National Journal of Health Sciences
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Intestinal Parasitic Infections in Pregnant Women: A Public Health Concern
No full textAbstract: Background: Intestinal parasitic infections affect pregnant women all over the world. The infection has been linked to the development of life-threatening conditions in both pregnant women and their developing fetus.
Objective: This study was conducted to determine the prevalence, intensity of infection and associated risk factor among pregnant women of five different wards of Hetauda sub-metropolitan city, Makawanpur, Bagmati province, Nepal.
Materials and Methods: A cross- sectional study was carried out among (100) conveniently sampled pregnant women receiving antenatal care services at Rural Urban health care center of Two, four, five, ten and 11 numbers wards of Hetauda in between July to December of 2023 after obtaining approval from the Ethical committee of the Institute of Science and Technology, Tribhuvan University, Nepal (IRB approval no. 23-0067). Structured questionnaires were administered to study participants to assess socio-demographic and other possible factors. Stool samples were collected from each pregnant woman and examined for the presence of intestinal parasites by microscopy using direct wet mount, flotation as well as formal-ether sedimentation techniques.
Result: The study revealed that of the 100 samples examined, 19 samples (19%) were found to be positive for gastrointestinal parasites. Parasites covering five genera. Ascaris lumbricoides (8%) was most predominant followed by Entamoeba histolytica (4%), Strongyloides stercoralis (3%), Trichuris trichiura (2%) and Hymenolepis nana (2%). Parasites are more observed amongst poorer population, independent of their age. Chi-square test conclude that there is association between parasites and financial situation (P= 0.0084).
Conclusion: Screening of the women for intestinal parasites and provision of health education during their ANC (Antenatal care) visit to prevent the adverse effects on maternal and fetal health from these infections
Frequency of Stroke among Children with Sickle Cell Disease in Southern Region of Saudi Arabia: Single Center Experience
No full textAbstract: Background: Sickle cell disease (SCD), being an autosomal recessive disorder of hemoglobin, carries a varied worldwide prevalence. It is characterized by a range of complications hemolytic crisis, vaso-occlusive crisis, splenic sequestration, acute chest syndrome and occasionally stroke.
Objective: To ascertain the frequency of stroke in pediatric population with sickle cell disease (SCD).
Materials and Methods: Retrospective observational study, was conducted in Pediatric Medicine Department, King Fahad Armed Forces Hospital Southern Region, Khamis Mushait, Kingdom of Saudi Arabia, from1st July 2018 to 30th June 2023. The data was collected for last five years regarding pediatric patients of sickle cell anemia and aged one to 14 years.
Result: Among 322 patients of sickle cell disease, 116 were female and 206 male with mean age 6 years 2 months. Each patient had an average of 2.3 admissions during the course of the disease. The most common diagnosis was vaso-occlusive crisis for the inpatient care. The mean hemoglobin was 9.24 g/dL. Transcanial doppler identified recording of high velocity in middle cerebral artery in 2% of sickle patients. 6 patients (1.9%) were found to have stroke with mean age of 9 years 10 months, with obliteration of middle cerebral artery in 4 patients (66%).
Conclusion: Among the children of southern region of Saudi Arabia, the frequency of stroke in SCD patients was 1.9%
Dental Age Estimation on Digital Panoramic Radiographs: A Comparison among Final Year Students, Graduates, and Postgraduate Trainees
No full textAbstract: Background: Panoramic radiographs aid in holistic treatment planning and dental age estimation based on tooth development stages and eruption sequence. Evaluating dental professionals’ proficiency to precisely estimate patient age using orthopantomograms (OPGs) is crucial for identifying existing skill gaps.
Objective: This study aimed to evaluate and compare the knowledge of dental age estimation using digital panoramic radiographs among final-year dental students, recent graduates, and postgraduate trainees.
Materials and Methods: This cross-sectional study was conducted at Sindh Institute of Oral Health Sciences (SIOHS), Jinnah Sindh Medical University (JSMU), over a two-month period from 1st October till 30th November 2022, at the Department of Oral Radiology. Ethical approval was obtained bearing number JSMU/IRB/2022/-639. The calculated sample size was 402, and non-probability convenience sampling was used. An online questionnaire was designed with eight digital OPGs (6–16 years), analyzed by dental specialists using the American Dental Association (ADA) eruption sequence guideline. Each OPG was accompanied by options related to the most likely age to be selected by the study participants. The Google Form link was shared with all potential participants via Facebook and WhatsApp Messenger. Frequency of correct responses was calculated, and chi-square test was applied to determine any significant differences between participants based on their responses (p- value ? 0.05).
Result: The response rate was 78.7%, with 493 completed forms analyzed. Most participants were aged 18-23 years (53.3%), and 71.2% were female. Participants comprised final-year students (32.7%), graduates (41%), and postgraduate trainees (26.4%). Postgraduate trainees had the highest percentage (60.4%) of correct responses, followed by graduates (54.7%) and final-year students (48.4%). Radiographic image 8 had the highest correct responses (74.2%), while image 7 had the lowest (25.6%). No statistically significant relationship was found between participants’ qualifications and their ability to identify the correct age range on OPGs (p > 0.05).
Conclusion: The ability to correctly identify the age range of OPGs seems to improve with progression in clinical training, since more postgraduate dental trainees were able to accurately identify the age range of patients compared to other participants
Etiology, Clinical Profile and Outcome of Non-Traumatic in Children
No full textAbstract: Background: Non-traumatic coma in children is a neurological emergency associated with high risk of mortality and undesired consequences.
Objective: To investigate the etiology, clinical profile and neurological and clinical outcome in children presented with non-traumatic coma at National Institute of Child Health Karachi.
Materials and Methods: A prospective follow-up study was conducted on inpatients visiting pediatric department of National Institute of Child Health Karachi. The study period was six months from 20th December 2022 to 19th June 2023. One hundred and forty-three non-traumatic coma children of age 2 months to 16 years were consecutively selected for investigation. Each child was assessed for vitals, GCS score, duration of unconsciousness and presenting complaints. Laboratory investigations were performed to confirm the etiology of non-traumatic coma. Each child was followed until hospital discharge for final neurologic and clinical outcomes.
Result: Out of 143 non-traumatic coma children, male children were 77 (53.8%) and female children were 66 (46.2%) with mean age of 6.74 ± 2.68 years. The most common clinical presentation was fever 123 (86.0%) followed by convulsions 117 (81.8%), headache 112 (78.3%), fast breathing 83 (58.0%), vomiting 70 (49.0%) and abdominal pain 52 (36.4%). Viral encephalitis 41 (28.7%) and acute bacterial meningitis 31 (21.7%) were the most common infectious; while epilepsy 24 (16.8%) and acute poisoning 11 (7.7%) were the most common non-infectious etiologies of nontraumatic coma. The most common neurological outcome was moderate disability 80 (55.9%) children followed by mild and severe disability in 32 (22.4%) and 31 (21.7%) children, respectively. Overall, 112 (78.3%) non-traumatic coma children survived while 31 (21.7%) children died.
Conclusion: Infections were the most common cause of non-traumatic coma and also the most common cause of death in children. Meningitis including acute bacterial meningitis and tuberculosis meningitis was the only significant cause of death in children of non-traumatic coma. Death was significantly associated with severe disability
Assessing the Predictive Ability of the Pyeloplasty Prediction Score on Surgical Outcomes: A New Use of a Tool in Pediatric Urology
No full textAbstract: Background: Pediatric urology requires precise surgical techniques and effective communication with parents. Establishing trust through knowledge sharing is essential for guiding treatment pathways. Parents, particularly those with antenatal diagnoses, seek reassurance through counseling. Antenatal hydronephrosis, affecting approximately 1 in 1000-1500 live births, often involves conditions like Pelviureteric junction obstruction (PUJO). Various scoring systems, including the ultrasound-based Pyeloplasty Prediction Score, assist in predicting surgical outcomes. Leveraging such scores as counseling tools enhances parental understanding and facilitates informed decision-making in pediatric urology.
Objective: To evaluate the predictive ability of Pyeloplasty Prediction Score on surgical outcomes of Pyeloplasty and to assess the use of this score as a counselling tool.
Materials and Methods: This prospective study, conducted at the Department of Urology, Tabba Kidney Institute, enrolled 50 patients under 15 years with antenatal hydronephrosis or incidental diagnosis of HDN. Patients over 15 years of age and those with bilateral hydronephrosis were excluded. The Pyeloplasty Prediction Score, comprising SFU grade, Anteroposterior Pelvic Diameter (APPD), and percentage renal length difference, was used for risk stratification. Scores were categorized as low (?4), intermediate (5-7), or high (?8) risk. Post-pyeloplasty, patients were monitored for hydronephrosis resolution and cortical thickness gain via ultrasound. Resolution was defined as APPD less than 10mm or more than 50% decrease from preoperative value.
Result: Out of the enrolled 50 patients, with a mean age of 6 years (range: 2 months to 11 years), 28 (56%) were female and 22 (44%) were male. 56% presented with antenatal hydronephrosis, while 44% had incidental PUJO-like HDN. 20 patients (40%) were categorized as high risk, and 30 patients (60%) as intermediate, with none in the low-risk group. Laparoscopic Retroperitoneal Pyeloplasty was performed in 19 patients (38%) above 2 years, and open Pyeloplasty with DJ stenting in 31 patients (62%) below 2 years. Postoperatively, 24 patients (80%) in the intermediate-risk group showed cortical thickness gain, compared to 9 patients (45%) in the high-risk group (p=0.05). Resolution of hydronephrosis was observed in 13 patients (65%) in the high-risk group and 12 patients (40%) in the intermediate-risk group, possibly due to pelvis excision in severely hydronephrotic cases (p=0.78).
Conclusion: The Pyeloplasty Prediction Score serves as an effective counseling tool for predicting the outcome of Pyeloplasty in terms of cortical gain, eliminating the need for radioisotope exposure post operatively. However, its effectiveness in predicting hydronephrosis resolution is limited. 
The Role of the Psycho-Oncology Multidisciplinary Tumor Board in Enhancing the Caregivers’ Well-Being for Cancer Patients
No full textProviding care to family members with prolonged illness challenges caregivers' well-being. Cancer is not just a disease, it reshapes the life of the patient and the family of the patient. The caregivers carry a heavy and unseen burden in a low-middle-income country like Pakistan, where the cancer system is already overburdened. In a research study conducted in Karachi, Pakistan, it was observed that 64% of caregivers experienced a burden in the Mild to Moderate range [1].
Along with this, in another study, it was seen that fatigue was reported as the most challenging aspect by the caregivers providing support to patients receiving active radiotherapy and having an advanced cancer diagnosis [2], and about 40-70% of caregivers experienced symptoms of depression [3]. Despite the evidence highlighting the need to support caregivers' well-being, there remains a lack of resources. Therefore, integrating a psycho-oncology multi-disciplinary tumor board (MDT) in cancer care can play a pivotal role in the well-being of cancer patients and in reducing the burden on the caregivers [4]
Fetomaternal Outcomes in Intrahepatic Cholestasis of Pregnancy at Tertiary Care Hospital in Lahore
No full textAbstract: Background: Intrahepatic cholestasis in pregnant women (ICP) is a liver disease that usually reported after 24 weeks of pregnancy with both maternal and fetal complications. ICP is common in general and especially in Pakistani-Asian populations. There is still very little information about fetomaternal outcomes related to ICP in the country.
Objective: The aim of this research is to evaluate the fetomaternal outcome of women with ICP in a tertiary health care hospital in Lahore.
Materials and Methods: A hospital-based single arm prospective observational study was conducted in the Department of Obstetrics & Gynecology PRTH/RMDC Lahore from September 1, 2024, to January 30, 2025 approval from institutional review Board (Ref no. 441/2024). 78 pregnant women in 2nd or 3rd trimester diagnosed with ICP were included. Diagnosis was based on clinical and laboratory findings. Information was gathered on the predesigned proforma. MS Excel 2007 and SPSS version 26 were used for data analysis.
Result: This study has 78 participants with a mean age of 26.42 years. The majority were aged 18-24 years (38.5%), and most had a BMI between 25-29 (42.3%). 64.1% were primigravida and 64.1% had completed primary education. 53.84% delivered full term (37-40 weeks), while 33.3% delivered between 34-36 weeks. The most common pregnancy complication was emergency caesarean section (38.46%), followed by preterm delivery (20.51%). There were 7 cases (8.97%) of spontaneous preterm delivery, 5 cases (6.41%) of intrapartum fetal death, and 1 stillbirth (2.5%).
Conclusion: The findings highlight that ICP predominantly affected younger, overweight primigravida with lower educational attainment. Furthermore, the study revealed significant neonatal complications, including low birthweight, respiratory distress, and meconium-staining
Evaluating the Predictors of Mortality in Extremely and very Preterm Neonates in a Developing Country
No full textAbstract: Background: Various comorbidities affect preterm infants throughout their hospitalization. Death among children under the age of five years occurs mainly due to complications developed after preterm births accounting for almost a million fatalities annually. Infants with extremely preterm births are at great risk of complications, which frequently cause death.
Objective: To identify the rate of survival and deaths in extremely and very preterm neonates in our center and to identify the commonest predictors of mortality in our preterm population.
Materials and Methods: This prospective observational longitudinal study was conducted at the Department of pediatric medicine, Liaquat National Hospital, Karachi, Pakistan, after obtaining the permission from Ethics Committee of the hospital (Ref. App # 0889 -2023-LNH-ERC), over a period of 9 months from 10th April 2023 to 10th January 2024. 169 Neonates in total were managed uniformly and followed up till discharge or death. Chi-square test was used to compare categorical variables. P-value ? 0.05 was taken as statistically significant.
Result: There were 53.3% male and 46.7% female patients. The majority of patients (89.3%) had very low birth weights. Most of the births were very preterm births (67.5%) followed by preterm births (20.1%), and extremely preterm births (12.4%). Death was recorded in 11 (6.5%) patients and among these patients sepsis was the most observed cause with 45.5%. Extremely preterm births and very preterm births were significantly associated with gender and birth weight, but not with survival status and predictors of mortality.
Conclusion: Very preterm was the most common birth status. Mortality was reported 6.5% cases. The most common predictor of mortality was Sepsis
Strengthening Family Planning to Sustain Pakistan’s Future
No full textPakistan is a country of more than 241.49 million people; the large and diverse population poses complex challenges in executing effective family planning (FP) services [1]. The improvement of FP faces continued barriers that particularly affect populations in rural areas and low socioeconomic status since they experience limited health access laterally with social and cultural barriers. The PDHS 2017-18 indicates the importance of as only 34% of women in Pakistan use a modern method of contraception, and 17% have an unmet need [2]. These gaps can only be addressed through a collective and innovative effort to redesign various sectors of the healthcare system in the country
Assessing Job Satisfaction and Perceived Improvement Measures among Early Career Hospital Pharmacists in Karachi: A Cross-Sectional Study
No full textAbstract: Background: Hospital pharmacists play a critical role in patient care, medication management, and efficiency of the healthcare system. Inadequate workload management, recognition and monetary remuneration may lead to higher turnover, lower job satisfaction which affects patient care
Objective: The aim of this study was to assess the job satisfaction among early career pharmacist of Karachi Pakistan. Together with the perceived measures needed to be taken in order to improve the job satisfaction.
Materials & Methods: From August 2023 to October 2023, a descriptive cross-sectional study was carried out by distributing a self-administered questionnaire through electronic media channels to pharmacist of different hospital sectors in Karachi. The study was approved from Institutional Bioethics Committee of University of Karachi and assigned the reference number of IBC KU-354/2023. The questionnaire was divided into Professional interaction with healthcare professionals, salary/incentive benefits and professional work environment. A five-point Likert scale, value ranging from 1 (strongly disagree) to 5 (strongly agree), was used to rate the questions. Since all of the questions were positively worded therefore, smaller mean values were considered as lower satisfaction.
Result: A total of 107 pharmacists responded to the questionnaire of which majority were females (82.2%). Overall, two-third of the pharmacist (63%) in Pakistan are dissatisfied. Major area of dissatisfaction was observed due to salary and incentive benefits (79%) received by the pharmacist. An otherwise positive response was observed with pharmacist professional interaction (56%). Pakistani pharmacists were inclined with receiving more trainings for their professional development preceded by more salary benefits.
Conclusion: Statutory bodies should devise a strategy to cope with the dissatisfaction of hospital pharmacists in Pakistan especially related to pharmacist salary and trainings