Comparison of Shisha Smoking Behavior among Medical and Pharmacy Students

Background: Health care workers are respected in every society and have a strong influence on the behaviour of the community. In order to reduce the shisha dependence in the Pakistani population, it is necessary to evaluate the perspective of future doctors and pharmacists regarding this addiction as they become role models for the future generations. Objective: The aim is to compare the knowledge, attitudes, and practices of shisha use among medical students and pharmacy students in order to assess their support in the anti-shisha campaigns of Pakistan. Methodology: Cross sectional study was performed in four major medical universities of Karachi, Pakistan through a modification of the WHO global health survey questionnaire. Result: 398 medical students and 470 pharmacy students were included in the study which showed that currently 9.6% pharmacy students and 4.8% medical students used shisha daily (p = 0.000). Pharmacy students started shisha use in less than 15 years of age while this number was 29.5% among medical students (P = 0.000). Moreover, 44.6% pharmacy students and 50% medical students were not planning to quit this addiction within the next six months. 14% of pharmacy students and 20.4% in medical students (P = 0.002) were unaware that passive smoking caused lung cancer, while 23.4% pharmacy students and 33.5% medical students rejected it as cause of heart diseases (p = 0.006). Conclusion: A significant number of medical and pharmacy students were unaware about some of the serious consequences of shisha smoking. Therefore, both groups of students need to be educated about the health hazards of shisha use, in order to control this growing menace.

Frequency of Musculoskeletal Pain and Associated Factors among Undergraduate Students

Objective: To study and compare the prevalence of musculoskeletal pain in Medical and non-medical students and find out the specific factors associated with the occurrence of this pain. Methodology: This is a cross-sectional study from March-May 2017 where a total of 400 medical and 350 non-medical students were registered using a structured questionnaire made by modification of Nordic questionnaire. Characteristics of musculoskeletal pain were determined Pain was also graded by using a grading scale. Results: Mean age for medical and non-medical students was 21.36 and 20.97 respectively. The prevalence of musculoskeletal pain was higher among females. More data were collected from 2nd and 5th year of medical and 1st and 2nd year of non-medical students. High incidence was found in medical students with occurrence mostly in Neck. This frequency of musculoskeletal pain was quiet high during the last 7 days. The long study hours and use of computer/laptop were found to be greater among medical undergraduates but no significant association was found in medical unlike non-medical students. Majority of undergraduate students reported a normal BMI. Our study has found no co-relation of BMI with prevalence of pain. It was also observed that medical students with musculoskeletal pain spent more time on travelling when compared to non-medical. Association was found with the use of back packs. The study observed the level of many daily activities like exercise and outdoor sports etc. but no significant relation was found. Conclusion: Prevalence of musculoskeletal pain among undergraduate students is truly high, more so in medical students. Medical students have shown no association of studying for long hours and use of computer/laptop with musculoskeletal pain when compared to non-medical students. More studies should be done to know contributing factors of musculoskeletal pain among undergraduate students.

Immune Thrombocytopenia Purpura (ITP) with Grave’s Disease, in a Plasmodium Vivax Positive Patient. A Case Report

Hyperthyroidism and thrombocytopenia have long been associated with each other. We present a case of 38 years old female presenting with complaints of bleeding from gums, bleeding per rectum, hematuria and easy bruising since 7 days ago. She also had a diffuse, non-tender neck swelling moving with deglutition and positive bruit on auscultation. Her laboratory results indicated thrombocytopenia (22 × 10^9/L) and her thyroid function test revealed TSH of 0.01 mIU/ml (normal: 0.17 - 4.05), free T3 of 19.19 pg/ml (normal: 1.6 - 3.7), free T4 of 4.09 ng/dl (normal: 0.89 - 1.79). Thyroid scan showed diffuse goiter with increased tracer uptake. Furthermore, her serum anti-thyroglobulin and anti-thyroid peroxide were elevated to 205 IU/ml and 713 IU/ml respectively. She was started on carbimazole and methylprednisolone immediately. On the 3rd day of admission, she was tested to be positive for Plasmodium Vivax after a fever spike and was started on Chloroquine (CQ) and later shifted to Primaquine (PQ). During 2 weeks of admission, her platelet count kept fluctuating between <10 × 10^9/L and <100 × 10^9/L with frequent transfusions of mega units of platelets. During 3rd week, her platelets improved and she was discharged with a platelet count of 370 × 10^9/L. This case, therefore, supports the association between autoimmune thyroid diseases such as Graves’ disease and idiopathic thrombocytopenic purpura (ITP) strongly suggesting the need for evaluating thyroid disease in cases of severe thrombocytopenia especially those refractory to treatment. Also, the effectiveness of treatment of thyroid disease on thrombocytopenia is also highlighted. In addition, it showed the possible added exacerbating effects of malarial infection on thrombocytopenia.