National Journal of Health Sciences
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Chronic Kidney Disease (CKD): A Growing Medical Issue
No full textWith an annual growth rate of more than 2.08%, the 231 million population of Pakistan is set to surpass 330 million by 2030 [1]. The country’s health system continues to be plagued by a paucity of resources, poor governance, a poor health informa- tion management system, corruption in the healthcare industry, and a dearth of skilled workers. The sector suffers from meager health budget allocations [2]. Kidney diseases, one of the lead- ing causes of death and disability, get further impetus due to an increasingly high prevalence of Diabetes Mellitus that further accentuates CKD [3]. The frequency of DM is set to increase by over 150% between 2000 and 2030 in South Asia [4]
Prevalence of Anxiety and Depression in COVID-19 Patients and Frontline Healthcare Workers
No full textAbstract: Background: During global health crises such as the COVID-19 pandemic, understanding the psychological impact on both patients and healthcare workers is crucial for effective public health response and support strategies.
Objectives: To assess anxiety and depression prevalence among COVID-19 patients and healthcare workers in Pakistan, utilizing the Aga Khan University Anxiety and Depression Scale.
Materials and Methods: A cross-sectional survey from 20th May 2020 to 25th August 2020, using a 15-item structured questionnaire was conducted on patients diagnosed with COVID-19 and healthcare workers at the Pakistan Kidney and Liver Institute & Research Center, Lahore. The Aga Khan University Anxiety and Depression Scale - Short Form (AKUADS-SF) was employed to assess the levels of anxiety and depres- sion among the participants. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression to identify significant predictors of anxiety and depression.
Result: Of 183 participants, 55% were healthcare workers and 44.8% were patients. Preliminary findings showed 37.6% of healthcare workers had anxiety and depressive symptoms. Significant predictors among healthcare workers included family members with psychiatric disorders, family members affected by COVID-19, and a history of psychiatric disorders. Among patients, 13.4% had positive scores on the AKUADS-SF, with significant predictors being marital status (single), affected family members, smoking, and addiction.
Conclusion: The study identified significant anxiety and depression among healthcare workers and patients during COVID-19. Predictors for healthcare workers included family psychiatric issues and personal history, while patients’ predictors were marital status, affected family members, smoking, and addiction. This underscores the need for targeted psychological support
Blockchain Revolutionizing Healthcare Industry: A Survey of Existing Literature
No full textAbstract : Health care is a vast industry that requires huge data storage and sharing and this is where this industry faces multiple challenges and requires an efficient system. This review article aimed to summarize the benefits of the blockchain industry in the healthcare sector. Literature review was conducted through PubMed and Google Scholar. A total of 30 articles were selected for review purposes with keywords health care, blockchain technologies, and benefits of blockchain and blockchain and health care industry with search engines like Google Scholar, Research Gate, and APA journals. A thorough review of existing literature suggests that blockchain technology can be beneficial for many fields and subfields of the healthcare industry including patients, organizations, hospitals, pharmaceuticals, global record-keeping organizations, health professionals, and researchers. Blockchain can be beneficial as it is efficient, reliable, transparent, cost-effective, easily accessible, vast data storage and management enable, and many in many more ways. In a nutshell, the importance of blockchain in the healthcare industry and suggests incorporating this technology in healthcare for efficient working
Evaluation of the Progress of Coronavirus Disease-19 Pneumonia using the British Society of Thoracic Imaging Reporting Model: A Validation Study
No full textAbstract: Background: SARS-COV-2 (also known as severe acute respiratory syndrome corona virus-2), emerged as a pandemic and became an overwhelming global concern, causing substantial morbidity and mortality worldwide. Reverse transcription polymerase chain reaction (RT-PCR) is considered a gold standard in detecting clinically symptomatic patients but can have false negative and false positive results. As chest X-Ray (CXR) is considered as a baseline investigation in many hospitals, BSTI reporting model during COVID-19 pandemic has been a useful tool in diagnosis of COVID-19 pneumonia.
Objective: To validate the British Society Thoracic Imaging (BSTI) coding system in the evaluation of the progress of the disease severity in patients with coronavirus disease-2019 (COVID-19) pneumonia.
Materials and Methods: This is a cross sectional observational study. Total 450 CXRs (which included both the baseline and serial CXRs) of 225 COVID positive patients (RT-PCR positive for COVID-19 on nasal swabs) were included. These were retrospectively reviewed and reported by two Radiologists (having experience of at least 5 years in Radiology Reporting) in Corona Ward in Dr. Ruth K M Pfau Civil Hospital Karachi, Pakistan, for the duration of 10 months from 1st March 2020 till 31st December 2020. BSTI coding system was used to classify and interpret the CXR imaging findings as normal, definitive, indeterminate and non-COVID for baseline (CXR on 1st day of admission) and follow up CXRs (done in between 3rd and 7th day of admission). Data was analyzed using SPSS version 25. Numeric data was assessed for distribution using Shapiro-Wilks test. Median and interquartile range (IQR) were reported for numeric variables. Frequencies and percentages were reported for categorical data. Kappa statistics was applied to assess the agreement between BSTI scoring at baseline and follow-up CXRs. A p-value ?0.05 was considered as statistically significant.
Result: CXRs (including 225 baseline and 225 follow up CXRs) of 225 RT-PCR COVID-19 positive patients were analyzed. Interval change in BSTI coding system was noted, increase in frequency of probable/definitive COVID-19 findings were diagnosed on serial CXRs. The BSTI scoring at baseline and follow-up showed moderate agreement with kappa statistics as 60.3% (p=0.001).
Conclusion: BSTI coding system can be helpful to classify the COVID-19 disease on CXR and filter for the prognosis of disease severity in the serial radiographs. Utilization of BSTI reporting model for reporting CXRs, even before RT-PCR, in future COVID pandemic can be considered as a useful tool
Surgical Management of Idiopathic Scrotal Elephantiasis: A Rare Case Report
No full textAbstract: Etiologically, massive scrotal lymphedema can be either congenital or acquired. Congenital is further divided into different types while the predominant variety in the acquired category includes infectious etiology. We present a case of a 35-year-old male presented with the complaint of scrotal swelling for 3 years. Blood tests for filarial, chlamydia, and tuberculosis were unremarkable. Excision of excessive scrotal skin was done and sent for biopsy. The wound was partially closed, and the remaining was left for healing by secondary intention. The biopsy report showed non-caseating granulomatous inflammation with no significant lymph node involvement
Physician Burnout during Covid-19 Pandemic in Pediatric Emergency Rooms of Low-Middle Income Country, Pakistan
No full textAbstract: Background: Burnout can adversely affect the mental health, quality of life and quality of work of healthcare workers.
Objective: We aimed to assess the burnout rate among physicians working in pediatric emergency rooms during COVID-19 pandemic, in public sector hospitals of Pakistan.
Materials and Methods: It is a descriptive study performed in March 2021. We included all physicians working in the pediatric emergency departments of 9 public sector hospitals of Sindh, Pakistan, excluding those who didn’t give consent. The participants were sent an online questionnaire based survey, comprising of Copenhagen Burnout Inventory (CBI) tool along with three added COVID-19 specific questions. It was disseminated electronically. Data was analyzed using SPSS ver22.
Result: A total of n=249 physicians filled the forms out of 320, giving a response rate of 77.8%. Majority 187 (75.1%) were females. Most of the physicians were females n=187 (75.1%) and worked primarily in emergency department n=186 (74.7%). The Copenhagen Burnout Inventory (CBI) score revealed that 88 (35.3%) of the physicians had burnout (Score > 50). The most common component was Personal burnout in 122 (48.9%). Physicians working in emergency department, full time shifts and at junior designations had higher rates of burnout (P value <0.05).
Conclusion: Burnout is a significant problem in pediatric emergency departments, specifically during the COVID-19 pandemic. Timely training and provision of supplies along with safety, security and alleviation of fear are important strategies to overcome burnout
Outcome of Delayed Distally Based Sural Flap for Distal Tibial and Foot Defects
No full textAbstract: Background: Lower limb defects can be tricky to repair. We have limited options for reconstruction in the leg and foot region. Sural flap is considered as the workhorse for reconstruction of these defects. We present our case series of delayed reverse sural flap.
Objective: To determine the outcome of Delayed Distally based sural flaps for distal tibial and foot defects.
Materials and Methods: Study was carried out at plastic and reconstructive unit HMC and MMC. Over a period of 10 years from January, 2009 to December, 2018. This is a cross sectional study, presenting with soft tissue defects of foot. Patients presented in the emergency, as an outpatient or as referrals from another center. All patients were admitted and operated as elective cases.
Result: In 24 patients, there were no complications. Two patients (6%) had partial flap loss and required revision surgeries. Two patients had marginal flap necrosis and were treated conservatively.
Conclusion: This study presents our experience with use of reverse sural flap. It provides a reliable option for foot and distal leg defects. It is relatively easy to do and easy to learn. It can be attempted in centers where expertise or facilities for microvascular surgery are not available and in patients who are not ideal candidates for a free flap
Trend of Infectious Disease Positivity in Exchange and Voluntary Blood Donors at Regional Blood Centre, Karachi
No full textAbstract: Background: Pakistan has a high prevalence of hepatitis and increasing prevalence of HIV, these infections imply a serious risk to the health of those who need blood transfusions. As blood donors are generally considered as the healthy population, assessing the risk of these silent killers in the blood donors can overall help in understanding the potential impact of these infections on the general population.
Objective: As the TTI prevalence is increasing rapidly in our region, it is much needed to take necessary actions for its prevention. The first step should be the actual frequency of these TTI’s in healthy blood donors, so our study aimed to identify the positive ratio of Hep B, Hep C, HIV, malaria and syphilis in exchange and voluntary blood donors, their comparison and need of effective testing.
Materials and Methods: It is a retrospective analysis in which all the data is taken from BBMIS software and analyzed by SPSS version 23. We included 56732 donors from 2020-2022. Screening of Hepatitis B, Hepatitis C and HIV was done by Chemoimmunoliscence (CLIA) whereas ICT based screening was done for Syphilis and Malaria.
Result: Among donors, 50147 (88.4%) were exchange while 6585 (11.6%) were voluntary donors. The frequency of HCV was 3.1% followed by HbsAg (2.3%) and syphilis (1.6%), HIV 0.3% and the least was malaria 0.2%. As 88% of the donors were exchange, TTI positivity was also more in them.
Conclusion: The prevalence of TTI in donors of RBC Karachi is worrysome. It highlights the fact of Nucleic Acid testing significance. Though CLIA is a sensitive technique, 100% safety of blood products requires the implication of Nucleic Acid testing, moreover the implication of voluntary blood donation should also be considered significantly
Observed Adverse Effects of Sinopharm COVID-19 Vaccine in Healthcare Workers
No full textAbstract: Background: Covid-19 was first identified in Wuhan China in December 2019, and rapidly spread world over. Vaccine was always thought as first line defence against viral infections, and Covid was no exception. Although developed through different technologies, Pakistan got its share of Sinopharm from China and vaccination started in February 2021, with priority for Healthcare workers. There were lot of myths and hesitancy related with the adverse effects and urgency in approving these vaccines. Addressing adverse effects in post vaccinated population hence, became an important matter.
Objective: Aim of this study was to observe the adverse effects of this vaccine in Pakistani population, to assess safety and develop confidence in Healthcare Workers.
Materials and Methods: A cross-sectional Observation study was carried out in vaccinated Healthcare Professional through Non-probability purposive sampling over a period of one month. A team collected data directly, as well as on the telephone call. A Google form was also generated and sent. Information was collected and analysed on IBM-SPSS 23.0
Result: Majority of the participants were less than 55 years with female dominance. Among co-morbidities, hypertension was most common, followed by diabetes. In local and systemic adverse effects, pain and fatigue were most common, followed by muscle weakness, fever and headache respectively. These effects were also more common after first injection.
Conclusion: Results favor that people should be more careful after the first dose as more adverse effects were felt after that. This vaccine has a good safety profile as no major adverse effects were noticed. It was also considered safe for patients with co-morbidities
Oral Hygiene Practices of Rural and Urban School Going Children in Punjab
No full textAbstract: Background: The early years of life are essential for establishing a solid foundation for oral and dental health. Children with poor oral and systemic health typically have poor dietary habits and insufficient oral hygiene practices, particularly brushing.
Objective: To assess and compare the oral hygiene practices of rural and urban school-going children in Punjab.
Materials and Methods: This cross-sectional study was conducted from September 2021 to August 2022, after the approval of IRB, among five urban and five rural schools in Punjab using an interview-administered survey tool through purposive sampling of 600 students. The questionnaire was developed by the authors and validated using face validity. The data were stored and analyzed using IBM SPSS version 23.
Result: A total of 650 students were approached; out of them, 600 responded. Almost one-third of them had the habit of brushing twice daily (27%), whereas most were brushing once daily (65.4%). The rural school children used miswak, manjan, and their finger more significantly; however, toothpaste was the major agent for cleaning teeth (89.4%). The urban school children were using toothbrushes more significantly. Rural school children more frequently used Miswak and finger. Urban schoolchildren often brushed at night, whereas no difference was reported between morning and nighttime.
Conclusion: Most urban school children were using toothbrushes and toothpaste. The use of miswak and manjan was more common in rural areas. The most common time for brushing was morning and night. Rural areas need to have access to oral health education and subsidized toothpaste and toothbrushes