Dear Madam, Osteoporosis results in the weakening of the bones over time; this is a preventable medical condition. Unfortunately, this makes people prone to low-impact fractures. People usually know about this disease after fracturing a bone(1). It is estimated that in Pakistan, 9.9 million people have osteoporosis, and 7.2 million are females. The numbers may rise to 12.01 million by 2050 (2). Things are much worse in a country with an ever-expanding population and a limited health budget; DEXA machines are sparse, which leaves clinicians to rely on heel ultrasound scanning. Above all, the lack of solid guidelines and limited patient compliance create havoc regarding this issue. In Pakistan, this disease prevalence is rising exponentially due to multi-parity, extended life post menopause, low calcium and vitamin D intake, and stagnant lifestyle (3). The Asia-Pacific Consortium on Osteoporosis came into existence in 2019 to reduce osteoporosis prevalence in Asia Pacific. Unfortunately, it too confirmed that local guidelines for osteoporosis treatment are non-existence in this part of the world(4). Primary health centres are the initial places to pick osteoporosis; however, studies indicate primary health care physicians feel it challenging to use FRAX (screening test) as there is no formal training to pick signs of osteoporosis(5). Therefore, the health ministry needs to take this issue seriously and form a national-level committee comprising multiple specialities (orthopaedic surgery, endocrinology, rheumatology, family medicine, primary care, etc.). Drafting local guidelines will also be an effective way to treat this silent undertreated disease. In addition, bisphosphonates should be promoted in the diagnosed patients as it has proven to be the most effective method to curb osteoporosis(6). Arranging seminars on world osteoporosis day (20th October) at educational centres, hospitals and public places will promote early seeking of help in case of osteoporosis. Follow-up in patients with diagnosed osteoporosis is crucial; setting up hotlines for such patients at the national level will help doctors fight poor compliance issues regarding management.
Purpose: Staphylococcus aureus is an important nosocomial pathogen and the progression of methicillin resistance stances a most important threat for its control. The current study was directed to govern the MRSA prevalence and its susceptibility to various antibiotics given for anti-staphylococcal strains in OPD treated patients. Study design: Prospective descriptive study. Place and duration: This study was conducted in the East Surgical Ward of Mayo Hospital, Lahore for two-year duration from January 2020 to December 2021. Methods: A total of 200 patients with septic wounds of both sexes were encompassed in the study. Swabs were taken from wounds which were infected and Stuart's medium was used to transport them. The samples were grown onto MacConkey agar, nutrient agar and blood agar and for 24 hours; incubated at 37 ° C. All MRSA isolates were biochemically and morphologically identified using standard procedures of laboratory by processing clinical specimens submitted to a microbiology laboratory. All isolates were tested for patterns of resistance and sensitivity. Results: A total of 200 patients were included, 115 (57.5%) were men and 85 (42.5%) were women with 27.3 years of mean age and age range from 15-70 years. The incidence of positive cases confirmed by culture was 118 (59%) and the MRSA incidence was 78 (39%). Of the 78 cases of MRSA, 50 (64.10%) are men and 28 (35.90%) are women. The incidence of other microorganisms was 40 (33.8%). MRSA was 100% sensitive to vancomycin, teicoplanin and linezolid. Of these, 24.4% were sensitive to cotrimoxazole, 47.4% were sensitive to fucidic acid and 28.2% were sensitive tetracycline antibiotics. Cultured MRSAs were resistant 100% to main antibiotic groups including penicillin, macrolides, cephalosporins, fluoroquinolones, meropenem, imipenem, gentamicin, and tazobactum/ pipracillin. Of all 78 MRSA patients, > 50% were from general surgery and orthopaedics departments, and the remainder from other related specialties, such as Gynecology, pediatric surgery, maxillofacial surgery, neurosurgery and otolaryngology. Of 78 patients with MRSA, 70 (89.7%) were hospitalized with a history of hospitalization, and 60 (76.9%) were hospitalized for >1-week. The organism was institute to be hundred percent resistant to the generally directed antibiotics. Conclusions: The incidence of MRSA is increasing. The organism spreads readily in a hospital setting, causing morbidity, mortality and higher costs. Special infection control actions and precautions should be taken to stop and prevent the MRSA spreading. Keywords: Nosocomial infections, MRSA and Antibiotic resistance
Menstruation, a physiological phenomenon, is still considered a stigmatized subject in 3rd world countries like Pakistan, leading to incorrect and incomplete knowledge, resulting in unhealthy practices (1). In lower socioeconomic classes, menstrual hygiene management(MHM) can be unhygienic and inconvenient for women (2). According to research in Karachi, at menarche, only 28.4 per cent of the general population had an idea of menses and proper placement of absorbent (1). Another study found a statistically significant association between reproductive morbidity and unhygienic menstrual practices (3). Unhygienic practices lead women to Reproductive tract infections, and many women have Pelvic inflammatory disease (PID). According to research, 76.7 per cent of women who came to health clinics had Reproductive tract infections (RTIs), and 14.7 per cent had PID (4). Reproductive tact infections is also a significant reason for secondary infertility (5). In rural areas, women do not have access to and knowledge about sanitary products (6). Recently, floods have inundated one-third of Pakistan. As a result, 33 million people were displaced, and 660,000 people live in relief camps (7), of which 8 million women are of reproductive age. Along with all other issues, women are facing problems regarding menstrual hygiene. Some women in Baluchistan were reported to be using tree leaves instead of pads (7). According to a study by AKU, women in Dadu (an area affected by flood from 2019-2021) were not using sanitary products, instead repeatedly changing out of and washing their stained clothes(7) During the evacuation from flood-affected areas, menstrual products have been unavailable for extended use of soiled products or bloodstained clothing (8). These unhygienic practices will cause Reproductive tract infections in these women, which may complicate PID or even secondary infertility. Paying attention to this problem is the need of the hour. Destigmatizing menstruation, educating women and ensuring the availability of low-cost menstrual hygiene products should be prioritized. These interventions will lead to decreased number of urogenital infections. Along with providing MHM products, women should be educated about proper disposal & waste management. Incineration could be used for this. Plastic pads will cause more water pollution in the flood-affected areas, and cloth towels need to be washed with clean water, which is unavailable in those areas. So natural sanitary products from bamboo fibre, banana fibre or sea sponges can be used (4). Women should be educated about stitching pads from cheap absorbent clothes available locally. ---Continue
Hyperlipidaemia is the utmost important factors influencing coronary heart disease. Statins are supposed to be the 1st line of drug in clinical exercise for lowering low-density lipoprotein, total cholesterol and increasing HDL cholesterol. This study was held for the comparison of the safety and efficacy of atorvastatin and rosuvastatin in lowering hyperlipidaemia among hyperlipidemic patients. Study Design: A prospective observational study. Place and Duration: In the Medicine department of Mayo hospital, Lahore for three-months duration from 15th March 2021 to 15th June 2021. Methods: This study comprised 90 patients with newly diagnosed hyperlipidaemia divided into two groups containing equal number of patients in both. Patients prescribed 10 mg of atorvastatin in Group A and 5 mg of rosuvastatin in Group B once daily for 6 weeks by the treating doctor of medicine. The data was saved in a personalized proforma format, and the SPSS 20.0 was used for analysis. Results: Serum total cholesterol decreased significantly afterwards the treatment with the rosuvastatin and atorvastatin groups (p <0.00001, correspondingly), but no significant variance (p = 0.510) noticed among the both groups treated with statins. The decrease in serum triglycerides was also significant (p = 0.0006 in the rosuvastatin group and p = 0.042 in the atorvastatin group) but the comparable difference in lowering hyperlipidemia was no significant among the both groups (p = 0.309). Similarly, LDL-C serum levels were significantly reduced in both groups (p <0.00001) but no statistically significant variance (p = 0.756) noticed among the two groups in terms of efficacy. Conclusion: No substantial changes in serum HDL levels were observed. The difference among the both groups was not significant (p = 0.731). This analysis = shows that both rosuvastatin and atorvastatin improved the lipid profile, but no changes were seen significantly among the both groups. Keywords: Hyperlipidemia, Atorvastatin and Rosuvastatin.
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