National Journal of Health Sciences
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Functional Outcomes of Subtrochanteric Femur Fracture Fixed with Dynamic Condylar Screw
No full textAbstract: Background: Orthopedic surgeons find it most difficult to manage subtrochanteric femur fractures because of its notorious location, where difficulties might arise. Various techniques, including intramedullary and extramedullary implant stabilization have been tried with varying level of success.
Objective: Our study aimed to assess the functional results of dynamic condylar screws in sub trochanteric femur fractures in order to aid the underprivileged masses in our area.
Materials and Methods: This prospective observational study was conducted in Akbar Medical Center Dabgari Garden Peshawar, Pakistan from September, 2018 to August, 2022. All patients of either gender having age above 20 years with proximal femoral fracture without concomitant fracture, with negative hepatitis profile and no diabetes were managed using a dynamic condylar screw. Functional outcome of the surgery was evaluated using Harris Hip Score.
Result: There were total 88 patients in the study with male to female ratio of 3:1 having mean age of 33.96±9.63. Postoperative functional outcome in terms of Harris hips score range from 64 to 94 with a mean of 83.87 ±7.27 SD. Excellent functional outcome were observed in 14.8% patients, good results in 64.8% patients, fair outcomes in 11.4% and poor outcome were observed in 9.1% patients.
Conclusion: DCS results are excellent and good functional outcome in majority of patients. Therefore, it can be used as a good alternative to other intra and extramedullary implants fixation
Disseminated Salmonella Typhi Infection Presenting with Slurred Speech and Encephalopathy: An Unusual Presentation
No full textAbstract: Salmonella enterica serovar Typhi causes systemic infections and typhoid fever in humans, mainly affecting infants and children. It presents mostly with fever, malaise, anorexia, abdominal pain, constipation, and/or diarrhoea. Complications of the disease include intestinal perforation and haemorrhage. However, sometimes extra-intestinal complications are also reported, which rarely include encephalopathy. This report presents a case of a 28-year-old male who presented with somnolence and later developed slurred speech. A week before his current admission, he was admitted with abdominal pain and underwent a laparoscopic appendectomy, and was discharged uneventfully. Now after eight days he presented with somnolence. His neurological examination was otherwise unremarkable. Imaging studies helped to rule out ischaemic stroke. A detailed system-wise examination revealed mild right upper quadrant tenderness and hepatosplenomegaly on abdominal examination. Imaging revealed hepatosplenomegaly with gallbladder wall oedema and mesenteric lymphadenopathy. Blood culture was reviewed, revealing extensively drug-resistant (XDR) Salmonella Typhi. A diagnosis of XDR Salmonella bacteraemia leading to encephalopathy was made. The patient responded well to antibiotic therapy guided by the culture and sensitivity
Factors Influencing Students’ Choice of Pursuing Nursing in Central Karachi
No full textAbstract: Background: The choice of pursuing nursing education is influenced by various factors that can vary from individual to individual. Determining these factors is crucial for improving the recruitment and retention of nursing professionals in the region.
Objective: This study aimed to determine the factors influencing students’ choice of pursuing nursing education in central Karachi.
Materials and Methods: Cross-sectional survey was employed, and data were collected from 1st-year nursing students of Generic Bachelor of Science in Nursing (GBSN). Convenient sampling was used to select participants from two Private Schools of Nursing in central Karachi from October 2022 to February 2023.
Result: A total of 100 participants were enrolled in the study, comprising 90% males and 10% females. Most of the students 70% strongly agreed that nursing is a profession characterized by caring and helpful attributes, and 50% agreed that it is also distinguished by recognition and respect. However, concerns were raised as 70% of students who disagreed or strongly disagreed that nursing is well-paid, and 52% felt it was too difficult for them.
Conclusion: Majority of nursing students viewed nursing as a caring and altruistic profession, which is considered a positive factor influencing their career choice. However, concerns about low pay and nursing as a difficult profession were highlighted
The 5Ss’ Approach for Managing Health of Client, Family and Community
No full textAbstract: Healthcare undergraduates’ curriculum is mostly based on clinical assessment and management of the patients. Consideration to the client, family, and community aspect is negligible. Health Management of a client requires a holistic approach encompassing the role of quality of services, communications skills, managing family and community; with ethical practices abiding the rules and regulations etc. World Health Organization (WHO) also defines health in terms of physical, mental, social and spiritual well-being and not merely the absence of disease or infirmity. Thus, for managing client, undergraduates need to be imparted with it is more than just teaching only the clinical approach. The 5Ss’ model concept is being presented for redesigning the healthcare undergraduate curriculum and to focus on the role of Self, Society, State, Systems and Spirituality as a part of the curriculum
Undergraduate Nursing Students’ Satisfaction Level with their Clinical Learning Experiences in Multan, Pakistan
No full textAbstract: Background: Clinical experience is an integral part of nursing education. Obtaining quality clinical experiences in a supportive and pedagogically calibrated clinical learning environment is a significant concern for nursing institutions. The quality of clinical learning reveals the quality of the curriculum structure. Therefore, it is important to investigate students’ clinical learning experiences to produce competent future nurses.
Objective: This study aimed to measure the undergraduate nursing students’ satisfaction level with their clinical learning experiences in government and private college of Nursing in Multan, Pakistan.
Materials and Methods: A quantitative approach, with analytical cross-sectional design, was used. A sample of 191 undergraduate nursing students participated in the study. Data was collected using the CLES+T evaluation scale. Online Google survey forms were used to collect data, due to the COVID-19 pandemic outbreak.
Result: The study findings revealed that students were satisfied with their clinical learning experiences. Students’ overall mean satisfaction score was 3.54 + 0.93 and significant (p<0.05) difference was found in the satisfaction score between the government and private undergraduate nursing students. Attending pre and post-conferences, faculty visit to students’ clinical placement, electronic communication between students and clinical faculty, and environment of clinical placement were the associated factors found with students’ satisfaction. The findings revealed that a meaningful clinical learning environment motivates students to continue nursing as their career choice.
Conclusion: This study concluded that, overall, students were satisfied with their clinical learning experiences, however, satisfaction varied according to the type of college and year of study
Frequency and Resistance Pattern of Carbapenemases (Class A & B) in E. Coli and Klebsiella Species
No full textAbstract: Background: Carbapenems are potent and strong antibiotics that are usually reserved as last resort for bacteria possessing basic antibiotic resistance. These are broad spectrum drugs with more effective coverage against gram negative organisms. The antibiotic resistance pattern observed in bacteria possessing chromosomal group 2f ?-lactamases is unique. It involves resistance to carbapenems while remaining sensitive to broadly attacking cephalosporins.
Objective: This study aims to provide assessment of frequency of class A & B carbapenamase in E.coli and Klebsiella species producers and establish the resistance pattern from clinical isolates, at a tertiary care hospital in Karachi.
Materials and Methods: This is a cross sectional, prospective study conducted at general hospital liyari, Karachi during Jan 2022- Jan 2023. Sample size was calculated as 400. Samples were divided into Urine samples of urinary tract infection patients (n=150), Pus sample from different sites (n=100), Respiratory tract, tracheal aspirates and sputum sample (n=100) and blood sample from suspected septicemia (n=50). SPSS-22 was used to enter and analyze the data. Chi-square test was used to analyze significance between two mean values, keeping ?0.05 as significant p-value.
Result: Distribution of microorganisms were reported as 120 (41.1%), 80 (28.5%), 2 (0.69%), 24 (8.36%), 55 (19.1%) and 6 (2%) of E. coli, Klebsiella Pneumonia, K.Oxytoca, Gram positive. Gram negative and Yeast respectively. The confirmed presence of carbapenemase (CP) was identifies in urine sample as 4/6 (26.6%) E.coli and 2/6 (13.3%) Klebsiella, while pus samples identifies 3/4 (20%) E.coli and 1/4 (6.6%) Klebsiella. Similarly samples of respiratory tract identifies 2/5 (13%) of E.coli and 3/5 (20%) of Klebsiella. The calculated p-value was insignificant with 0.834 and 0.913 for E.coli and Klebsiella respectively.
Conclusion: This study concludes that E.coli is by far the most frequently reported microorganism from class B while class A organisms are in lower frequencies. CRE indicated higher resistance from non-?-lactam antibiotics, limiting treatment options
Selecting the Right Cooking Medium
No full textThere are few areas that are so riddled with confusion, contradictions, misinformation and conflicting opinions and recommendations than the issue of selecting the right cooking oil and fat for preparing one’s food. It is imperative to understand the basic facts about fats and oils. While the chefs are fixated on an oil with a mild flavor and a high smoke point, the health experts are more concerned with the polyunsaturated versus saturated fat discussion. The issue is plagued with various misconceptions like Polyunsaturated Fatty Acids (PUFA) being always healthy, assumption that flax or apricot oil must be healthy since the source is healthy, and overemphasis on smoke point without considering the process that the oil might have gone through. For instance, flax seed oil may have beneficial Omega-3s and PUFA, but, the low smoke point damages these rendering them pro-inflammatory
Cloward Procedure Outcome using Hashmi Cage for Anterior Cervical Discectomy and Fusion Experience in Pakistan
No full textAbstract: Background: We aim to focus on ACDF patients treated with Hashimi cage filled with autologous bone. We will assess the safety of this approach based on the specific surgical level and its outcome.
Objective: Study aims to evaluate the results of the Hashmi cage used in the Cloward Procedure while using odom’s based criteria for the outcome.
Materials and Methods: This was a descriptive study researched at the Neuro Spinal Cancer Care Institute in Karachi, time duration from 16 June 2016 to 31 June 2022. The study included patients with a single-level prolapsed intervertebral cervical disc. During the surgery. Bony Fusion was assessed using movement ? 1 mm in flexion and extension cervical X-rays, was required.
Result: We had 162 patients; among them males were 102 (62.96%) and female patient were 60 (37.03%). The median range for the age was from 23 to 63 years with mean 48 years ± 3.6 age. Clinically the patients presented with radiculopathy, commonly of the C6 level which was patients (63.73%). Odom’s based criteria were used to evaluate the results of the procedure. Among the patients, 92.84% showed excellent outcomes, 4.9% had good results, 1.8% had fair outcomes, and 1.23% had a poor outcome.
Conclusion: ACDF with the Hashmi cage and plate application is a highly effective treatment option. This approach not only ensures better removal of the problematic discs but also significantly increases the likelihood of successful fusion and better radiological outcomes
Comparison of Efficacy and Safety of Thalidomide vs Hydroxyurea in Thalassemia Patients: A Single-Centre Pilot Study
No full textAbstract: Background: Beta thalassemia is a genetic disorder causing defective beta globin chain formation, leading to ineffective erythro- poiesis and hemolysis. It has three types: thalassemia major, thalassemia intermedia, and thalassemia minor. Treatment options include blood transfusions, iron chelation therapy, and bone marrow transplantation, but new treatments like HbF inducers (e.g., hydroxyurea) and erythro- poiesis modulators are being developed. Thalidomide and hydroxyurea are also being used to manage thalassemia by increasing HbF synthesis and reducing transfusion frequency.
Objective: To compare the efficacy and safety of thalidomide and hydroxyurea in beta-thalassemia patients for a period of six months.
Materials and Methods: A Prospective interventional single-centre study was conducted the tertiary care hospital of southern Pakistan, from 1st September 2021 to 03rd March 2022. A total of 39 patients of beta thalassemia major and intermediate with age ranges of >10 and <30 years were enrolled in this study. 24 patients were fulfilling the study requirement. Thalidomide was started with a dose of 50 mg/day (in patients >10-13 years) while the adult dose was 100 mg /day (age >13 Years) every night. Hydroxyurea was given at 15 mg/kg /day. Pre and post-treat- ment tests were done. For assessing the safety of thalidomide and hydroxyurea biochemistry test was done along with LDH, Platelets counts, and WBCs count. The efficiency of both drugs was analyzed by hemoglobin, reticulocyte count, nucleated red blood cells, MCV, MCHC, white blood cells, and platelets.
Result: Both groups showed a highly significant increment in Hb. Thalidomide treated group baseline was 6.8 ±1.3 and after 06 months 8 ±13; (p-value <0.001). Furthermore reticulocyte count was highly significantly augmented in HU treated group (p-value <0.001) Hydroxy- urea-treated group showed significant decline in NRBC with a difference of -2.3±1.1 (p-value 0.02). Moreover, the transfusion interval was more significantly increased in the thalidomide group. The hemolysis parameter, LDH significantly declined in both groups. The hydroxy- urea-treated group showed difference of -62.4±124.4 (p-value 0.03) while the thalidomide-treated group showed a difference of -64.36±32.9 (p-value 0.05). AST was only significantly decreased in thalidomide treated group.
Conclusion: Among both groups, hemoglobin, RBCs and reticulocyte count levels raise in both groups while NRBCs significantly decrease in HU treated group. Moreover, transfusion interval was also significantly increased by thalidomide. It shows safety by significantly decreasing the TBIL and AST, whereas LDH was decreased in the HU-treated group. This clinical trial was registered as # NCT06239389
Radiomics: A Powerful Tool
No full textThe Artificial Intelligence based technique of radiomics is an evolving modality that employs data characterization algorithms to extract a variety of useful features from medical images [1].Tumoral patterns are revealed that cannot be appreciated by the naked eye [2]. This can aid in assessing prognosis and gauging the response of tumor cells to therapy [3].
Various imaging modalities like CT, PET MR provide essential raw data. Extraction tools then use the raw data volumes to analyze pixel/voxel characteristics. Using these images, “volumes of interest” can be generated since such segmentation entails handling and processing of large image data; automatic and semiautomatic segmentation algorithms are employed enabling automation [4]. However, thorough testing and quality assurance are vital to ensure that the algorithm used is not only accurate, consistent, and reproducible but also time-efficient [5]