Numerous infectious diseases, including enteric fever, malaria, dengue fever, and, most recently, coronavirus disease-2019, are prevalent in Pakistan. All these diseases have overlapping clinical symptoms and can present a diagnostic challenge for the general practitioner. Since definitive testing for these disorders is time-consuming and expensive, basic clinical testing, such as a complete blood count, should be utilised to supplement clinical diagnosis, when possible. The current narrative review was planned to present specific alterations in haematological parameters for each of these disorders. The review was intended as a guide for practising physicians in their decision-making. Key Words: Complete blood count, Typhoid fever, Malaria, Dengue, COVID-19.
{"title":"Utilization of the complete blood count in diagnosing endemic diseases in Pakistan","authors":"Noor Khalid, Muhammad Umer","doi":"10.47391/jpma.8459","DOIUrl":"https://doi.org/10.47391/jpma.8459","url":null,"abstract":"Numerous infectious diseases, including enteric fever, malaria, dengue fever, and, most recently, coronavirus disease-2019, are prevalent in Pakistan. All these diseases have overlapping clinical symptoms and can present a diagnostic challenge for the general practitioner. Since definitive testing for these disorders is time-consuming and expensive, basic clinical testing, such as a complete blood count, should be utilised to supplement clinical diagnosis, when possible. The current narrative review was planned to present specific alterations in haematological parameters for each of these disorders. The review was intended as a guide for practising physicians in their decision-making. Key Words: Complete blood count, Typhoid fever, Malaria, Dengue, COVID-19.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"1 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":"136104918","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}
Laveeza Fatima, None Ahmad Danial, None Moosa Zulfiqar Ali
Insomnia, defined as difficulty falling or staying asleep, is prevalent among one-third of the general population. (1) It can give rise to various physical and mental problems, such as obesity, diabetes, anxiety, and depression. (2) While there are many effective medications for insomnia, a therapeutic approach for treating it is more likely to be dependable over time. A meta-analysis exploring the benefits of cognitive behavioural therapy (CBT) for chronic insomnia revealed an improvement of sleep onset latency by 19.03 minutes, a gain of total sleep time by 7.61 minutes, and improved sleep efficiency by 9.91%. (3)CBT has been recognized as a first-line treatment for insomnia by NIH Consensus and State of the Science Statements (4)as it is equally effective as medication for a brief treatment and is more reliable over time. One in every three persons in Pakistan is reported to have sleep problems and, a third of those take sleeping pills. (5)In developing countries like Pakistan, where people don't have resources, a therapeutic approach is likely to reduce the cost and risk of adverse effects of medications. Pakistan is a pill-oriented society, and people prefer pills over therapy. The awareness among the population to adopt treatments or shift to therapeutic interventions is close to none. The cultural stigma associated with therapy is a significant hurdle as well. Unlike medicines, therapy reduces the risk of relapse after its discontinuation. Introducing therapy in the public sector can result in more jobs for therapists and counsellors and provide a cheaper alternative to pills. The best way to introduce CBT among the population is through awareness campaigns, media, and discussions on public platforms. In addition, counsellors can provide outreach in places where additional resources are required to combat the stigma associated with psychotherapy and inform people regarding its benefits. Counsellors collaborating with other health care professionals and gaining a valuable referral source from primary care physicians can also be a meaningful strategy. It would be worth mentioning here that more studies comparing the pills to CBT should be conducted to address the issue.
{"title":"Is a Therapeutic approach required to treat Insomnia in Pakistan?","authors":"Laveeza Fatima, None Ahmad Danial, None Moosa Zulfiqar Ali","doi":"10.47391/jpma.8622","DOIUrl":"https://doi.org/10.47391/jpma.8622","url":null,"abstract":"Insomnia, defined as difficulty falling or staying asleep, is prevalent among one-third of the general population. (1) It can give rise to various physical and mental problems, such as obesity, diabetes, anxiety, and depression. (2) While there are many effective medications for insomnia, a therapeutic approach for treating it is more likely to be dependable over time. A meta-analysis exploring the benefits of cognitive behavioural therapy (CBT) for chronic insomnia revealed an improvement of sleep onset latency by 19.03 minutes, a gain of total sleep time by 7.61 minutes, and improved sleep efficiency by 9.91%. (3)CBT has been recognized as a first-line treatment for insomnia by NIH Consensus and State of the Science Statements (4)as it is equally effective as medication for a brief treatment and is more reliable over time. One in every three persons in Pakistan is reported to have sleep problems and, a third of those take sleeping pills. (5)In developing countries like Pakistan, where people don't have resources, a therapeutic approach is likely to reduce the cost and risk of adverse effects of medications. Pakistan is a pill-oriented society, and people prefer pills over therapy. The awareness among the population to adopt treatments or shift to therapeutic interventions is close to none. The cultural stigma associated with therapy is a significant hurdle as well. Unlike medicines, therapy reduces the risk of relapse after its discontinuation. Introducing therapy in the public sector can result in more jobs for therapists and counsellors and provide a cheaper alternative to pills. The best way to introduce CBT among the population is through awareness campaigns, media, and discussions on public platforms. In addition, counsellors can provide outreach in places where additional resources are required to combat the stigma associated with psychotherapy and inform people regarding its benefits. Counsellors collaborating with other health care professionals and gaining a valuable referral source from primary care physicians can also be a meaningful strategy. It would be worth mentioning here that more studies comparing the pills to CBT should be conducted to address the issue.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"47 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136104919","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, The proton-pump inhibitors (PPIs) belong to a class of medications that reduce stomach acid production by irreversibly inhibiting the stomach's H+/K+ ATPase pump. These medications are used in the treatment of many conditions, such aspeptic ulcer, gastroesophageal reflux, as part of H. Pylori eradication, gastrinomas, Barrett’s oesophagus and many other conditions. They are considered to be the most potent inhibitors of acid secretion, and have largely supplanted the H2 receptor antagonists and antacids. They are also among the most widely sold medications worldwide. The class of proton pump inhibitors is listed on WHO’s list of essential medicines.1Proton pump inhibitors are generally well tolerated. However, headache, nausea, diarrhoea, abdominal pain, fatigue, and dizziness are identified as some of the common side effects. Due to their efficacies and low risk profile, PPIs are often prescribed for extend than required period. Several recent studies have shown that long-term PPI use is associated with various adverse outcomes. A 2023 study published in JAMA Network Open demonstrated that long-term use of PPIs may lead to an increased risk of acquiring extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing enterobacterales.2Another study3 published in 2022 showed that PPI use was the only modifiable factor associated with the carriage of ESBL producers in residents of long-term care facilities. These studies add to the expanding list of adverse outcomes associated with PPIs. Other adverse events of long-term PPI use, include the risk of fractures, pneumonia, Clostridium difficile diarrhoea, hypomagnesaemia, vitamin B12deficiency, chronic kidney disease, and dementia.4 Proton pump inhibitors are still used widely in Pakistan. These new findings are concerning as ESBL-producing Enterobacteriaceae are highly prevalent in Pakistan. A meta-analysis showed that the overall pooled proportion of ESBLs in Pakistan is 40%5 whereas the German population showed an estimated ESBL proportion in the range of 10 to 15% and a US census reported 4 to 12% resistance due to ESBLs.5 This calls for a strict prescription control of PPIs by Pakistani physicians, and the duration of PPI use should not extend for longer than needed. In addition, the practice of PPI’s over the counter sale by the pharmacists in Pakistan should be stopped. Additional precautions should be taken in hospitalized patients who are using PPIs to prevent them from getting multi-drug resistant infections.
{"title":"Proton pump inhibitors- Adversaries in our fight against antibiotic resistance?","authors":"Sumayya Umar, Zoya Ejaz, Faizan Masood","doi":"10.47391/jpma.9693","DOIUrl":"https://doi.org/10.47391/jpma.9693","url":null,"abstract":"Madam, The proton-pump inhibitors (PPIs) belong to a class of medications that reduce stomach acid production by irreversibly inhibiting the stomach's H+/K+ ATPase pump. These medications are used in the treatment of many conditions, such aspeptic ulcer, gastroesophageal reflux, as part of H. Pylori eradication, gastrinomas, Barrett’s oesophagus and many other conditions. They are considered to be the most potent inhibitors of acid secretion, and have largely supplanted the H2 receptor antagonists and antacids. They are also among the most widely sold medications worldwide. The class of proton pump inhibitors is listed on WHO’s list of essential medicines.1Proton pump inhibitors are generally well tolerated. However, headache, nausea, diarrhoea, abdominal pain, fatigue, and dizziness are identified as some of the common side effects. Due to their efficacies and low risk profile, PPIs are often prescribed for extend than required period. Several recent studies have shown that long-term PPI use is associated with various adverse outcomes. A 2023 study published in JAMA Network Open demonstrated that long-term use of PPIs may lead to an increased risk of acquiring extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing enterobacterales.2Another study3 published in 2022 showed that PPI use was the only modifiable factor associated with the carriage of ESBL producers in residents of long-term care facilities. These studies add to the expanding list of adverse outcomes associated with PPIs. Other adverse events of long-term PPI use, include the risk of fractures, pneumonia, Clostridium difficile diarrhoea, hypomagnesaemia, vitamin B12deficiency, chronic kidney disease, and dementia.4 Proton pump inhibitors are still used widely in Pakistan. These new findings are concerning as ESBL-producing Enterobacteriaceae are highly prevalent in Pakistan. A meta-analysis showed that the overall pooled proportion of ESBLs in Pakistan is 40%5 whereas the German population showed an estimated ESBL proportion in the range of 10 to 15% and a US census reported 4 to 12% resistance due to ESBLs.5 This calls for a strict prescription control of PPIs by Pakistani physicians, and the duration of PPI use should not extend for longer than needed. In addition, the practice of PPI’s over the counter sale by the pharmacists in Pakistan should be stopped. Additional precautions should be taken in hospitalized patients who are using PPIs to prevent them from getting multi-drug resistant infections.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"47 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":"136104927","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}
None Eman Alamgir, Unsa Alamgir, None Iqra Alamgir
Madam, Pre-operative nil per or nothing by mouth from midnight practice has been in work since 1960s.1 Its indiscriminate use is believed to prevent perioperative aspiration causing pneumonia 2, respiratory failure, morbidity and mortality. In almost every hospital in Pakistan and globally, the fasting orders from midnight are excessively used in case of morning elective surgical and medical procedures using general or regional anaesthesia.3 These not take into account the duration and type of surgery, type of sedation, choice of airway, risk stratification for increased chances of aspiration such as obesity, age, esophageal disorders. 4 However, the revolutionised current guidelines for pre-operative fasting by ASA 5-6 suggest the much shorter “2-4-6” hour rule, with NPO for two hours for clear liquids, four hours for breast milk and six hours for solids. Hence, the awareness about this myth needs to change in Pakistani healthcare centres. Recent studies have led to a more sophisticated understanding of gastric emptying and pH of gastric contents. For instance, a cochrane review showed no statistical difference in gastric volumes or stomach pH in patients on a prolonged standard fast vs shortened (<180 minute) liquid fast.7 Furthermore, the 2-4-6 rule minimises the risk of dehydration, electrolyte imbalance, patient discomfort (thirst, hunger, nausea, vomiting, anxiety) 8, hypoglycemia, intraoperative haemodynamic instability, post- operative dehyhydration and extended hospital stay. In this way patient cooperation and satisfaction can be increased. Therefore, it is high time to change the highly controversial NPO policy to reach the international healthcare standard.
{"title":"The myth of superfluous pre-operative NPO after midnight","authors":"None Eman Alamgir, Unsa Alamgir, None Iqra Alamgir","doi":"10.47391/jpma.9448","DOIUrl":"https://doi.org/10.47391/jpma.9448","url":null,"abstract":"Madam, Pre-operative nil per or nothing by mouth from midnight practice has been in work since 1960s.1 Its indiscriminate use is believed to prevent perioperative aspiration causing pneumonia 2, respiratory failure, morbidity and mortality. In almost every hospital in Pakistan and globally, the fasting orders from midnight are excessively used in case of morning elective surgical and medical procedures using general or regional anaesthesia.3 These not take into account the duration and type of surgery, type of sedation, choice of airway, risk stratification for increased chances of aspiration such as obesity, age, esophageal disorders. 4 However, the revolutionised current guidelines for pre-operative fasting by ASA 5-6 suggest the much shorter “2-4-6” hour rule, with NPO for two hours for clear liquids, four hours for breast milk and six hours for solids. Hence, the awareness about this myth needs to change in Pakistani healthcare centres. Recent studies have led to a more sophisticated understanding of gastric emptying and pH of gastric contents. For instance, a cochrane review showed no statistical difference in gastric volumes or stomach pH in patients on a prolonged standard fast vs shortened (<180 minute) liquid fast.7 Furthermore, the 2-4-6 rule minimises the risk of dehydration, electrolyte imbalance, patient discomfort (thirst, hunger, nausea, vomiting, anxiety) 8, hypoglycemia, intraoperative haemodynamic instability, post- operative dehyhydration and extended hospital stay. In this way patient cooperation and satisfaction can be increased. Therefore, it is high time to change the highly controversial NPO policy to reach the international healthcare standard.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"49 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":"136105070","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}
only in Pakistan but worldwide. In Pakistan alone, approximately 33 million people suffer from Type 2 diabetes mellitus, with an additional 11 million adults with impaired glucose tolerance, while approximately nine million people with diabetes remain undiagnosed.1 Diabetes causes many fatal complications including hypertension, myocardial infarction, stroke, chronic kidney disease, neuropathy, etc. To lower the morbidity and mortality rates, prompt screening and treatment of complications of diabetes should be done, especially the lesser-known complications. In the past, a strong association between idiopathic pulmonary fibrosis and diabetes was noted by some physicians. This association was established by Stefan Kopf et al.2 More recently a study funded by Diabetes UK (a British-based patient, healthcare professional, and research charity) at the Imperial College of London claimed that there is a strong association between lung disorders and Type 2 diabetes mellitus.3 This study examined data from approximately 500,000 individuals in 17 large-scale investigations. According to the investigation, type 2 diabetics' elevated blood sugar levels directly affect lung function. For instance an increase in typical blood sugar levels from 4 mmol/L to 12 mmol/L. might cause a 20% decline in lung function and capacity. Dr. Ben Jones, Dr. Marika Kaakinen and Dr. Elizabeth Robertson were in pivotal positions in this research and they all quoted lung disorders occurring in Type 2 diabetic patients as a direct complication of diabetes.3 Rajasurya V et al defined diabetic lung or diabetic pneumopathy as a condition characterized by progressive lung disease caused by the microvascular complications associated with diabetes mellitus.4 The direct complications of diabetes mellitus in the lungs include interstitial lung disease and idiopathic pulmonary fibrosis. Interstitial lung disease involves different degrees of inflammation and fibrosis in the pulmonary parenchyma and Idiopathic pulmonary fibrosis involves chronic progressive fibrosis leading to progressive pulmonary failure.4 Knowing the extent of diabetic patients present in Pakistan and how quickly this number can escalate,5 a clinical trial should be replicated on a larger population. There is a need to establish protocols for screening of diabetes related pneumopathy. People should be educated about these lesser-known complications of diabetes, and diabetic patients should be trained to perform pulmonary function tests at home. Overall these measures will surely help to improve the quality of life of a diabetic patient and to reduce gross morbidity and mortality rates.
{"title":"Trending screen addiction---emerging risk of increased virtual autism among toddlers","authors":"Fatima Rehan, Maryam Nasrumminallah, Sawairah Mukhtiar","doi":"10.47391/jpma.8198","DOIUrl":"https://doi.org/10.47391/jpma.8198","url":null,"abstract":"only in Pakistan but worldwide. In Pakistan alone, approximately 33 million people suffer from Type 2 diabetes mellitus, with an additional 11 million adults with impaired glucose tolerance, while approximately nine million people with diabetes remain undiagnosed.1 Diabetes causes many fatal complications including hypertension, myocardial infarction, stroke, chronic kidney disease, neuropathy, etc. To lower the morbidity and mortality rates, prompt screening and treatment of complications of diabetes should be done, especially the lesser-known complications. In the past, a strong association between idiopathic pulmonary fibrosis and diabetes was noted by some physicians. This association was established by Stefan Kopf et al.2 More recently a study funded by Diabetes UK (a British-based patient, healthcare professional, and research charity) at the Imperial College of London claimed that there is a strong association between lung disorders and Type 2 diabetes mellitus.3 This study examined data from approximately 500,000 individuals in 17 large-scale investigations. According to the investigation, type 2 diabetics' elevated blood sugar levels directly affect lung function. For instance an increase in typical blood sugar levels from 4 mmol/L to 12 mmol/L. might cause a 20% decline in lung function and capacity. Dr. Ben Jones, Dr. Marika Kaakinen and Dr. Elizabeth Robertson were in pivotal positions in this research and they all quoted lung disorders occurring in Type 2 diabetic patients as a direct complication of diabetes.3 Rajasurya V et al defined diabetic lung or diabetic pneumopathy as a condition characterized by progressive lung disease caused by the microvascular complications associated with diabetes mellitus.4 The direct complications of diabetes mellitus in the lungs include interstitial lung disease and idiopathic pulmonary fibrosis. Interstitial lung disease involves different degrees of inflammation and fibrosis in the pulmonary parenchyma and Idiopathic pulmonary fibrosis involves chronic progressive fibrosis leading to progressive pulmonary failure.4 Knowing the extent of diabetic patients present in Pakistan and how quickly this number can escalate,5 a clinical trial should be replicated on a larger population. There is a need to establish protocols for screening of diabetes related pneumopathy. People should be educated about these lesser-known complications of diabetes, and diabetic patients should be trained to perform pulmonary function tests at home. Overall these measures will surely help to improve the quality of life of a diabetic patient and to reduce gross morbidity and mortality rates.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"15 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":"136105076","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}
Binary rubrics are used to differentiate between living and non-living, animal and plant, vertebrate and invertebrate, mammalian and non-mammalian, as well as male and female organisms. While this approach helps in classifying the vast majority of the target population, we must remember that these frameworks are man-made. Many human beings may be born with phenotypic, karyotypic, gonadal and/or genital characteristics that “do not fit typical binary notion of male or female bodies”.1 Such births may as frequently as once in every 50 births, though 1 and 2 per 1,000 live births require, and/or receive “corrective” genital surgery.2 Intersex conditions are defined in various ways. Ambiguous genitalia and atypical genitalia occur if genetic and hormonal development are disturbed, and genital differentiation is hampered. A more inclusive term, difference of sexual development (DSD) uses karyotyping to classify such conditions. Types of DSDS include 46XX and 46XY sex chromosome DSD, XX and XY sex reversal, and ovotesticular disorders.3 Though frequently confused with transgender persons, and those with non-heterosexual orientation, persons with DSD are different from these. Hence, distinct advocacy for DSD needs to be carried out. As United Nations Human Rights states, “intersex children and adults are often stigmatized and subjected to multiple human rights violations, including violations of their rights to health and physical integrity, to be free from torture and ill-treatment, and to equality and non-discrimination.” 1 While South Asian countries have progressive legislation for transgender rights, awareness about the unique challenges faced by intersex people is lacking.4 Considering the near ubiquitous presence of endocrine disruptor chemicals in our environment, it may be prudent to expect, and prepare for, and increase in the incidence of differences of sexual differentiation.5 The case of persistent Mullerian duct syndrome, published6 in the current issue of the Journal of Pakistan Medical Association, should serve as a stimulus to enhance awareness and advocacy of this, as well as other DSD. Apart from ensuring accurate and appropriate diagnosis, one must focus on person sensitive communication, psychological support and social modulation.7 We commend the authors6 for their work in the field of DSD. Much more needs to be done, however. Policy makers, planners, members of the public, and persons living with DSD should work collectively to ensure that persons living with DSD should get their rightful place under the sun. Continues...
{"title":"Differences of sexual differentiation: A place under the sun","authors":"None Sanjay Kalra","doi":"10.47391/jpma.23-92","DOIUrl":"https://doi.org/10.47391/jpma.23-92","url":null,"abstract":"Binary rubrics are used to differentiate between living and non-living, animal and plant, vertebrate and invertebrate, mammalian and non-mammalian, as well as male and female organisms. While this approach helps in classifying the vast majority of the target population, we must remember that these frameworks are man-made. Many human beings may be born with phenotypic, karyotypic, gonadal and/or genital characteristics that “do not fit typical binary notion of male or female bodies”.1 Such births may as frequently as once in every 50 births, though 1 and 2 per 1,000 live births require, and/or receive “corrective” genital surgery.2 Intersex conditions are defined in various ways. Ambiguous genitalia and atypical genitalia occur if genetic and hormonal development are disturbed, and genital differentiation is hampered. A more inclusive term, difference of sexual development (DSD) uses karyotyping to classify such conditions. Types of DSDS include 46XX and 46XY sex chromosome DSD, XX and XY sex reversal, and ovotesticular disorders.3 Though frequently confused with transgender persons, and those with non-heterosexual orientation, persons with DSD are different from these. Hence, distinct advocacy for DSD needs to be carried out. As United Nations Human Rights states, “intersex children and adults are often stigmatized and subjected to multiple human rights violations, including violations of their rights to health and physical integrity, to be free from torture and ill-treatment, and to equality and non-discrimination.” 1 While South Asian countries have progressive legislation for transgender rights, awareness about the unique challenges faced by intersex people is lacking.4 Considering the near ubiquitous presence of endocrine disruptor chemicals in our environment, it may be prudent to expect, and prepare for, and increase in the incidence of differences of sexual differentiation.5 The case of persistent Mullerian duct syndrome, published6 in the current issue of the Journal of Pakistan Medical Association, should serve as a stimulus to enhance awareness and advocacy of this, as well as other DSD. Apart from ensuring accurate and appropriate diagnosis, one must focus on person sensitive communication, psychological support and social modulation.7 We commend the authors6 for their work in the field of DSD. Much more needs to be done, however. Policy makers, planners, members of the public, and persons living with DSD should work collectively to ensure that persons living with DSD should get their rightful place under the sun. Continues...","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"59 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":"136105218","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 examine and predict the relationship among sociotropy-autonomy, self-criticism and self-esteem in individuals with or without depression. Method: The cross-sectional, case-control study was conducted from November 2021 to July 2022 in various government hospitals and universities in Lahore, Pakistan, and comprised depression patients of either gender aged 20-40 years in group A. Healthy subjects matched for age and gender were enrolled in control group B. Data was collected using a demographic sheet predesigned in Urdu language, and the Urdu versions of Personal Style Inventory, Form of Self-Criticism/Attacking and Self-Reassuring Scale, and the Rosenberg Self-Esteem Scale. Data was analysed using SPSS 21. Results: Of the 200 subjects, 100(50%) were males, while each of the two groups had 100(50%) subjects. The overall mean age of the sample was 27.93±5.23 years. Sociotropy-autonomy had a significant positive relationship with self-criticism (p<0.01) and a significant negative relationship with self-esteem (p<0.01). Self-criticism was significantly negatively correlated with self-esteem (p<0.01). Sociotropy-autonomy was a significant predictor of self-criticism and self-esteem (p<0.01). Inter-group comparison of the levels of sociotropy-autonomy, self-criticism and self-esteem were significant (p<0.05). Conclusion: Sociotropy-autonomy was a highly significant predictor of self-criticism and self-esteem. People with depression had high sociotropy-autonomy and self-criticism scores, and low scores in self-esteem. Keywords: Sociotropy, Autonomy, Self-criticism, Self-esteem, Depression.
{"title":"Sociotropy-autonomy, self-criticism and self-esteem in individuals with or without depression","authors":"Sahrash Jhangir, Rabia Jameel","doi":"10.47391/jpma.8189","DOIUrl":"https://doi.org/10.47391/jpma.8189","url":null,"abstract":"Objective: To examine and predict the relationship among sociotropy-autonomy, self-criticism and self-esteem in individuals with or without depression. Method: The cross-sectional, case-control study was conducted from November 2021 to July 2022 in various government hospitals and universities in Lahore, Pakistan, and comprised depression patients of either gender aged 20-40 years in group A. Healthy subjects matched for age and gender were enrolled in control group B. Data was collected using a demographic sheet predesigned in Urdu language, and the Urdu versions of Personal Style Inventory, Form of Self-Criticism/Attacking and Self-Reassuring Scale, and the Rosenberg Self-Esteem Scale. Data was analysed using SPSS 21. Results: Of the 200 subjects, 100(50%) were males, while each of the two groups had 100(50%) subjects. The overall mean age of the sample was 27.93±5.23 years. Sociotropy-autonomy had a significant positive relationship with self-criticism (p<0.01) and a significant negative relationship with self-esteem (p<0.01). Self-criticism was significantly negatively correlated with self-esteem (p<0.01). Sociotropy-autonomy was a significant predictor of self-criticism and self-esteem (p<0.01). Inter-group comparison of the levels of sociotropy-autonomy, self-criticism and self-esteem were significant (p<0.05). Conclusion: Sociotropy-autonomy was a highly significant predictor of self-criticism and self-esteem. People with depression had high sociotropy-autonomy and self-criticism scores, and low scores in self-esteem. Keywords: Sociotropy, Autonomy, Self-criticism, Self-esteem, Depression.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"7 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":"136105377","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}
Despite acknowledging the inadequacy of rehabilitation systems to meet the ever-increasing burden of disability, the World Health Organization’s Rehabilitation 2030 initiative has not highlighted nor adequately analysed the deficiencies of the rehabilitation care structures of populous countries in South Asia. The pragmatic and operational realisation of the initiative is not high in terms of visibility in developing countries with fragmented rehabilitative care structures. Hence, the current narrative review was planned to highlight the spectrum of rehabilitation healthcare in the perspective of Sustainable Development Goal-3 with reference to the most populous South Asian countries, including Pakistan. A total of 40 relevant English-language, articles, publications, reports and online resources were reviewed. The narrative review is significant since it may result in mainstreaming the individuals with disabilities, improving their quality of life, enhance their productivity and lessen the burden and socio-economic costs of disability on the community. ---Continue
{"title":"World Health Organization success in rehabilitation 2030 including refugees’ rehabilitation across South Asia: a narrative review","authors":"Nazia Mumtaz, Ghulam Saqulain","doi":"10.47391/jpma.9098","DOIUrl":"https://doi.org/10.47391/jpma.9098","url":null,"abstract":"Despite acknowledging the inadequacy of rehabilitation systems to meet the ever-increasing burden of disability, the World Health Organization’s Rehabilitation 2030 initiative has not highlighted nor adequately analysed the deficiencies of the rehabilitation care structures of populous countries in South Asia. The pragmatic and operational realisation of the initiative is not high in terms of visibility in developing countries with fragmented rehabilitative care structures. Hence, the current narrative review was planned to highlight the spectrum of rehabilitation healthcare in the perspective of Sustainable Development Goal-3 with reference to the most populous South Asian countries, including Pakistan. A total of 40 relevant English-language, articles, publications, reports and online resources were reviewed. The narrative review is significant since it may result in mainstreaming the individuals with disabilities, improving their quality of life, enhance their productivity and lessen the burden and socio-economic costs of disability on the community. ---Continue","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":"136105748","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, Artificial Intelligence (AI) is revolutionizing psychotherapy by combating its inaccessibility.1 AI chatbots and conversational agents are among the most promising integrations in psychiatry and psychology. By harnessing the power of machine learning and artificial intelligence (Figure I), AI chatbots and conversational agents can provide a level of interaction and support previously unattainable in the landscape of mental health. In this letter, I will explore some of their numerous benefits. Chatbots have evolved from early examples such as ELIZA, a programmable natural language processing program, and PARRY, a program that mimicked the behaviour of a human with schizophrenia, to modern ones such as Woebot, Tess, and Replika, which offer cognitive behavioural therapy, sessions, and self-understanding, respectively. Some chatbots such as Kaspar and Nao are also embodied in physical robots, which help children with autism spectrum disorder (ASD) learn social skills and facial recognition. AI chatbots can address the challenges of mental health care, such as the shortage of professionals2, especially in underdeveloped countries; the stigma of seeking help, which is prevalent in many cultures; the cost of therapy, which can be prohibitive for many people; and the limitations of human therapists, who can have variable attention spans, attention-to-detail, and memory capacities. AI chatbots can also offer benefits such as accessibility, anonymity, personalization, and effectiveness. Studies have shown that AI chatbots can improve the outcomes and experiences of mental health patients in various ways, such as enhancing the performance of those with ASD with robotic "therapists"1, increasing their disclosure of sensitive information to chatbots2, and reducing their distress after talking about their problems with conversational agents3. The benefits of AI chatbots for mental health are clear. However, they also face many challenges that limit their usability and reliability. They may lack the emotional skills of human therapists and may not be accountable for their diagnoses and recommendations. They may also not be based on sound mental health knowledge and evidence, as technology companies may not have expertise and experience in this field. Therefore, technology companies and mental health professionals must collaborate and adopt a rational approach to develop and evaluate chatbots. Only then can chatbots realize their full potential and complement existing mental health services safely and ethically.
{"title":"AI Chatbots and Psychotherapy: A Match Made in Heaven?","authors":"Huzaifa Saqib, None Sumyia, None Alizeh Saqib","doi":"10.47391/jpma.9608","DOIUrl":"https://doi.org/10.47391/jpma.9608","url":null,"abstract":"Dear Editor, Artificial Intelligence (AI) is revolutionizing psychotherapy by combating its inaccessibility.1 AI chatbots and conversational agents are among the most promising integrations in psychiatry and psychology. By harnessing the power of machine learning and artificial intelligence (Figure I), AI chatbots and conversational agents can provide a level of interaction and support previously unattainable in the landscape of mental health. In this letter, I will explore some of their numerous benefits. Chatbots have evolved from early examples such as ELIZA, a programmable natural language processing program, and PARRY, a program that mimicked the behaviour of a human with schizophrenia, to modern ones such as Woebot, Tess, and Replika, which offer cognitive behavioural therapy, sessions, and self-understanding, respectively. Some chatbots such as Kaspar and Nao are also embodied in physical robots, which help children with autism spectrum disorder (ASD) learn social skills and facial recognition. AI chatbots can address the challenges of mental health care, such as the shortage of professionals2, especially in underdeveloped countries; the stigma of seeking help, which is prevalent in many cultures; the cost of therapy, which can be prohibitive for many people; and the limitations of human therapists, who can have variable attention spans, attention-to-detail, and memory capacities. AI chatbots can also offer benefits such as accessibility, anonymity, personalization, and effectiveness. Studies have shown that AI chatbots can improve the outcomes and experiences of mental health patients in various ways, such as enhancing the performance of those with ASD with robotic \"therapists\"1, increasing their disclosure of sensitive information to chatbots2, and reducing their distress after talking about their problems with conversational agents3. The benefits of AI chatbots for mental health are clear. However, they also face many challenges that limit their usability and reliability. They may lack the emotional skills of human therapists and may not be accountable for their diagnoses and recommendations. They may also not be based on sound mental health knowledge and evidence, as technology companies may not have expertise and experience in this field. Therefore, technology companies and mental health professionals must collaborate and adopt a rational approach to develop and evaluate chatbots. Only then can chatbots realize their full potential and complement existing mental health services safely and ethically.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"32 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":"136106044","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}
Objectives: To determine the knowledge, attitude and practices related to food hygiene among those working inrestaurants.Method: The descriptive, cross-sectional study was conducted from January 5 to April 30, 2019, within restaurantslocated in Hay, Kut, Numania, Badra, Azizia and Suwera cities in the Wasit Governorate of Iraq. Those included usingsimple random sampling technique were food handlers of either gender. Data was collected using a predesignedquestionnaire.Results: Of the 330 subjects from 55 restaurants, 320(96.9%) were males and 10(3%) females. The overall mean agewas 31.6±9.5 years (range: 15-55 years). Overall, 193(58.4%) subjects were married, 279(84.5%) had work experience<10 years, 90(27.2%) had professional training, 212(64.2%) had studied up to secondary level, and 113(34.2%) wereworking as waiters. Of the total, 127(38.48%) subjects correctly described food hygiene, and 197(59.69%)acknowledged the necessity of obligatory periodical check-ups. Hygiene practice scores were poor in 223(67.57%)cases.Conclusion: The food hygiene knowledge, attitude and practice of food handlers in restaurants of Wasit governoratewere found to be poor.Keywords: Restaurants, Health, Knowledge, Attitudes, Practice, Hygiene, Surveys.
{"title":"The food hygiene practices among workers in restaurants of Wasit Governorate, Iraq","authors":"None Dhakam Mohammed Abbas, None Sameeha Naser Abed, None Rusul Abdulhameed Kadhim","doi":"10.47391/jpma.iq-19","DOIUrl":"https://doi.org/10.47391/jpma.iq-19","url":null,"abstract":"Objectives: To determine the knowledge, attitude and practices related to food hygiene among those working inrestaurants.Method: The descriptive, cross-sectional study was conducted from January 5 to April 30, 2019, within restaurantslocated in Hay, Kut, Numania, Badra, Azizia and Suwera cities in the Wasit Governorate of Iraq. Those included usingsimple random sampling technique were food handlers of either gender. Data was collected using a predesignedquestionnaire.Results: Of the 330 subjects from 55 restaurants, 320(96.9%) were males and 10(3%) females. The overall mean agewas 31.6±9.5 years (range: 15-55 years). Overall, 193(58.4%) subjects were married, 279(84.5%) had work experience<10 years, 90(27.2%) had professional training, 212(64.2%) had studied up to secondary level, and 113(34.2%) wereworking as waiters. Of the total, 127(38.48%) subjects correctly described food hygiene, and 197(59.69%)acknowledged the necessity of obligatory periodical check-ups. Hygiene practice scores were poor in 223(67.57%)cases.Conclusion: The food hygiene knowledge, attitude and practice of food handlers in restaurants of Wasit governoratewere found to be poor.Keywords: Restaurants, Health, Knowledge, Attitudes, Practice, Hygiene, Surveys.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134943835","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：