Journal of the Pakistan Medical Association最新文献

The importance of transparent communication regarding orthodontic risks during the informed consent process in paramount in terms of ensuring a strong orthodontistpatient relationship. Conducted on a national scale in Pakistan, the current study was planned to establish a consensus among orthodontic professionals regarding critical risks involved in such a discussion. The crosssectional survey involving 132 orthodontists across Pakistan led to the emergence of 10 key risks, including relapse, treatment duration and gingivitis. However, the study's sole focus on orthodontists' perspectives limited its insights, overlooking invaluable input from patients' experiences. Nevertheless, the consensus underscored the significance of addressing these risks to ensure informed consent and patient autonomy. Going forward, it is imperative to customise this evidence-based information according to individual patient needs, and maintain an ongoing dialogue regarding potential risks, fostering a collaborative approach to orthodontic care and decision-making.

Objective: To ascertain the frequency of hospitalised internal medicine patients requiring escalation to a higher level of care, and in-hospital mortality in such cases.

Methods: The prospective, observational study was conducted from September 1 to October 15, 2021 at a tertiary care hospital in Karachi, and comprised adult patients of either gender admitted to the internal medicine general wards and high dependency units. Data was collected prospectively using a proforma. Data was analysed using SPSS 23.

Results: Of the 837 patients admitted, 617(73.7%) were included. There were 310(50.2%) females and 307(49.8%) males with mean age 52.2±18.8 years. The most common comorbidity was hypertension 288(46.7%). Of the 617 patients, 51(8.3%) required escalation to a higher level of care. Escalation to the intensive care unit and high dependency unit occurred in 19(37.3%) and 32(62.7%) patients, respectively. In-hospital mortality among patients who required escalation to the intensive care unit was 52.6%. In instances where the escalation was required within 48 hours of admission, in-hospital mortality was 8.3% (2/24), whereas, it was 40.7% (11/27) in cases when it was initiated beyond 48 hours of admission (p=0.010). The median length of hospital stay was also significantly lower when the escalation was initiated within 48 hours of admission 5 days (interquartile range: 4-7 days) compared to when it was delayed 13 days (interquartile range: 6-19 days) (p<0.001). The principal discharge diagnosis of sepsis was significantly associated with escalation to a higher level of care (p<0.001) and in-hospital mortality (p<0.001).

Conclusions: Initiation of escalation to higher levels of care within 48 hours of admission was found to be associated with reduced in-hospital mortality and length of hospital stay.

Immune Thrombocytopenia Purpura (ITP) is an autoimmune disorder characterised by a low blood platelet count, which is attributed to both decreased megakaryocyte production in the bone marrow and the generation of autoantibodies causing platelet destruction in the spleen. Individuals with autoimmune conditions are highly susceptible to pulmonary embolism. This case involves a 39-year-old female with ITP who developed thromboembolisms. A comprehensive investigation into prothrombotic risk factors, including obesity, smoking, family history of thromboembolism, and ITP-related interventions such as prolonged corticosteroid use or splenectomy, revealed insignificant results, except for the patient's history of receiving corticosteroid therapy. Despite the disparate pathogenesis of thromboembolism (TE) and ITP, recent events of TE in ITP patients have been observed. This report underscores the potential lifethreatening complications in ITP and aims to explore their causes and pathogenesis for ensuring optimised patient care.

Objective: To determine the effects of instrument-assisted soft tissue mobilisation compared to manual myofascial release in terms of managing pain, improving range of motion, and reducing disability in patients with chronic mechanical low back pain.

Methods: The randomised controlled trial was conducted from July 2022 to July 2023 at the Foundation University College of Physical Therapy and Gul's Rehab Clinic, Rawalpindi, Pakistan, and comprised patients of either gender diagnosed with chronic mechanical low back pain. The patients were randomised into group A receiving manual myofascial release, and group B receiving instrument-assisted soft tissue mobilisation using long bar tool. The intervention lasted 9 sessions over 3 weeks. Data was analysed using SPSS 21.

Results: Of the 50 participants 37(74%) were females and 13(26%) were males. The overall mean age was 25.1±6.9 years. There were 25(50%) patients in each group. Pain, lumbar range of motion, and lumbar disability improved significantly in both groups (p< 0.05). Intergroup difference was not significant (p>0.05).

Conclusions: Manual myofascial release and instrument-assisted soft tissue mobilisation were equally effective in the treatment of chronic mechanical low back pain.

Rct number: NCT05709925. https://classic.clinicaltrials.gov/.

Objective: To explore the role of extracurricular activities in the development of leadership skills among undergraduate Doctor of Physical Therapy students.

Methods: The cross-sectional study was conducted from March to October 2023 at the Khyber Medical University and its affiliated institutes in Peshawar, Pakistan, and comprised undergraduate Doctor of Physical Therapy students of either gender aged at least 18 years. Data was collected using a a pilot-tested questionnaire. Data was analysed using SPSS22.

Results: Of the 340 students, 231(67.9%) were females and 109(32.1%) were males. The overall mean age was 21.55±1.75 years. The largest group was of students in the 7th semester 76(22.4%). Of the total, 131(38.5%) students were members of extracurricular societies, while 209(61.5%) were non-members. High-level leadership skills were found among the members compared to the non-members (p<0.001). Type of society (p<0.001) and gender (p=0.013) has a substantial association with leadership skills.

Conclusion: The role of extracurricular activities in the development of leadership skills among undergraduate Doctor of Physical Therapy students was found to be significant.

Pakistan faces significant challenges in attaining the Sustainable Development Goals for maternal and child health by the 2030 target. Separate vertical programmes, governance challenges due to paper-based systems, and limited availability of data contribute to the health system's suboptimal functioning. An innovative mHealth tool, Hayat, was introduced in remote areas of Pakistan to digitalise record-keeping by frontline workers, provide evidence-based awareness content for dissemination, and track performance through transparency enhanced by geographical information system tracking. There has been a limited translation of mHealth evidence into policy change globally. Hayat is one of the few donor-funded programmes, and strengthens the health system in Pakistan. It secured matching funding from the government to sustain operations and for scale-up. The current paper was planned to describe the intrinsic and extrinsic factors that led to the intervention's adoption by the government, including the technological and programmatic approaches, challenges and mitigation strategies, and policy recommendations for the long-term sustainability of similar mHealth interventions in low- and middle-income countries.

A 37 year old woman presented with a history of weakness and lethargy for many years. She had been amenorrhoeic for 5 years after a still birth at 37 weeks gestation, due to severe falciparum malaria. On examination, she appeared pale and lethargic, with a blood pressure of 100/70 mm Hg. Her systemic examination was unremarkable. Laboratory tests revealed low 9.00 am serum ACTH and cortisol levels, along with low free T4, FSH and LH levels. A short synacthen test showed an inadequate cortisol response at 30 minutes. MRI of the Pituitary gland displayed an empty sella. She was diagnosed with hypopituitarism due to postpartum pituitary necrosis, and was treated with hydrocortisone, thyroxine and sex hormone replacement therapy. The patient showed an excellent response to treatment.

Objectives: To determine the association of musculoskeletal disorders with ergonomic training and equipment with respect to the quality of life of nurses working in the intensive care unit.

Methods: The experimental study was conducted at Eskisehir Osmangazi University Health, Practice and Research Eskisehir, Turkiye from November 2018 to December 2019, and comprised adult intensive care unit nurses. The nurses were provided with ergonomic equipment (rollboards) to facilitate the transfer patients from bed to stretcher and from stretcher to bed. The nurses were trained on the use of rollboards for a month. Data was collected at baseline and after the training using a personal data collection form, Cornell Musculoskeletal Discomfort Questionnaire, Rapid Entire Body Assessment, and Short Form-36. Data was analysed using SPSS 21.

Results: Of the 103 nurses, 71(58.9%) were females and 32(31.1%) were males. There were 30(29.1%) subjects aged 25-29 years, and body mass index was <25kg/m2 in 62(60.2%). Median risk score for lower back was 3.50 (interquartile range: 1.50-14.00; Z=-2.58, p=0.01) and for risky working posture it was 5.00 (interquartile range: 5.00- 7.00; Z=-8.39, p<0.001) of nurses which decreased after training and the use of equipment. The sub-dimension scores of the quality of life for the physical function, mental health, social function, general health perception and pain decreased post-intervention, but the difference was not significant (p>0.05).

Conclusion: Nurses' musculoskeletal symptoms decreased as a result of ergonomic training and equipment use. Although ergonomic training and equipment use did not affect nurses' quality of life, the ergonomic workplace increased their awareness of ergonomic risk assessment.

The case report of a female with Asymptomatic hyperCKemia along with a literature review is presented. The objective of this report is to highlight an effective diagnosis and treatment option for Asymptomatic hyperCKemia patients, as well as to bring to attention a rare and benign cause of CK elevation, which can lead to diagnostic and therapeutic errors.