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Background: COVID-19 infection is a disease that remains the main concern globally due to high admissions and fatality rates among patients. Clinical manifestation and choice of treatment are various. Therefore, this study was developed to explore the physicians’ perceptions in this regard in a semi-governmental hospital in Sharjah. Aims and Objectives: The objective of this research is to (1) to outline physicians’ descriptions of the clinical presentation of COVID-19, (2) to explore the physicians’ perceptions regarding the different aspects of COVID-19 and its complications, and (3) explore the physicians’ experiences regarding the treatment of COVID-19 cases. Materials and Methods: A descriptive qualitative design was approached. A semi-structured interview guide was developed, validated and used for data collection. Ten in-depth individual interviews with physicians were conducted. Interviews were recorded, transcribed, and thematically analyzed. Results: After analysis, three main themes with their sub-themes emerged to describe physicians’ experience regarding COVID-19’s clinical presentation, complications, and management. Sub-themes cleared-up COVID-19’s signs, symptoms, and risk factors along with admission’s requirements. Furthermore, it showed COVID-19’s complication in main organs. Moreover, COVID-19’s treatment was clarified for both home-quarantine and admitted patients along with instructions for discharged patients. Conclusion: Cases varied in severity and classified from asymptomatic to severe. It showed the requirements for hospitalization and risk factors associated with severity. The management of COVID-19 disease followed by MOHAP protocol and provided adequate outcomes from physicians. Vaccination was one of physicians’ recommendations.
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Abstract Introduction Squamous cell carcinoma (SCC) of the maxillary alveolus is a relatively rare disease. There is lack of data on this subsite as compared with other sites. The factors that affect survival in cases of maxillary alveolar SCC are tumor stage, local and cervical metastases, histological grading, and the margin status. Objectives To evaluate the overall survival (OS), the disease free survival (DFS), and the complex interaction and effects of margin status, histological differentiation, habits (such as smoking and the use of smokeless tobacco products), and cervical and distant metastases based on clinicopathological data. Methods We examined the electronic database at our hospital from 2003 to 2017. We included all cases with a histopathological diagnosis of SCC of the maxillary alveolus. Tumors originating primarily from the maxillary alveolus were included, while those originating from adjacent subsites, like the hard palate, the buccal mucosa or the maxillary sinus were excluded. We also excluded all the patients who were not operated on with a curative intent. Results More than half of the patients had stage-IV tumors at the time of presentation, while only one fourth of them had nodal metastasis. The rate of recurrence increased in cases of primary tumors in advanced stages and the degree of histological differentiation. The 2-year and 5-year OS rates were of 54.5% (18 patients) and 30.3% (10 patients) respectively. Conclusion Primary tumors in advanced stages, histological grade, and presence of nodal metastasis are poor prognostic markers in terms of long-term survival.
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Transthyretin cardiac amyloidosis (ATTR-CM) is a rare and under-recognized disorder characterized by the aggregation of transthyretin-derived insoluble amyloid fibrils in the myocardium. Heterogeneity of symptoms at presentation, makes its diagnosis often delayed. An expert panel gathered on a virtual platform across India to conduct a meeting for developing a guiding tool for ATTR-CM diagnosis. The panel recommended younger age (40 years) for suspecting ATTR-CM and thick-walled non-dilated hypokinetic ventricle was considered as one of the important red flags. Electrocardiogram (ECG) and echocardiography (ECHO) findings were recommended as primary tests to raise the suspicion while nuclear scintigraphy and hematological tests were recommended to confirm the diagnosis and rule out amyloid light-chain (AL) amyloidosis. Cardiac magnetic resonance (CMR) and biopsy were recommended in case of ambiguity in the presence of red flags. Considering the lack of expert guidelines in the Indian scenario, a standardized diagnostic algorithm was also proposed.
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Abstract Introduction The routine practice of neck dissection in the surgical management of oral carcinoma has evolved into a more functionally conservative approach. Over time, the rationale for removal of the submandibular gland has been questioned. Routine extirpation of the submandibular gland can aggravate the xerostomia experienced by many patients, significantly affecting their quality of life. Objective The objective of the present study was to determine the incidence of submandibular gland metastases in oral cavity carcinoma and to identify possible factors that may affect their involvement. Methods A total of 149 cases of oral carcinoma presenting at a private tertiary care hospital in Karachi, Pakistan, over the course of 1 year were reviewed retrospectively. Results Histopathological data showed that the submandibular gland was involved in 7 (4.7%) cases. Involvement of level I lymph nodes was found in all of the cases. Direct extension of primary tumor was noted in two cases when the primary tumor was in the floor of the mouth. Conclusion The results suggest that preservation of the submandibular gland during neck dissection for oral carcinoma can be practiced safely when there is no evidence of direct extension of the primary tumor toward the submandibular gland or when there is no clinical or radiological evidence of neck disease in level I. Presence of pathological lymph nodes in level I requires caution when contemplating preservation of the submandibular gland.
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Background: The pathways that are involved for the duration of pregnancy and type of parturition are extremely complex, involving maternal as well as fetal systems. The objective of this study was to determine the frequency of types of parturition and their relationship with maternal characteristics among pregnant female patients.Methods: A cross-sectional survey using a non-probability convenient sampling technique was conducted among 195 healthy pregnant females at Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi, from 1st March 2019 to 31st August 2019. After taking written informed consent from the participants, the relevant data were gathered with the help of a structured questionnaire designed specifically for the study. Statistical package for social sciences was used for data entry while the chi-square test was applied for inferential analysis. The duration of the study was six months. Data were entered and analyzed using Statistical Package for Social Sciences version 20.0. Descriptive analysis was performed by generating means and standard deviations for continuous variables while frequencies and percentages for categorical variables. A Chi-square test was applied to perform the inferential analysis while the significance level was set at 0.05.Results: A total of 195 pregnant females were included in the study, whose mean age was 29.29±5.22 years. The study results showed that BMI before pregnancy (p=0.021), rest is taken during pregnancy (p=0.034) and gravida status (p=0.047) were all significantly associated with the type of parturition among the study participants, but spacing in pregnancies and parity were not.Conclusions: Maternal characteristics were found to be significantly associated with the type of parturition among pregnant females. For gynecologists the maternal characteristics identified in this study may serve as a useful indicator of the type of parturition expected in their patients.
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Effective pain relief is one of the important components of management of normal labor. Adequate pain relief is associated with reduction in maternal sympathetic activity and considerably decreased maternal anxiety level. Epidural analgesia is being increasingly used for this purpose. Many local anesthetic drugs are being used for providing epidural analgesia. We conducted this study to compare Ropivacaine and Levobupivacaine in terms of onset and duration of analgesia, motor involvement, hemodynamic effects and neonatal outcome. Methods: This was a prospective comparative study in which 100 patients presenting in spontaneous labour were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were divided into 2 groups on the basis of drug used. Group A patients received Ropivacaine along with fentanyl whereas group B patients received Levobupivacaine along with fentanyl. VAS score, Sensory and motor block and vital parameters were recorded before giving epidural and 5,15, 30 and 60 minutes and thereafter every hourly till delivery took place. Sensory block was assessed by pin prick sensation whereas motor block was assessed by modified bromage scale. Statistical analysis was done using SSPS 21 software and p value less than 0.05 was taken as statistically significant. Results: Parameters such as height, weight, body mass index, ASA grades, gravidity and duration of labor were found to be comparable in both the groups with no statistically significant difference in between 2 groups (P>0.05). Mode of delivery and conversion to LSCS was also similar in both the groups. Mean time for onset of analgesia was comparable in both the groups. The mean VAS scores in group A were found to be less as compared to group B during initial 1 hour after the bolus dose and the difference was found to be statistically significant (P<0.0001). After 1 hour the VAS scores were found to be comparable in both the groups with no statistically significant difference in the mean VAS scores of patients in both the groups (P>0.05). The need for top-up analgesia was found to be statistically significantly higher in group B as compared to group A (P=0.0277). The motor sparing was better in group A as compared to group B and the difference was found to be statistically significant (P=0.0026). Hemodynamics and neonatal outcome were found to be comparable in both the groups (P>0.05). Conclusion: Ropivacaine is a better local anesthetic drug as compared to Bupivacaine for labor analgesia. Its use is associated with better analgesic effect, superior motor sparing and less need for top up analgesic doses.
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Purpose@#Effective communication skills are essential for resident doctors to provide optimum patient care. This study was conducted to develop and validate a questionnaire for the self-assessment of resident doctors’ communication skills in India. @*Methods@#This was a mixed-methods study conducted in 2 phases. The first phase consisted of questionnaire development, including the identification of relevant literature, focus group discussions with residents and experts from clinical specialties, and pre-testing of the questionnaire. The second phase involved administering the questionnaire survey to 95 residents from the Departments of Medicine, Emergency Medicine, Pediatrics, and Surgery at the All India Institute of Medical Sciences, New Delhi, India in April 2019. Internal consistency was tested and the factor structure was analyzed to test construct validity. @*Results@#The questionnaire consisted of 3 sections: (A) 4 items on doctor-patient conflicts and the role of communication skills in avoiding these conflicts, (B) 29 items on self-assessment of communication skills in different settings, and (C) 8 items on barriers to practicing good communication skills. Sections B and C had good internal consistency (Cronbach α: 0.885 and 0.771, respectively). Section C had a 2-factor solution, and the barriers were classified as ‘training’ and ‘infrastructure’ factors. @*Conclusion@#This appears to be a valid assessment tool of resident doctors’ communication skills, with potential utility for identifying gaps in communication skills and developing communication skills modules.
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Objective: To document the reviewers' responses in terms of reviewers' demographic and professional characteristics, promptness of reply, and duration of reply to the request to review medical research articles for a general biomedical research journal
Study Design: Cross-sectional, observational study
Place and Duration Of Study: Department of Publications, College of Physicians and Surgeons Pakistan [CPSP], from October to December 2015
Methodology: Peer reviewed articles edited by a single staff editor were included. Editorials and correspondence were excluded. Manuscript category, discipline, and the total number of reviewers per manuscript were noted. Responses were divided into no response, regrets, and responded, i.e. provided with the review comments; and further sub-divided into timely response, i.e. within 21 days, or later. Total duration of response was counted in days from the date of dispatch to the date of receiving. Among those who provided a review, reviewers' characteristics were noted as designation, institute affiliation, qualification, and gender. Number and percentages of the studied variables were determined. Chi-square test of proportions was used for comparing the proportions with significance at p<0.05
Results: Reviewers for 50 articles including 28 original articles, 15 case reports, three letters to the editor, two short communications, and two new techniques, were evaluated. A total of 598 reviewers were contacted for those 50 articles; forming an average of 11.96 reviewers contacted and 2.2 responded per manuscript. Four hundred and seventy [78.59%] did not reply at all, 18 [3.01%] regretted, and 110 [18.39%] responded [79/110=71.81% timely, and 31/110=28.18% late]. Earliest reply was received in one day and the delayed reply in 87 days. Maximum number of reviewers was 24 for a single original article [internal medicine] and 22 for a case report [cardiology]. Significantly, more fellows, professors and females [p=0.004, p=0.002, and p=0.017, respectively] provided timely response
Conclusion: An overwhelming majority of the reviewers did not reply at all despite the incentives of CME credits and honorarium, adversely affecting the processing time. Majority of those who replied, were on time. Reasons for those who did not reply need to be explored
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Objective: Purpose of this study was to find out frequency of anemia and its causes in newly diagnosed treatment naive lymphoma patients
Methods: We retrospectively studied all lymphoma patients [> 18 years age] diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, from January 2016 till January 2017. The data was collected from electronic Hospital Information System. Descriptive statistics were done by using summary measures for categorical variables as well as continuous variables
Results: Out of a total 408 patients, 272 were males and 136 females. Median age of patients was 33 years [18-76]. Hodgkin lymphoma [HL] and diffuse large B cell lymphoma [DLBCL] were the diagnosis in 201 and 134 patients respectively; rest of the patients had low grade lymphomas. Anemia was present in 184 [45%] patients. Anemia of chronic disease was the commonest cause of anemia and was present in 61 [33.1%] patients. Remaining patients had anemia secondary to marrow involvement 50[27.17%]; iron deficiency anemia, Vitamin B-12 deficiency anemia and hemolytic anemia were the causes in 7.6, 1.6%, % and 0.54% respectively
Conclusion: Anemia is a common feature in newly diagnosed lymphoma patients with anemia of chronic disease as the commonest cause. It is more frequent in patients with higher stages of lymphoma especially when bone marrow is involved by lymphoma. Since anemia is an important adverse prognostic factor for the outcome of lymphoma patients, work up for anemia prior to initiation of chemotherapy should be done in every lymphoma patient in order to help improve the management of these patients
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Background Soluble suppression of tumorigenicity-2 (sST2) is a novel biomarker shown to be useful for prognostic assessment in heart failure (HF). However, very limited data exists about its prognostic utility in patients with HF in India. Methods We studied 150 patients [mean age 67.7 ± 13.3, 93 (62%) males], hospitalized with clinical HF, irrespective of their left ventricular ejection fraction (LVEF). HF was confirmed by N-terminal probrain natriuretic peptide (NT-proBNP) value above 125 ng/L. Primary end point was death or cardiac transplant at 1-year follow-up, with additional telephonic follow-up performed at 2 years. The clinical outcomes were correlated with the sST2 values obtained at the time of initial hospitalization. Results HF was ischemic in origin in 82.0% patients. The primary outcome occurred in 9.3% patients at the end of 1-year follow-up and in 16.7% patients at the end of 2 years. The patients who had events had significantly higher NT-proBNP and sST2 values, but there was no difference in the clinical characteristics, cause of HF, baseline LVEF, or serum creatinine. The patients with elevated sST2 levels (>35 ng/mL) had substantially higher event rates than those with normal sST2 levels (13.7% vs 0.0% at 1-year, P = 0.005; 22.5% vs 4.2% at 2-years, P = 0.004). On multivariate analysis, sST2 was the strongest predictor of adverse outcomes at both 1-year and 2-year follow-ups. Conclusion In patients hospitalized for HF, elevated sST2 >35 ng/mL at the time of initial hospitalization was associated with significantly high mortality over a 2-year period. The prognostic value of sST2 was incremental to that of NT-proBNP. These findings suggest that a single elevated sST2 value at the time of hospitalization should alert the physicians about the high risk of adverse outcomes and should help facilitate timely intensification of HF treatment.
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Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays. In doing so, we incorporated a unique strategy of global STEMI expertise. With this methodology, the recommendations were provided by expert Indian cardiologist and final guidelines were drafted after comprehensive discussions by the entire group of submitting authors. We expect these recommendations to be utilitarian in improving STEMI care in developing countries.
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Objective:To determine inhibitory activity of methanolic leaf extract of Piper umbellatum and Persea americana (P.americana) (traditionally used in Cameroon against diabetes) on α-glucosidase,β-glucosidase,maltase-gluconmylase,aldose reductase and aldehyde reductase activities,enzymes involved in starch digestion or diabetic complications.Methods:The methanol extracts from Piper umbellatum and P.americana were prepared by maceration.To assess relative efficacy of these extracts,the determination of concentrations that were needed to inhibit 50％ of enzyme activity was done,whereas,gas chromatography-mass spectrum was used to identify components from extracts that may be responsible for the activities.Resullts The tested extracts strongly inhibited α-glucosidase,maltase-glucoamylase,aldose reductase and aldehyde reductase activities with IC50 ranging from (1.07 ± 0.03) to 01.77 + 1.17) μg/mL.Among the tested extracts,P.americana was the most active against sensitive enzymes (IC50 of 1.07 ± 0.03 to 15.63 ± 1.23).But,none of the extracts showed interesting inhibitory effect against β-glucosidase as their percentage inhibitions were less than 16％.From gas chromatographymass spectrum analysis,10 and 8 compounds were identified in Piper umbellatum and P.americana extracts respectively,using NIST library 2014.Conclusions:Results of this study provide the scientific credential for a prospective usage of these plants to treat diabetes.
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Salacca zalacca (Gaertn.) Voss (family Arecaceae) is the snake fruit commonly known in Malay language as salak in Malaysia. This exotic fruit has diverse and potential pharmacological properties due to its high antioxidant content. It is often consumed due to its sweet taste. The abundant natural sugar and fibre along with minerals and vitamin makes it a nutritious fruit. Phytochemical investigation on this fruit has revealed the presence of flavonoids, phenolics, glycosides as well as some volatile and aromatic compounds, including gallic acid, quercetin, chlorogenic acid, epicatechin, proanthocyanidins, lycopene and β-carotene. Pharmacological studies on the fruit flesh and peel have shown some tremendous antioxidant, anti-inflammatory, anticancer and antidiabetic potential. This review provides the botanical information of Salacca zalacca as well as its scientific investigations involving the distinct pharmacological and phytochemical benefits. This could help in highlighting the lacking data and research gaps on this plant.
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Objective: To determine inhibitory activity of methanolic leaf extract of Piper umbellatum and Persea americana (P. americana) (traditionally used in Cameroon against diabetes) on α-glucosidase, β-glucosidase, maltase-glucoamylase, aldose reductase and aldehyde reductase activities, enzymes involved in starch digestion or diabetic complications. Methods: The methanol extracts from Piper umbellatum and P. americana were prepared by maceration. To assess relative efficacy of these extracts, the determination of concentrations that were needed to inhibit 50% of enzyme activity was done, whereas, gas chromatography-mass spectrum was used to identify components from extracts that may be responsible for the activities. Results: The tested extracts strongly inhibited α-glucosidase, maltase-glucoamylase, aldose reductase and aldehyde reductase activities with IC
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Objective: Determine the effectiveness of case-based discussion [CbD] in terms of annual professional ophthalmology examination performances [scores] at undergraduate level involving students
Study Design: Quasi experimental study
Place and Duration of Study: FMH College of Medicine and Dentistry for under graduate 4th year MBBS class in Ophthalmology [13 months' duration], from Dec 2013 to Dec 2014
Material and Methods: After approval from the IRB, scores of the historical control group, consisting of all 4th year MBBS students from previous four years included [64, 89, 96 and 85 respectively] were collected, who underwent traditional teaching. A total of 113 students were enrolled using non-probability convenience sampling technique in the interventional group of the study, who were exposed to CbD. Their scores in the annual university examination were collected in the subject of ophthalmology. The data was analyzed for its normalcy and Mann Whitney test was applied for comparison. Scores of both groups were correlated using Pearson's coefficient of correlation to determine similarity of constructs measured through traditional assessment method and CbD
Results: There was statistically insignificant difference [p-value 0.087] between scores obtained by historical controls and those who received intervention [CbD]. There was insignificant negative correlation in [-0.028] between scores obtained through traditional assessment and CbD
Conclusion: CbD fosters higher order thinking among undergraduate students in Ophthalmology. However, traditional assessment methods do not measure constructs that should be evaluated among undergraduate students, urging formal evaluation of the assessment items for further improvement
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Abstract Continuous adjustment of Propofol in manual delivery of anesthesia for conducting a surgical procedure overburdens the workload of an anesthetist who is working in a multi-tasking scenario. Going beyond manual administration and Target Controlled Infusion, closed-loop control of Propofol infusion has the potential to offer several benefits in terms of handling perturbations and reducing the effect of inter-patient variability. This paper proposes a closed-loop automated drug administration approach to control Depth Of Hypnosis in anesthesia. In contrast with most of the existing research on anesthesia control which makes use of linear control strategies or their improved variants, the novelty of the present research lies in applying robust control strategy i.e. Sliding Mode Control to accurately control drug infusion. Based on the derived patient's model, the designed controller uses measurements from EEG to regulate DOH on Bispectral Index by controlling infusion rate of Propofol. The performance of the controller is investigated and characterized with real dataset of 8 patients undergoing surgery. Results of this in silico study indicate that for all the patients, with 0% overshoot observed, the steady state error lies in between ±5. Clinically, this implies that in all the cases, without any overdose, the controller maintains the desired DOH level for smooth conduction of surgical procedures.
Resumo O ajuste contínuo de propofol na administração manual de anestesia para um procedimento cirúrgico onera a carga de trabalho de anestesistas que trabalham em ambiente multitarefa. Indo além da administração manual e da infusão alvo-controlada (IAC), o controle de circuito fechado da infusão de propofol tem o potencial de oferecer vários benefícios em termos de manejo das perturbações e reduzir o efeito da variabilidade interpaciente. Este artigo propõe uma abordagem para a administração automatizada de drogas em circuito fechado para controlar a profundidade da hipnose (PDH) em anestesia. Em contraste com a maioria das pesquisas existentes sobre o controle da anestesia que usam estratégias de controle linear ou de suas variantes melhoradas, a novidade da presente pesquisa reside na aplicação de uma estratégia de controle consistente; isto é, o Controle por Modos Deslizantes (CMD) para controlar com precisão a infusão da droga. Com base no modelo derivado do paciente, o controlador projetado usa as medições do EEG para regular a PDH no Bispectral Index (BIS), controla a taxa de infusão de propofol. O desempenho do controlador é investigado e caracterizado com um conjunto de dados reais de oito pacientes submetidos à cirurgia. Os resultados deste estudo in silico indicam que, para todos os pacientes, com 0% de excesso observado, o erro de estado estacionário fica entre ± 5. Clinicamente, isso implica que em todos os casos, sem qualquer sobredosagem, o controlador mantém o nível desejado de PDH para a condução tranquila dos procedimentos cirúrgicos.
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Humans , Male , Female , Adult , Propofol/administration & dosage , Hypnotics and Sedatives/administration & dosage , Anesthesia, Intravenous/methods , Infusions, Intravenous , Models, TheoreticalABSTRACT
Background and Objective: Dengue infection is an arthropod borne disease caused by Dengue virus in humans. Dengue virus infection has more potential to produce severe form of the disease with more severe symptoms. Proper diagnosis of dengue fever is very important for its safe management.The objective of this study was to evaluate the non structural protein-1 [NS1] positive parameter for identification of dengue fever by using ELISA from 2013 dengue outbreak in Khyber Pakhtunkhwa
Methods: It was a cross sectional study conducted among 384 patients tested for dengue admitted to different hospitals of Khyber Pakhtunkhwa April to December 2013 with symptoms related to classical dengue fever. Written informed consent was taken from 100 NS1 positive diagnosed patients, and 3 to 5 ml blood sample was collected for confirmation through ELISA testing. ELISA test for dengue IgG and IgM was performed two time in order to confirm the dengue cases. Data was entered and analyzed by using SPSS version 16
Result: The study performed on 100 NS1 positive samples of patients, admitted to hospitals with symptoms related to classical dengue fever, indicated that after performing the IgM and IgG capture ELISA test only 76 samples were actually found positive for dengue. The rest of the 24 samples were found negative for both IgM and IgG capture ELISAs. The study also revealed that 90.8 % patients had primary dengue infection and 35.5% patients had secondary dengue infection. Most patients were between the age of 10-20 years [26%], among them19.7% were having primary dengue infection. Among 10-20 years of age 50% female patients were false dengue patients
Conclusion: About 24 % NSI protein positive samples were found negative for both IgM and IgG capture ELISAs showed that NS1protein positivity does not confirm actual dengue infection