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Passive Smoking and Respiratory Symptoms among Children in Tertiary Care Hospital of Sindh
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Causes of Preterm and Low Birth Weight Babies in Pakistan: A Comprehensive Analysis
Full text linkPreterm birth and low birth weight are critical public health concerns globally, contributing to significant neonatal morbidity and mortality. As a developing country, Pakistan faces substantial challenges in addressing these issues. This paper aims to provide a comprehensive analysis of the causes of preterm birth and low birth weight babies in Pakistan. Through an exploration of socioeconomic, healthcare, maternal, and environmental factors, the paper seeks to shed light on the complex interplay of factors contributing to this problem. Understanding these causes is essential for designing effective interventions and policies to reduce the incidence of preterm birth and low birth weight, ultimately improving maternal and neonatal health outcomes in Pakistan
Emerging Need for Pre-Dialysis Nurses to Overcome the Growing Kidney Disease Burden in Pakistan
Full text linkAccording to the Global Burden of Disease, chronic kidney disease (CKD) was Pakistan's eighth most common cause of death in 2017. After having end-stage renal disease, most patients prefer hemodialysis as Kidney Replacement Therapy (KRT) because of the lack of kidney donors. There are specific fears related to hemodialysis therapy, but a multidisciplinary approach is required to remove the concern. Along with this, kidney disease is an irreversible condition; the primary goal of treatment is to delay disease progression. To accomplish this goal, pre-dialysis nurses can intervene in kidney disease stage III to delay the deterioration of kidney function and prevent further complications through health education and strengthening patients' self-care behavior. Employing pre-dialysis nurses in the nephrology clinics will be beneficial to the healthcare system as it will reduce hospital costs by reducing the number of hospital admissions, slow the progression of kidney disease, and, therefore, defer the requirement for dialysis therapy. However, multiple challenges exist to introducing pre-dialysis nurses in the healthcare sector, but through proper planning, these challenges can be overcome, and better health outcomes can be achieved. This position aims to highlight the vital role of pre-dialysis care nurses in the healthcare sector, their responsibilities with supporting arguments, the Chronic Care Model, challenges, and recommendations to overcome those challenges
Lymph Node Oligometastasis from Rectal Cancer in Contact with the Bowel Treated with High-Dose Planned Adaptive Radiotherapy
Full text linkThe efficacy of stereotactic ablative radiotherapy for oligometastases has been reported. However, there are no reports of oligometastatic lymph nodes in contact with the bowel being successfully treated with high-dose adaptive radiotherapy. A 61-year-old woman with oligometastatic pelvic lymph node after resection of rectal cancer was treated with high-dose planned adaptive radiotherapy using helical tomotherapy. Because the lymph node was in contact with the bowel, high-dose conventionally fractionated planned adaptive radiotherapy was used instead of stereotactic ablative radiotherapy to avoid bowel side effects such as perforation. Five years after radiotherapy, there is no recurrence and no adverse events. High-dose adaptive planned radiotherapy may become an alternative curative treatment for oligometastases in lymph nodes in contact with the bowel
Wandering Spleen: A Rare Condition with Splenic Torsion and Infarction in an Elderly Patient
Full text linkEctopic spleen or wandering spleen is an uncommon presentation in which the spleen's anatomical location is different from its fixed position in the left upper quadrant of the abdomen, due to the absence of the typical peritoneal attachments; the spleen is more mobile inside the abdomen. Congenital or acquired conditions are the cause of this anomaly, which could ultimately result in torsion and splenic infarction. Less than 0.2% of wandering spleen cases are reported annually, making it a rare clinical manifestation. Splenic vascular pedicle torsion can result in complications that can cause symptoms of an acute abdomen as a result of ischemic necrosis of the spleen. Computed tomography and ultrasonography with Doppler or CEUS are essential for accurate diagnosis due to the vague clinical signs and potential complications. This case involves a 70-year-old elderly woman who complained of extreme abdominal pain and vomiting for three days. On physical examination, a tense right lower quadrant lump was palpated, when she visited the emergency room. An urgent CT scan was done for the acute abdomen which revealed torsion of the splenic pedicle in a wandering spleen
Severe COVID-19 Pneumonia treated with Tocilizumab in a Pakistani population: Variables impacting Outcomes
Full text linkBackground:
The association of severity of COVID-19 with raised Interleukin-6 (IL-6) levels led to Tocilizumab (TCZ) approval for treatment based on its IL-6 inhibiting mechanism of action. Treatment outcomes reported have been variable, with little data from Pakistan.
Objective:
To identify demographic, clinical, and laboratory variables impacting outcomes (recovery or death) of patients with severe COVID-19 pneumonia treated with intravenous tocilizumab in a Pakistani hospital setting.
Methodology:
A single-center, retrospective, descriptive case series was conducted at the National Hospital Postgraduate Training and Medical Centre, Lahore from April to December 2020. Severe COVID-19 pneumonia (oxygen saturation below 90%, chest HRCT severity score more than 15) administered intravenous tocilizumab was included. Not fulfilling the above inclusion criteria. Data was analysed to identify significant differences between expired patients and those discharged after recovery.
Results:
Forty-nine patients were admitted to intensive care/ high dependency units (ICU/HDU) with severe COVID pneumonia and treated with intravenous tocilizumab during the study period. The mean age was 61 years, with male predominance. Of the 49 patients, 23 expired. In the expired group lactate dehydrogenase (LDH), and neutrophil to lymphocyte ratio (NLR) were significantly higher throughout the admission course, while D-Dimers plus the last available white blood cell (WBC) count, were significantly higher post-TCZ, as was odds of co-infection evidenced by positive blood cultures.
Conclusion:
Mortality correlated with increased inflammatory markers LDH and NLR ratio. Post TCZ raised D-Dimers may be indicators of fibrin microthrombi and prophylactic anticoagulation with TCZ may benefit such patients. High odds of secondary bacterial infection post-TCZ had a significant negative impact on recovery
Changing Trends of Suicide in Punjab from the Year 2016 to 2020: A Comparative Study
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Small Cell Neuroendocrine Carcinoma of the Endometrium - A Rare but Aggressive Tumor: A Case Report
Full text linkSmall Cell Neuroendocrine Carcinoma (SCNEC) of the uterus is a rare tumor, very aggressive and highly invasive. SCNEC accounts for only 2% of genital tract tumors, and their rarity highlights the challenges faced in the management. It most commonly occurs in perimenopausal and postmenopausal women, is diagnosed at an advanced stage, and carries a poor outcome. Here, we describe a case of SCNEC of the endometrium in a 69-year-old lady. Cancer was stage III at the time of diagnosis. Tumor cells were positive for immunohistochemical stains CD56 and Synaptophysin. It was treated with surgery, chemotherapy, and radiotherapy but ultimately succumbed to infections four months after the diagnosis. Due to its rarity and unavailability of a unified treatment strategy, the data is still scarce, opening future research windows
Comparative Analysis of Artificial Neural Networks and Extreme Learning Machine for Breast Cancer Diagnosis
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Anxiety, Depression, Traumatic Stress, Burnout, and Insomnia; COVID-19 Pandemic Effects on Health Care Providers: Insight from Systematic Review
Full text linkThe systematic review was to assess the mental health status of healthcare workers due to the COVID-19 Pandemic. For this systematic review, 25 articles were selected manually from 2021 and 2022. The selected articles focused on the effects of COVID-19 on health workers like burnout, insomnia depression, anxiety, and traumatic stress. Original peer-reviewed observational and descriptive studies were identified using PubMed, and Google Scholar engine. Articles revealed a high significance between health care professionals' post-traumatic stress disorder, sleeplessness, burnout, and depression, whereas few studies mainly indicated the positive correlation between burnout and stress among HCWs, with insomnia highly significant. The systematic review concluded that among healthcare personnel, an elevated risk of developing psychological distress, burnout, sleep quality, and insomnia during the COVID-19 pandemic exists. Our review underlines the requirement for intervention and further longitudinal study designs directed at prevention, treatment, and effective ways to delineate the causation of mental health outcomes in healthcare workers