National Journal of Health Sciences
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Multi Organ Failure (MOF) and a Promising Novel Device
No full textAcutely ill hospitalized patients are at risk of cascading failure of vital organs leading to prolonged stay in the hospital, persistent dysfunction of vital organs and higher probability of death. It is estimated that 50 to 75% of ICU patients have failure of one or more vital organs and as more organs are involved the risk of death increases [1, 2]. For example in Acute on Chronic Liver Failure (AOCLF) the 28 day probability of death increases from 20% with one vital organ failure to 90% or higher if 3 or more organs are involved. Dysfunction of brain, lungs, heart and kidneys are most commonly seen, kidney involvement is usually poor prognostic sign
Association of Simple Febrile Seizure with Iron Deficiency Anemia in Children: A Case Control Study
No full textAbstract: Background: Febrile seizure is an established entity in Pediatrics which characterizes with absence of any intracranial infection or metabolic disorders. Simple febrile seizure carries a favorable prognosis without any sequelae. Still, it emerges as the most common etiology of seizure till the age of five years. Iron deficiency anemia is a commonly witnessed micro-nutrient deficiency with a worldwide distribution.
Objective: To establish relation of simple febrile seizure with iron deficiency anemia in paediatric population.
Materials and Methods: Case-control study, conducted in Pediatric Medicine Department, King Fahad Armed Forces Hospital Southern Region, Khamis Mushayat, Kingdom of Saudi Arabia, from1st January 2022 to 30th June 2023. The 102 children, having age six months to five years, with a diagnosis of first simple febrile seizure were assessed. Likewise, the control group included 102 febrile children without convulsion. The hematological parameters evaluated for diagnosis of iron deficiency anemia included hemoglobin, mean corpuscular volume, serum ferritin, serum iron, total iron binding capacity & red cell distribution width.
Result: The mean age for first simple febrile seizure was 23 months. Acute respiratory infection was the most common etiology (80%). Iron deficiency anemia was identified in 17% of cases of simple febrile seizure, in contrary to 6% of cases with febrile illness without seizure, with odds ratio of 3.2.
Conclusion: This study demonstrated that the children with iron deficiency anemia are at significantly higher risk of having febrile convulsions compare to control group with fever but without anemia
Mental Health Challenges due to Health Care Discrimination among Transgender Youth: A Selective Review
No full textAbstract: Background: Transgender youth face various difficulties including mental health due to discrimination in healthcare settings because of their gender orientation. This review investigates the mental health of transgender youth and health care discrimination leading to inadequate health care.
Materials and Methods: The study complied with the latest publications using PRISMA reporting guidelines. For the selective review, 19 articles were selected over the last five years (between 2017 and 2022) which were primarily focused on mental health challenges and lack of health care due to health care discrimination among transgender youth. The study included publications at a global level, citing the global articles first, followed by Asia. The study only took into account biological and/or non-biological factors for the young transgender community, including both male and female factors.
Result: All 19 articles confirmed the positive significance of the Mental Health of the transgender youth community due to discrimination meanwhile, 08 articles mainly indicated about lack of healthcare or unfair healthcare in settings due to being transgender along with mental health concerns. This review identified the differences in mental health and discrimination that the transgender population faces.
Conclusion: As a reform, lower levels of depression and suicidality have been associated with social transition and having access to gender-affirming medical treatment. However, policies affecting this young transgender minority, who experience mental and social prejudice, must be changed. Multilevel intervention should also be advocated to address both of these severe issues
Depression, Anxiety, and Stress in Patients Undergoing Hemodialysis: Assessment of Contributing Factors
No full textAbstract: Background: The frequency of Chronic Kidney Disease (CKD) assessed worldwide is 13.4% (11.7-15.1%), and cases with ESKD demanding renal replacement therapy are calculated to be between 4.902 and 7.083 million. Several factors prompt anxiety and depression in hemodialysis cases. These include co-morbidities, frequent hospitalizations, habitual pain, sleep disturbances, chronic inflammation, increased fatigue, uremia, failure of family support, non-compliance to adjunctive therapeutics such as restrictions in diet and fluids, and dependence upon treatment and health professionals.
Objective: To assess the frequency and contributing factors for incidents of depression, stress, and anxiety in hemodialysis patients.
Materials and Methods: This is an observational, cross-sectional study conducted at the Karachi Institute of Kidney Diseases from February 2023 to March 2023, the obtained minimum sample size was 194. Data was collected with the help of DASS 10 questionnaire. The data was entered and analyzed by using Statistical Package of Social Sciences (SPSS) Version 22. Data significance was analyzed using Chi-Square test keeping P- value ?0.05 as significant.
Result: A total of 194 participants were recruited in the study, gender distribution recorded male dominance at 103 (53%) and females at 91 (46%). 139 (71.6%), the mean value of the length of dialysis was 15.4 ± 4.9 years while the mean days of dialysis were 2.7 ± 1.3. Moderate depression was reported in 101 (52%) of the study participants, while severe depression was reported in 25 (12.8%). Anxiety was reported as mild most frequently with 133 (68.5%) while stress was reported as mild in 48 (24.7%), moderate in 83 (42.7%), and severe in 63 (32.4%) with a p-value of 0.214. We identified a positive association of severe depression, anxiety, and stress with age ? 45 years in general, while participants from the upper middle class reported stress more frequently.
Conclusion: This study concluded that compromised socio-economic status, young age, and higher prognosis rates are contributing factors for depression, anxiety, and stress in hemodialysis patients
Impact of Metallic Brackets on Self-Perception of Orthodontic Patients
No full textAbstract: Background: The field of orthodontics has seen a drastic increase in patients demanding esthetic brackets. Metallic brackets have a negative impact on smile esthetics but their effects on orthodontic patients in terms of change in their self-perception, social interaction, confidence, experience of getting bullied have not been studied before.
Objective: This study aims to see the patients’ real social and psychological experiences while undergoing orthodontic treatment with metallic brackets.
Materials and Methods: This was a descriptive, cross-sectional study conducted for eight months at ABC Dental College, utilized 200 printed questionnaires that recorded data related to patients’ demographics, change in confidence, anxiety, experience of getting bullied, self-perception and social interaction after getting metallic brackets. Convenience sampling technique was used and patients who consented and had metallic brackets for at least 6 months were included. Data was analyzed by Statistical Package for the Social Sciences (Version 16.0) and reported in percentages.
Result: The age range of the patients who participated was 12-40 (mean=26) years. The patients who felt shy were 64 (33.7%) while, 57 (30%) had their smile esthetics affected, 37 (19.4%) were bullied and 46 (24.2%) experienced negative impact on their self-perception after getting metallic brackets. However, 103 (54.2%) of the patients would have selected esthetic brackets if had a choice.
Conclusion: Most of the patients felt good after having metallic brackets and their self-perception, confidence, and social standing did not get affected adversely. Though, most of them showed inclination towards esthetic brackets over metallic ones if given a choice
Tumefactive Multiple Sclerosis: A Mimicker of Intracranial Space-Occupying Lesions
No full textAbstract: A chronic disease of CNS, Multiple sclerosis is characterized by inflammation and demyelination with axonal injury affecting upper motor neurons of brain or spinal cord. Tumefactive multiple sclerosis is a rare form of MS which mimics intracranial tumor-like space-occupying lesions on radiography. A 25-year old gentleman presented 2-month history of gradual onset difficulty in walking, slurring of speech and double vision. The patient had an ataxic gait accentuated by tandem walking with tendency to fall towards right and a negative Romberg’s sign. There was dysarthria and signs of cerebellar lesion present on the right side. Muscle tone was normal in upper limbs but increased (spasticity) in lower limbs bilaterally. Power was normal but deep tendon reflexes were exaggerated in all 4 limbs with bilateral up-going plantar reflex. MRI scan of the brain demonstrated tumour-like tumefactive lesions in the right cerebellum, right pons and the left subcortical region with no post-contrast enhancement of these lesions. MRI of whole spine demonstrated subtle hyperintense signals in the cervical spine. He had a past history of transverse myelitis 2 years ago with full clinical recovery with oral steroids. He was diagnosed with Tumefactive Multiple Sclerosis and started on corticosteroid therapy resulting in dramatic improvement
The Non-Accessible Ureter: Can History, Gender, Age, BMI, Radiology and Stone Size Predict the Requirement of Pre-Stenting in Narrow Ureters
No full textAbstract: Background: The difficulty in access to the ureter during stone removal surgery enhances the chances of redo-surgery, DJ stenting, and associated complications, this failure leads to mistrust in the doctor-patient relationship.
Objective: This study aims to provide a comprehensive evaluation of the incidence & management of narrow ureters after failure to negotiate retrograde access of rigid or flexible Ureteroscope (6/7.5 Fr ).
Materials and Methods: This is a Prospective, cross-sectional study, conducted at the urology department of Tabba Kidney Institute, from June 2022 to June 2023. The minimum required sample size was 250. Patients aged between > 18 to <60 diagnosed with Unilateral and bilateral ureteric stones and hydronephrosis without ureteric stone obstruction were included in the study. SPSS 22 was used to analyze the data, the chi-square test was applied, with p-value <0.05 as significant.
Result: The overall mean age of the study population was estimated as 40.71 ± 12 years, while gender distribution indicated 138 (55.2%) male and 112 (44.8%) female patients. Group distribution identified 172 (68.8%) patients with negotiable ureter (Group A), while 78 (31.2%) with non-negotiable ureter (Group B).
Conclusion: We conclude that in our population there is a higher incidence of narrow ureters, as compared to other studies which are not accessible even using the same dilatation technique, so it is safe to counsel the patients pre-operatively about the possibility of the narrow ureter and need for pre-stenting. Tabba Ureter Accessibility (TUA) score can be used as a tool to predict the possibility of a narrow ureter
Association of Hand Dominance with Mechanism and Type of Hand Trauma in Patients Presenting at Civil Hospital Karachi
No full textAbstract: Background: All of the daily tasks in adults’ life such as eating, use of computers, kicking, throwing, learning, and writing are done with using the dominant hand. There are distinctive differences in hand functioning as an influence of hand dominance.
Objective: To determine the pattern of hand injury, its mechanism and its association with hand dominance in patients presenting at emergency department of Civil Hospital Karachi.
Materials and Methods: This cross-sectional study was performed in Emergency department, Civil Hospital Karachi during February to Octo- ber, 2023. Adults of age 18 years and above of any gender presenting with acute hand injuries were included into the study. Patients committed suicide and amputed upper limbs were excluded from this study. Patients’ data was documented in a pre-designed proforma. Data was analyzed using SPSS version 26.
Result: Total 249 patients were enrolled into the study. Median age of patients was 22 (IQR=18-33) years. Majority of patients were males (n=209, 80.6%). Majority had injury in their right hand (n=175, 70.3%) and dominant hand (n=171, 68.7%). The most common injury mode was road traffic accidents (n=90, 36.1%) followed by assault (n=71, 28.5%), workplace (n=70, 28.1%), burns (n=10, 4%) and knife cut injuries (n=8, 3.2%). Frequency of workplace injury was significantly higher among dominant hand than non-dominant hand. Frequency of RTA and assaults was higher in non-dominant hand (p<0.001).
Conclusion: The present study analyzed that in most of hand injuries cases dominant hand was affected. Frequency of workplace related hand injuries was significantly higher among dominant hand than non-dominant hand
Assessment of Knowledge about Referral Letters among Fresh Graduates and General Dentists of Karachi
No full textAbstract: Background: Medical or dental referrals are a very significant part of a health professionals’ job. It is imperative that they are proficient in developing effective referral letters with relevant information and sequence.
Objective: To find out how much the dentists know about effective referral letter writing. To assess the knowledge of fresh dental graduates and general dentists in Karachi regarding referral letters.
Materials and Methods: It is a cross-sectional questionnaire-based study. A questionnaire was developed consisting of two parts; first part pertaining to demographic data while second part consisted of multiple-choice questions. Convenience sampling technique was adopted and a sample size of n=75 was collected. Our study setting was Jinnah Medical and Dental College for fresh graduates while general dentists were approached from all over Karachi. The fresh graduates who were absent on the day of data collection and anyone who did not give consent was excluded from the study. Participants were approached by one of the investigators to fill out the designated questionnaires. Study duration spanned from October 2022 to January 2023. Data was documented in SPSS version 25 and frequencies calculated. T-test was used for comparison.
Result: Knowledge of n=35 fresh graduates and n=40 general dentists regarding referral letters was assessed. 31.4% of fresh graduates and 25% of general dentists exhibited good knowledge on cut-off scores. No significant comparative difference in the level of knowledge of the two groups was determined regarding the components of a referral letter.
Conclusion: Participants were well informed and knowledgeable about the relevance and importance of a referral letter
Orbital and Ocular Myiasis
No full textAbstract: Myiasis is the body’s infestation with maggots or eggs/larvae of certain flies. The infection is ether specific or non-specific. Although human Myiasis is rare, members of cyclorhabid, specifically the genus of Sarcophaga and Oestridae (Diptera), mainly produce myiasis [1]. Ocular and periocular myiasis are very rare and only few case reports have been published so far. Ophthalmomyiasis generally occurs in humans’ eyes, residing or working in close contact of livestock [2]. Older people, children, immunodeficient (people with orbital carcinomas, those with diabetes mellitus and with immunosuppressive drugs treatments) are affected usually [3]. However, there are few reports in which the infestation occurs in immuno-competent hosts. Compromised environmental sanitation and poor personal hygiene are often held as responsible factors. Infestation happens after fingers’ contamination after dealing with the infested livestock or by the fly itself. Under the skin, the larvae start the tissue penetrating and later they transform into large maggots. In the recent past ivermectin has largely been used with great success as non-invasive method of treating orbital myiasis [4]. The objective is to present a very rare case of ocular myiasis in a patient with infradiagnosed and careless squamous cell carcinoma of the upper eyelid