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Strengthening Health Systems: A Comparative Analysis of Pakistan and Canada through the WHO Building
Full text linkThe Health System Building Blocks framework guided the holistic approach that has been promoted by the World Health Organization to strengthen the health systems. The framework is composed of six fundamental components: the health workforce, access to essential medicines, information systems, leadership/governance, and financing. These components have been strengthened along with challenges and strategies for indicators like HIV, Nutrition, Child health, and sanitation in Canada, a high-income country compared with a lower-middle-income country such as Pakistan. This commentary identifies certain health system challenges and opportunities for betterment in each country by evaluating the indicators inside the WHO Health System Building Blocks framework that has a health workforce, service delivery, health information systems, access to essential medicines, leadership/governance, and financing
Efficacy and Safety of Uterine Artery Embolization for Symptomatic Uterine Leiomyomata in Pakistan: A Single Centre Experience
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Short-Term Diagnostic Follow-Up of Patients Undergoing Cholecystectomy for Development of Colorectal Cancer
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Surgical Site Infection Following Nail Bed Repair with or Without Nail Plate Coverage: A Randomized Clinical Trial
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Differential Withdrawal Symptoms of Typical and Atypical Antipsychotics: A Narrative Review
Full text linkAntipsychotics (APs) reduce abnormal neurotransmitter activity and treat mental conditions. However, APs can cause withdrawal symptoms, which can disrupt normal physiology. This research aimed to evaluate the APs' withdrawal symptoms and their evidence-based management. In the current review, forty-six papers were included after careful evaluation. All studies comparing the withdrawal symptoms between typical and atypical APs were included, while those focusing solely on safety were excluded. Quality and strength of evidence were also evaluated by standardised criteria. Abrupt discontinuation of typical APs results in dopaminergic rebound, causing motor symptoms. The aberrant discontinuation of atypical APs results in rebounds of dopaminergic, serotonergic, and cholinergic systems, leading to emotional dysregulation. Withdrawal symptoms must be managed by considering individual drug mechanisms as well as the demographics of patients. Clozapine withdrawal is associated with fewer side effects when tapered gradually over six months; risperidone discontinuation requires careful monitoring for dose-dependent extrapyramidal symptoms. Adolescents using olanzapine exhibit higher withdrawal-related morbidity compared to other age groups. Prolonged tapering of quetiapine has been shown to effectively mitigate withdrawal symptoms. Patients discontinuing aripiprazole experience mood swings due to its partial agonist effects on dopamine receptors; abrupt discontinuation of ziprasidone can lead to rebound psychosis and increased anxiety. The discontinuation of APs over a prolonged period shows improved patient outcomes; however, the period for discontinuation should be tailored to the individual patient's needs and the medication used. A holistic approach to tapered discontinuation can improve medical and psychosocial outcomes
Roadmap to Success: Fostering Medical Professionalism and Ethics in Pakistan
Full text linkThe authors highlight the pressing concerns regarding Pakistan's current medical ethics and professionalism by addressing the medical professionals with a sense of shared responsibility. The healthcare landscape in Pakistan is changing dramatically, posing both challenges and opportunities for medical professionals. We list here some of the possible challenges in fostering medical professionalism and ethics in Pakistan, along with their implications and possible solutions. These include ethical conflicts, limited healthcare access and resources, cultural sensitivity and barriers to communication, balancing professionalism with hierarchy and, mental health and burnout. A multifaceted strategy including educational interventions, institutional support, and systemic changes within the healthcare system is needed to address these challenges. Establishing a culture of professionalism in Pakistan's medical field requires equipping medical students with the necessary tools to overcome these obstacles. The authors emphasize the values that Pakistani medical professionalism is built upon and present recommendations for improving the healthcare landscape of Pakistan in terms of professionalism and ethics. In doing so, we intend to improve not only the health of our patients but also advance our profession in the service of humanity
Interventional Radiology and Urology in Suprapubic Catheterization: Bridging Expertise and Practice
Full text linkSuprapubic catheterization (SPC) is a commonly undertaken procedure allowing direct access to the bladder with drainage. This is preferable when urethral catheterization is not feasible. IR or Urology can perform an SPC, with either specialty increasingly being approached to consider the procedure. The review will assess the expertise, procedural ease, and associated clinical outcomes with SPC insertion performed by either specialty. An extensive literature review was carried out using databases such as PubMed, Scopus, Web of Science, and Google Scholar. Search terms included "suprapubic catheterization," "urology," "interventional radiology," and "clinical outcomes." IR-related success rates have been reported as being 99.6% under image guidance. Complication rates of approximately 7.2% have been recorded. In contrast, urologists use blind or cystoscopic-guided techniques, and they report a 10% intraoperative complication rate, including a 2.4% risk of bowel injury, along with a 19% overall complication rate within 30 days post-procedure.
IR excels in image-guided techniques, particularly for patients with complex anatomical challenges, whereas urologists are more proficient in cases requiring surgical expertise and cystoscopic guidance. The key outcome is the safety of the procedure under respective specialties, and the ability to demonstrate comparable safety profiles when adhering to established protocols and to maintain and enhance patient outcomes. Both interventional radiologists and urologists bring their unique strengths to SPC. Patient-specific factors and defined clinical scenarios will dictate which specialty to approach for the insertion. Ultimately, the need to improve patient care requires fostering relationships between each specialty and enhanced interdisciplinary collaboration
