National Journal of Health Sciences
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Prevalence of Red Blood Cell Alloimmunization among Children with Sickle Cell Disease in Southern Region of Saudi Arabia: A Single-Center Experience
No full textAbstract: Background: Sickle cell disease (SCD), carrying a varied worldwide prevalence, is a commonly encountered entity in Kingdom of Saudi Arabia and Mediterranean. It is characterized by a range of complications. Blood transfusion is essentially required for both episodic and chronic indications. These blood transfusions inherently imply various risks including alloimmunization.
Objective: To ascertain the incidence of red blood cell alloimmunization in children having sickle cell disease (SCD).
Materials and Methods: Retrospective cross-sectional study was conducted at the Department of Pediatric Medicine, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia, after obtaining permission from Research Ethics Committee (REC certificate number AFHS-RMREC/2024/Pediatrics/745). The data was collected for last three years 1st July 2021 to 30th June 2024, regarding pediatric patients having sickle cell disease while aged one to fourteen years.
Result: 188 patients of sickle cell disease - all with Saudi ethnicity - were selected with 81 (43%) patients being female and 107 (57%) male. The mean age was 6 years 2 months. Each patient had an average of 2.3 admissions during the course of the disease. Out of these 188 patients, 14 (7.4%) patients were found to have alloimmunization. Mean age at which they developed alloimmunization was 6 years 8 months. 12 patients were on hydroxyurea and 7 patients (50%) underwent splenectomy. On average these cases received 13 transfusions. In contrast, only three (21.4%) patients had undergone exchange transfusion. The most commonly identified single alloantibody was anti-E as seen in 3 patients (21.4%), followed by anti-M in two cases (14.3%). In 4 cases (28.6%), there was an indeterminate antibody (with no specific pattern). Two (14.3%) children were having combination of alloantibodies.
Conclusion: Among the children from southern region of Kingdom of Saudi Arabia, the incidence of alloimmunization in SCD was 7.4%
Addressing Soft Tissue Defects of Hand and Forearm Using Posterior Interosseous Artery Flap: An Observational Study
No full textAbstract: Background: Covering large wounds in a stable, long-lasting, and aesthetically pleasing manner is the primary task for a hand surgeon. Because the posterior interosseous artery (PIA) flap produces thin, malleable skin, it is an excellent tissue for covering hand deformities.
Objective: To determine frequency of successful flap survival based on PIA flap in patients with soft tissue injuries of the dorsum of the forearm and hand.
Materials and Methods: The prospective observational study was conducted at Plastic & Reconstructive Surgery Department of Dr. KM Ruth Pfau Civil Hospital in Karachi, Pakistan. After obtaining approval from the institutional review board's official, (IRB-3378/DUHS/clearance/2024/24), the study took place from 1st May to 30th October of 2024.The follow-up was done two weeks after their surgery. Clinical examination was used to monitor the flaps including assessment of flap color, skin turgor and absence of venous congestion. If patients were found normal and recovering during the follow-up, the flaps were marked as successful.
Result: A total of 32 patients were studied with average age of 31.4 ± 9.9 years. Age range of patients was 18-50 years. Three-fourth of study participants were males (75%).Average duration of injury was 15.8 ± 4.6 days. More than three-fourth were accident cases (84.4%) and had injury in hand (78.1%).Out of 32 patients, flap was successful in 31 patients. Only one flap was unsuccessful while complications were observed in 2 patients only. One had complication of wound infection and other had complication of marginal flap necrosis.
Conclusion: This study concludes that PIA flap is a safe and reliable technique in reconstruction of soft tissue defects of hand and forearm. However, patients should be closely monitored post-operatively to detect any complications for timely surgical intervention
Superior Vena Cava Syndrome in a Child with Steroid Resistant Nephrotic Syndrome; A Case Report and Review of Literature
No full textAbstract: Nephrotic syndrome (NS) is one of the risk factors for thromboembolism (TE). We report here a rare case of a 6.5-year-old boy who presented with superior vena cava syndrome (SVCS) secondary to thrombosis during relapse of NS. He was diagnosed with primary steroid resistant nephrotic syndrome (SRNS) and was maintaining partial remission with triple regime immunosuppressive treatment for the last one year. He presented in the emergency department with generalized body swelling, more marked on face and neck for last one week. Initially managed as relapse of nephrotic syndrome but it was observed that his face and neck edema instead of disappearing, increased despite his pedal edema improving. This raised suspicion of neck vein thrombosis. Ultrasound doppler revealed sluggish flow in the internal jugular vein (IJV) and superior vena cava (SVC). CT angiogram further confirmed thrombosis in IJV extending to SVC. The patient was successfully treated with low molecular weight (LMW) heparin followed by maintenance anticoagulant therapy with rivaroxaban, a factor X inhibitor. Early consideration and intervention may prevent morbidity and mortality
Effectiveness of Dexmedetomidine versus Ketamine for Control of Shivering and Hemodynamic Stability in Vaginal Hysterectomy under Spinal Anesthesia
No full textAbstract: Background: Shivering is an attempt by the body to increase the generation of heat through metabolism in response to core hypothermia. Ketamine and dexmedetomidine have been used to prevent shivering during anesthesia with variable findings.
Objective: To determine effectiveness of dexmedetomidine versus ketamine for control of shivering and comparing hemodynamic stability in vaginal hysterectomy under spinal anesthesia.
Materials and Methods: This double blinded randomized control trial was performed in Hamdard University Hospital during January to October, 2023. Before commencing the study, formal permission was taken from Ethics Committee of Hamdard University Hospital (Ref#HCM&D/20/2022). Patients of age 45-55 years undergoing vaginal hysterectomy with ASA grade of I-II were enlisted. Group D was given a prophylactic dose of dexmedetomidine (1mcg/kg) and Group K was given a prophylactic low dosage of ketamine (0.25 mg/kg). Blood pressure (mmHg), heart rate (bpm), oxygen saturation (%) and mean arterial pressure (mmHg) were recorded after every 15 minutes throughout the procedure.
Result: Total 104 patients were enrolled into the study with equal allocation in both the groups. In dexmedetomidine group, only 2 (3.8%) patients experienced shivering whereas in Ketamine group shivering was seen among 9 (17.3%). Among dexmedetomidine group, both of the patients developed shivering at 98 minutes. In ketamine group, average shivering onset time was 84 ± 29.8 minutes with range of 60-105 minutes. Average duration of shivering in dexmedetomidine group was 20±2.1 minutes whereas average duration of shivering for ketamine group was 26.1 ± 9.6 minutes.
Conclusion: The present study demonstrated that dexmedetomidine is superior to ketamine in shivering prevention and control following spinal anesthesia. This study also found that dexmedetomidine is also effective in maintaining hemodynamic stability throughout the procedure
Correlation of iPTH, Serum Calcium, and Serum Phosphorous with Different Stages of Chronic Kidney Disease
No full textAbstract: Background: CKD-mineral and bone disorders (CKD-MBD) include abnormalities in blood calcium (Ca), phosphate (P), and parathyroid hormone (PTH), as well as bony derangements and vascular calcification, which are increasingly more frequent in patients with chronic kidney disease (CKD) stages 4 and 5.
Objective: To assess the correlation of chronic kidney disease, mineral, and bone disorder (CK-MBD) with stages of CKD.
Materials and Methods: This is a cross-sectional, study conducted at the Tabba Kidney Institute, Serum levels of calcium, phosphate, and intact PTH (iPTH) were measured as part of the study at baseline. The statistical package of Social Sciences version 22 was used to enter, sort, and analyze data. To assess the risk of vascular calcification in different stages of CKD, odds ratio (OR) test was performed, keeping confidence interval as 95% and OR of 1 as positive risk of outcome after exposure.
Result: A total of 82 patients were enrolled in the study with a mean age of 59.6 ± 13.3 years. The results indicated positive odds of vascular calcification in CKD stage V with 1.418 and Confidence interval of 95% as a lower bound and upper bound of 1.121-10.817, indicating higher chances of vascular calcification in stage V patients. Similarly, CKD stage IV reported 0.042 OR with lower and upper bound of 0.352-4.162 confidence interval respectively.
Conclusion: This study concludes that CKD progression is directly associated with Bone mineral disorders and allied complications, including the risk of vascular calcification in patients which increases from stage III to V.  
Frequency and Risk Factors of Diabetic Retinopathy in Children having Type-1 Diabetes Mellitus
No full textAbstract: Background: Diabetic retinopathy is the most prevalent complication and the primary cause of blindness in people with type 1 diabetes mellitus. There are two categories of risk factors: modifiable and non-modifiable for development of diabetic retinopathy.
Objective: To determine the frequency and risk factors of diabetic retinopathy in children having type-1 diabetes mellitus.
Materials and Methods: Children aged 7 to 18 years participated in this cross-sectional study, which was carried out in the National Institute of Child Health’s endocrinology department. Clinical, anthropometric, and demographic data of the patients were gathered. To identify diabetic retinopathy, a fundus examination involved examining the optic disc, macula, retinal blood vessels, background, and fundus periphery.
Result: With an average age of 14.07±2.82 years, 157 patients were examined. 88(56.1%) were male and 69(43.9%) were female. Average HbA1C level was 10.10±2.63%. Total 116(73.9%) patients had diabetic retinopathy, of which 103(88.8%) had mild non-proliferative, 10(8.6%) had moderate non-proliferative, 1(0.9%) had severe non-proliferative, and 2(1.7%) had proliferative diabetic retinopathy. Diabetic retinopathy was significantly associated with age group (p=0.025), random blood sugar (p=0.050) and insulin regimen type (p=0.018). Male patients had a lower risk of diabetic retinopathy (OR=-0.497, p=0.069). Individuals with age 14 years or less had a lower probability of developing diabetic retinopathy (OR=0.437, p=0.027). Patients with High HbA1c had more risk to develop diabetic retinopathy (OR=1.314, p=0.003). Patients on basal bolus insulin had a higher risk of developing diabetic retinopathy (OR=2.378, p=0.020).
Conclusion: The results of our investigation showed that a significant portion of the study group had diabetic retinopathy. The most common kind of retinopathy was mild non-proliferative. Males who were less than 14 years old, had a low HbA1c, had the disease for less than ten years, and used regular insulin and neutral protamine Hagedorn (NPH) were less likely to develop diabetic retinopathy
Academic Procrastination among Nursing Students at Private Nursing Schools in Karachi
No full textAbstract: Background: Academic Procrastination refers to the act of delaying any academic task or assignment without any logical reason including academic assignments, examinations, and their preparation.
Objective: The purpose of this study is to determine academic procrastination among nursing students at private nursing schools in Karachi.
Materials and Methods: This cross-sectional analytical study was conducted in two private nursing colleges Horizon School of Nursing and Allied Health Sciences and Suvastu School of Nursing and Allied Health Sciences, from May 2023 to July 2023. The study participants were approached by a convenient sampling technique utilizing Procrastination Assessment Scale-Students (PASS) with a total sample size of 235 nursing students enrolled in Generic Bachelor of Science Nursing (GBSN) including 1st, 2nd, 3rd, and 4th years.
Result: The study findings show that 52.13% nursing students reported moderate levels of procrastination, 45.72% showed severe procrastination, and 2.56% mild procrastination. Moreover, there is a statistically significant difference between procrastination scores and gender (p = 0.001), but no significant difference was found regarding relationship status (p = 0.582), college attendance (p = 0.240), and academic year (p = 0.442) among the participants.
Conclusion: Majority of nursing students reported moderate to severe levels of academic procrastination, emphasizing the necessity for focused interventions and support to enhance time management and study habits in this student population
Sudden Unilateral Loss of Vision in a Young Girl: A Case Report
No full textAbstract: A casual association seems to exist between the onset of intracranial hypertension (IH) and growth hormone (GH) therapy. Children receiving GH treatment, if they complain of headaches or visual difficulties, should undergo detailed ophthalmological evaluation. Herein, we report a young girl who was receiving GH treatment for idiopathic short stature, and due to the adverse effects of GH, she developed intracranial hypertension, as a result of which, she developed unilateral blindness
Antimicrobial Susceptibility Pattern of Escherichia Coli (E-Coli) and Association of Infections in Immune-Compromised Cancer Patients
No full textAbstract: Background: Incidents of infections in immune-compromised patients are the cause of increased morbidity and mortality, this study aims to determine the microbial spectrum of Cancer patients with urinary tract infections, respiratory tract infections, and gastrointestinal tract infections.
Materials and Methods: This is a cross-sectional study conducted at a Layari General Hospital, in Karachi from March 2022 till May 2023. Patients from the oncology department were recruited in the study, Sputum, urine (mid-stream), or stool samples were collected for analysis. SPSS 22 was used to analyze the data. Effect modifiers were controlled through stratification. To assess the association between two variable mean values, a chi-square test was performed keeping the p-value ?0.05 as significant.
Result: A total of 170 patients were included in the study, with a mean age of 36.8 ± 12.9 years and, a mean weight of 66.8 ± 14.2 kgs. Gender distribution indicated higher incidents in male patients with 95 (%) while 80 (%) females were included in the study. Escherichia Coli (E-Coli) was the most frequently reported organism 133 (78.2%) in Urinary tract infection, similarly Staphylococcus aureus was most frequently reported in Respiratory tract infection with 86 (50.4%), and Salmonella spp. and Shigella Spp. were reported with equal frequency in Gastrointestinal infection with 26 (15.6%) and 26 (15.6%) respectively. Conclusion: According to this study’s findings, urinary tract infections are the most frequently reported illness in immune-compromised patients, with Escherichia Coli (E-Coli) being the most widely reported microorganism. Broad-spectrum antibiotic overuse causes antibiotic resistance and increases illness rates
Patient Satisfaction after Basal Cell Carcinoma (BCC) Excision in Head and Neck Region Followed by Reconstruction with Loco Regional Flaps and Full Thickness Skin Graft
No full textAbstract: Background: Basal cell carcinoma (BCC) is one of the most frequent malignancies and constitutes nearly 80% of the non-melanoma skin malignancies. There is scarcity of local data regarding the patient satisfaction level in the BCC treatment.
Objective: To assess patient satisfaction after BCC excision in head & neck region followed by reconstruction with loco regional flaps & full thickness skin grafts (FTSG).
Materials and Methods: The present prospective cohort study was performed in Department of Plastic & Reconstructive Surgery Department at Dr. Ruth KM, Pfau, Civil Hospital Karachi, Pakistan during 1st November 2023 to 1st November 2024 after obtaining approval from ethical committee (IRB-3096/DUHS/Approval/2023/420). Post-operatively, patient satisfaction was assessed using four key aspects: skin color, tissue coordination, scar appearance, and skin texture. Each aspect is scored on a scale of 1 to 5, with 1 indicating "Extremely Dissatisfied" and 5 indicating "Extremely Satisfied. Total satisfaction score was calculated by summing four categories and total score of ?14 was considered as greater patient satisfaction.
Results: Total 215 patients were enrolled into the study with mean age of 50.4 ± 10.0 years. More than half of the patients were males (68.4%) and having lesion of nose (51.6%). Mean lesion size was 1.6 ± 0.6 cm. Half of the patients underwent FTSG reconstruction (50.2%). Satisfaction related to skin color (4.2±0.8 vs 3.2±0.8, p<0.001), skin tissue (3.5±0.9 vs 3.3±0.8, p=0.009) and scarring (3.9±0.7 vs 3.6±0.6, p<0.001) were higher in patients underwent local flap reconstruction than FTSG.
Conclusion: The present study demonstrated that post-BCC excisional defects reconstruction in head and neck region using local-regional flap brings out higher satisfaction level among patients in comparison to full thickness skin graft