Journal of the Pakistan Medical Association最新文献

{"title":"Intra rater reliability of Y balance test in medical students.","authors":"Muhammad Mustafa Gul, Sidrah Shabbir, Muhammad Burhan, Muhammad Mahmood Alam, Muhammad Waseem Akhtar, Muhammad Shahbaz","doi":"10.47391/JPMA.11010","DOIUrl":"10.47391/JPMA.11010","url":null,"abstract":"<p><p>The cross-sectional study was planned to assess the Ybalance test's intra-rater reliability among a sample of 59 medical students. The subjects took six trials under supervision, and the reliability of the results improved, with intra-class correlation values >0.75, indicating high reliability. Though the study had a cross-sectional design, it provided insightful data for focussed assessment. The Ybalance test was found to be an easy and reliable technique for evaluating dynamic balance.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"480-481"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy-associated spontaneous coronary artery dissection: A challenging scenario in limited-resource setting.","authors":"Hassan Abdullah, Ayesha Rafique, Asad Jamil Awan, Muhammad Muzaffar Mahmood","doi":"10.47391/JPMA.11299","DOIUrl":"10.47391/JPMA.11299","url":null,"abstract":"<p><p>Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS). We report a case of SCAD in a patient who had her Caesarean section three weeks earlier. This report describes the management, emphasising the need to keep a high index of suspicion to avoid mismanagement, such as inadvertent thrombolysis which may prove disastrous in such situations. The practical aspects of performing percutaneous coronary intervention in patients with SCAD are also discussed.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"482-484"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is central venous catheter placement overrated for inotropic support: A voice from low-resource setting.","authors":"Zofishan Anwar, Madiha Ismail","doi":"10.47391/JPMA.21424","DOIUrl":"https://doi.org/10.47391/JPMA.21424","url":null,"abstract":"","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"522"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How safe and effective is oral analgesia for hip fracture patients? A prospective cohort study.","authors":"Zehra Abdul Muhammad, Tashfeen Ahmad","doi":"10.47391/JPMA.20532","DOIUrl":"10.47391/JPMA.20532","url":null,"abstract":"<p><strong>Objective: </strong>To assess the safety and pain reduction profile of routinely prescribed oral analgesics in patients of hip fracture surgery.</p><p><strong>Methods: </strong>The single-centre, prospective, cohort study was conducted from June 2022 to July 2023 at the Aga Khan University Hospital, Karachi and comprised adult patients of either gender with hip fractures. The analgesics prescribed at the time of hospital discharge and 1-week follow-up were recorded along with pain and adverse effects till the 2-week post-discharge follow-up. Pain was recorded using the visual analogue scale, with the target score set at 3/10. The relationship between covariates to pain or adverse events was assessed. Possible analgesic-related deaths/adverse events, absolute risk and agespecific death rates were also calculated. Data was analysed using SPSS 19.</p><p><strong>Results: </strong>Of the 133 patients, 80(60.1%) were females and 53(39.8%) were males. The overall median age was 73 years (interquartile range: 16 years). The median pain score was 4 (interquartile range: 2) and 2 (interquartile range: 2) at 1-week and 2-week follow-up, respectively. Adverse events were experienced by 83(62.4%) patients, while 1(0.75%) patient was lost to follow-up at both follow-ups. Of the remaining 132(99.2%) patients, 106(80.3%) were aged >60 years, and 26(19.6%) were aged <60 years. Sub-optimal analgesia at 1-week follow-up with high adverse events was observed after combining acetaminophen with analgesics like ibuprofen (100% and 50% of 2), diclofenac (55% and 50% of 20), meloxicam (50% and 50% of 4), celecoxib (71.4% and 42.8% of 7), tramadol (60% and 57% of 35), pregabalin (100% and 50% of 2), or gabapentin (50% and 50% of 2) respectively. There were 7(5.3%) deaths of which 5(71.4%) were analgesic-related. All 5 of 132 (3.78%) potentially analgesic-related deaths occurred among >60 years of age. Thus, in 106 patients with age >60 years, 5(4.7%) died, and the age-specific death rate was 4,717/100,000 population. The odds of adverse events increased with comorbidity (p=0.02). Pain score was significantly related to adverse events (p=0.007).</p><p><strong>Conclusion: </strong>Combining acetaminophen with other analgesics did not improve analgesia, but did increase adverse events. The risk of adverse events and mortality were higher with comorbidity and older age.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"434-442"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predic tors o f i n-hospital m or tality in patients requiring tr an sfer to the me dical in tensive care unit.","authors":"Huzefa Jibril, Muhammad Azhar, Ainan Arshad, Safia Awan, Syed Ahsan Ali, Muhammed Tariq","doi":"10.47391/JPMA.20092","DOIUrl":"10.47391/JPMA.20092","url":null,"abstract":"<p><strong>Objective: </strong>To identify the factors associated with higher odds of in-hospital mortalit y among inpatients requiring transfer to the medical intensive care unit.</p><p><strong>Methods: </strong>The ret rospective audit was conducted from Ap r il 1 to September 30, 2023, at The Aga Khan University Hospital, Karachi, Pak is t an and com prised dat a from January 1 , 2018, to December 31, 20 22, of patients initially admitted to the general ward or high dependency unit in the Department of Medicine who required transfer to the medical intensive care unit during hospitalisation. Data was analysed using SPSS 23.</p><p><strong>Results: </strong>Of the 601 patients with mean age 53.6±17.4 years, 373(62.1%) were males. Overall, 321(53.6%) of the patients expired while in the hospital. Patient s w hose t r ansfer t o the intensive care un it wa s initi ate d withi n 48 hours of admission had l o wer in-hospital mortality co mpared to those whose transfer wa s initiated beyond 48 hours of admission (p=0.004). Patients with a his to r y of autoimmune disease or mali gnancy as co -morbid conditions, o r a primary discharge diagnosis of sepsis had higher odds of in-hospital mor tality (p<0.05).</p><p><strong>Conclusion: </strong>In-hospital mortality in patients requiring transfer to the intensive care unit was found to be very high. Early transfer to intensive care unit could lead to improved survival rate.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"429-433"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Squamous cell carcinoma; a rare complication of long-standing renal stones: Case report and an overview.","authors":"Hamad Ali Shah, Asaf Alam Khan, Syed Munim Hussain, Muhammad Arsalan Ali","doi":"10.47391/JPMA.20471","DOIUrl":"10.47391/JPMA.20471","url":null,"abstract":"<p><p>Renal squamous cell carcinoma is an exceedingly rare and infrequent diagnosis, usually not suspected due to its rarity and non-specific radiological and clinical features. Patients are usually diagnosed at a late stage, with subsequent mortality. Surgical excision, usually a radical nephrectomy, remains the treatment of choice. We report a case of a 48- year-old female, presenting with generalised lower abdominal pain, who underwent a simple nephrectomy for a non-functioning kidney and was diagnosed as squamous cell carcinoma on a postoperative biopsy.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"492-494"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the enigma: Thyroid-like follicular carcinoma of the left kidney.","authors":"Nauman Zafar, Saud Iqbal, Shujah Muhammad, Nadeem Bin Nusrat, Assad Ur Rehman, Saira Imtiaz","doi":"10.47391/JPMA.11427","DOIUrl":"10.47391/JPMA.11427","url":null,"abstract":"<p><p>Thyroid-like follicular carcinoma of the kidney (TLFCK) is a rare renal cancer, not aligning with established renal cell carcinoma subtypes. Histologically akin to primary thyroid follicular carcinoma, TLFC poses diagnostic challenges due to absent thyroid immunohistochemistry markers. This case details a 40-year-old army personal, previously hypertension-free, presenting with bilateral flank pain and severe haematuria. Imaging revealed a 5.5 × 5 cm calcified lesion in the left kidney, suggestive of renal cell carcinoma (T3aN0Mx). Immunohistochemistry confirmed the diagnosis, with positive Paired box gene 8 (PAX8), Cytokeratin 7 (CK7) and Carbonic anhydrase IX (CAIX) and negative Cluster of differentiation 10 (CD10), Alpha-methyl acyl-CoA racemase (AMACR), Cluster of differentiation 117(CD117), Thyroid transcription factor 1 (TTF1) and thyroglobulin. The tumour was confined to the kidney, with clear margins. Subsequently, signs of metastasis prompted systemic treatment initiation with immunotherapy and tyrosine kinase inhibitors, emphasizing diagnostic intricacies and therapeutic complexities associated with TLFC.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"485-487"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does intraoperative neuromonitoring during thyroidectomy reduce the risk of hypoparathyroidism?","authors":"Zehra Zeynep Keklikkiran, Ezgi Tatlisu, Muzaffer Akinci, Gamze Citlak","doi":"10.47391/JPMA.10752","DOIUrl":"10.47391/JPMA.10752","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effect of intraoperative neuromonitoring on postoperative hypoparathyroidism after bilateral total thyroidectomy.</p><p><strong>Methods: </strong>The prospective study was conducted at the General Surgery Clinic of the University of Health Sciences Haseki Training and Research Hospital, Turkiye, from February 2016 to December 2020, and comprised patients who had undergone bilateral total thyroidectomy. They were evaluated for recurrent laryngeal nerve damage, hypocalcaemia and hypoparathyroidism. Further, it was explored whether the use of intraoperative neuromonitoring had an effect on postoperative complications between experienced surgeons with >5 years of experience and lessexperienced surgeons with <5 years of experience. Data was analysed using SPSS 15.</p><p><strong>Results: </strong>Of the 64 patients 59(92.2%) were females and 5(7.8%) were males. The overall mean age was 47.7±10.8 years. Experienced surgeons operated 38(59.4%) patients, while the less experienced operated 26(40.6%). The most common complications were transient hypocalcaemia 38(59.3%) and transient unilateral vocal cord paralysis 9(14%). There was no significant difference between experienced surgeons and less experienced surgeons in terms of postoperative complications (p>0.05).</p><p><strong>Conclusions: </strong>The use of intraoperative neuromonitoring during bilateral total thyroidectomy reduced the risk of hypoparathyroidism regardless of the surgeon's experience.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"388-392"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotypical depiction of Erdheim-Chester Disease on Tc-99m MDP skeletal scintigraphy.","authors":"Syeda Azam Najam, Xain Tauqeer, Aamna Hassan, Kashif Siddique","doi":"10.47391/JPMA.25-23","DOIUrl":"10.47391/JPMA.25-23","url":null,"abstract":"<p><p>Erdheim-Chester Disease (ECD) is a rare systemic histiocytic disorder characterized by symmetrical skeletal involvement and variable visceral manifestations. Tc-99m MDP bone scintigraphy, CT, MRI, and FDG PET-CT are essential for diagnosis and disease mapping. ECD's course depends on extraosseous involvement, with potential complications including heart and renal failure. We present the case of ECD with bilateral leg pain and orbital involvement. Imaging revealed mixed sclerotic and lytic skeletal lesions, cerebellar lesions, intraorbital soft tissue masses, mediastinal and retroperitoneal infiltration.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"512-513"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of family support on psychological adjustment of physically handicapped adolescents.","authors":"Madiha Zainab, Mamoona Ismail Loona, Seema Zahid","doi":"10.47391/JPMA.10737","DOIUrl":"10.47391/JPMA.10737","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of family support on psychological adjustment of physically handicapped adolescents, and to assess gender differences in this regard.</p><p><strong>Methods: </strong>The cross-sectional study was conducted in Rawalpindi and Islamabad, Pakistan, from May to July 2023, and comprised male and female physically handicapped adolescents living in joint family systems. Data was collected using standardised tools, including Family Support Scale and Psychological Adjustment Scale. The relationships between perceived family support and psychological adjustment were explored. The relationships between perceived family support and psychological adjustment were analyzed using descriptive statistics, correlation, t-test and regression analysis via SPSS version 22.0.</p><p><strong>Results: </strong>Out of total 150 individuals participants were 56(37%) and male participants were 94 (63%). The age range for the participants was 13 to 18 years (15.5±1.8) Increased family support meant increased psychological adjustment (p<0.05). There was no significant gender difference (p>0.01) in this regard.</p><p><strong>Conclusions: </strong>Family support was a strong predictor of psychological adjustment among physically handicapped adolescents, while gender difference in this regard was not significant.</p>","PeriodicalId":54369,"journal":{"name":"Journal of the Pakistan Medical Association","volume":"75 3","pages":"383-387"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}