Journal of the Pakistan Medical Association最新文献

In the context of haemodialysis for patients with end-stage renal failure, central venous catheterisation is often required to establish a vascular access route. However, procedural complications, including acute vascular rupture and haemorrhage may occur. Although rare, these complications pose significant management challenges, high treatment costs and substantial patient trauma, with some cases progressing to life-threatening emergencies. Notably, there are no previously reported cases of iliac vein perforation secondary to haemodialysis catheterisation. We present a case of right common iliac vein (CIV) perforation by a haemodialysis catheter extending into the psoas muscle, resulting in a massive retroperitoneal haematoma and haemorrhagic shock (HS).

Metabolic syndrome (MetS) is a group of interconnected conditions that include central obesity, insulin resistance, dyslipidaemia, and hypertension. Although the cardiovascular and endocrine effects of this syndrome are well-recognized, its impact on the function of the lower urinary tract is often overlooked. Bladder dysfunction often presenting as diabetic cystopathy in diabetes- may stem from the wider metabolic environment of MetS. In this review, we propose the term Metabolic Cystopathy. We detail the pathophysiological connections, clinical manifestations, diagnostic methodologies, and treatment options. We stress the importance of multifactorial management approach, including urology, endocrinology, nephrology, dietetics and physiotherapy, to effectively address this condition.

Obesity is a complex disorder with systemic and endocrine implications. Recent insights highlight the adrenal gland as both a target and contributor in obesity-related metabolic dysfunction. Obesity-induced changes in adrenal morphology and hormone dynamics-particularly involving cortisol, aldosterone, and catecholamines- reinforce insulin resistance, visceral adiposity, and cardiovascular risk. Additionally, adrenal-driven conditions such as Cushing's syndrome, primary aldosteronism, and pheochromocytoma may present with obesity or metabolic syndrome, often underrecognized. This review explores the emerging concept of "obese adrenals," emphasizing the bidirectional relationship between adiposity and adrenal activity and the importance of recognizing endocrine subtypes within the broader spectrum of obesity.

Despite a high burden of hepatitis B in Pakistan, administration of hepatitis B birth dose (HepB-BD) has not been introduced on a national level and timely coverage remains low in selected provinces where the vaccine is available. This project was undertaken to assess the ease of timely (within 24 hours of birth) administration of HepB-BD by delivery nurses. A total of 1,000 HepB-BD doses were provided to delivery units of two public tertiary care hospitals in Islamabad. Out of 2,008 births in three months, 2,000 (99.6%) were vaccinated with HepB-BD. Out of 1,986 new-borns with available time of vaccine administration, all received the vaccine within 24 hours of birth with 98.3% receiving the vaccine within an hour of delivery. Delivery wards are the best setting to provide HepB-BD. Provinces that are already procuring HepB-BD and future nationwide introduction of HepB-BD in Pakistan could use lessons from this pilot study to ensure high coverage with timely administration of HepB-BD.

Tumour thrombi are a rare but serious complication of malignancy. It involves extension of organised collection of neoplastic cells into adjacent blood vessels, in contrast to a bland thrombus which consists of platelets and fibrin. It occurs more commonly in renal cell or hepatic cell carcinoma. Tumour thrombi are often asymptomatic and incidentally detected on imaging, however, their presence can affect staging, treatment options and prognosis of the patient. We present a rare case of a FDG avid tumour thrombus in left brachiocephalic vein in a patient with previously treated metastatic urothelial carcinoma and a second primary lung carcinoma.

Objective: To evaluate the effect of platelet activity on neurological outcomes in patients experiencing cardiac arrest.

Methods: The prospective, observational study was conducted from January 1 to December 31, 2023, after approval from the ethics review board of Chonnam National University Hospital, Gwang-ju, South Korea, and comprised patients of either gender aged >18 years who had out-of-hospital cardiac arrest. Serial mean platelet volume, platelet count, and mean platelet volume-to-platelet count ratio were noted at admission and on days 1, 2 and 3 after the return of spontaneous circulation. The primary endpoint was neurological outcome at 3 months. A poor neurological outcome was defined as cerebral performance categories 3, 4 and 5, while categories 1 and 2 were taken as a good neurological outcome. Data was analysed using SPSS 18.

Results: Of the 86 patients with median age 62.0 years (interquartile range: 51.8-70.0 years), 61(75.5%) were males. Overall, 57(66.3%) patients had suffered cardiac arrest, while 30(34.9%) had shockable rhythms at sudden collapse. The median time between collapse and return of spontaneous circulation was 32.5 min (interquartile range: 21.8-44.0 minutes). Of the total, 62(72.1%) patients had a poor neurological outcome. The mean platelet volume-to-platelet count ratio at day 3 (adjusted odds ratio: 0.789; 95% confidence interval: 0.655-0.951; p=0.013) was independently associated with poor neurological outcomes.

Conclusions: After return of spontaneous circulation, the mean platelet volume-to-platelet count ratio at day 3 may be a useful element for assessing the neurological outcomes in patients who having suffered out-of-hospital cardiac arrest and undergone targetted temperature management.

Objective: To assess the effect of iron therapy on fatigue symptoms in non-anaemic iron-deficient women of reproductive age.

Methods: The double-blind placebo-controlled randomised trial was conducted at the department of Obstetrics & Gynaecology Central Park Teaching Hospital, Lahore from March 2023 to February 2024 and comprised women aged 18-45 years who were non-anaemic, had haemoglobin level >11g/dl a fatigue score of at least 36, and a low serum ferritin level. Socio-demographic data was recorded. The subjects were randomised into Group 1 receiving iron therapy and group 2 receiving placebo. After 2 months of intervention, the fatigue scores, haemoglobin and serum ferritin levels were assessed again, and compared with baseline values. Data was analysed using SPSS 26.

Results: Of the 164 subjects, 86(52.4%) were in Group 1 with mean age 30.70±18.123 years, and 78(47.6%) were in Group 2 with mean age 29.46±7.99 years (p=0.325). In Group 1, significant decrease in fatigue score and significant increase in ferritin and haemoglobin levels were noted post-intervention (p=0.05).

Conclusions: Iron supplementation alleviated fatigue and enhanced serum ferritin concentration in non-anaemic, iron-deficient women of childbearing age.

Objective: To determine coping strategies in caregivers of children with type-1 diabetes mellitus.

Methods: This cross-sectional study was conducted at the Outpatient Department of Paediatric Endocrinology, National Institute of Child Health, Karachi, from September 2022 to October 2023, and comprised caregivers aged up to 60 years of children aged 1-14 years who were known cases of type 1 diabetes mellitus. Coping strategy scoring and interpretation was done using the shorter 28-item version of the Coping Orientation to Problems Experienced Inventory. Data was analysed using SPSS 26.

Results: Of the 227 caregivers with mean age 39.93±7.13 years, 106(46.7%) were mothers. Among the children with mean age 12.79±4.27 years, 127(55.9%) were girls. The mean duration of care was 5.71±4.05 years. Coping strategies were found present among 99(43.6%) caregivers. The age of the caregivers with coping strategies was significantly higher compared to those without coping strategies (p<0.001). Among the caregivers with coping strategies, there were significantly more Urdu-speaking individuals than of any other language (p=0.025). Parents whose children were literate were more likely to have coping strategies (p=0.022).

Conclusion: Recognizing that age of the caregivers and language may influence coping strategies, healthcare providers should consider tailoring support and interventions to the specific needs of caregivers in different age groups and linguistic communities. The association between a child's education level and parental coping strategies highlights the importance of involving children in their care management.