National Journal of Health Sciences
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Gender Based Comparison of Mean Arterial Pressure and Pulse Pressure after Stress Induction in Healthy Adults
No full textAbstract: Background: Mean Arterial Pressure (MAP) and Pulse Pressure (PP) are both key parameters to diagnose and manage cardiovascular diseases and hypertension, a leading cause of mortality and morbidity globally. Men and women are physically different from each other.
Objective: Is to evaluate gender-based comparison of MAP and PP of healthy adults after stress induction.
Material and Methods: This cross-sectional study was designed and conducted in the Institute of Basic Medical Sciences (IBMS) at Khyber Medical University (KMU) from January 2022 to April 2022. A total of fifty-two participants including twenty-six males and twenty-six females were selected using convenience sampling. Sample size estimation was carried out using G*Power. Healthy adults between the age of 18-40 years were included in the study. Blood Pressure (BP) and Heart Rate (HR) were checked both before and after the stress induction. MAP and PP were calculated using the formulas obtained from the literature i.e., MAP = DP + 1/3 (PP) and PP = SBP-DBP.
Result: The mean age of males was 27.16 ± 4.28 years and that of females was 23.15 ± 2.86 years. Both pre and post stress comparison of mean difference between healthy adult males and females, revealed no significant difference between MAP (Post-Stress p=0.97 and Pre-Stress p=0.61), PP (Post-Stress p=0.18 and Pre-Stress p=0.05) and HR (Post-Stress p=0.11 and Pre-Stress p=0.57). Males had a higher PP than females in both pre and post stress phase. Females had a slightly higher MAP than males in the pre stress phase. In the post stress phase, MAP showed a positive correlation with HR and PP. While in the pre stress phase, all the variables (MAP, PP and HR) showed no correlation with each other.
Conclusion: MAP and PP show no significant difference between healthy adult males and females, after stress induction
Frequency and Etiology of Pediatric Trauma, Experience at Tertiary Care Hospital
No full textAbstract: Objective: To determine etiology and spectrum of trauma in children and to make recommendations for its prevention.
Materials and Methods: This Hospital based Retrospective observational study was conducted in department of pediatric surgery King
Edward medical university / Mayo hospital Lahore from March 2021 to February 2022. All patients presented in Pediatric Surgical emergency
King Edward Medical University/ Mayo Hospital Lahore were included in this study. Data regarding age, gender, mechanism and severity of
trauma and its management was analyzed and recorded on a prescribed Performa.
Results: During the study period a total of 3850 patients having trauma were presented in pediatric surgical emergency. There were
2206(57.3%) male patients and 1644(42.7%) females with male to female ratio of 1.3:1. Majority of children affected were 8 to 10 years age.
Burn trauma was noted in 2400(62.3%) while 1450(37.7%) patients have poly trauma due to different etiological factors. Regarding burn
trauma, majority of patients 1620 (67.5%) were having scald burn injury.Pedestrians (260(17.9%) hitting with motor vehicle was noted to be
major mechanism of trauma.
Conclusion: Motor vehicle collision is most common mechanism of pediatric trauma.There is a need for parental education and strict
implementation of traffic laws to prevent trauma at pediatric age group
Assessment of Average Length of Stay among Stroke Patients in a Tertiary Care Hospital
No full textBackground: Stroke is defined as a clinical syndrome where sudden onset neurological deficit appears and remains for 24 hours or more due to vascular compromise. Stroke is the leading cause of disability worldwide and the second leading cause of death. Certain risk factors have been discussed in the literature previously which are strongly associated with stroke. However, the literature is scarce in terms of risk factors affecting the hospital stay of patients suffering from stroke.
Objective: The objective of this study is to evaluate the risk factors that may affect the hospital stay in stroke patients.
Materials and Methods: This study was conducted prospectively at Aga Khan University Hospital, Karachi where length of hospital stay among stroke patients were included. The length of hospital stay (LOS) was found and compared by dividing the included participants into subgroups including age (30-50 and 51-80), gender (male and female), diabetes mellitus type II (yes or no), hypertension (yes or no), duration of disease (</=2 or >2 days), smoking (yes or no), BMI, and type of stroke (ischemic or hemorrhagic).
Results: We included 94 stroke patients. The LOS in hospital was significantly associated with age (P=0.01), gender (0.01), diabetes mellitus type II (P=0.04), smoking (P=0.01), BMI (P=0.01) while it was not associated significantly with hypertension (P=0.09), duration of disease (P=0.05) and type of stroke (P=0.08).
Conclusion: LOS after stroke differed according to the sex, age, diabetes mellitus type II, and BMI. Hence, BMI and smoking are modifiable risk factors that could decrease the LOS while more efforts can be made to control blood sugars at optimum levels for further decreasing the LOS
The Impact of COVID-19 on Orthodontic Practitioners and their Practice in Pakistan
No full textBackground: The Coronavirus pandemic is an ongoing coronavirus disease epidemic that had a profound effect on the healthcare system. When the epidemic first spread widely in Pakistan in March 2020, many dental offices went on an emergency-only closure schedule. Changes were evident even after they reopened.
Objective: Primary objectives were to ascertain the consequences of COVID-19 pandemic on Orthodontic practitioners and their practice in Pakistan; how their psychological and financial well-being was affected, and to bring light to the perception of Orthodontists regarding the impact of the COVID-19 pandemic on future of Orthodontists. Secondary objectives were to see if there was any difference in impact between male and female participants and Orthodontic Consultants and Orthodontic Residents.
Materials and Methods: This cross-sectional study was conducted among the Orthodontic community of Pakistan. It included 183 participants which comprised 41 Orthodontists and 142 Orthodontic Residents. A self-administered online questionnaire (Google forms) was circulated. Chi-square test was used to compare qualitative variables. P value less than or equal to 0.05 was considered significant.
Results: This study showed that 80% of the participants stopped their Orthodontic practice during the lockdown period. The majority of the practitioners had a negative impact on their psychological well-being. A significant difference was noted between male and female professionals’ responses(p=0.021). Most of the residents reported having a negative impact on their training as well.
Conclusion: The need for more training programs for infection control cannot be emphasized enough to prevent all the adverse effects caused by such outbreaks
Factors Affecting the Implementation of Nursing Care Plans in Patient Care
No full textAbstract: Background: Nursing Care Plan (NCP) is used in practice as a systematic and scientific problem-solving method to determining the care needs of individuals. There is lack of research on factors affecting regarding utilization of nursing care plan in patient care.
Objective: The objective of this study were to evaluate the implementation of the nursing process and to determine the factors that may influence the implementation of the nursing process.
Materials and Methods: A cross-sectional survey was conducted at a private hospital during February to June, 2023. The study protocol was reviewed and approved. Permission from institutional heads was sought. Informed consent was obtained before data collection. Simple random sampling method was employed. The data were collected with structured questionnaires whose responses were rated on Likert scale. Data were coded and analyzed using SPSS v25.0.
Result: A total 108 nurses participated in the study. Study findings revealed 89% of the nurses were female nurses and 82% possessed diploma in nursing. The knowledge 50.5%, confidence 50.9% and willingness 54.2%, were at borderline good level. Whereas, assessment and diagnosis, planning, implementation, evaluation, and nurses’ views about nursing care planning implementation were at < 50% as poor. There was a moderate positive correlation between knowledge and implementation R-Value 0.312 and confidence and evaluation R-Value 0.246. Barrier to implement nursing process included uncooperative patients, lack of awareness about nursing process, lack of preparedness, low satisfaction level, lack of in-service training, lack of time, and high patient flow.
Conclusion: Study’s findings revealed knowledge, confidence and willingness of the nurses determine the use of nursing process in their nursing practice
Leadership Skills Development & Establishment of Multi-Disciplinary Team (MDT) Tumor Boards
No full textLeadership and managerial skills have long been identified in the developed countries as essential components of their post graduate trainees to enable them to meet the challenges of modern health care systems. However, health care systems in LMIC have their own challenges. Certain models such as public, public-private partnerships, private, welfare and insurance-based systems do exist in this part of the world, but comprehensive and efficient integration is still lacking.
Cancer patients depend largely upon public sector facilities already over-burdened by long waiting list
Risk Factors Associated with Conversion of Laparoscopic to Open Cholecystectomy
No full textAbstract: Background: Gallstones disease is one of the major problem of gastro intestinal tract and surgical removal is usually advised. Surgery is usually laparoscopic but if the dissection is tedious, laparoscopic procedure can be converted into open procedure.Objective: This study aims to assess the reasons and risk factors for the conversion of laparoscopic cholecystectomy (LC) into opencholecystectomy (OC).Materials and Methods: A prospective assessment of medical records of patients who underwent laparoscopic cholecystectomy at ward-2, Jinnah Postgraduate Medical Centre from January 2019 to December 2021 was undertaken to identify indications of all laparoscopic cholecystectomies converted to open cholecystectomy and assess operative time and length of hospital stay of these patients.Results: A total of 984 elective cholecystectomies were performed in which 85.5% (n=841) were females and 14.5% (n=143) were males. Male to female ratio was 1:5.8 with conversion rate 0.40 % (n=04) and 4.36% (n=43) respectively. Laparoscopic cholecystectomy was done in 95.22% (n=937) cases while 4.78% (n=47) patients required conversion to open cholecystectomy with major pre-operative risk factors being acute cholecystitis (p<0.001), history of acute cholecystitis (p=0.012), history of acute pancreatitis (p=0.007), history of previous open surgery (p<0.001) and major per-operative risk factors being severe bleeding (p<0.001), dense adhesions (p=0.755), distorted anatomy (p<0.001), visceral damage (p<0.001) and biliary injury(p<0.001).Conclusion: We have identified some important risk factors for the conversion of surgical approach for acute cholecystitis. However, the open approach should be done by experienced surgeons when necessary. The overall impact of the study is to identify the patients who are the risk of conversion into open preoperatively so that proper arrangement and counseling should be done
Cutaneous Epithelioid Angiomatous Nodule with Unusual Localization
No full textAbstract: Brenn and Fletcher described cutaneous epithelioid angiomatous nodule (CEAN) as a benign vascular proliferation that was in 2004. It is very rare condition. It is characterized by endothelial cells that have histiocytoid appearance. It is generally found in the dermis or sub cutis and rarely, in visceral organs. Despite the etiology of CEAN is not clear, it is considered as a reactive entity and no association with either infection, trauma or immunosuppression has been described yet. A 76-year-old woman visited hospital for routine examination. The physician noticed an erythematous nodule on the upper part of her right labium minus which appears like a cystic lesion. Histopathological examination revealed a relatively circumscribed, unencapsulated, unilobular vascular lesion which is in the superficial dermis. There were also moderately lymphoplasmacytic infiltration on the background. There were also scattered extravasated erytrocytes around. Positive stained for CD34, CD31 and negative stained for HHV-8 (performed to rule out a possibility of Kaposi sarcoma), pancytokeratin and s-100 were prominent in epithelioid cells. The overall histopathological appearance was consistent with CEAN and there was not any previous report CEAN occurring at this area
Role of 68Ga-PSMA PET/CT in Patients with Recurrent Prostate Cancer and its Comparison with Serum PSA Levels and Gleason Scores
No full textAbstract: Background: Biochemical recurrence is seen 27–53% in carcinoma prostate patient after treatment. GS (Gleason score) and
baseline PSA level are predictor of recurrence. Post treatment persistent rising PSA level represent the recurrence and PSMA labelled PET-CT
is important part of imaging workup in these patient.
Objective: To detect the relationship of PSA levels and Gleason score in patients investigated for Gallium-PSMA-11 fused molecular imaging
in biochemical recurrent carcinoma prostate.
Material & Methods: This cross-sectional study was carried out at S.I.U.T Karachi. PSMA-PET/CT scan (September 2017-January 2022) of
patient who had biochemical recurrence and not receiving any cancer specific treatment at least 4-week prior scan were included. PSA level
from lab reports and GS from histopathological report were recorded. Biochemical recurrence were defined as when PSA level > 0.4 ng/ml
(post prostatectomy) or >2.0 ng/ml higher than nadir value after radiotherapy. PET/CT scan of 106 included patients were interpreted by
nuclear physician and radiologist team. SUVmax ? 2.5 considered positive for recurrence. Local recurrences, lymph nodal, osseous and
visceral metastasis were documented. Statistical analysis was done by utilizing IBM SPSS software (version 22.0).
Results: In 88 of 106 patients (83%), Gallium-PSMA-11 PET/CT scan detected at least one lesion characteristic of recurrent PCa. The median
PSA level was 12.1 (.01-892.0) ng/dl. In relating PSA value, it was noted that there was significant difference between lesion positive and
negative PSMA-11 labelled Ga-68 PET/CT scan but not statically significant for GS. Local recurrences seen in 70 patients, whereas lymph
node and osseous metastases were noted in 64 and 52 scans respectively. A PSA value 0.68 ng/ml was determined by utilizing ROC curve and
with AUC of 0.924 (95% CI 0.86-0.98) and will likely predict the positive/negative PSMA-11 Gallium PET/CT scan.
Conclusion: Raised PSA level may predict possibility of positive Ga-PSMA-11 PET/CT scan but there was no relationship noted between GS
and Ga-PSMA-11 PET/CT findings
Association of Visceral Fat Index with Coronary Collateral Circulation in Patients with Coronary Artery Disease
No full textBackground: Coronary collateral circulation (CCC) is a network of anastomosing channels, established by heart in response to ischemia of myocardium. Hypertension, diabetes mellitus, and BMI are well established risk factors for development of poor CCC. Good CCC minimizes symptoms of angina, reduce the size of infarcts and prevent adverse cardiac events. The current research study was designed to find out the association of visceral adiposity and development of CCC among patients with coronary artery disease.Materials and Methods: The prospective study, conducted in Civil Hospital Karachi, comprised of 270 patients of coronary artery disease. According to the Rentrop Cohen categorization, patients were placed into two groups: the group with good collateral circulation having Rentrop grades i2-3 (n = 140) and the group with poor collateral circulation having Rentrop grades i0-1(n = 130). Rentrop score was determined by angiography. Segmental multi-frequency bioelectrical impedance analyzer was used to determine body fat mass and body muscle mass. Using Omron body fat and weight measurement systems, visceral fat index (VFI) was evaluated to determine the composition of visceral adipose tissue. SPSS was used for data analysis (Version 22). To assess the independent risk factor for poor CCC, logistic regression analysis was used. ROC curve was constructed to assess the efficacy of VFI in identifying CCC.Results: Overall, good collateral circulations were observed in 51.9% (n=140) of CAD patients, whereas poor collateral circulations were ound in 48.1% (n=130) of patients. Poor CCC was significantly associated with hypertension (OR=3, 95%CI= 0.111-8.231, p = .001) and VFI (OR=2, 95%CI= 1.451-3.567, p =.001). ROC analysis revealed a VFI > 9 to be a potential predictor of poor CCC with AUC=0.9, sensitivity of 95.00% and specificity of 86%.Conclusion: The current study concluded that greater VFI and concomitant hypertension considerably increase the likelihood of having poor CCC, therefore, visceral adiposity can be considered as a potential target for preventing poor collateral circulation in patients with established cardiac disease