bluuebunny/crossref_metadata_2025 huggingface dataset:
Atypical presentation of left atrial myxoma: a case report
Authors: Mujtaba Azhar Siddiqui  , Muhammad Ismail Ibrahim  , Muhammad Salih  , Muneeba Khan  , Muhammad Tariq Farman
Published: August 2024

Atrial Myxoma is the most common primary benign tumour of the heart, commonly found in the left atrium. It typically presents in young females with characteristic features such as, constitutional symptoms, chest pain, and cardiac murmurs. However, atypical presentations can occur; causing a diagnostic challenge. This case report describes a 75-year-old male who visited the cardiology outpatient department (Name of the hospital with city) on 18th April, 2023 with a left-sided atrial myxoma in late adulthood without typical features including constitutional symptoms, chest pain, syncope, dizziness, digital clubbing or neurologic findings. Further discussed are the diagnostic techniques used to find the tumour and the treatment strategy. This case report highlights the need for cardiologists to consider Atrial Myxoma as a potential diagnosis, even in the absence of typical symptoms, in elderly male population.
Keywords: Atrial Myxoma, Intracardiac tumour, Myxoma, Myxoma Resection.
Role of therapeutic plasmapheresis in acute liver failure in paediatric patients: a case series
Authors: Ayaz Ur Rehman  , Khan Wajiha , Khan Salman , Awais Abbas  , Qalab Abbas  , Naveed Ur Rehman Siddiqui
Published: August 2024

Paediatric acute liver failure (PALF) is a rare yet severe condition that is associated with high mortality. Apart from liver transplant, no specific therapy exists, particularly in developing countries. Evidence suggests that removal of damage-associated molecular patterns, cytokines, toxins, and other metabolites that accumulate due to impaired liver function can enhance natural recovery. Plasmapheresis can be used to remove these products; however, there is limited evidence to support this approach. This case series discusses three critically ill patients with acute liver failure who underwent plasmapheresis. The patients included a seven-year-old boy (Case 1), a 17-year-old boy (Case 2), and a 16-month-old boy (Case 3). Two patients showed significant improvement in bilirubin level, coagulation profile, inotropes requirement, and Glasgow coma scale score. Unfortunately, one patient with PALF, complicated with multi-organ dysfunction, died due to refractory shock on the fourth day of hospitalisation.
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The effects of geriatric oral dental health training to dental students on their elderly attitudes
Authors: Hastaoglu Fatma
Published: August 2024

Objective: To measure the effect of geriatric oral health education on the attitude of dentistry students towards the elderly.
Methods: The interventional study was conducted in December 2022 at Sivas, and comprised students of the Faculty of Dentistry, Sivas Cumhuriyet University, Turkiye in their 4th and 5th academic year. A 20-hour training course was delivered over 3 days by faculty members. Baseline and post-intervention difference was assessed using the Kogan's Attitudes Towards Old People Scale. Data was analysed using SPSS 22.
Results: Of the 30 students, 18(60%) were females and 12(40%) were males. The overall mean age was 22.93±1.63 years. Besides, 18(60%) students belonged to 5th year and 12(40%) to the 4th year. The mean Kogan Elderly Attitude Scale score at baseline was 184.13±25.55, while post-intervention it was 195.36±22.36. (p<0.05).
Conclusion: Relevant training was found to have a significant impact on the attitude of dentistry students towards the elderly.
Key Words: Oral health, Dentistry, Aged, Attitude, Health education.
The effect of educational interventions by nurses through Orem’s self-care theory on the ability of self-care in myocardial Infarction patients in public sector hospital: a quasi-experimental study
Authors: Muhammad Shahid  , Masih Sarfraz , Lashari Nawaz , Farooqui Waqas Ahmed
Published: August 2024

Objective: To assess the impact of educational intervention by nurses guided by Orem’s theory to reinforce the of self-care abilities of patients experiencing myocardial infarction.
Method: The prospective, quasi-experimental case-control study was conducted from September 2020 to April 2021 at Dr. Ruth K.M. Pfau Civil Hospital, Karachi, and comprised myocardial infarction and heart failure patients with co-morbidities diabetes mellitus and hypertension. The patients were randomised into experiment group A and control group B. Group A received educational intervention one day before and one day after discharge in line with the American Heart Association guidelines. Two 30-45-minute sessions of seven modules were conducted. Group B received routine information from ward staff. Assessment was done at baseline and first month and second month post-intervention using the Heart Failure Self-Care Index version 6.2. Data was analysed using SPSS 20.
Results: Of the 80 patients, 40(50%) were in group A; 27(76.5%) males and 13(32.5%) females. The remaining 40(50%) patients were in group B; 20(50%) males and 20(50%) females. The overall age of the sample ranged 36-65 years and 48(60%) had a previous history of heart failure. The mean score of maintenance, management, confidence and overall self-care were significantly higher in group A compared to group B (p<0.05).
Conclusions: Nursing self-care educational intervention based on Orem’s theory was found to be highly effective among patients of myocardial infarction and heart failure with respect to their self-efficacy ability.
Key Words: Orem’s self-care deficit nursing theory, Self-care ability, Patient’s education, Myocardial infarction, Self-efficacy, Quality of life.
Efficacy of platelet rich plasma for acceleration of healing in chronic wounds; research article
Authors: Khan Mujtuba Pervez , Hyder Ali  , Suneel Kumar
Published: August 2024

Objective: To compare the standard dressing with normal saline with platelet-rich plasma for acceleration of healing in patients with chronic wounds.
Method: The study was conducted at the Department of Plastic and Reconstructive Surgery, Dow University of Health Sciences and Dr K.M. Ruth Pfau Civil Hospital, Karachi, from April 1, 2019, to March 31, 2020, and comprised patients of either gender aged 18-60 years with arterial ulcers on the lower limb with dimension of wound <10cm2, haemoglobin >10g/dl and platelet count >150x109/L. The patients were randomised into control group A, which received conventional treatment of dressing with normal saline, and intervention group B, which received daily dressings with normal saline and weekly application of platelet-rich plasma. The procedure was repeated every week for 3 weeks. Bates Jensen wound assessment tool was used to assess the final outcome. Data was analysed using SPSS 20.
Results: Of the 98 patients, with mean age 41.68±11.03 years, there were 49(50%) in group A; 45(91.8%) males and 4(8.2%) females with overall mean age 40.10±10.8 years. The other 49(50%) patients were in group B; 39(79.6%) males and 10(20.4%) females with overall mean age 43.27±11.1 years (p>0.05). Mean wound assessment score of group B patients decreased significantly compared to group A (p=0.002).
Conclusion: Platelet-rich plasma treatment showed better performance in accelerating healing of chronic arterial wounds compared to the standard treatment of daily dressing with normal saline.
Key Words: Wounds, Platelet-rich plasma.
A crucial step towards a safer healthcare system: embracing the WHO surgery checklist in Pakistan
Authors: Khan Abdullah , Yousaf Mirza Rehan , Naeem Hamza
Published: August 2024

Mistakes happen. We all make mistakes that makes us human. But when a surgeon makes mistake, it costs lives. Being surgeon, a little negligence might make catastrophic incidents happen. An unintentionally retained needle in the abdominal cavity or surgery of a normal limb instead of faulty gall bladder can have serious consequences not only for the patient and the patient-physician relation but also for the healthcare system. Such negligence events have become common in Pakistan. In Faisalabad, it was reported that a patient with gall stones was mixed up with a patient of limb surgery having the same name that led to inappropriate surgical procedures performed on both.[1] In Abbottabad, an incident was reported where the patient had to undergo an arm surgery but an eye surgery was performed in a private hospital. [2] Everyone blamed the surgeon and the health care system but no one dared to dig into the cause. Why are such childish mistakes happening? And if happened once how is this being repeated? How could a surgeon, a practically learned man make such non-sense? The answer to all these questions lies in the WHO Surgical Safety Checklist.
“Safe Surgery Save Lives” was initiated by the World Health Organization (WHO) in 2007 in order to alleviate the number of such unwanted events encountered in the surgical procedures. For the purpose of improving patient safety with least of the resource utilization, WHO came on board with safety checklist in 2008.[3] The WHO 19-item checklist is based on advocating safety checks and a good communication among surgery team members during perioperative periods. It also contains a time-out procedure. In Pakistan, in spite of the great effectiveness, the time-out is either not practiced or is done by some junior, and not by the operating surgeon at the preoperative time. A time-out is a short interval before incision during which it is confirmed that the patient on the surgery bed is the correct one, the procedure to be performed on it is exact and at the required part of body either marked or unmarked.[4] The surgeon should be present at the time-out and all members should guarantee the correct patient, procedure and site. Patient participation in the time-out process is also advised. Majority of the patients show great compliance and satisfaction for participating in the time-out procedure.
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Assessment of barriers to the dietary adherence among type 2 diabetic patients in Pakistan: a cross-sectional study
Authors: Shabbir Sukaina , Amer Mehreen , Mughal Saba , Rashid Thamina , Habiba
Published: August 2024

Objective: To assess the common barriers responsible for non-adherence to dietary recommendations among type 2 diabetic patients.
Method: The cross-sectional study was conducted from October 4, 2021, to March 6, 2022, at the National Institute of Diabetes and Endocrinology, Dow University of Health Sciences, Karachi, and comprised type 2 diabetes patients of either gender aged 18-80 years who had previously been given recommended dietary advice. Dietary barriers were assessed using a 27-item validated questionnaire, and the subjects were compared in terms of age and diabetes duration. Anthropometric measurements and laboratory parameters were also measured. Data were analysed using Stata 17.
Results: Of the 312 subjects, 234(75%) were females. The overall mean age was 52.2±11.2 years, and mean body mass index was 27.2±5.5kg/m2. The reliability of the questionnaire was established with Cronbach’s alpha 0.89. Factor analysis yielded 8 common barriers; lack of knowledge about dietary recommendations (variance: 14.7%), situational barrier (variance: 10.7%), lack of family support (variance: 9.5%), stress-related eating problems (variance: 9.1%), boring and monotonous diet (variance: 8.0%), expensive and ineffective diet recommended (variance: 6.5%), work conditions/don’t like food in diet (variance: 5.5%), and feeling hungry and weak (variance: 5.4%). The total variation explained by all the 8 factors was 69.4%.
Conclusion: Lack of knowledge regarding dietary recommendations was reported to be the most common barrier towards recommended dietary adherence.
Key Words: Diabetes mellitus, Type 2 diabetes, Dietary adherence, Barriers, Non-adherence, Dietary advice.
Comparative analysis between outcomes of minimally invasive gynaecological surgeries and traditional abdominal surgeries for benign gynaecological conditions
Authors: Ammara Iqbal Muhammad  , Najeeb Wajeha , Naima Komal  , Shaheera Akram  , Ayub Ashraf Mallhi
Published: August 2024

Objective: To compare outcomes of minimally invasive gynaecological surgeries with open gynaecological surgical techniques in a low-resource setting.
Method: The quasi-experimental study was conducted at a tertiary care public-sector hospital in Rawalpindi, Pakistan, from September 2022 to August 2023, and comprised women with benign gynaecological conditions. The subjects were divided into two groups. Group-I included participants who underwent minimally invasive gynaecological surgeries, while Group-II patients underwent open gynaecological surgical intervention. Outcome variables included pre-discharge pain score, post-operative mobility, operative time, blood-loss during surgery, length of hospital stay and intraoperative as well as postoperative complications. Data was analysed using SPSS 25.
Results: Of the 319 women, 146(45.7%) were in Group-I with mean age 30.83±5.47 years, and 173(54.2%) were in group-II with mean age 44.87±10.46 years. Body mass index, length of marriage, history of previous surgery, comorbidities and menopausal status were significantly different between the groups (p<0.05). Duration of surgery and hospital stay were lower in Group-I compared to Group-II (p<0.05). Intra-operative complications were not significantly different between the groups (p<0.05), while the differences in post-operative complications were significant (p<0.05).
Conclusion: Better clinical outcomes were observed for minimally invasive gynaecological surgeries than open surgeries among women diagnosed with benign gynaecological diseases.
Key Words: Minimally invasive surgical procedures, Operative surgical procedures, Laparotomy, Gynaecological diseases.
Role of oral hypoglycaemic drugs in preventing complication in non-alcoholic fatty liver disease with type 2 diabetes mellitus
Authors: Zahid Museera , Perwaiz Khan Samia , Ershad Sana , Izhar Safia , Warraich Rizwana , Asghar Ali
Published: August 2024

Objective: To determine the prevalence of non-alcoholic fatty liver disease, and the effect of oral hypoglycaemic drugs and lifestyle modifications in reducing fatty liver changes and liver enzymes in these patients.
Method: The comparative, observational study was conducted at the Department of Pharmacology, Sohail University, Karachi, from October 2022 to October 2023, and comprised patients of either gender having elevated liver enzymes and ultrasound finding of fatty liver changes along with raised glycated haemoglobin, transaminases, total cholesterol and triglycerides. The participants were prescribed oral hypoglycemic agents by endocrinologists. Those given empaglifazolin + metformin were in group A, empaglifazolin + linglaptin in group B, sitaglaptin + metformin in group C, metformin alone in group D and sitaglaptin alone in group E. Lifestyle modifications were advised in all the treatment groups, while control group F was only advised lifestyle modifications. The intervention lasted 3 months. Investigations included B-mode ultrasound liver, liver enzymes and glycated haemoglobin, which were done at baseline and after the intervention. Data was analysed using SPSS 25.
Result: Of 200 patients, 40 were males and 160 were females in ratio of 1:4. The overall mean age was 48+16 years. There were 154(77%) patients who had non-alcoholic fatty liver disease with type 2 diabetes mellitus, while 46(23%) had only fatty liver changes. There were 50(25%) patients in group A, 30(15%) in group B, 30(15%) in group C, 40(20%) in group D, 10(5%) in group E, and 40(20%) in group F. Post-intervention improvement was noted in 48(24%) patients, with 20(41.7%) of them being in group A.
Conclusion: The prevalence of non-alcoholic fatty liver disease with type 2 diabetes was high. Combination of empagliflozin + metformin along with lifestyle modifications was highly effective in reducing fatty changes and the level of liver enzymes.
Key Words: Non-alcoholic fatty liver diseases, Metformin, SGLT2- inhibitor, Type 2 diabetes mellitus, AST, ALT.
YouTube as a learning modality for clinical procedures among medical and dental students: a study in public sector teaching institutes
Authors: Shah Hina , Ahmed Sanaa , Ayaz Sumbul , Gul Amna , Fatima Urooj , Abbas Mohammad Taha
Published: August 2024

Objectives: To evaluate the effectiveness and analyse the influence of YouTube as a learning modality for clinical procedures among medical and dental students in a public-sector setting.
Method: The cross-sectional study was conducted at the medical and dental constituent institutes of Jinnah Sindh Medical University and Jinnah Postgraduate Medical Centre between August and October 2023, and comprised undergraduate, graduate, and postgraduate students of either gender aged 18-40 years. Data was collected using a self-administered, structured, closed-ended 16-item questionnaire, which was developed in the English language and explored the usage of YouTube as a source of information about medical and dental clinical procedures. Data was coded and analysed using SPSS 26.
Results: Of the 314 participants, 153(48.7%) were medical students and 161(51.3%) were from the dental stream, 175(55.7%) were females, and 139(44.3%) were males. YouTube was a helpful tool for 143(45.5%) students who used it when needed, 172(54.8%) used it occasionally before attempting procedures, while majority of the dental students 140(44.6%) used it to study for prosthodontics. There were 154(49%) students who supported the idea that faculty should recommend watching relevant videos on YouTube, while 256(81.5%) preferred other websites.
Conclusion: YouTube was mostly used for learning clinical procedures by the students.
Key Words: Computer-assisted instruction, Deep learning, Communication, Oral surgical procedures, Education, Dental.
Clinical training and practice of using digital health solutions among healthcare workers in clinical settings during Hajj season
Authors: Alghamdi Saeed Mardy
Published: August 2024

Digital health solutions are widely used in Saudi Arabia, but training, clinical practice and challenges related to using digital health applications have not been evaluated from the perspective of healthcare workers during the Haj season in Makkah. The current study was planned to explore clinical training, practices and challenges related to the use of digital health among healthcare workers during the Haj season from June to August 2023. Of the 470 subjects, 347(73.8%) were males and 123(26.2%) were females. The overall median age was 40 years (interquartile range: 27-56 years). In the clinical practice of using digital health, 185(39.4%) of the subjects strongly agreed that digital health was useful and beneficial during transportation difficulties, and 167(35.5%) strongly agreed that digital health applications had changed their working routine during the Haj season. Negative outcome expectations were the challenge least reported by 72(15.3%) respondents.
Screening first-degree relatives of patients with Chronic Kidney Disease (CKD) in Pakistan
Authors: Ilyas Amna , Ali Bakhtawar
Published: August 2024

Dear Sir / Madam
Chronic Kidney Disease (CKD) poses a worldwide health concern, affecting more than eight hundred million people globally, with underdeveloped nations sharing the greatest disease burden.1 It’s hypothesised that by 2030, countries with less than 15% of the economy will account for over 70% of the patients with ESRD. 2 Therefore, early detection through targeted screening is crucial in developing countries like Pakistan. However, owing to racial and ethical differences in results, the Kidney Disease Prevention Network unanimously agreed that each country, based on the prevalence of risk factors at a local level, must delineate their own high-risk groups to be screened.2
Recent studies in Pakistan3,4, like those in India5, Nigeria6, and China7, have shown evidence of clustering of CKD in first-degree relatives, making them an important target population for screening. Nonetheless, due to the lack of proper screening in Pakistan, there are delays in management as well as referrals to nephrologists, even among individuals with a strong family history of CKD.
In Pakistan, where access to dialysis therapy is already limited due to the continuously increasing per-person cost of dialysis and lack of availability, we must shift the focus towards screening high-risk populations to prevent strain on the economically vulnerable. The targeted screening of first-degree relatives will not only save millions spent on dialysis and renal transplants but will also reduce the recruitment costs of screening as the family members are in constant contact with the healthcare system. Moreover, since they're also firsthand witnesses to the financial and physical impact of delayed diagnosis, family members of CKD feel more motivated to actively participate in screening programmes.
Considering the above, it is imperative to conduct more extensive clinical trials and assess the efficacy of screening, including opportunistic screening in dialysis units as well as outdoor settings, of first-degree relatives in Pakistan.
Post-Tuberculosis Morbidity in children and adolescents: A letter to the Editor
Authors: Bushra Khalid  , Mariam Fatima Ali
Published: August 2024

Madam,
Tuberculosis is a leading health problem worldwide. Among the countries with a high burden of tuberculosis, Pakistan is ranked fifth by WHO, accounting for the disease burden of 61% in the WHO Eastern Mediterranean Region. There is considerable age-wise variation in tuberculosis presentation. Younger children are more susceptible to extrapulmonary and disseminated tuberculosis than older children. (1) Of the total TB cases load, children account for 11%, with a 1.1 million incidence rate. (2) In addition to this, there is relative underreporting of childhood tuberculosis which makes disease in this population relatively forsaken. (3) In 2019, 49% of the 21 million DALYs attributed to incident tuberculosis in young children were due to post-tuberculosis sequelae. (4)
Since extrapulmonary TB is more common in children, the prevalence and character of pediatric post-tuberculosis morbidity may differ from those of adult-type sequelae. (1) In 2023, a systematic review on post-tuberculosis sequelae included long-term outcomes 1 month to 36 years after tuberculosis. According to the available data, the study revealed the following sequelae post-tuberculosis:

Among children with CNS tuberculosis and tuberculous meningitis, the outcomes included Intellectual disability, motor disorders, epileptic seizures, behavioral and emotional disorders, language difficulties, visual impairment, hearing deficiency, endocrine disturbances, hydrocephalus, and attention-deficit hyperactivity disorder.
Sequelae following spinal tuberculosis included spinal deformity, osteoporosis, reduced physical activity, residual pain, loss of lung capacity, neurological disabilities, and paraplegia.
Following Tuberculosis involving bone and joints, the outcomes included limb length discrepancy, limited mobility, and bone deformity.
Following pulmonary tuberculosis, there was persistent coughing, wheezing, and radiological sequelae including fibrosis, calcification, atelectasis, emphysema, bronchiectasis, and lymphadenopathy.
Sequelae following urogenital, cutaneous, and abdominal tuberculosis included urogenital obstruction, skin scarring, chronic renal failure, and intestinal obstruction, respectively.
There were long-term psychological and economic effects which included reduced quality of life, stigmatization, social dependency and maladjustment, and the need for schools to provide functional and educational assistance and financial burden. (4)

A key challenge in managing childhood TB in Pakistan is the absence of a systematic referral process for children suspected of having TB from primary healthcare facilities to those with childhood TB diagnostic services. Consequently, understanding how geographic distance affects the availability of childhood TB services could help inform evidence-based health policies to reduce barriers to TB care and improve outcomes for children across the country. (5)
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Semaglutide: an emerging treatment option for patients with obesity related HFpEF
Authors: Khaskheli Sanya Ashraf , Rajpar Najaf Ahmed
Published: August 2024

Dear Madam, Heart failure is a key contributor to patient morbidity and mortality and affects a staggering 64 million individuals around the globe1. An important sub-phenotype of heart failure is HFpEF, which is characterised by a left ventricular ejection fraction (LVEF) of 50 per-cent. Alarmingly, the incidence of this subtype has been rising globally, making the need for new treatment options extremely crucial2. Initially, the use of Semaglutide, a glucagon-like peptide-1 receptor agonist, showed favourable outcomes in cardiac function of mice. This study observed that weight loss achieved using Semaglutide was met with improvements in several factors associated with HFpEF (reduced LV hypertrophy and fibrosis, improved diastolic function, reduced lung congestion and improved exercise capacity) as compared to weight loss achieved through simple dietary means3. A step further in this direction is a clinical trial that shows that a weekly dosage of 2.4mg of Semaglutide in obesity related HFpEF patients is associated with significantly reduced symptoms and physical limitations, improved exercise function and greater weight loss than placebo4. Of the several parameters observed, improvements in CSS (Clinical Survey Score) of KCCQ (Kansas City Cardiomyopathy Questionnaire) and six minute walking distance were the most clinically meaningful. These promising findings are of particular value to Pakistani population, which has been prey to obesity and HF owing to Westernised eating habits, sedentary lifestyles and fewer healthcare facilities. In addition, South Asians have more fat content per BMI as compared to their white counterparts which coupled with the rising trends in NCD risks in South Asia5, are an immediate call for innovation in therapeutics. Semaglutide, considering its array of cardiometabolic benefits, may provide our doctors with a chance to step away from prescribing long lists of medications that are conventionally given to HF patients for symptom improvement. In a low- income country like Pakistan, this will ensure a better drug compliance and reduced disease burden. It is high time that we tap into the potential of Semaglutide and test its efficacy of it in our native population and take strides in ensuring its easy availability.
Lost in translation: the need for qualified medical interpreters
Authors: Sangah Abdul Basit , Saleem Shaikh Shazia , Khalid Muhammad Zain
Published: August 2024

Dear Editor,
Pakistan is home to various cultures and varied languages. We are writing this letter to share our insights and to emphasize the essential need for highly trained medical interpreters in Pakistan's healthcare system, particularly in different urban locations like Karachi. As a multilingual city with many immigrants and visitors from other provinces and countries, efficient communication is vital for outstanding service. However, we have noticed in the public and private Outpatient Departments (OPDs) that hospital-appointed interpreters frequently lack the information, training, and qualifications necessary for proper medical interpretation.

Hale found in her study that untrained interpreters may not comprehend the reasons behind certain procedures, particular questions, or styles of delivery in varied situations, as well as the value of the layperson’s replies in enabling the healthcare workers to fulfill their tasks efficiently and correctly.1 We discovered especially in Infectious and Internal Medicine OPDs of teaching hospitals that inexperienced translators typically ignore or alter clinical information, failing to convey essential information. Furthermore, the patients feel uneasy revealing their confidential worries with a translator. Consequently, essential subtleties are missed, complicating diagnosis and therapy.

With patients traveling from distant areas, like Afghanistan and Iran, failed communication on a single visit, becomes detrimental. Using qualified medical interpreters is associated with improved clinical outcomes, patient satisfaction and adherence. M. Shoaib et, al. suggested a potential solution to tackle this issue by recommending that medical professionals from all backgrounds sign up to volunteer as translators and that each tertiary care facility have a group of language facilitators who are readily available in the hospital so that patients may provide first-hand health information without any barriers,2 however it could be difficult to achieve this. Moreover, Bashir. S mentioned in her thesis that the ability of therapists to interact with patients and establish a therapeutic bond is significantly impacted by the presence of trained interpreters.3 Hence better training must be provided to interpreters to improve their clinical knowledge and expertise in treatment. To ensure that all patients in Karachi get excellent treatment, regardless of language barriers, we encourage healthcare institutions to hire properly certified translators. If finances pose a barrier, existing employees could undergo rigorous, standardized training on medical vocabulary, ethics and communication strategies. Such initiatives will facilitate empathetic communication, foster shared understanding, and ultimately lead to better health outcomes.
The Scourge of Poliomyelitis in Pakistan: Barrier towards its eradication
Authors: Aisha Mehnaz
Published: August 2024

Poliomyelitis is an extremely disabling disease caused bythe polio virus, a virus belonging to Picornaviridae family.Humans are the only natural host. The virus principallyinvolves the motor neurons resulting in permanentasymmetrical lifelong paralysis. Effective vaccines areavailable for its eradication. Unfortunately despite vaccineavailability the disease cannot be eradicated from earth yet.Pakistan and Afghanistan are the only two nationsharbouring the polio virus. Lately sporadic cases ofPoliomyelitis have also been reported from countries likeMozambique, which had an outbreak following importingof wild poliovirus (WPV1) from Pakistan.1 As long as a singlechild remains infected, children in all countries are at riskof contracting polio.2
Expanded Programme for Immunization (EPI) was initiatedin Pakistan in 1978. Polio vaccine was included along withfive other vaccines against life threatening diseases likeTuberculosis, Diphtheria, Pertussis, Tetanus, and Measles.The journey that took off smoothly with over 50% vaccinecoverage by 1990 raised to 80% coverage by 2007, hastaken a sharp dip in the ensuing decades. Pakistanunfortunately never recovered from the scourge of poliodisease. In 1988 Global Polio Eradication Initiative (GPEI)was started, that resulted in a decline to 99% cases of polioin the world, but Pakistan continued to face challengeswhich has prevented total eradication of polio.3
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Adherence to Medical Nutrition Therapy: From Barriers to Bridgers
Authors: Sanjay Kalra  , Nitin Kapoor
Published: August 2024

Type 2 diabetes is a major clinical and public healthdisorder worldwide.1 While multiple drugs are nowavailable for its treatment, no management strategy can besuccessful without nutritional and dietary intervention. Thenature of lifestyle-related interventions including diet, issuch that they intrude into one’s preferred way of life. Suchtherapies, therefore, are associated with lower adherenceand persistence.2
In medicine, we are trained to take a history and evaluatepossible causes of a condition before planning ourtreatment. Similarly, in diabetes care, we must find thecausative and contributory factors that influence aparticular lifestyle choice. This step is essential to build asustainable and sufficient diabetes care ecosystem.
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3D Sapiotyping: A Three Dimensional Definition
Authors: Sanjay Kalra  , Atul Dhingra  , Nitin Kapoor
Published: August 2024

Precision medicine and personalized care have been atcentre-stage in diabetology, and rightfully so. Variousmeans of classification and clustering have been proposedto help identify clinical features, causative factors and‘curative’ strategies for people living with diabetes.Sapiotype describes “the various attitudes that person withdiabetes may have towards their disease, their doctor orhealth care providers, a specific diagnostic procedure, drug,delivery device, and the health care system at large”. Thesapiotypic spectrum is a wide one, which encapsulatessapiotypic fluidity, or variability in attitudes, as well. In thiscommunication, we further expand the sapiotypicspectrum by creating a 3- dimensional model.
Handling false chronic kidney disease and diabetes treatment information
Authors: Sourabh Sharma  , Himanshu Verma  , Sanjay Kalra
Published: August 2024

While examining the social perspectives of chronic kidneydisease (CKD) and its most common cause, diabetes, acommon problem is spread of misleading information byunqualified people. This concerning trend makes it moredifficult for patients to receive prompt and proper medicaladvice, which in turn further delays their referral tonephrologists and endocrinologists. In this communication,we highlight the challenges and consequences of thisburning issue. We also propose the steps that variousstakeholders and policy makers should take to contain thisissue at the earliest.Keywords: Chronic kidney disease. Community health,Diabetes, Health education, Quinary prevention.
The Baro-Adrenal Axis
Authors: Sanjay Kalra  , Ashok Kumar  , Nitin Kapoor
Published: August 2024

The adrenal gland is a player in the Ominous Octet ofobesity, which lists eight endocrine contributors to thedevelopment of obesity. Baro-adrenal axis describes thebidirectional, multifaceted link between weighthomoeostasis and adrenal function, in health and disease.This communication lists the various ways in which adrenalfunction influences, and is impacted by, obesity.Keywords: Adrenal, Cushing’s syndrome, obesity,overweight, person centred care, pheochromocytoma,stress
Knowledge, attitude, and practices of surgeons regarding venous thromboembolism prophylaxis in tertiary healthcare hospitals of the Rawalpindi Districts
Authors: Khan Amna , Syeda Fatima  , Aamna Abbas Naqvi
Published: August 2024

Objectives: To assess doctors' knowledge, attitudes and practices regarding venous thromboembolism prophylaxis.
Method: The cross-sectional study was conducted from April to September 2021 in three public-sector hospitals affiliated with the Rawalpindi Medical University: Holy Family Hospital, Benazir Bhutto Hospital and Rawalpindi District Headquarters Hospital, Rawalpindi, Pakistan, and comprised physicians of either gender who were actively involved in patient care. Data was collected using a predesigned questionnaire regarding venous thromboembolism. Data was analysed using SPSS 25.
Results: All the 220(100%) subjects approached responded positively to the study questionnaire. There were 144(65.45%) general surgeons, 50(22.72%) gynaecologists and 26(11.81%) orthopaedic surgeons. Overall, there were 26(11.81%) senior consultants, 65(29.54%) postgraduate residents and 129(58.63%) house officers. There were 150(68.2%) doctors who reported having witnessed deep-vein thrombosis in their patients, and 113(51.4%) had witnessed deaths related to pulmonary embolism. Among the methods employed for DVT diagnosis, the use of clinical criteria was the most common 136(36.1%), while venography was the least common technique used 8(2.2%). While 210(95.5%) subjects expressed the desire for adopting an institute-wide regimen for venous thromboembolism prophylaxis, only 66(30%) were currently following such a regimen.
Key Words: Venous thromboembolism, Practice patterns, Physicians, Health Knowledge, Attitudes, Practice, Education, Medical, Quality improvement, Evidence-based medicine, Patient outcome assessment, Healthcare delivery.
Clinical outcomes of patients with deferred revascularisation based on fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) negative coronary artery lesions in Pakistani population
Authors: Muhammad Nasir Rahman  , Ali Jamshed , Sheema Saadia  , Adnan Ghufran
Published: August 2024

Objective: To assess long-term clinical outcomes and factors associated with target vessel revascularisation in patients with deferred revascularisation based on negative fractional flow reserve and negative instantaneous wave-free ratio.
Method: The longitudinal, retrospective study was conducted from July 1, 2020, to January 1, 2022, at the Aga Khan University Hospital, Karachi, and comprised medical records from January 2012 to January 2020 of patients with deferred revascularisation having intermediate to severe coronary lesions on coronary angiogram and had negative fractional flow reserve >0.80 or instantaneous wave-free ratio >0.89 and had not undergone immediate or planned revascularisation on the basis of negative physiological assessment. Data was collected from the institutional records, while final follow-up was taken by reviewing the medical records or telephonic interviews regarding any major adverse cardiac event after the index procedure. Data was analysed using Stata 14.2.
Results: Of the 345 patients, 245(71%) were males. The overall mean age was 62±11 years. There were 194(56%) patients who presented with stable angina and 151(44%) presented with acute coronary syndrome. Mean fractional flow reserve was 0.87±0.04 and mean instantaneous wave-free ratio was 0.93±0.03. Multivessel disease was present in 223(65%) patients. Median follow-up period was 29 months (IQR: 24-36 months). Major adverse cardiovascular events occurred in 22(6%) patients, and target vessel revascularisation was required in 11(3%). Diabetes and percentage of stenosis were found to be independent predictors of major adverse cardiovascular events (p<0.05).
Conclusion: Deferral of revascularisation and opting for medical treatment for coronary artery stenosis with higher fractional flow reserve or instantaneous wave-free ratio could be considered a safe and reasonable strategy.
Key Words: Fractional flow reserve, Instantaneous wave-free ratio, Deferred revascularisation, Target vessel revascularisation.
Adult-onset erythrokeratodermia variabilis (EKV) triggered by pregnancy and crash dieting: A rare case report
Authors: Afzal Ghazal , Najia Ahmed  , Nighat Jamal  , Fatima Zahoor
Published: August 2024

Erythrokeratodermia variabilis (EKV) is a rare inherited genodermatosis characterised by migratory and erythematous patches changing over the course of hours to days and fixed keratotic plaques. The disease begins mostly at birth or within the first year of life; it very rarely starts after childhood. We present here a sporadic case with adult onset EKV that was aggravated by pregnancy with spontaneous resolution, and later on, after crash diet more persistent patches and plaques appeared with no spontaneous resolution. The patient showed excellent response to systemic retinoids.
Keywords: Acitretin, Adult onset, Crash diet, Erythrokeratodermia variabilis, pregnancy, Retinoids, Sporadic.
Correlação entre o índice de massa corporal e parâmetros de funcionalidade em idosos
Authors: Angelo Fernando Damasceno de Albuquerque , Oliveira Luciano Machado Ferreira Tenório de , Farah Breno Quintela , Mariano Caio Vinícius Gomes , Silva Júnior Wellington Rodrigues da , Oliveira Valéria Mayaly Alves de , Araújo Rodrigo Cappato de , Pirauá André Luiz Torres
Published: August 2024

Introdução: O envelhecimento populacional vem crescendo nos últimos anos, e os comprometimentos funcionais em idosos, associados a diversas comorbidades, podem aumentar os riscos de mortalidade nessa população. Além disso, outra preocupação refere-se ao crescimento dos níveis de obesidade em idosos. No entanto, não se sabe até que ponto o índice de massa corporal pode impactar na funcionalidade do idoso. Objetivo: Verificar a correlação entre o índice de massa corporal (IMC) e a funcionalidade em idosos. Métodos: Trata-se de um estudo observacional de delineamento transversal correlacional. A amostra foi composta por 99 idosos de ambos os sexos, sendo avaliados o IMC, mobilidade funcional (Timed Up and Go test), força isométrica (dinamômetro de preensão manual), aptidão muscular funcional (teste de sentar e levantar) e flexibilidade (teste de sentar e alcançar). As análises de correlação foram realizadas pelo teste de Spearman. Significâncias foram consideradas quando p < 0,05. Resultados: O índice de massa corporal apresentou correlação negativa com a flexibilidade (p < 0,001) e a aptidão muscular funcional (p < 0,001), independentemente do sexo, idade e escolaridade. Força muscular, mobilidade funcional e número de quedas não apresentaram correlação significativa. Conclusão: Idosos com maior obesidade apresentaram menor aptidão muscular funcional e flexibilidade.
Menarca precoce e risco cardiovascular em mulheres na idade adulta
Authors: Martinho Liana Carla Albuquerque Peres , Andreazzi Ana Eliza , Mourão Junior Carlos Alberto , De Oliveira Alvim Rafael
Published: August 2024

Introdução: As doenças cardiovasculares (DCV) representam a principal causa de mortalidade global, exercendo um impacto significativo na qualidade de vida e nos custos com a saúde. A identificação precoce dos fatores de risco associados às DCV e seus possíveis mediadores é crucial para o desenvolvimento de estratégias de prevenção mais eficazes e para o estabelecimento de metas terapêuticas, visando melhores resultados clínicos e a prevenção de desfechos adversos. As evidências sugerem que a menarca precoce está associada ao aumento do risco de desenvolvimento de DCV na vida adulta. Portanto, considerar a idade da menarca durante as avaliações clínicas pode ser um fator importante para identificar mulheres com maior probabilidade de desenvolver DCV e seus fatores de risco ao longo da vida. Objetivos: Revisar a literatura sobre a relação entre menarca precoce e risco cardiovascular em mulheres na idade adulta. Métodos: Foram utilizados artigos científicos em inglês e português publicados até 2023 nas bases de dados PubMed, Scopus e SciELO, utilizando os descritores “early menarche, hypertension, dyslipidemia, diabetes e obesity” com o operador booleano “and”. Resultados: Esta revisão explora aspectos fundamentais relacionados às alterações metabólicas e hormonais associadas ao desenvolvimento puberal precoce, bem como sua ligação com os principais fatores de risco para DCV, como obesidade, hipertensão, diabetes e dislipidemia. Conclusão: A obesidade desempenha um papel significativo como mediadora da influência da maturação precoce sobre os demais fatores de risco. No entanto, outras variáveis devem ser consideradas, evidenciando a necessidade de investigações adicionais para uma compreensão mais abrangente da associação entre menarca precoce e os fatores de risco para DCV.
Tecnologias educativas de enfermagem para o autocuidado de pessoas com estomia intestinal de eliminação
Authors: Menegassi Diorlhi , Pötter Garcia Raquel , Harter Jenifer , Dalmolin Angélica , Silveira Cardoso Leticia , Sodré Simon Bruna
Published: August 2024

Introdução: As estomias intestinais de eliminação podem ser compreendidas como condições crônicas, as quais demandam a necessidade de autocuidado. A promoção deste autocuidado pode ser realizada por meio das tecnologias educativas. Objetivo: Analisar as evidências científicas sobre as tecnologias educativas de enfermagem para o autocuidado de pessoas com estomia intestinal de eliminação. Métodos: Revisão integrativa, realizada em maio de 2024 via Portal Periódicos Capes com acesso ao CAFe, na Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online e EMBASE. Após aplicação dos critérios de elegibilidade, foram selecionados dez artigos. Resultados: As principais tecnologias encontradas nos artigos foram as mídias digitais, como plataformas, software e aplicativos, seguido das cartilhas/guias impressos, e vídeos. Como limitador dessas tecnologias, destaca-se, o alcance às pessoas analfabetas e com deficiências auditivas e/ou visuais. Conclusão: Evidencia-se o predomínio de estratégias por meio de tecnologias educativas que envolvem recursos tecnológicos, que visam promover a saúde, desenvolver habilidades das pessoas e profissionais da saúde, gerar autoconfiança e prevenir complicações, fatores que favorecem a autonomia da pessoa com estomia.
Ágyú vagy vaj : az európai államok fiskális felkészültsége Oroszország Ukrajna elleni háborújára
Authors: Kutasi Gábor , Marton Ádám , Waszkiewicz Grzegorz
Published: August 2024

Az ágyú vagy vaj dilemma a közpénzek átcsoportosításának egy speciális esete, amely az elvileg negatív összegű védelmi kiadások és a jóléti kiadások közötti választásból ered. Oroszország Ukrajna elleni háborúja Európa különböző térségeiben élesítette ezt a fiskális dilemmát. A tanulmány első lépés egy többlépcsős kutatási folyamatban, ennek keretében a kiválasztott európai NATO- és EU-országok felkészültségét méri meg klaszterelemzés módszerével a védelmi és jóléti kiadások közötti átcsoportosítás szempontjából. A klaszterváltozók a következők: a védelmi kiadások, a CDS-felárban kifejezett államháztartási kockázat, az adóékkel kifejezett fiskális mozgástér, a Gini-együttható, az Oroszországtól való távolság. Az elemzés egyértelműen elhatárol öt klasztert, amelyek alapján megállapítható, hogy a háborúhoz gravitáló földrajzi helyzet már a 2022 előtti, alacsonyabb lángon égő konfliktus idején is erősítette a védelmi kiadások irányába történő átcsoportosítást. A fiskális mozgástér, amely az átcsoportosítás jóléti áldozatát tompítaná, a felkészültség szintén fontos elhatároló tényezője.
The Influence of Service Quality and Location on Customer Loyalty through Customer Satisfaction Staying at the Hotel Garuda Pontianak
Authors: Hermanto Aldy , Fachri Helman
Published: August 2024

The purpose of this study is to determine the Influence of Service Quality and Location on Customer Loyalty Through Customer Satisfaction Staying at the Garuda Pontianak Hotel. This study uses an associative method. Primary data in this study were collected through; (1) Interviews; (2) Questionnaires. The minimum sample was 96 people, the researcher took a sample of 100 respondents. The results of the study showed that all indicator items in the measurement model showed good item validity, with outer loadings values ​​above 0.7. The tested constructs also met strong reliability standards, with Cronbach's alpha and Composite Reliability values ​​above 0.7, and Average Variance Extracted (AVE) exceeding 0.5, indicating adequate convergent validity. Discriminant validity has also been met, as indicated by the AVE root value which is greater than the correlation between constructs. The results of the Goodness of Fit Model test show that the exogenous constructs (Service Quality and Location) have a moderate influence on Customer Satisfaction, with an R-squared value of 0.308.
Parlamenti választások Horvátországban: kampányhangulat a voksolások előtt és után
Authors: Orosz Anna
Published: August 2024

Szoros eredménnyel zárultak a horvát választások, így az fogja eldönteni a kormányalakítás sorsát, hogy melyik oldal tudja előbb prezentálni az elnöknek a 76 parlamenti képviselő támogatását a 151 fős Száborban. A koalícióalkotás valamennyi érintett párt szempontjából kompromisszumkényszert jelent; jelen állás szerint a 2016 óta kormányon lévő Horvát Demokratikus Közösségnek és Andrej Plenković kormányfőnek a legjobbak erre az esélyei. Az ellenzék számára rögösebb lehet az út a koalíció megalakításához, amelyet egyedül a kormánypárt leváltásának szándéka kötne össze. Ráadásul a baloldal a jelenlegi államfőt, Zoran Milanović-ot jelölte miniszterelnöknek, ami komoly alkotmányos aggályokat vet föl.