National Journal of Health Sciences
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Anti-NMDA Receptor Encephalitis: A Rare but Important Auto-Immune Cause of Encephalitis
No full textAbstract: A previously healthy 30-year old lady presented with 1-day history of high grade fever and drowsiness. Five days prior to
presentation, she developed insomnia and visual hallucinations of seeing unknown faces. Three days prior to presentation, she suffered from 5
episodes of generalized tonic colonic fits. On admission, she had a temperature of 102oF and GCS of 10/15 with no signs of meningeal
irritation, no focal neurological deficit, normal deep tendon reflexes and down-going plantar reflex bilaterally. Her brain MRI scan showed
mild hyper-intense signals in right cerebellum. Her CSF was tested for Anti-NMDA receptor antibodies which were positive. She was
diagnosed as having Anti-NMDA Receptor Encephalitis and started on immediate Plasma Exchange with drastic improvement
Assessment of Segmental Hepatic Fat Distribution using Magnetic Resonance Proton Density Fat Fraction MR-PDFF in Non-alcoholic Fatty Liver Disease (NAFLD)
No full textBackground: Non-Alcoholic Fatty Liver Disease (NAFLD) is a significant healthcare challenge. MR proton density fat fraction (MR-PDFF) is a quantitative imaging parameter that allows a precise estimation of hepatic steatosis. Determination of segmental and lobar fat distribution is also important since underestimation or overestimation may lead to hurdles in patient management and may also alter outcomes during liver donor assessment for living donor liver transplant.Objective: To determine the heterogeneity of hepatic fat distribution across different liver segments and both lobes in patients with non-alcoholic fatty liver disease (NAFLD).Materials and Methods: This cross-sectional descriptive study included 35 patients of NAFLD. MR-PDFF sequence was performed, two regions of interest (ROI) were drawn at the periphery of each hepatic segment and their mean was taken. We calculated mean values, ranges, and standard deviations for individual segments, both lobes and the entire liver. Pearson’s correlation was used to assess the relation between MR-PDFF and MR-PDFF variability. Paired sample t-test was utilized to compare the means of the right and the left lobe of the liver.Results: The fat fraction in segment I was the lowest and in segment VII the highest. The right and left lobes showed a significant difference in fat fraction with values of 14% and 11.4% respectively (paired sample t-test, p<0.005). The left lobe showed a greater MR-PDFF variability than the right lobe (1.9 vs 1.6%).Conclusion: In patients with NAFLD, segments VII and VIII show the greatest while segments I and IV show the least fat infiltration. Hepatic fat preferentially gets deposited more in the right lobe of the liver
A Photographic Assessment of Smile by Modifying Crown Height, Width and Angulation of Maxillary Lateral Incisor among Orthodontic Patients of Karachi, Pakistan
No full textAbstract: Background: Smile aesthetics vary culturally, influenced by media and the Golden Proportion in dental beauty. Challenges arise with missing lateral incisors, treated through composite build-up or canine substitution, highlighting the importance of crown dimensions and the need for clinician expertise in personalized treatments.
Objectives: The objective of the study is to evaluate the influence of altering height, width and angulation of maxillary lateral incisors on the perception of smile.
Materials and Methods: This cross-sectional study was conducted at OPD of Jinnah Medical and Dental College, Karachi from January 2020 to June 2020, on 120 orthodontic patients (44 males and 76 females) aged between 15 and 35 years. Photoshopped photographs of an ideal smile were shown to the participants. In an ideal smile photo, the width of lateral incisor was 62% of the width of maxillary central incisors. The pictures showed to the participants had modifications in terms of crown heights, width and angulation of only maxillary lateral incisor without doing any changes to the other maxillary teeth. The responses of the participants were graded on the basis of perception of attractiveness.
Result: Mean score for height, width and angulation changes were obtained. The highest score by males was given to lateral incisor whose length was increased by 1mm (6.87±2.21) and in females; the highest score was given to lateral incisor which is modified by adding 0.5 mm increment (6.98±1.05). Both males and females preferred narrow lateral incisors as esthetically attractive. The mean highest scores for the decrease in width given by males were 6.52±2.52 and 6.8±2.217 by females, respectively. Both males (6.37±2.18) and females (6.64±1.81) preferred 10 degrees of mesial angulation of lateral incisor as more esthetically pleasing. Changes in distal angulation of more than 5 degrees are considered unattractive by both genders. Mean values were 6.04±2.15 for males and 6.00±1.99 for females.
Conclusion: In conclusion females are more concerned to the change in height, while in terms of width both genders preferred narrower maxillary lateral incisors over wider ones. Both genders perceived a 10 degree mesially angulated lateral incisor as more attractive
Diagnostic Accuracy of NIHSS Score in Predicting in-Hospital Mortality in Patients of Ischemic Stroke taking Actual in-Hospital Mortality as Gold Standard
No full textAbstract: Objective: To determine the diagnostic accuracy of NIHSS score for predicting in-hospital mortality among patients of ischemic stroke taking in-hospital mortality as gold standard.Material & Methods: The present cross-sectional study was carried out from May 2020 to November 2020 at Medicine Department, Services Institute of Medical Sciences Lahore. A total of 142 patients aged 30-70 years of both sex with ischemic stroke patients as per-operational definition of duration ?24 hours were enrolled. Patients of hemorrhagic stroke, cardiac disease and CRF were excluded. After taking informed consent, NIHSS score was evaluated in each patient and in hospital mortality will be noted. All patients were followed by the researcher herself and in hospital mortality was noted.Results: Mean age was 53.5+9.2 years with74 (52.11%) females. Mean disease duration was 6.8+1.7 hours and mean NIHSS score was 24.3+7.1. NIHSS score was evaluated in each patient and found 75 True Positive while 06 False Positive. In the 61 NIHSS score negative patients, in-hospital mortality was seen in 06 (False Negative) while 55 (True Negative) did not have in-hospital mortality (p-value <0.001). The Specificity, Sensitivity, Negative Predictive Value (NPV), Positive Predictive Value (PPV) and diagnostic accuracy of NIHSS score to predict in-hospital mortality among patients of ischemic stroke taking in-hospital mortality as gold standard was 92.59%, 90.16%, 92.59%, 90.16% and 91.55% respectively.Conclusion: Diagnostic accuracy of NIHSS score in predicting in-hospital mortality in ischemic stroke patients is quite high
Dialysis Termination and Dialysis Dose in Severe Intra-Dialytic Hypotension Managed with Inotropic Support in a Low Income Setting
No full textBackground: Intradialytic Hypotension (IDH) still remains a major complication and burden, and is associated with inadequate dose, poor quality of life, increased morbidity and mortality. Inotropic support could minimize dialysis termination and improve the dialysis dose.Objective: To determine the impact of inotropic support on the incidence of dialysis termination (a common finding in resource limited settings), and the dialysis dose.Materials and Methods: This retrospective, observational study compared the dialysis outcome in severe IDH with, and without dopamine treatment..Results: The 36 participants had 518 sessions with IDH, of this, 405 (78.19%) were without dopamine while 113 (21.81%), with severe IDH, were managed with dopamine. The mean ages of participants in the two groups were not significantly different, P=0.05. The risk of severe IDH was negatively related to the predialysis systolic blood pressure (SBP) P=0.03 while the postdialysis. Blood pressure was higher in dopamine treated sessions (DTSs). The blood flow rate (BFR) and dialysis dose were higher in the DTSs (P=0.05) and (P=0.04), but the dialysis dose was lower with anemia (P<0.001), metabolic acidosis (P<0.001), heart failure (0.04) and diabetes (P=0.04). In DTSs, females were more likely to have lower dialysis doses, (P=0.02). Independent associates of inadequate dialysis dose were infrequent dialysis sessions, infrequent erythropoietin doses, metabolic acidosis and anemia.Conclusion: Managing severe intradialytic hypotension with low dose dopamine is associated with reduced frequency of dialysis termination and augmentation of the dialysis dose. Reductions in the intradialytic BP gradients could minimize the complications associated with wide intradialytic BP variations
The Experiences of Smokers Admitted to a Smoking Cessation Center in Samsun Regarding their Addiction: A Qualitative Study
No full textAbstract: Background: Primary care physicians have a vital opportunity to help their patients quit smoking. They need to provide an individualized approach to them while in the cessation process in order to help them understand.
Objective: The aim of this study is to investigate the individualized interacting factors and principles of starting, maintaining, quitting, and relapse of tobacco addiction among smokers.
Materials and Methods: This qualitative research performed between March and December 2015 involved 331 smokers who had applied to the Ondokuz Mayis University, Medical Faculty Family Medicine Cessation Clinic, Türkiye. In the first meeting, a workshop (lasting approximately 1 hour) was held for all the participants (31) and recorded. In this workshop the participants discussed how they started smoking and why they wanted to quit. They reported examples of successful quitting with which they were familiar, together with any precautions they took in order to protect themselves and the people around them. Every workshop was decoded and analyzed by the researchers.
Result: One hundred nineteen (35.7%) of the participants were women, and the mean age of the study group was 37.75 ± 12.41 years. Most of the participants (n=280, 85%) began smoking under the age of 18, with a close friend providing the cigarettes in the majority of cases (n=212, 64%). The main motivation differed between younger and older participants. In order to protect themselves, participants used external tar filters, smoked ‘light’ cigarettes, and refrained from smoking after eating or before sleeping. They also tended to smoke in the kitchen or on the balcony to protect other household members from their smoke. In addition, the participants increased their physical activity levels, requested more laboratory or screening tests from their physicians, and consumed healthier diets (honey, vitamin pills, and water).
Conclusion: The addiction dynamics of cigarette addicts differ very widely
Factors Influencing Level of Anxiety and Pain in Patients’ Receiving Endodontic Treatment
No full textAbstract: Background: Dental anxiety is a vicious cycle in which avoidance of dental care, poor oral health, and psychosocial consequences are prevalent. It might be a significant impediment to receiving prompt dental care until absolutely required.
Objectives: To evaluate the level of dental anxiety and pain in patients receiving root canal treatment and to identify factors that might increase anxiety levels.
Materials and Methods: This was a cross-sectional study conducted at Fatima Jinnah Dental College Hospital, Karachi, Pakistan from the period of August-December 2022. The study included participants who scheduled their first appointment for endodontic treatment during this period. Participants were included between the ages of 18 and 60, those who provided verbal consent. The sample size of 100 cases were calculated through power analysis at a 95% confidence interval. Data was analyzed by using SPSS version 20 software. P-value <0.05 was considered significant.
Result: According to the Modified dental anxiety scale, the average score was 12.7±4.53, which is considered to be a moderate anxiety. The Pearson correlation of mean anxiety score showed statistically significantly results such as gender (p<0.001), age (p<0.001), level of education (p=0.015), employment (p=0.029), ethnicity (p=0.009) and level of pain (p=0.008). The study showed a lower pain threshold among female patients than males with a statistically significant result (p=0.008).
Conclusion: The incidence of dental anxiety among study participants ranged from mild to moderate. Women, young patients, and those with less education were more concerned than their male counterparts. Patients who need urgent root canal therapy more commonly experience dental pain and anxiety
Assessment of Depression, Anxiety, and Stress among Health Care Professionals due to Covid - 19
No full textAbstract: Background: The emergence of an undisclosed pneumonia outbreak in Wuhan, China, in December 2019 led to the global spread of Corona virus Disease (COVID-19), declared a pandemic by the WHO on March 12, 2020. Healthcare workers (HCPs) faced unprecedented challenges, with studies revealing elevated stress, depression, and anxiety. Despite differing roles, direct health care providers reported higher psychological distress. The absence of a definitive treatment compounded fears, resulting in anxiety, depression, and stress among patients, Healthcare professionals and normal subject.
Objective: To identify the level of anxiety, depression, and stress among health care professionals due to the wave of Covid- 19.
Materials and Methods: Analytical cross-sectional survey was done among health care workers who were working in a tertiary care hospitals, Sohail Trust Hospital Korangi Industrial Area, Karachi, and Medicare Cardiac and Dental Hospital, Tariq Road, Karachi from January 2022 to April 2022 in the third wave of Covid-19. The Depression, Anxiety, and Stress Scale-21 Items (DASS-21) self reporting scale based questionnaire was used to examine mental health. During data analysis, descriptive and inferential statistics were calculated in SPSS.
Result: Out of 416 participants, 56% were females and 56.2% were single. The mean age of the respondents was 29.36 years (± 5.5). The symptoms of anxiety were reported by 47%, depression by 35% and stress was reported by 21% of participants. The level of anxiety, depression, and stress was higher in male technicians, frontline workers, HCP with chronic illnesses, and those who got covid-19 infection. Based on the results, it was identified that male had higher odds of developing anxiety while female, HCPs belonging to age groups of above 25 years and those with work experience lesser than 5 years showed to have greater odds of having stress.
Conclusion: COVID-19 has caused Anxiety, Depression, and Stress among Pakistani healthcare workers. Early intervention with focused strategies and psychological therapies could help to prevent more serious problems
Complete Labial Fusion in a Post Menarche Adolescent Girl
No full textAbstract: Labial fusion is commonly seen in pre-pubertal girls but is rarely reported in adolescent females after menarche. Its main
cause is low estrogen levels. A patient can be completely asymptomatic and self-limiting or present with a wide range of symptoms
which can vary from urinary tract infection, urine retention, incontinence, dyspareunia, etc. We present a case of a 12-year-old
female who presented in our department with a complaint of difficulty in voiding and lower urinary tract symptoms. After a detailed
examination, she was diagnosed with labial fusion for which adhesiolysis was done and patient remained asymptomatic after it