National Journal of Health Sciences
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Intraoperative Hypotension: Immediate and Short Term Impact on Mortality. Findings from a High Dependency Cardiac and Vascular Surgical Center in Nigeria
No full textAbstract: Introduction: Intraoperative hypotension in cardiac surgery could be complicated by acute kidney injury (AKI), cardiac arrest and death due to poor organ perfusion. We studied intraoperative hypotension (IOH) and its immediate and short term relationship with post-operative mortality.
Materials & Methods: A retrospective study of participants, 16-86 years old who underwent cardiac and vascular surgery at Tristate Heart and Vascular Center, Ilishan-Remo, Nigeria, a high dependency cardiac and vascular surgical center between January 2015 and March 2021. Study participants were grouped into three cohorts and primary outcome was all-cause post-operative death.
Results: The records of four hundred and fifteen (258 males and 157 females) cohorts were studied, with mean age of 56.6 ± 5.4 years, 14.69% of the participants were 65 years or older. The surgeries were coronary artery bypass graft (CABG) alone (26.03%), CABG with valve surgery (38.31%) and, valves surgery alone (35.66%). The mean arterial pressure (MAP) pre-induction, and intra-operative and immediate post-op were 71.37 ± 14 09 mmHg, 68.6 ± 11.24 mmHg and 72.24 ± 33 mmHg respectively. The incidence of IOH was 86.30%, prevalence of background kidney dysfunction was 29.40% and incidence of AKI was 25.54%. Eleven (2.65%) participants died, all (100%) had IOH, 1 (9.09%) was intradialytic. The predictors of mortality were aging (aOR-4.23, 1.65-5.85), IOH (aOR-1.55, CI-0.34-1.96), background kidney disease (aOR-3.96, CI-1.43-4.78), comorbidity (aOR-2.77, CI-0.87-3.17), emergency surgery (aOR-4.62, CI-1.35-5.12), pre-induction MAP (aOR-4.22, CI-3.15-6.49) and, combined CABG and valve surgery (aOR-2.17, CI-1.69-4.57)).
Conclusion: Intraoperative hypotension commonly results from cardiac and vascular surgeries and could be complicated by AKI, cardiac arrest and death. The risk of these complications is increased by background kidney disease, comorbidities and episodes of IOH.Keywords: , , , , , 
An Interesting Acute Renal Failure Case which Developed in a Patient with Chronic Kidney Disease
No full textAbstract: Chronic Kidney Disease (CKD) is defined as a chronic and progressive deterioration in kidney functions such as, balancing fluid-solute equilibrium and metabolic-endocrine effects as a result of a decrease in glomerular filtration rate. In present case, we aimed to report an acute renal failure case in an elderly man with CKD. A sixty two year old man presented with dyspnea, leg swelling and loss of appetite for two weeks. He is diagnosed with acute exacerbation of CKD caused by infected diabetic foot ulcer. He responded well to antibiotic and diuretic treatment. Management of acute exacerbation of kidney failure in patients with CKD requires a systematic approach and elimination of underlying causes. Careful treatment usually results in restoration of kidney function to the pre-exacerbation stage
Differential Diagnostics of a Tonsillar Lymphoangiomatous Polyp
No full textAn overview of a rare clinical case of a tonsillar lymphoangiomatous polyp in a patient with a history of retinoblastoma. A sampleof tonsillar tissue was taken for histological review and appropriate stainings applied to establish the aetiology of the condition and exclude certain malignancies
Gamma Knife Radiosurgery - A Revolutionary Modality in the Treatment of Brain Tumors
No full textFor delivering highly accurate radiation therapy with pin-point accuracy to brain tumors, radiosurgery employing Gamma Knife Radiosurgery technique is a revolutionary new armamentarium that enables delivering focused intense beam of gamma rays to brain lesions. Neither employing an actual knife nor surgery, it is called “surgery” because the results are as good, even better, than actual surgeries
Workplace Violence against Nurses Working in Emergency Departments at Public Hospitals Lahore
No full textBackground: Work place violence is an alarming and devastating issue worldwide particularly in the emergency departments.Incident of work place violence is common towards nurses in health care settings. Nurses are more prone to workplace violence due to lack of respect towards nursing profession in Pakistani society and the nature of work performed by the nurses.Objective: The main purpose of this study was to assess the prevalence of work place violence including physical and non physical and bring awareness about work place violence among nurses at the emergency departments of health care systems.Methodology: A cross sectional descriptive survey was performed to assess the prevalence of work place violence at tertiary care hospitals of Lahore. A convenient sample of n = 147 was used to collect the data. A structured standardized adopted questionnaire was used to collect data. The questionnaire consisted demographic, physical and non physical variables. The data was collected from Jinnah and services hospital Lahore. The data was analyzed on SPSS version 21.Results: It was found that 77.55% stated that they are not exposed to physical violence last 12 months, 13.6% said once, 7.48% said 2-3 times and 1.3% stated they have been exposed 4-5 times during last year. On the other hand the participants exposed to Nonphysical violence in last 12 months,12.93% stated that they are not exposed to physical violence last 12 months, 25.85% said once, 40.82% said 2-3 times and 19.73% stated they have been exposed 4-5 times during last year.Most recent physical incident in which 10.20% of incidents were happened at resuscitation room 2.04% at waiting room and 10.20% in treatment room. The most recent nonphysical incident in which 38.10% of incidents were happened at resuscitation room 0.68% in triage 12.24% at waiting room and 37.41% in treatment room 0.68% in other places.Conclusion: The physical violence prevalence was found less that the nonphysical violence, but Physical violence is more threatening than the nonphysical violence
A Case of Long Standing Unusual Elbow Pain, Diagnosed as Glomus Tumor on Biopsy: A Case Report and Review of Literature
No full textExtradigital presentation of glomus tumors is not common. We are presenting the case report of glomus tumor around elbow andreview of literature with regard to its clinical presentation, work-up and management. We also want to highlight glomus tumor as the essential part of differential diagnosis into patients having atypical pain around elbow joint
Acute Myeloid Leukemia Transformed from Aplastic Anemia following Anti-thymocyte Globulin Therapy: A Case Report with Clinicopathologic and Molecular Findings
No full textAbstract: Aplastic Anemia (AA) incidence is threefold higher in Asia compared to the western world. It is associated with pancytopenia that is induced by impaired bone marrow function. Cytopenias of at least two lineages are required for the diagnosis. Symptoms include pallor, weakness, fever, frequent infections, bruises, petechiae, and mucosal bleeding. Bone Marrow Transplant (BMT) and immunosuppressive therapy are the treatment options. Patients with Severe Aplastic Anemia (SAA) are susceptible to developing malignancies like acute myeloid leukemia (AML) or Myelodysplastic Syndrome (MDS). In this report, we present a case of SAA who transformed to AML/MDS. 5 years of post- Anti-Thymocyte Globulin (ATG), she acquired monosomy 7, RUNX1 & SETBP1 gene mutations. RUNX1 and SETBP1 mutations are correlated with poor overall survival and are predicted to have a lack of response from hypo-methylating agents. As the aspect of somatic mutation is complex and still not fully understood, it should be cautiously analyzed along with morphologic and cytogenetic results
Red Cell Distribution Width and Mortality in Hemodialysis Patients: A Single Center Experience in COVID-19 Era
No full textAbstract: Introduction: Red Cell Distribution width (RDW) is found to be related with mortality in hemodialysis patients. In December 2019, a new corona virus spread was detected in China, which turned into a pandemia with significant mortality. Both RDW and chronic kidney disease were found to be related with mortality in COVID-19 patients. This study investigated if the association of RDW and mortality in hemodialysis patients still existed in the COVID-19 era.
Materials & Methods: This single center study included 117 hemodialysis patients. They were followed for 20 months (between December 2019 and July 2021) or until death. The relation of RDW with all-cause mortality and COVID-19 related deaths were studied.
Results: 21 (17.9%) out of 117 patients died during the follow-up. RDW was found to be an independent risk factor for all-cause mortality (HR:1.35, p=0.009). In post-hoc analyzes, RDW was significantly higher in non-COVID-19 related and cardiovascular deaths.
Conclusion: RDW was found to be an independent and powerful risk factor of all-cause and cardiovascular mortality even in the mortalCOVID-19 era
Hypopituitarism as a Rare Cause of Hyponatremia
No full textHypopituitarism is defined as pituitary hormone (or hormones) deficiency caused by dysfunction of pituitary gland and/orhypothalamus. Clinical findings and diagnostic procedure depend to the deficient pituitary hormone. The prognosis of patients with hypopituitarism is associated with presentation, age, the degree and severity of the hormonal disorder, and the response to medical and surgical treatment. In present case, we report a 78 years old woman that presented with hyponatremia, nausea and vomiting, whom consequently diagnosed with hypopituitarism and we discussed diagnostic procedure to establish the diagnosis. In sake of prevention of mortality, physicians should be aware of hypopituitarism in subjects with nausea, vomiting and electrolyte disturbances. Once the diagnosis established, replacement therapy should be initiated immediately
Nipah Virus- A Rapidly Emerging Zoonoses: A Mini Review
No full textNipah virus is one of the deadliest viruses of Paramyxoviridae family, of the order Mononegavirales. The virus is harbored byPteropus fruit bats and transmitted to pigs via partially eaten fruits or direct exposure to infectious bat secretions. Viral determinants that contribute to Nipah virus infection include V and W proteins where W protein plays a more prominent role. It is Known for causing severe and rapidly progressive encephalitis and thus classified among BSL-4 organisms due to its high mortality rate and lack of vaccines and drugs. Due to wide spread primary host the potential for outbreaks to occur in new regions remains significant and suggests a serious potential for larger epidemics in the future. Therefore proper management and preventive measures are needed to be implemented by health care workers, as well as at the government level