Journal of the Pakistan Medical Association最新文献

Objectives: To describe the pattern of calls received at a psychiatry helpline service of a tertiary care centre.

Methods: The retrospective, descriptive chart review was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all calls and messages received by the Psychiatry Helpline Service from October 2019 to September 2022. Before the commencement of the service in 2019, a minimum level of specific training was a mandatory requirement for the nursing staff who were to act as the front end of the service. The helpline number was provided to all the patients who were discharged or left against medical advice, those attending outpatient clinics or were being followed up through consultation-liaison psychiatric services. The helpline was active from 8 am to 4 pm on weekdays only. Any messages received outside the specific time period were addressed on the next working day. On receiving a call or message, basic socio-demographic details and queries were recorded online. Data collected by the nursing staff was later recorded in a database.

Results: Of the 4,547 calls received, 315(7%) related to 2019, while 1,825(40.13%) were received in 2022. Overall, 2,316(50.9%) callers were females. Most people used the helpline for dose adjustment 1,390(30.56%), followed by psychoeducation 828(18.2%). Of the 38(0.83%) calls related to suicidal ideation, 31(81.6%)) were made by females compared to 7(18.4%) by males.

Conclusions: The psychiatry helpline service experienced a significant increase in patient contacts, indicating its growing utilisation, and underscoring the potential for expanding its scope within the organisation to further cater to patient needs.

Objective: To assess the type and presentation patterns of tumours metastasising to orbit.

Methods: The retrospective study was conducted at the Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan, and comprised data of all patients with orbital metastatic lesions over a 20-year period, from January 1, 2004, to December 31, 2023. Data was analysed using SPSS 22.

Results: Of the 30 patients, 17(56.7%) were males and 13(43.3%) were females. The highest incidence of orbital metastatic disease was among those aged <10 years 9(30%) and >60 years 11(36.7%). Roof was the commonest site of involvement within the orbit 13(43.3%). Proptosis was the main feature at presentation. Diagnosis was made clinically in 14(46.7%) patients and histologically in 16(53.3%). All the 30(100%) cases were referred to the oncology service for further management. Of them, 2(6.7%) patients were lost to follow-up, 20(66.7%) died within one year of diagnosis, and 8 (26.6%) patients were still under treatment.

Conclusions: The diagnosis of orbital metastasis should always be considered for orbital lesions in all age groups, especially in patients with a known cancer elsewhere. Orbital metastasis usually becomes evident at an advanced stage of underlying malignancy, leading to a high mortality rate..

Objectives: To assess the changes in the expression of anti-oxidant and pro-oxidant enzymes in patients with type 2 diabetes and diabetic nephropathy, and to examine their correlation with insulin resistance.

Methods: The case-control study was conducted from March to November 2021 at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and comprised adult patients of either gender with diabetic nephropathy in DN group, patients with type 2 diabetes but without diabetic nephropathy in T2D group, and non-diabetic individuals in the control group. Serum insulin levels were measured using a modular analyser, while nicotinamide adenine dinucleotide phosphate oxidase, glutathione S-transferase and superoxide dismutase 3 levels were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 29.0.1.

Results: Of the 74 subjects, 45(60.8%) were females and 29(39.2%) were males. The overall mean age was 53±14 years. There were 20(27%) patients in DN group with mean age 60±11 years, 29(39.2%) patients in T2D group with mean age 56±12 years, and 25(33.8%) in the control group with mean age 43±11 years. Nicotinamide adenine dinucleotide phosphate oxidase levels were significantly lower in T2D and DN groups than in the control group (p<0.05). Glutathione S-transferase levels were significantly lower in the DN group than in the control group (p<0.05). T2D and DN groups had significantly lower superoxide dismutase 3 levels than the control group (p<0.05). Glutathione S-transferase levels correlated positively with glycated haemoglobin levels in the DN group, and negatively with fasting blood glucose levels in the T2D group (p<0.05). Superoxide dismutase 3 levels were negatively correlated with insulin and homeostatic model assessment of insulin in T2D group (p<0.05).

Conclusions: Type 2 diabetes and diabetic nephropathy induced changes in the levels of superoxide dismutase 3, glutathione S-transferase and nicotinamide adenine dinucleotide phosphate oxidase. Low levels of superoxide dismutase 3 in type 2 diabetes correlated with insulin resistance, suggesting the need for anti-oxidant replacement therapy as part of diabetes control measures to prevent diabetic nephropathy.

Pulmonary embolism (PE) can lead to chronic thromboembolic pulmonary hypertension (CTEPH) which can result in right heart failure. Therefore, timely management of this condition can save patients from serious complications. In the department of Nuclear Medicine, ventilation perfusion (V/Q) scan has been used to supplement detection of PE especially in cases where contrast based computed tomography pulmonary angiography (CTPA) cannot be performed. With the advent of single photon emission computed tomography (SPECT/CT), perfusion scan with SPECT/CT is being frequently used. It has also been used for the diagnosis of various other indications such as right to left cardiac shunts in addition to PE. Technetium 99m macroaggregated human serum albumin (99mTc HSA) is commonly used in lung perfusion scans. It can also be taken up by extra pulmonary organs such as brain or kidneys due to presence of shunt. We present an interesting case of simultaneous detection of PE and right to left shunt in a young patient.

Objectives: To assess latrophilin-3 (LPHN3) and Homeobox protein (NKX- 3.1) protein expression in breast cancer, and the association with metastasis.

Methods: The case-control study was conducted at the Dow University of Health Sciences, Karachi, and comprised breast carcinoma tissue sections diagnosed between July and November 2022. The tissues were divided into 2 equal groups, with group A having cases with metastasis and group B having controls without metastasis. expression of latrophilin-3 and NKX3.1 in tissue was assessed using immunohistochemistry in both the groups. Data was analysed using SPSS 21.

Results: Of the 80 women with mean age 50±1.20 years, 40(50%) were in each of the 2 groups. Overall, 31(38.8%) tissues were from the right-side breast, and 49(61.2%) were from the left-side breast. Latrophilin-3 was highly expressed in group A 35(87.5%) compared to group B 10(25%) (p<0.001). The expression of NKX3.1 was weak in 10(25%) group A cases and 4(10%) group B controls (p=0.070).

Conclusions: The expression of latrophilin-3 could play an important role in the prediction of metastasis in earlystage breast cancers. In contrast, NKX3.1 expression had no significant association with metastasis.

Objective: To assess the frequency, types and contributing factors of missed nursing care among registered nurses in a tertiary care setting.

Methods: The analytical cross-sectional study was conducted from May to November 2022 at the Dow University Hospital, Karachi, and Dr Ruth Katherina Martha Pfau Civil Hospital, Karachi, and comprised nurses registered with the Pakistan Nursing and Midwifery Council. Data was collected using a validated tool. Data was analysed using SPSS 23.

Results: Of the 232 nurses, 127(54.7%) were males, 105(45.3%) were females, 123(53%) were aged 30-39 years, and 73(31.5%) had work experience of 1-5 years. Nursing care components neglected by the nurses were patient bathing 127(54.7%), attending care conference 108(46.6%) and focussed reassessment 100(43.1%). Factors responsible for missed care were manpower resources identified by 152(65.5%) nurses, material resources by 141(60.8%), and communication factors identified by 84(36.2%).

Conclusions: Various nursing care components were found missing during patient hospitalisation. Major reason for missed care was identified by the nurses as lack of manpower resources.

Rehabilitation following a stroke faces challenges in offering customized treatment and attaining the best possible outcomes. The utilization of artificial intelligence (AI) presents transformative solutions that have the potential to revolutionize existing practices. This minireview discusses the use of AI in rehabilitation after stroke, in form of customized intervention, task-specific training with robotics, real time monitoring by wearable devices and remote monitoring through tele rehabilitation. Despite the recent advances, issues such as algorithm bias, concerns about data security, and access disparities remain. Future directions include creating predictive analytics for tailored stroke therapies, incorporating virtual reality for increased participation, and assuring ethical and equitable distribution. Collaborative efforts are necessary to address these challenges and advance AI-driven stroke therapy. This review highlights the potential of AI to revolutionize stroke rehabilitation outcomes through interdisciplinary collaboration and ethical implementation.