The current study aims to assess the effectiveness of different teaching methods adopted for the practical session of Cardio-Pulmonary Resuscitation (CPR). CPR training is one of the compulsory modules of the Public Health Pharmacy (PHP) course at Universiti Sains Malaysia. CPR training comprises of 10% of total marks of the PHP course. To test the effectiveness of the different teaching strategies, three groups were defined using a two-stage cohort distribution—i.e. based on grade point average (GPA) and different teaching modalities. Group One was instructed using images and PowerPoint lecture slides. Group Two was instructed using videos and PowerPoint lecture slides. Group Three was instructed using PowerPoint slides with white boards and videos. Students in Group Three were not provided with a hard/soft copy of the PowerPoint slides and were encouraged to write down all the information on their personal notebooks. A 20-item questionnaire was used to assess the students’ understanding toward the CPR session. Data were analyzed using the Statistical Package for Social Science Students, SPSS version 13®. Based on the response attained, the comparison of the final score among the groups was undertaken using one way ANOVA. Twenty-seven students have participated in this study. Final evaluation using the questionnaire revealed that student’s in Group Three had a better understanding of CPR (18.1 ± 1.5, p <0.001) than the other two. Students’ note taking during the lecture and use of traditional chalkboard teaching were found significant to improve the students’ understanding and learning in the CPR session.
Teaching strategies; Chalkboard; Cardio-Pulmonary Resuscitation (CPR)
A rare case of ascaris coming out through the anterior abdominal wall is reported here. A 40-year-old female had undergone dilatation and curettage by a quack. On the second day she presented with presented with features of peritonitis. She was explored. Resection anastomosis of the ileum was done for multiple perforations of the ileum. Patient developed a fistula in the anterior abdominal wall which was draining bile-colored fluid. On the 12th postoperative day a 10-cm-long worm was seen coming out through the fistulous tract which was found to be Ascaris lumbricoids. Ascaris lumbricoids can lead to many complications ranging from worm colic to intestinal obstruction, volvulus, peritonitis, pancreatitis, cholangiohepatitis, liver abscess and many more. Worm has been reported to come out through mouth, nostrils, abdominal drains, T-tubes etc. But ascaris coming out through the anterior abdominal wall is very rare hence reported here.
Ascaris; bile; perforation
Anonychia/hyponychia congenita is a rare autosomal recessive developmental disorder characterized by the absence (anonychia) or hypoplasia (hyponuchia) of finger- and/or toenails frequently caused by mutations in the R-spondin 4 (RSPO4) gene.
Three hypo/anonychia consanguineous Pakistani families were ascertained and genotyped using microsatellite markers spanning the RSPO4 locus on chromosome 20p13. Mutation screening of the RSPO4 gene was carried out by direct sequencing of the entire coding region and all intron-exon boundaries.
Mutations in the RSPO4 gene were identified in all families including a novel missense mutation c.178C>T (p.R60W) and two recurrent variants c.353G>A (p.C118Y) and c.3G>A (p.M1I). The c.3G>A variant was identified in unaffected family members and a control sample in a homozygous state.
This study raises to 17 the number of known RSPO4 mutations and further expands the molecular repertoire causing hypo/anonychia. The c.353G>A emerges as a recurrent change with a possible founder effect in the Pakistani population. Our findings suggest that c.3G>A is not sufficient to cause the disorder and could be considered a polymorphism.
Anonychia; Hyponychia; Mutation; RSPO4 gene; Polymorphism
The current study aims to evaluate the patient’s level of satisfaction with health care services provided by the pharmacist at Aljaber ENT hospital, Eastern Region Alahsah, Kingdom of Saudi Arabia. A cross sectional study was planned from 1st March 2011 until 31st May 2011. A 27 item questionnaire was used, scoring of the responses was done to classify the patient satisfaction into sublevels. The maximum possible score was 36; those scoring less than twenty were graded as poor satisfaction level followed by moderate satisfaction level 21–25, good satisfaction level 26–30 and high satisfaction level 31–36. Statistical package for social science version 13® was used to analyze data, One-way ANOVA and independent sample t-test were applied to see the differences in the level of satisfaction. Every third patient visiting pharmacy was given a chance to participate in this study. A total of N = 991 patients were randomized using the pharmacy appointment number. Of whom 657 patients have shown willingness to participate in this study. The response rate of this study was 66.30%, most of the respondents 383 (58.1%) were male ranging from the age group of 21–40 years with a mean age of 32 years SD 9.73. The mean score for all patients was 26.15 SD ±3.4. Among all the demographic variables a significant difference in satisfaction level was found among in terms of age (df = 8, F = 8.36, p = <0.001∗), gender (t = −4.089, df = 656, p=<0.001∗) and race (df = 2, F = 8.47, p = <0.001. The satisfaction level among Saudi nationals was least in comparison to Egyptians and others. In general, it is seen that respondents of age 56–60 years were most satisfied with the healthcare services provided by the pharmacist. In addition, the satisfaction level was higher among female patients in comparison to men.
Patient’s level of satisfaction; Health care services; Pharmacist; Aljaber ENT hospital; Kingdom of Saudi Arabia
The current study aims to assess the community pharmacist’s skills to make correct use of metered dose inhalers (MDIs). Seventy-four pharmacists were approached using six clusters from the most populous areas of Alahsa, Eastern region Saudi Arabia. Of whom n = 71, responses were taken in consideration to perform the statistical analysis. Scoring of pharmacist demonstration was done using a nine-step checklist for the appropriate use of inhaler. A simulated patient approach was used to assess pharmacist’s skill. Majority, 98.6% of the pharmacists were Egyptian nationals with a mean age of 38.74 ± SD 4.52. Overall, pharmacists were found to have a poor recognition (mean score = 4.2 ± SD 2.08) with the steps considered while using an inhaler. However, significantly better knowledge differences were observed among the pharmacists aged 30–35 years (5.52 ± 2.14, t = 2.851, p = 0.009∗). In addition, job experience (3–4 years) was found significantly (p = 0.003∗) associated with a better knowledge toward the appropriate use of inhaler. It was seen that the young pharmacists working on chain pharmacies have comparatively better knowledge than the other groups.
Inhalers; Knowledge; Community pharmacist
This study aims to highlight the factors associated with suicidal behavior among patients with depressive disorders.
Material and methods
A retrospective (Jan 2002 – Dec 2007) evaluation of medical records was done at the psychiatric clinic at the Penang (Malaysia) Public Hospital. Data was analyzed using Statistical Package for Social Science SPSS version 13®. Chi-square (χ2) test was used to assess the association among variables. Odds ratios were calculated. Multiple logistic regression was applied to identify the predictors for suicidal behavior.
Of 298 patients, 99 patients reported having thoughts of suicide. Overall, female respondents, particularly Chinese, constituted the majority reporting suicidal thoughts (p = 0.01). Cigarette (p < 0.01) and alcohol use (p < 0.01) were found to be associated with suicidal ideation. Among patients with medical comorbidities, diabetics were at a high risk for suicidal thoughts (odds ratio – OR = 1.05, 95% confidence interval – CI 0.45-2.46). In terms of social problems, marital and relationship difficulties were the main risk factors (OR = 2.03, 95% CI: 1.16-3.58). The significant predictors for suicidal behavior were found to be smoking and alcohol use (adjusted R2 = 0.39, F change = 75.55, p < 0.01).
Chinese females were found at higher risk of suicidal ideation, as were smokers and alcohol users. The elderly aged 50 and over were also at a higher risk, followed by adolescents and youths aged 15-24 years. Comorbid medical complications and social problems were other factors that may contribute to suicidal ideation among the patients with depressive disorders.
suicidal behaviour; Penang Public Hospital; comorbidities; social problems; smoking and alcohol use
Objectives To identify the aetiology and clinical presentation of depression among Malaysian women.
Methods A cross-sectional study was conducted at the Psychiatry Clinic, Public Hospital, Pulau Penang, Malaysia. Retrospective evaluations of records were conducted between January 2002 and December 2007. The data were analysed using the statistical software, SPSS v. 131®.
Results Ninety-six (56.8%) of the patients were Chinese, the mean (± SD) age of the patients was 45 ± 17.8 years, with a majority (72; 42.6%) aged over 50 years. The incidence of depression with comorbid hypertension and comorbid diabetes mellitus was significant among women aged over 50 (P < 0.001 (hypertension) P < 0.015 (diabetes mellitus)). Marital and relationship problems were found to significantly affect Chinese women aged 15–30 years (P = 0.019). In terms of the clinical presentation of depression among Malaysian women, suicidal ideation and somatic symptoms like reduced energy/being easily fatigued were more frequent among Chinese.
Conclusion Symptoms of being short-tempered, crying, restless and doubtful/distracted should not be neglected in primary care because of the possibility of mental health disorders. The timely evaluation of diabetic and hypertensive patients is an ideal strategy to prevent mental health disorders.
aetiology; clinical presentation; depression; Malaysian women
Postnatal depression (PND) is a major psychiatric challenge to women's mental health worldwide. Particularly speaking of the Asian subcontinent i.e. India and Pakistan (Indo-Pak), many women suffer through PND but remain undiagnosed, which may be due to lack of knowledge and awareness about alteration in mood and thoughts during pregnancy and after delivery. Certain factors like low socio-economic status, a history of marital violence and depression entail a higher risk of PND. In addition, one factor which remains neglected is the husband's knowledge about PND and his behaviour toward the woman suffering from PND. The husband's poor knowledge of PND and his attitude toward the mother play a vital role in the initiation of PND. Pre-delivery interventions focusing on a couple's knowledge of PND, the couple's mutual understanding/relationship and identification of the potential stressors for a depressive episode may be one way to reduce the incidence of PND among both women and men.
Asian subcontinent; postnatal depression; pre-delivery interventions
The past decade has witnessed an exponential increase of novel therapeutic modalities for a variety of rheumatic disorders, including gout. During the past few years two novel therapeutic agents have been approved by the US Food and Drug Administration for the treatment of hyperuricemia in patients with gout, one of them being febuxostat, a nonpurine selective inhibitor of xanthine oxidase. Review of its pharmacokinetics and pharmacodynamics, efficacy and safety profile, and use in gout patients with comorbid conditions reveals that age and gender have no clinically significant effect and dose adjustments based on age or gender are not required. In addition, febuxostat can be used in patients with mild-to-moderate renal or hepatic involvement. Its overall efficacy and safety profile is comparable and, in certain subsets such as gout patients with mild and moderate renal insufficiency, is superior to allopurinol.
hyperuricemia; febuxostat; gout; safety profile; efficacy profile
Background The aim of the present study was to evaluate the knowledge and perception of depression among students of University Sains Malaysia (USM), in Penang, Peninsular Malaysia.
Method Face‐to‐face interviews were conducted using a pre‐validated 21‐item questionnaire among students at USM.
Results A total of 500 respondents participated in the survey comprising 24.6% (n=123) males and 75.4% (n=377) females. Half (50.0%, n=250) were Malays, followed by Chinese (44.0%, n=220) and Indians (6.0%, n=30). Whilst exploring the respondents' knowledge of the symptoms of depression, it was found that Chinese females had a comparatively better knowledge (P=0.058) of the symptoms of depression in comparison with Malays and Indians. Overall, social issues were attributed as the possible cause of depression. A cursory knowledge level was observed regarding medication for depression. Female students were more inclined towards the use of alternative and traditional medicines. However, with regard to seeking professional help, consultation with a psychiatrist was preferred by the majority.
Conclusion Overall, a moderate level of knowledge about the symptoms of depression and a cursory knowledge of its therapy were observed. Those with personal experience of depression had better knowledge of the symptoms and therapy. Alternative treatments and traditional medicines were also favoured. There is a risk that this may affect the ability of Malaysian youths to seek evidence‐based mental health care.
alternative medicine; depression; knowledge; perception; personal experience; students
Objective This study aims to highlight the subjective experience of an
immigrant Pakistani woman during postnatal depression (PND), with a special emphasis on
the husband's knowledge and behaviour towards PND.
Methods A face‐to‐face interview was conducted with
a woman reporting symptoms of depression on the fourth day after delivery. She was
evaluated using the Diagnostic and Statistical Manual of Mental Disorders, fourth
edition (DSM IV)
and the Edinburgh Postnatal Depression Rating Scale (EPDRS).
The evaluations were completed by a qualified psychiatrist. The demographic
information, personal and family medical history and attitude towards the child were the
principal issues recorded. In addition, five items were used to evaluate the husband's
knowledge about PND. The EPDRS differences before and after counselling were evaluated
using a student t‐test.
Results The patient was 32 years old and this was her first experience of
delivery by Caesarean section. The evaluation for depression confirmed the diagnosis of
PND and she scored 16 on the EPDRS. The husband's knowledge of PND was poor.
Conclusion This case study suggests that lack of social support and
understanding appear to play a vital role in the persistence of symptoms of PND among new
mothers. Therefore, counselling of couples may be an effective additional tool in treating
knowledge; postnatal depression; social support
This study aims to explore attitudes towards, complications of and preventive measures
for depression and the barriers that result in delays in seeking help among the various
ethnic groups in Penang, Malaysia. In June 2007 a questionnaire‐based survey
was undertaken in Penang. Face‐to‐face interviews were conducted,
and 1855 respondents were approached to participate in the study by adopting a cluster
random sampling method. A 25‐item questionnaire was used to explore public
attitudes towards, complications of and preventive measures for depression and delays in
seeking help. A total of 1149 (61.94%) showed willingness to participate in the survey.
Ethnically, 490 (42.6%) of the respondents who participated in the survey were Malay,
while 413 (35.9%) were Chinese, 149 (13%) Indian and 97 (8.4%) from other ethnic
minorities. The mean age of the respondents was 30 years (SD ± 11.5). In
evaluating public attitudes, the majority (n = 910, 79.2%) agreed with
the statement that family and friends can enhance the depression recovery process by
providing more care and attention to the patient and this was found to be statistically
significant (P ≤0.001). More than one‐third of
the respondents (n = 437, 38.0%) perceived depression as a normal medical
condition and believed that it subsides automatically. The majority (n =
830, 72.2%) stated that depression results in social problems, while some felt that it can
lead to raised blood pressure (n = 518, 45.1%). In terms of prevention,
most of the respondents indicated that one can prevent depression by maintaining a good
social life. In evaluating the barriers to seeking professional help, the majority
(n = 582, 50.7%) stated that they did not believe they were at risk,
with the next largest group identifying a lack of awareness regarding the signs and
symptoms. However, a positive attitude was observed towards the complications and
prevention of depression. Initiatives to increase mental health literacy will prove
fruitful in neutralising the negative public perceptions towards the treatment of
depression and barriers to seeking professional help.
attitudes; barriers; complications; depression; prevention; treatment
Sexually transmitted Infections (STIs) rank among the most important health issues for the people especially the young adults worldwide. Young people tend to engage in sexual activity at younger ages in the past decade than in the 1970s, and 1980s. Knowledge is an essential precursor of sexual risk reduction. A cross-sectional study was conducted in Pulau Pinang, Malaysia, to produce the baseline information about school students' awareness and perception about sexually transmitted Infections (STIs) and their sexual activity to help establish control and education programmes.
Students from form 4 (aged between 15 to 16 years), form 5 (aged between 16 to 17 years) and form 6 (aged between 18 to 20 years) in their class rooms were approached and asked to complete self administered and anonymous pre-validated questionnaires. SPSS for windows version 13 was used to analyze the results statistically and results were presented in tabular form.
Data was collected from 1139 students aged between 15 to 20 years, 10.6% of which claimed that they never heard about STIs. Sexual experience related significantly with gender, race, and education level. Approximately 12.6% claimed to have sexual experience of which 75.7% had their sexual debut at 15-19 years and 38.2% were having more than 3 partners. Sexual experience was found to be significantly associated with gender (p = 0.003), ethnicity (p = 0.001) and education level (p = 0.030). However, multiple partner behaviour was significantly associated only with gender (p = 0.010). Mean knowledge score was 11.60 ± 8.781 and knowledge level was significantly associated with religion (p = 0.005) education level (p = 0.000), course stream (p = 0.000), socioeconomic class (p = 0.000) and sexual experience (p = 0.022).
It was concluded that school students have moderate level of knowledge about STIs although they are sexually active. Interventions such as reinforcing the link between STIs and HIV/AIDS, assessing the current status of sexuality education in schools and arranging public talks and seminars focusing on STIs prevention education are needed to improve their awareness.
Ankle brachial index (ABI) has been utilized in the management of peripheral arterial disease (PAD).ABI is a surrogate marker of atherosclerosis and recent studies indicate its utility as a predictor of future cardiovascular disease and all-cause mortality. Even so, this critical test is underutilized. The purpose of this review is to summarize available evidence associated with ABI methodology variances, ABI usage in the treatment of PAD, and ABI efficacy in predicting cardiovascular disease. This review further evaluates how ABI is used in the prognosis and follow-up of lower extremity arterial disease.We reviewed the most current American College of Cardiology guidelines for the management of PAD, the Trans Atlantic Intersociety Consensus (TASC) working group recommendations, and searched the Medline for the following words: ankle brachial index, ABI sensitivity and specificity, and peripheral arterial disease.
The ABI is a simple, noninvasive clinical test that should not only be applied to diagnose PAD, but also to provide important prognostic information about future cardiovascular events. Although the ABI has been employed in clinical practice for some time, our review of various studies reveals a lack of standardization regarding both the method of measuring ABI and the cutoff point for abnormal ABI. It is extremely important that we understand all aspects of this crucial test, as it is now being recommended as part of a patient’s routine health risk assessment.
Peripheral arterial disease; Ankle Brachial index; ABI Sensitivity and Specificity; Atherosclerosis; Cardiovascular morbidity and mortality.
The title compound, C20H26O4, was extracted from Leucas Urticifolia, a wild Lamiaceae herb distributed in the Punjab, Baluchistan, Sindh and the Rajputana desert of Pakistan. The plant is utilized for various medicinal applications by the local community. The title compound is based on the pimarane–diterpene skeleton. The molecule exhibits an epoxy ring fused to momilactone-A, leading to a pentacyclic molecular structure. The absolute configuration was assigned by comparison with the crystal structure of momilactone, but needs further verification. The crystal structure is governed by four intermolecular hydrogen-bond interactions of the C—H⋯O type.
People from British South Asian communities have an increased risk of mortality from coronary heart disease (CHD). Doxazosin, a selective α1-adrenergic blocker, in addition to lowering blood pressure, has been shown to have positive effects on glucose metabolism and lipid profiles in patients with hypertension.
We studied doxazosin (1–8 mg) and bendrofluazide (2.5 mg) in patients of British South Asian origin with existing mild to moderate hypertension (doxazosin n = 78; bendrofluazide n = 82), to compare their effects on glucose and lipid metabolism in this group.
Design of study
A 34-week randomised, double-blind, parallel-group, multicentre study.
Primary care in the UK.
All doxazosin patients started with an initial dose of 1 mg once daily, titrated to a maximum 8 mg once daily if diastolic blood pressure was >90 mmHg or was not <5 mmHg of the baseline value. The primary efficacy variables were mean glucose and total cholesterol concentrations at week 21.
Doxazosin reduced glucose, total cholesterol, low-density lipoprotein-cholesterol and triglycerides and increased high-density lipoprotein-cholesterol. There were significant differences between doxazosin and bendrofluazide for glucose concentrations at week 21 (P = 0.029) and week 34 (P = 0.015), total cholesterol at week 21 (P = 0.048) and triglycerides at week 21 P = 0.047) and week 34 (P = 0.009). There was no significant difference in blood pressure lowering between the two treatments.
Doxazosin exhibits beneficial effects on glucose concentrations and lipid profile, in particular in lowering triglyceride concentrations in British South Asians. Whether these desirable characteristics translate to improved overall cardiovascular risk requires formal evaluation.
bendrofluazide; doxazosin; ethnic groups; glucose; hypertension; lipids