In this case report we will discuss a case of a 47-year-old woman who presented with abdominal pain, nausea, oliguria and right heart failure. A Computed Tomography (CT) aortogram revealed a fistulous abdominal aortic aneurysm. The objective of this study is to discuss the haemodynamic changes regarding aortocaval fistula and consider various management options. A literature search was undertaken on PubMed using appropriate search terms. Case series and reviews reporting presentation, diagnosis and operative management of aortocaval fistula were selected and discussed. We reached a conclusion that early identification improves surgical planning and reduces mortality. Major abdominal arteriovenous fistula repair appears to be a safer and more successful therapy with positive short and midterm outcomes. Aortocaval fistula care requires a more extensive patient series, so even better conclusions can be drawn. Keywords: Inferior vena cava; Aortocaval fistula; Abdominal aortic aneurysm; Open aneurysm repair; EVAR; Hybrid abdominal aortic aneurysm repair.
{"title":"Bursting heart syndrome; a rare case of aortocaval fistula repair","authors":"Talha Kareem, Muhammad Adeel Ahmed, Faizan Nihal, Omer Ehsan, Iqbal Khan","doi":"10.47391/jpma.8455","DOIUrl":"https://doi.org/10.47391/jpma.8455","url":null,"abstract":"In this case report we will discuss a case of a 47-year-old woman who presented with abdominal pain, nausea, oliguria and right heart failure. A Computed Tomography (CT) aortogram revealed a fistulous abdominal aortic aneurysm. The objective of this study is to discuss the haemodynamic changes regarding aortocaval fistula and consider various management options. A literature search was undertaken on PubMed using appropriate search terms. Case series and reviews reporting presentation, diagnosis and operative management of aortocaval fistula were selected and discussed. We reached a conclusion that early identification improves surgical planning and reduces mortality. Major abdominal arteriovenous fistula repair appears to be a safer and more successful therapy with positive short and midterm outcomes. Aortocaval fistula care requires a more extensive patient series, so even better conclusions can be drawn. Keywords: Inferior vena cava; Aortocaval fistula; Abdominal aortic aneurysm; Open aneurysm repair; EVAR; Hybrid abdominal aortic aneurysm repair.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"47 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136104920","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}
Sameen Shahid, Haneen Kamran, None Hafiz Muhammad Qasim Zafar
Dear Madam, Around 52.5 million people worldwide suffer from the neurological illness known as epilepsy, which is frequently characterized by recurring seizures. (1, 2) As epilepsy is a chronic disorder that can lead to cognitive deficits, sadness, and anxiety in sufferers, it has a considerable negative impact on individuals and society. The most common type of seizures, affecting around 61% of persons with epilepsy, are focal seizures, which raise the risk of injury and early death (2). One of the most common forms of focal epilepsy, temporal lobe epilepsy (TLE), is characterized by recurring spontaneous seizures that begin in the temporal lobe. (s). (3) In the last two decades, many new antiseizure medications (ASMs)have been developed; however, about 40% of people with epilepsy may be drug-resistant, meaning ASMs are unable to control their seizures; therefore, despite the advent of new treatments, a high unmet need remains unaddressed. (2) Surgery is an alternate treatment, however, it cannot be used if larger areas of the brain are affected, in such cases, neuromodulation is a novel and successful therapeutic tool developed. (4) Conventionally, neural activity in epilepsy is categorized into interictal, and post-ictal states. With the help of continuous EEG, researchers have subdivided interictal state into a pre-ictal and pro-ictal state in temporal lobe epilepsy patients (which is the typical drug-resistant focal epilepsy targeted for interventions such as neuromodulation). The pre-ictal states indicate imminent seizure onset, while pro-ictal states reflect changes in neural activity that create a propensity for seizures over longer periods. The EEG-based pro-ictal state detection is critical to adaptive neuromodulation, with early detection of seizure allowing electrodes to be applied therapeutically to the brain's seizure onset zone and thalamus enabling treatment to be modified as per seizure risk. (5) A prospective cohort study was conducted on adults with drug-resistant temporal lobe epilepsy at UTHealth Houston, in which pro-ictal state – i.e., pathologic brain activities during periods of heightened seizure risk could be detected up to one-half hour prior to seizure onset. A classifier was developed that could reasonably accurately distinguish between physiological and pathologic brain states in temporal lobe epilepsy. Thalamocortical dynamics were used to identify pro-ictal states in each patient. As the limbic thalamus exerts a diverse influence on cortex activity, thalamocortical EEG was used for pro-ictal state detection as opposed to previous paradigms derived solely from cortical structures. ---Continue
{"title":"Prediction of Seizures in Patients with Temporal Lobe Epilepsy, more than 30 minutes before onset","authors":"Sameen Shahid, Haneen Kamran, None Hafiz Muhammad Qasim Zafar","doi":"10.47391/jpma.9689","DOIUrl":"https://doi.org/10.47391/jpma.9689","url":null,"abstract":"Dear Madam, Around 52.5 million people worldwide suffer from the neurological illness known as epilepsy, which is frequently characterized by recurring seizures. (1, 2) As epilepsy is a chronic disorder that can lead to cognitive deficits, sadness, and anxiety in sufferers, it has a considerable negative impact on individuals and society. The most common type of seizures, affecting around 61% of persons with epilepsy, are focal seizures, which raise the risk of injury and early death (2). One of the most common forms of focal epilepsy, temporal lobe epilepsy (TLE), is characterized by recurring spontaneous seizures that begin in the temporal lobe. (s). (3) In the last two decades, many new antiseizure medications (ASMs)have been developed; however, about 40% of people with epilepsy may be drug-resistant, meaning ASMs are unable to control their seizures; therefore, despite the advent of new treatments, a high unmet need remains unaddressed. (2) Surgery is an alternate treatment, however, it cannot be used if larger areas of the brain are affected, in such cases, neuromodulation is a novel and successful therapeutic tool developed. (4) Conventionally, neural activity in epilepsy is categorized into interictal, and post-ictal states. With the help of continuous EEG, researchers have subdivided interictal state into a pre-ictal and pro-ictal state in temporal lobe epilepsy patients (which is the typical drug-resistant focal epilepsy targeted for interventions such as neuromodulation). The pre-ictal states indicate imminent seizure onset, while pro-ictal states reflect changes in neural activity that create a propensity for seizures over longer periods. The EEG-based pro-ictal state detection is critical to adaptive neuromodulation, with early detection of seizure allowing electrodes to be applied therapeutically to the brain's seizure onset zone and thalamus enabling treatment to be modified as per seizure risk. (5) A prospective cohort study was conducted on adults with drug-resistant temporal lobe epilepsy at UTHealth Houston, in which pro-ictal state – i.e., pathologic brain activities during periods of heightened seizure risk could be detected up to one-half hour prior to seizure onset. A classifier was developed that could reasonably accurately distinguish between physiological and pathologic brain states in temporal lobe epilepsy. Thalamocortical dynamics were used to identify pro-ictal states in each patient. As the limbic thalamus exerts a diverse influence on cortex activity, thalamocortical EEG was used for pro-ictal state detection as opposed to previous paradigms derived solely from cortical structures. ---Continue","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"47 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136104923","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 develop and validate a tool for the assessment of professionalism in medical students during clerkship. Method: The mixed-method study was confucted from February to September 2018 at the Islamic International Medical College, Riphah University, Islamabad, Pakistan. A preliminary focus group discussion ws followed by two rounds of Delphi technique to validate micro-scenarios for the relevance of each item of the instrument alongside its content validity. For content and construct validation of the tool, content validity, cognitive validity, cognitive pretesting, confirmatory factor analysis and reliability assessment was done. Piloting was done on medical students doing clerkship. Data was analysed using SPSS 21 and AMOS 21. Results: A 35-item preliminary tool from micro-scenarios generated after focus group discussion was developed for the first Delphi round. For the second round, a 29-item tool was resent to the experts for validation. After the second round, the content validity scale was 0.94. Removal of 1 item produced a 28-item tool. Pre-cognitive testing of the 28 items resulted in rephrasing of 4, modification of 2, and deletion of 1 and a tool with 27 items. Piloting was carried out and after CFA resulted in a reduced 21 item tool. Cronbach’s alpha value was 0.96. A good to excellent model fit was produced after performing confirmatory factor analysis. Conclusion: A tool comprising of 21 items scored on a 5-point Likert scale that had acceptable construct validity and good content validity was developed. It can be used to evaluate the level of professionalism of local medical students doing clerkship. Key Words: Professionalism, Delphi, Focus group, Medical students, Factor analysis.
{"title":"Validation of an assessment tool for professionalism in medical students: a mixed method study","authors":"Humaira Fayyaz Khan, Raheela Yasmeen, Shabana Ali","doi":"10.47391/jpma.7770","DOIUrl":"https://doi.org/10.47391/jpma.7770","url":null,"abstract":"Objective: To develop and validate a tool for the assessment of professionalism in medical students during clerkship. Method: The mixed-method study was confucted from February to September 2018 at the Islamic International Medical College, Riphah University, Islamabad, Pakistan. A preliminary focus group discussion ws followed by two rounds of Delphi technique to validate micro-scenarios for the relevance of each item of the instrument alongside its content validity. For content and construct validation of the tool, content validity, cognitive validity, cognitive pretesting, confirmatory factor analysis and reliability assessment was done. Piloting was done on medical students doing clerkship. Data was analysed using SPSS 21 and AMOS 21. Results: A 35-item preliminary tool from micro-scenarios generated after focus group discussion was developed for the first Delphi round. For the second round, a 29-item tool was resent to the experts for validation. After the second round, the content validity scale was 0.94. Removal of 1 item produced a 28-item tool. Pre-cognitive testing of the 28 items resulted in rephrasing of 4, modification of 2, and deletion of 1 and a tool with 27 items. Piloting was carried out and after CFA resulted in a reduced 21 item tool. Cronbach’s alpha value was 0.96. A good to excellent model fit was produced after performing confirmatory factor analysis. Conclusion: A tool comprising of 21 items scored on a 5-point Likert scale that had acceptable construct validity and good content validity was developed. It can be used to evaluate the level of professionalism of local medical students doing clerkship. Key Words: Professionalism, Delphi, Focus group, Medical students, Factor analysis.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"49 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105071","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}
Stroke is the leading global cause of death and disability and the need for stroke rehabilitation services in increasing. The usual stroke rehabilitation protocol involves a combination of therapeutic exercises, occupational therapy, speech therapy and counselling sessions depending upon the severity of the deficit and associated co-morbidities. However, there is a need for better protocols and new therapies for improving outcomes after stroke rehabilitation. The term 'task-oriented training' (TOT) refers to guided rehabilitation training of patients' limb function using goal oriented tasks, which can be used to enhance neuroplasticity in brain after injury. Task oriented training could be modified with action selection and environmental enrichment to fulfill the limitations of stroke like, holistic approach, outcome/goal based intervention, proper dosage for desirable outcomes. This mini review provides an overview of the TOT and to identify gaps and challenges in stroke rehabilitation related to integrating TOT. Keywords: Stroke, Rehabilitation, holistic approach, task oriented training.
{"title":"Task oriented training for Stroke Rehabilitation: A mini review","authors":"None Ayesha Afridi, None Arshad Nawaz Malik, None Farooq Azam Rathore","doi":"10.47391/jpma.23-98","DOIUrl":"https://doi.org/10.47391/jpma.23-98","url":null,"abstract":"Stroke is the leading global cause of death and disability and the need for stroke rehabilitation services in increasing. The usual stroke rehabilitation protocol involves a combination of therapeutic exercises, occupational therapy, speech therapy and counselling sessions depending upon the severity of the deficit and associated co-morbidities. However, there is a need for better protocols and new therapies for improving outcomes after stroke rehabilitation. The term 'task-oriented training' (TOT) refers to guided rehabilitation training of patients' limb function using goal oriented tasks, which can be used to enhance neuroplasticity in brain after injury. Task oriented training could be modified with action selection and environmental enrichment to fulfill the limitations of stroke like, holistic approach, outcome/goal based intervention, proper dosage for desirable outcomes. This mini review provides an overview of the TOT and to identify gaps and challenges in stroke rehabilitation related to integrating TOT. Keywords: Stroke, Rehabilitation, holistic approach, task oriented training.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"3 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":"136105216","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}
Allotriophagy is defined as food cravings that are different from the expected or the norm. It gives clinical pointers to an underlying diagnosis. We propose a new term, allotriodipsia which suggests a preference for beverages that are different from the norm. Taken together, these two entities may point towards certain endocrinological abnormalities and iatrogenic sequelae. In this communication we highlight the clinical relevance of allotriophagy and allotriodipsia. Keywords: Allotriophagy, Allotriodipsia, Anorexia nervosa, Bulimia nervosa, Food fads, Orthorexia nervosa, Osteomalacia, Sheehan’s syndrome.
{"title":"Allotriophagy and Allotriodipsia in Endocrinology","authors":"None Sanjay Kalra, None Avivar Awasthi, None Saurabh Arora, None Nitin Kapoor","doi":"10.47391/jpma.23-93","DOIUrl":"https://doi.org/10.47391/jpma.23-93","url":null,"abstract":"Allotriophagy is defined as food cravings that are different from the expected or the norm. It gives clinical pointers to an underlying diagnosis. We propose a new term, allotriodipsia which suggests a preference for beverages that are different from the norm. Taken together, these two entities may point towards certain endocrinological abnormalities and iatrogenic sequelae. In this communication we highlight the clinical relevance of allotriophagy and allotriodipsia. Keywords: Allotriophagy, Allotriodipsia, Anorexia nervosa, Bulimia nervosa, Food fads, Orthorexia nervosa, Osteomalacia, Sheehan’s syndrome.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"40 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":"136105219","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}
Conflict of interest (COI) in medical practice, and how it affects healthcare delivery and quality, is a poorly studied issue in Pakistan. COI can broadly be defined as a situation that arises when the opportunity for personal gain takes primacy over an individual’s professional responsibilities.1 In medicine, trust is the cornerstone of the doctor-patient relationship. Doctors hold an authoritative position based on their knowledge and expertise and are entrusted by the healthcare system and patients to put the patients’ best interests first. This means that to maintain trust, not only doctors are required to appropriately diagnose, treat and/or manage patients’ illnesses, but also consider their social and financial circumstances. In this editorial, we draw attention to a prime example of how COI manifests in medical practice as a result of the interactions between doctors and pharmaceutical sales representatives (PSRs). While PSRs are a source of knowledge on existing and new pharmaceutical products, this relationship can turn into an apparatus of financial corruption, when, in their efforts to maximise profits, PSRs incentivise doctors for prescribing. We refer to this as incentive-linked prescribing (ILP) whereby doctors accept some form of incentive in exchange for prescribing to meet pharmaceutical sales targets, without considering the added financial burden on patients and adverse health outcomes. In 2021, the Drug Regulatory Authority of Pakistan (DRAP) published rules by which pharmaceutical companies are prohibited to offer incentives to doctors for prescriptions, however, these rules are poorly enforced.2 The absence of concrete legislation, clear-cut guidelines, sound monitoring, and regulation mechanism paves the way for the establishment of the unethical profit-driven relationship between doctors and the pharmaceutical industry. Consequences of ILP to patients, doctors, and the healthcare system There is growing attention to ILP and its consequences to medical practice and public health in Pakistan. Research has shed light on the well-entrenched influence of PSRs on physicians prescribing practices.3 This level of influence is achieved with the help of incentives, which foster dependent relationships between physicians and the pharmaceutical industry. Alarmingly, much of the research concludes that ILP has become normalised within the medical fraternity and how they interact with pharmaceutical companies.3,4 ILP can lead to several negative consequences for patients, doctors, and the healthcare system, and it is critical that doctors are made aware of these consequences. Patients may be aware of the unethical profit-driven relationship between doctors and pharmaceutical companies, and for this reason, lose trust in doctors. Doctors may prescribe most costly and/or unnecessary medications than what would otherwise have been prescribed. This can put patients under additional financial pressure and subject them to potential adverse h
{"title":"Conflict of interests driven by pharmaceutical incentivisation: risks to the medical fraternity in Pakistan","authors":"None Muhammad Naveed Noor, None Afifah Rahman-Shepherd, None Amna Rehana Siddiqui","doi":"10.47391/jpma.23-91","DOIUrl":"https://doi.org/10.47391/jpma.23-91","url":null,"abstract":"Conflict of interest (COI) in medical practice, and how it affects healthcare delivery and quality, is a poorly studied issue in Pakistan. COI can broadly be defined as a situation that arises when the opportunity for personal gain takes primacy over an individual’s professional responsibilities.1 In medicine, trust is the cornerstone of the doctor-patient relationship. Doctors hold an authoritative position based on their knowledge and expertise and are entrusted by the healthcare system and patients to put the patients’ best interests first. This means that to maintain trust, not only doctors are required to appropriately diagnose, treat and/or manage patients’ illnesses, but also consider their social and financial circumstances. In this editorial, we draw attention to a prime example of how COI manifests in medical practice as a result of the interactions between doctors and pharmaceutical sales representatives (PSRs). While PSRs are a source of knowledge on existing and new pharmaceutical products, this relationship can turn into an apparatus of financial corruption, when, in their efforts to maximise profits, PSRs incentivise doctors for prescribing. We refer to this as incentive-linked prescribing (ILP) whereby doctors accept some form of incentive in exchange for prescribing to meet pharmaceutical sales targets, without considering the added financial burden on patients and adverse health outcomes. In 2021, the Drug Regulatory Authority of Pakistan (DRAP) published rules by which pharmaceutical companies are prohibited to offer incentives to doctors for prescriptions, however, these rules are poorly enforced.2 The absence of concrete legislation, clear-cut guidelines, sound monitoring, and regulation mechanism paves the way for the establishment of the unethical profit-driven relationship between doctors and the pharmaceutical industry. Consequences of ILP to patients, doctors, and the healthcare system There is growing attention to ILP and its consequences to medical practice and public health in Pakistan. Research has shed light on the well-entrenched influence of PSRs on physicians prescribing practices.3 This level of influence is achieved with the help of incentives, which foster dependent relationships between physicians and the pharmaceutical industry. Alarmingly, much of the research concludes that ILP has become normalised within the medical fraternity and how they interact with pharmaceutical companies.3,4 ILP can lead to several negative consequences for patients, doctors, and the healthcare system, and it is critical that doctors are made aware of these consequences. Patients may be aware of the unethical profit-driven relationship between doctors and pharmaceutical companies, and for this reason, lose trust in doctors. Doctors may prescribe most costly and/or unnecessary medications than what would otherwise have been prescribed. This can put patients under additional financial pressure and subject them to potential adverse h","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"28 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":"136105220","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}
Irisin is a novel adipomyokine which has extensive systemic and local effects in different tissues of the body. The scientific interest in understanding the physiological roles of irisin in the body has increased tremendously in the past few years due to its vast therapeutic potential in different fields of medicine. The current narrative review was planned to describe the molecular mechanisms by which irisin regulates oral hard and soft tissues. The information gleaned provided useful insights for future researchers to investigate newly discovered roles of irisin in craniofacial health and disease, and to explore the potential of irisin as a promising therapeutic and diagnostic agent in clinical dentistry. Key Words: FNDC5, Irisin, Human periodontal ligament cell, Human dental pulp stem cell, Bone, Regeneration.
{"title":"Irisin; a myokine with therapeutic and diagnostic potential in clinical dentistry","authors":"Alina Saleem, None Sarah Ghafoor","doi":"10.47391/jpma.8360","DOIUrl":"https://doi.org/10.47391/jpma.8360","url":null,"abstract":"Irisin is a novel adipomyokine which has extensive systemic and local effects in different tissues of the body. The scientific interest in understanding the physiological roles of irisin in the body has increased tremendously in the past few years due to its vast therapeutic potential in different fields of medicine. The current narrative review was planned to describe the molecular mechanisms by which irisin regulates oral hard and soft tissues. The information gleaned provided useful insights for future researchers to investigate newly discovered roles of irisin in craniofacial health and disease, and to explore the potential of irisin as a promising therapeutic and diagnostic agent in clinical dentistry. Key Words: FNDC5, Irisin, Human periodontal ligament cell, Human dental pulp stem cell, Bone, Regeneration.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"65 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":"136105868","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}
Amna Faheem Mufti, Abdul Wahid Rizwan, Hassan Farooq
Madam, Endometriosis is a potentially debilitating disease in which endometrial tissue is present outside the uterine cavity. It can be symptomless in some women, while causing severe pelvic pain, dysmenorrhea, dyspareunia, and decreased fertility in others.1 According to the World Health Organisation (WHO), endometriosis affects 10% (190 million) of reproductive age women globally.2 Endometriomas are the most common manifestation of endometriosis on the ovary, indicating a more severe disease state.3 In October 2022, a randomised trial was conducted to study Silymarin's efficacy on endometrioma-related manifestations. 4 The trial was the first of its kind. It showed that Silymarin, a herbal supplement with potent antioxidant effects, significantly decrease endometrioma size and the chronic pelvic pain related to it.4 Oxidative Stress, an imbalance between ROS and antioxidants, is known as a primary factor in the endometriosis pathogenesis5, and Silymarin may be ten times as potent as Vitamin E, another antioxidant which has been investigated in relation to endometriosis treatment.4 In Pakistan, the estimated prevalence of endometriosis is 16.8%6, which means a significant number of women are living with the manifestations that come with the disease, including endometriomas, which are seen in 17 to 44% of individuals with endometriosis.3 Silymarin is already available and used in Pakistan for its hepatoprotective effects. In light of this, it is of great importance that this new treatment and its effects are studied on a larger scale, specifically on the Pakistani population to learn more about its potential in reducing the suffering and improving the quality of life of these women.
{"title":"Women suffering from endometrioma-related symptoms may benefit from Silymarin, an antioxidant","authors":"Amna Faheem Mufti, Abdul Wahid Rizwan, Hassan Farooq","doi":"10.47391/jpma.9669","DOIUrl":"https://doi.org/10.47391/jpma.9669","url":null,"abstract":"Madam, Endometriosis is a potentially debilitating disease in which endometrial tissue is present outside the uterine cavity. It can be symptomless in some women, while causing severe pelvic pain, dysmenorrhea, dyspareunia, and decreased fertility in others.1 According to the World Health Organisation (WHO), endometriosis affects 10% (190 million) of reproductive age women globally.2 Endometriomas are the most common manifestation of endometriosis on the ovary, indicating a more severe disease state.3 In October 2022, a randomised trial was conducted to study Silymarin's efficacy on endometrioma-related manifestations. 4 The trial was the first of its kind. It showed that Silymarin, a herbal supplement with potent antioxidant effects, significantly decrease endometrioma size and the chronic pelvic pain related to it.4 Oxidative Stress, an imbalance between ROS and antioxidants, is known as a primary factor in the endometriosis pathogenesis5, and Silymarin may be ten times as potent as Vitamin E, another antioxidant which has been investigated in relation to endometriosis treatment.4 In Pakistan, the estimated prevalence of endometriosis is 16.8%6, which means a significant number of women are living with the manifestations that come with the disease, including endometriomas, which are seen in 17 to 44% of individuals with endometriosis.3 Silymarin is already available and used in Pakistan for its hepatoprotective effects. In light of this, it is of great importance that this new treatment and its effects are studied on a larger scale, specifically on the Pakistani population to learn more about its potential in reducing the suffering and improving the quality of life of these women.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"22 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":"136106050","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}
Fahad Umer, Niha Adnan, Madiha Khan, Madiha Bilal Qureshi
Periapical diseases ranges from mild granulomatous lesions to large cystic ones, with the treatments corresponding to their respective pre-operative diagnoses. However, the determination of cause of periapical radiolucency is impossible on pre-operative clinical and radiographic examinations. We present a case highlighting the difficulties encountered in treating a periapical cyst using the current evidence in literature. It demonstrates the uncertainty involved in treating such lesions, owing to the impossible nature of determining the histopathological nature of the cyst, i.e., being either true cysts or pocket cysts. This case includes orthograde re-treatment; decompression of the cystic lesion, followed by peri-apical surgery of two teeth over a course of three years; and the uncertain outcomes encountered after each phase of the treatment. Keywords: Granuloma, periradicular lesion, apical cyst, periapical surgery, non-surgical retreatment.
{"title":"The dilemma of management of cystic lesions; an uncertain way forward: a case report","authors":"Fahad Umer, Niha Adnan, Madiha Khan, Madiha Bilal Qureshi","doi":"10.47391/jpma.8601","DOIUrl":"https://doi.org/10.47391/jpma.8601","url":null,"abstract":"Periapical diseases ranges from mild granulomatous lesions to large cystic ones, with the treatments corresponding to their respective pre-operative diagnoses. However, the determination of cause of periapical radiolucency is impossible on pre-operative clinical and radiographic examinations. We present a case highlighting the difficulties encountered in treating a periapical cyst using the current evidence in literature. It demonstrates the uncertainty involved in treating such lesions, owing to the impossible nature of determining the histopathological nature of the cyst, i.e., being either true cysts or pocket cysts. This case includes orthograde re-treatment; decompression of the cystic lesion, followed by peri-apical surgery of two teeth over a course of three years; and the uncertain outcomes encountered after each phase of the treatment. Keywords: Granuloma, periradicular lesion, apical cyst, periapical surgery, non-surgical retreatment.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"47 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136104922","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}
Muhammad Taha Nasim, Ayesha Ali, Muhammad Tabish Nasim
Madam, Tirzepatide, also known as Mounjaro, has become increasingly popular among diabetic patients due to its potential to aid in weight loss. However, with the growing demand for this medication for its weight-loss benefits, there are apprehensions that it may soon become scarce. Tirzepatide, a dual Glucagon-like peptide (GLP-1) and Glucose-dependent insulinotropic polypeptide (GIP) receptor agonistis an injectable synthetic peptide with glucose-lowering effects.(1) It stimulates first- and second-phase insulin secretion, and reduce glucagon levels. Since its approval by the FDA in late 2021, Tirzepatide has become increasingly popular among diabetic patients as it has reported a mean decrease of 1.53% in patients' HbA1C levels in the first 40 weeks of use, which is higher than other drugs available in the market(1,2). Many patients also reported significant weight loss after starting the medication, which has led to increased demand for the drug. While this drug is yet to be approved by FDA for weight loss, it is expected that it will be approved for weight loss by mid of 2023. Despite that, some doctors already e off-label as a weight loss drug in people not suffering from Diabetes(3). This can lead to an increased demand for the drug as seen earlier in the case of Ozempic (semaglutide) in 2022 leading to an acute shortage (4). Pharmacies are already reporting low supplies of Tirzepatide, and some patients are facing trouble in getting their prescriptions filled(5). For diabetic patients who are relying on Tirzepatide to manage their blood glucose levels and promote weight loss, this shortage could have serious consequences. Patients who are unable to acquire the drug may be forced to switch to other medications or try alternative treatments, which may not be as effective. In conclusion, the recent surge in demand for Tirzepatide has led to concerns about a potential shortage of the medication. While the drug has shown promise in helping diabetic patients improve glycemic control and promote weight loss, patients need to have access to the medication when they need it. To help mitigate the shortage of Tirzepatide, some experts are calling for increased production of the drug and improved distribution channels to ensure that patients can continue to benefit from this promising treatment option.
{"title":"The Potential Weight Loss Benefits of Tirzepatide: A Double-edged Sword?","authors":"Muhammad Taha Nasim, Ayesha Ali, Muhammad Tabish Nasim","doi":"10.47391/jpma.9519","DOIUrl":"https://doi.org/10.47391/jpma.9519","url":null,"abstract":"Madam, Tirzepatide, also known as Mounjaro, has become increasingly popular among diabetic patients due to its potential to aid in weight loss. However, with the growing demand for this medication for its weight-loss benefits, there are apprehensions that it may soon become scarce. Tirzepatide, a dual Glucagon-like peptide (GLP-1) and Glucose-dependent insulinotropic polypeptide (GIP) receptor agonistis an injectable synthetic peptide with glucose-lowering effects.(1) It stimulates first- and second-phase insulin secretion, and reduce glucagon levels. Since its approval by the FDA in late 2021, Tirzepatide has become increasingly popular among diabetic patients as it has reported a mean decrease of 1.53% in patients' HbA1C levels in the first 40 weeks of use, which is higher than other drugs available in the market(1,2). Many patients also reported significant weight loss after starting the medication, which has led to increased demand for the drug. While this drug is yet to be approved by FDA for weight loss, it is expected that it will be approved for weight loss by mid of 2023. Despite that, some doctors already e off-label as a weight loss drug in people not suffering from Diabetes(3). This can lead to an increased demand for the drug as seen earlier in the case of Ozempic (semaglutide) in 2022 leading to an acute shortage (4). Pharmacies are already reporting low supplies of Tirzepatide, and some patients are facing trouble in getting their prescriptions filled(5). For diabetic patients who are relying on Tirzepatide to manage their blood glucose levels and promote weight loss, this shortage could have serious consequences. Patients who are unable to acquire the drug may be forced to switch to other medications or try alternative treatments, which may not be as effective. In conclusion, the recent surge in demand for Tirzepatide has led to concerns about a potential shortage of the medication. While the drug has shown promise in helping diabetic patients improve glycemic control and promote weight loss, patients need to have access to the medication when they need it. To help mitigate the shortage of Tirzepatide, some experts are calling for increased production of the drug and improved distribution channels to ensure that patients can continue to benefit from this promising treatment option.","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":"136104926","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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