Burcin Meryem Atak Tel, S. Bilgin, O. Kurtkulagi, G. Kahveci, Recep Aktaş, K. Kurt, T. Duman, G. Aktas
Abstract: Objective: Methotrexate is used to suppress inflammation in many rheumatologic conditions. Here we present an elderly patient who developed serious side effects due to methotrexate. A 78 year old male admitted to emergency department with oral mucosal bleeding, skin rash, decrease in oral nutrition intake and weakness. He had been using 5 milligrams of methotrexate as 2 tablets twice a day for 10 days, after he was diagnosed with psoriatic arthritis 15 days ago. A diagnosis of methotrexate intoxication established with history, physical examination and laboratory analysis, which revealed pancytopenia. His signs and symptoms, as well as pancytopenia were recovered on 6th day of the hospitalization. He had been treated with folinic acid and filgrastim along with supportive care. Although methotrexate treatment and toxicity is well established it is still a clinical challenge that all clinicians must be aware of. In conclusion, methotrexate intoxication is a clinical entity that can lead to serious clinical consequences, and it is essential to diagnose and initiate appropriate treatment without delay to prevent morbidity and mortality. Keywords: Methotrexate toxicity, Pancytopenia, Treatment, Folinic acid, Filgrastim, Inflammation, Psoriatic arthritis.
{"title":"Severe Pancytopenia and Stomatitis Case due to the Treatment with High Dose Methotrexate","authors":"Burcin Meryem Atak Tel, S. Bilgin, O. Kurtkulagi, G. Kahveci, Recep Aktaş, K. Kurt, T. Duman, G. Aktas","doi":"10.21089/njhs.61.0032","DOIUrl":"https://doi.org/10.21089/njhs.61.0032","url":null,"abstract":"Abstract: Objective: Methotrexate is used to suppress inflammation in many rheumatologic conditions. Here we present an elderly patient who developed serious side effects due to methotrexate. A 78 year old male admitted to emergency department with oral mucosal bleeding, skin rash, decrease in oral nutrition intake and weakness. He had been using 5 milligrams of methotrexate as 2 tablets twice a day for 10 days, after he was diagnosed with psoriatic arthritis 15 days ago. A diagnosis of methotrexate intoxication established with history, physical examination and laboratory analysis, which revealed pancytopenia. His signs and symptoms, as well as pancytopenia were recovered on 6th day of the hospitalization. He had been treated with folinic acid and filgrastim along with supportive care. Although methotrexate treatment and toxicity is well established it is still a clinical challenge that all clinicians must be aware of. In conclusion, methotrexate intoxication is a clinical entity that can lead to serious clinical consequences, and it is essential to diagnose and initiate appropriate treatment without delay to prevent morbidity and mortality. Keywords: Methotrexate toxicity, Pancytopenia, Treatment, Folinic acid, Filgrastim, Inflammation, Psoriatic arthritis.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124753061","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}
The doctors who are going through our postgraduate residency training programs are tomorrow’s specialists who will be playing pivotal roles as healthcare policy decision-makers. To establish site-specific multidisciplinary tumor boards, we have to rely on our present-day resident’s leadership skills. We intend to provide meaningful specific patient-centered goals to our postgraduate students who are our future specialist healthcare providers. We are witnessing a slow positive change towards shared care and the implementation of multidisciplinary culture. This is high time to develop modules with a specific learning objective of providing high-quality leadership skills to all our postgraduate trainees. Effective and efficient team-building skills will enable them to initiate and maintain multidisciplinary professional processes complying with international standards [1].
{"title":"Non-Institutional Independent Tumor Boards Beneficial Impact on Post-Graduate Medical Training","authors":"A. Abbasi, Sohail Rasool, M. Bashir","doi":"10.21089/njhs.61.0003","DOIUrl":"https://doi.org/10.21089/njhs.61.0003","url":null,"abstract":"The doctors who are going through our postgraduate residency training programs are tomorrow’s specialists who will be playing pivotal roles as healthcare policy decision-makers. To establish site-specific multidisciplinary tumor boards, we have to rely on our present-day resident’s leadership skills. We intend to provide meaningful specific patient-centered goals to our postgraduate students who are our future specialist healthcare providers. We are witnessing a slow positive change towards shared care and the implementation of multidisciplinary culture. This is high time to develop modules with a specific learning objective of providing high-quality leadership skills to all our postgraduate trainees. Effective and efficient team-building skills will enable them to initiate and maintain multidisciplinary professional processes complying with international standards [1].","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126462709","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}
Abstract: Objective: Helicobacter pylori (H. pylori) is considered in the category of biological agent directly responsible for cancer. Guidelines recommend discontinuing suppressive conditions prior to histopathological helicobacter pylori testing, but there is little clinical trial data on how outcome is affected if this is not done. Optimal test recommendations in the guidelines are based on in vitro study results. In present study, we aimed to observe whether there was a difference in the prevalence of H. pylori histopathologically in patients who met the necessary prerequisites before Esophago-Gastro-Duodenoscopy (EGD) compared to the subjects group who did not meet the PPI discontinuation condition. Materials & Methods: This retrospective study was conducted between October 2015 and August 2016 in a reference hospital with 1.5 million hinterlands. Patients who underwent EGD by meeting all the prerequisites recommended by the guidelines for the H. pylori test were included in the study group (n=213), and those who discontinued other suppressive drugs except PPI were included in the control group (n=193). Results: While H. pylori was found to be 74.6% positive in the study group that provided all the prerequisites for histopathological H. pylori detection, H. pylori was found to be 64.9% positive in the control group continuing to receive PPI treatment (p=0.02). Conclusion: In conclusion, we suggest that it is necessary to proceed with the guidance of classical knowledge in determining the presence of H. pylori, which is a common public health problem that is up-to-date. Keywords: Helicobacter pylori, Suppressive condition, Proton pump inhibitor, Histopathology, Cancer, Guideline.
摘要:目的:幽门螺杆菌(Helicobacter pylori, H. pylori)被认为是直接导致癌症的生物制剂。指南建议在组织病理学幽门螺杆菌检测之前停止抑制条件，但很少有临床试验数据表明如果不这样做会如何影响结果。指南中的最佳测试建议是基于体外研究结果。在本研究中，我们旨在观察在食管胃十二指肠镜检查(EGD)前满足必要条件的患者与未满足PPI停药条件的受试者组在组织病理学上是否存在幽门螺杆菌患病率的差异。材料与方法:本研究于2015年10月至2016年8月在一家有150万腹地的参考医院进行回顾性研究。研究组(n=213)为符合幽门螺杆菌检查指南推荐的所有前提条件的EGD患者，对照组(n=193)为停用除PPI以外其他抑制药物的患者。结果:研究组幽门螺杆菌阳性率为74.6%，为组织病理学检测幽门螺杆菌提供了所有条件，而继续接受PPI治疗的对照组幽门螺杆菌阳性率为64.9% (p=0.02)。结论:总之，我们建议有必要在经典知识的指导下确定幽门螺旋杆菌的存在，这是一个常见的公共卫生问题，是最新的。关键词:幽门螺杆菌，抑制状态，质子泵抑制剂，组织病理学，癌症，指南。
{"title":"Is The Theoretical Knowledge Reflected in Current Practice: Histopathological Helicobacter Pylori Research?","authors":"Mehmet Ali Kosekli","doi":"10.21089/njhs.61.0022","DOIUrl":"https://doi.org/10.21089/njhs.61.0022","url":null,"abstract":"Abstract: Objective: Helicobacter pylori (H. pylori) is considered in the category of biological agent directly responsible for cancer. Guidelines recommend discontinuing suppressive conditions prior to histopathological helicobacter pylori testing, but there is little clinical trial data on how outcome is affected if this is not done. Optimal test recommendations in the guidelines are based on in vitro study results. In present study, we aimed to observe whether there was a difference in the prevalence of H. pylori histopathologically in patients who met the necessary prerequisites before Esophago-Gastro-Duodenoscopy (EGD) compared to the subjects group who did not meet the PPI discontinuation condition. Materials & Methods: This retrospective study was conducted between October 2015 and August 2016 in a reference hospital with 1.5 million hinterlands. Patients who underwent EGD by meeting all the prerequisites recommended by the guidelines for the H. pylori test were included in the study group (n=213), and those who discontinued other suppressive drugs except PPI were included in the control group (n=193). Results: While H. pylori was found to be 74.6% positive in the study group that provided all the prerequisites for histopathological H. pylori detection, H. pylori was found to be 64.9% positive in the control group continuing to receive PPI treatment (p=0.02). Conclusion: In conclusion, we suggest that it is necessary to proceed with the guidance of classical knowledge in determining the presence of H. pylori, which is a common public health problem that is up-to-date. Keywords: Helicobacter pylori, Suppressive condition, Proton pump inhibitor, Histopathology, Cancer, Guideline.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130636208","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}
Abstract: Objective: Thrombocytopenia is a frequent finding in Dengue fever. Immune Thrombocytopenia (ITP) is a diagnosis of exclusion and is not associated with febrile illness. Ignoring fever, low platelet count and clinical signs may be similar in both conditions. Peripheral film finding in Dengue fever shows many reactive lymphocytes. Enumeration of these reactive lymphocytes as high fluorescence lymphocyte count (HFLC) and computing immature fraction of platelets (IPF) may be useful in differentiating these two disorders as soon as the blood sample is analyzed on XN-1000 hematology analyzer. Materials and Methods: A cross-sectional study was conducted at National Institute of Blood Disease and Bone Marrow transplantation from January to July 2019 during (Dengue season); blood samples from emergency room were analyzed on XN-1000 hematology analyzer for complete blood count and IPF. Samples with thrombocytopenia were checked for IPF count and HFLC from the extended research parameter data of the analyzer. Patients presenting with fever, had Dengue NS-1 tested. Detailed history & examination was recorded from the patients. Results: Out of the 124 patients, 62 (50%) patients of Dengue and ITP respectively. Male to female ratio was 2:1. Mean age in Dengue was 25.52±10.46 years while 34.44 + 20.82 years in ITP group. Mean platelet count was significantly higher in dengue than ITP patients (120.59 ± 80.28 x109/L versus 41.84 ±38.62 x109/L) (p<0.001). HFLC was 11.71± 7.17% in Dengue fever while 0.198±0.25% in ITP patients whereas IPF in ITP group was 21.91 ± 16.09% while 8.79± 4.39%in Dengue patients were found to be significant i.e. (p<0.001). Conclusion: Excluding fever, thrombocytopenia, presence of increased number of HFLC and low or normal IPF can reliably a predictor of a diagnosis in Dengue season. Keywords: High fluorescence lymphocyte counts, Immature platelet functions, Dengue, Immune thrombocytopenia, Resource constraint Laboratories, Research parameters.
摘要:目的:血小板减少症是登革热的常见病。免疫性血小板减少症(ITP)是一种排除性诊断，与发热性疾病无关。忽略发热，低血小板计数和临床症状在这两种情况下可能相似。登革热外周膜显示许多反应性淋巴细胞。在XN-1000血液学分析仪上分析血液样本后，计数这些反应性淋巴细胞作为高荧光淋巴细胞计数(HFLC)和计算未成熟血小板分数(IPF)可能有助于鉴别这两种疾病。材料和方法:2019年1月至7月(登革热季节)在国家血病和骨髓移植研究所进行了一项横断面研究;采用XN-1000型血液学分析仪对急诊室采血标本进行全血细胞计数和IPF分析。从分析仪的扩展研究参数数据中检查血小板减少的样品的IPF计数和HFLC。出现发热症状的患者接受了NS-1登革热检测。详细记录患者的病史和检查。结果:124例患者中，登革热和ITP分别为62例(50%)。男女比例为2:1。登革热组平均年龄25.52±10.46岁，ITP组平均年龄34.44±20.82岁。登革热患者的平均血小板计数明显高于ITP患者(120.59±80.28 x109/L vs 41.84±38.62 x109/L) (p<0.001)。登革热组HFLC为11.71±7.17%，ITP组为0.198±0.25%;ITP组IPF为21.91±16.09%，登革热组为8.79±4.39%，两者差异有统计学意义(p<0.001)。结论:排除发热、血小板减少、HFLC数量增加和IPF低或正常可以可靠地预测登革热季节的诊断。关键词:高荧光淋巴细胞计数，未成熟血小板功能，登革热，免疫性血小板减少症，资源约束实验室，研究参数
{"title":"High Fluorescence Lymphocyte Count and Immature Platelet Fraction; “Can these Two Parameters Reliably Distinguish between Dengue and ITP?”","authors":"J. Hassan, S. Waheed, Madiha Abid, T. Shamsi","doi":"10.21089/njhs.61.0017","DOIUrl":"https://doi.org/10.21089/njhs.61.0017","url":null,"abstract":"Abstract: Objective: Thrombocytopenia is a frequent finding in Dengue fever. Immune Thrombocytopenia (ITP) is a diagnosis of exclusion and is not associated with febrile illness. Ignoring fever, low platelet count and clinical signs may be similar in both conditions. Peripheral film finding in Dengue fever shows many reactive lymphocytes. Enumeration of these reactive lymphocytes as high fluorescence lymphocyte count (HFLC) and computing immature fraction of platelets (IPF) may be useful in differentiating these two disorders as soon as the blood sample is analyzed on XN-1000 hematology analyzer. Materials and Methods: A cross-sectional study was conducted at National Institute of Blood Disease and Bone Marrow transplantation from January to July 2019 during (Dengue season); blood samples from emergency room were analyzed on XN-1000 hematology analyzer for complete blood count and IPF. Samples with thrombocytopenia were checked for IPF count and HFLC from the extended research parameter data of the analyzer. Patients presenting with fever, had Dengue NS-1 tested. Detailed history & examination was recorded from the patients. Results: Out of the 124 patients, 62 (50%) patients of Dengue and ITP respectively. Male to female ratio was 2:1. Mean age in Dengue was 25.52±10.46 years while 34.44 + 20.82 years in ITP group. Mean platelet count was significantly higher in dengue than ITP patients (120.59 ± 80.28 x109/L versus 41.84 ±38.62 x109/L) (p<0.001). HFLC was 11.71± 7.17% in Dengue fever while 0.198±0.25% in ITP patients whereas IPF in ITP group was 21.91 ± 16.09% while 8.79± 4.39%in Dengue patients were found to be significant i.e. (p<0.001). Conclusion: Excluding fever, thrombocytopenia, presence of increased number of HFLC and low or normal IPF can reliably a predictor of a diagnosis in Dengue season. Keywords: High fluorescence lymphocyte counts, Immature platelet functions, Dengue, Immune thrombocytopenia, Resource constraint Laboratories, Research parameters.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"145 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124667084","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 Saeed, Memona Mohiuddin, Mohammad Hassan Al-Sumaili
Abstract: Objective: Multiple sclerosis is immune mediated disorder of central nervous system (CNS). Diagnosis of multiple sclerosis is based on clinical findings and investigations, like MRI of CNS. Herein, we presents a 13-year old boy who presented with sudden loss of vision in both eyes for two days duration. The concurrent phenomenon of optic neuritis and multiple sclerosis is less common in children and rarely reported. Keywords: Multiple sclerosis (MS), Optic neuritis (ON), Child, Steroids, Visual loss, Magnetic resonance imaging (MRI) brain, Fundoscopy.
{"title":"Acute Visual Loss in Young Boy","authors":"Muhammad Saeed, Memona Mohiuddin, Mohammad Hassan Al-Sumaili","doi":"10.21089/njhs.61.0035","DOIUrl":"https://doi.org/10.21089/njhs.61.0035","url":null,"abstract":"Abstract: Objective: Multiple sclerosis is immune mediated disorder of central nervous system (CNS). Diagnosis of multiple sclerosis is based on clinical findings and investigations, like MRI of CNS. Herein, we presents a 13-year old boy who presented with sudden loss of vision in both eyes for two days duration. The concurrent phenomenon of optic neuritis and multiple sclerosis is less common in children and rarely reported. Keywords: Multiple sclerosis (MS), Optic neuritis (ON), Child, Steroids, Visual loss, Magnetic resonance imaging (MRI) brain, Fundoscopy.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124670178","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}
S. Dildar, Asma Danish, M. Imam, A. Naz, T. Shamsi
Abstract: Objective: To evaluate the diagnostic performance of Electrochemiluminescence (ECLIA) enzyme linked immunosorbent (ELISA) and lateral flow Immunofluorescence (LFIA) for anti-SARS-COV-2 antibody detection. Materials and Methods: Sensitivity was calculated with convalescent plasma (CP) donor’s samples. Specificity was checked by using pre-pandemic October 2019 samples. All samples were tested for anti-SARS-COV-2 antibody by using Electrochemiluminescence (ECLIA), Enzyme Linked Immunosorbent Assay (ELISA) and Lateral flow Immunofluorescence (LFIA) assay. Results: Total 55 patients were included, 45 patients were CP donors and 10 were Pre-Pandemic October 2019 samples archived from our blood bank. The ECLIA-total antibody, ELISA-IgG and LLFIA-IgG were positive in 41 (91.1%), 34 (75.5%) and 44 (97.75%) respectively. The highest sensitivity was observed for LFIA with highest specificity among all three assays. There was almost perfect agreement between LFIA and ECLIA (k=0.936, p<0.001) but there was fair agreement between LFIA and ELISA (k=0.412, p=0.001) and ECLIA and ELISA (k=0.357, p=0.001). Conclusion: The LFIA showed a higher sensitivity and specificity in comparison with ECLIA and ELISA. It might be due to fact that LFIA detect antibody against ncleocapsid and spike protein as well of SARS- COV-2 virus, while ECLIA and ELISA detects antibodies only against “N” Protein of SARS- COV-2 virus. Keywords: Convalescent plasma donors, Lateral flow Immunofluorescence assay, Electrochemiluminescence assay, Enzyme linked immunosorbent assay, Performance.
{"title":"Diagnostic Performance of Three Serological Assays for Anti-SARS-CoV-2 Antibody Detection","authors":"S. Dildar, Asma Danish, M. Imam, A. Naz, T. Shamsi","doi":"10.21089/NJHS.54.0162","DOIUrl":"https://doi.org/10.21089/NJHS.54.0162","url":null,"abstract":"Abstract: Objective: To evaluate the diagnostic performance of Electrochemiluminescence (ECLIA) enzyme linked immunosorbent (ELISA) and lateral flow Immunofluorescence (LFIA) for anti-SARS-COV-2 antibody detection. Materials and Methods: Sensitivity was calculated with convalescent plasma (CP) donor’s samples. Specificity was checked by using pre-pandemic October 2019 samples. All samples were tested for anti-SARS-COV-2 antibody by using Electrochemiluminescence (ECLIA), Enzyme Linked Immunosorbent Assay (ELISA) and Lateral flow Immunofluorescence (LFIA) assay. Results: Total 55 patients were included, 45 patients were CP donors and 10 were Pre-Pandemic October 2019 samples archived from our blood bank. The ECLIA-total antibody, ELISA-IgG and LLFIA-IgG were positive in 41 (91.1%), 34 (75.5%) and 44 (97.75%) respectively. The highest sensitivity was observed for LFIA with highest specificity among all three assays. There was almost perfect agreement between LFIA and ECLIA (k=0.936, p<0.001) but there was fair agreement between LFIA and ELISA (k=0.412, p=0.001) and ECLIA and ELISA (k=0.357, p=0.001). Conclusion: The LFIA showed a higher sensitivity and specificity in comparison with ECLIA and ELISA. It might be due to fact that LFIA detect antibody against ncleocapsid and spike protein as well of SARS- COV-2 virus, while ECLIA and ELISA detects antibodies only against “N” Protein of SARS- COV-2 virus. Keywords: Convalescent plasma donors, Lateral flow Immunofluorescence assay, Electrochemiluminescence assay, Enzyme linked immunosorbent assay, Performance.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"58 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127712974","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}
Abstract: Sofosbuvir is an oral nucleoside analogue and potent inhibitor of the Hepatitis C virus (HCV) RNA polymerase that is used in combination with other antiviral agents to treat chronic Hepatitis C Nevertheless, and for unknown reasons, successful antiviral therapy of Hepatitis C with Sofosbuvir and other direct acting agents in patients with cirrhosis is occasionally complicated by hepatic decompensation. Here we describe 2 case report of upper gi bleed at initial days of treatment with Sofosbuvir and Ribavirin. Keywords: Variceal bleeding , Sofosdbuvir, Ribavirin, Heptitis C, Nucleoside analogue, Antiviral.
{"title":"Variceal Bleeding in Patients with Initation of Sofosbuvir and Ribavirin – Case Reports","authors":"Sadiq Memon, Madiha Zaki, S. A. Jiskani","doi":"10.21089/NJHS.54.0175","DOIUrl":"https://doi.org/10.21089/NJHS.54.0175","url":null,"abstract":"Abstract: Sofosbuvir is an oral nucleoside analogue and potent inhibitor of the Hepatitis C virus (HCV) RNA polymerase that is used in combination with other antiviral agents to treat chronic Hepatitis C Nevertheless, and for unknown reasons, successful antiviral therapy of Hepatitis C with Sofosbuvir and other direct acting agents in patients with cirrhosis is occasionally complicated by hepatic decompensation. Here we describe 2 case report of upper gi bleed at initial days of treatment with Sofosbuvir and Ribavirin. Keywords: Variceal bleeding , Sofosdbuvir, Ribavirin, Heptitis C, Nucleoside analogue, Antiviral.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"17 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113935127","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}
{"title":"Pharmacovigilance – A Medication Safety Perspective","authors":"Syed Saad Hussain","doi":"10.21089/NJHS.54.0148","DOIUrl":"https://doi.org/10.21089/NJHS.54.0148","url":null,"abstract":"","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130194957","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}
A. Abbasi, Fatima Shaukat, S. Abrar, B. Qureshi, N. Ali, A. Hafiz, Hina Hafiz
{"title":"Onco-Fertility Tumor Board is Vitally Important for Addressing Fertility Issues in Cancer Patients","authors":"A. Abbasi, Fatima Shaukat, S. Abrar, B. Qureshi, N. Ali, A. Hafiz, Hina Hafiz","doi":"10.21089/NJHS.54.0146","DOIUrl":"https://doi.org/10.21089/NJHS.54.0146","url":null,"abstract":"","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126958435","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}
N. Anwar, A. Arshad, N. Fatima, S. Shaheen, T. Shamsi
Abstract: Objective: Aplastic anemia (AA) is characterized by pancytopenia and hypocellular bone marrow. Several factors like infections, toxins, chemotherapeutics and radiations are known causes for the suppression of hematopoietic cells which results in bone marrow failure but the exact etiology is unknown. The current study was conducted to assess the baseline demographics, laboratory and clinical characteristics of patients presenting with aplastic anemia and evaluate their cytogenetic profile. Materials and Methods: A retrospective cohort study conducted at National Institute of Blood Diseases and Bone Marrow Transplantation after approval by Institutional Ethics Committee. In this study, AA patients were enrolled from January 2010 to December 2018. Data collection included demographic, laboratory and clinical characteristics including age, gender, symptoms, treatment, and blood counts. Cytogenetic analysis was performed on bone marrow samples. Data analysis was done by using SPSS version 23. Results: Based on camitta classification, a total of 362 aplastic anemia patients were enrolled in the study. The frequency of severe aplastic anemia was most common 199(55%). Median and interquartile range (IQR) age of overall patients was 17(11-26) years, for children and adult population it was 12(9-14) years and 28 (21-43) years respectively. Male predominance was observed i.e.251(69%). The most common presenting complaint was fever 202(55.8%). The median and IQR of hemoglobin (Hb) was 7.8(5.8-9.4)g/dl, MCV 90(83-91)fl, total leucocyte count (TLC) 2.6 (1.9-3.6) × 109/l, absolute neutrophil count (ANC) 0.64 (0.27-1.2)×109/l and platelet count 13 (5-27) ×109/l. Bone marrow cytogenetics was done and 76 (67%) patients were found to have normal karyotype. CMV was positive in 24(6.6%). Majority of patients were treated with blood transfusion and supportive care only 230(64%) and the survival rate was 84%. Conclusion: In conclusion, the study represents a large cohort of aplastic anemia in the country. Majority of cases were acquired aplastic anemia predominantly being severe aplastic. Limited numbers of patients opted for standard treatment options probably due to financial reservations to afford standard treatments like immune suppression therapy and hematopoietic stem cell transplant. Further, local studies with larger number of sample size and provision of standard treatment options are needed to explore the treatment response, etiological factors, prognosis and outcomes. Keywords: Aplastic anemia, Cytogenetics, Clinicohematological characteristics, Laboratory analysis, Survival outcome, Pakistan.
{"title":"Clinicohematological Characteristics and Survival Analysis of Aplastic Anemia in Pakistan; A Single Centre Experience","authors":"N. Anwar, A. Arshad, N. Fatima, S. Shaheen, T. Shamsi","doi":"10.21089/NJHS.54.0157","DOIUrl":"https://doi.org/10.21089/NJHS.54.0157","url":null,"abstract":"Abstract: Objective: Aplastic anemia (AA) is characterized by pancytopenia and hypocellular bone marrow. Several factors like infections, toxins, chemotherapeutics and radiations are known causes for the suppression of hematopoietic cells which results in bone marrow failure but the exact etiology is unknown. The current study was conducted to assess the baseline demographics, laboratory and clinical characteristics of patients presenting with aplastic anemia and evaluate their cytogenetic profile. Materials and Methods: A retrospective cohort study conducted at National Institute of Blood Diseases and Bone Marrow Transplantation after approval by Institutional Ethics Committee. In this study, AA patients were enrolled from January 2010 to December 2018. Data collection included demographic, laboratory and clinical characteristics including age, gender, symptoms, treatment, and blood counts. Cytogenetic analysis was performed on bone marrow samples. Data analysis was done by using SPSS version 23. Results: Based on camitta classification, a total of 362 aplastic anemia patients were enrolled in the study. The frequency of severe aplastic anemia was most common 199(55%). Median and interquartile range (IQR) age of overall patients was 17(11-26) years, for children and adult population it was 12(9-14) years and 28 (21-43) years respectively. Male predominance was observed i.e.251(69%). The most common presenting complaint was fever 202(55.8%). The median and IQR of hemoglobin (Hb) was 7.8(5.8-9.4)g/dl, MCV 90(83-91)fl, total leucocyte count (TLC) 2.6 (1.9-3.6) × 109/l, absolute neutrophil count (ANC) 0.64 (0.27-1.2)×109/l and platelet count 13 (5-27) ×109/l. Bone marrow cytogenetics was done and 76 (67%) patients were found to have normal karyotype. CMV was positive in 24(6.6%). Majority of patients were treated with blood transfusion and supportive care only 230(64%) and the survival rate was 84%. Conclusion: In conclusion, the study represents a large cohort of aplastic anemia in the country. Majority of cases were acquired aplastic anemia predominantly being severe aplastic. Limited numbers of patients opted for standard treatment options probably due to financial reservations to afford standard treatments like immune suppression therapy and hematopoietic stem cell transplant. Further, local studies with larger number of sample size and provision of standard treatment options are needed to explore the treatment response, etiological factors, prognosis and outcomes. Keywords: Aplastic anemia, Cytogenetics, Clinicohematological characteristics, Laboratory analysis, Survival outcome, Pakistan.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122334180","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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