National Journal of Health Sciences
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Olanzapine in Chemotherapy Induced Nausea and Vomiting
No full textAbstract: Objective: Patients diagnosed with cancer and undergoing chemotherapeutic regimen often anticipate many negative effects of the therapy. Chemotherapy induced nausea and vomiting is of their principal concerns which remains one of the most unpleasant, distressing and feared adverse effect. The management of chemotherapy induced nausea and vomiting has always been a challenge for high and moderate emetogenic chemotherapeutic agent. D2 receptor antagonists were the first agents to produce antiemetic effect. Then 5-HT3 receptor antagonist and NK1 receptor antagonist were developed which proved to possess higher selective antiemetic effect compared to D2 receptor antagonist. This review includes the clinical advancements of an atypical antipsychotic agent olanzapine and its role in chemotherapy induced nausea and vomiting. Olanzapine is traditionally used to treat schizophrenia and manic disorder. But recent clinical studies have illustrated its additional therapeutic effect as an antiemetic agent. This advancement may prove to have beneficial effect in managing chemotherapy induced nausea andvomiting and providing a better quality of life to patient being treated with different chemotherapeutic agents
Interim-Guidelines for COVID-19 Vaccination in Hematological Malignancies and Hematopoietic Stem Cell Transplant Recipients
No full textAbstract: Objective: Hematologic malignancies such as Acute Leukemias, Myelodysplastic Syndromes (MDS), MyeloproliferativeNeoplasms (MPNs), Lymphomas and Multiple Myeloma (MM) can be treated with chemotherapy, Hematopoietic Stem Cell Transplant (HSCT) or Chimeric Antigen Receptor T-cell (CAR-T) therapies with either a curative intent or to prolong survival. The hematologic malignancy itself or the anti-cancer therapies can result in long-term immunodeficiency; COVID-19 infection in this population is associated with a significantly higher risk of hospitalization and death [1].Given lack of available data on COVID-19 vaccination from Pakistan, this guidance is based on the review of safety and efficacy of FDA and CDC approved vaccines for the prevention of COVID-19 disease and recommendations of European Society for Blood and Marrow Transplant (EBMT), American Society for Transplantation and Cellular Therapies (ASTCT) and British Society of Haematology (BSH) for the use of COVID vaccination in HSCT recipients and those with hematological malignancies. The American Society of Hematology (ASH), EBMT, ASTCT and BSH recommends the desired access to vaccines for this highly susceptiblegroup along with care takers, family members, and domestic& everyday contacts when vaccine supply is available
Twenty years of Bone Marrow Transplantation in Pakistan Lessons Learnt and Future Vision
No full textCord Compression from Bony Metastasis: An Important Quality of Life Issue which can be Resolved by a Spinal MDT Tumor Board
No full textCancer prevalence is increasing over the past few decades. Spinal osseous metastasis is one of the most common sites of secondary neoplastic disease among cancer patients [1]. Spinal malignancies can broadly be classified into primary spinal cancers and secondary spinal metastasis. Metastatic spinal cancers are more common than primary malignancy of the spine. Metastatic spinal cancers are further subdivided into two parts based on the involvement of the dura mater; metastasis external to dura mater can be termed as metastatic epidural spinal cancers (MESC); metastasis inside the dura mater is called metastatic intradural spinal cancers (MISC) [2]. Bony involvements of vertebrae are common at the presentation of MESC while the involvement of the spinal cord and meninges is a prominent feature of MISC. However, the clinical presentation is quite overlapping and timely-decision making is quite challenging in several cases. Several grading systems have been developed to assess the severity of spinal cancers [3-6]. Such ambiguities require a need for teamwork between different specialties to decide the management plan for better patient care. Multidisciplinary Tumor Boards (MDT) are the practical venue where different specialists are present for the discussion [7]
Aldosterone: Implications in Diabetic Nephropathy
No full textAbstract: Objective: The focus of this review is to summarize the recent advancement to understand the molecular pathogenesis of diabetic nephropathy (DN). Also, to highlight the role of abnormal aldosterone secretion on the development and progression of diabetic nephropathy.
Background: Diabetic Nephropathy (DN) is a progressive disease of nephron due to slow progressive failure of kidney tubule to perform its filtration process. It is often associated with proteinuria and glomerular stiffening which eventually leads to low glomerular filtration rate, finally succumbs the patient toward the end stage of kidney disease. The abnormal level of aldosterone in diabetes mellitus is a fatal combination to combat because of progressive development of diabetic nephropathy.
Methods: We reviewed the literatures for implications of aldosterone in diabetic nephropathy. The literatures that were related to different aspects of diabetic nephropathy in relation to aldosterone were analyzed and summarized in this review article
Synchronous Occurrence of B-Cell Non Hodgkin Lymphoma and Metastatic Small Cell Carcinoma of Lung
No full textAbstract: Synchronous occurrence of multiple malignancies i.e.: epitheliod and lymphoproliferative are rare but well reported. Here we have presenting a case of 82 year old male, known smoker, admitted at Shifa International Hospital Islamabad, with complaints of shortness of breath, productive cough, weight loss, generalized weakness and cervical lymphadenopathy. The laboratory investigations; complete blood counts and peripheral blood showed patient is having absolute lymphocytosis with flow cytometric analysis performed on peripheral blood revealing B-cell Non Hodgkin lymphoma. However p53 deletion was not detected on using fluorescence in-situ hybridization. Although bone marrow biopsy examination was surprisingly seen with multiple cohesive metastatic clumps and dispersed atypical cells with positivity of CKAE1/AE3, CD56, TTF1 giving diagnosis of metastatic lung carcinoma. Hence occurrence of both epitheliod and lymphoproliferative malignancy was made and reported in Pakistan most likely for the first time
Zika a Big Concern to the Recent World
No full textAbstract: ZIKV is the most promising mosquito borne Arbovirus infection. Aedes mosquitoes are responsible for causing this disease. About 80% of infections are asymptomatic. Our aim is to get an overview about the epidemics of ZIKV infections throughout the years from the first case in Uganda whyich occurred in 1947 till now. Studies reveal that the disease occurs from being mild to severer with complications like microcephaly, fetal malformations and Guillain-Barre syndrome (GBS). It arises from the regions of Africa, Nigeria, Sierra, Leone, and Gabon. Diagnosis occurs through PCR; Zika viruses can cross-react with other flaviviruses. There are various factors that are vague regarding the Pathogenicity of ZIKV. No medication and vaccine are available for treating Zika virus infection. Vaccine of Zika is expected to arrive soon. If the modern procedures are followed and chased appropriately it could lead to the control of this infection
Management of Simultaneous Bilateral Femur Fractures in a Tertiary Care Hospital: A Retrospective Review
No full textAbstract: Introduction: Bilateral long bone fractures are rare and usually are associated with increased risk of complications. These fractures are usually associated with poly traumatic injuries or high impact trauma resulting in shock. Commonest etiology is road traffic accident. Closed diaphyseal fractures are best managed by intramedullary nailing; management becomes difficult if there are open fractures and late arrival. In this study we intend to present our experience of managing these patients.Materials and Methods: Medical records of all adult patients (age more than 16 years of age) admitted at Aga Khan University and Hospital with bilateral femur fractures +/- other systemic injuries 2006-2014 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 retrieved 11 cases of bilateral femur fractures. Mean age of patients was 34.5 +/- 20.9, with male predominance constituting 72.7%. Common mode of injury was fall from height and road traffic accident (RTA) 45.5% each, with the exception of one gunshot. Mean Injury Severity Score was 26.9+/-7.79. Mean Revised Trauma Score was 7.39 +/-0.62; mean Trauma Injury and Severity Score was 92.4 +/- 6.6%. 2 patients had surgical site infections and 1 had non-union. We encountered no mortality. Increase ISS is associated with increased risk of morbidity and length of hospital stay (p= 0.02)
Trend of Anti-SARS-COV-2 Seropositivity in Karachi
No full textAbstract: Objective: This study aims to determine the trend of seropositivity of anti-SARS-CoV-2 antibodies (total including IgM, Ig G) in patients presenting at a private hospital in Karachi.
Materials & Methods: A total of 2500 patients were included in the study. Informed consent was obtained and a questionnaire including patient’s age, gender, symptoms, history of traveling, contact with people who had travelled recently, contact with confirmed/suspected COVID-19 patient at home or work was filled. Samples were analyzed for anti-SARS-CoV-2 antibodies on Roche Cobase601
What do the White Spots in the Second Part of Duodenum Tell Us?
No full textAbstract: Objective: The underlying conditions/diseases of scattered white spots in the duodenum are rather not very clear in the literature. We aimed to find out whether Helicobacter pylori, diabetes mellitus or inflammation has an impact on the presence of duodenal white spots.
Materials & Methods: We included all patients who underwent endoscopy between the time-period 2007-2017 in the Endoscopy Unit of Cumhuriyet University and had scattered white spots in the duodenum. Our control group was formed by randomly selected patients who underwent endoscopy at the same time period in whom duodenal biopsy was taken. The demographic data of both the patient and the control group, the presence of diabetes, endoscopic and histological diagnoses, neutrophil lymphocyte ratio, thrombocyte lymphocyte ratio, mean platelet volume and erythrocyte distribution width were obtained from the computer system of the hospital in detail