National Journal of Health Sciences
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Proposal to Publication: Experience of a Research Capacity Building Initiative from a Low Middle-Income Country
No full textAbstract: Research is primary to academic acceleration and no intellectual growth can happen without its presence. To pursue the recom- mended path of academic progress, research training and capacity building are essential. In low-middle-income countries, institutes lack skilled human resources and financial stability to plan & implement an outcome-based research training program. This article describes an experience of executing a research capacity-building program with minimum financial and human resource. The article is written from the lens of an orga- nizer and a participant, to share challenges and areas of improvement
Charlson Comorbidity Index can be a Predictor of Post-Operative Complications and Hospital Stay by Using Clavien-Dindo Classification of Patients Undergoing Per-Cutaneous Nephrolithotomy
No full textAbstract: Background: The post-operative complications after PCNL are comparatively higher in patients with comorbidities such as old age, recurrent renal stones, multiple stones, stone location and composition.
Objective: The purpose of this study is to evaluate the efficacy of Charlson comorbidity index to predict the post-operative complications and hospital stay of elderly patients by using Clavien Dindo classification under-going PCNL.
Materials and Methods: This is a prospective follow-up study, conducted at urology department of Tabba Kidney Institute. Patient aged ? 50 years, both genders diagnosed with Single or multiple, unilateral or bilateral renal stones and, solitary kidney were included in the study. CCI and Clavien Dindo classifications were documented and analyzed for associated and independent results. SPSS 22 was used to analyze the data.
Result: Total 152 participants were recruited in the study. The mean age of study population was 53.5 ± 14.2 years, with range of 38 years. Stone clearance was reported as 97% with 147(96.7%) complete stone free cases and 5(3.2%) cases with confirmed residual stones requiring METs to achieve complete clearance. Correlation of CCI and Clavien Dindo classification identified that there is a direct association with higher grading of both classification with post-operative complications. Assessment of odds of outcome were higher in Grade III Clavien Dindo with 1.48 indicating positive odds of complications and CCI higher grading.
Conclusion: Charlson Comorbidity Index is a swift, simple, and reproducible scoring system to properly calculate the morbidity and mortality after PCNL
Diagnostic Comparison of Transabdominal and Transvaginal Ultrasound in Determining Endometrial Thickness
No full textAbstract: The investigation of the endometrium is essential for any pathology related to the female menstrual cycle. Endometrial thickness serves as a significant biomarker in transvaginal and pelvic ultrasound examinations, closely tied to gynecological function. To enhance the precision of predicting endometrial thickness, we have synthesized various studies and literature to incorporate bleeding patterns and combine transabdominal and transvaginal ultrasounds. These techniques offer accurate and noninvasive means of exploring endometrial thickness (ET).
However, the current body of literature lacks a unanimous agreement on the threshold value for defining normal ET levels, especially when considering women who are symptomatic or asymptomatic during both pre and post menopause stages. This study aims to compare ultrasound findings in endometrial thickness between transabdominal and transvaginal approaches. Several studies suggest that pelvic ultrasound pro- vides a reliable method for diagnosing endometrial conditions and assessing uterine pathologies by observing internal genitalia morphology.
Conversely, transvaginal ultrasound is suggested as a primary approach due to its superior resolution and broader field of view, positioning it potentially as the first-line technique
Correlation of Blood Groups and Intelligence Quotient Levels among Medical Students
No full textAbstract: Background: Blood group and intelligence are both highly heritable traits unique to each individual. For the past several years, a possible correlation between these two traits has been suggested but existing studies report contrasting results in different geographical populations.Objective: To investigate a potential relationship between blood group and intelligence among consenting medical and dental students of Dow University of Health Sciences, Karachi.Materials & Methods: This study is a cross-sectional study involving the MBBS and BDS students of Dow University of Health Sciences within age group of 18-21 years. The study was conducted in the department of Physiology, Dow Medical College (DUHS) from 15th February 2021 to 1st July 2021. After the Institutional Review Board’s approval, we determined the ABO and Rh blood group of the participants through test tube method (forward grouping) during the physiology practical sessions. Intelligence levels were assessed using the Stanford Binet IQ Test. SPSS 21 was used to analyze the data collected.Results: Out of 353 participants, 67 (18.98%) were male and 286 (81.01%) were female with a mean age of 20 years. We found highest IQ scores in blood group A negative (25.80±8.25) with no statistical significance (p=0.162). Moreover, there was no statistically significant difference between the intelligence of male and female participants (p=0.257).Conclusion: Blood group and intelligence of an individual are two heritable traits that are not linked with each other. There is no difference in the IQ of males and females. This finding has important implications in the educational field as it shows that male and female students of different blood groups have similar cognitive capabilities and consequently, similar educational needs
Experience from Cancer Registry of a Developing Country Regarding Quality of Care and Non-Compliance among Osteosarcoma Patients
No full textAbstract: In this study, we evaluated the level of care given by our institution and to assess the non-compliance along with predictor for
non-compliance among osteosarcoma patients.
Materials and Methods: The included participants were proven for osteosarcoma after biopsy between January 2014 to December 2020.
Records were searched from Departmental Cancer Registry for details regarding treatment plans and follow-ups. The data of outcomes were
compared with the standard guidelines. Patients who did not attend follow-ups, surgery or chemotherapy were termed as non-compliant. The
patients or their next of kins were inquired about the factors behind non-compliance.
Results: 46 participants with 34 (74.9%) males and 12 (26.1%) females and a mean age of 19.7± 9.7 years were included. The prescribed
treatment plan was followed by 11 (23.91%) patients. Neoadjuvant and adjuvant chemotherapy were taken by 18 (39.13%) and 10 (21.74%)
candidates, respectively. Surgery was performed in 22(44.9%). The patients who did not received chemotherapy was attributed to affordability
(P=0.008) and patients’ or next to kins’ choices (P=0.02) while age (P=0.039), patients’ consent not given (78.3%; P=0.05), and stage II
(52.2%; P=0.048) were predictors of surgical non-compliance.
Conclusion: We conclude that the care deferred significantly from the guidelines regarding surgery and chemotherapy. Age, affordability, late
stage, and personal choices are the significant predictors for non-compliance for chemotherapy and surgery
Validation of MRI Quantification of Liver Fat, Keeping CT Liver Attenuation Index (LAI) as Gold Standard
No full textBackground: Non – Alcoholic Fatty Liver Disease (NAFLD) is emerging as a considerable health problem in patients visiting gastroenterology clinics. It is of crucial importance to evaluate the extent of hepatic steatosis in potential candidates for living donor liver transplantation (LDLT) to ensure donor safety as well as optimum graft regeneration.Objective: To validate the MRI quantification of liver fat keeping CT liver attenuation index as gold standard.Materials and Methods: This cross-sectional study was carried out in the department of Diagnostic Radiology, Pakistan Kidney and Liver Institute and Research Centre from 10th October, 2022 to 10th December, 2022. We determined the sample size using WHO sample size calculator. The MR fat fraction sequence was acquired as a part of the obligatory MRCP in 70 potential liver donors who undertook CT abdomen. Liver Attenuation Index (LAI) and MR fat fraction were determined separately by two radiologists who were blinded to each other. LAI was calculated as: Mean liver attenuation – mean splenic attenuation. MRI fat fraction from seven areas of liver were taken and their mean calculated to determine the percentage of liver fat. SPSS version 20 was employed for statistical analysis and Pearson’s Correlation was applied.Results: Among the 70 donors 42 were males and 28 were females (M: F= 1.5: 1). The hepatic fat fraction values on MR were correlated with the liver attenuation index on CT using a two – tailed Pearson correlation test. The results showed a very strong negative correlation between the two; the lower the LAI, the higher the MR fat fraction (Pearson correlation coefficient r = -0.932, p<0.05).Conclusion: Strong correlation was found between MRI estimation of liver fat and CT LAI fat estimation. MRI is safer than CT as it does not involve ionizing radiation, is quicker to perform, and hence can be recommended as future method of choice
Perception and Attitude of Dental Students and Graduates towards Business Management as a Subject in the Dental Curriculum
No full textBackground: In the past two decades, dentistry has transformed into a market-driven, entrepreneurial industry; consequently, the next generation of dentists must demonstrate proficiency in the disciplines of dental economics.
Objective: To identify the attitude, awareness, and willingness of final-year dental students and dental graduates regarding dental business management as a subject in dentistry.
Materials and Methods: This cross-sectional study was conducted from April 22 to September 22, with the approval of the IRB of CMH Lahore Medical College. The survey was conducted using online questionnaires developed by the authors and sent to the final-year dental students and young dental graduates in private and public dental colleges. The first part targeted demographics, and the second part dealt with attitude, awareness, and willingness regarding dental business management as a subject.
Results: A total of 281 people responded, with 48.6% males and 53.4% females. Lack of business knowledge (n=198, 70.5%) and a lack of funds (n=157, 55.9%) were key obstacles. Most respondents were slightly aware (n=141, 50.2%) of the criteria for setting up a dental practice. 95.7% (n=267) were not taught dental business management, nor had any seminars (n=187, 66.5%) or workshops (n=184, 65.5%). Most respondents agreed (n=243, 86.4 %) that business management will help them establish a successful practice. A significant difference was observed between private and public institutions regarding lack of funds, confidence, and communication skills.
Conclusion: Most students had favorable opinions on dental business management as a subject in dentistry. We must teach aspiring dentists both dental education and business management at the same time
Inherited Bone Marrow Failure Syndromes – Challenges and Updates
No full textAbstract: Congenital or inherited bone marrow failure syndromes are hereditary syndromes of diverse nature which are characterized by
inadequate production of blood cells causing cytopenias. Failure of bone marrow can be limited to one or more lineages of blood cells, along
with symptoms specified to lineage, through it can affect all cell lineages leading to clinical picture like aplastic anemia. These syndromes are
genetic diseases of heterogenous nature caused by germline mutations affecting basic pathways of cell including telomerase biology,
biogenesis of ribosomes, structural proteins, and repair of DNA. Common inherited bone marrow failure syndromes consist of Schwachman –
Diamond syndrome, Diamond – Blackfan anemia, Fanconi anemia, and Dyskeratosis Congenita. These syndromes have different prognosis
and tendency to develop solid or hematological malignancies. Therefore, the adequate diagnosis of these disorders and their differentiation
from other bone marrow failure syndromes and/or other etiologies of the bone marrow failure is very significant for surveillance and
management of patients. Acquired causes may also lead to bone marrow failure including radiations, chemicals, drugs, immune diseases, viral
infections, myelodysplastic syndromes, large granular lymphocytic leukemia, or paroxysmal nocturnal hemoglobinuria (PNH). Inherited bone
marrow failure syndromes are heritable and affects family members as well, therefore need genetic counselling. In this review, differential
diagnosis, various causes, and their pathogenesis of discussed for better understanding of inherited bone marrow failure syndromes
Benefits of Ferric Carboxymaltose Administration for Enhanced Hemoglobin Levels in Urban Population of Sindh: BOFERIN® Observational Study
No full textBackground: Iron deficiency anemia is a major public health issue in developing countries, especially among women of reproductive age. Anemia is a major public health problem in women of reproductive age in rural Pakistan and a large proportion of women were found to have low levels of serum iron.Materials and Methods: A multicenter observational cohort study was conducted at Karachi & Hyderabad from 8th February 2022 to 30th April 2022. Women with low hemoglobin level and age 18-45 years were included in this study. Patients were grouped according to 1-week assessment and 3-week assessment of hemoglobin concentration. A single dose of a generic substituent ferric carboxymaltose (Boferin®) was administered to the patients over 15 minutes infusion. Baseline hemoglobin levels were compared at 1 week and 3 weeks after administration of Ferric Carboxymaltose.Results: A total of 104 patients were enrolled in this study. The mean hemoglobin levels at baseline were 9.22 ± 0.175 g/dl and 7.55 ± 0.329 g/ dl for 1-week and 3-week, respectively. The mean hemoglobin increases after 1 week and 3 week was reported as 1.4211± 0.169 g/dl (p< 0.001) and 2.321± 0.335 g/dl (p< 0.001) respectively. Only three patients presented with mild to moderate adverse effect which included abdominal discomfort and nausea.Conclusion: This is a first in class study has shown statistically significant increase in hemoglobin at 1-week and 3-week interval with minimal side effects. It is concluded that Boferin® is efficacious in increasing hemoglobin levels in patients with iron deficiency anemia with its safety being documented in pregnant Pakistani population as well
Barriers and Beliefs Related to Covid-19 Vaccine in a Rural Area of Peshawar, Pakistan
No full textBackground: After the corona virus outbreak, a new challenge has presented itself in the form of vaccine hesitancy, a decision which stems from personal beliefs and perceptions, which may lead to the prevalence of a disease that can otherwise easily dealt with.Objectives: This study aimed to determine the barriers and beliefs related to COVID-19 vaccine in a rural area of Peshawar, Pakistan.Materials and Methods: An analytical cross-sectional study was conducted from May 2021 to October 2021 on a population from rural areas of Peshawar with a non-probability convenience sampling technique. An interview based self-administered questionnaire was used with questions regarding beliefs and about the COVID-19 vaccine as well as their vaccination status. An SPSS software was used to analyze the data for descriptive as well as inferential statistics.Results: A total of 526 people from the rural area participated in our study with 73% males (n = 384) and 27% females (n = 142). Only 23.6% got vaccinated voluntarily, 8% agreed that there was enough information available regarding the vaccine to trust, around 17.5% agreed the vaccine does not cause adverse reactions, only 15.6% believed that the vaccine had no unknown side effects, 22.1% trusted the vaccine to be effective in combating the coronavirus while 54.4% believed it to be a conspiracy.Conclusion: Vaccine hesitancy was quite profound which was caused by the amalgamation of many negative beliefs based on claims that had no sound basis. A great confusion surrounds the COVID-19 vaccine for the people of the rural area who are concerned about various aspects of the vaccine