OBJECTIVE: To find-out the association of dyslipidemia with anxiety and depression in patients with polycystic ovarian syndrome (PCOS). METHODS: This descriptive cross-sectional study was conducted ...at Mardan Medical Complex, Mardan, Pakistan from December-2019 to March-2020. One hundred & forty diagnosed cases of PCOS, ranging in age from 20-40 years, were selected through purposive sampling. Anxiety and depression were calculated using hospital anxiety and depression scale (HADS) score. Total cholesterol (TC), triglycerides, low-density-lipoproteins (LDL), high-density-lipoproteins (HDL) and testosterone were tested through fasting blood samples. RESULTS: Anxiety and depression were documented in 102 (72.9%) & 99 (70.7%) cases respectively. Primary infertility, oligomenorrhoea, Hirsutism & acne were present in 69 (49.3%), 111 (73.5%), 81 (57.9%) and 55 (39.3%) patients respectively. Twenty-two (15.7%) patients were overweight/obese. All patients had raised testosterone levels and polycystic ovaries on ultrasound. Raised triglyceride levels (≥150 mg/dl), Low levels of HDL (≤ 60mg/dl), raised levels of LDL (≥130 mg/dl), raised cholesterol levels (≥200 mg/dl) were reported in 71/99 (71.7%), 56/99 (56.6%), 38/99 (38.4%) & 10/99 (10.2%) cases with depression as compared to 27/41 (65.9%), 13/41 (31.7%), 21/41 (51.2%) & 14/41(34.1%) non-depressed patients respectively. Similarly raised triglyceride levels, low levels of HDL, raised levels of LDL, raised cholesterol levels were reported in 73/102 (71.6%), 58/102 (56.9%), 40/102 (39.2%) & 12/102 (11.76%) cases with anxiety as compared to 25/38 (65.8%), 11/38 (28.9%), 19/38 (50%) and 12/38 (31.6%) patients without anxiety respectively. CONCLUSION: Dyslipidemia, anxiety and depression are very common in PCOS. Dyslipidemia is associated with anxiety and depression in PCOS patients.
OBJECTIVE: To determine the effects of short inter delivery interval (IDI) on mode of delivery in patients with immediate previous one caesarean section (C-Section). METHODS: This is a retrospective ...chart review of 120 patients treated at Khyber Teaching Hospital, Peshawar, Pakistan from December 2017 to December 2019. Patients of previous one C-Section and with gestational age of >37 weeks were included in this study. Outcome variables were mode of delivery whether operative or vaginal delivery, maternal and fetal complications such as scar dehiscence or scar rupture and fetal distress. RESULTS: Mean age of the patients was 28.9±2 years. IDI was <18 months in 35/120 (29.2%) cases, 18-24 months in 54/120(45%) cases and >24 months in 31/120 (25.8%) cases. Out of 120, 102 (85%) patients underwent trial of labour after C-section (TOLAC). TOLAC was successful in 64 (62.7%) cases. Patient who underwent TOLAC with IDI of <18 months, 5/21 (23.8%) patients delivered vaginally and 16/21 (76.2%) patients had emergency C-Section while those with 18-24 months IDI, 38/51 (74.5%) patients delivered and 13/51 (25.4 %) patients had emergency C-Section. Main indications for emergency C-Section were scar tenderness and maternal tachycardia (n=16; 42.10%) and fetal distress (n=11, 28.9%). There were two cases of interauterine deaths. Uterine scar dehiscence was observed in 14.28% and 2.4% in short and normal IDI respectively. CONCLUSION: Patients with short IDI had high C-section and uterine scar dehiscence rate. IDI of >18 months is recommended to avoid the maternal and fetal morbidity and mortality.
OBJECTIVE: To explore the discrepancies regarding screening, diagnosis & management of gestational diabetes mellitus (GDM) among postgraduate trainees of Obstetrics & Gynaecology (OBG) and Medicine ...disciplines. METHODS: This multicentre cross-sectional study was conducted from 1st to 31st August 2022. The questionnaire regarding screening, diagnosis, management of GDM, & postnatal follow-up with neonatal care were distributed among postgraduate trainees of medicine/OBG through google-form/hardcopies. Data was analysed through SPSS-22 RESULTS: Out of 236 trainees, 184 (78%) were following national institute of clinical excellence (NICE) guidelines for management of GDM. Majority of medicine (n=87/120 (72.5%) & OBG (n=76/116; 65.5%) trainees failed to identify the correct cut-off of oral glucose tolerance test for GDM. A big chunk of both OBG (n=93/116; 80.2%) & Medicine (n=96/120; 80%) trainees were unable to differentiate pre-existing diabetes mellitus from GDM. The clinical knowledge about carbohydrate diet (n=119/236; 50.4%), calories intake (103/236; 43.6%) & low glycaemic index (138/236; 58.5%) was poor among trainees of both specialities. Surprisingly, the medicine trainee’s knowledge about insulin types, dose & tocolytic agent was not evidence-based. The practicing knowledge of both specialities was poor about identification of neonatal hypoglycemia (n=30/236; 12.7%) & its management (n=47; 19.9%). Trainees of both specialities had poor knowledge about postnatal follow-up (n=64/236; 27.1%) of GDM patients. CONCLUSION: GDM is a common domain for OBG & medicine disciplines with no consensus guidelines for its uniform management. This study has identified some basic gaps in the clinical practice of future consultants regarding GDM management, urging the need of combined local guidelines.
Upper airway obstructions represent a huge burden to the health care system due to its high morbidity and cost to the economic systems. Therefore, it is important to understand the physiological ...parameters used in diagnosis and prognosis of these diseases. Various physiological lung parameters should be examined simultaneously to make the precise diagnosis of upper airway obstruction. Relying on only one parameter and neglecting others might lead to misdiagnosis and subsequent mismanagement. The shape of the flow-volume loop, Forced Expiratory Flow at 50% of vital capacity/Forced Inspiratory Flow at 50% of vital capacity ratio (FEF-50%/FIF-50%), Forced Expiratory Volume in 1 second /Forced Expiratory Volume after 0.5 seconds (FEV1/FEV0.5), Empey index, and the refined version of the Expiratory Disproportion Index (EDI) are of great value in the diagnosis of different types of upper airway obstructions. The shape of the flow-volume loop changes earlier than other spirometrical parameters and is very useful in detecting early changes in upper airway diseases. This review was aimed to explain and simplify the role of pulmonary function tests and flow volume curve not only for pulmonologists, but also for surgeons, anesthesiologists, and ENT specialists who can utilize and implement usefully these tests in their clinical practice.
OBJECTIVE: To determine the frequency and determinants of dental caries among children with special health care needs in the special needs schools of Karachi, Pakistan METHODS: This cross-sectional ...study was conducted among 196 children (aged 6-18 years) attending the public and private sector special-needs schools of Karachi, Pakistan. Children with mental and/or physical disability were included in the study. Prevalence of dental caries determined oral examination using the Decayed Missing Filled Teeth and Decayed Filled Teeth (DMFT/dft) index. Parental education level, oral health knowledge and house-hold level socioeconomic status were measured through a structured questionnaire. Data were analyzed in SPSS version 20. RESULTS: The overall frequency of dental caries was 58.2% with 70.3% and 55.3% prevalence in the public and private special needs schools. The mean DMFT/dft value was 1.85±2.28. The Down syndrome group had the highest mean (DMFT/dft=2.45±2.65), followed by the group including (vision impairment, autistic and cerebral palsy children) (DMFT/dft=2.05±2.51), Intellectual disability (DMFT/dft=1.70±2.01) and the deaf or hard of hearing group (DMFT/dft =1.49±2.27). Caries status was not significantly associated with gender (p=.518), socioeconomic status (p=.067), father education (p=.158) and mother education (p=.758). CONCLUSION: The frequency of dental caries was high among children with disabilities in the Karachi district of Pakistan. The most important factor in improving the oral health status of these children is the awareness of their families by continuous community oriented medical and dental education programs.
Myxopapillary ependymoma (MPE), a rare pathological subtype of ependymoma which shows predilection for middle-aged adults between third and fifth decades of life. It is a benign tumor that primarily ...occurs at filum terminale of spinal cord with a rare possibility to metastasize to the brain. Primary intracranial MPEs have been reported only rarely. Two-year-old child presented with a space-occupying lesion in fourth ventricle. Based on clinical and radiological findings, particularly owing to patient’s age differential diagnosis of medulloblastoma was considered. Biopsy followed by histopathological and immunohistochemical analysis yielded diagnosis of primary intracranial myxopapillary ependymoma. In conclusion, MPEs can occur anywhere in intracranial space and in any age group. Despite their indolent behavior, their metastatic potential necessitates thorough investigation to rule out former before establishing diagnosis of primary intracranial MPE.
The use of patient-reported outcome measures (PROM) and caregiver-reported outcome measures can raise the patient centeredness of treatment and improve the quality of palliative care. Nevertheless, ...the everyday implementation of self-report in patients and caregivers is complex, and should be adapted for use in specific settings. We aimed to implement a set of outcome measures that included patient and caregiver self- and proxy-reported outcome measures in specialised outpatient palliative care (SOPC). In this study, we explore how the Integrated Palliative Outcome Scale (IPOS), IPOS Views on Care (IPOS VoC) and the Short-form Zarit Caregiver Burden Interview (ZBI-7) can be feasibly, acceptably and appropriately implemented in the daily care routines of SOPC.
Five SOPC teams were trained, and used the outcome measures in daily practice. Team members were mainly nurses and physicians. To investigate their feedback, we used a multi-method qualitative design consisting of focus groups with SOPC-team members (n = 14), field notes of meetings and conversations with the SOPC teams. In an iterative process, we analysed the findings using qualitative content analysis and refined use of the outcome measures.
We found that integrating patient and caregiver outcome measures into daily care routines in SOPC is feasible. To improve feasibility, acceptability and appropriateness, the resulting burden on patients and relatives should be kept to a minimum, the usefulness of the measures must be understood, they should be used considerately, and administration must be manageable. We removed ZBI-7 from the set of measures as a result of feedback on its content and wording.
SOPC-team members have reservations about the implementation of PROM in SOPC, but with appropriate adjustments, its application in daily care is feasible, accepted and perceived as appropriate. Previous to use, SOPC-team members should be trained in how to apply the measures, in the design of manageable processes that include integration into electronic documentation systems, and in ongoing evaluation and support. They should also be taught how useful the measures can be.
May 19
, 2017, German Clinical Trials Register DRKS-ID: DRKS00012421 .
TRUE LEFT SIDED GALL BLADDER: A SURGICAL SURPRISE Khalid Obaid Alanazai; Zia Uddin Afridi; Turki Faheem Alshammari ...
Khyber Medical University journal,
10/2022, Letnik:
14, Številka:
4
Journal Article
Recenzirano
Odprti dostop
INTRODUCTION: Left sided gallbladder is a rare anomaly & several variants exist. The condition cannot be diagnosed pre-operatively by most of the radiological modalities and it can take the operating ...surgeon, by surprise. CASE PRESENTATION: A young lady with symptomatic gallstones was unexpectedly found to have a left sided gallbladder during laparoscopic cholecystectomy. Though, her routine preoperative work up did not show anything abnormal, as is usual in such anatomical variation. She was successfully managed by laparoscopic cholecystectomy by modifying the camera angle & the dissection technique. CONCLUSION: The anatomical knowledge of the various structures & to timely recognize the variations is very important to avoid injury in such cases. The operating technique may need to be modified for a safe & successful outcome.
Introduction
Bleeding disorders (BDs) may influence health‐related quality of life (HRQoL) in children and caregivers. Measuring HRQoL gives insight into domains requiring support and provides an ...opportunity to evaluate the effects of novel therapies.
Aim
To gain insight in the current body of literature on HRQoL in children with BDs in order to identify knowledge gaps for research and further development of this field.
Methods
Scoping review.
Results
We included 53 articles, describing studies mainly performed in Europe and North–America (60.4%) and mostly within the last ten years. Only 32% studies included children <4 years. Almost all studies (47/53, 88.7%) were performed in boys with haemophilia, pooling haemophilia A and B (n = 21) and different disease severities (n = 20). Thirteen different generic and five disease‐specific HRQoL‐questionnaires were applied; all questionnaires were validated for haemophilia specifically. Six (11,3%) combined generic and disease‐specific questionnaires. Self‐reports were most frequently applied (40/53, 75.5%), sometimes combined with proxy and/or parent‐reports (17/53, 32.1%). Eleven studies used a reference group (20.8%). Statistical analyses mostly consisted of mean and SD (77.4%).
Conclusion
HRQoL‐research is mainly performed in school‐aged boys with haemophilia, treated in developed countries. Pitfalls encountered are the pooling of various BDs, subtypes and severities, as well as the application of multiple generic questionnaires prohibiting comparison of results. More attention is needed for broader study populations including other BDs, young children, feminine bleeding issues and platelet disorders, as well as the use of HRQoL as an effect‐measurement tool for medical interventions, and more thorough statistical analysis.
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