National Journal of Health Sciences
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Case-Fatality Rates for COVID-19: Are we Ignoring Something?
No full textAbstract: The availability of accurate data is of vital importance in the COVID-19 pandemic which has presented itself as a formidable challenge. The objective of our paper was to identify the flaws in simple estimates of case-fatality rate (CFR), the epidemiological indicator currently in use, and compare it to another more effective indicator, the adjusted case-fatality rate (aCFR). aCFR is defined as the number of COVID-19-associated fatalities*100/ total cases that reached outcome, i.e. death or recovery, according to the methodology of Ghani and colleagues. The results showed varying CFRs and aCFRs for several countries, signifying the problem with using CFR. Belgium is a prime example of such a case as it had a CFR of 15.82% while an aCFR of 36.38% and the number of cases in Belgium is high enough to make the discrepancy in these results significant. The deaths caused by COVID-19 are being underrepresented by CFR. It can lead to misleading results, especially when comparing countries and regions on their mortalities
Acute Leukemia of Ambiguous Lineage with a Rare Abnormality Del17p by FISH Analysis
No full textAbstract: The World Health Organization (WHO) has categorized acute undifferentiated leukemia (AUL) as a rare subtype of acute leukemia of ambiguous lineage (ALAL). The prognosis of AUL is considered poor and it expresses no known lineage-specific markers. In majority of the cases, AUL has been associated with karyotypic abnormalities, most commonly deletion 5q and complex karyotype. Deletion 17p correlation with acute myeloid leukemia and myelodysplastic syndome has been previously established and is associated with poorer outcomes. Herein we are reporting a case of forty years old male who was referred to National institute of blood diseases and bone marrow transplantation with complains of fever, multiple neck swellings, and early satiety and was diagnosed as Acute Undifferentiated Leukemia along with deletion 17p. This is a rare entity and can aid in further diagnostic and therapeutic approaches
Infective Endocarditis: A Growing Concern and Treatment Approaches: An Observational Study
No full textAbstract: Objective: To determine the frequency of prevailing microorganism, treatment approach, different treatment complexities and rationalize the approach for treating Infective Endocarditis (IE) patient. Material and Methods: The retrospective study was conducted from 01st January 2015 to 31st October 2019. Data was collected and after applying exclusion criterion 40 patients were selected and their available record was evaluated. To obtain the conclusive results, frequency and percentages were calculated
Comparative Prevalence of Intestinal Helminths in Satar and Chaudhary Communities of Birtamode Municipality, Jhapa, Nepal
No full textAbstract: Introduction: Intestinal parasitic infections remain a major public health problem in many parts of the world, particularly in low and middle-income countries like Nepal. Materials and Methods: The different ethnic groups are geographically, socio-economically, culturally, and genetically diverse and their heterogeneity needs explanation to understand the variation in the prevalence of IPIs among them. The aim of this study was to compare the prevalence of intestinal helminths in Satar and Chaudhary communities of Birtamode Municipality and to identify the risk factors associated with either of them. A total of 220 stool samples, 110 from each community were collected and examined by unstained and stained smear preparation, floatation, and sedimentation technique. A set of questions regarding the risk factors of parasitosis was filled by interviewing each respondent. R-version 1.1.463 was used to perform the chi-square test for statistical analysis of data, and 95% confidence interval and P<0.05 were considered statistically significant. Results: The overall prevalence of infection was found 28.63%. A significant difference was seen in the prevalence of parasites between Satar and Chaudhary communities (p<0.05). The age-wise prevalence revealed a high rate of infection among children, followed by old age and adults, while sex-wise prevalence showed marginally higher infection in males in both communities. Altogether six types of parasites were encountered; A. lumbricoides (13.18%) was the most prevalent parasite. In risk factor analysis, significant associations were seen between parasitic infections and handwashing habits, use of handwashing agent, defecation site preference, and barefoot walking habit in the Satarcommunity. Similarly, a significant association of parasitic infection with handwashing habits and barefoot walking habits were seen in the Chaudhary community. Conclusion: Hence, a remarkable prevalence of parasitic infection was indicated by the present study. Improvements in personal hygiene, environmental sanitation, provision of sanitary toilets, provision of awareness programs, and preventive measure implementation are important to overcome the parasitic infection in these communities
Medical Errors in a Newly Established Teaching Hospital- Some Lessons Learnt for Better Practices
No full textAbstract: Objective: Medical errors (MEs) are flaws in implementation of act and failure of planning associated with patients. To avoid errors healthcare units are trying to make safer strategies that decrease morbidity and mortality due to MEs. The aim of this study was to evaluate errors and make strategies to avoid such errors in future. Methods: A cross sectional study conducted at NIBD-PECHS campus Karachi, Pakistan. Approval was taken from institutional review board. Data was collected from February 2018 to January 2019. Reporting form included variables like reporting month, location, department, classification, root cause, risk, action taken, financial burden and status. Analysis was done by using SPSS 23.0. Results: A total of 42 MEs were reported at our hospital which were divided into four categories: patient care events 19 (45.2%), management events17 (40.5%), criminal events 3 (7.1%) and equipment error errors 3 (7.1%). Most of errors occurred in inpatient department 27 (64.2%) and nurses were responsible for 17 (40.5%) errors. In most of cases 23 (54.8%) root cause was staff negligence and to resolve this 22 (52.4%)verbal warnings were given. About 367.62USD (52,000PKR) were consumed to resolve the errors. Conclusion: We concluded that reporting MEs is practical approach to give quality services to patients and facilitates in making new policies to reduce errors in future
Hypopituitarism as a Rare Cause of Hyponatremia
No full textAbstract: Hypopituitarism is defined as pituitary hormone (or hormones) deficiency caused by dysfunction of pituitary gland and/or hypothalamus. Clinical findings and diagnostic procedure depend to the deficient pituitary hormone. The prognosis of patients with hypopituitarism is associated with presentation, age, the degree and severity of the hormonal disorder, and the response to medical and surgical treatment. In present case, we report a 78 years old woman that presented with hyponatremia, nausea and vomiting, whom consequently diagnosed with hypopituitarism and we discussed diagnostic procedure to establish the diagnosis. In sake of prevention of mortality, physicians should be aware of hypopituitarism in subjects with nausea, vomiting and electrolyte disturbances. Once the diagnosis established, replacement therapy should be initiated immediately
Tumor Board Saves Lives – More Evidence is Emerging for the Mandatory Development of Site Specific Multi-Disciplinary Teams
No full textSite specific Multi-disciplinary Tumor Boards play a pivotal role in the provision of high quality comprehensive cancer care. This dictum was thoroughly validated via a number of studies conducted across the world. In our region, our team of cancer carers came forward and we have tried to establish site specific Multi-disciplinary Teams in various institutes of the country and region. As expected, many hurdles of varied nature were encountered by our team and we are still traveller of this journey which we have started on voluntary basis. Site specific teams conduct this activity and maintain quality of these boards [1
Secondhand Water-Pipe Smoking and its Association with Systemic Inflammation among Cafés Employees in Karachi, Pakistan
No full textObjective: The study was designed to determine the correlation of exposure to secondhand smoking (SHS) of Water pipe (WP) with Neutrophils to Lymphocytes ratio and Platelets to Lymphocytes ratio. Material & Methods: A cross sectional survey was conducted among employees at cafes and restaurants of Karachi, where WPs were offered to customers. A total of 200 participants were selected through convenience sampling, out of which 181 consented to participate. Participants were divided into exposed (to SHS) and unexposed groups. Data were collected by using structured questionnaire, and blood samples weredrawn to measure systemic inflammatory markers (Neutrophil to Lymphocyte ratio NLR, Platelet to Lymphocyte ratio PLR). Data was analyzed by using SPSS software. Results: Among the included 181 participants, 48.1% (n = 87) were unexposed to SHS, 31.5% (n = 57) were exposed to SHS of WP and 20.4% (n = 37) were exposed to SHS of cigarette & WP. Mean NLR (P = 0.779) and mean PLR (P = 0.205) did not vary significantly according to exposure to SHS among participants. After adjusting for socio-demographic covariates, associated of NLR and PLR with exposure to SHS was also not found to have a statistical significance. Conclusion: The study found no correlation between exposure to SHS of WP and systemic inflammation using different markers. However,the cross-sectional nature of data and uncontrolled confounding and relatively lower level of exposure in the study sites may potentially explain the overall findings of the study
Knowledge and Awareness about Hepatitis B and C Infections among Visitors of the Gastroenterology Clinic of Tertiary Care Centre in Pakistan
No full textAbstract: Background: Hepatitis B and C infections are endemic in Pakistan. The general population has poor knowledge about the HBV vaccine’s availability and the modes of transmission for HBV/HCV. Therefore we decided to assess the knowledge of HBV & HCV infection, their spread and modes of prevention amongst the general population and its association with the ethnic, socioeconomic and educational status. Material and Methods: This cross-sectional analytical study was conducted in Gastroenterology clinic, Sindh Institute of Urology and Transplantation, Karachi, from August 2016 to December 2016. All patients and their attendants of age >18 years visiting GI-OPD were enrolled. A predesigned questionnaire was filled and data was entered in SPSS version 20.0. Results: Out of 641 respondents, 382 (59.6%) were males; the mean age of the participants was 38.46 ± 14.15 years. Only 44% respondents were aware about the availability of HBV vaccination. Most of respondents believed that re-usage of syringes, sharing of razors, use of unsterilized dental and surgical instruments can spread these infections. Majority had the misconceptions that these viruses can transmit through handshakes and hugs, smoking, alcohol use, sharing utensils and mosquito bite. Only 23 (3.6%) respondents had good knowledge. Statistical significance of adequacy of knowledge was noted with profession, monthly family income, education status and thnicity. Conclusion: Our study indicates the overall knowledge regarding the modes of transmission and prevention of HBV/HCV is very poor among the visitors of GI-clinic from different part of the country. We believe that our study highlights the need to increase the public awareness among general population of HBV/HCV infection in Pakistan. Public awareness seminars should be implemented with special emphasis on mode of transmission of HBV/HCV infection and measures to control risk factors
De Novo Deletion 17p (del17p) in an Adult T-Cell Prolymphocytic Leukemia as a Rare Presentation
No full textAbstract: T-Cell Prolymphocytic leukemia is a rare and an agressive lymphoproliferative disease which is unresponsive to conventional chemotherapy. We present a case of 72 years old female hospitalized in July 2018 in National Institute of Blood diseases and BMT, Karachi, Pakistan, having lymphadenopathy, splenomegaly, and leukocytosis with lymphocytosis, thrombocytopenia and peripheral smear showed predominant population of mature looking lymphocytes. Immunophenotyping shows CD45 (+), CD3(+), CD4(+), CD5(+), ZAP70(+), CD38(+)*, CD25(+)* and negative CD19, CD20, CD10, CD11c, CD8, FMC, Kappa & Lambda and cytogenetics by FISH showed del17 p53 in 35% of interphase nuclei. In patients of T-PLL, del 17 p53 has never been reported previously