For delivering highly accurate radiation therapy with pin-point accuracy to brain tumors, radiosurgery employing Gamma Knife Radiosurgery technique is a revolutionary new armamentarium that enables delivering focused intense beam of gamma rays to brain lesions. Neither employing an actual knife nor surgery, it is called “surgery” because the results are as good, even better, than actual surgeries. Gamma Knife radiosurgery can be as effective in treating nerve conditions and blood vessel malformations as brain tumors [1] (Table 1). The tumor gradually shrinks after treatment that damages and destroys the tumor cell DNA that cannot grow or reproduce anymore.
{"title":"Gamma Knife Radiosurgery - A Revolutionary Modality in the Treatment of Brain Tumors","authors":"S. Kamal","doi":"10.21089/njhs.74.0142","DOIUrl":"https://doi.org/10.21089/njhs.74.0142","url":null,"abstract":"For delivering highly accurate radiation therapy with pin-point accuracy to brain tumors, radiosurgery employing Gamma Knife Radiosurgery technique is a revolutionary new armamentarium that enables delivering focused intense beam of gamma rays to brain lesions. Neither employing an actual knife nor surgery, it is called “surgery” because the results are as good, even better, than actual surgeries. Gamma Knife radiosurgery can be as effective in treating nerve conditions and blood vessel malformations as brain tumors [1] (Table 1). The tumor gradually shrinks after treatment that damages and destroys the tumor cell DNA that cannot grow or reproduce anymore.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130265242","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}
Shamsa Abdul Rehman, Kanwal Lalwani, Rabbiah Mughal
Abstract: Background: Osteoporosis is a metabolic disease which is common globally. It is defined as decrease in bone mass and bone tissue destruction that causes decrease in bone strength and increase the chances of fractures. Over 200 million people are suffering from osteoporosis worldly and the number of individuals will increase greatly in coming decades due to aging and sedentary lifestyle. Knowledge combined with strategic planning related to preventive measures decrease its occurrence. Objective: The objective of this study was to evaluate the knowledge, attitude and practice of osteoporosis in students of physical therapy. Materials and Methods: A Questionnaire-Based survey was conducted at Department of Physiotherapy, Isra University Hyderabad in April 2021 to December. 2021. The study approval was given by Ethical Committee of Isra Institute of Rehabilitation Sciences, Isra University Hyderabad. 200 students from 3rd to final year were asked to complete the questionnaire. The knowledge, attitude and practice (KAP) of osteoporosis questionnaire consisted of 20 close ended questions. Results: A total of 200 were selected out of which 182 participants completely filled and returned the questionnaire. The mean age of participants was 22.31±1.86 years. Male participants were 34 (18.7%) and female participants were 148 (81.35%) in this study. High knowledge regarding osteoporosis was found among students with percentage of 99.45%. The participants showed positive attitude related to osteoporosis with percentage of 60.9%. These students also had positive impression towards management practices for osteoporosis with the percentage of 70.33%. Conclusion: This study concluded that the participants have better knowledge regarding osteoporosis. Further proper health education programs must be held in university to encourage them to adopt healthy practices about osteoporosis in daily life.
{"title":"Osteoporosis Knowledge, Attitude and Practice among Doctor Of Physical Therapy Students","authors":"Shamsa Abdul Rehman, Kanwal Lalwani, Rabbiah Mughal","doi":"10.21089/njhs.74.0151","DOIUrl":"https://doi.org/10.21089/njhs.74.0151","url":null,"abstract":"Abstract: Background: Osteoporosis is a metabolic disease which is common globally. It is defined as decrease in bone mass and bone tissue destruction that causes decrease in bone strength and increase the chances of fractures. Over 200 million people are suffering from osteoporosis worldly and the number of individuals will increase greatly in coming decades due to aging and sedentary lifestyle. Knowledge combined with strategic planning related to preventive measures decrease its occurrence. Objective: The objective of this study was to evaluate the knowledge, attitude and practice of osteoporosis in students of physical therapy. Materials and Methods: A Questionnaire-Based survey was conducted at Department of Physiotherapy, Isra University Hyderabad in April 2021 to December. 2021. The study approval was given by Ethical Committee of Isra Institute of Rehabilitation Sciences, Isra University Hyderabad. 200 students from 3rd to final year were asked to complete the questionnaire. The knowledge, attitude and practice (KAP) of osteoporosis questionnaire consisted of 20 close ended questions. Results: A total of 200 were selected out of which 182 participants completely filled and returned the questionnaire. The mean age of participants was 22.31±1.86 years. Male participants were 34 (18.7%) and female participants were 148 (81.35%) in this study. High knowledge regarding osteoporosis was found among students with percentage of 99.45%. The participants showed positive attitude related to osteoporosis with percentage of 60.9%. These students also had positive impression towards management practices for osteoporosis with the percentage of 70.33%. Conclusion: This study concluded that the participants have better knowledge regarding osteoporosis. Further proper health education programs must be held in university to encourage them to adopt healthy practices about osteoporosis in daily life.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130139962","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: Aplastic Anemia (AA) incidence is threefold higher in Asia compared to the western world. It is associated with pancytopenia that is induced by impaired bone marrow function. Cytopenias of at least two lineages are required for the diagnosis. Symptoms include pallor, weakness, fever, frequent infections, bruises, petechiae, and mucosal bleeding. Bone Marrow Transplant (BMT) and immunosuppressive therapy are the treatment options. Patients with Severe Aplastic Anemia (SAA) are susceptible to developing malignancies like acute myeloid leukemia (AML) or Myelodysplastic Syndrome (MDS). In this report, we present a case of SAA who transformed to AML/MDS. 5 years of post- Anti-Thymocyte Globulin (ATG), she acquired monosomy 7, RUNX1 & SETBP1 gene mutations. RUNX1 and SETBP1 mutations are correlated with poor overall survival and are predicted to have a lack of response from hypo-methylating agents. As the aspect of somatic mutation is complex and still not fully understood, it should be cautiously analyzed along with morphologic and cytogenetic results.
{"title":"Acute Myeloid Leukemia Transformed from Aplastic Anemia following Anti-thymocyte Globulin Therapy: A Case Report with Clinicopathologic and Molecular Findings","authors":"Q. Abedin, Saima Siddiqui, J. Hassan","doi":"10.21089/njhs.74.0193","DOIUrl":"https://doi.org/10.21089/njhs.74.0193","url":null,"abstract":"Abstract: Aplastic Anemia (AA) incidence is threefold higher in Asia compared to the western world. It is associated with pancytopenia that is induced by impaired bone marrow function. Cytopenias of at least two lineages are required for the diagnosis. Symptoms include pallor, weakness, fever, frequent infections, bruises, petechiae, and mucosal bleeding. Bone Marrow Transplant (BMT) and immunosuppressive therapy are the treatment options. Patients with Severe Aplastic Anemia (SAA) are susceptible to developing malignancies like acute myeloid leukemia (AML) or Myelodysplastic Syndrome (MDS). In this report, we present a case of SAA who transformed to AML/MDS. 5 years of post- Anti-Thymocyte Globulin (ATG), she acquired monosomy 7, RUNX1 & SETBP1 gene mutations. RUNX1 and SETBP1 mutations are correlated with poor overall survival and are predicted to have a lack of response from hypo-methylating agents. As the aspect of somatic mutation is complex and still not fully understood, it should be cautiously analyzed along with morphologic and cytogenetic results.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134421903","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}
T. Ali, S. Abrar, M. Tariq, Yumna Jamil, Muhammad Muaz Abbasi
Abstract: Colorectal cancer ranks third amongst various malignancies worldwide out of which a major proportion is of rectal carcinoma. With increasing incidence of rectal cancer amongst younger population in past two decades various advancements towards organ preservation approach have been devised. Total Neo-adjuvant approach (TNT) is current standard of care in various clinical scenarios involving rectal malignancy. In this review article role of Radiation in neo adjuvant setting and various landmark trials leading to it are discussed in detail.
{"title":"Tumor Board can save Sphincter, A Review of Contemporary Multidisciplinary Management of Rectal Cancer","authors":"T. Ali, S. Abrar, M. Tariq, Yumna Jamil, Muhammad Muaz Abbasi","doi":"10.21089/njhs.74.0174","DOIUrl":"https://doi.org/10.21089/njhs.74.0174","url":null,"abstract":"Abstract: Colorectal cancer ranks third amongst various malignancies worldwide out of which a major proportion is of rectal carcinoma. With increasing incidence of rectal cancer amongst younger population in past two decades various advancements towards organ preservation approach have been devised. Total Neo-adjuvant approach (TNT) is current standard of care in various clinical scenarios involving rectal malignancy. In this review article role of Radiation in neo adjuvant setting and various landmark trials leading to it are discussed in detail.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131125924","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. Malik, S. Nawaz, Masood Rasheed, Iqra Nadeem, S. Shah, Falak Nigar
Abstract:The objective of this study was to determine correlation of β- HCG levels with size of gestational sac in patients of ectopic pregnancy presenting to a tertiary care health facility. Materials and Methods: This descriptive cross-sectional study was carried out in the Department of Obstetrics and Gynecology, district headquarter Hospital, Rawalpindi from Jan 2019 to Jan 2020. This study involved 100 pregnant women aged between 20-40 years diagnosed of ectopic pregnancy on transvaginal ultrasound. Serum βhCG level was acquired in all these women while the size of gestational sac was measured on transvaginal ultrasound. Outcome variable was correlation between serum βhCG level and size of gestational sac on transvaginal ultrasound which was noted and compared across various subgroups of patients based on age, gestational age, site of ectopic pregnancy and presence/absence of fetal cardiac activity. Results: The mean age of the patients was 29.3±6.1 years while the mean gestational age was 5.1±1.1 weeks. Serum βhCG level ranged from 1647 mIU/mL to 18378 mIU/mL with a mean of 7968.4±4523.7 mIU/mL while the size of gestational sac on TVS ranged from 17 mm3 to 45 mm3 with a mean of 36.40±7.86 mm3. There was significantly strong positive correlation between serum βhCG and size of gestational sac on TVS (r=0.659; p- value<0.001). Conclusion: There was significantly strong positive correlation between serum βhCG and size of gestational sac on TVS (r=0.659; p-value<0.001).
{"title":"Correlation of βhCG Levels with Size of Gestational Sac in Patients of Ectopic Pregnancy Presenting to a Tertiary Care Health Facility","authors":"S. Malik, S. Nawaz, Masood Rasheed, Iqra Nadeem, S. Shah, Falak Nigar","doi":"10.21089/njhs.74.0169","DOIUrl":"https://doi.org/10.21089/njhs.74.0169","url":null,"abstract":"Abstract:The objective of this study was to determine correlation of β- HCG levels with size of gestational sac in patients of ectopic pregnancy presenting to a tertiary care health facility. Materials and Methods: This descriptive cross-sectional study was carried out in the Department of Obstetrics and Gynecology, district headquarter Hospital, Rawalpindi from Jan 2019 to Jan 2020. This study involved 100 pregnant women aged between 20-40 years diagnosed of ectopic pregnancy on transvaginal ultrasound. Serum βhCG level was acquired in all these women while the size of gestational sac was measured on transvaginal ultrasound. Outcome variable was correlation between serum βhCG level and size of gestational sac on transvaginal ultrasound which was noted and compared across various subgroups of patients based on age, gestational age, site of ectopic pregnancy and presence/absence of fetal cardiac activity. Results: The mean age of the patients was 29.3±6.1 years while the mean gestational age was 5.1±1.1 weeks. Serum βhCG level ranged from 1647 mIU/mL to 18378 mIU/mL with a mean of 7968.4±4523.7 mIU/mL while the size of gestational sac on TVS ranged from 17 mm3 to 45 mm3 with a mean of 36.40±7.86 mm3. There was significantly strong positive correlation between serum βhCG and size of gestational sac on TVS (r=0.659; p- value<0.001). Conclusion: There was significantly strong positive correlation between serum βhCG and size of gestational sac on TVS (r=0.659; p-value<0.001).","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132890052","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. M. Shah, Zamir Butt, Muhammad Afzal, S. Tarar, S. Talat
To determine the diagnostic accuracy of ROSIER scale in patients with ischemic stroke taking non-enhanced CT scan brain as gold standard. Materials and Methods: Cross-sectional study conducted at tertiary care hospital in Gujrat from October 2019 to December 2020. Patients of both sex groups aged 30- 75 years presented in emergency within 24 hours of onset of focal neurological deficit which is objectively present and suspected of ischemic stroke. 289 patients were included. Patient history and neurological examination done calculating ROSIER scale and ischemic stroke diagnosed after CT scan brain done 24 hours after onset of symptoms. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of ROSIER scale were calculated. Data analysis was done using SPSS 20.0. Results: In this study group 141(48.8%) were male while 148(51.2%) were female. Mean age was 62.1+11.02 years. 49(17%) patients were aged <50 years while 240(83%) were aged >50 years. 215(74.4%) presented within 12 hours while 74(25.6%) after 12 hours of symptoms onset. Sensitivity of ROSIER scale for diagnosing ischemic stroke was 98.86%(95%CI;95.96%-99.86%), specificity 5.31%(95%CI;1.97%-11.20%), PPV 61.92%(95% CI;60.82%-63.01%) and NPV was 75%(95%CI;38.13%-93.59%). LR+ was 1.04(95%CI; 1.00-1.09) while LR- was 0.21(95%CI; 0.04-1.04). Conclusion: ROSIER score can be used as initial screening test in patients with stroke. It has high sensitivity but low specificity and is a good test to rule in and rule out stroke patients.
{"title":"Diagnostic Accuracy of Recognition of Stroke in Emergency Room Score in Patients with Ischemic Stroke","authors":"S. M. Shah, Zamir Butt, Muhammad Afzal, S. Tarar, S. Talat","doi":"10.21089/njhs.63.0100","DOIUrl":"https://doi.org/10.21089/njhs.63.0100","url":null,"abstract":"To determine the diagnostic accuracy of ROSIER scale in patients with ischemic stroke taking non-enhanced CT scan brain as gold standard. Materials and Methods: Cross-sectional study conducted at tertiary care hospital in Gujrat from October 2019 to December 2020. Patients of both sex groups aged 30- 75 years presented in emergency within 24 hours of onset of focal neurological deficit which is objectively present and suspected of ischemic stroke. 289 patients were included. Patient history and neurological examination done calculating ROSIER scale and ischemic stroke diagnosed after CT scan brain done 24 hours after onset of symptoms. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of ROSIER scale were calculated. Data analysis was done using SPSS 20.0. Results: In this study group 141(48.8%) were male while 148(51.2%) were female. Mean age was 62.1+11.02 years. 49(17%) patients were aged <50 years while 240(83%) were aged >50 years. 215(74.4%) presented within 12 hours while 74(25.6%) after 12 hours of symptoms onset. Sensitivity of ROSIER scale for diagnosing ischemic stroke was 98.86%(95%CI;95.96%-99.86%), specificity 5.31%(95%CI;1.97%-11.20%), PPV 61.92%(95% CI;60.82%-63.01%) and NPV was 75%(95%CI;38.13%-93.59%). LR+ was 1.04(95%CI; 1.00-1.09) while LR- was 0.21(95%CI; 0.04-1.04). Conclusion: ROSIER score can be used as initial screening test in patients with stroke. It has high sensitivity but low specificity and is a good test to rule in and rule out stroke patients.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123513270","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}
Introduction: Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease that mainly characterized by sacroiliac joint and spine involvement. Although there is no clear evidence that any of these agent prevent the radiologic progression, anti-TNF drugs provide significant improvements in the disease activity score, functional index and quality of life. In AS patients, knowledge of the factors that determine the need for anti-TNF treatment will be associated with fewer complication sand better treatment. The purpose of this study is to investigate the possible factors which willmark the transition to the anti-TNF therapy in AS patients. Materials and Methods: This study was conducted in the Rheumatology division of the Internal medicine department of the Ondokuz Mayis University of Medicine hospital between January 2012- June 2015. The study protocol was approved by the Ethics Committee of Ondokuz Mayis University. A total of 165 patients, who were diagnosed as AS according to the ASAS classification criteria, were enrolled in this study. There were 85 women (51.5%) and 80 men (48.5%), aged between 15-69. Patients were divided into two groups according to their use of anti-TNF drug. Results: A total of 165 Ax-SpA patients (85 women and 80 men) were included in the study. The mean age was 37.82±11.24 years. The mean duration of the disease was 4.59±5.35 years. male gender, uveitis, delay in diagnosis, elevations in sedimentation CRP levels, increase in disease activity and functional indexes such as BASDAI and BASFI scores shows the more frequent need for anti-TNF drug use. Conclusion: In our study, patients who needed anti-TNF treatment had a longer time between symptom onset and diagnosis than patients who did not hear. The delay in diagnosing these patients leads to a delay in treatment so that the focus of inflammation increases and these patients need more anti-TNF as this window of opportunity escapes.
{"title":"Does Late Axial Spondyloarthropathy Diagnosis Cause Extra Anti-TNF Therapy?","authors":"Fatih Tay, M. Özgen, Mustafa Büyükkör","doi":"10.21089/njhs.63.0094","DOIUrl":"https://doi.org/10.21089/njhs.63.0094","url":null,"abstract":"Introduction: Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease that mainly characterized by sacroiliac joint and spine involvement. Although there is no clear evidence that any of these agent prevent the radiologic progression, anti-TNF drugs provide significant improvements in the disease activity score, functional index and quality of life. In AS patients, knowledge of the factors that determine the need for anti-TNF treatment will be associated with fewer complication sand better treatment. The purpose of this study is to investigate the possible factors which willmark the transition to the anti-TNF therapy in AS patients. Materials and Methods: This study was conducted in the Rheumatology division of the Internal medicine department of the Ondokuz Mayis University of Medicine hospital between January 2012- June 2015. The study protocol was approved by the Ethics Committee of Ondokuz Mayis University. A total of 165 patients, who were diagnosed as AS according to the ASAS classification criteria, were enrolled in this study. There were 85 women (51.5%) and 80 men (48.5%), aged between 15-69. Patients were divided into two groups according to their use of anti-TNF drug. Results: A total of 165 Ax-SpA patients (85 women and 80 men) were included in the study. The mean age was 37.82±11.24 years. The mean duration of the disease was 4.59±5.35 years. male gender, uveitis, delay in diagnosis, elevations in sedimentation CRP levels, increase in disease activity and functional indexes such as BASDAI and BASFI scores shows the more frequent need for anti-TNF drug use. Conclusion: In our study, patients who needed anti-TNF treatment had a longer time between symptom onset and diagnosis than patients who did not hear. The delay in diagnosing these patients leads to a delay in treatment so that the focus of inflammation increases and these patients need more anti-TNF as this window of opportunity escapes.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116577982","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}
Acute pancreatitis is responsible of considerable amount of hospital admissions, and therefore, significant morbidity and mortality in the modern world. The disease poses a significant burden to healthcare systems since its incidence have been rose to as high as 45 subjects in every 100000 population since early 1990s. Excessive alcohol consumption and biliary tract disorders are two most common causes of acute pancreatitis. Other etiological factors include dyslipidemia, surgery or traumatic injury of abdomen, hypercalcemia, infections, inflammation related to vasculitis, tumors of pancreas or ampulla and various drugs. Drugs that cause acute pancreatitis are anti-neoplastic agents (i.e., asparaginase, azathioprine, mercaptopurine), antibiotics (i.e., tetracycline, isoniazid, sulfonamides, metronidazole), anti-inflammatory drugs (i.e., celecoxib, meselamine, leflunomide), thiazide diuretics, anti-diabetic treatments (i.e., exenatide, sitagliptin), and anti-hypertensive and anti-hyperlipidemia therapies (methyl dopa, enalapril, fenofibrate, simvastatin). Medical interventions such as enteroscopy, peritoneal dialysis, endoscopic retrograde colangio-pancreatography, may also induce acute pancreatitis. Cystic fibrosis and pancreas divisum are also contributing conditions to acute pancreatitis.
{"title":"Acute Pancreatitis; New Methods for Understanding an Old Problem","authors":"G. Aktas","doi":"10.21089/njhs.63.0090","DOIUrl":"https://doi.org/10.21089/njhs.63.0090","url":null,"abstract":"Acute pancreatitis is responsible of considerable amount of hospital admissions, and therefore, significant morbidity and mortality in the modern world. The disease poses a significant burden to healthcare systems since its incidence have been rose to as high as 45 subjects in every 100000 population since early 1990s. Excessive alcohol consumption and biliary tract disorders are two most common causes of acute pancreatitis. Other etiological factors include dyslipidemia, surgery or traumatic injury of abdomen, hypercalcemia, infections, inflammation related to vasculitis, tumors of pancreas or ampulla and various drugs. Drugs that cause acute pancreatitis are anti-neoplastic agents (i.e., asparaginase, azathioprine, mercaptopurine), antibiotics (i.e., tetracycline, isoniazid, sulfonamides, metronidazole), anti-inflammatory drugs (i.e., celecoxib, meselamine, leflunomide), thiazide diuretics, anti-diabetic treatments (i.e., exenatide, sitagliptin), and anti-hypertensive and anti-hyperlipidemia therapies (methyl dopa, enalapril, fenofibrate, simvastatin). Medical interventions such as enteroscopy, peritoneal dialysis, endoscopic retrograde colangio-pancreatography, may also induce acute pancreatitis. Cystic fibrosis and pancreas divisum are also contributing conditions to acute pancreatitis.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123792546","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}
Introduction: Informed consent is an important aspect of ensuring good medical care and patient autonomy. In a developing country, the experience of women is often overlooked when deciding methods for obtaining consent. This study assesses the practice of taking informed consent in a hospital setting and factors that affect decision-making for treatment methods among gynecology patients Pakistan. Materials and Methods: Women coming to the Hamdard University Hospital gynecology outpatient department or surgery were asked to participate in the study. The questionnarie asked about informed consent, cultural factors, and interaction between the doctor and the patient. The study was conducted for a duration of 5 months. Descriptive statistics were used to analyze the results. Results: 300 women participated in the study. While all women said that doctors asked for consent before examination, 30.7% said they were not aware they could say no to being examined, 23% said the doctors did not explain the benefits or side effects of the medicines prescribed, and 22.7% were not told about alternative treatments. 91.7% said their husbands signed consent forms for them. Conclusion: This study highlights the need to improve the practice of taking informed consent in the country, as it involves educating the patient about the intervention before obtaining consent. It is important that doctors keep in mind the cultural factors that influence decisions when obtaining consent and informing patients about their treatments and management.
{"title":"Informed Consent and Shared Decision Making in Women at a Tertiary Care Hospital","authors":"T. Parveen, Samar Faheem, Shabnum Hassan, J. Khan","doi":"10.21089/njhs.63.0111","DOIUrl":"https://doi.org/10.21089/njhs.63.0111","url":null,"abstract":"Introduction: Informed consent is an important aspect of ensuring good medical care and patient autonomy. In a developing country, the experience of women is often overlooked when deciding methods for obtaining consent. This study assesses the practice of taking informed consent in a hospital setting and factors that affect decision-making for treatment methods among gynecology patients Pakistan. Materials and Methods: Women coming to the Hamdard University Hospital gynecology outpatient department or surgery were asked to participate in the study. The questionnarie asked about informed consent, cultural factors, and interaction between the doctor and the patient. The study was conducted for a duration of 5 months. Descriptive statistics were used to analyze the results. Results: 300 women participated in the study. While all women said that doctors asked for consent before examination, 30.7% said they were not aware they could say no to being examined, 23% said the doctors did not explain the benefits or side effects of the medicines prescribed, and 22.7% were not told about alternative treatments. 91.7% said their husbands signed consent forms for them. Conclusion: This study highlights the need to improve the practice of taking informed consent in the country, as it involves educating the patient about the intervention before obtaining consent. It is important that doctors keep in mind the cultural factors that influence decisions when obtaining consent and informing patients about their treatments and management.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"150 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117126202","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: Acquired Hemophilia A (AHA) is a rare autoimmune disease that can result in life threatening bleeding. Formation of auto-antibodies (inhibitors) against coagulation factor VIII develops the hemorrhagic syndrome that may appear at any age; however, prevalence of AHA is chiefly observed in post-partum and elderly persons. Idiopathic acquired hemophilia is commonest type of acquired hemophilia whereas it is also associated with autoimmune disease, malignant neoplasm, medication and vaccinations. Post-partum acquired hemophilia (PAH) may develop due to development of antibodies against fetal FVIII. In this case report, 36-year-old Asian woman presented with complain of bruises from 2 months. There was history of cesarean section four months ago. Family history, past medical and drug history were not significant. As there was no active bleeding, patient was started an oral prednisolone along with azathioprine and was counseled regarding disease and precautions. Patient presented after 2 weeks with severe PV bleed, anemia secondary to self-induced medicine abortion. For this she receives pack cells and cryoprecipitate. Steroids and azathioprine were continued and patient was discharged in stable condition. Her ultrasound pelvis however showed small fibroids. Patient went back to her village where she again develops severe PV bleed and for that she underwent hysterectomy. Patient presented in our hospital with severe operative site bleeding, pain and anemia. She was managed with Packed Red Blood (PRBCs), Fresh Frozen Plasma (FFP), Recombinant Activated Clotting Factor VII (rFVIIa), prednisolone IV and azathioprine PO. Her Activated Partial Thromboplastin, Hemoglobin were continuously monitored. After a week bleeding was stopped but Activated Partial Thromboplastin Time (APTT) was still prolonged so we tapered rFVIIa dose and advice two sessions of plasmapheresis. APTT, hemoglobin levels, inhibitor titer, High-Sensitivity C – reactive protein (hs-CRP) levels were improved. Patient was discharged in a stable condition and was advised to continue medication at home with supportive care and wound dressing.
{"title":"Postpartum Acquired Hemophilia (PAH) – A Rare Entity","authors":"S. Khan, Saima Siddiqui, Q. Abedin","doi":"10.21089/njhs.63.0142","DOIUrl":"https://doi.org/10.21089/njhs.63.0142","url":null,"abstract":"Objective: Acquired Hemophilia A (AHA) is a rare autoimmune disease that can result in life threatening bleeding. Formation of auto-antibodies (inhibitors) against coagulation factor VIII develops the hemorrhagic syndrome that may appear at any age; however, prevalence of AHA is chiefly observed in post-partum and elderly persons. Idiopathic acquired hemophilia is commonest type of acquired hemophilia whereas it is also associated with autoimmune disease, malignant neoplasm, medication and vaccinations. Post-partum acquired hemophilia (PAH) may develop due to development of antibodies against fetal FVIII. In this case report, 36-year-old Asian woman presented with complain of bruises from 2 months. There was history of cesarean section four months ago. Family history, past medical and drug history were not significant. As there was no active bleeding, patient was started an oral prednisolone along with azathioprine and was counseled regarding disease and precautions. Patient presented after 2 weeks with severe PV bleed, anemia secondary to self-induced medicine abortion. For this she receives pack cells and cryoprecipitate. Steroids and azathioprine were continued and patient was discharged in stable condition. Her ultrasound pelvis however showed small fibroids. Patient went back to her village where she again develops severe PV bleed and for that she underwent hysterectomy. Patient presented in our hospital with severe operative site bleeding, pain and anemia. She was managed with Packed Red Blood (PRBCs), Fresh Frozen Plasma (FFP), Recombinant Activated Clotting Factor VII (rFVIIa), prednisolone IV and azathioprine PO. Her Activated Partial Thromboplastin, Hemoglobin were continuously monitored. After a week bleeding was stopped but Activated Partial Thromboplastin Time (APTT) was still prolonged so we tapered rFVIIa dose and advice two sessions of plasmapheresis. APTT, hemoglobin levels, inhibitor titer, High-Sensitivity C – reactive protein (hs-CRP) levels were improved. Patient was discharged in a stable condition and was advised to continue medication at home with supportive care and wound dressing.","PeriodicalId":441304,"journal":{"name":"National Journal of Health Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128730753","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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