Begum Kulsum Saifullah Khan
An Inspiration for Humanity
Occupational Asthma
Prevalence of
Vitamin D
Deficiency in General
Population of Islamabad
Lipomodelling
for Breast Surgery
Begum Kulsum Saifullah Khan
An Inspiration for Humanity
Begum Kulsum Saifullah had unequivocally an illustrious career
which enfolded the mainstream functions of State of Pakistan.
She had innumerable feathers in her cap. In addition to being a
Founder member of APWA and chairperson of number of Women
organizations, she contributed in the National politics as member
provincial assembly, member of Federal council, member of
National Assembly of Pakistan and first lady Federal minister. She
represented Pakistan at annual session of General assembly in
the United Nations International Council on Population. She was
a nationalist political leader and a successful entrepreneur. She
remained the Chairperson of Saif Group of Companies till 1990.
Her life was full of struggle and was marked with success and
accomplishments. Mothers, politicians and business community
look towards her as a symbol of struggle and success.
She influenced the national politics and struggled for the women
to have their rights as laid down in our religion, in Pakistan.
Her main contribution is her professional children who had and
will have long lasting impressions on our society, politics and
entrepreneurship. Extremely affectionate and caring mother who
believed to be at giving end always be it reward, prayers, wishes
or guidance. She did assume her next journey but has left an
immortal legacy behind which we all have to carry forward. We
miss her as a mother and pledge to adhere to her teachings and
advice with conviction so that our efforts bear fruit. We supplicate
to Allah Karim that she rests in eternal peace and rise with the
commended.
Prof. Iqbal Saifullah Khan
Director, Saif Healthcare Limited
O ccupational Asthma
Dr. Shazli Manzoor (Consultant Pulmonologist, KIH)
Occupational Asthma is considered a serious disease, which
contributes up to 15% adult-onsite asthma, and may become
fatal. Adult-onsite asthma is diagnosed after the age of 20.
This disease is most common in industrial sector and leads
to worsening of health, working ability and productivity.
Work exposure can cause or intensify asthma and can also
be associated with different variants of asthma. Specific
workplace sensitizers can cause occupational asthma,
which is an agent that carries asthma through a mechanism
associated with immunologic response. Occupational
sanitizers are commonly high molecular weight agents that
produce specific IgE antibodies and allergic responses. Low
molecular agents can also cause sensitization which leads
to asthma. Figure 1 shows high molecular agents which put
workers on risk.
Figure 1
Agents
High-molecular-weight agents
Workers at Risk of Exposure
Animal allergens
Farmers, persons who work with laboratory animals, veterinarians
Plants
Greenhouse workers, farmers
Plant products (e.g., natural rubber latex)
Latex-glove makers and users, makers of other latex products
Cereals and grains
Farmers, grain workers, bakery workers
Other foods (e.g., milk powder and egg powder)
Food-production workers, cooks
Fungi
Office workers, laboratory workers
Enzymes
Laboratory workers, pharmaceutical workers, bakery workers
Insects
Farmers, greenhouse workers
Fish and crustaceans
Workers handling herring or snow crabs
Vegetable gums (e.g., guar and acacia)
Printers, including carpet makers
Low-molecular-weight agents
Diisocyanates (e.g., toluene diisocyanate, hexamethylene
diisocyanate, and methylene diphenyl diisocyanate)
Makers of rigid or flexible polyurethane foam, installers of polyurethane
foam insulation, urethane spray painters, those who work with
urethane adhesives or urethane molds in foundries.
Acid anhydrides (e.g., phthalic anhydride, maleic anhydride, and
trimellitic anhydride)
Makers of epoxy resins for plastics.
Acrylic monomers
Chemical-industry workers, dental workers, aestheticians applying
artificial nails
Wood dusts (e.g., from red cedar and exotic woods)
Carpenters, sawmill workers, forestry workers
Complex platinum salts
Refinery workers, jewelry workers
Other metal salts (e.g., nickel chromium)
Metal-plating workers, welders of stainless steel
Biocides (e.g., glutaraldehyde and chlorhexidine)
Health care workers
Phenol-formaldehyde resin
Makers of wood products, foundry workers
Persulfates and henna
Hairdressers
Drugs (e.g., antibiotics)
Pharmaceutical workers, pharmacists
Aliphatic amines (e.g., ethylenediamines and ethanolamines)
Lacquer handlers, soldering workers, spray painters, professional
cleaners
4
It is estimated that 1 in 10 cases of adult-onset asthma are
directly related to workplace. A study which was conducted
in 13 countries with 7000 participants shows that 10%-25%
of population is at risk of occupational asthma equivalent
to 250-300 cases per million per year.
Diagnosis
Occupational asthma needs to be suspected in every new
onsite asthma patient. Respiratory symptoms including
wheezing, dyspnea, chest tightness, cough and sputum
production are similar to non-work related asthma but its
occurrence is tied to work related exposure. Symptoms begin
variably – at the beginning and end of the work shift or in the
evening after working hours. Improvement in the condition
occurs during weekend or holidays. Detailed occupational
and clinical history should be obtained before diagnosing
occupational asthma. Diagnosis include assessment of
clinical symptoms, objective confirmation, testing for
skin or serologic specific IgE antibodies, documentation
of symptomatic, functional, and inflammatory changes in
response to exposure to occupational agents. Basic facilities
include Pre-bronchodilator FEV1 and Pre-bronchodilator
FVC as a percent of predicted.
Prevention
Tertiary Prevention
1. Evaluating the symptomatic workers early, obtaining
accurate diagnosis and removing employee from
further exposure after confirmed diagnosis.
2. Controlling other causes and usage of pharmacologic
measures when required.
3. Monitoring patient’s asthma in future work locations
to ensure safe placement.
Future Developments
Primary prevention can be achieved through following
practices.
Prevalence of occupational asthma continues to grow.
Current areas of particular interest include Novel
agents, mechanisms of sensitization and the health
effects associated with complex multiple exposures
are the current areas of interest. In addition to
this, diagnostic process in occupational asthma and
appropriate investigations is the subject of current
debate.
Primary Prevention
1. Carrying out a complete risk asthma assessment
of the workplace, allowing reduction in exposure
to asthmagens and through an appropriate health
surveillance program.
2. Avoiding the introduction of predicted new sensitizing
agents at workplace.
3. Monitoring and controlling the levels of exposure to
workplace sensitizers.
4. Educating workers in the use of safe practices at work.
5. To reduce the risk of exposure by modifying the physical
or chemical form of known sensitizers (e.g., less volatile
preparations, polymerized products, and latex gloves
with a low-protein and low-powder content).
Secondary Prevention
1. Introducing medical surveillance programs for workers at
risk.
2. Educating workers on the risks of occupational asthma
through workplace programs and information provided
by healthcare providers.
References
1. Fishwick, D., Barber, C., Bradshaw, L., Roberts, J.,
Francis, M., Naylor, S., Ayres, J., Burge, P., Corne, J.,
Cullinan, P., Frank, T., Hendrick, D., Hoyle, J., Jaakkola,
M., Taylor, A., Nicholson, P., Niven, R., Pickering, A.,
Rawbone, R., Stenton, C., Warburton, C. and Curran,
A., 2008. Standards of care for occupational asthma,
[Online] Available at <https://www.brit-thoracic.org.
uk/document-library/clinical-information/asthma/
occupational-asthma-a-standard-of-care/> [20 June
2015].
2. Tarlo, S. and Lemiere, C,. 2014. Occupational Asthma,
The New England Journal of Medicine, 370(7), pp. 640649.
5
Prevalence
ofof
V itamin-D
Prevalence
D eficiency in
Vitamin-D
G eneral Population
Introduction
DEFICIENCY IN Gof
ENERAL
I slamabad,
POPULATION OF
Pakistan
(Corresponding
Author: Asim Ansari – Manager Clinical
Laboratory, KIH)
Objective: The current study was
designed to determine the prevalence
of vitamin D in the general population
of Islamabad and its suburbs.
Vitamin D (sunshine vitamin) belongs to the class
of secosteroids which are fat-soluble and performs
the important function of intestinal absorption of
calcium and phosphate. The vitamin, first identified
in 1921, has two main types namely Vitamin D3
and vitamin D2. These two vitamins are also called
cholecalciferol and ergocalciferol respectively. Both
these types are collectively termed as calciferol. The
main sources of the vitamin are skin production (via
sun exposure) and dietary intake. Most individuals rely
on sunlight exposure (UVB 290 – 315 nm) to fulfill
their requirements for vitamin D. The serum vitamin
D level reflects exogenous intake in diet as well as
endogenous production from exposure to sunlight. It is
accepted that synthesis may add in the maintenance of
sufficient serum concentrations. Approximately 95%
of the vitamin D which is measured in serum is of
D type whereas D is less than 5% and only reaches
to higher levels in individuals who are on vitamin D
supplements. Vitamin D is helpful in bone health and
causes a reduction in mortality in aged women Vitamin
D deficiency results in osteomalacia (rickets in case of
children). Insufficient vitamin D, in addition to causing
rickets, increase osteoporosis in adults, and results in
osteomalacia which is very painful. In addition, reduced
vitamin D levels have also been associated with
reduced bone mineral density. The most important
vitamin D metabolite which can be estimated
in the blood is the 25-hydroxyvitamin D (25OHD), which includes the major circulating
form that can safely be related with skin
production and dietary intake.
Vitamin D has received an enormous
attention recently. In the United States,
the deficiency of vitamin D has been
found to be 36% in adults while up to 57%
in general medicine patients. Therefore,
Vitamin D deficiency is now recognized
as an epidemic in the USA.The same has
also been reported from Europe in even
higher percentages. A report from Australia
indicated in Australians as Vitamin D deficient.
Reports from Pakistan have also demonstrated
Vitamin D deficiency. The number of cases with
deficiency of vitamin D in Pakistan is on the rise
yet the issue has not been given due attention
by the concerned government authorities nor by
ISLAMABAD
6
the individuals. The problem is further compounded due
to the fact that people do not have basic knowledge and
awareness on how to maintain required level of vitamin D
in the body. According to surveys conducted in the recent
past, over 85 percent of both non-pregnant and pregnant
mothers have been found vitamin D deficient. In Pakistan,
the prevalence of vitamin D deficiency among children has
been reported as 41.1% including 10.1% severe cases while
31% deficient cases. Inadequate vitamin D is frequent
and deficiencies can be found in all countries in all ethnic
groups, and across all ages. In Islamabad, the frequency
of vitamin D deficiency hasn’t been fully elaborated in the
general population. This particular study was designed
to determine the prevalence of vitamin D deficiency in
general population of Islamabad and its suburbs. group are
at borderline and caution while normal are with adequate
concentration of vitamin D.
Material and Methods
This wasa retrospective, cross-sectional study conducted
from January 2012 to December 2012, at the Department
of Pathology, Kulsum International Hospital, Islamabad.
During the study period, 737 subjects were selected
through convenience sampling technique and tested for
vitamin D.
The inclusion criteria included all subjects referred to
the hospital during the study period. About 3 ml blood
from all the study subjects was collected in gel tubes
and serum was separated via centrifugation at 4,000
rpm for 5 minutes. The test principle is based on a Electrochemiluminescence Immuno Assay (ECLIA). The assay uses
a vitamin D binding protein (VDBP) as capture protein in
the assay which binds to vitamin D and vitamin D (25hydroxyvitamin). The reagents and kit were stored and
used according to manufacturer’s instructions. All the
results were analyzed using MS excel.
Results
562 study subjects (76.2%) were females while 175 (23.8%)
were males with a mean age of 36.3 years (age range 1575 years). The patients were placed in three categories
according to the quantity of vitamin D in their blood namely
deficient, insufficient and normal.
Individuals falling in the deficient category need immediate
vitamin D ingestion and those in insufficient group are at
borderline and caution while normal are with adequate
concentration of vitamin D. Females had significantly
higher mean Vitamin D deficiency (56.2%) compared to
males (15.3%). Insufficiency has been reported by 11.3%
individuals with 9.65% females and 1.65% males. The rest of
the subjects (17.2%) were normal including 10.5% females
and 6.7% males. The results have been summarized in the
following tableI.
Table I: Signification of Vitamin D Deficiency in
Males and Females
Category
Total
Female
Male (T/%)
Deficient
527 (71.5%)
414 (56.2%)
113 (15.3%)
Insufficient
83 (11.3%)
71 (9.65%)
12 (1.65%)
Normal
127 (17.2%)
77 (10.5%)
50 (6.7%)
Total
737 (100%)
562 (76.2%)
175 (23.8%)
Discussion
There are many factors which contribute to the vitamin D
deficiency in general population worldwide. These factors
include reduced exposure to sunlight, age-linked reduction
in cutaneous synthesis, and intake of food with a reduced
vitamin D level. Vitamin D deficiency is a new global
epidemic among both children and adults. There are some
evidences which confirm the association of vitamin D
deficiency with high possibility of other morbidities such
as diabetes mellitus (both types 1 and 2), cardiovascular
illness, and malignancy particularly of the intestine and
prostate. The results of vitamin D levels are also used as
an aid for the assessment of bone metabolism. Vitamin
D supplements are given to make the muscle strength
better and lessen the fall percentage by around 50%.
Our study has reported a higher percentage of vitamin D
deficient individuals in Islamabad region. The frequency
of vitamin D deficiency escalated considerably with age
and was found higher in women. This was in line with a
study conducted in Australia in which 11,247 adults from
42 randomly selected districts were studied and exhibited
31% deficiency. Our results are also supported by a national
data reported from Faisalabad, Punjab in which 77.5% of
the sample showed Vitamin D deficiency whereas 18%
were in the category of Vitamin D insufficiency. Another
study from the same city (Faisalabad) reported the highest
prevalence of vitamin D deficiency in females. The study
showed that 87% pregnant women were having Vitamin D
deficiency, 10% were having Vitamin D insufficiency while
only 3% had normal levels. High prevalence of vitamin
D deficiency in females might be because they are not
exposed to sunlight properly and are mostly house-wives
involved in domestic work. The chances to expose their
bodies are not available even if they go out because they
wear clothes covering most of their body except face and
hands. This is due to the cultural, social and religious norms
existing in our society. The lack of awareness regarding
healthy balanced diet and the overcooking of food are a
few other contributing factors to the prevailing vitamin
D deficiency. A national programme by government on
the supplementation of vitamin D and a public awareness
campaign are urgently needed.
Conclusion
The study showed a high percentage of vitamin D deficient
individuals. The frequency of vitamin D deficiency increased
considerably with age and was greater in females. There is
a need to take immediate measures to tackle this growing
public health problem.
(This article was originally published in Annal of PIMS)
7
Oncoplastic Breast Reconstruction Surgeon – KIH
Lipomodelling is the transfer of autologous fat from a
donor site, such as the thighs or abdomen, to a recipient
site with the aim of defect correction. In recent years there
has been a growing interest in the use of lipomodelling to
correct shape, symmetry and volume defects following
breast conservating surgery or reconstructive surgery for
breast cancer. In addition to this, lipomodelling may be used
in cosmetic enhancement of the breasts or in correction of
congenital abnormalities such as Poland’s syndrome.
The technique involves harvesting fat from a suitable
donor site by blunt needle aspiration. The samples are
then placed in a centrifuge to purify the fat which is
injected into the breast in thin strips at different depths.
This time-consuming technique is necessary to avoid
pooling of fat which can lead to fat necrosis, calcification
and oil cyst formation. Several procedures may be required
to obtain an optimal outcome as fat absorption may lead
to a loss of 10% - 30% of volume in the 6 months following
injection. An emerging technique, cell-assisted transfer,
may increase the amount of Adipose Derived Regenerative
Stem Cells (ADRCs) in the harvested fat prior to injection
with the aim of reducing the amount of fat absorption.
The aesthetic outcomes of lipomodelling are very
encouraging, papers reporting these as ‘good’ and ‘very
good’ in up to 90% of patients. The same papers report
low complications rates with no apparent increase in
breast cancer recurrence rates1,2,3,4. There are, however,
many unanswered questions regarding the safety of such
a procedure following breast cancer treatment.
Worryingly, in vitro and experimental animal models have shown that ADCRs
can be induced into promoting tumour cell growth and metastasis when present
in a tumour micro-environment5,6,7. Conversely, there is also evidence that the
ADRCs can inhibit tumour growth when treated with appropriate growth factors
and cytokines8.
Publicised case series have demonstrated low recurrence rates following
mastectomy and reconstruction with lipomodelling to correct volume
deficiencies1,9. There is limited evidence following breast conserving surgery10. To date there are no studies comparing
recurrence rates of breast cancer patients that have undergone lipomodelling with controls and therefore the true
oncological safety of this procedure cannot be determined. Until such evidence exists it would seem sensible to
implement a careful follow up protocol of patients that have undergone lipomodelling and to withhold cell-assisted
transfer outside the context of clinical trials. An international register of cell-assisted fat transfer cases has been
proposed by the Cell Society11.
Fat that is aspirated for lipomodelling contains Adipose Derived Regenerative
Stem Cells (ADRCs) which are pluripotent and may be of therapeutic value.
Cell-assisted transfer is a technique that has been developed to increase the
yield of ADRCs with the aim of improving graft survival12,13. There is no reliable
evidence from controlled clinical trials to support the efficacy of this.
Fat necrosis, a complication of lipomodelling, may appear as
microcalcifications on mammography. Experienced breast radiologists may
be able to diagnose these as benign however indeterminate lesions will
lead to an increase in investigation. A recent multicentre study concluded
that lipomodelling did not interfere with radiological follow up after breast
conserving surgery however this study did not compare patients with a
control group that had not undergone lipomodelling10. There is currently no evidence to substantiate the suggestion that
the presence of benign calcifications disguises malignant calcification and leads to a delay in diagnosis of recurrence.
To date, several agencies have reviewed the literature and developed guidance of lipomodelling. In July 2009 the American
Society of Plastic Surgeons’ task force stated that there was a ‘tremendous need for high-quality clinical studies’ and
they were unable to make any specific recommendations for the clinical use of fat grafting due to a lack of data14. In
8
their December 2010 report, the National Institute for Health and Clinical Excellence (NICE) essentially agreed with the
Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S) report of September
2010 that stated the available literature was poor with a complete lack of comparative evidence15,16. All three agencies
concluded that there was a need for controlled trials to assess safety and to identify which patients would benefit most
from the procedure. In light of the above considerations, guidelines have been developed by a writing group which has
been appointed by the Association of Breast Surgery (ABS), The British Association of Plastic, Reconstructive and Aesthetic
Surgeons, and the British Association of Aesthetic Plastic Surgeons. These guidelines have been produced with the aim of
supporting training and audit in this relatively new technique, informing appropriate use of lipomodelling, and promoting
patient safety.
References
1.
Delay E, Garson S, Tousson G et al. Fat injection to the breast:
technique, results, and indications based on 880 procedures
over 10 years. Aesthetic Surgery Journal. 2009; 29: 360–78.
2.
Illouz YG, Sterodimas A. Autologous fat transplantation to
the breast: a personal technique with 25 years of experience.
Aesthetic Plastic Surgery. 2009; 33: 706–15.
3.
Missana MC, Laurent I, Barreau L et al. Autologous fat
transfer in reconstructive breast surgery: indications,
technique and results. European Journal of Surgical
Oncology. 2007; 33: 685–90.
4.
Panettiere P, Marchetti L, Accorsi D. The serial free fat
transfer in irradiated prosthetic breast reconstructions.
Aesthetic Plastic Surgery. 2009; 33: 695–700.
5.
Jotzu C, Alt E, Welte G, Li J et al. Adipose tissue derived stem
cells differentiate into carcinoma-associated fibroblast-like
cells under the influence of tumor derived factors. Cellular
Oncology. 2011; 34: 55-67
6.
7.
8.
Razmkhah M, Jaberipour M, Erfani N et al. Adipose derived
stem cells (ASCs) isolated from breast cancer tissue
express IL-4, IL-10 and TGF-β1 and upregulate expression
of regulatory molecules on T cells: Do they protect
breast cancer cells from the immune response? Cellular
Immunology. 2011; 226(2): 116-22
Muehlberg F, Song Y, Krohn A et al. Tissue-resident stem
cells promote breast cancer growth and metastasis.
Carcinogenesis. 2009; 30(4): 589-597
Grisendi G, Bussolari R, Cafarelli L et al. Adipose-derived
mesenchymal stem cells as stable source of tumor necrosis
factor-related apoptosis-inducing ligand delivery for cancer
therapy. Cancer Research. 2010; 70: 3718-3729
9.
Rigotti G, Marchi A, Stringhini P et al. Determining the
oncological risk of autologous lipoaspirate grafting for
post-mastectomy breast reconstruction. Aesthetic Plastic
Surgery. 2010; 34: 475–80.
10. Petit J, Lohsiriwat V, Clough K et al. The oncologic outcome
and immediate surgical complications of lipofilling in
breast cancer patients: A multicenter study – Milan-ParisLyon experience of 646 lipofilling procedures. Plastic and
reconstructive surgery. 2011; 128(2): 341-6
11. www.cellsociety.org
12. Weiler-Mithoff E, Perez Cano R, Calabrese C et al. Cellenhanced reconstruction after breast conservation therapy:
A proven technique. Abstract at San Antonio Breast Cancer
Symposium 2009. Cancer Research. 2009; 69: Supplement
3, 748s
13. Zhu M, Zhou Z, Chen Y et al. Supplementation of fat grafts
with adipose-derived regenerative cells (ADRCs) improves
long-term graft retention. Ann Plast Surg. 2010; 64(2): 222228
14. Gutowski K, ASPS Fat Graft Task Force. Current applications
and safety of autologous fat grafts: A report of the ASPS fat
graft task force. Plastic Reconstructive Surgery. 2009 Jul;
124(1):272-80
15. www.guidance.nice.org.uk/IP/845/DraftGuidance
16. Leopardi D et al. Systematic review of autologous fat transfer
for cosmetic and reconstructive breast augmentation.
ASERNIP-S Report No. 70. Adelaide, South Australia:
ASERNIP-S, September 2010.
9
Handwashing Week:
Health experts recommend handwashing using soap
to prevent spread of infection and communicable
diseases. Practice of hand washing improves health
and saves life by preventing infections. Many
infections start when hands are contaminated
with disease-causing bacteria and viruses. Nursing
department at Kulsum International Hospital took
an initiative by celebrating Handwashing Week
and made people aware of this hygiene practice.
A ceremony was also held at the end of week by
Mrs. Salimah Jalal Baig, Chief of Nursing KIH. Key
speakers on this occasion were Dr. Muhammad
Saleem Khan, CEO KIH and Dr. Syed Muntazir Mehdi
Zaidi, Head of Operations KIH.
Percutaneous
Vertebroplasty:
Services for Percutaneous Vertebroplasty have been
introduced at Kulsum International Hospital with
an aim of providing this treatment modality to the
patients. Vertebroplasty is a minimally invasive, image
guided therapy used in relieving the pain from a
vertebral body fracture. Percutaneous Vertebroplasty
involves percutaneous injection of cement called
Polymethylmethacrylate in to the vertebral bodies.
A patient was brought for a treatment with history
of trauma having TH12 collapse vertebral body and
painful spine. Pain was radiating to the ribs. Dr. Umair
Rashid Chaudhry, Consultant Neuro-Radiologist at KIH,
conducted the procedure using local anesthesia under
Fluoroscopy. The procedure had excellent results.
Pulmonary Discussion Forum:
Prevalence of Pulmonary diseases has shown
an increase lately. Diseases including Asthma,
Atelectasis, Bronchitis, Chronic obstructive
pulmonary disease (COPD), Emphysema and Lung
cancer; have higher percentage of occurrence.
Kulsum International Hospital organized a
Pulmonary Discussion Forum on 30th of January,
2015. Aim of this conducive activity was to exchange
the experiences of pulmonary cases among medical
experts and improve existing practices. Esteemed
panel comprised of Maj. Gen. Jawad K Ansari, Dr.
Wajid and Dr. Shazli Manzoor along with other
fellows.
10
Success Story:
Shamshad Begum, age 43, came to KIH Physiotherapy
department with right Frozen Shoulder. Shamshad
Begum is a housewife and a mother of three young
children. Her children are greatly dependent on their
mother to take care of them. From making them study
at home to dropping them off to school, Shamshad
Begum has to do it all. Being right handed, she faced
extreme difficulty in carrying out even her basic
daily activities including dressing and cooking due to
severe pain in her right shoulder and arm for the past
one year. She felt helpless and depressed. Having met
several doctors who would prescribe daily intake of
pain killers for weeks, Shamshad Begum’s shoulder
remained stiff and restricted. After consulting several
physiotherapists from other reputed hospitals in the
vicinity, she had almost given up the thought of using
her dominant arm fully and freely like before until she
came to KIH Physiotherapy Department. Our young
and competent physiotherapist, Dr. Shafaq Altaf
(BSPT, PPDPT) assessed her condition and designed
an efficient exercise plan along with the use of
Interferential Current therapy for pain management.
After following physiotherapy for consecutive two
weeks and alternate exercise sessions for the next
one week, Shamshad Begum has now returned to
her household routine with a mobile and pain free
shoulder.
This is what she has to say about KIH Physiotherapy
department:
“I am lucky enough to have been treated by a wonderful
team of physiotherapists. My exercise sessions
were carried out in a very friendly, comfortable and
motivational environment. My kids are happy to have
their joyful and active mother back.”
Hypertension – An
enemy inside you:
An awareness session was conducted at Kulsum
International Hospital on Hypertension with the
theme “Hypertension, An enemy inside you”. Dr.
Hamid Iqbal (Cardiologist) presented particulars
to patients and visitors about the life style and
factors which promote hypertension. Audience
was provided with education material which helps
in making them understand causes, effects and
complications of hypertensive life style.
11
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