Search

Background: Around 5.5 million people die from stroke each year, making it the second leading cause of mortality worldwide. Increased homocysteine levels lead to early neurological deteriorations in ischemic stroke and may have an association with other risk factors of stroke. Objective: To determine how closely homocysteine levels are associated with other risk factors for ischemic stroke. Methods: This is a cross-sectional study, which was performed in the Department of Neurology, Liaquat National Hospital, Karachi from January to December 2021. All ischemic stroke patients of either gender above the age of 16 were included. Ischemic stroke was identified by neuroimaging MRI in patients presenting with focal neurological deficits lasting more than 24 hours. For statistical analysis, data was entered into SPSS version 21. Results: A total of 100 patients were included in the study with a mean age of 56.8 ± 15.6 years. Most of the patients were males (65%). Hypertension and diabetes were present in 76% and 42% of patients respectively. 45% of patients had homocysteine levels 30 μmol/l homocysteine levels (intermediate). None of them had a level >100 μmol (severe). On univariate analysis, the odds of increasing homocysteine levels were higher in males than females. Increasing B12 levels were associated with decreased odds of intermediate homocysteine levels. On the multivariable model after adjusting the model with other covariates, increasing B12 levels remained associated with homocysteine levels with a lower likelihood of intermediate homocysteine levels. Conclusion: According to the results of our study, there is a strong correlation between high homocysteine levels and low B12 levels, making homocysteine a substantial risk factor for ischemic stroke. Vitamin B12 has a major role in homocysteine pathomechanisms and its deficiency predisposes to hyperhomocysteinemia and hence stroke. Larger multicenter studies may be done to evaluate the role of B12 as a homocysteine-lowering agent both for the treatment and prevention of ischemic stroke

Background: Preeclampsia, a significant contributor to maternal and fetal health risks, is characterized by hypertension and proteinuria occurring post 20 weeks of gestation. Timely identification of renal issues in pre-eclamptic individuals is essential to prevent severe complications. This study aimed to assess how serum cystatin-C and uric acid levels together could predict renal impairment in pre-eclamptic patients. Methods: This longitudinal study was conducted from June 2023 to May 2024 at the Department of Physiology, LUMHS, in collaboration with the gynecology and obstetrics units of Civil Hospital, Hyderabad, and Liaquat University Hospital, Jamshoro. A total of 150 pre-eclamptic patients between 20 and 36 weeks of gestation were selected consecutively. Blood samples were collected at two stages; during 20-25 weeks and again at 36 weeks to measure serum cystatin-C and uric acid levels. Statistical analysis was performed using SPSS version 26.0, with descriptive statistics summarizing patient characteristics, chi-square tests, ANOVA, Spearman correlation, and ROC curve were used to analyze biomarker levels and their relationship with gestational age. Results: The study demonstrated significantly elevated serum cystatin-C (1.5 ± 0.3 mg/L) and uric acid levels (7.2 ± 1.5 mg/dL) in pre-eclamptic patients with renal impairment compared to those without (p < 0.01). A significant positive correlation was observed between gestational age and biomarker levels (r = 0.65, p < 0.01). The combined use of these biomarkers improved sensitivity to 90% and specificity to 85% in predicting renal impairment. Conclusion: Simultaneous measurement of serum cystatin-C and uric acid enhances early detection of renal impairment in pre-eclamptic patients.

ABSTRACT Background: Urinary Incontinence is a worldwide problem that remains a highly prevalent cross-cultural and costly condition affecting millions regardless of age and gender. Physiotherapy is among the recommended treatment options for the managementof stress incontinence. Objectives: To assess the awareness among doctors regarding the role of physiotherapy in stress incontinence “management Methods: A cross-sectional study was done among gynecologists, nephrologists and urologists selected from public and private hospitals of Karachi through non-probability convenient sampling; total sample size of the study was 100. Data was entered and analyzed using SPSS version 17. Chi square test was used to find association for qualitative variables and p value

Background: During the whole period of pregnancy women’s body undergoes various physical and physiological changes. Due to the change during and after pregnancy common problems faced by the women’s are low back pain, stress urinary incontinence, pelvic pain. Physiotherapy can help in this through postural reeducation, strengthening of pelvic floor muscles and through some modalities. Objective: To assess the awareness of obstetricians/ gynecologist regarding the role of physiotherapy in managing obstetric patients. Methods: A cross-sectional study was done among gynecologists and obstetricians selected from tertiary care hospitals of Karachi through non-probability convenient sampling, total sample size of the study was 300. Data was entered and analyzed by using SPSS version 17. Chi square test was used to find association for qualitative variables and p value

ABSTRACT Background: Cupping therapy is a type of alternative medicine that is gaining popularity among people during last few years but the extent of its use and awareness of public towards it has not been widely studied. Objectives: The aim of this study was to assess the opinion and attitude about cupping therapy among general population of Karachi. Methods: A descriptive cross sectional study with ample size of 400 individuals from general population. Data was collected using non probability convenience sampling technique thru structured and selfadministered questionnaire from April to June 2013. Data was analyzed by using SPSS version 19. Results: Out of total study participants, 58% were females. Among them 48.7% said that they have used alternative medicine and out of them 23% opt for it as it is natural and effective. 59.6% of the respondent agreed that the cupping therapy helps in treatment; 59% said that it has fewer side effects and 57.8% said it is cost effective. Conclusion: There is increased public interest to know more about cupping therapy. A positive attitude towards cupping therapy was observed, yet most people are reluctant to discuss it with their physicians. Campaigns should be organized to increase the level of awareness towards the alternatives for treatment of ailments. KEY WORDS: Complementary and Alternative Medicine, Cupping Therapy, Awareness.

Background: Obesity is a chronic disease which requires aggressive management. Obesity, although not a direct cause of most diseases, unfavorably alters the risk factor profile. It may lead to high blood pressures and high cholesterol levels, which can result in cardiovascular diseases or strokes. In addition to these diseases, the quality of life is also severely impaired. Successful treatment of obesity not only alleviates the associated medical problems, but also improves the quality of life dramatically. Objectives: To observe and compare obesity, its perception and complications among different socioeconomic classes in Karachi. Methods: A predesigned questionnaire was filled out at two hospitals of Karachi for a sample representing patients from lower and higher socioeconomic strata. BMI of these patients was calculated and assessed with respect to their income, education level and occupation, eating patterns, frequency of exercise. The presence of associated non-communicable diseases like hypertension and diabetes mellitus was also recorded. Data was analyzed using SPSS software. Results: The patients· population comprised 31 males and 19 females. The mean age was 45.56 (SD + 12.08). Minimum age was 15 years, while maximum was 75 years. Pathological analysis revealed that majority of SCC cases were moderately differentiated, SCC with clinical stage T2 or T3, N0,M0/N1,M0. Most common oral sites came out to be buccal mucosa of cheeks followed by lateral borders of tongue and lips. All patients underwent primary resection ± neck dissection and reconstruction when necessary. Conclusion: Obesity was observed in all classes irrespective of the education, income and occupation of the respondents with sedentary lifestyle being the main causal factor. There exists lack of awareness of the harmful consequences of obesity KEY WORDS: BMI, Obesity, Morbid Obesity.

Background: News viewing is directly linked to a person’s cognitive behavior and hence deeply affects psychological status of the viewer. Live events and deteriorating images affects different aspects of a person’s cognition. Stress is one of them which was measured in this study using a Psychological Stress Scale (PSS). Objective: To assess the psychological effects of viewing news channels among adult population of Karachi, Pakistan. Methods: This Cross Sectional study was carried out for a 2 month duration targeting the adult population of Karachi. Total 400 participants were selected through the convenience sampling technique. A pretested and self administered questionnaire was used to collect data. PSS (Psychological Stress Scale) was used to measure stress among study participants. The data was analyzed using SPSS version 20. Results: Of total n=400 participants, 273 (68.3%) used TV as the source of getting news and at the time of watching TV 166 (41.5%) preferred to watch news channels. 115 (28.8%) individuals had lasting effect after watching news of violence and 173 (43.3%) participants were stressed after watching news. Using PSS, 288 (72%) individuals had moderate stress score, 78 (19.8%) had low and 34(8.3%) had high stress score. Conclusion: It was concluded from the research that news is adversely affecting the psychological health Key Words: Psychological Effects, News Channel, Psychological Stress Scale (PSS).

Background: Diarrhea is cited as one of the main causes of death for infants and children, especially in squatter settlements, owing to poor sanitary conditions. Treatment and prevention of diarrhea can be managed at home by primary caregivers. It is therefore important for mothers and primary care givers to be aware of strategies for management and treatment of diarrhea. Objective: To assess the awareness of mothers regarding home management of childhood diarrhea in a squatter settlement of Karachi. Methods: A cross sectional study was conducted from 2012 to 2013 among mothers from Gulshan-eSikanderabad of Karachi who had at least one child under age of 5years. In total 110 mothers were interviewed. Non probability convenience sampling technique was used. Data was collected by structured questionnaire filled via personal interview. Informed consent was obtained before collection of data. Data Analysis was done by using SPSS version 20. Results: Out of total 110, 93 (84.5%) mothers said that their children had an episode of childhood diarrhea during last 3 months. For the management of diarrhea 91 (82.7%) mothers took their children to PHC centre and 99 (89.9%) mothers were aware about ORS. Almost two third of them aware about the ingredients of homemade ORS but their knowledge about correct amount was poor. Dirty water and food was identified as the important causes of diarrhea by 106 (96%) and 76 (69%) mothers respectively. According to 101 (91.8%) mothers hand washing would be an effective measure to prevent diarrhea. Conclusion: Despite the high rate of diarrhea in this community, knowledge of mothers regarding home management of diarrhea was found satisfactory. Adopting the preventive measures and intensifying the mothers education is the dire need to reduce the high rate of diarrhea in this community. Key Words: Childhood Diarrhea, Home Management, Awareness and Practices of Mothers, Squatter Settlement.

Background: Hepatosplenic sizes of children vary with age .There are many diseases which affect the sizes of the liver and spleen ranging from acute liver disease to other hepatosplenic disorders . Ultrasound is a quick and reliable method .Unfortunately there is lack of sufficient data in our population therefore my study would be beneficial in determining various disease processes. Objective: To establish normative data of Hepato-Splenic sizes in Pakistani pediatric population using ultrasonography. Methods: The study was conducted at the Ziauddin University Hospital, a tertiary care teaching facility in Karachi. The cross sectional prospective hospital based study was conducted with 150 patients aged 1 month to 14 years. Ultrasonographic evaluation for the assessment of liver, spleen and portal vein size was performed. These were correlated with the age, sex, height/length and weight of the children. Results: Normal liver and spleen length and its ranges with portal vein diameter were obtained. The liver, spleen length and portal vein significantly correlated highly with the height/length (r=0.7,0.7,0.6 )respectively and weight of the subjects (r=0.7,0.7,0.4 respectively). Conclusion: The study provides the normal values of liver and spleen size by ultrasonography in healthy Pakistani pediatric population. Key Words: Hepatosplenic Size, Ultrasound, Liver Transplant, Chronic Liver Disease.

Background: The ABO Blood group system has been evaluated many a times for increased risk of vascular accidents and heart diseases. This study aims to prove that the reason behind the decreased risk of thrombosis in O blood group population could be the decreased levels of clotting factors in its plasma compared to other blood groups. Objective: To assess the levels of clotting factors VII, VIII, IX and X in all blood groups to determine whether blood group O has the lowest levels of all clotting factors in its plasma. Methods: This is a Descriptive Cross sectional study, conducted at Dr. Ziauddin Hospital Karachi and Dow University of Health Sciences over a period of six months. The study involves 16 plasma units divided into four of each blood group. On the day of testing plasma was thawed and assays of factor VII, VIII, IX and X were performed on all blood groups and results noted. Results: Levels of Factor VIII, IX and X were found to be highest in blood group AB and lowest in blood group O. Factor VII levels varied from others. Conclusion: Our results showed that factor VII levels vary in different blood groups, may be due to its short half-life. Thus we could not establish a link between ABO blood groups and clotting factor levels. Key Words: Fresh Frozen Plasma, Thawed Plasma, Clotting Factors, ABO Blood Groups.

Background: Thyroid gland volume (TGV) is highly variable as it is greatly influenced by age, gender, anthropometric measurements and geographical location. It has become essential for every population to determine reference range of their normal thyroid gland volume (TGV) in healthy individuals. This in turn will help the population in grading of goiter and will guide in large scale iodine monitoring programs. Objective: To determine TGV in a subset of Karachi population and to determine its association with age and gender. Methods: A cross-sectional study employing 421 volunteers aged 21 years and above went through the ultrasound (US) examination of their thyroid gland (TG) after being confirmed euthyroid by their serum thyroid stimulating hormones (TSH) evaluation. Results: TGV in the study was found to be 6.26 ± 2.89 ml. Males had significantly higher TGV 6.78 ± 2.88 ml as compared to females 5.7 ± 2.79 ml (P=0.00). Volume of right lobe was significantly greater than that of left lobe (P=0.00) in both the genders. TGV increased significantly with age till 60 years (P

Background: Motivation and job satisfaction ultimately effect work performance of an individual. There are various factors which influence the work motivation and knowledge of these factors can help in improving the work performance. Objective: To assess the different factors that are associated with work motivation among nurses working in private and public tertiary care hospitals of Karachi. Methods: This descriptive, cross-sectional study was carried out among nurses for duration of 3 months in 2013. Total 240 nurses from two tertiary care hospitals of Karachi were selected by convenience sampling. A pretested and self-administered questionnaire was used to assess factors associated with work motivation. Data was analyzed using SPSS version 20.0. Results: Of total 240 study participants, 48.8% (117) nurses were in favor of financial incentives that motivate them most. Salary structure and appraisal system both showed significant difference (p-value= 0.000) between nurses from public and private hospitals while the most content place to work was reported government hospitals by 43.4% (104) nurses. Work motivation mean score revealed significant difference (p-value =0.003) among nurses from different working areas of hospital. Factors associated with job satisfaction showed significant difference (p value = 0.000) among nurses from private and public sector hospitals. Conclusion: Financial incentives were found to be the most important motivating factor for nurses that improve their performance. It was also concluded that public sector hospitals along with so many factors of satisfaction are the most content place of working that motivate them most. Key Words: Motivation, Nurses motivation, Tertiary care hospital, factors of motivation.

The Myers-Briggs Type Indicator (MBTI) is a personality assessment test that measures the psychological preferences of different people and helps them identify their strengths and limitations, interests and satisfaction to make right choices. The history of MBTI is unique and interesting, it was inspired by the work of Carl Gastav Jung, a Swiss psychiatrist who proposed psychological types theories which described how people are innately different both in terms of how they perceive and take in information and how they make decisions. The MBTI instrument was initially designed by Katharine Cook Briggs and her daughter Isabel Briggs Mayers after their research on their work on different personality types theories…

It is an emerging concept now a day that epicardial adipose tissue (EAT) thickness has an essential character in the progression for cardiac risk profile. It is now consider as a new and consistent cardiovascular risk factor. EAT thickness is the indicator for cardiac adiposity. It modifies the cardiac morphology and function. It has close anatomical relation to myocardium. It causes local paracrine interactions between myocardial tissues. It causes enlargement of left ventricle with its diastolic dysfunction. Measurement and assessment of epicardial adipose tissue thickness is now done by new method echocardiography. It appraises visceral adiposity and inflammation. Association of EAT location and its physiological or pathological impor – tance requires advance research. EAT in future may replace waist circumference, as a marker of abdominal obesity. This article briefly discussion the structure of epicardial adipose tissue and its function. It also describes the method for its assessment. KEY WORDS: Epicardial adipose tissue thickness, Cardiac adipose tissue, Brown adipose tissue, Visceral adipose tissue

Background: Multiple renal pathogenesis manifested as unilateral or bilateral size changes, therefore there should be normative reference data for proper comparison. Our goal is to determine normal standard value ranges for renal dimensions in pediatric population in Karachi. Sonographically renal length in 150 children were measured and correlate with age, gender, body height, weight and BMI. Objective: Sonographic Measurement of Normal Renal Size and Correlation with Somatic Variables in Subset of Karachi Pediatric Population. Methods: A six month cross sectional hospital based assessment of kidney size (length, width) was evaluated with the help of sonography. XarioTM 200 Toshiba with convex 3.5 frequency transducer will be used. The mean renal dimensions with standard deviation (SD) were estimated for every group of age. The renal length and width were determined and corresponded with different somatic variables. Descriptive statistics with Regression analysis was done. Results: The normal length and the width of kidneys and its ranges were obtained. Right kidney length moderately and significantly correlated with height and weight (r=0.651, r=0.654) and age (r=0.538) respectively. However, moderately insignificant with BMI (0.129). Lefts kidney moderately and significantly correlated with height and weight (r=0.665 r=0.705), negative insignificant with age (0.564) and moderately weak insignificant relationship with BMI (0.174). Conclusion: The research presents the normal range parameters of renal size and measurements by sonography in healthy pediatric population in Karachi. Guideline measurements of kidneys represent a statistically important and comprehensive interaction with specifications of growth which allows us to easily calculate the renal size by derived regression analysis. Key Words: Renal Size, Sonography, Children, Chronic Renal Disease.

Background: Infertility is a common problem globally affecting a large proportion of world population. Laparoscopy provides meaningful information regarding different factors that may cause infertility. Objective: To determine the frequency of causes of primary infertility in women by diagnostic laparoscopy. Study Design: Cross sectional study design Setting: Study was performed at the Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi Duration: September 2011 to February 2012 Subjects and Methods: 86 patients with primary infertility were included in the study and underwent laparoscopy for deter – mining causes of infertility. Data was analyzed on SPSS, frequencies and percentages were determined for qualitative variables while mean and standard deviation was determined for quantitative variable. Results: Eighty six females were included in the study with mean age of 28.6 + 5.2 years and mean duration of infertility was 4.9 + 1.9 years. Findings on laparoscopy were analyzed and 51.2% of females were found with tubal blockage, while other findings were; hydrosalpinx in 25.6%, PCOs in 22.1%, Ovarian abnormalities in 38.4%, Pelvic adhesions in 38.4% and uterine congenital anomalies in 3.5%. Conclusion: Tubal diseases found to be one of the major factor causing primary infertility and diagnostic laparoscopy will play a valuable role in early and prompt diagnosis and management of causes leading primary infertility. Key Words: Primary Infertility, Diagnostic Laparoscopy, Tubal Blockage, PCOs, Pelvic Adhesions, Hydrosalpinx.

Background: It is estimated that more than 6 million children die in the developing world at the hands of preventable conditions; primarily pneumonia and diarrhea. WHO in 1992 initiated the Integrated Management of Childhood Illness (IMCI) program as a strategy to provide an integrated approach for the management of major causes of childhood morbidity and mortality. Objective: To assess if IMNCI workshops that are held in hospitals that have post graduate training program in field of pediatrics are effective in enhancing knowledge; hence skills for improving health care delivery in limited resources. Methods: A KAP survey was conducted in 2013 among IMNCI trained doctors working in 5 tertiary care hospitals of Karachi. N=57 doctors were identified and administered a structured questionnaire based on recall questions and scenarios. Questionnaire was developed from a similar study conducted elsewhere. Data entry and analysis was done on SPSS version 20. Results: A total of n=57 doctors were included in the study, out of them resident medical officers (RMO) were n=10, postgraduate trainees (PG) n=38 and Medical Officers (MO) were n=9. Mean score of correct answers was 14 (3). No significant difference was observed when mean scores of PGs was compared with RMO and MO combined through application of Independent sample t test. Conclusion: The study revealed gaps in knowledge and practices of trained doctors regarding management according to IMNCI guidelines. Key Words: IMNCI, Vaccination, WHO, Training Programs.

ABSTRACT Background: Low back pain is a common musculoskeletal disorder affecting 84% people oncein third life time. It may be acute or chronic. Among various available options for management of low back pain, William's flexion exercise is one of them. William’s flexion exercises the set of physical exercises use to enhance lumbar flexion to avoid lumbar extension, and strengthen the abdominal and gluteus musculature to manage low back pain Objective: To assessthe effectiveness of William flexion exercise in managementof patients with low back pain. Methodology: A cross sectional study was conducted among 250 patients with low back pain from different hospitals of Karachi. Sample was selected by convenience sampling technique and data wascollected on structured questionnaire. These patients were provided William’s Flexion Exercise and changesin pain and posture were noticed before and after exercise. Data was analyzed by SPSS version 17and P value

Abstract Introduction This study examined the long‐term influence of loneliness and social isolation on mental health outcomes in memory assessment service (MAS) attendees and their care partners, with a focus on interdependence and bidirectionality. Methods Longitudinal data from 95 clinic attendees with cognitive impairment, and their care partners (dyads), from four MAS in the North of England were analyzed. We applied the actor–partner interdependence model, seeking associations within the dyad. At baseline and 12‐month follow‐up, clinic attendees and care partners completed measures of loneliness and social isolation, depression, and anxiety. Results Social isolation at baseline was more prevalent in care partners compared to MAS attendees. Social isolation in MAS attendees was associated with higher anxiety symptoms (β = 0.28, 95% confidence intervals [CIs] = 0.11 to 0.45) in themselves at 12 months. We found significant positive actor and partner effects of loneliness on depression (actor effect: β = 0.36, 95% CIs = 0.19 to 0.53; partner effect: β = 0.23, 95% CIs = 0.06 to 0.40) and anxiety (actor effect: β = 0.39, 95% CIs = 0.23 to 0.55; partner effect: β = 0.22, 95% CIs = 0.05 to 0.39) among MAS attendees 1 year later. Loneliness scores of the care partners have a significant and positive association with depressive (β = 0.36, 95% CIs = 0.19 to 0.53) and anxiety symptoms (β = 0.32, 95% CIs = 0.22 to 0.55) in themselves at 12 months. Discussion Loneliness and social isolation in MAS clinic attendees had a downstream effect on their own and their care partners’ mental health. This highlights the importance of including care partners in assessments of mental health and social connectedness and expanding the remit of social prescribing in the MAS context.

Background: There are few evidence-based non-pharmacological interventions adapted for people with dementia (PwD) in lower- and middle-income countries (LMIC). Thus, there is value in culturally adapting existing interventions from other settings. One such intervention for PwD involves hearing rehabilitation, which may improve dementia-related outcomes.Objective: To culturally adapt and evaluate the feasibility and acceptability of a multi-faceted hearing support intervention to enhance quality of life in PwD for a LMIC setting, Pakistan.Design: This was a study in three phases: (1) training and capacity building to deliver the study, including Patient and Public Involvement (PPI); (2) cultural adaptation of the intervention; and (3) delivery of a single-group feasibility study with a pre-test post-test design.Setting: Home-based intervention, in two cities of Pakistan.Participants: Adults aged ≥ 60 with mild-moderate dementia and uncorrected or partially corrected hearing impairment, and their study partners (n = 14).Intervention: An adapted hearing support intervention (HSI) comprising a full assessment of hearing function, fitting of hearing aids, and home-based support from a “hearing support practitioner.”Outcomes: Ratings of the feasibility of the study procedures, and acceptability/tolerability of the adapted intervention were ascertained through questionnaires, participant diaries, therapist logbooks and semi-structured interviews. A signal of effectiveness of the intervention was also explored using a battery of dementia-related outcome measures.Results: Following cultural adaptation and capacity building for study conduct and delivery, we successfully implemented all intervention components in most participants, which were well-received and enacted by participant dyads. Acceptability (i.e., understanding, motivation, sense of achievement) and tolerability (i.e., effort, fatigue) ratings and safety of the intervention were within a priori target ranges. Recruitment and retention targets required improvement, due to the COVID-19 pandemic outbreak, as well as the lack of a clear clinical diagnostic pathway for dementia in both sites. Areas for future modification were clearly identified, including: the assessment/delivery logistics circuit; procedures for arranging visits; communication among referring clinicians and the study team.Conclusion: This is the first study in a LMIC of sensory enhancement to improve dementia outcomes. Positive feasibility, acceptability and tolerability findings suggest that a full-scale effectiveness trial, with certain modifications is warranted.

Abstract Background Second-hand smoke (SHS) exposure during pregnancy is associated with poor pregnancy and foetal outcomes. Theory-based behaviour change interventions (BCI) have been used successfully to change smoking related behaviours and offer the potential to reduce exposure of SHS in pregnant women. Systematic reviews conducted so far do not evaluate the generalisability and scalability of interventions. The objectives of this review were to (1) report the BCIs for reduction in home exposure to SHS for pregnant women; and (2) critically appraise intervention-reporting, generalisability, feasibility and scalability of the BCIs employed. Methods Standard methods following PRISMA guidelines were employed. Eight databases were searched from 2000 to 2015 in English. The studies included used BCIs on pregnant women to reduce their home SHS exposure by targeting husbands/partners. The Workgroup for Intervention Development and Evaluation Research (WIDER) guidelines were used to assess intervention reporting. Generalisability, feasibility and scalability were assessed against criteria described by Bonell and Milat. Results Of 3479 papers identified, six studies met the inclusion criteria. These studies found that BCIs led to increased knowledge about SHS harms, reduction or husbands quitting smoking, and increased susceptibility and change in level of actions to reduce SHS at home. Two studies reported objective exposure measures, and one reported objective health outcomes. The studies partially followed WIDER guidelines for reporting, and none met all generalisability, feasibility and scalability criteria. Conclusions There is a dearth of literature in this area and the quality of studies reviewed was moderate to low. The BCIs appear effective in reducing SHS, however, weak study methodology (self-reported exposure, lack of objective outcome assessment, short follow-up, absence of control group) preclude firm conclusion. Some components of the WIDER checklist were followed for BCI reporting, scalability and feasibility of the studies were not described. More rigorous studies using biochemical and clinical measures for exposures and health outcomes in varied study settings are required. Studies should report interventions in detail using WIDER checklist and assess them for generalisability, feasibility and scalability. Trial registration CRD40125026666.

Objective: The objective of this study will be to assess the self-esteem and its association with various demographic factors among patients with facial burn injury in Karachi. Materials and Methods: This cross-sectional study was conducted among burn patients with facial injury. 100 patients were selected through simple random sampling from burn unit of two tertiary care hospitals. Data was collected through interview technique by using State-Self Esteem Scale. Data was analyzed through SPSS version 17. Results: The mean of overall score of State of Self-esteem Scale was found to be 56.94. Score for subcomponents was found to be 20.42, 17.18 and 19.34 for Performance, Social and Appearance respectively. Mean of overall score and sub-components was dichotomized into two groups as above average and below average. Of all participants 66% have below average overall score while 34% have above average. Similarly for sub-components 52%, 73% and 40% have below average while 48%, 27% and 60% have above average score in Performance, Social and Appearance Self-Esteem respectively. Significant difference in mean of overall score and score of sub-components was found for gender, occupational status, nature of injury, reason of burn and injury sustained at, however all age groups also showed significant difference for overall and subcomponent score accept performance self-esteem. Respondents between the age brackets of 15-25 years and 46-55 years presented better scores for self-esteem in all three sub-components whereas the respondents between the age brackets of 26-35years and 36-45 years had more below average scores. Individuals with burn injuries resulting from an accident exhibited lower self-esteem as compared to those who were injured incidentally. Conclusion: The overall score of State of Self-esteem Scale of burn victims with facial injury was found to be low with 66% of subjects presenting below average scores as compared to 34% with above average scores. There is a significant association between facial burns and lower self-esteem at p-value 0.001.

Objective: To assess the awareness and practices of school going children aged 11 to 16 years regarding oralhealth and hygiene in a squatter settlement of Karachi. Methods: Data of this cross sectional study was collected by self administered questionnaire from schoolstudents of Gulshan e Sikanderabad, a squatter settlement in Karachi. Sample size of 204 was selected bysimple random sampling and school going children aged 11 to 16 years were included in the study. The datawas analyzed by SPSS version 20. Results: Total 204 students were included in this study with mean age of 14.5 + 1.9 years, of them 140(68.6%) were males and 64 (31.4%) were females. Significant difference (p= 0.001) was found between thepractices and beliefs of students regarding oral health and hygiene. It was observed that gum bleeding, foulsmelling, dental caries, plaque formation and tooth loosening were the most common problems faced byalmost half of the school students. Chalia (Areca nut) was consumed by majority i.e. 113 (55.4%) of the schoolstudents. Cigarette, Gutka and Naswar were also consumed less frequently than chalia but still by notableproportion of students. Conclusion: Students from the schools of this squatter settlement were aware of the importance of maintainingoral health and hygiene and practice them as well; however they were also involved in consuming oralsubstance abuse despite knowing the damaging outcome of these substances.

Objectives: To assess the frequency of Sacroiliitis in patients with Low Back Pain (LBP) due to prolonged sitting Methodology: A cross-sectional study was conducted in Physiotherapy Department of Ziauddin UniversityHospital among patients with history of low back pain and continuous sitting for minimum 3 hours. Data was collected from 216 patients who were selected through convenience sampling technique. A pre-tested and structured questionnaire was used to collect data. Data was entered and analyzed by using SPSS version 17. Results: It was found that out of 216 patients, 127 (58.8%) had sedentary work. Mean of pain intensity in VASscale was found as 4.81 ±1.63. It was observed that sitting has been the most aggravating factor for LBP and it was relieved by rest, physiotherapy and medication. Association of frequency of LBP with gender and daily continuous sitting was found significant with p-value=0.03 and 0.00 respectively. Among LBP patients Fabers test was used for diagnosis of Sacroiliitis. Faber's test association with type of work was found significantly positive in those with sedentary work with p-value=0.031. Conclusion: The study showed that there was significant association of prolonged sitting with Sacroiliitis inpatients with LBP.