Journal of the Pakistan Medical Association最新文献

This retrospective case series evaluates the experience of endovascular aortic repair procedures at a single centre in Pakistan, focussing on patient selection, procedural feasibility, and associated challenges. The study includes 21 patients (six women and 15 men) who underwent various endovascular interventions: six received endovascular aneurysm repair (EVAR), one underwent fenestrated EVAR (FEVAR), 12 had thoracic endovascular aortic repair (TEVAR), and two underwent interventions for aortic coarctation. Of these procedures, seven were performed in emergency settings, while fourteen were elective. The results highlight the effectiveness of endovascular techniques in reducing operative mortality and morbidity for aortic aneurysms and dissections. However, limited accessibility in Pakistan due to high costs and scarcity of specialised referral centres restricts widespread implementation. Strengthening vascular services, improving affordability, and increasing awareness among healthcare professionals and patients could enhance the adoption of these life-saving procedures.

Objectives: To identify the factors associated with loss to follow-up and death during drug-resistant tuberculosis treatment.

Methods: The retrospective study was conducted in Punjab, Pakistan, and comprised data from January 1, 2020, to December 31, 2022, of extensively drug resistant tuberculosis patients enrolled for treatment at four major Programmed Management Drug-resistant Tuberculosis sites. Socio-demographic, microbiological, clinical data along with treatment outcomes was extracted in December 2022 from the relevant database. The association of treatment success was explored with patient characteristics, and independent factors associated with loss to follow-up and death during the treatment were identified. Data was analysed using SPSS 21.

Results: Of the 680 patients with mean age 35±15 years, 374(55%) were males and 306(45%) were females. There were 305(44.9%) cases of treatment success, 162(23.8%) were lost to follow-up, and 213(31.3%) died. Factors related to loss to follow-up were age >35 years, previous history of second-line anti-tuberculosis drugs, adverse events of treatment, employed status, and resistance to all first-line anti-tuberculosis drugs (p<0.05). Factors associated with death were previous history of second-line anti-tuberculosis drugs, adverse events of treatment and employed status (p<0.05).

Conclusions: Employed status, previous history of second-line drugs, and adverse events of treatment were associated with loss follow-up and death in extensively drug resistant tuberculosis.

Objectives: To assess the effectiveness of de-escalation training among nurses exposed to workplace violence in hospitals.

Methods: The quasi-experimental study was conducted at the private-sector Ziauddin Hospital and the public-sector Dr Ruth K.M. Pfau Civil Hospital, Karachi, from June to December 2022, and comprised nurses aged 20-50 years with a minimum of six months of professional experience who had faced exposure to workplace violence in the preceding two months. The subjects were randomised into intervention group A and control group B. Those in group A received de-escalation training, while their counterparts in group B engaged in infrequent discussions. De-escalation training was delivered through a oneday workshop. Nurses' self-attributed confidence levels were measured at baseline and two months post-training using the Confidence Coping with Patient Aggression instrument. Data was analysed using SPSS 22.

Results: Of the 131 subjects, 95(72.5%) were females, 36(27.5%) were males and 102(77.9%) were aged 20-30 years. There were 67(51.1%) subjects from the public-sector facility and 64(48.9%) were from the private-sector entity. There were 67(51.1%) subjects n group A and 64(48.9%) in group B. De-escalation training proved significantly effective both in private and public hospital settings compared to baseline scores (p<0.05) and the control group (p<0.05).

Conclusions: Among the nurses exposed to workplace violence, de-escalation training was successful in boosting the confidence level of the nurses.

Sarcoidosis is a multisystem illness with an unclear aetiology. The characteristic feature is non-necrotising granulomas in various organs. Rarely, sarcoidosis can present as a case of necrotising granulomas. The objective of this report is to highlight this unusual manifestation of the disease. This report presents the case of a 62-year-old male with a confirmed diagnosis of sarcoidosis. The patient presented with prolonged history of fever without obvious aetiology; anti-tuberculous therapy did not prove helpful. Imaging revealed nodular infiltrations in the liver, spleen, and bone marrow. Upon biopsy histological features were consistent with necrotising granulomatous inflammation. Treatment was started with corticosteroids and the patient's condition began to improve. The patient is currently recovering and is on follow-up. Early diagnosis and treatment of sarcoidosis is crucial for better prognosis. This case highlights the need to consider sarcoidosis in the differential diagnosis of fever of unknown origin and necrotising granulomatous inflammation involving multiple organs.

Herlyn-Werner-Wunderlich syndrome is a rare congenital anomaly characterized by uterus didelphys, obstructed hemi-vagina, and ipsilateral renal agenesis. This study aims to present a case of Herlyn-Werner-Wunderlich syndrome seen at Shifa International Hospital in Islamabad, Pakistan, in March 2024. A 32-year-old married woman who presented with dysmenorrhoea for two years and cyclic abdominal pain. Abdominal examination revealed a tender mass in the right iliac fossa. Ultrasound showed uterus didelphys, absent right kidney, a distended endometrial cavity with complex fluid, and a pelvic adnexal cyst. MRI suggested differentials including exophytic leiomyoma, adnexal cyst, or endometriosis. She was planned for hysterectomy and myomectomy. Intraoperatively, two separate uterine bodies with individual adnexa were identified, confirming Herlyn-Werner-Wunderlich syndrome. Both the uteri were preserved. The patient was discharged after two days and advised to undergo a hysterectomy at the age of 40. Atypical presentation with dysmenorrhoea and abdominal pain can delay diagnosis, increasing risk of complications like infertility and endometriosis.

Objective: To analyse the distribution and characteristics of accidents during the Arba'een pilgrimage.

Methods: The retrospective, descriptive study was conducted at the Ministry of Health, Baghdad and Karbala and comprised data from July 26 to August 26, 2024 related to accidents during the Arba'een pilgrimage in Karbala, Iraq. The data was obtained from health directorates across Iraq. The incidents were categorised by type, health depar tment, and pilgrim nationality (Iraqi or foreign). The distribution of injuries and fatalities was assessed. Data was analysed using SPSS version 26.

Results: Of the 728 injuries recorded, 681(93.54%) involved Iraqi nationals and 47(6.46%) involved foreign pilgrims (p=0.0051). Of the 19 fatalities reported, Iraqi pilgrims accounted for 12(63.2%) and foreign pilgrims 7(36.8%) (p=0.00018). Falls, fractures, and road traffic accidents were the most common injury types. High-risk regions, such as Karbala and Najaf, received significant resource allocation, including medical personnel and emergency response services.

Conclusion: Different types of injuries and fatalities during the Arba'een pilgrim mostly affected Iraqis, and the most common type of incidents was road traffic accidents.