Journal of Gandhara Medical and Dental Science
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Suicide Associated with Risk Factors in Patients Suffering from Depression
Get PDFOBJECTIVES:
The purpose of this study was to assess suicide and their relationship with risk factors i.e. degree of hopelessness, severity of depression and suicidal ideations.
METHODOLOGY:
It was a cross sectional study conducted in Psychiatry unit Khyber Teaching Hospital Peshawar. The total sample of this study was forty-eight admitted patients. Those patients were included in the study that scored moderate to high in Hamilton Depression Rating Scale (HDRS), Hopelessness Scale and Reasons for Living Inventory (RLI). The collected data were analysed using SPSS version 22.
RESULTS:
Study showed that reasons for living as well as the subscales of reasons for living inventory i.e. responsibility towards family, hope of improvement and surviving and coping beliefs have significant inverse correlation with score on Hopelessness Scale and suicidal ideations. The score on subscale religious beliefs had significant correlation only with score on hopelessness. Married individuals’ responses were different on total reasons for living to a significant extent. The patients with past psychiatric history had significantly greater fear of suicide. The three different social groups did not differ to a significant extent in scoring on reasons for living.
CONCLUSION:
The reasons for living as a whole and some of the subscales of Reasons for Living Inventory have significant inverse relationship with suicidal risk factors showing the modulatory effect of these reasons on suicidal risk. Moreover, these reasons are not equally distributed among some of the sociodemographic and clinical groups
Illness Seeking Behavior and Self-Medication Practice Among Medical Students: A Cross Sectional Study
No full textOBJECTIVES: To determine the illness seeking behavior and self-medication among students of private medical college in Peshawar.METHODOLOGY:This study was a cross sectional descriptive study. It was conducted from September till December 2018. Study setting was a private medical college of Peshawar. A total of 250 students were recruited after taking well informed consent. Sampling technique was stratified sampling, from every academic year proportional number of students was selected for the study. Pilot study to check feasibility of questionnaire was done on 10% sample size. Data was collected from students by face-to-face interviews. Data was entered and analyzed in SPSS version 21. RESULTS:The study data regarding illness-seeking behaviors among medical students showed that 162 (64.8%) out of 250 practiced self-medication. The common illness was fever, headache and sore throat. Students used pain-killers and antibiotics without getting consultation. CONCLUSION:Self-medication is common among medical students of all five professional years in medical college of Gandhara University Peshawar. Regarding illness seeking behaviors most of the students preferred self-medication as most of the time medicines are available without prescription in the medical stores. However, still some percentage of students prefers to consult doctors or pharmacist before taking any medicine for their illness.KEYWORDS: Illness, Behavior, Self-Medication, Medical Students, Headach
Prevalence and Factors Associated with Harassment in Female Doctors and Nurses in Teaching Hospitals of KPK
No full textOBJECTIVES:To determine the prevalence of physical and verbal harassment in nurses and doctors and to evaluate the associated factors which lead to harassment in Teachings Hospitals in Peshawar district in 2018.METHODOLOGY:Nurses and doctors of three government and one private hospital of District Peshawar were included in this study. Sample size was 384. Simple random sampling was used and those nurses and doctors having experience less than 6 months were excluded. A self-administered questionnaire was implemented having both closed and open-ended questions and a written informed consent was taken. Data was analyzed using SPSS version 22.RESULTS:Out of 384 respondents 235 (61.3%) were harassed. Common type was verbal. Prevalence was more in nurses (69.5%) than doctors (52.2%), in non-pathan (73%), Muslim (62%), rural (67.2%), non-married (61.3%), younger age and in surgical and allied (65.5%) nurses and doctors. Main source of harassment were colleagues. More harassment occurs in wards and in night shift and among those nurses and doctors whose daily working hours are more than 8 hours (62.5%) and working experience is more than 4 years (64.6%).CONCLUSION:The prevalence of harassment in our study was 61.3% and significant associated factors of harassment in our study are ethnicity, daily working hours, duration of job, nature of duty, place of duty, religion, work specialty and assailant.KEYWORDS: Physical Harassment, Verbal Harassment, Prevalence, Risk Factors, Lady Doctors, Nurse
Students Feedback about Lecture Rooms to Improve the Effectiveness of the Lectures
Get PDFOBJECTIVES: The study aim was to determine the feedback regarding the environment, satisfaction and further needs for modification in improving the effectiveness of the lecture. METHODOLOGY: It was a cross-sectional study to measure the student's feedback about lecture rooms to improve the effectiveness of the lectures. A questionnaire was designed to assess the student's response about the environment of the lecture room, the learning experience of the students, needs of other lecture rooms’ modification, seating design and temperature of the lecture room. The total numbers of the participants were 115 students including both genders from Sardar Begum Dental College, Peshawar. Second- and fourth-year professional students were excluded from the study. Responses were recorded from 115 participants of the first- and third-year students of BDS. The obtained data were analyzed using SPSS 20. RESULTS:This study results showed that 100% of the students were satisfied with the environment of the classroom, to improve the learning experience 98% of the students were detected, 91% of students required modification of lecture rooms. 47% of the students preferred chairs with tables, 40% bench with tables and 11% are satisfied with the current setup. Twenty-four per cent of students suggested heaters in the lecture room during winter, 1.7% required air condition and 35% of students were satisfied with the room temperature. 38% of the students were satisfied with the effectiveness of the lectures.CONCLUSION:Students’ feedbacks were satisfactory and it enhanced their learning experience. Students preferred the change in the seating design, chairs with tables. KEYWORDS: Learning Experience, Lecture Room, Environment, Feedback, Modificatio
Burden of Accidents Involving Motorcyclists in District Kohat, Pakistan
Get PDFOBJECTIVES:The main aim was to assess the frequencies of accidents of motorbike in previous one year and also to estimate the factors related with the accidents.METHODOLOGY:The study design was quantitative and the data was collected from motorcyclists. In order to collect the primary data; a structured questionnaire was used. We interviewed 412 motorcyclists. Almost all the motorcyclist responded and thus we achieved 99% response. Statistical Package for Social Sciences (SPSS) version 21 was used to enter data, clean it and analysis.RESULTS:After the analysis we got hold of some factors, which were associated with accidents. Some of these factors were human, vehicle and environment related factors completing the epidemiological triad of agent, host and environment. CONCLUSION:Based on the results of the study we concluded that bikers must shun the practice of speeding over and above the limits of speed given by the government, one-wheeling, and listening to music while driving. Moreover, the bikers must be taught the basic skills of motorbike riding by authorized personnel and keep latest models of motorbikes, which are in excellent condition. The guardians or parents along with the law enforcement agencies must make ensure that biker must get a license before using the bike. KEYWORDS: District Kohat, Road Traffic Accidents, Burden, Motorbike
Correlation Between Glycosylated Haemoglobin and Thyroid Function Tests in Patients with Type-2 Diabetes Mellitus
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OBJECTIVES: The aims of this study were to determine the frequency of undetected dysfunction of thyroid in patients with diabetes, determination of correlation between glycosylated Hb and thyroid hormones, and to find out the relationship between blood glucose control and function of thyroid in patients of type 2 diabetes mellitus in comparison to normal individuals.
METHODOLOGY:This study was carried out at Department of Medicine, Hayatabad Medical Complex, Peshawar. It was a cross sectional study. A sample size of 358 subjects was taken using non-probability consecutive sampling in which 179 had type-2 diabetes and 179 were healthy normal subjects. Based on the results, they were classified into either hypothyroid or hyper thyroid categories, and then a comparison was done with HbA1c to determine their correlation. The data was analyzed by using SPSS version 23.
RESULTS: The mean age of both the groups was 54.35 ± 9.38 years and 42.66 ± 9.20 years respectively on comparison of median (as data lacked normality) and mean ages of cases was much higher as while drawing comparison to control group with p-value less than 0.001. In these cases, the total number of male patients were 62 (34.64%) and females were 117 (65.36%) while in controls the males and females were 124 (69.27%) and 55 (30.73%) respectively. In these cases, the number of hypothyroid patients were 13 (7.3%), hyperthyroid individuals were 26 (14.5%) and 11(6.1%) cases had subclinical hyperthyroidism. Normal thyroid function was found in all controls. In these cases, a weak positive correlation was found between HBA1c and T3 (r=0.239, p-value 0.001). Also, there was an insignificant correlation with T4 (r= - 0.017, p-value = 0.817) and correlation of insignificant nature found with TSH (r= -0.036, p-value = 0.634). Among controls same (insignificant) correlation was found between Glycosylated Hb and T3 (r= 0.070 p-value = 0.352), a weak positive correlation with T4 (r= 0.238, p-value = 0.001) and a moderate negative relationship with thyroid stimulating hormone (r= - 0.586, p-value <0.001).
CONCLUSION: Early detection of thyroid dysfunction in diabetic patients can prevent complications and leads to optimum control of blood glucose level
Correlation Between the Maturation Stages of Mandibular Third Molars and Chronological Age in Patients Visiting Sardar Begum Dental College, Peshawar
Get PDFOBJECTIVES:
The objective of this study was to determine the correlation of chronological age with the maturation stages of mandibular third molar.
METHODOLOGY:
This descriptive, cross-sectional study was conducted at Sardar Begum Dental College, Gandhara University Peshawar on 384 patients from January 2018 to June 2018 and included patients having age 11-26 years with good quality Orthopantomogram showing mandibular third molar tooth germs bilaterally. Data were analyzed using SPSS version 22. p ≤ 0.05 was considered as statistically significant.
RESULTS:
Females 286 (74.5%) were predominant than males 98 (25.5%) with mean age presentation of 18.12±3.03 years. The most frequent stage of Demirjian’s stages of mandibular third molar was stage F (24.7%). Pearson correlation showed that maturation stages of mandibular third molars were significantly related to the chronological age ( r=0.446, p value=0.00).
CONCLUSION:
A correlation between maturation stages of mandibular third molars and chronological age existed
ONE DISEASE WITH MULTIPLE FACES
No full textOne disease with multiple symptoms and multiple presentations, this time reported in Khyber Pakhtunkhwa as epidemic, yes, I am talking about dengue fever.
Dengue fever is one of the mosquito-born infections1, transferred from one person to another by mosquito bite. The exact history is not known, but most of the cases were reported after Second World War. Nowadays, it is present throughout the world infecting up to 500 million people in more than 110 countries around the globe. It is reported that around 10 to 20 thousand people die annually due to dengue fever throughout the world. It is now considered as one of the most dangerous but equally neglected tropical disease.
In Pakistan, its first outbreak was reported in 2014 and after that it follow different courses. The first dangerous outbreak in Khyber Pakhtunkhwa and Peshawar was reported in 2017. But unluckily since then, its number is increasing. It is considered as one of the most reported disease by national media in Pakistan. Due to its strange name for the general public and some reported mortality, it is considered as a dreadful disease in the community. Severity of symptoms and fear of death compel every patient with fever to rush to the hospital and request for dengue test.
In 2019, again there was an outbreak throughout the country. But this time, presentation was very atypical in a set of patients that created a lot of problem to diagnose such patients clinically with suspected dengue fever and decide about their investigations. These atypical manifestations were really confusing2. In one set of patients who presented with classical symptoms of upper respiratory tract, characterized by cough, sore and congested throat, fever and body aches. Initial impression was made of common cold or viral upper respiratory tract infection. But later, the patient turned out to have low platelets and dengue fever. In another set of patients, the presentation was fever, body aches, severe epigastric pain, vomiting and diarrhoea. Initial impression was made of acute gastroenteritis, but later the patients were found to have dengue fever. We also observed loss of appetite, body aches, constipation, nausea and abdominal pain mimicking like enteric fever, but later most of these patients were found to have dengue fever. Luckily, severity in new cases was not observed and most of them were managed as outdoor patients. Admission was needed usually for those cases, which presented with recurrent dengue fever or in those patients who were suffering with other concomitant disease like chronic renal failure and chronic liver disease. Mortality in dengue fever was mostly reported with recurrent dengue fever and in patients having cardiac, renal, respiratory and hepatic problems3.
Dengue fever is now one of the leading health problems in our country. Still we must run a long way to fight against it. We must know about all the aspects of the disease, including its different clinical presentations and complications. If someone gets infected with one of its genotypes, it confers immunity against that genotype of dengue virus for life. But infection with another genotype of dengue virus in the form of recurrence can lead to severe infection and thus increase chances of mortality4. So, let’s keep a close watch on the different clinical presentation to diagnose recurrence timely and manage it appropriately in future. We need to educate and train our health professionals to fight this war against dengue fever in a more professional way in future.
We should also educate our community to adopt measure, which can prevent its spread in future. Our ignorance towards cleanliness as nation can put the whole society at greater risk in future. Future epidemic with different genotype will be dreadful. All these measures will work, if we concentrate more on prevention and follow the lesson of Islam about cleanliness and adopt it in true spirits. Commitment from the state agencies, policy makers, health professional and responsible community can decrease the future epidemics
TOBACCO CESSATION: DO SMOKERS NEED PROFESSIONAL HELP TO QUIT?
No full textTobacco use is considered a risk factor for 6 ofthe 8 leading causesof death worldwide and isknownto cause diseasesaffectingthe heart and lungs1. Tobacco hasa definite rolein the etiologyofa number of dental morbidities, and is an established riskfactor for Oral Cancer and periodontitis. World health organization reported more than a billionsmokersworldwide. Thenumber ofsmokersis increasingand a shift ofincreasednumber of smokersin developing world is noticed. Tobacco isa bigkilleras more than 10% ofadultdeathsannually, fromallcauses are attributedtoit. Moreover,tobacco kills almost five and a half million annuallyand on the average 10 persons per minute2. Considering gravityof thesituation, a global and localtobacco controlstrategybecomes veryimportant. The Government ofPakistan hasincreased taxesontobacco products, bannedits use inpublicplacesto discourageits use. Thisstrategywould helpreducethe number of tobacco productsused byindividuals. But what’smissing isto focus on regular smokers, and assesswhethertheyneed professional help to quit tobacco. Most ofthesmokersfind it difficult to quit on their own, while some successfulquittersconsider motivation, willpower and commitment important factors. Howcan aregularsmoker be motivated isstillnot clear andneedsmore research3.Theself-quitproportion for regular smokersis 3-5%4,which isquite lowand most ofthe tobacco usersfind it difficult to quit, evenafter feelingthe effectsafteryearsofsmoking. The reason could be addictionto dailydose ofnicotineto the brain. Agood number ofsmokerswant to quit at some time, but it is alsonotedthat onlya limitednumber ofthesessmokers have ever tried5. Theclinical practice guidelinesfor treatment ofTobacco use and dependence, recommendstheuse “Five A’s”for tobacco cessation6. Thefirst stepofthissmokingcessation protocol is to “ASK” anindividual about current smoking statusand anypreviousattempt to quit smoking. The next step is to “ADVISE”,througha clearand strong personalizedmessage andhelp identifyaquitting date. This isfollowed by“ASSESS”, whether the smoker isreadyto quit. This isfollowedbythestep “ASSIST”, in which literature isprovidedto help thesmoker understand the benefits ofquitting. Thelast stepiscalled “ARRANGE”, whichmeans arranging a follow upvisit,usuallyafter 1 to2 weeksofquitting date. Health professionalsare consideredas acredible source ofinformation.Familyphysicians canplaya veryimportant part in helping their patients who are regular smokers. Bybringing “Five A’s” modelinto practice,a physiciancangivea better opportunityto asmoker to understand the health hazardsoftobacco use, andknowthe benefits ofquittingperiodically. Thiscan lead to a higherpercentageof successfultobacco quitters. Otherhealthcare professionals, who can playanimportant role in helpingsmokersquit, are the dentalprofessionals. Apatient would spend more time in a dental office and routine dentaladvice should alsoinclude quit tobacco, alongwith oralhygieneinstructions and dietaryadvice. Dentalassociations should encourage their membersto advisepatients about oral and systemic hazards of tobaccoproducts
MEDICAL EDUCATION AND DILEMMA OF A CLINICAL TEACHER
No full textWeas clinicianshave manyjobsto do. Apartfromourfamily, socialandreligious obligations, we teach,treat, manage patients andhave administrative duties. We have beenmeagerlytrained for teaching, administration and other competencies as is evidentfromourundergraduate andpostgraduatemedicalcurriculum. Havingbeengiventherole of a teacher in medical profession, weteach manyundergraduateand postgraduate students, supervise them, regularlytake part in assessments, papercheckingand questions development. The dilemma is; is it not enough for us to be designated asteachers? Ofcourse, bydoing somanythings as mentioned above, we are teachers. Hardenand Crosbyhavedescribed 12roles ofa clinicalteacher1. Clinical teacher isnot just aninformation provider to undergraduate and postgraduatestudents.Rather,aclinicalteacher should be trained enough to developasa role model, mentor, facilitator, learningresourcescreator and provider, course organizerandan evaluator.Teachingat undergraduate andpostgraduate levelneeds conversionfromtiring, longlectures for presenting alotofinformation into objective based,interactive, relevant, and shortlectureskeepingin mindthe learningstyles ofstudents. Thiscan be achieved byfollowingthe Gagne'snineevents ofinstructions2. The clinicalteachersneed to followthese guidelinesto make theirlecturesatpar with internationalstandardsofteaching.Clinicalteachers need tofollowthe new ways ofworkplace-basedteaching andlearning strategieslike one-minute preceptor modelofbedside teachingtoavoid tiring teaching rounds bydiscussingirrelevant topics, without keepinga focus on patient problems3. Theassessment systemneedsa revamp in oureducational system. In addition to goodqualitymultiplechoice questionswe needto convert as wellto keyfeature format and cluster questions to increasestudent's problemsolvingand criticalthinking abilities4. Similarly,short answer questionsneedtobedesigned properlyto increase thereliabilityand validityof assessments. Most ofour ObjectiveStructuredPractical/ClinicalExaminations (OSPE/OSCE)assess the cognitive domain ofstudents but actuallythese areintendedto assess the psychomotor andaffectivedomains. Thisresults in low validityand reliability of our assessments5. Regarding paper checking, a uniform policy for checking should beapplied. This canbe done bydeveloping a proper keyfor each question byusingtheproper principles ofassessment. Role modelling isconsidered to be a powerfultool for learning6. Teacher should developthe attributes ofa good rolemodelto have an impact over student's learning. Thesystemoffeedback israre inourundergraduate and postgraduate medical institutions. Feedbackisconsideredtobethebackbone ofa teaching organisation7, and we the teachersneedto learn, applyand habituate feedbackin our culture. Evaluationstrategies for our teaching, patient's management, administrative actions needto beappliedand necessarycorrectionsto bedone. Toovercome all theseshortcomingson part of clinicalteachers, itismandatoryfor teachersto enroll in amedical education program. These programsare in the form of certificates (6 months), diploma andmaster degree programs (2 years),and doctoralprograms. In thecomingyears, the Pakistan Medicaland DentalCouncil(PM&DC)isconsideringthese programsmandatoryfor promotion offacultyfromassociate professor to the post ofprofessor andappointment ofprincipals and deansof educationalinstitutions. These programs revolve around sixbasic concepts ofmedicaleducation;educational psychology, teachingand learning,curriculum,assessment, research, professionalismand academicleadership.Ifwe lagbehind in the concept of"Train theTrainee", wewillremain in a dilemma and continueto march to the beat ofourown drumthinking thateveryoneelse isoutof step. The clinicalteacherscan improve these skillsbyenrollingthemselves in these educational programsoftheir choice to bring theteaching, assessments, research,and professionalism at par with international standards