National Journal of Health Sciences
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Some Pertinent Solutions to the Challenges Faced by the Pakistani Healthcare Systems
No full textHealth systems worldwide face various challenges. Disparities are evident among different geographic locations. There are several hurdles in providing high-quality professional education, especially in low- and Lower-Middle-Income Countries (LMICs), including insufficient basic infrastructure and a shortage of professionally trained staff. This issue presents a particular risk in LMICs that are ill-equipped to deal with complex and expensive treatments [1, 2]. Although developing and enhancing educational programs to yield more healthcare professionals is constructive, these efforts need to be accompanied by educational structuring that will provide postgraduates with the necessary competencies [3]. It is not uncommon for the patients in LMICs with a potentially curable disease to receive sub-optimal treatment because of a lack of competencies and a caring attitude. This prompts some interesting challenges around the speciality training of postgraduates. In particular, what we are trying to achieve in modern oncology training programmes? Are current examination systems an effective test of knowledge, skills, and safety to practice? And, if so, are they sufficient to prepare for independent practice? Or should training programmes incorporate non-clinical skills related to issues? Interestingly, according to World Health Organization (W.H.O.), there are six elements or system building blocks of the health system that includes (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance [4]. We believe that these elements overlap with our proposal of inclusion of non-clinical leadership skills during their early years so that they are aware of the gaps and develop a mindset to improve the healthcare system by themselves.In this paper, we propose these five concepts to be inducted into our postgraduate training that will pave the way to improve our healthcare system
The Relationship between the Severity of Lumbar Spinal Stenosis and Levels of Vitamin D and Parathyroid Hormone
No full textBackground: It is known that parathyroid hormone (PTH) and vitamin D have a wide variety of effects on bone metabolism. However, the levels of PTH and vitamin D in patients with lumbar spinal stenosis (LSS) have not been adequately investigated in the literature.
Objective: The objective of this study was to investigate the relationship between PTH and vitamin D levels and the severity of stenosis in patients with LSS.
Materials and Methods: This retrospective observational study included consecutive patients who presented to the Neurosurgery outpatient clinic with chronic leg pain and low back pain and were diagnosed with LSS between January 2019 and July 2022. Patients were categorized into three groups based on their vitamin D and parathyroid hormone status. Group 1: High parathyroid hormone and Low vitamin D levels; Group 2: Normal parathyroid hormone and low vitamin D levels; Group 3: Normal parathyroid hormone and vitamin D levels. There were 17 (37%), 10(22%), and 19(41%) subjects in groups I, II, and III, respectively.
Results: The mean age of the groups with a total of 46 patients I, II and III were 62.2±11, 58.3±6, and 63.2±6.4 years, respectively (p=0.553). Sex of the study groups was not statistically different, either (p=0.079). Spinal canal AP diameter (p=0.002) and ligamentous interfacet distance (p=0.008) were significantly different in study groups. Vitamin D positively correlated with Spinal canal AP diameter (r=0.56, p<0.001) and ligamentous interfacet distance (r=0.51, p=0.003), while PTH was inversely correlated with them (r=-0.33, p=0.020), ( r=-0.47, p=0.007) .
Conclusion: Vitamin D is significantly correlated with the diameters of spinal canal AP and ligamentous interfacet distance. PTH is negatively correlated with the diameters of spinal canal AP and ligamentous interfacet distance
Measuring Emotional Intelligence in First Year Medical Students
No full textAbstract: Background: The term emotional intelligence is being used more often in the medical field and different healthcare-related fields. The evaluation of emotional intelligence is crucial in assessing how well students adjust and perform academically. Neglecting this stage of life can result in psychiatric issues or make them worse, as well as failure in social and academic situations.Objectives: To evaluate first-year medical students' emotional intelligence (EI) and determine how it relates to their social and personal characteristics.Materials and Methods: This cross-sectional study included 166 first-year medical students and took place at University College of Medicine and Dentistry between September and December 2022. Ethical approval was obtained from the ERB committee before the study was conducted. A proforma was used to collect social and demographic information, while an emotional quotient self-assessment checklist was used to assess participants' emotional intelligence, rated on a five-point Likert scale. The collected data was then subjected to statistical analysis.Results: Out of 166 students approached in the first year class, 149 (79 females and 70 males) participated in the study with an average age of 19.12 ± 0.69 years. Results showed that 33.6% of the first-year medical students scored below the 20 cutoff in all emotional intelligence domains. Those who reported making a conscious career choice, getting adequate sleep, and engaging in more social and physical activity than average had higher emotional intelligence scores (p=0.05). Additionally, females had significantly higher emotional intelligence scores compared to males (p=0.02). A positive correlation was observed among the various emotional intelligence domains.Conclusion: Good emotional intelligence comprises the capacity to comprehend and regulate emotions, to be empathic, to be emotionally aware, and so on. These traits enhance general communication abilities, which enhance performance in the medical training
Platelet Rich Plasma Effects on Diabetic Foot Ulcers - A Review
No full textAbstract: Utilizing platelet rich plasma, one of the newest autologous cellular therapies, as an adjuvant therapy in a regenerative medicine management, can be very beneficial. Patients with complications like osteoarthritis, spinal disorders and musculoskeletal problems still facing global lacking in the area of tissue repair strategies. Along with this another major complication associated is with diabetic patients - the development of diabetic foot ulcers that predisposes to limb amputation. To advance the healing process and prevent the patients from progressing towards amputations. Besides many other approaches used. Platelet Rich Plasma (PRP) therapy is attaining momentum, which is composed of platelet growth factors that assist the wound healing cascade – inflammation, proliferation and remodeling. It may occur because of provision of vital growth factors necessary for healing. Currently, variety of PRP formulations have been assessed. The article intends to evaluate the PRP effectiveness for managing diabetic ulcers
Osteoporosis and Osteopenia – A Rising Healthcare Problem
No full textWith Asia housing 75% of humanity, and the proportion of seniors rapidly climbing from 5.3% in 2015 to 9.3% by 2025, Osteoporosis is rapidly becoming a growing medical ailment in this part of the world too [1].In Pakistan, though clear data on occurrence of hip fractures (osteoporotic) annually is not established, large ultrasound studies suggest that there may be more than 9 million people (7 million women, 2 million men) afflicted with Osteoporosis. It is expected that these estimates may very well cross 12 million by the year 2050 – becoming a major health burden. Low per capita income and high hospital costs further derail the earning capacity.Estimations indicate the population to cross 340 million by the year 2050, and of these 14.9% (50 million) will be over the age 60 years. A five year study from one hospital revealed a 2:1 female to male ratio of hip fracture cases, with 61 years being the average age of patients having osteoporotic fracture. This average age is lower than that reported in North America and Europe but matches data from India. Another study revealed 16% and 34% occurrence of osteoporosis and osteopenia respectively in females of age group 45 to 70 using ultrasound technique. Another study from KPK province estimated the numbers at 29 and 42% respectively. 75% of postmenopausal women from Peshawar seemed to be at risk of osteoporosis on a clinical risk score analysis [2-7]
Coronavirus – Do We Know Enough?
No full textCoronavirus 2019 (COVID-19), previously called as 2019-nCoV, was emerged from Wuhan, China in December 2019. It is causedby Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). By 22 March 2020, 323,265 people were infected from this virus, including 13,745 deaths globally. It is declared as pandemic by World Health Organization as it involved 185 countries of the world. World Health Organization also declared it as 6th public health emergency of international concern. COVID-19 presents as various outcomes; asymptomatic (carrier), pneumonia and acute respiratory disease. People of all ages can be affected from this virus but adult population is observed to be involved in high ratio. Additionally, there is possibility that infection can be spread as nosocomial infection to patients and healthcare workers. On chest imaging, ground – glass opacity with bilateral involvement is seen as most common abnormality in patients with pneumonia. Older patients are prone to develop more severe disease as compared to young population. Patients with underlying chronic co-morbidities are also more prone to develop poor outcome. Till now, specific treatment of COVID-19 is not available; however clinical trials are under investigation to see the clinical efficacy of various therapeutic agents in China e.g. remdesivir and chloroquine etc. At this time, standard infection control measures are only possible means for prevention of SARS-CoV-2
Does Late Axial Spondyloarthropathy Diagnosis Cause Extra Anti-TNF Therapy?
No full textIntroduction: Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease that mainly characterized by sacroiliacjoint and spine involvement. Although there is no clear evidence that any of these agent prevent the radiologic progression, anti-TNF drugs provide significant improvements in the disease activity score, functional index and quality of life.In AS patients, knowledge of the factors that determine the need for anti-TNF treatment will be associated with fewer complication sand better treatment. The purpose of this study is to investigate the possible factors which willmark the transition to the anti-TNF therapy in AS patients.Materials and Methods: This study was conducted in the Rheumatology division of the Internal medicine department of the Ondokuz MayisUniversity of Medicine hospital between January 2012- June 2015. The study protocol was approved by the Ethics Committee of OndokuzMayis University. A total of 165 patients, who were diagnosed as AS according to the ASAS classification criteria, were enrolled in this study.There were 85 women (51.5%) and 80 men (48.5%), aged between 15-69. Patients were divided into two groups according to their use ofanti-TNF drug.Results: A total of 165 Ax-SpA patients (85 women and 80 men) were included in the study. The mean age was 37.82±11.24 years. The meanduration of the disease was 4.59±5.35 years. male gender, uveitis, delay in diagnosis, elevations in sedimentation CRP levels, increase indisease activity and functional indexes such as BASDAI and BASFI scores shows the more frequent need for anti-TNF drug use.Conclusion: In our study, patients who needed anti-TNF treatment had a longer time between symptom onset and diagnosis than patients whodid not hear. The delay in diagnosing these patients leads to a delay in treatment so that the focus of inflammation increases and these patientsneed more anti-TNF as this window of opportunity escapes
Protective Effect of Nigella Sativa on Taurocholate Induced Pancreatitis in Rats
No full textIntroduction: Acute necrotizing pancreatitis with a high mortality rate and the search for treatment continues. We investigated theprotective effect of Nigella Sativa (NS), with antioxidant and anti-inflammatory effects, in experimental acute necrotizing pancreatitis.Materials and Methods: Thirty six male Wistar albino rats (weights 180-220 g) were randomised into four groups. Group 1 (Control): Ratswere given standard mouse chow. No pro-drug or pancreatic intervention was performed. Group 2 (NS): In addition to their standard diet, ratswere given 0.1 ml/100gr of NS orally for 3 days prior to the experiment. Group 3: Necrotizing pancreatitis was induced by retrogradeadministration of 3% Na-Taurocholate through the distal common bile duct of the rats on on experiment day. Group 4 (NS+ANP): Necrotizingpancreatitis was also formed in rats receiving 0.1ml/100 mg of NS for 3 days. Rats were given high-dose anesthesia 8 hours after the onset ofpancreatitis. Immunohistochemical (TNF-a, MDA, MPO, Caspase), histological pancreatitis scoring and biochemical (LDH, Lipase, amylase)analyzes were performed from the blood and pancreatic tissue samples obtained.Results: There was no difference in histopathological, immunohistochemical and biochemical values between Group 1 and Group 2 (p>0.05).There were significiant differences between Group 4 and Group 3 in terms of histopathological, immunohistochemical and biochemicalparameters (p<0.001). The pancreatitis findings of the Group 4 were found to be significantly milder than Group 3, which did not receive NS.Conclusion: NS pretreatment alleviates NaTaurocholate-induced experimental pancreatitis. NS firstly studied in experimental models ofpancreatitis
Bedsores Incidence in ICU Patients: A Tertiary Care Experience
No full textIntroduction: The aim of this study was to see the incidence of bedsores in our hospital and determine relating factors.Material and Methods: This cross sectional study was performed on 71 consecutive ICU admissions at Ziauddin hospital ICU from March to May 2015. Data was analyzed on SPSS version 16 by independent sample t-test and chi square test. In 71 patients, 12 developed bedsores, of which seven were males and five were females. Available data in Performa included: demographics, functional class, comorbidities, category(surgical, medical or trauma patient), primary cause of ICU admission, total day of ICU stay, total period of mechanical ventilation, requirement of dialysis, albumen level and if bedsore developed than its details and grade.Result: In this study, 71 patients were admitted in ICU; 40 patients, which is 56.33%, were male and 31 patients, which is 43.66%, were female. Twelve patients that are 16.90% were affected with bedsores of which seven were males and five were females and this was found to be statistically significant. The mean age of patients with bedsores was 66.75 years ± 18.29 as compared to 52.42 years ± 18.20 in group with no bedsore development. Total mechanical ventilation required in the group that developed bedsore was 4 days ± 1.67 to group with no bedsore development, which was 2.36 days ± 1.21.The patients who developed bedsore had serum albumen levels 2.54 ± 0.26 and group that did not develop bedsore had albumen levels 3.14 ± 0.77 and the result was found to be statistically significant.Duration of Study: From June 2017 to June 2018.Conclusion: Development of bedsore was found to be statistically significant to the poor functional class, high mean age, total hospital stay, mean mechanical ventilation and low level of albumin