National Journal of Health Sciences
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Onco-Fertility Tumor Board is Vitally Important for Addressing Fertility Issues in Cancer Patients
No full textSome cancers and some cancer treatments can lead to temporary or permanent infertility. Infertility is a special issue which need to be considered and addressed in cancer patients who may face this issue due to their malignancy itself or due to the treatment offered to them. Our team had reviewed contemporary literature and came to the opinion that it is vitally important to establish a specialized board of experts who can have regular board meetings in which all selected cases of cancer patients are discussed who can potentially suffer from some form of temporary or permanent infertility. The relationship between infertility and cancer is being documented in various studies and systemic reviews published lately [1, 2]. Counselling of patients and their next of kin is also an important aspect of this proposed multi-disciplinary team (MDT) Board .Before making any consideration regarding the relevance of the issue of infertility in selected cases of cancer the multidisciplinary team has to develop robust processes in order to make sure that we will not be missing this important problem which our cancer patients may face at the time of diagnosis, treatment or later on as a late sequela of oncological treatment. Practice committee on onco-fertility consortium made clear recommendations highlighting the importance of expert team involvement. The proposals are being published in January 2021 issue of Journal of assisted reproduction [3]. This document provides a valuable insight regarding the establishment healthcare quality processes and their practical implications
Prevention and Management of Blood Disorders Under Shariah Guidance
No full textAbstract: Objective: The purpose of writing this article is to convince the Muslim communities worldwide - the second largest religious entity of the world - to adopt modern medical steps, which provide safety and care. Methods and Discussion: Irrespective of their education, Muslims are highly influenced by Islam. They never consider science equal to their religion; therefore, in Muslim countries it is very difficult for any government, authority or institution to enforce norms in the respective medical sector through acts or ordinances. Instead, the canon source of Shariah can communicate this message easily. The masses practice theirdaily affairs as per Shariah as they believe that Shariah is the fountain of divine wisdom. Providing Muslim religious sources in this research paper is purely to communicate a scientific study under the guidance of Shariah to the community worldwide. Conclusion: It is hoped that numerous Muslims would take advantage from it. The Ulama [Muslim clergy] and Madrasahs [Seminaries] have a pivotal role in influencing health education and its promotion amongst members of the Muslim community. They can provide potential access to people for raising, understanding and encouraging the use of health services as well as ethnic blood donor drives
Effects of Chemotherapy in Breast Cancer Patients
No full textAbstract: Introduction: A descriptive, non-interventional study was conducted from April 2011 to September 2013, at KIRAN hospital, Karachi among n = 811 female breast cancer patients to assess the effects of chemotherapeutic agents that were employed for the treatment of breast cancer. The assessment was done so as to see the variation in response of the patients towards the drugs used specifically the adverse effects that have to be combated during therapy. Methodology: During 3-6 months, a follow up was done to collect data for ADEs (Adverse Drug Events) that occurred among patients after therapy. The SPSS version 16.0 was used for statistical analysis of the data. The adverse events that occurred due to adjuvant chemotherapyincluding severity, preventability and causality were evaluated using three International scales i.e. Modified Schumock and Thornton scale, modified Hartwig’s and Siegal’s scale and Naranjo’s algorithm. Results and Discussion: Majority of the patients received 6 cycles of FAC therapy (5-fluorouracil, Adriamycin/doxorubicin, cyclophosphamide) and showed good response. The assessment of ADRs using different scales revealed hair loss, nausea, vomiting, anemia and neutropenia as the non-preventable definite effects that were experienced by the patients. Mild to moderate diarrhea/constipation was probably preventable and hence doubtful. Moderately probable effects included mucositis and mouth ulcers whereas possible effects included fever andchills. Conclusion: Through the right use of medicines, the mild effect of headache and pain could be certainly preventable. Hence chemotherapeutic agents must be chosen for each patient on individual basis to prevent or lessen the toxic effects rendered to them and be useful in the disease course
Comparison of Open Gastrostomy and Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients, Tertiary Care Hospital Experience
No full textAbstract: Objective: The current study was conducted to review and compare PEG and Gastrostomy in terms of early complications in head and neck cancer patients.Materials and Methods: This was prospective comparative study recruited total 60 patients as per the inclusion criteria, 30 in each group. Patients were assigned to the groups based on the surgeon’s choice. Ethical clearance was taken from ethical review board. Informed consent was taken from patients before enrolling them into the study. Non-probability consecutive sampling technique was used to enroll study participants. Data was collected on pre-designed performa and analyzed using SPSS version 16.Setting: Section of Otolaryngology, Department of Surgery, Aga Khan University Hospital Karachi.Results: The two groups did not differ on basis of age, gender and tumor site. The outcomes variables including pain and bleeding from post-operative day1 to day 5 were significantly lower in patients who underwent PEG placement as compared to patients whom we performed OPEN gastrostomy. None the patient had peristomal infection in PEG group throughout the study. However, difference between the groups was statistically significant from post-operative day 3 to day 5.Conclusion: In our study, PEG was associated with lesser complications than open gastrostomy. Recently clinicians are using newer modalities like radiological and laparoscopic gastrostomy at various centres in Pakistan as the first option for placing feeding gastrostomy.Therefore, future studies are warranted to compare their efficacy and post-operative complications PEG
Comparative Study of Outcome of Simple Decompression Versus Anterior Transposition of Ulnar Nerve in the Treatment of Cubital Tunnel Syndrome
No full textAbstract: Background: Cubital tunnel syndrome (CuTS) is the second most common entrapment neuropathy in the upper limb, after the entrapment of the median nerve in the carpal tunnel. Different techniques of nerve decompression have been described, however, the idyllic surgical treatment and technique for CuTS remain controversial. Objective: Our aim is to compare the outcome of simple decompression with anterior subcutaneous transposition of ulnar nerve in the treatment of CuTS. Methods: The study included 20 patients that were surgically treated in the Neurosurgery department at Gamal Abdel Nasser Hospital - General Authority for Health Insurance between August 2014 and February 2015. These patients were randomly distributed into two equal groups, each consisting of 10 cases. In the first group, only simple decompression was performed while in the second group, anterior subcutaneous transposition was supplemented. All cases were followed for at least 6 months. Results: Seventy percent of the patients were females and the mean age was 45.35 ± 14.62. The duration of symptoms before surgery variedfrom 4 months to 2 years. Occupational repetitive elbow flexion and extension was the most common contributing factor. Seven out of ten patients, in the simple decompression group, showed clinical and electrophysiological improvement at 6 months interval. While in the second group, only six patients showed improvement 6 months after surgery. The difference was found to be statistically insignificant. There was no significant effect of the duration of symptoms or co-morbidities on the outcome.Conclusion: Long term follow up revealed no significant difference between simple decompression and anterior subcutaneous transposition. Simple decompression of the ulnar nerve, in our experience, is an effective and less invasive technique for patients with cubital tunnel syndrome
High PATI Score is Associated with Increase Mortality in Patients with Penetrating Abdominal Injuries; A Retrospective Review
No full textABSTRACT: Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. In literature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trauma index) as a more accurate method of quantifying the extent of damage in patients with the penetrating abdominal trauma and association of high PATI score (>25) with mortality. Objective: To determine the association of mortality in patient with penetrating abdominal trauma with high PATI score (more than 25). Methods and Design: Medical records of all adult patients (age more than 16 years of age) admitted at Aga Khan University and Hospital with penetrating abdominal injuries from 2006 - 2012 were reviewed retrospectively; adult patients with complete medical records were included and patients with missing data were excluded from the study. SPSS version 19 was used for data entering and statistical analysis. Results: We included 74 patients, mostly men (95.9%), with a mean age of 34.4 +/- 11.9 years. Gunshot injuries accounted in 63 patients. Majority of the patients (31.1%) presented with grade 2 shock. Emergency laparotomies were done in 62 patients, 4 patients underwent damage control laparotomies. Seven patients were treated conservatively. Most commonly injured intraabdominal organ was small bowel (31%). Mean injury severity score was 12.97, mean revised trauma score was 7.63, andmean TRISS was 96.19. Mean PATI Score was 10.85 +/- 8.9. Mortality occurred in 9 patients, among them four patient hadPATI score more than 25 (p=0.021). There is a seven time increase in risk of mortality in patients with high PATI score. Conclusion: Gunshots are mainly responsible for penetrating abdominal injuries in our study. Management was by mandatory laparotomy after clinical assessment, in majority of patients. PATI score is a valuable scoring for estimation of severity of penetrating abdominal injury in context with the outcome
Clinicohematological Characteristics and Survival Analysis of Aplastic Anemia in Pakistan; A Single Centre Experience
No full textObjective: Aplastic anemia (AA) is characterized by pancytopenia and hypocellular bone marrow. Several factors like infections, toxins, chemotherapeutics and radiations are known causes for the suppression of hematopoietic cells which results in bone marrow failure but the exact etiology is unknown. The current study was conducted to assess the baseline demographics, laboratory and clinical characteristics of patients presenting with aplastic anemia and evaluate their cytogenetic profile.Materials and Methods: A retrospective cohort study conducted at National Institute of Blood Diseases and Bone Marrow Transplantation after approval by Institutional Ethics Committee. In this study, AA patients were enrolled from January 2010 to December 2018. Data collection included demographic, laboratory and clinical characteristics including age, gender, symptoms, treatment, and blood counts. Cytogenetic analysis was performed on bone marrow samples. Data analysis was done by using SPSS version 23.Results: Based on camitta classification, a total of 362 aplastic anemia patients were enrolled in the study. The frequency of severe aplastic anemia was most common 199(55%). Median and interquartile range (IQR) age of overall patients was 17(11-26) years, for children and adult population it was 12(9-14) years and 28 (21-43) years respectively. Male predominance was observed i.e.251(69%). The most common presenting complaint was fever 202(55.8%). The median and IQR of hemoglobin (Hb) was 7.8(5.8-9.4)g/dl, MCV 90(83-91)fl, total leucocyte count (TLC) 2.6 (1.9-3.6) × 109/l, absolute neutrophil count (ANC) 0.64 (0.27-1.2)×109/l and platelet count 13 (5-27) ×109/l. Bone marrow cytogenetics was done and 76 (67%) patients were found to have normal karyotype. CMV was positive in 24(6.6%). Majority of patients were treated with blood transfusion and supportive care only 230(64%) and the survival rate was 84%.Conclusion: In conclusion, the study represents a large cohort of aplastic anemia in the country. Majority of cases were acquired aplastic anemia predominantly being severe aplastic. Limited numbers of patients opted for standard treatment options probably due to financial reservations to afford standard treatments like immune suppression therapy and hematopoietic stem cell transplant. Further, local studies with larger number of sample size and provision of standard treatment options are needed to explore the treatment response, etiological factors, prognosis and outcomes
Non-Institutional Independent Tumor Boards Beneficial Impact on Post-Graduate Medical Training
No full textThe doctors who are going through our postgraduate residency training programs are tomorrow's specialists who will beplaying pivotal roles as healthcare policy decision-makers. To establish site-specific multidisciplinary tumor boards, wehave to rely on our present-day resident’s leadership skills. We intend to provide meaningful specific patient-centeredgoals to our postgraduate students who are our future specialist healthcare providers. We are witnessing a slow positivechange towards shared care and the implementation of multidisciplinary culture. This is high time to develop moduleswith a specific learning objective of providing high-quality leadership skills to all our postgraduate trainees. Effective andefficient team-building skills will enable them to initiate and maintain multidisciplinary professional processes complyingwith international standards [1]
Is The Theoretical Knowledge Reflected in Current Practice: Histopathological Helicobacter Pylori Research?
No full textAbstract: Objective: Helicobacter pylori (H. pylori) is considered in the category of biological agent directly responsible for cancer.Guidelines recommend discontinuing suppressive conditions prior to histopathological helicobacter pylori testing, but there is little clinical trial data on how outcome is affected if this is not done. Optimal test recommendations in the guidelines are based on in vitro study results. In present study, we aimed to observe whether there was a difference in the prevalence of H. pylori histopathologically in patients who met the necessary prerequisites before Esophago-Gastro-Duodenoscopy (EGD) compared to the subjects group who did not meet the PPI discontinuation condition.Materials & Methods: This retrospective study was conducted between October 2015 and August 2016 in a reference hospital with 1.5 million hinterlands. Patients who underwent EGD by meeting all the prerequisites recommended by the guidelines for the H. pylori test were included in the study group (n=213), and those who discontinued other suppressive drugs except PPI were included in the control group (n=193).
Results: While H. pylori was found to be 74.6% positive in the study group that provided all the prerequisites for histopathological H. pylori detection, H. pylori was found to be 64.9% positive in the control group continuing to receive PPI treatment (p=0.02).Conclusion: In conclusion, we suggest that it is necessary to proceed with the guidance of classical knowledge in determining the presence of H. pylori, which is a common public health problem that is up-to-date
A Case Report: An Overweight Patient with High Dose Insulin Usage
No full textAbstract: Insulin is vital for patients with type 1 diabetes and useful for certain patients with type 2 diabetes [1]. In this article we aim to explain a case wrongly using high dosage insulin. A 68-year-old female patient with known 10 years of type 2 diabetes mellitus and hypertension came to our outpatient clinic because her blood glucose levels were high at home. She was using perindopril 10 mg, metformin and insulin. Since the patient did not want to make multiple injections her previous doctor has changed her therapy from glargine u300 1x50 units and insulin aspart 3x30 units to a mixed insulin; insulin degludec + insulin aspart, as 2x 40 units per day. However, the patient did not understand the change of treatment and made the combination of insulin glargine u300 1x50 units and insulin degludec + insulin aspart two times a day as 30 units. She was using this therapy more than two months. Diabetes and complications of diabetes is a challenging healthcare problem. Especially patients’ education is as important as the drug therapy [2, 3]. Among serious side-effects of insulin therapy are overdose, resulting in severe hypoglycemia, causing seizures, coma and even death [1]. Patients must be well educated about the risks of using high doses of insulin