W. Memon, Javed Altaf Jat, P. Mal, A. Arain, T. Jatoi, A. Arain, A. Ahmed
Abstract: Background: Understanding the importance of pre-operative assessment is something nephrologists are probing for years to avoid any post-operative complication and AVF failure. Objective: To assess the physical examination as primary tool as compared to Ultrasound Doppler in assessment of AVF planning in hemodialysis patients. Materials and Methods: This was a Retrospective, Cross-sectional study. Secondary data was collected from the Urology Department of Liquate University of Medical and health sciences, Jamshoro starting from October 2021 to October 2022. For physical examination, both the arterial and venous circulation were evaluated. Arterial patency, pulse amplitude and Allen’s test were recorded. After collection of data, statistical Package for Social Science (SPSS) version 17. 0 statistical software was used for analysis. Results: A total of 105 participants with mean age of 42.9 ± 13.9 years, 78 (74.3%) males and 27 (25.7%) females were included. The physical examination findings indicated facial swelling as the most frequently reported sign in with 59 (56.2%) of patients, followed by generalized body edema reported in 22 (21%) of participants. The estimated analysis of Allen’s test indicated good results with a mean of 12.4 ± 2.8 seconds in all patients, indicating good blood flow of the ulnar artery. The mean duration of hemodialysis was 55.2 ± 23.4 days before AVF, while central venous line duration was 57.2 ± 20.5 days. After 6 days fistula maturation was assessed, while mean fistula maturation duration was 44 ± 7.1 days. Conclusion: To monitor functioning, the Physical Examination of vascular access is convenient, straightforward, and cost-effective. Physical examination (PE) has been validated with diagnostic techniques for detecting stenosis.
摘要:背景:了解术前评估的重要性是肾内科医生多年来一直在探讨的问题，以避免任何术后并发症和AVF失效。目的:评价体格检查与超声多普勒对血液透析患者AVF规划的评价。材料和方法:本研究为回顾性横断面研究。次要数据收集于2021年10月至2022年10月期间，位于Jamshoro的Liquate医学和健康科学大学泌尿外科。体格检查时，评估动脉和静脉循环。记录动脉通畅度、脉搏幅值及艾伦氏试验。收集数据后，使用SPSS (statistical Package for Social Science)第17版。采用0统计软件进行分析。结果:共纳入105例受试者，平均年龄42.9±13.9岁，其中男性78例(74.3%)，女性27例(25.7%)。体格检查结果显示，面部肿胀是59例(56.2%)患者最常报告的症状，其次是22例(21%)参与者报告的全身水肿。Allen’s试验的估计分析表明，所有患者的平均时间为12.4±2.8秒，结果良好，表明尺动脉血流良好。AVF前血液透析的平均持续时间为55.2±23.4天，中心静脉插管持续时间为57.2±20.5天。6天后进行瘘管成熟评估，平均瘘管成熟时间为44±7.1天。结论:血管通路体格检查方便、直接、经济，可监测血管功能。体格检查(PE)已被证实与诊断技术检测狭窄。
{"title":"Experience of Physical Examination as a Primary Tool for Surgical Access Planning in Hemodialysis Patients","authors":"W. Memon, Javed Altaf Jat, P. Mal, A. Arain, T. Jatoi, A. Arain, A. Ahmed","doi":"10.21089/njhs.82.0075","DOIUrl":"https://doi.org/10.21089/njhs.82.0075","url":null,"abstract":"Abstract: Background: Understanding the importance of pre-operative assessment is something nephrologists are probing for years to avoid any post-operative complication and AVF failure. Objective: To assess the physical examination as primary tool as compared to Ultrasound Doppler in assessment of AVF planning in hemodialysis patients. Materials and Methods: This was a Retrospective, Cross-sectional study. Secondary data was collected from the Urology Department of Liquate University of Medical and health sciences, Jamshoro starting from October 2021 to October 2022. For physical examination, both the arterial and venous circulation were evaluated. Arterial patency, pulse amplitude and Allen’s test were recorded. After collection of data, statistical Package for Social Science (SPSS) version 17. 0 statistical software was used for analysis. Results: A total of 105 participants with mean age of 42.9 ± 13.9 years, 78 (74.3%) males and 27 (25.7%) females were included. The physical examination findings indicated facial swelling as the most frequently reported sign in with 59 (56.2%) of patients, followed by generalized body edema reported in 22 (21%) of participants. The estimated analysis of Allen’s test indicated good results with a mean of 12.4 ± 2.8 seconds in all patients, indicating good blood flow of the ulnar artery. The mean duration of hemodialysis was 55.2 ± 23.4 days before AVF, while central venous line duration was 57.2 ± 20.5 days. After 6 days fistula maturation was assessed, while mean fistula maturation duration was 44 ± 7.1 days. Conclusion: To monitor functioning, the Physical Examination of vascular access is convenient, straightforward, and cost-effective. Physical examination (PE) has been validated with diagnostic techniques for detecting stenosis.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"100 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122406089","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}
J. Ainuddin, Nasreen Majid, Azram Aslam, R. Sikander, Sarmad Iqbal, Syed Saad Hussain
Abstract: Background: Iron deficiency anemia is a major public health issue in developing countries, especially among women of reproductive age. Anemia is a major public health problem in women of reproductive age in rural Pakistan and a large proportion of women were found to have low levels of serum iron. Materials and Methods: A multicenter observational cohort study was conducted at Karachi & Hyderabad from 8th February 2022 to 30th April 2022. Women with low hemoglobin level and age 18-45 years were included in this study. Patients were grouped according to 1-week assessment and 3-week assessment of hemoglobin concentration. A single dose of a generic substituent ferric carboxymaltose (Boferin®) was administered to the patients over 15 minutes infusion. Baseline hemoglobin levels were compared at 1 week and 3 weeks after administration of Ferric Carboxymaltose. Results: A total of 104 patients were enrolled in this study. The mean hemoglobin levels at baseline were 9.22 ± 0.175 g/dl and 7.55 ± 0.329 g/ dl for 1-week and 3-week, respectively. The mean hemoglobin increases after 1 week and 3 week was reported as 1.4211± 0.169 g/dl (p< 0.001) and 2.321± 0.335 g/dl (p< 0.001) respectively. Only three patients presented with mild to moderate adverse effect which included abdominal discomfort and nausea. Conclusion: This is a first in class study has shown statistically significant increase in hemoglobin at 1-week and 3-week interval with minimal side effects. It is concluded that Boferin® is efficacious in increasing hemoglobin levels in patients with iron deficiency anemia with its safety being documented in pregnant Pakistani population as well.
{"title":"Benefits of Ferric Carboxymaltose Administration for Enhanced Hemoglobin Levels in Urban Population of Sindh: BOFERIN® Observational Study","authors":"J. Ainuddin, Nasreen Majid, Azram Aslam, R. Sikander, Sarmad Iqbal, Syed Saad Hussain","doi":"10.21089/njhs.82.0062","DOIUrl":"https://doi.org/10.21089/njhs.82.0062","url":null,"abstract":"Abstract: Background: Iron deficiency anemia is a major public health issue in developing countries, especially among women of reproductive age. Anemia is a major public health problem in women of reproductive age in rural Pakistan and a large proportion of women were found to have low levels of serum iron. Materials and Methods: A multicenter observational cohort study was conducted at Karachi & Hyderabad from 8th February 2022 to 30th April 2022. Women with low hemoglobin level and age 18-45 years were included in this study. Patients were grouped according to 1-week assessment and 3-week assessment of hemoglobin concentration. A single dose of a generic substituent ferric carboxymaltose (Boferin®) was administered to the patients over 15 minutes infusion. Baseline hemoglobin levels were compared at 1 week and 3 weeks after administration of Ferric Carboxymaltose. Results: A total of 104 patients were enrolled in this study. The mean hemoglobin levels at baseline were 9.22 ± 0.175 g/dl and 7.55 ± 0.329 g/ dl for 1-week and 3-week, respectively. The mean hemoglobin increases after 1 week and 3 week was reported as 1.4211± 0.169 g/dl (p< 0.001) and 2.321± 0.335 g/dl (p< 0.001) respectively. Only three patients presented with mild to moderate adverse effect which included abdominal discomfort and nausea. Conclusion: This is a first in class study has shown statistically significant increase in hemoglobin at 1-week and 3-week interval with minimal side effects. It is concluded that Boferin® is efficacious in increasing hemoglobin levels in patients with iron deficiency anemia with its safety being documented in pregnant Pakistani population as well.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"89 9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123172500","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. Khan, M. U. Karim, N. Wallace, Fatima Shaukat, Muhammad Muaz Abbasi
Health systems worldwide face various challenges. Disparities are evident among different geographic locations. There are several hurdles in providing high-quality professional education, especially in low- and Lower-Middle-Income Countries (LMICs), including insufficient basic infrastructure and a shortage of professionally trained staff. This issue presents a particular risk in LMICs that are ill-equipped to deal with complex and expensive treatments [1, 2]. Although developing and enhancing educational programs to yield more healthcare professionals is constructive, these efforts need to be accompanied by educational structuring that will provide postgraduates with the necessary competencies [3]. It is not uncommon for the patients in LMICs with a potentially curable disease to receive sub-optimal treatment because of a lack of competencies and a caring attitude. This prompts some interesting challenges around the speciality training of postgraduates. In particular, what we are trying to achieve in modern oncology training programmes? Are current examination systems an effective test of knowledge, skills, and safety to practice? And, if so, are they sufficient to prepare for independent practice? Or should training programmes incorporate non-clinical skills related to issues? Interestingly, according to World Health Organization (W.H.O.), there are six elements or system building blocks of the health system that includes (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance [4]. We believe that these elements overlap with our proposal of inclusion of non-clinical leadership skills during their early years so that they are aware of the gaps and develop a mindset to improve the healthcare system by themselves. In this paper, we propose these five concepts to be inducted into our postgraduate training that will pave the way to improve our healthcare system.
{"title":"Some Pertinent Solutions to the Challenges Faced by the Pakistani Healthcare Systems","authors":"A. Khan, M. U. Karim, N. Wallace, Fatima Shaukat, Muhammad Muaz Abbasi","doi":"10.21089/njhs.82.0047","DOIUrl":"https://doi.org/10.21089/njhs.82.0047","url":null,"abstract":"Health systems worldwide face various challenges. Disparities are evident among different geographic locations. There are several hurdles in providing high-quality professional education, especially in low- and Lower-Middle-Income Countries (LMICs), including insufficient basic infrastructure and a shortage of professionally trained staff. This issue presents a particular risk in LMICs that are ill-equipped to deal with complex and expensive treatments [1, 2]. Although developing and enhancing educational programs to yield more healthcare professionals is constructive, these efforts need to be accompanied by educational structuring that will provide postgraduates with the necessary competencies [3]. It is not uncommon for the patients in LMICs with a potentially curable disease to receive sub-optimal treatment because of a lack of competencies and a caring attitude. This prompts some interesting challenges around the speciality training of postgraduates. In particular, what we are trying to achieve in modern oncology training programmes? Are current examination systems an effective test of knowledge, skills, and safety to practice? And, if so, are they sufficient to prepare for independent practice? Or should training programmes incorporate non-clinical skills related to issues? Interestingly, according to World Health Organization (W.H.O.), there are six elements or system building blocks of the health system that includes (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance [4]. We believe that these elements overlap with our proposal of inclusion of non-clinical leadership skills during their early years so that they are aware of the gaps and develop a mindset to improve the healthcare system by themselves. In this paper, we propose these five concepts to be inducted into our postgraduate training that will pave the way to improve our healthcare system.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126849976","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}
Faryal Ijaz, Samina S. Khan, M. S. Rafique, Sana Kundi, T. Malik, Ahmad Malik
Abstract: Background: Non – Alcoholic Fatty Liver Disease (NAFLD) is emerging as a considerable health problem in patients visiting gastroenterology clinics. It is of crucial importance to evaluate the extent of hepatic steatosis in potential candidates for living donor liver transplantation (LDLT) to ensure donor safety as well as optimum graft regeneration. Objective: To validate the MRI quantification of liver fat keeping CT liver attenuation index as gold standard. Materials and Methods: This cross-sectional study was carried out in the department of Diagnostic Radiology, Pakistan Kidney and Liver Institute and Research Centre from 10th October, 2022 to 10th December, 2022. We determined the sample size using WHO sample size calculator. The MR fat fraction sequence was acquired as a part of the obligatory MRCP in 70 potential liver donors who undertook CT abdomen. Liver Attenuation Index (LAI) and MR fat fraction were determined separately by two radiologists who were blinded to each other. LAI was calculated as: Mean liver attenuation – mean splenic attenuation. MRI fat fraction from seven areas of liver were taken and their mean calculated to determine the percentage of liver fat. SPSS version 20 was employed for statistical analysis and Pearson’s Correlation was applied. Results: Among the 70 donors 42 were males and 28 were females (M: F= 1.5: 1). The hepatic fat fraction values on MR were correlated with the liver attenuation index on CT using a two – tailed Pearson correlation test. The results showed a very strong negative correlation between the two; the lower the LAI, the higher the MR fat fraction (Pearson correlation coefficient r = -0.932, p<0.05). Conclusion: Strong correlation was found between MRI estimation of liver fat and CT LAI fat estimation. MRI is safer than CT as it does not involve ionizing radiation, is quicker to perform, and hence can be recommended as future method of choice.
{"title":"Validation of MRI Quantification of Liver Fat, Keeping CT Liver Attenuation Index (LAI) as Gold Standard","authors":"Faryal Ijaz, Samina S. Khan, M. S. Rafique, Sana Kundi, T. Malik, Ahmad Malik","doi":"10.21089/njhs.82.0080","DOIUrl":"https://doi.org/10.21089/njhs.82.0080","url":null,"abstract":"Abstract: Background: Non – Alcoholic Fatty Liver Disease (NAFLD) is emerging as a considerable health problem in patients visiting gastroenterology clinics. It is of crucial importance to evaluate the extent of hepatic steatosis in potential candidates for living donor liver transplantation (LDLT) to ensure donor safety as well as optimum graft regeneration. Objective: To validate the MRI quantification of liver fat keeping CT liver attenuation index as gold standard. Materials and Methods: This cross-sectional study was carried out in the department of Diagnostic Radiology, Pakistan Kidney and Liver Institute and Research Centre from 10th October, 2022 to 10th December, 2022. We determined the sample size using WHO sample size calculator. The MR fat fraction sequence was acquired as a part of the obligatory MRCP in 70 potential liver donors who undertook CT abdomen. Liver Attenuation Index (LAI) and MR fat fraction were determined separately by two radiologists who were blinded to each other. LAI was calculated as: Mean liver attenuation – mean splenic attenuation. MRI fat fraction from seven areas of liver were taken and their mean calculated to determine the percentage of liver fat. SPSS version 20 was employed for statistical analysis and Pearson’s Correlation was applied. Results: Among the 70 donors 42 were males and 28 were females (M: F= 1.5: 1). The hepatic fat fraction values on MR were correlated with the liver attenuation index on CT using a two – tailed Pearson correlation test. The results showed a very strong negative correlation between the two; the lower the LAI, the higher the MR fat fraction (Pearson correlation coefficient r = -0.932, p<0.05). Conclusion: Strong correlation was found between MRI estimation of liver fat and CT LAI fat estimation. MRI is safer than CT as it does not involve ionizing radiation, is quicker to perform, and hence can be recommended as future method of choice.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116800106","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}
M. S. Rafique, Ayesha Ayub, Ahmad Malik, Tahir Malik, Sana Kundi, Abdullah Saeed
Abstract: Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a significant healthcare challenge. MR proton density fat fraction (MR-PDFF) is a quantitative imaging parameter that allows a precise estimation of hepatic steatosis. Determination of segmental and lobar fat distribution is also important since underestimation or overestimation may lead to hurdles in patient management and may also alter outcomes during liver donor assessment for living donor liver transplant. Objective: To determine the heterogeneity of hepatic fat distribution across different liver segments and both lobes in patients with non-alcoholic fatty liver disease (NAFLD). Materials and Methods: This cross-sectional descriptive study included 35 patients of NAFLD. MR-PDFF sequence was performed, two regions of interest (ROI) were drawn at the periphery of each hepatic segment and their mean was taken. We calculated mean values, ranges, and standard deviations for individual segments, both lobes and the entire liver. Pearson’s correlation was used to assess the relation between MR-PDFF and MR-PDFF variability. Paired sample t-test was utilized to compare the means of the right and the left lobe of the liver. Results: The fat fraction in segment I was the lowest and in segment VII the highest. The right and left lobes showed a significant difference in fat fraction with values of 14% and 11.4% respectively (paired sample t-test, p<0.005). The left lobe showed a greater MR-PDFF variability than the right lobe (1.9 vs 1.6%). Conclusion: In patients with NAFLD, segments VII and VIII show the greatest while segments I and IV show the least fat infiltration. Hepatic fat preferentially gets deposited more in the right lobe of the liver.
摘要:背景:非酒精性脂肪性肝病(NAFLD)是一个重大的医疗挑战。磁共振质子密度脂肪分数(MR- pdff)是一种定量成像参数，可以精确估计肝脏脂肪变性。节段性和叶性脂肪分布的确定也很重要，因为低估或高估可能导致患者管理的障碍，也可能改变活体肝移植的肝供体评估结果。目的:探讨非酒精性脂肪性肝病(NAFLD)患者肝脂肪在不同肝段和双叶分布的异质性。材料和方法:本横断面描述性研究纳入35例NAFLD患者。进行MR-PDFF序列，在每个肝段周围绘制两个感兴趣区域(ROI)并取其平均值。我们计算了各个肝段、肝叶和整个肝脏的平均值、范围和标准差。Pearson相关性用于评估MR-PDFF和MR-PDFF变异性之间的关系。采用配对样本t检验比较肝左右叶均值。结果:第一节段脂肪含量最低，第七节段脂肪含量最高。左右叶脂肪含量差异显著，分别为14%和11.4%(配对样本t检验，p<0.005)。左脑叶MR-PDFF变异性大于右脑叶(1.9 vs 1.6%)。结论:NAFLD患者脂肪浸润以第VII段和第VIII段最多，第I段和第IV段最少。肝脏脂肪更倾向于在肝脏右叶沉积。
{"title":"Assessment of Segmental Hepatic Fat Distribution using Magnetic Resonance Proton Density Fat Fraction MR-PDFF in Non-alcoholic Fatty Liver Disease (NAFLD)","authors":"M. S. Rafique, Ayesha Ayub, Ahmad Malik, Tahir Malik, Sana Kundi, Abdullah Saeed","doi":"10.21089/njhs.82.0057","DOIUrl":"https://doi.org/10.21089/njhs.82.0057","url":null,"abstract":"Abstract: Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a significant healthcare challenge. MR proton density fat fraction (MR-PDFF) is a quantitative imaging parameter that allows a precise estimation of hepatic steatosis. Determination of segmental and lobar fat distribution is also important since underestimation or overestimation may lead to hurdles in patient management and may also alter outcomes during liver donor assessment for living donor liver transplant. Objective: To determine the heterogeneity of hepatic fat distribution across different liver segments and both lobes in patients with non-alcoholic fatty liver disease (NAFLD). Materials and Methods: This cross-sectional descriptive study included 35 patients of NAFLD. MR-PDFF sequence was performed, two regions of interest (ROI) were drawn at the periphery of each hepatic segment and their mean was taken. We calculated mean values, ranges, and standard deviations for individual segments, both lobes and the entire liver. Pearson’s correlation was used to assess the relation between MR-PDFF and MR-PDFF variability. Paired sample t-test was utilized to compare the means of the right and the left lobe of the liver. Results: The fat fraction in segment I was the lowest and in segment VII the highest. The right and left lobes showed a significant difference in fat fraction with values of 14% and 11.4% respectively (paired sample t-test, p<0.005). The left lobe showed a greater MR-PDFF variability than the right lobe (1.9 vs 1.6%). Conclusion: In patients with NAFLD, segments VII and VIII show the greatest while segments I and IV show the least fat infiltration. Hepatic fat preferentially gets deposited more in the right lobe of the liver.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127449015","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}
With Asia housing 75% of humanity, and the proportion of seniors rapidly climbing from 5.3% in 2015 to 9.3% by 2025, Osteoporosis is rapidly becoming a growing medical ailment in this part of the world too [1]. In Pakistan, though clear data on occurrence of hip fractures (osteoporotic) annually is not established, large ultrasound studies suggest that there may be more than 9 million people (7 million women, 2 million men) afflicted with Osteoporosis. It is expected that these estimates may very well cross 12 million by the year 2050 – becoming a major health burden. Low per capita income and high hospital costs further derail the earning capacity. Estimations indicate the population to cross 340 million by the year 2050, and of these 14.9% (50 million) will be over the age 60 years. A five year study from one hospital revealed a 2:1 female to male ratio of hip fracture cases, with 61 years being the average age of patients having osteoporotic fracture. This average age is lower than that reported in North America and Europe but matches data from India. Another study revealed 16% and 34% occurrence of osteoporosis and osteopenia respectively in females of age group 45 to 70 using ultrasound technique. Another study from KPK province estimated the numbers at 29 and 42% respectively. 75% of postmenopausal women from Peshawar seemed to be at risk of osteoporosis on a clinical risk score analysis [2-7].
{"title":"Osteoporosis and Osteopenia – A Rising Healthcare Problem","authors":"S. Kamal","doi":"10.21089/njhs.82.0045","DOIUrl":"https://doi.org/10.21089/njhs.82.0045","url":null,"abstract":"With Asia housing 75% of humanity, and the proportion of seniors rapidly climbing from 5.3% in 2015 to 9.3% by 2025, Osteoporosis is rapidly becoming a growing medical ailment in this part of the world too [1]. In Pakistan, though clear data on occurrence of hip fractures (osteoporotic) annually is not established, large ultrasound studies suggest that there may be more than 9 million people (7 million women, 2 million men) afflicted with Osteoporosis. It is expected that these estimates may very well cross 12 million by the year 2050 – becoming a major health burden. Low per capita income and high hospital costs further derail the earning capacity. Estimations indicate the population to cross 340 million by the year 2050, and of these 14.9% (50 million) will be over the age 60 years. A five year study from one hospital revealed a 2:1 female to male ratio of hip fracture cases, with 61 years being the average age of patients having osteoporotic fracture. This average age is lower than that reported in North America and Europe but matches data from India. Another study revealed 16% and 34% occurrence of osteoporosis and osteopenia respectively in females of age group 45 to 70 using ultrasound technique. Another study from KPK province estimated the numbers at 29 and 42% respectively. 75% of postmenopausal women from Peshawar seemed to be at risk of osteoporosis on a clinical risk score analysis [2-7].","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126193740","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: Brenn and Fletcher described cutaneous epithelioid angiomatous nodule (CEAN) as a benign vascular proliferation that was in 2004. It is very rare condition. It is characterized by endothelial cells that have histiocytoid appearance. It is generally found in the dermis or sub cutis and rarely, in visceral organs. Despite the etiology of CEAN is not clear, it is considered as a reactive entity and no association with either infection, trauma or immunosuppression has been described yet. A 76-year-old woman visited hospital for routine examination. The physician noticed an erythematous nodule on the upper part of her right labium minus which appears like a cystic lesion. Histopathological examination revealed a relatively circumscribed, unencapsulated, unilobular vascular lesion which is in the superficial dermis. There were also moderately lymphoplasmacytic infiltration on the background. There were also scattered extravasated erytrocytes around. Positive stained for CD34, CD31 and negative stained for HHV-8 (performed to rule out a possibility of Kaposi sarcoma), pancytokeratin and s-100 were prominent in epithelioid cells. The overall histopathological appearance was consistent with CEAN and there was not any previous report CEAN occurring at this area.
{"title":"Cutaneous Epithelioid Angiomatous Nodule with Unusual Localization","authors":"S. Ozer","doi":"10.21089/njhs.81.0042","DOIUrl":"https://doi.org/10.21089/njhs.81.0042","url":null,"abstract":"Abstract: Brenn and Fletcher described cutaneous epithelioid angiomatous nodule (CEAN) as a benign vascular proliferation that was in 2004. It is very rare condition. It is characterized by endothelial cells that have histiocytoid appearance. It is generally found in the dermis or sub cutis and rarely, in visceral organs. Despite the etiology of CEAN is not clear, it is considered as a reactive entity and no association with either infection, trauma or immunosuppression has been described yet. A 76-year-old woman visited hospital for routine examination. The physician noticed an erythematous nodule on the upper part of her right labium minus which appears like a cystic lesion. Histopathological examination revealed a relatively circumscribed, unencapsulated, unilobular vascular lesion which is in the superficial dermis. There were also moderately lymphoplasmacytic infiltration on the background. There were also scattered extravasated erytrocytes around. Positive stained for CD34, CD31 and negative stained for HHV-8 (performed to rule out a possibility of Kaposi sarcoma), pancytokeratin and s-100 were prominent in epithelioid cells. The overall histopathological appearance was consistent with CEAN and there was not any previous report CEAN occurring at this area.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"433 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116703187","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}
Hira Moosa, Dileep Kumar, M. Naeem, Syed Baquer Rivzi, I. Bhatti, Shabina Jaffer, S. Qureshi
Abstract: Background: Gallstones disease is one of the major problem of gastro intestinal tract and surgical removal is usually advised. Surgery is usually laparoscopic but if the dissection is tedious, laparoscopic procedure can be converted into open procedure. Objective: This study aims to assess the reasons and risk factors for the conversion of laparoscopic cholecystectomy (LC) into open cholecystectomy (OC). Materials and Methods: A prospective assessment of medical records of patients who underwent laparoscopic cholecystectomy at ward-2, Jinnah Postgraduate Medical Centre from January 2019 to December 2021 was undertaken to identify indications of all laparoscopic cholecystectomies converted to open cholecystectomy and assess operative time and length of hospital stay of these patients. Results: A total of 984 elective cholecystectomies were performed in which 85.5% (n=841) were females and 14.5% (n=143) were males. Male to female ratio was 1:5.8 with conversion rate 0.40 % (n=04) and 4.36% (n=43) respectively. Laparoscopic cholecystectomy was done in 95.22% (n=937) cases while 4.78% (n=47) patients required conversion to open cholecystectomy with major pre-operative risk factors being acute cholecystitis (p<0.001), history of acute cholecystitis (p=0.012), history of acute pancreatitis (p=0.007), history of previous open surgery (p<0.001) and major per-operative risk factors being severe bleeding (p<0.001), dense adhesions (p=0.755), distorted anatomy (p<0.001), visceral damage (p<0.001) and biliary injury(p<0.001). Conclusion: We have identified some important risk factors for the conversion of surgical approach for acute cholecystitis. However, the open approach should be done by experienced surgeons when necessary. The overall impact of the study is to identify the patients who are the risk of conversion into open preoperatively so that proper arrangement and counseling should be done.
{"title":"Risk Factors Associated with Conversion of Laparoscopic to Open Cholecystectomy","authors":"Hira Moosa, Dileep Kumar, M. Naeem, Syed Baquer Rivzi, I. Bhatti, Shabina Jaffer, S. Qureshi","doi":"10.21089/njhs.81.0013","DOIUrl":"https://doi.org/10.21089/njhs.81.0013","url":null,"abstract":"Abstract: Background: Gallstones disease is one of the major problem of gastro intestinal tract and surgical removal is usually advised. Surgery is usually laparoscopic but if the dissection is tedious, laparoscopic procedure can be converted into open procedure. Objective: This study aims to assess the reasons and risk factors for the conversion of laparoscopic cholecystectomy (LC) into open cholecystectomy (OC). Materials and Methods: A prospective assessment of medical records of patients who underwent laparoscopic cholecystectomy at ward-2, Jinnah Postgraduate Medical Centre from January 2019 to December 2021 was undertaken to identify indications of all laparoscopic cholecystectomies converted to open cholecystectomy and assess operative time and length of hospital stay of these patients. Results: A total of 984 elective cholecystectomies were performed in which 85.5% (n=841) were females and 14.5% (n=143) were males. Male to female ratio was 1:5.8 with conversion rate 0.40 % (n=04) and 4.36% (n=43) respectively. Laparoscopic cholecystectomy was done in 95.22% (n=937) cases while 4.78% (n=47) patients required conversion to open cholecystectomy with major pre-operative risk factors being acute cholecystitis (p<0.001), history of acute cholecystitis (p=0.012), history of acute pancreatitis (p=0.007), history of previous open surgery (p<0.001) and major per-operative risk factors being severe bleeding (p<0.001), dense adhesions (p=0.755), distorted anatomy (p<0.001), visceral damage (p<0.001) and biliary injury(p<0.001). Conclusion: We have identified some important risk factors for the conversion of surgical approach for acute cholecystitis. However, the open approach should be done by experienced surgeons when necessary. The overall impact of the study is to identify the patients who are the risk of conversion into open preoperatively so that proper arrangement and counseling should be done.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129291666","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}
Leadership and managerial skills have long been identified in the developed countries as essential components of their post graduate trainees to enable them to meet the challenges of modern health care systems. However, health care systems in LMIC have their own challenges. Certain models such as public, public-private partnerships, private, welfare and insurance-based systems do exist in this part of the world, but comprehensive and efficient integration is still lacking. Cancer patients depend largely upon public sector facilities already over-burdened by long waiting list.
{"title":"Leadership Skills Development & Establishment of Multi-Disciplinary Team (MDT) Tumor Boards","authors":"S. Kamal","doi":"10.21089/njhs.81.0001","DOIUrl":"https://doi.org/10.21089/njhs.81.0001","url":null,"abstract":"Leadership and managerial skills have long been identified in the developed countries as essential components of their post graduate trainees to enable them to meet the challenges of modern health care systems. However, health care systems in LMIC have their own challenges. Certain models such as public, public-private partnerships, private, welfare and insurance-based systems do exist in this part of the world, but comprehensive and efficient integration is still lacking. Cancer patients depend largely upon public sector facilities already over-burdened by long waiting list.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123371483","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}
Shamail Zia, Abdul Salam, Sanam Nusrat, Muhammad Hamza Khan, V. Chunchu, Hassan Nawaz, D. Hassan, Tatheer Zehra, Fazail Zia, Farozaan Shamail
Abstract: Utilizing platelet rich plasma, one of the newest autologous cellular therapies, as an adjuvant therapy in a regenerative medicine management, can be very beneficial. Patients with complications like osteoarthritis, spinal disorders and musculoskeletal problems still facing global lacking in the area of tissue repair strategies. Along with this another major complication associated is with diabetic patients - the development of diabetic foot ulcers that predisposes to limb amputation. To advance the healing process and prevent the patients from progressing towards amputations. Besides many other approaches used. Platelet Rich Plasma (PRP) therapy is attaining momentum, which is composed of platelet growth factors that assist the wound healing cascade – inflammation, proliferation and remodeling. It may occur because of provision of vital growth factors necessary for healing. Currently, variety of PRP formulations have been assessed. The article intends to evaluate the PRP effectiveness for managing diabetic ulcers.
{"title":"Platelet Rich Plasma Effects on Diabetic Foot Ulcers - A Review","authors":"Shamail Zia, Abdul Salam, Sanam Nusrat, Muhammad Hamza Khan, V. Chunchu, Hassan Nawaz, D. Hassan, Tatheer Zehra, Fazail Zia, Farozaan Shamail","doi":"10.21089/njhs.81.0028","DOIUrl":"https://doi.org/10.21089/njhs.81.0028","url":null,"abstract":"Abstract: Utilizing platelet rich plasma, one of the newest autologous cellular therapies, as an adjuvant therapy in a regenerative medicine management, can be very beneficial. Patients with complications like osteoarthritis, spinal disorders and musculoskeletal problems still facing global lacking in the area of tissue repair strategies. Along with this another major complication associated is with diabetic patients - the development of diabetic foot ulcers that predisposes to limb amputation. To advance the healing process and prevent the patients from progressing towards amputations. Besides many other approaches used. Platelet Rich Plasma (PRP) therapy is attaining momentum, which is composed of platelet growth factors that assist the wound healing cascade – inflammation, proliferation and remodeling. It may occur because of provision of vital growth factors necessary for healing. Currently, variety of PRP formulations have been assessed. The article intends to evaluate the PRP effectiveness for managing diabetic ulcers.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131763108","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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