National Journal of Health Sciences
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From Global Warming to Global “Boiling” – UN Secretary General
No full textThe steady increase in average global temperatures, both on land and sea, coupled with an increasing frequency of extreme weather events is not only endangering ecosystems but now even threatening plants and animal species. Shrinking glaciers, dry spells, heat waves and forest fires compounded by ever increasing greenhouse gases synergistically escalate the problem.A 0.1°, 0.5°, 1.5° or 2°C rise in temperature may have profound effects. A half a degree or even a few tenths of a degree change may have a dramatic impact – causing dire water shortages, flooding and heat waves. Polar ice caps and coral reefs may be severely impacted by even a 0.5° C rise [1].The Intergovernmental Panel on Climate Change (IPCC) report states that unparalleled climate changes caused by human activity has increased the planet’s temperature by 1.1°C [1]
A Case Report of Spinal Cord Edema and Cervical Spondylosis Masquerading as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
No full textA 64-year-old previously-healthy male presented with 2-year history of progressive neurological symptoms of numbness and muscleweakness involving all 4 limbs. There was gait disturbance, urinary and fecal incontinence. On examination, the left upper limb had normaltone, diminished deep tendon reflexes and power of 4/5 with wasting both in proximal and distal muscles. There were reduced pinprick pain andtemperature sensations below the elbow bilaterally with intact vibration and proprioception. Both lower limbs had increased tone, diminisheddeep tendon reflexes, power of 3/5 with wasting both in proximal and distal muscles with unequivocal plantar reflex bilaterally. There werereduced pinprick pain and temperature sensations below the knee on right and below the ankle on left with intact vibration and proprioception.Nerve Conduction Studies (NCS) were done which showed axonal type of denervation in all limbs. MRI scan of Cervical Spine showed T2Whyperintense signals and narrowing of spinal canal from C3 to C7 region. The final diagnosis was spinal cord edema in the cervical region andcervical spondylosis causing spinal cord compression
Nephrotic Syndrome Secondary to Primary Membranoproliferative Glomerulonephritis in a 27 Years Old Nigerian Male
No full textAbstract: Membranoproliferative glomerulonephritis (MPGN) is not a common cause of nephrotic syndrome (NS) in adults unlike in children. It is commonly steroid-resistant in adults unlike in children. Tissue diagnosis needed for effective management could be unavailable due to cost, particularly in resource poor settings. Patient was examined, had urine analysis, serum biochemistry assay, kidney scan and a kidney biopsy for histological diagnosis.
The patient had generalized oedema, with ascites, elevated blood pressure (156/90 mmHg) and massive proteinuria (4.6 g/day). The haemogram showed haematocrit of 32%, with absolute lymphocytosis (72%). Fasting lipids showed hypercholesterolemia (533 mg/dl), elevated LDL (274 mg/dl), low HDL (27 mg/dl) and hypertriglyceridemia (302 mg/dl). Ultrasound showed enlarged kidneys. Histological findings were mesangial hypercellularity, double-contour formation along the glomerular capillary wall (tram track appearance) and endocapillary proliferation. He was managed with intravenous methylprednisolone, (followed by gradually reducing oral doses), frusemide, atorvastatin, antibiotics and had daily weighing. He responded well to treatment. He was counselled on good compliance and has been on follow-up visits. His clinical and laboratory parameters have been normal.
Nephrotic syndrome from MPGN should be looked out for in adults presenting with NS and their treatment with steroids could be very beneficial
Management of Malignancy Associated Superior Vena Cava Syndrome in the Emergency Department
No full textAbstract: Objective: The objective of this article was to do a review of the available literature on Malignancy associated Superior Vena Cava Syndrome (SVCS), and provide a quick effective guide on the latest approaches on management of patients presenting in the Emergency Room with SVCS.Methods: Multiple documents were identified which were published with regards to SVCS, Emergency Management of SCVS and case reports. All the papers were studied and latest diagnostic methods and management protocols were identified and extrapolated from the literature.Results: Of approximately 30 papers shortlisted that were written on SVCS, newer ways of identifying and managing SVCS is the ER (specifically) were collected and presented. Newer therapies i.e. External Beam Radiation Therapy via Photons in the Emergency setting, Multidisciplinary approach to Malignancy associated SVCS were discussed along with traditional symptoms relief measures.Conclusion: Both adults and children who present with the signs and symptoms of SVCS in the emergency room require extra care and multidisciplinary management
Current Trends Regarding Perioperative Pharmacological Anticoagulation in Lower Limb Surgeries among Orthopedic Surgeons of Pakistan- A Critical Survey
No full textAbstract: Perioperative anticoagulation has been recommended by AAOS, AACP, and ASH during orthopedic procedures of the lower limb.
Guidelines show a difference of opinion regarding the optimum duration and drug of choice giving a way to use different methods of
anticoagulation. This survey assessed the differences in preferences for pharmacological anticoagulation in lower limb surgeries among
orthopedic surgeons of Pakistan.
Materials & Methods: Orthopedic surgeons (n=632) were invited to fill in the questionnaires. A total of 85 orthopedic surgeons responded
completely. An electronic eight-question survey was designed which included questions about demographics of surgeons, the drug of choice,
perioperative duration, preferred surgeries, and average incidence of thromboembolism per year.
Results: 12.9% surgeons use anticoagulation for all surgeries while 82.3% of orthopedic surgeons use anticoagulants in selective surgeries.
LMWH (94.1%) and Rivaroxaban (17.6%) were the drug of choice for most surgeons. 70.6% of respondents never used anticoagulation
preoperatively. 17.7% used it three days preoperatively. 28.24% of surgeons prescribed anticoagulation for 3 days postoperatively while 17.7%
of surgeons prescribed anticoagulation for 2 weeks postoperatively. 10.6% of surgeons never used anticoagulation postoperatively.
Arthroplasty (71.7%), trauma (55.3%), and pelvis and acetabulum (54.1%) were the subspecialties with routine anticoagulation. 81.2% and
17.7% of surgeons reported less than 1% and 1% to 3% incidence of thromboembolism, respectively. No surgeon reported any incidence of
thromboembolism above 5%.
Conclusion: Use of anticoagulation is prevalent among orthopedic surgeons in Pakistan. However, significant differences are observed
regarding the perioperative duration. The surgeons need to prescribe DOAC such as Rivaroxaban and Dabigatran as agents of choice while
extended postoperative pharmacological anticoagulation of 28-35 days needs to be adopted
Experience of Physical Examination as a Primary Tool for Surgical Access Planning in Hemodialysis Patients
No full textBackground: Understanding the importance of pre-operative assessment is something nephrologists are probing for years to avoid any post-operative complication and AVF failure.Objective: To assess the physical examination as primary tool as compared to Ultrasound Doppler in assessment of AVF planning in hemodialysis patients.Materials and Methods: This was a Retrospective, Cross-sectional study. Secondary data was collected from the Urology Department of Liquate University of Medical and health sciences, Jamshoro starting from October 2021 to October 2022. For physical examination, both the arterial and venous circulation were evaluated. Arterial patency, pulse amplitude and Allen’s test were recorded. After collection of data, statistical Package for Social Science (SPSS) version 17. 0 statistical software was used for analysis.Results: A total of 105 participants with mean age of 42.9 ± 13.9 years, 78 (74.3%) males and 27 (25.7%) females were included. The physical examination findings indicated facial swelling as the most frequently reported sign in with 59 (56.2%) of patients, followed by generalized body edema reported in 22 (21%) of participants. The estimated analysis of Allen’s test indicated good results with a mean of 12.4 ± 2.8 seconds in all patients, indicating good blood flow of the ulnar artery. The mean duration of hemodialysis was 55.2 ± 23.4 days before AVF, while central venous line duration was 57.2 ± 20.5 days. After 6 days fistula maturation was assessed, while mean fistula maturation duration was 44 ± 7.1 days.Conclusion: To monitor functioning, the Physical Examination of vascular access is convenient, straightforward, and cost-effective. Physical examination (PE) has been validated with diagnostic techniques for detecting stenosis
Giant Lipoma of Unusual Regions: A Case Series of Two Unfortunate Adults
No full textLipomas are prevalent, benign, asymptomatic mesenchymal tumors that can develop in various areas where adipose tissue is present. However, when lipomas reach sizes larger than 10 cm in width or exceed 1 kilogram in weight, they are classified as giant lipomas [1-3]. These oversized lipomas can lead to functional restrictions, aesthetic concerns, and compression-related injuries, all of which can negatively impact an individual’s quality of life. They are usually surgically removed to avoid injury to major neurovascular structures; however, they have a predisposition for recurrence and the risk of malignancy following surgery. This case series discusses the clinical findings and surgical treatment of two patients who had enormous, deformable, fatty tumors of buttocks and thigh, respectively
Different Covid-19 Vaccines in Pakistan: Administration and Effectiveness
No full textPfizer-BioNTech, Moderna, Sputnik V (typically manufactured in Russia), CoronaVac (China), Sinopharm (China), Vaxzevria, and Cansino (both made in China) are among the vaccines that have been certified for emergency use in several countries. All of the above vaccinations were authorized to Pakistan, bypassing Pfizer and Moderna. The effectiveness, safety, mechanism of action, dosage, and availability of mandatory vaccines in Pakistan up to May 20, 2021. We searched PubMed and Google Scholar for all known material on COVID-19 vaccinations. We also looked at grey literature papers. Instead of Pfizer and Moderna, Pakistan has approved all the preceding vaccines. Moderna and Pfizer were determined to be the most effective among all vaccinations, with 90% effectiveness, followed by Vaxzevria, Sputnik V, Sinopharm, and Cansino. All immunizations have caused lesser bad effects like fever, injection site pain, or headaches. Further clinical studies are being done throughout the world to combat the epidemic. In large populations, public attention plays a critical role in vaccination efforts
Minimal Invasive Plate Osteosynthesis for Distal Tibia Fractures
No full textAbstract: Background: Distal tibia fractures, challenging for surgeons due to unique anatomy, often result from high-energy trauma. Traditional treatments like ORIF entail significant soft tissue dissection. MIPO, a promising alternative, lacks sufficient empirical support for treating distal tibia fractures, warranting further study.
Materials and Methods: This Prospective case series study was conducted on 36 consecutive patients of either sex having age range of 18 and above seen between May 2017 and December 2020 at the Department of Orthopedic and Trauma, Government Lady Reading Hospital Medical Teaching Institute, Peshawar. The Effectiveness of the MIPO was assessed radiographically and functionally. Healing in bone as seen in three cortices out of four is called radiographic healing and pain free full weight bearing is called functional healing.
Result: A total of 36 individuals were investigated for this investigation. 27 men and 9 women, or a 75% to 25% gender split. The patients ranged in age from 18 to 60, with an average age of 36.36. The standard deviation of 13.749 indicates that the patients’ ages varied, but the results were usually reliable. Thirteen (36.1%) of the instances were falls, whereas 23 (63.9%) of the cases involved high-velocity trauma such automobile collisions. The AO/OTA categorization system allowed for the identification of several fracture forms. Type A fractures were recorded in 17 instances (47.25%) of all reported fractures. Type B fractures were found in 13 cases (36.15%), while Type C fractures were documented in 6 cases (16.7%). Of the patients who got treatment, thirty (83.3%) experienced no complications at all. Six patients experience rare problems. It’s noteworthy that conservative approaches were used to solve every one of these problems.
Conclusion: MIPO is a safe and effective treatment option for distal tibia fractures, providing adequate fracture reduction and favorable functional results. Because there is less soft tissue injury, patients heal more quickly and have fewer complications
A Case of Celiac Disease Admitted to Our Clinic with Symptoms of Malabsorption
No full textAbstract: Celiac disease is an immune-mediated chronic intestinal disease that causes atrophy of the intestinal mucosa by ingestion of gluten and related proteins in genetically susceptible individuals. Presentation of the illness can differ from a severe malabsorption to mild symptomatic and even asymptomatic. The only treatment for celiac disease is to follow a strict gluten-free diet for life and it is not a cure. A 37-year-old female patient was followed up with the diagnoses of irritable bowel syndrome and dyspepsia applied to our outpatient clinic with severe malabsorption symptoms. She was diagnosed as celiac disease. Celiac disease should be questioned in all patients presenting with dyspeptic complaints. With a simple treatment, the quality of life increases significantly