Sadia Rehman, None Muhammad Farhan, Asma Naveed, Shafaq Mahmood, None Muhammad Irfan Khattak
Objective: To evaluate the impact of haemodialysis on plasma carnitine levels. Method: The cross-sectional study was conducted from April 20, 2020 to May 10, 2022, at the dialysis unit of the nephrology ward of Jinnah Postgraduate Medical Centre, Karachi, and the Pakistan Navy Ship Shifa Hospital, Karachi, in collaboration with the Department of Biochemistry, University of Karachi, and comprised patients of either gender aged >18 years. They were divided into chronic kidney disease group A and end-stage renal disease group B. Control group C included subjects from the general population. Free carnitine and total carnitine values were detected using enzyme-linked immunosorbent assay. Acyl carnitine was estimated by applying the standard formula, and the ratio between acyl carnitine and free carnitine was calculated for accurate assessment of the carnitine status. Data was analysed using SPSS 23. Results: Of the 203 subjects, 143(70.44%) were cases and 60(29.55%) were controls. Among the cases, 120(84%) were recruited from Jinnah Postgraduate Medical Centre and 23(16%) from Pakistan Navy Ship Shifa Hospital. There were 60(29.55%) patients in group A, 83(40.88%) in group B and 60(29.55%) in group C. The mean age in group A was 47.90/5,65 years, it was 44.10/8.92 years in group B and 40.90/6.73 years in group C. There was a significant difference related to free carnitine, total carnitine, acyl carnitine values and the ratio between acyl carnitine and free carnitine values in groups A and B compared to control group C (p<0.05). Conclusions: Patients on maintenance haemodialysis developed were found to have developed carnitine deficiency. Key Words: Carnitine, Chronic kidney disease, Dialysis-related carnitine disorder, Haemodialysis.
{"title":"Impact of haemodialysis on plasma carnitine concentrations in haemodialysis patients","authors":"Sadia Rehman, None Muhammad Farhan, Asma Naveed, Shafaq Mahmood, None Muhammad Irfan Khattak","doi":"10.47391/jpma.9170","DOIUrl":"https://doi.org/10.47391/jpma.9170","url":null,"abstract":"Objective: To evaluate the impact of haemodialysis on plasma carnitine levels. Method: The cross-sectional study was conducted from April 20, 2020 to May 10, 2022, at the dialysis unit of the nephrology ward of Jinnah Postgraduate Medical Centre, Karachi, and the Pakistan Navy Ship Shifa Hospital, Karachi, in collaboration with the Department of Biochemistry, University of Karachi, and comprised patients of either gender aged >18 years. They were divided into chronic kidney disease group A and end-stage renal disease group B. Control group C included subjects from the general population. Free carnitine and total carnitine values were detected using enzyme-linked immunosorbent assay. Acyl carnitine was estimated by applying the standard formula, and the ratio between acyl carnitine and free carnitine was calculated for accurate assessment of the carnitine status. Data was analysed using SPSS 23. Results: Of the 203 subjects, 143(70.44%) were cases and 60(29.55%) were controls. Among the cases, 120(84%) were recruited from Jinnah Postgraduate Medical Centre and 23(16%) from Pakistan Navy Ship Shifa Hospital. There were 60(29.55%) patients in group A, 83(40.88%) in group B and 60(29.55%) in group C. The mean age in group A was 47.90/5,65 years, it was 44.10/8.92 years in group B and 40.90/6.73 years in group C. There was a significant difference related to free carnitine, total carnitine, acyl carnitine values and the ratio between acyl carnitine and free carnitine values in groups A and B compared to control group C (p<0.05). Conclusions: Patients on maintenance haemodialysis developed were found to have developed carnitine deficiency. Key Words: Carnitine, Chronic kidney disease, Dialysis-related carnitine disorder, Haemodialysis.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"16 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135086455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This case report described the surgical-orthodontic interdisciplinary treatment of a patient with skeletal anterior open bite, class III skeletal pattern, steep mandibular plane, increased lower face height, and thin mandibular symphysis. The orthodontic preparation included an unusual extraction pattern (maxillary right first molar, maxillary left second premolar, and mandibular right central incisor), combined with two-jaw surgery comprised of maxillary advancement and differential impaction, bilateral malarplasty augmentation and mandibular asymmetric bilateral sagittal split osteotomy setback. The follow-up of a rare complication of surgical hooks breakage during surgery is reported. Guided by 3-dimesional digital platforms, treatment planning and execution, resulted in a more balanced and proportionate face with functional occlusion, and the case stability is shown in a 32-month follow-up. Keywords: CL III malocclusion, (AOB) anterior open bite, dentofacial deformity, orthognathic surgery, digital dentistry.
{"title":"Surgical-orthodontic with atypical extraction pattern as a treatment for an anterior open bite: a case report","authors":"Abdurahman Alwadei","doi":"10.47391/jpma.9365","DOIUrl":"https://doi.org/10.47391/jpma.9365","url":null,"abstract":"This case report described the surgical-orthodontic interdisciplinary treatment of a patient with skeletal anterior open bite, class III skeletal pattern, steep mandibular plane, increased lower face height, and thin mandibular symphysis. The orthodontic preparation included an unusual extraction pattern (maxillary right first molar, maxillary left second premolar, and mandibular right central incisor), combined with two-jaw surgery comprised of maxillary advancement and differential impaction, bilateral malarplasty augmentation and mandibular asymmetric bilateral sagittal split osteotomy setback. The follow-up of a rare complication of surgical hooks breakage during surgery is reported. Guided by 3-dimesional digital platforms, treatment planning and execution, resulted in a more balanced and proportionate face with functional occlusion, and the case stability is shown in a 32-month follow-up. Keywords: CL III malocclusion, (AOB) anterior open bite, dentofacial deformity, orthognathic surgery, digital dentistry.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"128 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135371957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chronic blockage of the lymphatic system due to functional or anatomical causes results in lymphoedema which results inswelling due to accumulation of lymphatic fluid in the soft tissue. Lymphoedema commonly affects the upper and lowerlimbs but may be seen in the neck, chest wall, abdomen and genitalia. Lymphoscintigraphy is non-invasive and maps thelymphatic channels thereby indicating location of blockage along the lymphatic pathways. Blockage of lymphatic channelsmay lead to back pressure resulting in dermal backflow. We present a case of dermal backflow in bilateral lymphoedema.Keywords: lymphoscintigraphy, dermal backflow, lymphedema
{"title":"Clinical significance of dermal backflow on lymphoscintigraphy in patients with lower limb edema","authors":"None Areej Aijaz, None Tanzil Sajid, None Aamna Hassan","doi":"10.47391/jpma.23-97","DOIUrl":"https://doi.org/10.47391/jpma.23-97","url":null,"abstract":"Chronic blockage of the lymphatic system due to functional or anatomical causes results in lymphoedema which results inswelling due to accumulation of lymphatic fluid in the soft tissue. Lymphoedema commonly affects the upper and lowerlimbs but may be seen in the neck, chest wall, abdomen and genitalia. Lymphoscintigraphy is non-invasive and maps thelymphatic channels thereby indicating location of blockage along the lymphatic pathways. Blockage of lymphatic channelsmay lead to back pressure resulting in dermal backflow. We present a case of dermal backflow in bilateral lymphoedema.Keywords: lymphoscintigraphy, dermal backflow, lymphedema","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"73 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To assess the association of oxytocin receptor (rs53576) and melatonin hormone receptor 1B (rs1387153) gene single nucleotide polymorphisms with psychological symptoms in women with gestational diabetes mellitus. Method: The case-control study was conducted from May 1 to June 1, 2022, at the Department of Physiology, University of Karachi, in collaboration with the Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, and the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. Fifty gestational diabetic pregnant women (group A), and ninety healthy pregnant women (control group B) were recruited. Sanger sequencing was performed to assess the genotypic frequency and polymorphic variation of all subjects. Perceived stress scale and diabetes-related distress scale were used to assess the stress levels. Data was analysed using SPSS 23. Results: Of the 140 subjects, 90 (64.3%) were controls with mean age 24.96±4.35 years, and 50 (35.7%) were cases with mean age 28.78±5.25 (p<0.05). Mean body weight and mean gestational age were not significantly different between the groups (p>0.05). Melatonin hormone receptor 1B rs1387153 frequency was significantly different between the groups (p<0.05). Among the cases, a significant mean difference for regimen distress scores between AA and GG was observed for oxytocin receptor rs53576 (p=0.04). A significant mean difference in sum of PSS, diabetes-related stress, total diabetes-related stress and emotional distress was noted between CC and TT genotypes for melatonin hormone receptor 1B rs1387153 (p=0.001). Conclusion: MTNR1B rs1387153 genotypes were associated with perceived stress, diabetes-related stress, diabetic distress, and emotional burden, while OXTR rs53576 genotypes were associated with regimen distress in GDM women. Key Words: Diabetes, Distress, Gestational diabetes mellitus, Genotypes, Stress, Psychological stress, Pregnancy.
{"title":"Relationship between Genetic Variant of OXTR (rs53576) and MTNR1B (rs1387153) and Symptoms of Psychological Stress in Females with Gestational Diabetes Mellitus","authors":"Fatima Abid, Sadaf Ahmed, Shamoon Noushad, Sabah Farhat, Syeda Sadia Fatima","doi":"10.47391/jpma.10096","DOIUrl":"https://doi.org/10.47391/jpma.10096","url":null,"abstract":"Objective: To assess the association of oxytocin receptor (rs53576) and melatonin hormone receptor 1B (rs1387153) gene single nucleotide polymorphisms with psychological symptoms in women with gestational diabetes mellitus. Method: The case-control study was conducted from May 1 to June 1, 2022, at the Department of Physiology, University of Karachi, in collaboration with the Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, and the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi. Fifty gestational diabetic pregnant women (group A), and ninety healthy pregnant women (control group B) were recruited. Sanger sequencing was performed to assess the genotypic frequency and polymorphic variation of all subjects. Perceived stress scale and diabetes-related distress scale were used to assess the stress levels. Data was analysed using SPSS 23. Results: Of the 140 subjects, 90 (64.3%) were controls with mean age 24.96±4.35 years, and 50 (35.7%) were cases with mean age 28.78±5.25 (p<0.05). Mean body weight and mean gestational age were not significantly different between the groups (p>0.05). Melatonin hormone receptor 1B rs1387153 frequency was significantly different between the groups (p<0.05). Among the cases, a significant mean difference for regimen distress scores between AA and GG was observed for oxytocin receptor rs53576 (p=0.04). A significant mean difference in sum of PSS, diabetes-related stress, total diabetes-related stress and emotional distress was noted between CC and TT genotypes for melatonin hormone receptor 1B rs1387153 (p=0.001). Conclusion: MTNR1B rs1387153 genotypes were associated with perceived stress, diabetes-related stress, diabetic distress, and emotional burden, while OXTR rs53576 genotypes were associated with regimen distress in GDM women. Key Words: Diabetes, Distress, Gestational diabetes mellitus, Genotypes, Stress, Psychological stress, Pregnancy.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"7 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetes is associated with a myriad of mental health challenges, ranging from distress and depression to schizophrenia and substance abuse. These conditions are associated with hyperglycaemia, and also interfere with efforts to achieve good glucose control. One way in which this can be handled is by screening, early diagnosis, and timely management of mental health dysfunction and disorders. We term this action as psychovigilance. Keywords: Anxiety, depression, diabetes distress, psychosocial aspects, type 1 diabetes, type 2 diabetes
{"title":"Psychovigilance in diabetes","authors":"None Sanjay Kalra, None Komal Verma, None Navneet Agrawal, None Atul Dhingra","doi":"10.47391/jpma.23-94","DOIUrl":"https://doi.org/10.47391/jpma.23-94","url":null,"abstract":"Diabetes is associated with a myriad of mental health challenges, ranging from distress and depression to schizophrenia and substance abuse. These conditions are associated with hyperglycaemia, and also interfere with efforts to achieve good glucose control. One way in which this can be handled is by screening, early diagnosis, and timely management of mental health dysfunction and disorders. We term this action as psychovigilance. Keywords: Anxiety, depression, diabetes distress, psychosocial aspects, type 1 diabetes, type 2 diabetes","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madam, Valproic acid is a widely used anticonvulsant medication that exerts its therapeutic effects by increasing GABA activity in the brain, making it a first-line therapy for focal and generalized seizures. However, despite its efficacy, the medication is associated with significant adverse effects in pregnant or childbearing-age women, with teratogenicity being the most severe outcome. A Study1 published in Italy raised some serious concerns regarding prenatal exposure to valproic acid, which can affect the prenatal and postnatal intellectual development of the newborn, and the use of alternative drugs was preferred to reduce unwanted exposure to the drug. Nordforks.org’s research and Taiwan’s2 research program 2022 concluded that the exposure of pregnant women to sodium valproate increases the chance of autism and intellectual disability up to 3 folds or more. In many countries of the world, the prescription of this drug during childbearing age has been banned and alternative medicine are prescribed instead. In a study conducted in Brazil, it was discussed that these antidepressants cause changes in gene expression, leading to structural and functional changes in various regions of the brain, leading to intellectual disabilities. A group of researchers conducted a meta-analysis3 i.e., published in Canada, concluded that Medications like lamotrigine and levetiracetam have been proven to be statistically less teratogenic than valproate and monotherapy is preferred over polytherapy and the meta-analysis4 published in 2022 has proved lamotrigine to be the most suitable first-line alternatives to valproic acid. According to JAMA's publication of 20235, taking sodium valproate during or before pregnancy increases the risk of neurodevelopmental disorders in children. On the other hand, prenatal exposure to lamotrigine does not increase the risk of such disorders. In a developing country such as Pakistan, where a large proportion of the population requires proper counseling regarding medical treatments and follow-ups, physicians need to exercise due diligence when prescribing sodium valproate, particularly to female patients. The physician should ascertain whether the patient is of childbearing age and, if so, inquire about their marital status and pregnancy plans. Moreover, the physician must inform the patient and their attendants about the adverse effects of the drug if taken during pregnancy, the significance of alternative drugs, and the importance of regular follow-ups. The doctors must prioritize ensuring that patient receives thorough counselling on these issues to avoid mishaps in the future.
{"title":"The Valproic Acid Dilemma: Safe Alternatives for Pregnant Women and women of childbearing age with Epilepsy","authors":"Momina Abid, None FNU javairia, None Abdul Basit","doi":"10.47391/jpma.10077","DOIUrl":"https://doi.org/10.47391/jpma.10077","url":null,"abstract":"Madam, Valproic acid is a widely used anticonvulsant medication that exerts its therapeutic effects by increasing GABA activity in the brain, making it a first-line therapy for focal and generalized seizures. However, despite its efficacy, the medication is associated with significant adverse effects in pregnant or childbearing-age women, with teratogenicity being the most severe outcome. A Study1 published in Italy raised some serious concerns regarding prenatal exposure to valproic acid, which can affect the prenatal and postnatal intellectual development of the newborn, and the use of alternative drugs was preferred to reduce unwanted exposure to the drug. Nordforks.org’s research and Taiwan’s2 research program 2022 concluded that the exposure of pregnant women to sodium valproate increases the chance of autism and intellectual disability up to 3 folds or more. In many countries of the world, the prescription of this drug during childbearing age has been banned and alternative medicine are prescribed instead. In a study conducted in Brazil, it was discussed that these antidepressants cause changes in gene expression, leading to structural and functional changes in various regions of the brain, leading to intellectual disabilities. A group of researchers conducted a meta-analysis3 i.e., published in Canada, concluded that Medications like lamotrigine and levetiracetam have been proven to be statistically less teratogenic than valproate and monotherapy is preferred over polytherapy and the meta-analysis4 published in 2022 has proved lamotrigine to be the most suitable first-line alternatives to valproic acid. According to JAMA's publication of 20235, taking sodium valproate during or before pregnancy increases the risk of neurodevelopmental disorders in children. On the other hand, prenatal exposure to lamotrigine does not increase the risk of such disorders. In a developing country such as Pakistan, where a large proportion of the population requires proper counseling regarding medical treatments and follow-ups, physicians need to exercise due diligence when prescribing sodium valproate, particularly to female patients. The physician should ascertain whether the patient is of childbearing age and, if so, inquire about their marital status and pregnancy plans. Moreover, the physician must inform the patient and their attendants about the adverse effects of the drug if taken during pregnancy, the significance of alternative drugs, and the importance of regular follow-ups. The doctors must prioritize ensuring that patient receives thorough counselling on these issues to avoid mishaps in the future.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"3 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laiba Abid, Muhammah Ahmed Shaikh, Usama Abdul Ahad Memon
Madam, This is to bring your attention to a long-standing issue despite several activities devised to curb it. Being aware of the effect of drastic climatic changes, developing countries like Pakistan should remain alert about the emergence of infectious outbreaks. The stagnant water after heavy rainfall and flood is a ground for the breeding of dengue vector called Aedes aegypti mosquitoes. The virus is transmitted from one person to another through these mosquitoes. Lately, the surge in the cases of dengue virus was due to massive flooding in Pakistan in 2022. A total of 25932 cases were reported and 62 deaths were recorded during the dengue outbreak during the flood crisis of 2022[1]. Dengue virus comprises of four serotypes 1, 2, 3, and 4. A person infected by a distinct serotype of the virus gains immunity against it and future infection by the same DENV will not affect the person’s health but infection by a heterogenous serotype causes secondary infection in the form of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Expansive capillary leakage in DHF due to an increase in the permeability of blood vessels can turn on a shock state called DSS. This deprivation of blood to highly functional organs like the brain, kidney, and heart puts them at risk of multi-organ failure [2]. The seasonal surge of secondary infection puts a burden on hospitals as the patient requires vigilant inpatient hospital care. The patient's health deteriorates further because of self-treatment at home with local herbs and over-the-counter (OTC) drugs [3]. As modern medicine is focused more on prevention than treatment, the need for the approval of the use of the dengue vaccine on high-risk individuals in an endemic country like Pakistan should be considered. The DENGVAXIA is a well-tolerated vaccine protecting against all the serotypes and is approved for use in individuals 9 to 45 years who are previously infected by the dengue virus in the past. [4] The vaccine will restrain the rise in DHF and DSS cases as it is for high-risk individuals who are already infected in the past thus curbing the incidence of secondary infection. Many endemic countries like the Philippines and Brazil have already taken a step against secondary dengue by granting the license of DENGVAXIA [5]. As Pakistan is developing country, approving the license for DENGVAXIA should be considered.
{"title":"Calamity of secondary Dengue Virus followed by climatic changes","authors":"Laiba Abid, Muhammah Ahmed Shaikh, Usama Abdul Ahad Memon","doi":"10.47391/jpma.9623","DOIUrl":"https://doi.org/10.47391/jpma.9623","url":null,"abstract":"Madam, This is to bring your attention to a long-standing issue despite several activities devised to curb it. Being aware of the effect of drastic climatic changes, developing countries like Pakistan should remain alert about the emergence of infectious outbreaks. The stagnant water after heavy rainfall and flood is a ground for the breeding of dengue vector called Aedes aegypti mosquitoes. The virus is transmitted from one person to another through these mosquitoes. Lately, the surge in the cases of dengue virus was due to massive flooding in Pakistan in 2022. A total of 25932 cases were reported and 62 deaths were recorded during the dengue outbreak during the flood crisis of 2022[1]. Dengue virus comprises of four serotypes 1, 2, 3, and 4. A person infected by a distinct serotype of the virus gains immunity against it and future infection by the same DENV will not affect the person’s health but infection by a heterogenous serotype causes secondary infection in the form of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). Expansive capillary leakage in DHF due to an increase in the permeability of blood vessels can turn on a shock state called DSS. This deprivation of blood to highly functional organs like the brain, kidney, and heart puts them at risk of multi-organ failure [2]. The seasonal surge of secondary infection puts a burden on hospitals as the patient requires vigilant inpatient hospital care. The patient's health deteriorates further because of self-treatment at home with local herbs and over-the-counter (OTC) drugs [3]. As modern medicine is focused more on prevention than treatment, the need for the approval of the use of the dengue vaccine on high-risk individuals in an endemic country like Pakistan should be considered. The DENGVAXIA is a well-tolerated vaccine protecting against all the serotypes and is approved for use in individuals 9 to 45 years who are previously infected by the dengue virus in the past. [4] The vaccine will restrain the rise in DHF and DSS cases as it is for high-risk individuals who are already infected in the past thus curbing the incidence of secondary infection. Many endemic countries like the Philippines and Brazil have already taken a step against secondary dengue by granting the license of DENGVAXIA [5]. As Pakistan is developing country, approving the license for DENGVAXIA should be considered.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"10 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Clinical auditing is a widely accepted practice world wide to assess the quality of health care given by a provider (1). It is described as a quality improvement approach that aims to enhance patient care and outcomes by systematically examining of treatment against stated criteria and implementing change (2). A clinical audit provides a service with the capacity to identify deficiencies, areas of excellence, and generate relevant suggestions that would drive change. It enhances the practice of evaluating against established standards (1). In developed countries, it is an essential component of clinical practice; nevertheless, it has yet to achieve equal status in developing countries. As a result, the demand for a structured Clinical Audit program is long overdue. Surprisingly, a thorough online literature search from 2021 till date was conducted on PakMediNet and PubMed that yielded only three clinical audit studies in Pakistan as shown in Table - 1. All these studies are closed-loop audits that follow accurate guidelines and reported significant improvement after intervention in the re-audit cycle. Ashraf M et al. reported that operative notes can be improved, by using audits to identify poor areas (3). According to Shah MH et al. standard venous thromboembolism (VTE) risk assessment and prophylactic prescription guidelines were not followed, but after intervention and re-audit, it was discovered that a simple and effective educational intervention improved VTE risk assessment and prophylactic prescribing practices (4). Similarly, Rabbani RA et al. emphasize the need for clinical audits in improving standard surgical procedures (5). No doubt that clinical audits are a tool that, when used correctly, can result in a change in the quality of care provided by a service (1). New research and clinical audit programs are crucial to the future of quality care in Pakistan (2). As a result, it is critical that our future healthcare workers understand how to conduct clinical audits and lead them during their training (2). Continuous improvement can be achieved by a healthcare unit that incorporates frequent audits with clinical practice in its curriculum. Clinical auditing will help to strengthen and increase their clinical knowledge and communication abilities. At the end of the day, it will result in improved patient care and outcomes. Therefore, the need of the hour is to promote clinical audit studies among healthcare workers.
{"title":"Clinical audit: a necessity or a formality?","authors":"Sami Ajaz, Muhammad Ahmad, RAZA SARFRAZ","doi":"10.47391/jpma.9310","DOIUrl":"https://doi.org/10.47391/jpma.9310","url":null,"abstract":"Dear Editor, Clinical auditing is a widely accepted practice world wide to assess the quality of health care given by a provider (1). It is described as a quality improvement approach that aims to enhance patient care and outcomes by systematically examining of treatment against stated criteria and implementing change (2). A clinical audit provides a service with the capacity to identify deficiencies, areas of excellence, and generate relevant suggestions that would drive change. It enhances the practice of evaluating against established standards (1). In developed countries, it is an essential component of clinical practice; nevertheless, it has yet to achieve equal status in developing countries. As a result, the demand for a structured Clinical Audit program is long overdue. Surprisingly, a thorough online literature search from 2021 till date was conducted on PakMediNet and PubMed that yielded only three clinical audit studies in Pakistan as shown in Table - 1. All these studies are closed-loop audits that follow accurate guidelines and reported significant improvement after intervention in the re-audit cycle. Ashraf M et al. reported that operative notes can be improved, by using audits to identify poor areas (3). According to Shah MH et al. standard venous thromboembolism (VTE) risk assessment and prophylactic prescription guidelines were not followed, but after intervention and re-audit, it was discovered that a simple and effective educational intervention improved VTE risk assessment and prophylactic prescribing practices (4). Similarly, Rabbani RA et al. emphasize the need for clinical audits in improving standard surgical procedures (5). No doubt that clinical audits are a tool that, when used correctly, can result in a change in the quality of care provided by a service (1). New research and clinical audit programs are crucial to the future of quality care in Pakistan (2). As a result, it is critical that our future healthcare workers understand how to conduct clinical audits and lead them during their training (2). Continuous improvement can be achieved by a healthcare unit that incorporates frequent audits with clinical practice in its curriculum. Clinical auditing will help to strengthen and increase their clinical knowledge and communication abilities. At the end of the day, it will result in improved patient care and outcomes. Therefore, the need of the hour is to promote clinical audit studies among healthcare workers.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Foetal akinesia deformation sequence (FADS) represents a group of disorders resulting from absent or diminished in utero foetal mobility. The aetiology is multifactorial, including genetic, environmental, maternal, and foetal causes. The absence of foetal movements leading to multiple joint contractures, pulmonary hypoplasia, and intrauterine growth restriction are the key features of foetal akinesia deformation sequence. Herein we describe the case of a 30-year-old gravida 4 (para 2+1) who came for foetal ultrasound at 28 weeks of gestation due to decreased foetal movements. Ultrasound showed features of FADS with fixed flexed position of foetal limbs, pulmonary hypoplasia, polyhydramnios, and intrauterine growth restriction. The timely use of ultrasound enables early detection of these cases and aids in appropriate counselling and management. Keywords: Foetal arthrogryposis, antenatal, foetal akinesia, ultrasound.
{"title":"Foetal akinesia deformation sequence; a rare lethal entity- A case report","authors":"Gulnaz Shafqat, Kulsoom Fatima, Farida Hanif","doi":"10.47391/jpma.8513","DOIUrl":"https://doi.org/10.47391/jpma.8513","url":null,"abstract":"Foetal akinesia deformation sequence (FADS) represents a group of disorders resulting from absent or diminished in utero foetal mobility. The aetiology is multifactorial, including genetic, environmental, maternal, and foetal causes. The absence of foetal movements leading to multiple joint contractures, pulmonary hypoplasia, and intrauterine growth restriction are the key features of foetal akinesia deformation sequence. Herein we describe the case of a 30-year-old gravida 4 (para 2+1) who came for foetal ultrasound at 28 weeks of gestation due to decreased foetal movements. Ultrasound showed features of FADS with fixed flexed position of foetal limbs, pulmonary hypoplasia, polyhydramnios, and intrauterine growth restriction. The timely use of ultrasound enables early detection of these cases and aids in appropriate counselling and management. Keywords: Foetal arthrogryposis, antenatal, foetal akinesia, ultrasound.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Uzma Imam, Ait Parkash, Nandlal Daryani, Fahad Mumtaz
Objective: To determine the usefulness of Sofosbuvir-Daclatasvir combination in the treatment of hepatitis c virus infection in paediatric cancer. Method: The retrospective study was conducted at the Oncology Department of the National Institute of Child Health, Karachi, and comprised medical charts of patients who received sofosbuvir and daclatasvir from January 2018 to January 2022. Efficacy was documented by clearance of hepatitis C virus ribonucleic acid as rapid viral response, early viral response and sustained viral response at weeks 4, 12 and 24, respectively. Drug efficacy was determined by monitoring and recording adverse effects. Chemotherapy protocol for the treatment of patients concomitantly receiving direct acting antivirals was modified while looking at drug-drug interactions. The total duration of direct acting antiviral therapy was 12 weeks. Data was analysed using SPSS 24. Results: Of the 804 patients with different malignancies, 132(16.4%) were found positive for hepatitis C virus. Of them, 28(21.21%) patients were started on direct acting antivirals; 17(60.71%) boys and 11(39.28%) girls. The overall mean age was 9.93±6.12 years. The diagnosis was pre-B acute lymphoblastic leukaemia in 18(64.28%) cases, 16(57.14%) were on maintenance chemotherapy, and 18(64.28%) had genotype 1. Pre- and post-treatment mean alanine transaminase levels were 328.00±324.00IU and 36.00±29.00IU, respectively (p=0.003). Pre- and post-treatment mean serum bilirubin levels were 3.13±3.95mg/dl and 0.61±0.21mg/dl (p=0.022). Rapid viral response was achieved in 26(92.85%) children, while early viral response and sustained viral response were achieved in all 28(100%) patients. Minor side effects were noted in 4(14.28%) patients and chemotherapy was continued in all 28(100%) cases as per the designed protocol. Conclusion: The sofosbuvir-daclatasvir combination was found to be effective in hepatitis C virus treatment in paediatric cancer patients. Key Words: Childhood cancer, HCV infection, Direct acting antiviral agents.
{"title":"Usefulness of Sofosbuvir and Daclatasvir combination in the treatment of HCV infection in childhood cancer patients: experience from a tertiary care hospital","authors":"Uzma Imam, Ait Parkash, Nandlal Daryani, Fahad Mumtaz","doi":"10.47391/jpma.8433","DOIUrl":"https://doi.org/10.47391/jpma.8433","url":null,"abstract":"Objective: To determine the usefulness of Sofosbuvir-Daclatasvir combination in the treatment of hepatitis c virus infection in paediatric cancer. Method: The retrospective study was conducted at the Oncology Department of the National Institute of Child Health, Karachi, and comprised medical charts of patients who received sofosbuvir and daclatasvir from January 2018 to January 2022. Efficacy was documented by clearance of hepatitis C virus ribonucleic acid as rapid viral response, early viral response and sustained viral response at weeks 4, 12 and 24, respectively. Drug efficacy was determined by monitoring and recording adverse effects. Chemotherapy protocol for the treatment of patients concomitantly receiving direct acting antivirals was modified while looking at drug-drug interactions. The total duration of direct acting antiviral therapy was 12 weeks. Data was analysed using SPSS 24. Results: Of the 804 patients with different malignancies, 132(16.4%) were found positive for hepatitis C virus. Of them, 28(21.21%) patients were started on direct acting antivirals; 17(60.71%) boys and 11(39.28%) girls. The overall mean age was 9.93±6.12 years. The diagnosis was pre-B acute lymphoblastic leukaemia in 18(64.28%) cases, 16(57.14%) were on maintenance chemotherapy, and 18(64.28%) had genotype 1. Pre- and post-treatment mean alanine transaminase levels were 328.00±324.00IU and 36.00±29.00IU, respectively (p=0.003). Pre- and post-treatment mean serum bilirubin levels were 3.13±3.95mg/dl and 0.61±0.21mg/dl (p=0.022). Rapid viral response was achieved in 26(92.85%) children, while early viral response and sustained viral response were achieved in all 28(100%) patients. Minor side effects were noted in 4(14.28%) patients and chemotherapy was continued in all 28(100%) cases as per the designed protocol. Conclusion: The sofosbuvir-daclatasvir combination was found to be effective in hepatitis C virus treatment in paediatric cancer patients. Key Words: Childhood cancer, HCV infection, Direct acting antiviral agents.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"32 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136106043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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