BackgroundTuberculosis (TB) is endemic in Pakistan which ranks fifth amongst the twenty two countries designated to be highly burdened by TB according to the World Health Organization. However, there is paucity of data regarding the knowledge of diagnosis of TB and its management amongst public and private practitioners. In this study, we endeavor to identify this gap in knowledge regarding the diagnosis and management of TB between public and private doctors and the factors affecting these knowledge scores in urban Pakistan.MethodsThis cross sectional survey was conducted between June and December 2011. Doctors from public hospitals, private hospitals and private clinics scattered in all eighteen towns of Karachi were included in the study. Qualified MBBS doctors working in any specialty were eligible to participate whereas doctors working in both the public and private sectors were excluded from the study. Vignette based clinical scenarios were given to assess the knowledge score regarding the diagnosis and management of TB.ResultsA total of 196 doctors participated in the study. There was a significant difference between private and public physicians in terms of age and years of practice (p-value <0.05). Significant differences in the proportion of knowledge scores were observed between the public and private doctors and National TB Control Program trained and untrained doctors in Karachi. Factors associated with inadequate knowledge scores were being female gender [OR: 2.76 (95% CI: 1.418-5.384)], private employment status [OR: 1.50 (95% CI: 1.258-2.439)], and not trained by NTP [OR: 2.98 (95% CI: 1.286-3.225)] on multivariate logistic regression analysis.ConclusionIt is concluded that a knowledge gap exists between the public and private doctors in Karachi. Strengthening of currently implemented public private mix model along with improvement in the trainings of public and private practitioners is highly recommended to control TB in Pakistan.

BACKGROUND:Mini-laparoscopic cholecystectomy (MLC) has widened the horizons of modern laparoscopic surgery. Standard four port laparoscopic cholecystectomy (SLC), which has long been established as the “Gold Standard” for gall bladder diseases, is under reconsideration following the advent of further minimally-invasive procedures including MLC. Our study aims to provide a comparison between MLC and SLC and assesses whether MLC has any added benefits.MATERIALS AND METHODS:Patients with symptomatic gall bladder disease undergoing MLC or SLC during the 2.5-month period were included in the study. Thirty-two patients underwent MLC while SLC was performed on 40 patients by the same surgeon. Data was collected prospectively and analysed retrospectively using a predesigned questionnaire.RESULTS:In our study, both the groups had similar age, body mass index (BMI) and gender distribution. No cases of MLC required insertion of additional ports. The mean operative time for MLC was 38.2 min (33-61 min), which is longer than SLC; but it was not statistically significant. There was no significant difference in mean operative blood loss, postoperative pain, analgesia requirement and mobilization. Patients who underwent MLC were able to return to normal activity earlier than patients undergoing SLC (P < 0.01).CONCLUSION:Our experience suggests that MLC can safely be used as an alternative to SLC. Compared to SLC, it has the added benefit of an early return to work along with excellent cosmetic results. Further large scale trials are required to prove any additional benefit of MLC.

Background: Aspirin non-adherence or discontinuation is associated with an almost three-fold increase in risk of major adverse cardiac events. Compliance, commonly known as adherence, has been a major health care issue. Some studies have reported non-adherence rates to aspirin as high as fifty percent. The main objective of this study was to determine the frequency and predictors of non-compliance to aspirin in post myocardial infarction patients.Methods: This cross sectional study was conducted over a period of 3 months from May 2015 to July 2015 at Civil Hospital, Karachi. All patients visiting Cardiology out-patient department (OPD) with previously diagnosed myocardial infarction were included in the study. Patients who were not prescribed aspirin or those with contraindication to aspirin therapy such as hemophiliacs and peptic ulcer disease patients, and those with memory problems were excluded from the study. A pre-coded questionnaire was presented to the selected sample of 456 patients. Compliance was assessed through self-report. Chi square test was used as the primary statistical test. Results:Out of 456 patients, 39% (n=178) were non-compliant to aspirin therapy. The most common reported cause for non-compliance was the failure to remember taking the drug reported by 40.7% (n=72) of the people. The second most common cause was the lack of awareness of the importance of the drug and the possible side effects of not taking it 31.4% (n =56). Conclusion:It can be concluded that non-compliance to aspirin is a major problem present in Pakistan. With the number of cardiovascular deaths increasing around the globe and in Pakistan, it is vital that non-compliance to aspirin should be taken as a serious issue.

Coronary artery bypass graft surgery (CABG) is the gold standard treatment for relieving angina symptoms and reducing mortality among ischemic heart disease patients. As post-operative thrombosis of the grafts has been a frequent complication of CABG, antiplatelet therapy remains essential to maintain graft patency. Since a long time, aspirin has been used as a single anti-platelet agent post CABG. However, in some high risk patients aspirin alone is insufficient in preventing graft occlusion. Therefore, dual antiplatelet therapy involving aspirin plus clopidogrel is becoming increasingly popular. Aspirin plus clopidogrel therapy has proved to be highly efficacious in patients with acute coronary syndrome; however, its role in patients after CABG has remained unclear. In this review, we outline the effects of dual antiplatelet therapy involving aspirin plus clopidogrel with respect to graft patency, post-operative angina/myocardial infarction, major bleeding event and mortality.