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INTERNATIONAL JOURNAL OF ENDORSING HEALTH SCIENCE (IJEHSR)

Journal Papers (41) Details Call for Paper Manuscript submission Publication Ethics Contact Authors' Guide Line
1 SORTS AND SOURCES OF STRESS IN PAKISTAN; A COMPREHENSIVE OUTLOOK, Sadaf Ahmed & Shamoon Noushad
Objective: to evaluate Psycho-physiological cause and developing burden that account for stress with variability in terms of duration, intensity and healthy or unhealthy effects on physical and emotional well-being. Background: In Pakistan the condition of physiological and psychosocial health is becoming weaker with time due to occurrence of non peaceful and haphazard life resulted in constant stress. Method:. There are various ways of analyzing stress from observing symptoms, change in behaviors. These can be lead to body either towards strength, improved body reactions and better performance as psycho-physiological being. We have highlighted here the emerging stressors in Pakistan and their effects on body & mind. Result: The psycho-physiological conditions result of experiencing changes in homeostatic balance, these imbalances either lead to positive or negative impact on health status of well being and trigger three main pathways physiologically Conclusion: In this editorial the predictable indicators of stress response and there positive and negative influences are summarized with respect to emerging and existing stressors known to effect this set of population. Application: This is a theoretical evidenced based psychoanalysis will be leading towards designing an inventory specifically based on recent stressors acting on human body and types of induced stress.
2 SCINTIGRAPHIC EVALUATION OF KIENBOCKS DISEASE IN COMPARISON TO PLAIN RADIOGRAPHY, Zaheer Chiragh, Muhammad Iftikhar Alam &. Shahab Fatmi
Kienbocks disease is a rare pathology of uncertain etiology, resulting in osteo-necrosis of lunate bone. The authors present interesting images for comparison of both plain radiography and bone scan findings done in a young male laborer.
3 TEMPERATURE REGULATION OF CBC SAMPLES IN CLINICAL LABORATORIES OF KARACHI, Zoobia Zaheeruddin, Aisha Abdul Haq &. Humaira Aman
To determine how Labs are maintaining their Laboratory temperatures,To measure the temperature of different clinical laboratories & to check their controls,to compare temperature affects on Samples & Controls with normal values & with each others.In a cross-sectional study, fifteen clinical laboratories in Karachi are examined for observing the standard protocols for running a lab with particular reference to temperature regulation. A questionnaire to the effect is filled and data are statistically analyzed and the following results are obtained. In the 15 labs observed, the mean of complete blood counts performed daily was 1.93 0.88. All 15 (100%) labs had a temperature reader. All 15 (100%) labs had an air-conditioner installed. Out of these 15, only 12 were found to be in working condition. Out of 15 laboratories 8 (53.3%) of them perform the sample immediately, 2 of the laboratories (13.3%) perform after half an hour, 3 (26.6) perform within 1 hour while 1 (6%) takes more than 1 hour to perform the sample.The finding of this survey showed that some of CBC parameters can be changed with the variation in temperature; therefore it is better to do the CBC test after blood taking as soon as possible. So, the commercial laboratories should be properly registered and their quality standardized.
4 DUAL INHIBITORY ACTIVITIES OF ADHATODA VASICA AGAINST CYCLOOXYGENASE AND LIPOXYGENASE , Sagheer Ahmed, Saima Gul, Humera Gul & Muhammad Hanif Bangash
Adhatoda vasica (L.) Nees is a well-known plant drug in Ayurvedic and Unani medicine. It has been used for the treatment of various diseases, particularly for the treatment of inflammatory and cardiovascular diseases. However, the scientific rationale and mechanisms by which it functions in these diseases is not known. This study was designed to explore the inhibitory activity of Adhatoda vasica aqueous and butanolic fractions on arachidonic acid (AA) metabolism. For this purpose aqueous and butanolic fractions of Adhatoda vasica were screened for the presence of activities against arachidonic acid (AA) metabolites and their effectiveness was further evaluated by studying platelet aggregation induced by a AA, adenosine diphosphate (ADP), platelet activating factor (PAF), and collagen. AA metabolism was studied by thin layer chromatography system while platelet aggregation was measured by dual channel Lumi aggregometer. Aqueous fraction of Adhatoda vasica but not of butanolic fraction inhibited the AA metabolites through COX pathway (TXB2) and LOX pathway (LP1 and 12-HETE). However, in platelet aggregation studies butanolic extract of Adhatoda vasica showed strong inhibition against AA, PAF and collagen induce aggregation but not against ADP. Aqueous fraction of Adhatoda vasica was active against none of the four aggregating agents. Adhatoda vasica possesses components which can inhibit AA metabolism and platelet aggregation. This may be one of the underlying mechanisms of their anti-inflammatory effects.
5 SIGNIFICANCE OF RADIOGRAPHER AWARENESS IN PNEUMOTHORAX DETECTION, Saima Khan, Sadaf Ahmed & Shamoon Noushad
The purpose of the study is to aware and educated a radiographer of certain pathological conditions seen on chest x-ray specifically we are dealing with types and severity of pneumothorax and the quality of information a radiographer communicate to his primary team for evaluation. Radiographer can identify or detect pneumothorax by taking x-rays in three positions i-e upright, supine or decubitis with complete awareness of diverse conditions of pneumothorax. For suitable imaging radiographer should know about position, safety of the patient and the techniques of Breath holding during exposure. Whereas ALARA (as low as reasonably achievable) should be kept standard. In our study mostly cases were of tension pneumothorax in which immediate decompression of thorax is mandatory and it requires instant action as on x-ray film as lung marking diminishes in this condition. According to radiological policy for panic conditions the chest x- rays were observed through PACS after every two hours. We evaluated the role of radiographer in observing pneumothorax and how it is his/her utmost responsibility to inform their primary team or the concerned radiologist urgently. We observed 36 panic pneumothorax out of 2865 portable chest x-rays of admitted patients from May 2012 till November 2012. Out of these 36 cases radiographers correctly identified 28 cases while 6 were missed when compared with radiologists detection.We concluded that 77% of radiographers are aware of panic conditions detected on chest x-ray but we find it very necessary to aware and educate radiographers more particularly to detect pneumothorax and related pathologies on chest x-rays in order to improve proper patient care in health care system and maintain required standards.
6 HUMAN SKIN MODEL SERVING IN ELECTRICAL STIMULATION OF ANTERIOR TIBIAL ARTERY , Hina Shafi , Iqra Ashqeen , Madiha Kanwal & Zia Mohy Uddin
Cardiac activities are one of the vital signs of life. To monitor these activities there are several methods including electrocardiography (ECG), photo plysthesmography, electrical impedance plythesmography. The purpose of the paper is to design external electrodes placed on the uppermost skin layer called stratum corneum which are capable of stimulating human anterior tibial artery without damaging it. This artery is present along the length of human tibia bone or shin bone .The designed electrodes are diminutive enough to attach with any easily wearable device. These electrodes when supplied with potential stimulate the artery helping in the procedure of electrical impedance plethysmography, this method is simple and low-cost.On the other hand, Electrical Impedance Plethysmography appears to be the most practical solution as compared to the above mentioned techniques of monitoring cardiovascular activities By varying electrode size and the distance between the electrodes we can skillfully judge the point where the electric field reaches the artery. The simulation of this model is done by Comsol Multiphysics.
7 BIO-ELECTRICAL IMPEDENCE PLETHYSMOGRAPHY-DESIGNING AN EFFICIENT NON-INVASIVE ELECTRODE FOR CARDIAC RATE ANALYSIS , Daniya Umer, Ghanwa Ellahi, Warda Ellahi, Saba Ayub &. Zia Mohy Ud Din
Cardiac rate analysis is constituted as one of the most essential parts of physiological patient monitoring. In this research paper, it has been investigated that electrical impedance plethysmography is the most conducive technique for this purpose. It is perceptible that the artery closest to the epidermis will generate a precise reading and for that purpose, we have designed an efficient non-invasive model based on a tetra-electrode setup placed in contact with the stratum corneum of the skin. By varying electrode size and the distance between the electrodes we can efficiently judge the point where the electric field reaches the artery. The simulation of this model is carried out by Comsol Multiphysics.
8 EARLY CHILDHOOD MILK AND MILK PRODUCTS INTAKE MATERNAL PERCEPTIONS & PRACTICES, Asma Shehzad Makhani, Ayesha Zahid Khan & Ghazala Rafique
The prevalence of micronutrient deficiencies in young children has a profound effect on their immune system, growth and mental development. However, many micronutrients deficiencies in children such as calcium can be prevented. This research has explored the perceptions and practices of mothers, residing in Karachi, regarding milk and milk products (MAMPs) intake in children of age 2-5 years, in order to find out the amount of MAMPs in their diet and the factors affecting such intake. This is a qualitative exploratory study. Semi structured, in-depth interviews were conducted. Eighteen mothers whose childrens age were 2-5 years old were purposively recruited from three daycare centers of three different socioeconomic status areas of Karachi. The MAMPs intake of children in three different socioeconomic areas of Karachi was in accordance with 2006s, American Academy of Pediatrics recommendations for requirements, i.e. 2 cups per day of Milk/Dairy for 2-4 years old children. However, the type of MAMPs and childrens preferences differs considerably. The most preferred MAMPs among children of age were yogurt and plain milk. The preferences for MAMPs in children were mainly determined by their peers, mothers ethnicity and media advertisements. Most of the mothers did not prefer giving MAMPs in several common childhood illnesses due to prevailing misconceptions. It was also explored that maternal ethnicity plays considerable role in selecting and combining various food items mainly fish with MAMPs. Recognizing the MAMPs intake of children and their mothers perceptions and practices can help researchers to better understand childrens preferences for different MAMPs and the factors influencing their intake. Food policies and recommendations related to MAMPs in children can be evaluated for their relevance to childrens ecological determinants to address the issues related to growth and development in early ages.
9 COMPARATIVE EFFECTS OF CAFFEINE & L-THEANINE CONSUMPTION ON SUBJECTIVE CARDIOVASCULAR SIGNS AND NEUROPHYSIOLOGICAL RESPONSES., Hira Zameer., Mehrunisa Iqbal., Lubna Anwer., Sadaf Ahmed & Samia Mushtaq
Non-alcoholic beverages comprise of Caffeine and L-theanine as core ingredients. Caffeine is attributed to augment cardiovascular and neurophysiological responses by enhancing the neurotransmission of catecholamines after binding with adenosine receptors antagonistically. L-theanine, as a constituent of green tea is helpful in lowering blood pressure by antagonizing the effects of excitatory neurotransmitters after subsequent release of inhibitory neurotransmitter GABA. 87 healthy females with age 18-19 years, participated in the study were divided into three different groups. Group A was subjected to consume cold beverage (soft drink). Participants of group B & C were allowed to take hot beverages in the form of tea and green tea respectively. Cardiovascular parameters and neurophysiological responses were assessed before and after 45 minutes of beverages intake.Statistical analysis revealed a significant improvement in the reaction time of tea and in concentration test of both tea and green tea consumers. In addition, a less significant increase in HR with tremendous decrease in PR was observed among green tea consumers. Furthermore, significant reduction in both systolic & diastolic blood pressure was evident with green tea consumers.Experimental results are unveiling effectiveness of L-theanine over caffeine in lowering BP, HR & PR after antagonizing the release of excitatory neurotransmitter along with the opening of ligand gated chloride channels that leads to hyperpolarization. Moreover, a favorable combination of caffeine & L-theanine is responsible for enhancing cognitive performances, alertness and well being.
10 COMMUNITY AWARENESS ON CORONARY HEART DISEASE IN NORTHERN AREAS OF PAKISTAN (PROCESS EVALUATION OF HEALTHY HEART PROGRAM), Laila Salim
This document presents data from qualitative research using a series of focus groups which were conducted for the community from 15th April to 30th April 2007. The focus groups were conducted to ascertain the awareness of degree of Coronary Heart Disease (CVD); the quality of the training program, and if behavior has changed as a result of the awareness program, in Northern areas of Pakistan. There were nine focus groups conducted and each group consisted of 6 to 8 participants.All participants in general, reported that they were happy with the awareness program but mentioned that some of the material for health education was not culturally appropriate. Further, all participants were talked about their health behavior and beliefs.The findings suggest that there is a need to focus more on the processes of planning to develop awareness of coronary heart disease (CHD), organize more innovative health education and interventions that aim to empower community to become more informed and active consumers of health care.
11 CEREBRAL PALSY IN RELATION TO MATERNAL HEALTH, Kisa Fatima & Maria Altaf
Cerebral palsy (CP) is neurological disorder which effect motor and sensory neurons the effected individual may suffer ophthalmic problems, impaired speech, movements and posture mental and physical abnormalities as well. The study design was observational prospective, done on the population consists of 65 mothers having their child with CP, and children with other physical and mental disabilities were completely excluded. The data was collected at Dow Institute of Physical Medicine and Rehabilitation (IPM&R), DUHS.Prenatal causes (placenta previa, hypertension, diabetes, and seizures) accounted for majority of CP conditions. 21.5% mothers were found with gestational diabetes, 56.9% with hypertension, 16.9% with seizures and 20.0% with placenta previa.As it is well observed that Women with pregnancy induced diabetes (gestational diabetes) have a greater chance of having a baby with birth defects including CP. Gestational diabetes puts the fetus at greater risk of CP while women with hypertension are also most likely to have a child with CP.
12 ROLE OF FATHERS IN EARLY YEARS OF CHILDS LIFE, Mona Minhaz Ali Jindani & Sanober Nadeem
The study focus on investigating the perceptions and practices of fathers and its impact on childrens development. It attempts to establish the effect of fathers involvement in children life. Very few studies to date could be found on this subject area. In recent days, people are more learned and want to educate their selves on how they should deal their children and at the same time best practices for fathers should also be established by researches and studies. This study was done to involvement of fathers in child care as their involvement effects socio economic development of a child. Fathers are usually preoccupied in earning bread for the family however they should play their role in child carePurposive sampling was done for the purpose of this search after which focused group discussion (FGD) were conducted on 5 different locations to address all the socio economical classes of fathers. Father of a given sample were accumulated at a single place for the purpose of the research study and interviews/discussion were conducted in presence of a note taker and a principal investigator, prior consent was taken from all the fathers before the focused group discussion. According to the study it has been proved that fathers involvement had a great influence on children development. Children were good at schools and interaction with other where fathers involvement was high. Usually, fathers are ideal for child but studies shows that paternal involvement has been low in comparison to maternal but this perception is changingwith time. The research identified that fathers are usually busy in earning bread for their family due to which they have fairly less stake in the child development however there is an increasing trend in fathers who understands the importance of their role in child care and child development and also they try to give maximum contribution in the upbringing of their children.
13 NOVEL STRESS EVALUATING TOOL; SADAF STRESS SCALE (SSS), TESTED SO FAR ON PAKISTANI POPULATION, Shamoon Noushad & Sadaf Ahmed
A tool has been developed for evaluation of stress by observing major signs & symptoms, and classification of these symptoms in seven different classes. The tool comprised of 114 items that differentiates physical, mental, traumatic, psychosocial, nutritional, emotional & chemical stress. It will help the researchers with a tool for evaluation of cause as it is first of its kind & will help the health professionals for assessment of stressed. Preliminary data was collected from Pakistan and analyses showed that the tool has both high reliability and validity. The Cronbach reliability test was carried out and the ? value obtained was between 0.954-0.916. In this study the Spearman-Brown Coefficient analysis has been used to obtain the significant level of related coefficients (0.900-0.884). The findings of this study support the use of SSS as an evaluation tool.
14 WORKLOAD AND HEALTH PROBLEMS IN MEDICAL STUDENTS, Maria Altaf, Kisa .F Altaf, Aaishah Iftikhar, Sharmeen Gohar & Yusra
The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. Although common, depression associates with a high degree of disability and chronicity, with symptoms such as low mood, lack of energy, poor concentration, low self-esteem, and a lack of interest in the environment however stress has been shown to have deleterious effects on ones physical and mental well-being .The extreme stress levels inherent in the medical profession, put premedical and medical students at risk for both physical and psychological problems. The aim of this study is to determine the workload stress which leads to different health problems in medical and dental students during their undergraduate training. It was a self-administered questionnaire based survey conducted on 114 medical and dental students (32 males and 118 females) who were randomly selected in Fatima Jinnah Dental College and Dow University of Health Sciences. The result of this study shows that undergraduate medical students are suffering with stress and anxiety due to their hectic schedule and vast syllabus. From this study we can evaluate that health problems such as muscular aches and pains especially in neck, head, lower back and shoulders have increased which leads to sleep disorders. Data was analyzed using SPSS 20.0.This study suggests that a small percentage of medical students experience physical and mental distress throughout their medical undergraduate training.
15 WORKLOAD AND HEALTH PROBLEMS IN MEDICAL STUDENTS, Maria Altaf, Kisa .F Altaf, Aaishah Iftikhar, Sharmeen Gohar & Yusra
The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. Although common, depression associates with a high degree of disability and chronicity, with symptoms such as low mood, lack of energy, poor concentration, low self-esteem, and a lack of interest in the environment however stress has been shown to have deleterious effects on ones physical and mental well-being .The extreme stress levels inherent in the medical profession, put premedical and medical students at risk for both physical and psychological problems. The aim of this study is to determine the workload stress which leads to different health problems in medical and dental students during their undergraduate training. It was a self-administered questionnaire based survey conducted on 114 medical and dental students (32 males and 118 females) who were randomly selected in Fatima Jinnah Dental College and Dow University of Health Sciences. The result of this study shows that undergraduate medical students are suffering with stress and anxiety due to their hectic schedule and vast syllabus. From this study we can evaluate that health problems such as muscular aches and pains especially in neck, head, lower back and shoulders have increased which leads to sleep disorders. Data was analyzed using SPSS 20.0.This study suggests that a small percentage of medical students experience physical and mental distress throughout their medical undergraduate training.
16 WORKLOAD AND HEALTH PROBLEMS IN MEDICAL STUDENTS, Maria Altaf, Kisa .F Altaf, Aaishah Iftikhar, Sharmeen Gohar & Yusra
The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. Although common, depression associates with a high degree of disability and chronicity, with symptoms such as low mood, lack of energy, poor concentration, low self-esteem, and a lack of interest in the environment however stress has been shown to have deleterious effects on ones physical and mental well-being .The extreme stress levels inherent in the medical profession, put premedical and medical students at risk for both physical and psychological problems. The aim of this study is to determine the workload stress which leads to different health problems in medical and dental students during their undergraduate training. It was a self-administered questionnaire based survey conducted on 114 medical and dental students (32 males and 118 females) who were randomly selected in Fatima Jinnah Dental College and Dow University of Health Sciences. The result of this study shows that undergraduate medical students are suffering with stress and anxiety due to their hectic schedule and vast syllabus. From this study we can evaluate that health problems such as muscular aches and pains especially in neck, head, lower back and shoulders have increased which leads to sleep disorders. Data was analyzed using SPSS 20.0.This study suggests that a small percentage of medical students experience physical and mental distress throughout their medical undergraduate training.
17 WORKLOAD AND HEALTH PROBLEMS IN MEDICAL STUDENTS, Maria Altaf, Kisa .F Altaf, Aaishah Iftikhar, Sharmeen Gohar & Yusra
The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. Although common, depression associates with a high degree of disability and chronicity, with symptoms such as low mood, lack of energy, poor concentration, low self-esteem, and a lack of interest in the environment however stress has been shown to have deleterious effects on ones physical and mental well-being .The extreme stress levels inherent in the medical profession, put premedical and medical students at risk for both physical and psychological problems. The aim of this study is to determine the workload stress which leads to different health problems in medical and dental students during their undergraduate training. It was a self-administered questionnaire based survey conducted on 114 medical and dental students (32 males and 118 females) who were randomly selected in Fatima Jinnah Dental College and Dow University of Health Sciences. The result of this study shows that undergraduate medical students are suffering with stress and anxiety due to their hectic schedule and vast syllabus. From this study we can evaluate that health problems such as muscular aches and pains especially in neck, head, lower back and shoulders have increased which leads to sleep disorders. Data was analyzed using SPSS 20.0.This study suggests that a small percentage of medical students experience physical and mental distress throughout their medical undergraduate training.
18 WORKLOAD AND HEALTH PROBLEMS IN MEDICAL STUDENTS, Maria Altaf, Kisa .F Altaf, Aaishah Iftikhar, Sharmeen Gohar & Yusra
The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. Although common, depression associates with a high degree of disability and chronicity, with symptoms such as low mood, lack of energy, poor concentration, low self-esteem, and a lack of interest in the environment however stress has been shown to have deleterious effects on ones physical and mental well-being .The extreme stress levels inherent in the medical profession, put premedical and medical students at risk for both physical and psychological problems. The aim of this study is to determine the workload stress which leads to different health problems in medical and dental students during their undergraduate training. It was a self-administered questionnaire based survey conducted on 114 medical and dental students (32 males and 118 females) who were randomly selected in Fatima Jinnah Dental College and Dow University of Health Sciences. The result of this study shows that undergraduate medical students are suffering with stress and anxiety due to their hectic schedule and vast syllabus. From this study we can evaluate that health problems such as muscular aches and pains especially in neck, head, lower back and shoulders have increased which leads to sleep disorders. Data was analyzed using SPSS 20.0.This study suggests that a small percentage of medical students experience physical and mental distress throughout their medical undergraduate training.
19 PREVALENCE OF NEEDLE STICK INJURIES AMONG HEALTH CARE PROVIDERS., Najma Rais & Hafiza Mubashira Jamil
Percutaneous exposure to contaminated needle sticks and other sharps is an occupational hazard to HCWS that causes morbidity and mortality from infections with blood borne pathogens. This study was conducted to see the prevalence of needle stick injuries among health care providers at Civil Hospital Karachi (CHK).The objective is to study the prevalence of NSI among HCWs, the most frequent reason of injury, common causative equipment, and affected site of hand. It is an Prospective Observational cross sectional study at CHK in its 3 units including 100 participants. Study was conducted from 2nd Jan 2012 to 28th Feb 2012. Result shows that a large percentage (77%) of HCWs reported having had one or more NSIs in their career. While 23% did not report NSI in their career.(40.3%) NSIs occurred during use of the needle. Greater part of injuries reported due to disposable syringes (45/77 or 58.4%). Finger was affected by NSIs, in 72.7% cases.Our study concluded that the occurrence of NSI was found to be very frequent among HCWs in our setup. Poor compliances to universal precautions is a risk factor for sharp injuries. Some circumstances such as pressure of work and time constraint was a contributing factor. NSIs could reduce with the use of safer designed equipment. The promotion of adequate working conditions and Training programs regarding safety precautions on ongoing basis is very essential for future control of NSIs among health care workers at Hospitals.
20 EVALUATION OF PATIENTS UNDERGOING TRANSARTERIAL CHEMOEMBOLIZATION (TACE) FOR HEPATOCELLULAR CARCINOMA WITH RESPECT TO TUMOR SIZE, SITE AND NUMBER OF LESIONS., Amjad Sattar, Shabbir Naeem, Ahsan Ali & Kiran Nazeer.
TACE is the combination of two procedures, an infusion of the mixture of chemotherapeutic agents (e.g. doxorubicin, cysplatin, or mytomycin C) and hepatic artery embolization in which particles such as polyvinyl alcohol or gelfoam, are injected simultaneously into selected branches of the hepatic artery supplying the tumor. Hepatocellular carcinoma is rarely seen before the age of 40 years and reaches a peak at around 70 years of age. Owing to its multicentricity, large tumor size and pre-existing cirrhosis most of these tumors were deemed unrespectable at the time of diagnosis. The purpose of this study was to evaluate the tumor size, site and number of lesions that is acquired on hepatic angiogram during TACE of the liver, and compare it with the information provided by pre-interventional contrast enhanced CT images as there is a possibility that CT may not show smaller lesions. This study was carried out in the Department of Angiography, Sindh Institute of Urology and Transplantation (SIUT) from May to October 2011. A total of 30 patients was included in the study. All individuals underwent pre-procedural imaging with contrast material, enhanced CT angiography or MR to ensure that the disease was liver-dominant and to visualize the blood vessels of the liver. This study included 30 patients age ranges 40-80 years, 22 of whom were males and 8 of them were females. HCC had been diagnosed in all patients. Each patient underwent selective Hepatic Chemoembolization in either the right, left or in both lobes. . In comparison to CT, the hepatic angiogram showed 14(46.6%)patients having single lesion, 7(23.3%) were having double lesions and 9 (30%) were having multiple lesions. So the overall sensitivity of hepatic angiogram in the detecting number of lesions is 75 % 80%. The size of ?2cm HCC was found in 12(35%) patients, HCC >3cm were found in 7(21%) patients and HCC >4cm was found in 15(44.4%) patients.The size of the HCC which we found in most of the patients during our study is >4cm.
21 PSYCHOLOGICAL IMPACT EVALUATION OF EARLY MARRIAGES., Sadaf Ahmed,Saima Khan, Malka Alia & Shamoon Noushad
Lower awareness of health knowledge, physical growth and development, women bearing children at early ages face higher risk of maternal health problems, disability and death, reinforces risking problems for their newborns as a result, early marriages are always being a very big issue in developing countries specially in primitive uncivilized districts of Asia including India, Pakistan and Bangladesh etc. Moreover its a controversial fact that in civilized society, evidences of getting married in early ages are greatly increased because of our religious beliefs, norms and social impacts. Due to early marriages young girls dont have the ability to deal with responsibilities, early pregnancy and pregnancy-related mortality and morbidity, causing major physiological and psychological health issues in adolescent girls, resulting in losing relationship confidence and ability to maintain a healthy relationship. Purpose of the study was to evaluate the aspects of psychological disturbances occurring in married young girls along with depression rate and educational withdrawal, with comparison of unmarried young girls of the same age specifically there is a strong correlation between a womans age at marriage and the education that she receives. Uniformly across the countries, early marriage is associated with lower educational attainment. Observational study was conducted through multi logistic structured questionnaire and girls in b/w age of 13 to 35 were included. On the basis of above study it is concluded that early marriage, multiple responsibilities and early pregnancies are risk factors of depression and it is further evaluated that married girls are at higher level when compared with unmarried.
22 EVALUATION OF SATISFACTION OF STUDENTS OF DOCTOR OF PHYSICAL THERAPY REGARDING THEIR FIELD OF EDUCATION., Bakhtawar Wajeeha Qureshi & Muhammad Salman Haider Qureshi
To assess the satisfaction level of students of Doctor of Physical Therapy (DPT) regarding their field of education. To identify the causes responsible for dissatisfaction of students with their field of study. Physical Therapy is an emerging and growing field in Pakistan and currently is passing through its stage of infancy. Five year program of Doctor of Physical Therapy (DPT) has been now introduced resulting in increased influx of students. Yet unawareness among the students as well as society still prevailed that resulted in confusing the minds of young undergraduate students of Physical Therapy. A cross-sectional study was conducted in the Institute of Physical Medicine and Rehabilitation, Peshawar. Total 100 students of Doctor of Physical Therapy. Were interviewed through structurally designed questionnaires. Ethical consideration was taken into account. The response rate was 78%. 55.1% students were found satisfied with the field, 7.6% were dissatisfied while 37.1% were unable to analyze whether satisfied or dissatisfied majority being basic sciences students. Students highlighted certain factors as responsible for their dissatisfaction.Majority of the students satisfied from their field of education belonged to clinical sciences which indicate their well-aware attitude about the significance of this field. Moreover, the students held disrespectful attitude of society, Limited facilities and job opportunities and Incapable Physical Therapists imparting bad name to this profession responsible for their dissatisfaction.
23 COMPARATIVE STUDY IN THE DIAGNOSIS OF ANEMIA BY SYSMEX KX-21N HEMATOLOGY ANALYZER WITH PERIPHERAL BLOOD SMEAR, Ejaz Farah, Ahmed Mehwish & Hassan Ali Nafisa
In this era, automated peripheral blood count for the diagnosis of anemia is widely accepted in routine practice. Despite the sophistication of present day instruments, there is still need to depend on manual microscopic scan of peripheral blood smear for the diagnosis and appropriate treatment of different types of anemia. Also, the correlation between automated hematology analyzer and manual microscopic scan is rare and conflicting. Hence, the present study was designed to demonstrate a procedure that, the uses of manual scan is to validate rather than to replace automation. The benefit of manual microscopic scan is the ability to identify clinically significant cell type that are not quantifiable by instruments as it flags on such type of cells. Therefore, automated hematology analyzer are as reliable as standard manual scan, even though the latter gives additional diagnostic information through blood pictures and less imprecision and technical error over automation. Patient care and lab operations could be optimized as a validation procedure rather than as a reflexive substitute. Hence manual microscopic scan is still gold standard in the diagnosis and classification of anemia and other blood disorders. Whereas usage of automated method would ease our workload and save time for patients.
24 MEDICAL STUDENTS BEARING MENTAL STRESS DUE TO THEIR ACADEMIC SCHEDULE, Maria Altaf, KisaF.Altaf, Salman Zahid ,Rabia sharf ,Ahsan Inayat, Mohammad Owais, Hisham Usmani.
Medical education is inherently stressful and demanding. Overwhelming burden of information leaves a minimal opportunity to relax and recreate and sometimes leads to serious sleep deprivation. Environmental and social circumstances play a major role in the onset of stress-related diseases. Developing countries share the heavy burden of social and economic challenges. A number of factorsincluding academic pressure, workload, financial concerns, sleep deprivation, exposure to patients suffering and deaths, student abuse and a ?hidden curriculum? of cynicism have been hypothesized to contribute to this decline in students mental health. This study determines the rate of anxiety and depression, and the associated social and environmental factors in undergraduate medical students. This study was divided into two measures theoretical problems and academic factors. Randomly data was collected by means of structured close ended questionnaire of 121 students from Fatima Jinnah Dental College(23 boys, 98 girls). Data was analyzed using SPSS 20.0 Factors causing stress in undergraduate medical students was a vast syllabus which makes it difficult for their time management, there was a direct and positive relationship for lack of time for assignments and fear of catching up after a leave.
25 PSYCHO-SOCIAL DEPRESSION AND CARDIOVASCULAR HEALTH; A STUDY ON RISK FACTORS IN HYDERABAD, PAKISTAN., Raza Naseer, Muhammad Muneeb, Sanjay Maheshwari, Asad Khatri, Shamoon Noushad & Sadaf Ahmed.
Cardiovascular health hazards has become one of major life threats in Pakistan, the risks may vary from province to province. Present study aims to find out the role of psycho-social depression & its relation with risks of cardiovascular maladies in city of Hyderabad-Pakistan. A cross-sectional study was conducted from November 2012 to February 2013; based on multiple logistic to investigate the relationship between Depression, lifestyle & blood pressure variations. The Study included 174 subjects both males and females gender with age between 18- 25 years. Depression rating scale was used to evaluate type & cause of depression furthermore BMI and blood pressure of each subject were also noted. Our study observed that the intensity of stress is directly related with the disturbed blood pressures. Study also observed that with the increasing BMI the prevalence of depression is high. It is therefore concluded that depression is the major risk factor that will increase the risks of cardiovascular maladies; along with other factors like obesity, psychosocial issues like elevating crime & violence rate could be the major cause of depression in Hyderabad city.
26 PATHOPHYSIOLOGY & MANAGEMENT OF ISCHEMIC AND NEUROPATHIC PAIN , Sadaf Ahmed & Shamoon Noushad
Both nociceptive and neuropathic types of pain utilize the same nervous pathway for conduction with considerable physiologic disparities exist in the mechanism through which the body processes and resolves these painful stimuli. Nociceptive pain that results from a known or obvious source (eg, trauma, cancer metastasis, ischemia, arthritis) is often simple to recognize. Neuropathic pain, however, may occur with the nonappearance of any particular precipitating cause. Anticonvulsants, topical anesthetic agents, antidepressants, antiarrythmics, anti-inflammatory agents, opioid analgesics, NMDA receptor antagonists, combined analgesic therapy, physiotherapeutic modalities and other ways are used as treatment. Other interventions such as motor cortex stimulation, transcutaneous electrical nerve (TENS) stimulation units, and other peripheral stimulation have been shown to be supportive. A frequent sequella of both types of diabetes is the development of peripheral neuropathy in either motor or sensory nerves, or both. High-frequency TENS can suppress abnormal, spontaneous activity in a damaged peripheral nerve and can block nociceptive transmission in the dorsal horn, the use of this practice seems a practical approach for relief of neuropathic pain. Indeed, TENS applied to the lower extremities of neuropathic pain sufferers reduces the intensity of pain. However what actual molecular mechanism is followed is still a mystery and These studies emphasize for carrying out further work to correlate the neuropathic and ischemic aspects of disorders in these patients.
27 POSSIBLE MECHANISM OF ACTION OF MENTHA ARVENSIS IN CARDIOVASCULAR DISEASES , Saima Gul, Humaira Gul & Rukhsana Nawaz
Mentha arvensis (MA) is traditionally used in hypertension and in patients with ischemic heart disease. The scientific rationale for its use is not known. In order to find a pharmacological basis of its use in traditional medicine we made three polarity based fraction from the crude extract of MA and investigated their effects on arachidonic acid metabolism. MA inhibited arachidonic acid metabolite thromboxane B2-a stable analogue of thromboxane-A2, formed via cyclooxygenase pathway and lipoxygenase product 1 and 12-hydroxyeicosatetraenoic acid formed via lipoxygenase pathway. More potent inhibition of thromboxane-B2 compared to lipoxygenase product 1 and 12-hydroxyeicosatetraenoic acid was observed and indicates MA might possess antiplatelet activity as thromboxane-B2 is one of the strongest proponents of platelet aggregation. When MA was investigated for antiplatelet activity, it was found to inhibit human platelet aggregation induced by arachidonic acid as well as by adenosine diphosphate and platelet activating factor while collagen-induced platelet aggregation was unaffected by MA. Since arachidonic acid-induced aggregation is mediated through thromboxane-A2, these results indicate that inhibition of platelet aggregation may be responsible for the observed beneficial effects of MA in patients with ischemic heart disease. Furthermore, MA was also effective in enhancing glutathione peroxidase activity, although it had no significant effect on superoxide dismutase activity. These activities were however, distributed throughout various fraction of MA.
28 EVALUATION OF NUMBER OF RENAL ARTERIES IN LIVE RELATED RENAL DONORS BY CT ANGIOGRAPHY AND CONVENTIONAL ANGIOGRAPHY, Amjad Sattar, Shabbir Naeem, Ahsan Ali, Mustafa Akhtar, Adeeb Rizvi & Anwar Naqvi
Renal transplantation represents the best available replacement treatment for patients with end stage renal disease patients than performing dialysis, and living donor transplantation has been shown to offer better graft survival than cadaver donor renal transplantation. It was demonstrated that kidneys from living, unrelated donors succeed as well as kidneys obtained from brothers and sisters who share half of the tissue matching antigens with kidney recipients. The study was carried out at department of Angiography, Sindh Institute of Urology and Transplantation (SIUT) from January 2009 to September 2011. A total of 30 patients were included in the study. Informed consent was taken from all patients. Result demonstrates a total of 115 renal arteries in 60 kidneys of donors were depicted at CT angiography (CTA). Only 57 of kidneys showed more than one or multiple arteries, 52 of these had two renal arteries, and 6 had three renal arteries.
29 CHILD SEXUAL ABUSE: A BURNING ISSUE , Shaista Taufiq Meghani, Muslim Shah, Neelam Saleem Punjani, Salima Shams & Rashid Abbas
Child Sexual Abuse (CSA) is one of the major public health problems that exist globally. Abuse, is the term which has been using for long period of time since the human societies existed in the world. But, we would like to be more specific to the CSA in Pakistani context. For the purpose, Logical Framework Analysis (LFA) was developed to design project in the community health settings for a health prevention, promotion, and health maintenance of the people living in the community. Child Sexual Abuse, issue was identified after thorough assessment of the community which was prevalent but unreported. LFA approach was used to explore the problems through root cause analysis and discover some of the relevant strategies to solve the identified problems. In conclusion, there is an intense need of awareness regarding child sexual abuse to prevent this problem not only in the community but also at country level.
30 MENTAL STRESS DECREASES WITH OLDER AGE IN KARACHI, PAKISTAN., Kisa Fatima Altaf, Shamoon Noushad , Syed Zain Azher& Sadaf Ahmed
Mental Stress is a Kind of mental revival or strain that can be aroused by a number of mental taskse.g., mental arithmetic, maze solving or a mentally troubled condition is called the mental stress. Major life events as changes in work, financial problems, studies load, children and family problems are few of these. Mental stress is seen to affect parts of the brain where thoughts, approach, speculation and decision making are processed through and stored along with basic motor activities. Constant exposure to mental stress hormones, whether it occurs during the upbringing, teenage years, old age, has an impact on brain structures involved in cognition and mental fitness. The WHO suggests that there can be no health without mental health. People in many countries are exposed to harmful stress that leads to an augment in mental stress. The purpose of this study is to evaluate the cause of mental stress in Karachi population through Sadaf stress scale (SSS); various stressors may contribute to these mental stresses. The data was collected from different areas of Karachi .Sadaf stress scale (SSS) was used as an instrument for evaluation of mental stress. Results demonstrates that in age 20 and less shows 16.0% mild level of stress, in age 20 to 30 shows 24.0% mild level of stress, in age 30 to 40 shows 5.0% mild level of stress however 40 and greater age shows no stress levels. The hypothesis that mental stress responses are associated with age and gender was investigated.
31 DIAGNOSTIC ACCURACY OF ULTRASOUND & X-RAY KUB IN URETERIC COLIC TAKING CT AS GOLD STANDARD, Syed Muhammad Faiq, Nazish Naz , Fatima Batool Zaidi & Adeeb ul Hassan Rizvi
The objective of the study was to compare the sensitivity and specificity of ultrasound, X-ray KUB and CT for the diagnosis of ureteral colic in patients with acute flank pain. This study was carried out in Department of Radiology Sindh Institute of Urology and Transplantation (SIUT) from Aug 2010 to Nov 2010. A total of 190 patients with mean age of 35 years were included in the study. All individuals underwent pre procedural imaging X-ray KUB, U/S and CT. On these imaging modalities obstruction of urinary tract and stones were determined. X-ray KUB was done as a guide for U/S exam only. Ureteral stones were confirmed in 190 patients. Specificity for ct was 100% whereas X-ray KUB and U/S was 94% and 76% respectively. Sensitivity for CT 100%, U/S 52.6% and X-ray KUB 89.5% respectively. Some stones were not detected by U/S and few stones were not detected on X-ray KUB due to bowel gases. Cases were correctly diagnosed with all three techniques. CT is the most reliable technique for the detection of uretric stones however, X-ray and U/S also be chosen alternative to CT with a reduce radiation dose.
32 HEALTH CARE ETHICS AM I DYING, Neelam Saleem Punjani, Sahreen Malik Bhanji , Shaista Taufiq Mehgani & Muslim Shah
One of the most complex ethical dilemmas faced by health care professionals working with terminally ill patients is whether, when, how and how much to tell terminal ill patients about their diagnosis and prognosis of disease. Deception is still sometimes used by health care professionals while treating terminally ill patients (Tuckett, 1998). Truth telling to terminally ill patients is a common ethical dilemma that nurses have to deal with on a daily basis when families are reluctant to disclose the poor diagnosis with patients. However, by abiding by certain principles and ethics, the nurses can make the best decision. The purpose of this paper is to review, analyze and evaluate the case scenario in light of four principles of Beauchamp and Childress (2001) namely autonomy, beneficence, non-maleficence, and justice.
33 SUICIDAL BEHAVIOR AMONG TEENAGERS: A REVIEW , Mohammad Ishaq, Muslim Shah, Shaista Taufiq Meghani & Neelam Punjani
After every 16 minutes one individual die not merely from a disease or an accident but intentionally through suicide. Literature reveals that it is a long process usually stretches over years from suicidal ideation to planning and finally an attempt. The causes of suicidal behavior are immense which captivate these poor and innocent creatures in great troubles. In teenagers the suicidal ideations are related to multiple internal and external factors. They consume different lethal liquids and adopt different methods for performing this violent act. Further on its impact is not only on her individual and family life but has a great impact on the society as well. It is not an essay task to eradicate this violent act but as we a responsible member of the society we can assess their suffering and agony and help them identifying different social groups. Along with it we can also prevent the suicide at three different levels thats primary secondary and tertiary. We can also do the counseling. In conclusion, I would say that it is a rising issue of todays world and we all must give our efforts to show a reduction in its prevalence.
34 EMOTIONAL STRESS ESTIMATION IN GENERAL POPULATION, Maria Altaf, Shamoon Noushad, Sadaf Ahmed, Syed Zain Azher & Shaikh Muhammad Tahir
Despite great deal of popular research interest in existence and altered body responses of emotional stress there are still strong arguments regarding its positive and negative impact on psychophysiological health. Stress is a state of mental or emotional strain or suspense and also a number of normal reactions of the body (mental, emotional, and physiological) and designed for self-preservation. The potentially lethal consequences of emotional stress are deeply rooted in folk wisdom, as reflected by phrases such as scared to death and a broken heart. In the past decade, cardiac contractile abnormalities and heart failure have been reported after acute emotional stress. a cross sectional study, data was collected by means of structured questionnaire from 370 subjects (age ranges between 20-50 years). Stress was accessed by using Sadaf Stress Scale (SSS) which comprises of 114 items divided into seven subscales data was analyzed by using SPSS 20.0. The main findings of this study are that emotional stress has a direct relation with age. People ranging below 30 years showed emotional stress and women being remarkably more susceptible to it.
35 ANALYSIS OF HEALTH CARE DELIVERY SYSTEMS: PAKISTAN VERSUS UNITED STATES, Neelam Saleem Punjani, Salima Shams & Sahreen Malik Bhanji
Health plays an important role in shaping the human capital. Good health enhances the productivity and efficacy of the labor force which leads to the economic growth and human welfare (Settle, 2012). World health organization (WHO) has defined health system as all organizations, people and actions whose primary intent is to promote, restore or maintain health (WHO, 2008). Healthcare delivery system is comprehensive therefore; for the analysis purpose; WHO health care system framework will be used (Appendix A). It has six building blocks which will be utilized as an instrument. The six blocks is comprised of leadership, human resource, information, medical products and technology, financing and service delivery. Intermediate output leads to the desired health outcomes (WHO, 2008). This paper presents the comprehensive analysis of the health care systems of Pakistan and United States America with the help of WHO health care system framework followed by health system challenges and concludes with some practical strategies to overcome those challenges
36 POSTRAUMATIC STRESS DISORDER IN KARACHITES DUE TO RANDOM EVENTS OF VIOLENCE., Sadaf Ahmed, Shamoon Noushad, Sehrish Shahzad, Syed Zain Azher, Adnan Aziz & Muhammad Taha Saleem
Karachi is one of the biggest City in Asia and since past 20 years terrorism in Karachi is increasing frequently, due to these terrorist activities people living here have developed several phobias and anxiety disorders. To contrast the occurrence of traumatic events and its relationship with symptoms of post-traumatic stress disorder in Karachites. Survey of residents of Karachi was conducted between January 12, 2011 and March 4, 2012. Symptoms of PTSD were assessed using questionnaire related to psycho social factors that prone to PTSD .Out of total 164 both male and females, 62% of respondents reported appetite changes due to these terrifying activities, 58% of respondents reported hostile personalities , depression & mood fluctuations, while remaining 30% reported insomnia. 76.82% reported depression According to their economical condition 71% Middle class was highly affected as compare to upper class and lower class. There was also a significant difference observed among the populations who are engaged both in education and also doing jobs for survivals. 88% of them were found frustrated & protesting against the situation of the city. The results of the current study suggest that the trauma incident by the resident population is significant. Stresses tend to be numerous and chronic. The trauma experienced correlated strongly with psycho social, somatic, PTSD symptoms and depression.
37 COMPARISON AND ANALYSIS OF HEALTH CARE DELIVERY SYSTEM: PAKISTAN VERSUS CHINA, Shaista Taufiq Meghani, Sana Sehar & Neelam Saleem Punjani
Healthcare delivery system is an arrangement that serves best to any countrys population with effective, efficient and fair distributions of resources, and funds through organized infrastructure to thrive well. Better health improves countrys labor force and ultimately raises human welfare and economic stability. This healthy labor force and productive human capital resources can be attained through structured healthcare facilities by the government for its people. Globally, health sectors varies from country to country and it depends on how much expenditures on health is been effectively utilized. In majority of the developing countries, private healthcare sectors, donor, and out of pocket expenditures are the primary contributors in health care services that may raise human capital and economic growth of the country. Whereas, public health sectors remains underprivileged due to structural fragmentation, lack of resources, and functional inabilities. This paper is mainly going to discuss about health care delivery system of Pakistan in comparison to China followed by organizational structure, analysis of both the healthcare systems, and some recommendations to improve healthcare reform and its utilization.
38 EARLY MARRIAGE; A ROOT OF CURRENT PHYSIOLOGICAL AND PSYCHOSOCIAL HEALTH BURDENS, Sadaf Ahmed, Amna khan, Saima khan & Shamoon Noushad
It is confirmed that early marriage and early childbirth leads to higher rates of adolescent fertility and pregnancy related complications. According to UNICEF (1994) unfortunately the mortality rate of the married girls aged between 15-19 years is twice as compare to the girls who marry after the age of 20 years. As their bodies are immature thats why their health is affected by giving birth to a child. Millions of children are affected by the tradition of early marriage at is being practiced and widespread in many regions of South Asia. Early marriage is also called as child marriage that is marriage below the age of 18 when girls are too weak to shoulder their responsibilities physiologically, psychologically and socially. Early married females are more prone to diseases like HIV/AIDS and obstetrics obstacles. They are also affected psychologically and they may become victim of depression, anxiety and other mood disorders. An observational study was conducted between married and unmarried female to know their perspective about getting married early and to highlight whether it is a positive response according to them. Results showed that in relation to unmarried girls the married females were also not in favor of getting married early as they are equally invaded by health problems. Mental distress and depressive symptoms are more common in married females. Girls prefer doctors for concerning their reproductive health problems while girls can also concerned their mothers but they are in minority. Many health consequences are being reported by early married females and they were hesitated to share them with their in laws. Most of them approached lady doctors whereas few were relying on their mothers for their problems to be solved. Marriages below the age of 18 is not helping the females infract its demolishing their self esteem, their will to study and their physiological well being also.
39 ORGANIZATION REPORT: PRIVATE SCHOOL OF NURSING AT KARACHI, PAKISTAN, Neelam Saleem Punjani & Sahreen Malik Bhanji
Nursing as a profession today still faces several challenges. There seems a dire need to produce such professional nurses that up bring the dignity of this distinct profession. The heavy responsibility of producing such professional nurses lies in the hands of nursing institutions and primarily the schools and colleges of nursing. The standard of the education offered by these institutions plays an important role in this regard. While addressing at the inaugural ceremony of the Aga Khan University School of nursing and midwifery, His Highness the Aga Khan, chancellor of the Aga Khan University spelt out the vision for the nursing profession in the following words today, this is the beginning, the birth of a new medical institution in Pakistan, the Aga Khan Universityand I hope, this day will also be the dawn of a new dimension for the profession of nursing in Pakistan (Aga Khan, February 16, 1981). Thus it is important that nursing institutions undergo continuous quality assurance process to maintain the high standards of nursing education to develop nurses that can claim their position in this challenging era.
40 SINONASAL POLYPOSIS AND FUNGUS: A GROWING RELATIONSHIP, Atif Hafeez Siddiqui, Arsalan Ahmed Sheikh,Tariq Zahid Khan, M. Saleem Marfani & Arif Ali
OBJECTIVES: To determine the frequency of underlying fungus in nose and paranasal sinuses in patients present with nasal polyposis. METHODOLOGY:A total of 324 patients presented with nasal polyps were included in this study. Data collected from all the patients admitted in ENT department with diagnosis of nasal polyposis. All the relevant information about their presenting symptoms was recorded in a proforma. Post operatively the removed material was sent for histopathology and fungal culture. Later the findings of biopsy and culture reports were also recorded and analysed. RESULTS: Out of 324 patients 159 were males and 165 were females. Underlying fungus was present in 226(69.75%) and out of them, 102(45.13%) were males and 124(54.86%) were females with a P value of 0.039. The mean age was 25.95 9.32 (15-45) years for the patient with fungus. Aspergillus was the commonest organism found. CONCLUSION: Underlying fungus was found in a significantly high number of patients presented with nasal polyps and Aspergillus was the commonest organism found.
41 GOOD CLINICAL PRACTICE; EDUCATION AS A NECESSITATE FOR RADIOLOGY, Sadaf Ahmed, Saima khan, Shamoon Noushad & Amna khan
A good clinical practice (GCP) is an ethical and scientific quality act from oldest enduring customs in the historic times of medicine. As the guiding ethical code it is primarily known for its edict to do no harm to the tolerant. However, the complexities of modern medicine research necessitate a more elaborate set of guidelines that address a physicians ethical and scientific responsibilities such as obtaining informed consent or disclosing risks of these biohazards. our country in last decades has excelled so much in terms of offering training programs for these professional to bridge the gap between the therapeutic interventions and knowledge of these working individuals. We have done a survey on both male and female working in specific hospitals in Karachi. They were interviewed about their skills, duties and knowledge about standards of clinical practice. With reference to the patient care and conditions they were inquired about the medical background, awareness of the sufferers ailment and ethical concerns like patient safety & rights. We have found nearly disappointing results as most of these workers were ignorant of the fact that they lack basic knowledge of related responsibilities of concerned patients. Rest of the data also gave the evidence for a huge breach among the awareness, education and realistic approach in this selected workforce. We suggest that caregivers must be aware of indications and have strong medical foundation of the concerned departments where they are serving. We propose the medical education and clinical workshops of this set of serving individuals at ground levels along with the technical fine tuning with the help of case studies and good clinical practice.