Journal of Pakistan Medical Association最新文献

{"title":"Diabetic pneumopathy: A latest finding","authors":"None Ariba Fida, Muhammad Sheheryar Javed, None Fezan Rasool","doi":"10.47391/jpma.10133","DOIUrl":"https://doi.org/10.47391/jpma.10133","url":null,"abstract":"Madam, Diabetes is one of the major causes of death not only in Pakistan but worldwide. In Pakistan alone, approximately 33 million people suffer from Type 2 diabetes mellitus, with an additional 11 million adults with impaired glucose tolerance, while approximately nine million people with diabetes remain undiagnosed1. Diabetes causes many fatal complications including hypertension, myocardial infarction, stroke, chronic kidney disease, neuropathy, etc. To lower the morbidity and mortality rates, prompt screening and treatment of complications of diabetes should be done, especially the lesser-known complications. In the past, a strong association between idiopathic pulmonary fibrosis and diabetes was noted by some physicians. This association was established by Stefan Kopf et al2. More recently a study funded by Diabetes UK (a British-based patient, healthcare professional, and research charity) at the Imperial College of London claimed that there is a strong association between lung disorders and Type 2 diabetes mellitus3. This study examined data from approximately 500,000 individuals in 17 large-scale investigations. According to the investigation, type 2 diabetics' elevated blood sugar levels directly affect lung function. For instance an increase in typical blood sugar levels from 4 mmol/L to 12 mmol/L. might cause a 20% decline in lung function and capacity. Dr. Ben Jones, Dr. Marika Kaakinen and Dr. Elizabeth Robertson were in pivotal positions in this research and they all quoted lung disorders occurring in Type 2 diabetic patients as a direct complication of diabetes3. Rajasurya V et al defined diabetic lung or diabetic pneumopathy as a condition characterized by progressive lung disease caused by the microvascular complications associated with diabetes mellitus4. The direct complications of diabetes mellitus in the lungs include interstitial lung disease and idiopathic pulmonary fibrosis. Interstitial lung disease involves different degrees of inflammation and fibrosis in the pulmonary parenchyma and Idiopathic pulmonary fibrosis involves chronic progressive fibrosis leading to progressive pulmonary failure4. Knowing the extent of diabetic patients present in Pakistan and how quickly this number can escalate5,a clinical trial should be replicated on a larger population. There is a need to establish protocols for screening of diabetes related pneumopathy. People should be educated about these lesser-known complications of diabetes, and diabetic patients should be trained to perform pulmonary function tests at home. Overall these measures will surely help to improve the quality of life of a diabetic patient and to reduce gross morbidity and mortality rates.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Stem Cells in Urology: A Promising Development for the Treatment of Urological Disorders\"","authors":"None Shah Ahmed","doi":"10.47391/jpma.9321","DOIUrl":"https://doi.org/10.47391/jpma.9321","url":null,"abstract":"Madam, It was fascinating to read the latest research published in the Journal of Pakistan Medical Association (JPMA) on the utilisation of stem cells in urology. The study had some amazing findings, and I believe it has the power to revolutionise the treatment of urological disorders.1 Recent advances in stem cell research have opened new possibilities for treating various urological conditions. For example, findings have shown that stem cells can be used to promote tissue regeneration and repair in patients with urinary incontinence or erectile dysfunction.2 Additionally, stem cells can regenerate damaged renal tissue, offering the latest treatment options for patients with kidney disease.4 Apromising area of research includes use of mesenchymal stem cells (MSCs) to treat urological conditions. MSCs are multipotent cells that can specify into various cell types, including muscles, bones, and cartilage. They have been shown to up level the symptoms and improve quality of life in patients with urinary incontinence,They may also be very effective in treating a variety of urological conditions.2 One more area of research entails the use of induced pluripotent stem cells (iPSCs) in urology. iPSCs are reprogrammed from adult cells, like skin cells, into an embryonic-like state. They are differentiated into various cell types, making them a potentially important tool for regenerative medicine. Research has shown that iPSCs can be used to produce functional urothelial cells, which line the urinary tract and play a major role in bladder function.5 Overall, stem cell research in urology is a developing area that shows promise. It offers new treatment varieties for patients with urological conditions and has the potential to improve their quality of life. I strongly believe that this research will be of great interest to clinicians and researchers in this urology field, and I look forward to seeing further more developments in this exciting area of medicine. It is also important to note that further research is strongly needed to fully explore the potential of stem cells in urology. This includes examining the long-term safety standards and efficacy of stem cell therapy, as well as identifying the optimal stem cell sources and delivery methods for variety of urological conditions. I strongly believe that ongoing research will continue to shed light on these important questions.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"22 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136106040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Exposure to Pregabalin During Pregnancy: Safe or Unsafe?","authors":"Araj Naveed Siddiqui, Fakiha Ahmed Shah, Yamna Naveed Siddiqui","doi":"10.47391/jpma.9683","DOIUrl":"https://doi.org/10.47391/jpma.9683","url":null,"abstract":"Madam, pregabalin is an anticonvulsant used mainly for the treatment of epilepsy, neuropathic pain, and anxiety. Recently, a safety advisory by the Drug Regulatory Authority of Pakistan (DRAP) associated the use of pregabalin during pregnancy with a slightly increased risk of major congenital malformations in the inborn child.1 Given that a considerable portion of pregnant women in Pakistan self-medicate, there is an immediate need to address this issue.2 This decision was made in consideration of a drug safety update issued by the Medicines and Healthcare products Regulatory Agency (MHRA) of the United Kingdom, in which findings from a European study and a Nordic observational study were thoroughly analysed before coming to the conclusion.3 The MHRA-reviewed Nordic study examined the effect of pregabalin exposure on 2,700 pregnant women and observed a higher prevalence of major congenital abnormalities (5.9%) in babies exposed to pregabalin compared to babies not exposed to any anti-epileptic drug (4.1%).4 Pregabalin-exposed children had a slightly higher risk of developing certain anomalies of the eye, face, the nervous and urological systems.3 In light of these findings, the MHRA decided that pregabalin product labelling should be updated, and pregnant women should be advised to use effective contraception while taking the medication, or altogether avoid it, unless absolutely essential.3 However, MHRA also stated, as the Nordic study was observational and based on registry data, the outcomes could have been influenced by various other factors.3 Furthermore, a few other  researchers have expressed differing opinions regarding the MHRA’s warning. A critical appraisal by Richardson JL et.al. described this update on pregabalin as inadequately supported and leading to confusion and misinformed clinical risk-benefit decision making. This was attributed to certain methodological flaws in the study and low-quality evidence that suggested the possibility of only a minor, unconfirmed risk that could not be solely associated with foetal exposure to pregabalin.5 A multi-centred study should be conducted to develop a better understanding of the role of pregabalin in causing congenital malformations. However, since the MHRA-reviewed Nordic study is the largest population-based study currently available, guidelines given out by the MHRA and DRAP regarding patient exposure to pregabalin during pregnancy cannot be ignored. Public awareness is required to educate pregnant women in Pakistan regarding the risks associated with pregabalin.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"22 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136106049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Folliculotropic mycosis fungoides in a child: a rare case","authors":"None Fatima Zahoor, Shakila Junaid, None Ghazal Afzal","doi":"10.47391/jpma.8348","DOIUrl":"https://doi.org/10.47391/jpma.8348","url":null,"abstract":"Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides characterized by infiltration of hair follicle epithelium by neoplastic lymphoid cells. Generally, it is usually typified by indurated plaques and tumours mainly on the head and neck. However, a wide range of clinical signs have been noted. The clinical presentation of FMF may include prurigo-like lesions, acneiform lesions, cysts, nodules, areas of scarring alopecia, and hypopigmented plaques or papules with follicular prominences. The average age of diagnosis is 60 years while it is rare in childhood and adolescence. We discuss the case of a 12-year-old boy patient who had an asymptomatic, erythematous, infiltrating plaque across his left nasolabial fold for three months prior to presentation. Histological assessment of lesion showed characteristic findings of follicular mucinosis with predominance of CD4+ lymphocytes and immunohistochemical studies were positive for CD3+ stains. An increased CD4:CD8 ratio and negative CD20 was also shown. ---Continue","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"47 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136104924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of Health Policy and Systems Research for Strengthening Rehabilitation in Health Systems: A Call to Action to Accelerate Progress","authors":"None Walter R. Frontera, None Wouter DeGroote, None Abdul Ghaffar","doi":"10.47391/jpma.23-90","DOIUrl":"https://doi.org/10.47391/jpma.23-90","url":null,"abstract":"During the last few decades, the field of rehabilitation has experienced substantial development, growth, and acceptance. Rehabilitation addresses the impact of a health condition on a person’s everyday life by optimizing their functioning and reducing their experience of disability. Rehabilitation expands the focus of health beyond preventative and curative care to ensure people with a health condition can remain as independent as possible and participate in education, work, and meaningful life roles.1 A definition of rehabilitation for research purposes has been recently published.2 Scientific and clinical research have generated a body of knowledge that strongly supports the use of many rehabilitation interventions with positive outcomes in various populations and health conditions. We also have now a better understanding of the growing global need, demand, and recognition of rehabilitation around the world. For example, it has been estimated that 2.41 billion people in the world could benefit from rehabilitation services. This means that at least one in every three persons in the world needs rehabilitation at some point during the course of their disease or injury.3 This figure has most likely increased because of the COVID-19 pandemic. The need for rehabilitation increased by 63% between 1990 and 2017 because of the aging population, the increasing prevalence of noncommunicable health conditions, and the shifting epidemiological profile in most countries.3 Finally, according to the 2022 global report on health equity for persons with disabilities, approximately 1.3 billion people or 16% of the world’s population has moderate to severe levels of disability associated with the underlying health conditions and impairments.4 Now more than ever before, it is crucial that rehabilitation is available and accessible to populations globally according to their needs. The important contribution of rehabilitation to the functioning, including social and occupational participation and well-being of populations worldwide, can no longer be denied or delayed. Rehabilitation is critical for the attainment of the United Nations Sustainable Development Goal 3, Ensure healthy lives and promote well-being for all at all ages.5 Notwithstanding the foregoing arguments, there continues to be a high unmet need for rehabilitation globally, with some low- and middle-income countries reporting unmet needs up to 50% of those who could benefit from rehabilitation. Rehabilitation services are not accessible to many people around the world.6 Many of those in need do not have access because of the failure, at least partially, to effectively plan for rehabilitation services. Many nations and health systems have not implemented policy measures that recognize rehabilitation as an essential component of universal health coverage7,8 Health policy, planning, and decision making for rehabilitation often require more local evidence to adequately plan, finance, implement,and monitor","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"73 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital diarrhoea in a neonate with hypernatraemia and dehydration","authors":"None Ammara Kaleem, None Javaria Younus, None Farah Haroon, None Bushra Fatima, None Faria Afzal, None Shumaila Chaudhry","doi":"10.47391/jpma.7876","DOIUrl":"https://doi.org/10.47391/jpma.7876","url":null,"abstract":"Diarrhoea, vomiting, and dehydration are frequently encountered in neonatal emergency. However, it is challenging to manage resistant hypernatraemia and metabolic acidosis associated with it. Diagnosing the exact cause is even more difficult. Glucose-galactose malabsorption commonly presents with hypernatraemia and repeated dehydration. In the case described here, the baby started to have diarrhoea in the first week of life and presented in the neonatal emergency with severe dehydration and hypernatraemia. Higher sodium levels were difficult to manage throughout the course of illness. Hypernatraemia and diarrhoea worsened on feeding, whether formula or mother’s feed, which raised suspicion of glucose and galactose malabsorption. So, genetic testing was performed and fructose based formula was started which led to improvement in the condition. Later, genetic testing confirmed our diagnosis. ---Continue","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"49 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of problem-based learning in dental education and exploring barriers to its implementation: theory to reality","authors":"Khadija Farrukh, None Ambreen Usmani, None Syed Bilal Yousuf","doi":"10.47391/jpma.7890","DOIUrl":"https://doi.org/10.47391/jpma.7890","url":null,"abstract":"There are 59 dental colleges in Pakistan out of which 17 are in the public sector and 42 in private. However, only a few use problem-based learning methods, though it is a popular strategy in dental education all around the world. This study aims to assess problem-based learning model in dental education and explore the barriers of its implementation in a private dental college of Karachi. Qualitative case-study approach was employed. The philosophical stance used was critical realism. Qualitative data was collected by participant observation, video recorded observation and video elicited semi-structured in-depth interviews of five faculty members and 15 students. Results showed that students were more interested in interactive sessions while faculty members were in favour of problem-based learning sessions. Thematic analysis was done to generate themes. This research applies reproduction method to explain the necessary and contingent relations and causal powers. ---Continue","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"15 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the Monkeypox virus pose a potential threat for Pakistan with new emerging cases?","authors":"None Haiqa Zulfiqar, None Uzma Aslam, None Yusuf Hasan Ali","doi":"10.47391/jpma.9917","DOIUrl":"https://doi.org/10.47391/jpma.9917","url":null,"abstract":"Madam, Monkeypox (MPX) is a viral disease belonging to the orthopoxvirus genus with a clinical presentation strikingly similar to that of smallpox which includes fever, rash and lymphadenopathy [1]. The disease is primarily transmitted through direct contact with an infected person, animal, or contaminated material. Recently, Pakistan reported its first two confirmed cases of Monkeypox, and there has been a global outbreak of over 78,000 people infected [2]. Given the statistics, Pakistan should also take preventive actions to control the country-wide spread of the disease. The symptoms of the Monkeypox virus usually begin within a week but may range between 1-21 days after the initial exposure. Initial signi in most individuals is a rash beginning on the face and eventually spreading over the body extending to the palms and soles. The distinct lesions typically appear in stages, beginning with macular, then papular, then vesicular and eventually pustular. Moreover, there can be serious complications including pneumonitis, encephalitis, sight-threatening keratitis and secondary bacterial infections [3]. Cases in the current outbreak have been atypical, with the characteristic rash starting in the genital and perianal areas with or without dissemination to other body parts[4]. The clinical recognition of Monkeypox can be challenging especially in resource-poor endemic regions. Diagnosis is usually done through identification of viral DNA by collecting swabs from the crusts of lesions. According to the Center for Disease Control and Prevention (CDC), no specific vaccine or treatment for the Monkeypox virus is currently available.[5] Prevention is better than cure, it is important to highlight the need for better surveillance and early detection systems nationwide. Promoting campaigns on both small and large scales is crucial to raise awareness about the disease. These campaigns can include awareness sessions in educational institutions and setting up roadside camps in high-risk areas. The public should be advised to take necessary precautions to protect themselves and their communities by restraining contact with infected individuals and practicing isolation if infection is suspected. Front- line health officials are particularly vulnerable and should follow strict standard operating procedures, while airports should be closely monitored for potential cases. While the world is still challenged by the COVID19 pandemic, the emergence of new outbreak by monkeypox virus has raised concerns and therefore, it is high time for the government to plan and implement appropriate actions on emergency basis to control the spread of this disease.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"28 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined medial and lateral bucket handle meniscus tears with associated complete anterior cruciate ligament tear-a case report","authors":"Muhammad Amir Sohail, Amna Bashir, None Umair Ul Hassan","doi":"10.47391/jpma.8153","DOIUrl":"https://doi.org/10.47391/jpma.8153","url":null,"abstract":"The majority of meniscal tears in bucket handles are associated with anterior cruciate ligament (ACL) impairment. Its a rare condition which is rarely encountered when the meniscus has a bucket handle on both sides of the compartment. Here we present the case of a 28-year-old male cricket player with a total ACL rupture, a double Posterior Cruciate ligament (PCL) sign on MRI (Magnetic Resonance Imaging), an uncommon occurrence of a complex bucket handle rupture of the medial meniscus with a double PCL sign. It was a complete ACL tear and displaced bucket handle medial meniscus that was also visible on the magnetic resonance imaging. In this report, double PCL sign was shown on MRI and that was confirmed during the arthroscopic procedure. Keywords: Complete ACL tear, combined medial & lateral bucket handle, meniscus tears.","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"23 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Müllerian duct syndrome diagnosed incidentally: a case report","authors":"Nazish Fatima, Zareen Kiran, Khalil Ullah Shabbir, Akhtar Ali Baloch","doi":"10.47391/jpma.9172","DOIUrl":"https://doi.org/10.47391/jpma.9172","url":null,"abstract":"Persistent Müllerian Duct syndrome is a rare male disorder of sexual development. The phenotypically and genotypically male patient presents with female internal organs (i.e., uterus, cervix, fallopian tubes and upper part of vagina) due to deficiency of anti-mullerian hormone or insensitivity of tissues to Anti Mullerian Hormone. We present a 19 year old male who came with complaint of right iliac fossa pain. He was investigated for acute appendicitis and on imaging, he was diagnosed to have bilateral cryptorchidism with rudimentary uterus. Computed tomography followed by pelvic ultrasonography was done which indicated two testes in abdomen and a soft tissue density structure, identified as a rudimentary uterus located posterior to the urinary bladder. CT scan findings were further confirmed by magnetic resonance imaging pelvis. A trial of stepwise orchidopexy followed by orchidectomy with removal of rudimentary uterus was performed laparoscopically. ---Continue","PeriodicalId":16673,"journal":{"name":"Journal of Pakistan Medical Association","volume":"511 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136106045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}