8^th 2024 till June 8^th 2024.

Methodology: A total of 124 dentures (62 maxillary dentures and 62 mandibular complete dentures) were included in the study. The dentures fabricated by BDS 3^rdyear and 4^th year students; clinically assessed by senior doctors were selected. The patients were comfortably seated in the dental chair at the final insertion stage of the denture and the factors affecting denture satisfaction (retention, stability, support and esthetics) were clinically evaluated. Denture retention was assessed on 3 parameters; 1) over extended buccal or lingual flanges, 2) under extended buccal and lingual flanges, 3) inadequate post dam area. The denture stability was assessed on 3 parameters i.e.; 1) correct set up of teeth, 2) occlusal interferences, 3) correct flanges extension in sulci. Denture support was assessed on 3 parameters; 1) Adaptation to underlying tissue, 2) Adequate denture on favorable, 3) impression accuracy. 3 parameters for esthetics;1) polished surface finishing, 2) tooth shape and shade selection, 3) accurate arrangement of teeth.

Results: The percentage of errors in all parameters of retention and denture support were less. The parameters determining denture stability i.e.; correct tooth setup and accurate flanges extension had a smaller number of errors, however percentage of errors of occlusal interference was found to be maximum;64.0%. The parameters determining denture esthetics i.e.; correct tooth selection shade/shape and accurate teeth arrangement had less errors however the polished surface finishing had the maximum number of errors;75.2%. The association of all the errors in parameters determining denture satisfaction with patient gender showed insignificant results; p<0.05; except parameter determining denture support (extension on favorable tissues) p<0.05. The correlation of age with all the parameters of factors determining patient satisfaction with dentures was insignificant, however the parameter of esthetics (tooth shape and shade selection) was found to have a significant correlation p<0.05.

Conclusion: It can be concluded that the most frequently made errors in denture fabrication process by undergraduate students that affect patient satisfaction with the dentures were errors in parameters determining denture stability i.e.; occlusal interferences and denture esthetics i.e.; poor finishing and polishing of the polished surfaces.

Keywords: Complete dentures, Denture retention, Denture esthetics, Denture stability, Errors, Gender, Undergraduates.

Religious Coping Used by Earthquake Survivors during Huge Earthquake in Türkiye

HÜSEYIN ÇAKSEN — 2024-11-23

On 6 February 2023 a huge earthquake struck Türkiye with a magnitude of Mw 7.7. More than 10 million people in eleven cities have personally experienced the great and terrible and frightening shaking of the earthquake. In the earthquake, more than one hundred thousand people were injured and more than 50 thousand people died. Religion is a law enacted by Allah, which, by their own will, guides people of intelligence to goodness in this world and salvation in the hereafter . Religious coping is religiously framed cognitive, emotional, or behavioral responses to stress, encompassing multiple methods and purposes as well as positive and negative
dimensions. Herein, we presented some examples of religious coping used by earthquake survivors during the huge earthquake in Türkiye to emphasize the importance of religion and spirituality.