National Journal of Health Sciences
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Mental Health Care in Pakistan
No full textPakistan faces multiple challenges in the health sector, including the status of mental health care. This issue is further compounded by socio-cultural, religious, economic factors, and a weak inadequate mental health care infrastructure [1]. The health budget allocated for Pakistan in 2023 is PKR 24.25 billion, constituting 2.8% of the total development budget and a mere 0.05% of the GDP. Of this, the allocation for mental health care is a mere 0.4%. Moreover, despite a population exceeding 220 million, the country has fewer than 500 qualified psychiatrists [2]. The mental health of our populace has further deteriorated due to longstanding political disputes, violence, terrorism, epidemics, droughts, earthquakes, economic challenges, and unemployment issues [3].  
Breastfeeding Practices and Morbidity among Infants Born to Covid-19 Mothers at a Tertiary Care Hospital Karachi, Pakistan: A Prospective Cohort Study
No full textAbstract: Background: The novel coronavirus disease 2019 has affected general population including pregnancy due to physiological changes that can causes partial immune compression in women and increases risk of acquiring severe infections. It has also shown an impact on infants born to Covid-19 mothers. The aim of the study was to compare breastfeeding and Morbidity among infants born to Covid positive and negative mothers at the age of six months.
Objective: The study aimed to evaluate the long-term impact of breastfeeding and morbidity of infants among Covid 19 mothers.
Materials and Methods: This is a prospective cohort study which was conducted at the Aga Khan University Hospital (AKUH) from 20th November 2020 to 2nd July 2021, after obtaining the permission from the Research Ethics Board at Shaheed Zulfiqar Ali Bhutto Institute of Science and Technology (SZABIST) (IERB(7)/SZABIST-KHI(LIFE)/19104121/200118) and the AKUH Ethical Review Committee (ERC#:-Ped-ERC- 2020-5576-14891). Mothers were identified from hospital medical records and were followed-up at the age of six months. Participants were recruited via a non-probability purposive sampling method. Antenatal, perinatal, postnatal outcomes and neonatal data was collected via structured questionnaire.
Result: Altogether 208 neonates were enrolled in the study, (n=104) in each group. Early initiation of breastfeeding within first hour of life was observed in 69 (33.3%) neonates (p value=0.049). Altogether, 120 (58.5%) neonates were exclusively breastfed during hospital stay. It was observed that exclusive breastfeeding was higher (68.9%) in non-exposed group immediately after birth. There was no significant difference in breastfeeding practices (RR; 1.0, 95% CI: 0.76-1.32; p value= 0.99) and morbidity status (RR; 1.07, 95% CI: 0.82-1.41; p value= 0.579) of infants at the age of six months among both groups.
Conclusion: COVID-19 has impacted maternal and early neonatal outcomes, necessitating prompt interventions to reduce complications. Encouraging timely breastfeeding initiation can enhance benefits, lower infant morbidity, and support sustained exclusive breastfeeding
Diagnostic Accuracy of Orthopantogram in Identifying the Proximity of Inferior Alveolar Nerve Canal to the Roots of Mandibular Third Molar as Compared to Cone Beam Computed Tomography
No full textAbstract: Background: Third molar extraction is the most frequent surgical treatment performed in a dental office. For initial risk evaluation of IAN damage, traditional radiographic examinations like orthopantomography (OPG) are indicated. To gather local evidence, we did this research.
Objective: The aim of this research is to compare orthopantomography with cone beam computed tomography in identifying whether an impacted mandibular third molar (IM3M) is near the inferior alveolar nerve canal.
Materials and Methods: This cross sectional (validation) study was conducted at the Department of Oral & Maxillofacial Surgery, Faisalabad Medical University, Faisalabad from 30-5-2022 to 30-11-2022 after obtaining the permission from ethical review committee (F.No.48-ERC/2020-21/PHRC/FMU/103). 280 candidates fulfilled selection criteria were selected from the OPD. Patients then underwent OPG and findings were recorded and patient was labeled as positive or negative. Later on, patients underwent CBCT and findings were recorded. All the data was recorded on proforma while analyzed in SPSS ver 20.0.
Result: The mean age of patients was 34.76±9.27 years. Out of 280 patients, there were 131 (46.8%) males and 149 (53.2%) females. Out of 280 patients, 135 (48.2%) had left side IM3M extraction while 145 (51.8%) had right side IM3M extraction. On OPG, 65 (23.2%) had superimposition, 71 (25.4%) had interruption, 64 (22.9%) had darkening of roots and 80 (28.6%) had narrowing. The sensitivity of OPG was calculated as 79.8%, specificity was 97.2%, while PPV and NPV were calculated as 97.9% and 74.8% and diagnostic accuracy of OPG was 86.4%, taking CBCT as gold standard.
Conclusion: Thus, OPG can be somewhat reliable method for IAN position before Im3M extraction
Modernizing Thalassemia Detection: Insights from Third Generation Sequencing
No full textAbstract: Thalassemia, an inherited hematologic disorder, places a considerable societal and economic burden. Efficient prevention and management of this ailment necessitates the implementation of comprehensive screening strategies. Third–generation sequencing (TGS), an innovating technology, shows significant potential for applications in screening and diagnosis across numerous disorders. Although its utilization in the detection of thalassemia is in early phases, the current review explores recent and extensive applications, benefits of TGS, and associated problems and resolutions in incorporating it into routing screening and diagnostic procedures of thalassemia. In essence, TGS has displayed heightened degrees of progressive detection analysis and diagnostic precision in comparison to traditional methodologies and NGS. This observation suggests that technologies of TGS stands as a reasonable choice for diagnostic laboratories conducing the testing of thalassemia. The integration of TGS in diagnosis of thalassemia is anticipated to simplify the formulation of operational prevention and therapeutic approaches, ultimately mitigating impact of thalassemia on individuals and community
Effect of Nasal Deviation on the Perception of Upper Dental Midline by General Dentists and Orthodontists
No full textAbstract: Background: Establishing the relationship between dental and facial midlines aids in achieving the desired dentofacial aesthetics post-orthodontic treatment.
Objective: The primary objective of this study was to assess the effect of nasal deviation on the perception of maxillary dental midline by the orthodontic practitioners and general dentists. Secondary objectives were to see if there was any significant difference between the perception of female and male participants, and orthodontic practitioners and general dentists.
Materials and Methods: This cross-sectional study was conducted in Margalla Institute of Health Sciences (MIHS) Rawalpindi after obtaining ethical approval. Morphed frontal smiling photographs of a female subject were used to assess the perception of the participants. The nasal midline was progressively altered at every 1 mm from 0 mm to 4 mm towards left while keeping the upper dental midline on. The data were analyzed by using SPSS version 26.0. P-values of < 0.05 were taken as significant.
Result: Out of 200 study subjects, 106( 53%) were general dentists and 94 (47%) were orthodontic practitioners. There was a significant increase in the misperception of upper dental midline with an increase in the nasal deviation. There was no statistically significant difference found between the findings of general dentists and orthodontists, with the exception of one image (Image 2), for which the p value was 0.017. Statistically, no significant difference was observed between male and female participants’ results.
Conclusion: The nasal deviation affects dental midline perception, with only minor differences between general dentists and orthodontists underscoring the necessity for comprehensive facial evaluations in dental practice to ensure accurate aesthetic and functional assessments
Evaluation of Pattern of Deep Wrist Injuries in Suicidal versus Accidental Cases Presenting in a Tertiary Care Hospital
No full textAbstract: Background: The hand is the most dominant and important part of human body. Hand and wrist injuries are frequently associated with long-term pain, loss of productivity, disability and hence compromised quality of life. The primarily cause of wrist injuries are can be accidental or suicidal.
Objective: to determine accidental and suicidal deep wrist injury (DWI) rate and compare patients’ anatomical features among the two injury types.
Materials and Methods: This cross-sectional study was performed in Ruth Pfau Civil Hospital, DUHS during June to December, 2022. Patients visiting emergency rooms with acute hand injuries were enrolled into the study. The assigned data collectors’ participants’ features in a pre-designed structured proforma. Data was analyzed using SPSS version 26.
Result: Total 384 patients were enrolled into the study with median age of 32 (IQR=25-45) years. Majority of victims were males (77.3%). Frequency of accidental injury was 82.6%. Out of 317 (82.6%) patients with accidental injury, common mechanism was road traffic accident (51%) followed by occupational injury (21.1%) and domestic violence (14.1%). None of the patients’ features were significantly different among accidental and suicidal injuries except marital status. Frequency of suicidal injury was significantly higher among married individuals than those who were single. Frequency of ulnar nerve (p=, flexor pollicis longus tendon (p= and flexor digitoram profundus (p=) was significantly higher in accidental cases than suicidal cases whereas ulnar artery (p=) and radial artery was significantly higher in suicidal cases.
Conclusion: The current study found that almost one-fifth of DWI were suicidal attempts. Suicidal injuries were mainly damaging to radial and ulnar arteries where accidental injuries affected deep wrist structures such as ulnar nerve, flexor tendons and flexor digitoram profundus
Pandemic-Risk Pathogens
No full textParasites, fungi, bacteria and viruses cause significant impact on the community health. Of these the simplest are the viruses that can be highly transmissible, and even can be generated from synthetic DNA. Viruses can trigger outbreaks. The 1918 influenza pandemic killed 17 million people [1]. Small pox and measles have also been major killers. Prior to effective eradication program, small pox caused more than 2 million fatalities a year [2]. Before the initiation of widespread vaccination, measles was also a big killer. Advances in virology has led to the development of vaccines and therapeutic agents that have enabled a drastic reduction in disease burdens caused by influenza, COVID-19, poliomyelitis, hepatitis C, HIV/AIDS etc. Recently development of COVID-19 vaccines within a period of one year is a remarkable example. The rapid development and deployment of these vaccines prevented 14-20 million deaths worldwide [3]
Prevalence and Antimicrobial Resistance of Deep Neck Space Infections (DNSIs) in Patients at Combined Military Hospital (CMH), Muzaffarabad, Azad Jammu & Kashmir
No full textAbstract: Background: Deep neck infections are one of the major threats for cellulitis and abscess in the head and neck region which may have various origins. Therefore, it is required to have microbes identified and anti-microbial sensitivity to be established which may lead to better therapeutic decisions and patient outcomes.
Objective: This study aimed to determine the clinical presentation, the bacterial agents involved, and the antimicrobial sensitivity patterns of microorganisms associated with DNSI in our hospital patients.
Materials and Methods: A cross-sectional study was conducted at the ENT department of Combined Military Hospital, Muzaffarabad, from April to October 2022 (Ethical Approval No. DME-469). The 115 patients, aged between 18 and 60 years, who were of DNSI, were included in the study. Data collection involved detailed patient history, a physical examination, a microbiological study of pus, and a CT scan. In terms of the data analysis, SPSS was utilized.
Result: Mean age of patients included were 39.8 ± 12.1 years with male to female ration being 1.6:1. Symptoms that were most frequently reported in the cases with dysphagia (29.6%) and sore throat (29.6%). The preferred site of abscess formation was the parapharynx (38.3%). Streptococci were the predominant isolates (40%) to be recovered from the patients, followed by anaerobes (30.4%) and Staphylococci (29.6%). The isolates were highly susceptible to the combination of amoxicillin/clavulanic acid and chloramphenicol.
Conclusion: This study emphasizes that Streptococcus is the most frequently encountered pathogen for DNSI and therefore, early diagnosis and targeted antibiotic therapy of DNSI are very important. It is recommended to use the empirical treatment of amoxicillin/clavulanic acid or chloramphenicol
Does the Time of Day have an Effect on the Success and Complications of ERCP?
No full textAbstract: Background: In ERCP, if modifiable risk factors can be minimized, indirectly, the rates of complications will also decrease.
Objective: In the present study, the aim is to investigate whether the timing of ERCP (morning versus afternoon) was associated with the success of cannulation and procedure-related complications in patients with bile duct stones undergoing ERCP.
Materials and Methods: This is a retrospective study of patients who underwent ERCP for common bile duct (CBD) stones. We compared the complication rate and the success of CBD cannulation between procedures conducted in the morning and those carried out in the afternoon during ERCP.
Result: A total of 402 patients were enrolled. The mean age of patients was 64.4 ± 19 years with a total bilirubin value of 7.5 ± 11.6 mg/dL, direct bilirubin value of 4.9 ± 8.6 mg/dL, and CBD of 11±2.4 mm. 201 (50%) of the patients underwent ERCP in the morning and 201 (50%) in the afternoon. The rates of post-ERCP pancreatitis, bleeding, and the success of cannulation were 5.5%, 10%, and 96.5% in the morning ERCP group and 5%, 13.4%, and 93% in the afternoon ERCP group, respectively. There were no statistically significant differences between groups in post-ERCP pancreatitis (p=0.606), bleeding (p=0.277), and the success of CBD cannulation (p=0.117).
Conclusion: Between morning and afternoon ERCP procedures, no statistically significant difference was detected
Comparison of Mean Hospital Stay after Nebulization with 3% Hypertonic Saline vs Salbutamol in Treatment of Bronchiolitis
No full textAbstract: Background: With an estimated prevalence of 33% in children age >2years and owing to 1 in 10th cause of hospitalization in children, Bronchiolitis is a major factor for morbidity and mortality. Varying nebulization doses have been shown to produce different clinical outcomes in patients with bronchiolitis.
Objective: To compare mean hospital stay after nebulization with 3% hypertonic saline compared to the salbutamol among patients of bronchiolitis
Materials and Methods: This was a randomized control study done at pediatric medicine ward, Services Hospital, Lahore. The study was done during 8th May 2018 to 8th November 2018. Data was collected from 68 children of age >3 months to < 2 years of both genders i.e. (34 in each group) fulfilling inclusion criteria. SPSS software was used for data entry and analysis. For quantitative variables age, mean and standard deviation were used whereas for qualitative variables like gender, frequency and percentages were used. Independent sample t-test was used for comparing mean hospital stay among the two groups taking p-value<0.05 as significant.
Result: Average age in Salbutamol group was 1.06 ± 0.50 years and in Hypertonic solution mean age was 1.24 ± 0.55 years. There was significant difference in mean hospital stay with relatively lesser in hypertonic solution vs the Salbutamol group [3.18 ± 1.11 vs 4.44 ± 1.08 ; p-value <0.001]. Upon post-stratification analysis, the mean hospital stay was found to be significantly lower in the Hypertonic group vs. Salbutamol group with respect to age, gender and the duration of the disease (p-values<0.05 for all).
Conclusion: This study concludes that the mean hospital stay was statistically lower in the hypertonic solution group vs the Salbutamol group. Moreover, the clinical efficacy of the hypertonic saline can be utilized in future to gain early recovery of Bronchiolitis and hence it can reduce the hospital stay and related cost