National Journal of Health Sciences
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Diagnostic Performance of Three Serological Assays for Anti-SARS-CoV-2 Antibody Detection
No full textAbstract: Objective: To evaluate the diagnostic performance of Electrochemiluminescence (ECLIA) enzyme linked immunosorbent (ELISA) and lateral flow Immunofluorescence (LFIA) for anti-SARS-COV-2 antibody detection.
Materials and Methods: Sensitivity was calculated with convalescent plasma (CP) donor’s samples. Specificity was checked by using pre-pandemic October 2019 samples. All samples were tested for anti-SARS-COV-2 antibody by using Electrochemiluminescence (ECLIA), Enzyme Linked Immunosorbent Assay (ELISA) and Lateral flow Immunofluorescence (LFIA) assay.Results: Total 55 patients were included, 45 patients were CP donors and 10 were Pre-Pandemic October 2019 samples archived from our blood bank. The ECLIA-total antibody, ELISA-IgG and LLFIA-IgG were positive in 41 (91.1%), 34 (75.5%) and 44 (97.75%) respectively. The highest sensitivity was observed for LFIA with highest specificity among all three assays. There was almost perfect agreement between LFIA and ECLIA (k=0.936, p<0.001) but there was fair agreement between LFIA and ELISA (k=0.412, p=0.001) and ECLIA and ELISA (k=0.357, p=0.001).Conclusion: The LFIA showed a higher sensitivity and specificity in comparison with ECLIA and ELISA. It might be due to fact that LFIA detect antibody against ncleocapsid and spike protein as well of SARS- COV-2 virus, while ECLIA and ELISA detects antibodies only against “N” Protein of SARS- COV-2 virus
Hypothyroidism is Strongly Correlated with Mean Platelet Volume and Red Cell Distribution Width
No full textAbstract: Objective: Hypothyroidism is characterized with insufficient production and release of thyroid hormones, and cause a variety symptoms including cold intolerance, constipation, deceleration in movement, and hair loss. It is associated with increased inflammatory burden. Therefore, we aimed to observe red cell distribution width (RDW) and mean platelet volume (MPV) levels, novel predictors of inflammation, in patients with hypothyroidism and to compare to those in healthy subjects.Materials and Methods: The subjects with hypothyroidism that show up in internal medicine outpatient clinics of Abant Izzet Baysal University Hospital between January 2020 and January 2021 were enrolled to the retrospective study. Healthy volunteers were enrolled as control subjects. MPV and RDW of the study groups were compared.Results: The median RDW level of hypothyroid and control groups were 13.3 (10-20.7) % and 15.3 (11.8-21.3) %, respectively (p<0.001). The median MPV level of hypothyroid and control groups were 10.2 (6.4-12.4) fL and 8.1 (5.4-11.5) fL, respectively (p<0.001). MPV levels greater than 9.47 fL have 80% sensitivity and 72% specificity in predicting hypothyroidism (AUC: 0.66 [95% CI: 0.58-0.74]; p<0.001). RDW levels greater than 13.4% have 80% sensitivity and 50% specificity in predicting hypothyroidism (AUC: 0.67 [0.82 [95% CI: 0.59-0.75]; p<0.001).Conclusion: We suggest that elevated MPV and reduced RDW levels should alert physicians for hypothyroidism in otherwise healthy subjects
A Suggested Professional Development Plan for Specialist Doctors Taking Leading Roles in the Establishment of Quality Healthcare
No full textIn modern healthcare centers physicians play an important and pivotal role in the establishment of quality health care systems and processes. One of the most important factor in professional development and growth of specialist is implementation of processes. I am postulating a plan for the consideration of specialist faculty colleagues
Epidemiology of Postpartum Depression in Pakistan: A Review of Literature
No full textABSTRACT: Objective: This literature review aims to explore the risk factors, preventive measures and treatment options for women with postpartum depression especially in Pakistan. Introduction: Postpartum depression affects 12.5% women on average and is one of the most common complications of pregnancy. Among Asian countries, Pakistan has the highest prevalence rate that is 28%- 63%. The consequences of PPD go beyond the mother and affect the partner and the child as well and can even lead to infanticide and maternal death, often by suicide. Besides, not all women are assessed for PPD or receive its treatment despite of several treatment options available. Method: Comprehensive and systematic literature search was undertaken by using various electronic research databases. Studies were eligible for this review if they were published in last twenty years in English language and focused on epidemiology, risk factors, consequences, prevention and treatment of PPD especially in Pakistan. Results: Postpartum depression is a prevalent illness, with complications that are severe. The causes can be situational or maternal and thus, recommended prevention is to reduce the burden related to public health. If primary prevention fails, programs for screening to detect early can be well thought-out for timely treatment. If there is any progress in the disease, implementation of antidepressant, effectual psychotherapy besides the recommended diet are beneficial. Exercise and appropriate sleep as well are also recommended for the patients. Moreover, barriers to each level of prevention exist due to maternal factors, healthcare factors and socioeconomic factors in Pakistan. Conclusion: Results suggest that women do not proactively seek help when suffering from postpartum depression due to many factors, the root cause of which is lack of awareness especially in developing countries like Pakistan. Since this ignored illness can lead to serious complications, the issue should be addressed to promote public health
Complications Associated with Diabetes: A Case Study
No full textABSTRACT: Background: The current study has focused on the complications arising in a patient due to diabetes mellitus and how the patient’s quality of life has been affected. The most feared complication of the disease is loss of lower limb due to infection and major cardiovascular complications. Objectives: Management of a patient with diabetes and cardiovascular complication with history of tuberculosis is studied along with antimicrobial interventions for curing the ulcer and reducing risk of amputation. Cardiovascular complication, one of the co-morbidity of diabetes, was also managed. Methods: After selection of the patient, consent from patient and approval from relevant authority were obtained, patient was kept under observation for a week.Case Presentation: Patient was admitted with complaints of: shortness of breath, palpitation, exertional dyspnea and a spreading right shin discharging foot ulcer. Conclusion: Patient was treated with antibiotics and ionotropic agent and indicated better rate of prognosis
Descriptive Controlled Study Regarding the Effects of Negative Chronotropic Agents on Lowering Heart Rate and Morning Surge in a Tertiary Care Hospital
No full textABSTRACT: Objective: To determine the optimal therapy for lowering the heart rate (HR) of cardio-compromised patientsby observing the effect of negative chronotropic agents. Methods: The retrospective study was conducted at the 24 Holter monitoring data centre of Agha Khan University Hospital from August 2010 to July 2011. Data was extracted by using a predesigned Performa on individuals with compromised cardiovascular disease. The sample population was categorized into four groups. Furthermore, two time intervals were set which included an early morning and a later period. Result: Of the 600 patients, 369 were males (61.5%) and 231 were females (38.5%) with a mean age of 54.9±19.2 years old. Average HR’s for patients on BB, CCB, combination therapy and drug naïve were 71.14±11.4 bpm, 72.38±11.95 bpm, 66.88±10.37 bpm and 76.47±13.63 bpm respectively (p value<0.01). In period I, 42.5% of patients on BB had the lowest HR with a mean of 50.47±10.27 bpm, 36% on nCCB had a mean of 51.7±13.6 bpm, 50% on combination had a mean of 47.38± 8.3 bpm and 39.86% of drug naïve patients had a mean of 50.87±10.47 bpm (p-value <0.8). In period II, 57.5% on BB had the lowest HR with a mean of 49.87±9.15 bpm, 64% on nCCB had a mean of 50.75±10.23 bpm, 50% on combination had a mean of 50.5±5.01 bpm and 61.14% of drug naïve patients had a mean of 52.04±11.56 bpm (p value<0.61). Conclusion: Negative chronotropic agents are highly effective in reducing a patient’s HR as compared to those who were drug naive
Intestinal Obstruction Caused by Retained Surgical Swab
No full textABSTRACT: Retained surgical swab (RSS) is an infrequent and avoidable complication after any type of abdomino-pelvicsurgeries which leads to increased morbidity of patient as well as the cost of treatment. We report one such case of a 32 yearsold female patient who presented with signs and symptoms of acute intestinal obstruction, 1 year after a cesarean section. Onexploration a mass was found in the region of terminal ileum which was resected followed by end to end anastomosis. Upondissection of the mass, a large surgical swab was found inside the lumen of the gut. The mass which is formed around aretained surgical swab is known as Gossypiboma. Complete intra-luminal migration is very rare and a delayed complication ofRSS and is difficult to diagnose due to vague presentation and inconclusive imaging. Surgical intervention is mainstay oftreatment although it may be removed endoscopically in accessible parts of the gut and may even pass with defecation withoutany intervention
Substantiation of Multinational Association for Supportive Care in Cancer (MASCC) Score in Risk Assessment of Febrile Neutropenic Patients in Hematological Disorders: A Regional Study from Pakistan
No full textAbstract: Background: The incidence of neutropenia in hematological malignancies comprises of huge burden of febrile neutropenia. Multinational Association of Supportive Care in Cancer (MASCC) risk index score is the most widely used model for forecast of complications.
Objective: The aim of this study was to determine diagnostic accuracy of MASCC scoring system in febrile neutropenia patients suffering from hematological disorders.
Materials & Methods: Patients suffering from hematological disorders and presenting with febrile neutropenia were stratified into low and high risk groups according to MASSC score. The standard score range from 0 to 26 points; score of more than or equals to 21 were considered to be low risk and score of less than 21 was high-risk category. As an in-patient at National Institute of Blood Disease & Bone Marrow Transplantation, they were followed over the course of illness for development of any serious medical condition until resolution of febrile neutropenia
Variceal Bleeding in Patients with Initation of Sofosbuvir and Ribavirin – Case Reports
No full textAbstract: Sofosbuvir is an oral nucleoside analogue and potent inhibitor of the Hepatitis C virus (HCV) RNA polymerase that is used in combination with other antiviral agents to treat chronic Hepatitis C Nevertheless, and for unknown reasons, successful antiviral therapy of Hepatitis C with Sofosbuvir and other direct acting agents in patients with cirrhosis is occasionally complicated by hepatic decompensation. Here we describe 2 case report of upper gi bleed at initial days of treatment with Sofosbuvir and Ribavirin