National Journal of Health Sciences
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Total Laryngectomy in Advanced Papillary Thyroid Cancer Infiltrating into Larynx: A Case Report & review of Literature
No full textAbstract: Among differentiated thyroid cancer (DTC), papillary thyroid cancer (PTC) is the most commonly encountered histological type.
Patients with papillary thyroid carcinoma (PTC) show an excellent prognosis. Infiltration of PTC into the larynx is very rare and can worsen
the disease prognosis. We are reporting one such rare case in which PTC showed invasion in the larynx causing narrowing of the airway. We
performed total thyroidectomy with total laryngectomy and neck dissection
Drug-Drug Interaction between Non-Steroidal Anti-Inflammatory and Angiotensin Receptor Blocker
No full textAbstract: In pharmacotherapy, factors such as mode of administration, dose, and contraindications play a significant part in determining the optimal pharmacotherapeutic strategy. A drug's ability to influence the safety or efficacy of another drug (drug-drug interaction) is another factor to consider when choosing the best pharmacotherapy [1]. When multiple medications are prescribed at the same time, they may interact [2]. Drug-drug interactions (DDIs) can have a variety of outcomes, and adverse DDIs might result in patient death or drug withdrawal. Drug interactions can alter the pharmacokinetics and/or pharmacodynamics of a drug which may leads to therapeutic failure or any adverse drug event. Co-administration of naproxen with losartan will decrease the action of losartan which is an anti-hypertensive agent leads to uncontrolled hypertension. NSAIDs inhibit prostaglandin thus antagonise effect of converting enzyme inhibitors. Losartan is angiotensin receptor blocker, whose natriuretic effects decreased by naproxen
Frequency of Nucleophosmin1 Gene Mutation (NPM1) in Acute Myeloid Leukemia - A Single Center Experience
No full textIntroduction: NPM1 mutation is considered to be an important event in the process of leukemogenesisas it affects the p53 tumorsuppressor pathway in the form of frame shift mutation. It is thought to provide a favorable outcome to the disease especially in the absence of FLT3 mutation.This study was conducted to find out the frequency of NPM1 mutations in patients with AML in Pakistani population.Materials & Methods: This was a descriptive cross sectional study conducted for a time period at the National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi. Study subjects’ demographics including age, gender, presence and duration of the symptoms. Diagnosis was made on the morphology of blood and/or bone marrow samples in accordance to the revised WHO classification of myeloid neoplasms, 2016. All the patients were treatment naive at the time ofenrollment into the study. Sanger sequencing was performed to detect NPM1 mutation.Results: Out of 100 patients who were enrolled in the study, 60% were males. The mean age of patients was 38.9 years (range: 8yrs - 60yrs). NPM1mutation was detected in 14(14%) patients of the total AML cases with equal presence in both genders. According to the WHO classification 2016, NPM1 was found in 3(3%) in AML without maturation, 4(4%) in AML with maturation, 3(3%) in acute promyelocytic leukemia and 3(3%) in acute myelomonocytic leukemia.Conclusion: NPM1 was detected in 14% cases of AML in our study. The presence of the NPM1 mutationhas a considerable impact on the prognosis of the disease as it may help in the tailoring of the future treatment of the AML patients particularly those with normal cytogenetics
Disturbances in Serum Electrolytes in Type 2 Diabetes Mellitus
No full textIntroduction: Diabetes mellitus is a multi-factorial disease having widespread effect on various functions of body. Electrolyteimbalance is a major problem presenting in diabetic patients due to direct effect of hyperglycemia on these electrolytes.Objective: The aim of this study is to evaluate the electrolyte imbalance in patients with diabetes mellitus type 2.Methods: It is a prospective study, conducted at Department of Pathology, Indus Medical College. Tando Muhammad Khan between the periods of January 2018 to March 2018. A total of 290 patients were included in this study. Group A contains 140 known diabetic patients and Group B contains 150 normal healthy individuals. Blood samples of all patients were evaluated for HbA1c, serum sodium (Na), potassium (K) and chloride (Cl).Results: A total of 290 patients were included in the study. Male to female ratio was higher in both diabetic and control groups. Hemoglobin A1C (HbA1c) was found to be higher in diabetic patients as compared to normal healthy individuals with statistically significant difference (p< 0.001). Sodium (Na) was found to be low in diabetic group as compared to normal healthy individuals with statistically significant difference (p = 0.02). Potassium (K) and chloride (Cl) did not show any difference in diabetic group and normal healthy individuals.Conclusion: Diabetes mellitus has wide diversity of effects on major functions and cellular events. Electrolyte imbalance is a major problem in diabetic patients as disturbs the distribution of cells across the cellular compartments
Diagnostic Accuracy of Recognition of Stroke in Emergency Room Score in Patients with Ischemic Stroke
No full textObjective: To determine the diagnostic accuracy of ROSIER scale in patients with ischemic stroke taking non-enhanced CT scanbrain as gold standard.Materials and Methods: Cross-sectional study conducted at tertiary care hospital in Gujrat from October 2019 to December 2020. Patients ofboth sex groups aged 30- 75 years presented in emergency within 24 hours of onset of focal neurological deficit which is objectively presentand suspected of ischemic stroke. 289 patients were included. Patient history and neurological examination done calculating ROSIER scale andischemic stroke diagnosed after CT scan brain done 24 hours after onset of symptoms. Sensitivity, specificity, PPV, NPV and diagnosticaccuracy of ROSIER scale were calculated. Data analysis was done using SPSS 20.0.Results: In this study group 141(48.8%) were male while 148(51.2%) were female. Mean age was 62.1+11.02 years. 49(17%) patients wereaged <50 years while 240(83%) were aged >50 years. 215(74.4%) presented within 12 hours while 74(25.6%) after 12 hours of symptomsonset. Sensitivity of ROSIER scale for diagnosing ischemic stroke was 98.86%(95%CI;95.96%-99.86%), specificity5.31%(95%CI;1.97%-11.20%), PPV 61.92%(95% CI;60.82%-63.01%) and NPV was 75%(95%CI;38.13%-93.59%). LR+ was 1.04(95%CI;1.00-1.09) while LR- was 0.21(95%CI; 0.04-1.04).Conclusion: ROSIER score can be used as initial screening test in patients with stroke. It has high sensitivity but low specificity and is a goodtest to rule in and rule out stroke patients
Sweat Gland Tumors – A Systematic Review on the Histopathology and Immunohistochemistry
No full textObjective: The categorization of sweat gland tumors has been inconsistent over time. These tumors, having varying potential formalignancy, may behave as indolent neoplasms while others can be highly metastatic. The characteristics of most of these tumors areoverlapping and the information of distinctive findings about these neoplasms is imperative. Traditionally, sweat gland tumors were classifiedas eccrine and apocrine only but recently, this has been found that several sweat gland tumors may exhibit eccrine and apocrine types both.Some tumors exhibit further complex features due to the existence of other differential appearances. This can be in the instance of apocrineneoplasms because of the close embryological link between apocrine glands, hair follicles and sebaceous glands and they can be classified asfollicular and/or sebaceous tumors. Cutaneous adnexal neoplasms are a diagnostic challenge, especially for tumors with sweat glanddifferentiation, due to a huge number of uncommon entities, designation of different terms to the identical tumor following to disagreementabout the taxonomy and nomenclature of such tumors. This review article provides updated information about various cancerous sweat glandneoplasms with emphasis on recent conclusions for the diagnosis and generalized therapy of such neoplasms
Postpartum Acquired Hemophilia (PAH) – A Rare Entity
No full textObjective: Acquired Hemophilia A (AHA) is a rare autoimmune disease that can result in life threatening bleeding. Formation ofauto-antibodies (inhibitors) against coagulation factor VIII develops the hemorrhagic syndrome that may appear at any age; however,prevalence of AHA is chiefly observed in post-partum and elderly persons. Idiopathic acquired hemophilia is commonest type of acquiredhemophilia whereas it is also associated with autoimmune disease, malignant neoplasm, medication and vaccinations. Post-partum acquiredhemophilia (PAH) may develop due to development of antibodies against fetal FVIII. In this case report, 36-year-old Asian woman presentedwith complain of bruises from 2 months. There was history of cesarean section four months ago. Family history, past medical and drug historywere not significant. As there was no active bleeding, patient was started an oral prednisolone along with azathioprine and was counseledregarding disease and precautions. Patient presented after 2 weeks with severe PV bleed, anemia secondary to self-induced medicine abortion.For this she receives pack cells and cryoprecipitate. Steroids and azathioprine were continued and patient was discharged in stable condition.Her ultrasound pelvis however showed small fibroids. Patient went back to her village where she again develops severe PV bleed and for thatshe underwent hysterectomy. Patient presented in our hospital with severe operative site bleeding, pain and anemia. She was managed withPacked Red Blood (PRBCs), Fresh Frozen Plasma (FFP), Recombinant Activated Clotting Factor VII (rFVIIa), prednisolone IV andazathioprine PO. Her Activated Partial Thromboplastin, Hemoglobin were continuously monitored. After a week bleeding was stopped butActivated Partial Thromboplastin Time (APTT) was still prolonged so we tapered rFVIIa dose and advice two sessions of plasmapheresis.APTT, hemoglobin levels, inhibitor titer, High-Sensitivity C - reactive protein (hs-CRP) levels were improved. Patient was discharged in astable condition and was advised to continue medication at home with supportive care and wound dressing
Anti Campylobacter Activity of Extracts of Daphne Mucronata and Symplocos Racemosa Against Avian Isolates
No full textAbstract: Bacterial gastroenteritis mainly caused by Campylobacter sp. is a major health concern in Pakistan. In order to investigate the primary sources of Campylobacter infection, total 81 cloacal swab samples were collected from different avian species in Karachi. Campylobacter strains were isolated, identified and antibiotic susceptibility pattern was studied. All isolates of Campylobacter were sensitive to Gentamicin and Ofloxacin. It was observed that 23% of the C. jejuni positive isolates were resilient to tetracycline, 45% to ampicillin, and 12% to erythromycin. The Campylobacter isolates showed susceptibility to the extracts of two plants namely Daphne Mucronata and Symplocos racemosa. The sensitivity of the isolates towards these extracts can be an alternative to the traditional antibiotics for the treatment of Campylobacter infections. 
Pharmacovigilance – A Medication Safety Perspective
No full textThe aim of pharmacovigilance (PV) is to evaluate the risk of adverse events of medication being administered to patients keeping in mind that no medication is completely safe [1]. Goal of therapeutics is to improve patient quality of life with minimizing risk and harmful effects associated with it. Medication safety is the process which optimizes the use of medicines and prevents from harm. Medicines are generally safe but as chemical in nature and xenobiotics to living organism are associated with unknown and known risk. Previously, drug safety issues were not discussed galanty due to false adversity consideration [2], but with time and awareness this has changed with highlighting the importance and necessity of pharmacovigilance. WHO classifies pharmacovigilance as the science and process that is associated with detection, assessment, understanding and prevention of adverse effects or any other drug related problem [3]. Moreover, we should consider that the medications to be administered to patient must be assessed by the science of pharmacovigilance. It is the activity that majorly involve monitoring the effect of any medication during its life cycle starting from manufacturing to the patient’s use [4]