National Journal of Health Sciences
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The Impact of COVID-19 Pandemic in Pakistan
No full textObjective: COVID-19 is a public health international emergency. The objective is to gain the understanding on how this virusaffects the human body and what were the risk factors affecting the morbidity and mortality.Materials and Methods: The data was collected from Chaudhry Muhammad Akram research and teaching hospital. The data was collectedfrom the patient notes and the Performa’s were filled. The population for study were in the age range of 30 to 70 years and both males andfemales were included. The pregnant women were not included in this study. The notes of patients were taken from the year 2021.Results: This retrospective study included hospitalized patients. The total patients included in this study were fifty. The symptoms studied werefatigue, fever, cough and shortness of breath. All the patients admitted complained of fatigue (100%). 21(42%) patients had fever. 23 patient(46%) complained of cough and 21(42%) had shortness of breath. The male admitted were 31 (62%) and females were 19. (38%) There were3 patients (6%) admitted in the age ranging from 30-40 years, ten (20%) were 41-50 years, sixteen(32%) were 51-60 years old and twentyone(42%) were 61-70 years old. 40 (80%) patients completely recovered, 2 (4%)patients were referred to other hospital because of lack ofrequired facilities. Twenty patients (40%) admitted had existing medical problem. Eight patients (16%) who were on ventilators had comorbidities like hypertension, diabetes, and obesity died. There were two women and six men who died.Conclusion: Our study concluded having any comorbidity increased the risk of hospital fatality with COVID-19. The data suggested that moremales were admitted as compared to females. The fatality was more in male compared to females. Male sex can be identified as a risk factorfor death. Most of patients belonged to group 51-70 years age. The survival rate in our study was 80%
Association between Diabetes Mellitus and Periodontal Diseases
No full textObjective: Diabetes mellitus (DM) is a serious health burden and its frequency is increasing worldwide. Several complications arerelated with diabetes mellitus and now periodontal disease (PD) is also considered as DM-related problem. A 2-way association between DMand PDs has been reported. The purpose of this article is to deliver the knowledge relating to the association between DM and PDs. Severalresearches have been published over the past 50 years in this regard yet more research is obligatory so as to elucidate the two-way relationshiptrait between DM and PDs
Assessing Resilience in Healthcare setups of Karachi using Connor Davidson Resilience Scale
No full textAbstract: Background: Healthcare sector of Pakistan is complex and changing rapidly. This complex and transforming phase create more hurdles for employees especially for healthcare managers. During this transition phase, healthcare managers are burdened with more uncertainties and adversities. Managing under these circumstances is not an easy task as this requires frequent adaptations. One of the most important traits that can aid in these adaptations is resilience, which is ignored in healthcare management.Objective: The first and main objective of the study is to assess the extent to which the healthcare managers are resilient. Secondly, to compare the resilience of public and private sector healthcare managers. At last, to assess the impact of gender, income and other demographic variables like age, socioeconomic status, marital status, education, designation, and work experience etc.Materials and Methods: It was a cross sectional study conducted at 13 different leading healthcare institutes of Karachi. These hospitals and healthcare services were divided broadly according to public and private sector categories. Employees were asked to complete structured questionnaire, a 25 item Connor Davidson Resilience Scale (CD-RISC) and demographic characteristics. Data were collected from 438 healthcare managers working at tertiary care hospitals in Karachi.Results: Health managers at both sectors were found resilient, with mean score of public sector and private sector were 52.55 (SD± 15.05), and 50.74 (SD± 14.15) respectively although the relationship was found insignificant relationship. Income, experience, designation, and worksite variables were significantly associated with resilience while age, gender, working hours, marital & socioeconomic status were insignificant.Conclusion: In conclusion, the healthcare managers working in both public and private sector were found resilient. There was no significant difference found in resilience of male and female healthcare managers. In addition demographic variables like age, marital status, socioeconomic status, and working hours showed no significant relationship with resilience while designation, income, working experience, and worksite variables showed significant relationship with resilience
Psoriasis and its Variants
No full textAbstract: Background: Psoriasis is a chronic, immune-mediated, inflammatory illness of the skin which is quite common. The typical lesions are well demarcated, flaky and erythematous plaques that are frequently observed on the extensor regions. Psoriasis causes vasodilatation and hyper proliferation of keratinocytes expressed as thickened and erythematous skin, generally covered with silver gray scales. Although the etiology of this disease is not very clear, yet there may be genetic and environmental implications. There are a number of variants of psoriasis which include palm plantar, pustular, erythrodermic, and guttate types. Psoriasis is related to several systemic impediments and coexisting illnesses rendering a great effect on patients. Psoriasis displays coexistence of both autoimmune and auto inflammatory reactions and the stability between the two is important for clinical and histopathological demonstration. Chronic plaque psoriasis shows adaptive immune responses whereas pustular psoriasis displays innate and auto inflammatory responses. Histopathological analysis is the main diagnostic tool for atypical and controversial situations which aids in discerning psoriasis from other dermatoses; biopsy is seldom required for typical psoriasis
Optimal Gestational Weight Gain Based on Different Body Mass Index and its Relation with Adverse Pregnancy Outcome in a Tertiary Care Hospital
No full textAbstract: Introduction: Maternal and neonatal complications have been linked to pre-pregnancy Body Mass Index (BMI) and gestational weight gain. Controlling of BMI and weight gain during pregnancy is desirable in order to optimize the maternal and perinatal outcomes. The aim of this study is to determine gestational weight gain in different BMI groups and its relation with pregnancy outcomes.Methods: This observational study was performed on 370 reproductive age women with singleton pregnancy from January 2015 to December 2016 at Hamdard University Hospital, Karachi. BMI and total GWG were calculated and patients were followed to see pregnancy outcomes. Data was analysed by using SPSS 21.Results: Out of 370 participants, 8(2.2%) were underweight, 119(32.2%) were healthy, 126(34.1%) were overweight and 86(23.2%) were obese and 31(8.4%) were very obese. Overweight and obese multiparous women gained weight more than IOM recommendations. Adverse pregnancy outcomes like GDM 124(33.5%), PIH 69(18.6%), Pre-eclampsia 9(2.4%), placental abruption 14(3.8%), cesarean section 214(57.8%), postoperative wound infection 54(14.6%), macrosomia 27(7.3%), low Apgar score 112(30.3%) and NICU admissions 174(47%) were noted in overweight and obese women with excessive GWG. We interestingly, noted adverse pregnancy outcomes in women with upper limit of normal BMI and GWG ranges.Conclusion: Implementing optimal BMI and GWG helps to avoid adverse pregnancy outcomes. Asians especially Pakistani women need local BMI and GWG recommendations to have better pregnancy outcomes
A Severe Hypokalemia Case Due to Ectopic Acth Syndrome Secondary to Small Cell Lung Cancer
No full textEctopic adrenocorticotropic hormone (ACTH) syndrome is responsible about 15% of Cushing syndrome cases. Malignant tumors,such as, small cell lung cancer, gastric or bronchial carcinoids, pheochromacytoma, medullary thyroid cancer, are principle causes of ectopic ACTH secretion. Syndrome manifest with impaired glucose tolerance or overt diabetes, hypertension, hypokalemia and lipid disorders. Here we report a subject presented with severe hypokalemia due to ectopic ACTH syndrome, who was diagnosed with small cell lung cancer consequently.A sixty five year old man presented with severe hypokalemia. He was diagnosed with small cell lung cancer. Serum ACTH and cortisol levels of the subject were extremely high. Although chemotherapy initiated, he died due to respiratory failure. Radiologic studies should be ordered to rule out underlying tumoral developments in patients presenting with delirium and hypokalemia. Moreover, hyperglycemia in elderly without prior history of diabetes mellitus should be evaluated for malignant lesions and ectopic release of ACTH
Sero Prevalence of Brucellosis in Pregnant Women Visiting Gynaecology Department of Kathmandu Model Hospital, Kathmandu, Nepal
No full textIntroduction: Brucellosis is a highly contagious zoonotic disease caused by ingestion of unpasteurized milk or undercooked meatfrom infected animals or close contact with their secretions.Subject and Methods: Sero-prevalence of brucellosis in pregnant women was conducted for the first time in Kathmandu, Nepal. A total of 80 sera samples were collected from the pregnant women visiting Kathmandu Model Hospital. The patients were categorized on the basis of age, trimester and ethnic groups. The sera samples were tested by ELISA method.Results: The sero-prevalence of brucellosis among pregnant women was found to be 11.25%. Madhesi ethnic group showed the highest (16.66%) seropositivity rates followed by Janajati (11.53%) and the lowest was in Brahmin (8.33%) ethnic group. Similarly, the age group 31-35 years showed highest prevalence (29.41%) followed by the age group 26-30 years (13.33%). There is absence of seropositivity among the age group 16-20 years and 21-25 years. The highest sero-prevalence rate (12.76%) was found in the third trimester followed by first trimester (10%) and the lowest was in second trimester (8.69%). About 3% of them consume raw milk directly from milking animals which is one of the risk factor of brucellosis in pregnant women.Conclusion: The prevalence was found to be high in pregnant women and ELISA was a sensitive and specific test for the detection of IgG antibodies against Brucella
Acid Base Imbalance in Dialysis: Risk Factors and Impact on Intradialysis Blood Pressure Changes. Findings from a Single Center Prospective Study in Nigeria
No full textAbstract: Introduction: Despite improvements in hemodialysis delivery, acid base imbalance is still common in the dialysis population and it is associated with intradialysis blood pressure changes, dialysis termination, inadequacy and poor treatment outcome. We studied acid base imbalance in maintenance hemodialysis, its determinants and relationship with intradialysis blood pressure changes.
Materials & Methods: A prospective study carried out at Babcock University Teaching Hospital, Ilishan-Remo between May 2019 and April 2021 that involved 298 participants who had 1642 hemodialysis sessions.
Results: The mean age was 51.44 + 7.31 years, with the females been older than males, P=0.04. The mean predialysis and post dialysis serum bicarbonate were 18.41 ± 3.63 mmol/l and 20.61 ± 6.26 mmol/l (P<0.001). The prevalence of pre and post dialysis metabolic acidosis were 79.0% and 38.3% (P<0.001) and of intradialysis hypotension and hypertension were 19.1% and 25.0% (P=0.02). The risk of intradialysis hypotension was negatively correlated with predialysis bicarbonate while intradialysis hypertension was positively correlated with predialysis bicarbonate. The mean dialysis dose was higher in males (P=0.03). Metabolic acidosis was commoner in elderly and females, and was associated with intradialysis hypotension, dialysis termination and inadequacy. Aging and infrequent dialysis, predicted metabolic acidosis.
Conclusion: Metabolic acidosis is common in maintenance hemodialysis, particularly in females, aged and infrequent dialysis, and leads to intradialysis hypotension, dialysis termination, inadequacy and poor treatment outcome
Role of the Gut Microbiome in the Pathophysiology and Treatment of Type 2 Diabetes Mellitus: A Mini Review
No full textAbstract: Introduction: Diabetes mellitus type 2 is a chronic metabolic condition characterized by insulin resistance along with inadequate circulating insulin in the blood. It has been observed that the changes in the complex habitat composed of trillions of bacteria can cause metabolic disturbances. Previous studies have explained the phenomenon of dysbiosis which leads to the development and progression of diabetes mellitus type 2. It has been reported that there are altered gut microbiota levels present in patients with type 2 diabetes mellitus. Main Body: Gut microbiota and its metabolites are involved in the pathogenesis of multiple metabolic diseases including type 2 diabetes mellitus therefore, intestinal microbiota may be one of the crucial medicinal targets for the disease. Studies have shown that diabetes can be managed effectively by altering the human gut microbiome. This review presents three therapeutic options which can be used to alter the gut microbiome. The therapeutic options are; fecal microbial transplant, use of probiotics and cinnamon. These interventions have proven to increase richness and diversity of gut microbiota. A vast number of studies support the beneficial effects of probiotics in treating type 2 diabetesdue to its oxidative stress inhibiting properties. Cinnamon has shown similar benefits owing to its anti-inflammatory and anti-oxidative nature. An adequate number of animal studies and few human studies have reported improvement in insulin sensitivity in fecal microbial transplant recipients.Conclusion: Consumption of probiotics and cinnamon have shown potential benefits in the treatment and prevention of type 2 diabetes mellitus. Fecal microbiota transplant has been shown to improve insulin sensitivity along with other impaired characteristics for example HbA1c found in diabetics. It can be suggested that microbiota-based interventions can be used for the prevention and treatment of type 2 diabetes mellitus. Further studies are necessary to explore the mechanisms by which these treatment options provide potential beneficial effects in T2DM patient
