Acute Pancreatitis; New Methods for Understanding an Old Problem

Gulali Aktas

Acute pancreatitis is responsible of considerable amount of hospital admissions, and therefore, significant morbidity and mortality in the modern world. The disease poses a significant burden to healthcare systems since its incidence have been rose to as high as 45 subjects in every 100000 population since early 1990s. Excessive alcohol consumption and biliary tract disorders are two most common causes of acute pancreatitis. Other etiological factors include dyslipidemia, surgery or traumatic injury of abdomen, hypercalcemia, infections, inflammation related to vasculitis, tumors of pancreas or ampulla and various drugs. Drugs that cause acute pancreatitis are anti-neoplastic agents (i.e., asparaginase, azathioprine, mercaptopurine), antibiotics (i.e., tetracycline, isoniazid, sulfonamides, metronidazole), anti-inflammatory drugs (i.e., celecoxib, meselamine, leflunomide), thiazide diuretics, anti-diabetic treatments (i.e., exenatide, sitagliptin), and anti-hypertensive and anti-hyperlipidemia therapies (methyl dopa, enalapril, fenofibrate, simvastatin). Medical interventions such as enteroscopy, peritoneal dialysis, endoscopic retrograde colangio-pancreatography, may also induce acute pancreatitis. Cystic fibrosis and pancreas divisum are also contributing conditions to acute pancreatitis.

Received: March 23, 2022
Revised: July 14, 2022
Accepted: July 18, 2022


Consultants & Trainees Active Participation in Multi-Disciplinary Team (MDT): Tumor Boards can Play a Major Role in the Achievement of their Academic Professional Development Goals

Fatima Shaukat, Muhammad Owais Aziz, Sehrish Abrar, Ahmed Nadeem Abbasi and Tahir Sultan Shamsi

We wish to share with the readers of this scientific journal our experiences and observations regarding educational gains achieved by the consultant faculty and trainee postgraduate residents via active participation in multidisciplinary team (MDT) Tumor Boards. The rapid modernization of teaching methodologies is being observed in both postgraduate residents and faculty professional education learning processes. Contemporary literature is increasingly depicting academic work which is being directed towards the exploration of both educational and social determinants of health care [1].
Several socio-economic factors have been discussed across the globe which have an impact on the health care systems [2]. Researchers argued over the fact that the leading factor for a positive outcome is socioeconomic wellbeing especially for patients with diseases, like cancer, diabetes mellitus, etc. If we critically evaluate the curriculums designed on the principles of traditional problem-based learning and case-based learning, they are very well-established students centre approaches, but on their merit, they failed to provide a holistic picture
of the patient care [3].

Received: December 12, 2021
Revised: February 08, 2022
Accepted: February 09, 2022


Does Late Axial Spondyloarthropathy Diagnosis Cause Extra Anti-TNF Therapy?

Fatih TAY, Metin Özgen and Mustafa Büyükkör

Abstract: Introduction: Ankylosing Spondylitis (AS) is a chronic inflammatory rheumatic disease that mainly characterized by sacroiliac joint and spine involvement. Although there is no clear evidence that any of these agent prevent the radiologic progression, anti-TNF drugs provide significant improvements in the disease activity score, functional index and quality of life. In AS patients, knowledge of the factors that determine the need for anti-TNF treatment will be associated with fewer complication sand better treatment. The purpose of this study is to investigate the possible factors which willmark the transition to the anti-TNF therapy in AS patients.
Materials and Methods: This study was conducted in the Rheumatology division of the Internal medicine department of the Ondokuz Mayis University of Medicine hospital between January 2012- June 2015. The study protocol was approved by the Ethics Committee of Ondokuz Mayis University. A total of 165 patients, who were diagnosed as AS according to the ASAS classification criteria, were enrolled in this study. There were 85 women (51.5%) and 80 men (48.5%), aged between 15-69. Patients were divided into two groups according to their use of anti-TNF drug.
Results: A total of 165 Ax-SpA patients (85 women and 80 men) were included in the study. The mean age was 37.82±11.24 years. The mean duration of the disease was 4.59±5.35 years. male gender, uveitis, delay in diagnosis, elevations in sedimentation CRP levels, increase in disease activity and functional indexes such as BASDAI and BASFI scores shows the more frequent need for anti-TNF drug use.
Conclusion: In our study, patients who needed anti-TNF treatment had a longer time between symptom onset and diagnosis than patients who did not hear. The delay in diagnosing these patients leads to a delay in treatment so that the focus of inflammation increases and these patients need more anti-TNF as this window of opportunity escapes.

Received: October 28, 2021
Revised: May 17, 2022
Accepted: May 26, 2022


Diagnostic Accuracy of Recognition of Stroke in Emergency Room Score in Patients with Ischemic Stroke

Syed Muhammad Ali Shah, Zamir Butt, Muhammad Afzal, Shahida Husain Tarar and Syed Usama Talat

Abstract: Objective: To determine the diagnostic accuracy of ROSIER scale in patients with ischemic stroke taking non-enhanced CT scan brain as gold standard.
Materials and Methods: Cross-sectional study conducted at tertiary care hospital in Gujrat from October 2019 to December 2020. Patients of both sex groups aged 30- 75 years presented in emergency within 24 hours of onset of focal neurological deficit which is objectively present and suspected of ischemic stroke. 289 patients were included. Patient history and neurological examination done calculating ROSIER scale and ischemic stroke diagnosed after CT scan brain done 24 hours after onset of symptoms. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of ROSIER scale were calculated. Data analysis was done using SPSS 20.0.
Results: In this study group 141(48.8%) were male while 148(51.2%) were female. Mean age was 62.1+11.02 years. 49(17%) patients were aged <50 years while 240(83%) were aged >50 years. 215(74.4%) presented within 12 hours while 74(25.6%) after 12 hours of symptoms onset. Sensitivity of ROSIER scale for diagnosing ischemic stroke was 98.86%(95%CI;95.96%-99.86%), specificity 5.31%(95%CI;1.97%-11.20%), PPV 61.92%(95% CI;60.82%-63.01%) and NPV was 75%(95%CI;38.13%-93.59%). LR+ was 1.04(95%CI; 1.00-1.09) while LR- was 0.21(95%CI; 0.04-1.04).
Conclusion: ROSIER score can be used as initial screening test in patients with stroke. It has high sensitivity but low specificity and is a good test to rule in and rule out stroke patients.

Received: September 12, 2021
Revised: July 01, 2022
Accepted: July 05, 2022


Protective Effect of Nigella Sativa on Taurocholate Induced Pancreatitisin Rats

Mehmet Ali Kosekli, Ozlem Ozmen, Sima Sahinduran and Mustafa Yilmaz

Abstract: Introduction: Acute necrotizing pancreatitis with a high mortality rate and the search for treatment continues. We investigated the protective effect of Nigella Sativa (NS), with antioxidant and anti-inflammatory effects, in experimental acute necrotizing pancreatitis.
Materials and Methods: Thirty six male Wistar albino rats (weights 180-220 g) were randomised into four groups. Group 1 (Control): Rats were given standard mouse chow. No pro-drug or pancreatic intervention was performed. Group 2 (NS): In addition to their standard diet, rats were given 0.1 ml/100gr of NS orally for 3 days prior to the experiment. Group 3: Necrotizing pancreatitis was induced by retrograde administration of 3% Na-Taurocholate through the distal common bile duct of the rats on on experiment day. Group 4 (NS+ANP): Necrotizing pancreatitis was also formed in rats receiving 0.1ml/100 mg of NS for 3 days. Rats were given high-dose anesthesia 8 hours after the onset of pancreatitis. Immunohistochemical (TNF-a, MDA, MPO, Caspase), histological pancreatitis scoring and biochemical (LDH, Lipase, amylase) analyzes were performed from the blood and pancreatic tissue samples obtained.
Results: There was no difference in histopathological, immunohistochemical and biochemical values between Group 1 and Group 2 (p>0.05). There were significiant differences between Group 4 and Group 3 in terms of histopathological, immunohistochemical and biochemical parameters (p<0.001). The pancreatitis findings of the Group 4 were found to be significantly milder than Group 3, which did not receive NS.
Conclusion: NS pretreatment alleviates NaTaurocholate-induced experimental pancreatitis. NS firstly studied in experimental models of pancreatitis.

Received: November 29, 2021
Revised: December 23, 2021
Accepted: December 29, 2021


Informed Consent and Shared Decision Making in Women at a Tertiary Care Hospital

Tehmina Parveen, Samar Faheem, Shabnum Hassan and Jawwad Azeem Khan

Abstract: Introduction: Informed consent is an important aspect of ensuring good medical care and patient autonomy. In a developing country, the experience of women is often overlooked when deciding methods for obtaining consent. This study assesses the practice of taking informed consent in a hospital setting and factors that affect decision-making for treatment methods among gynecology patients Pakistan.
Materials and Methods: Women coming to the Hamdard University Hospital gynecology outpatient department or surgery were asked to participate in the study. The questionnarie asked about informed consent, cultural factors, and interaction between the doctor and the patient. The study was conducted for a duration of 5 months. Descriptive statistics were used to analyze the results.
Results: 300 women participated in the study. While all women said that doctors asked for consent before examination, 30.7% said they were not aware they could say no to being examined, 23% said the doctors did not explain the benefits or side effects of the medicines prescribed, and 22.7% were not told about alternative treatments. 91.7% said their husbands signed consent forms for them.
Conclusion: This study highlights the need to improve the practice of taking informed consent in the country, as it involves educating the patient about the intervention before obtaining consent. It is important that doctors keep in mind the cultural factors that influence decisions when obtaining consent and informing patients about their treatments and management.

Received: August 17, 2022
Revised: October 10, 2022
Accepted: October 26, 2022


The Impact of COVID-19 Pandemic in Pakistan

Shabnum Sibtain and Aaleen Azeez

Abstract: Objective: COVID-19 is a public health international emergency. The objective is to gain the understanding on how this virus affects the human body and what were the risk factors affecting the morbidity and mortality.
Materials and Methods: The data was collected from Chaudhry Muhammad Akram research and teaching hospital. The data was collected from the patient notes and the Performa’s were filled. The population for study were in the age range of 30 to 70 years and both males and females were included. The pregnant women were not included in this study. The notes of patients were taken from the year 2021.
Results: This retrospective study included hospitalized patients. The total patients included in this study were fifty. The symptoms studied were fatigue, fever, cough and shortness of breath. All the patients admitted complained of fatigue (100%). 21(42%) patients had fever. 23 patient (46%) complained of cough and 21(42%) had shortness of breath. The male admitted were 31 (62%) and females were 19. (38%) There were 3 patients (6%) admitted in the age ranging from 30-40 years, ten (20%) were 41-50 years, sixteen(32%) were 51-60 years old and twenty one(42%) were 61-70 years old. 40 (80%) patients completely recovered, 2 (4%)patients were referred to other hospital because of lack of required facilities. Twenty patients (40%) admitted had existing medical problem. Eight patients (16%) who were on ventilators had co morbidities like hypertension, diabetes, and obesity died. There were two women and six men who died.
Conclusion: Our study concluded having any comorbidity increased the risk of hospital fatality with COVID-19. The data suggested that more males were admitted as compared to females. The fatality was more in male compared to females. Male sex can be identified as a risk factor for death. Most of patients belonged to group 51-70 years age. The survival rate in our study was 80%.

Received: August 29, 2022
Revised: November 06, 2022
Accepted: November 17, 2022


Association between Diabetes Mellitus and Periodontal Diseases

Sahar Abdelkhalik Elsheikh, Khalid Mahmood Uddin, Shamail Zia, Syeda Alveera Batool and Fahmeeda Khatoon Junejo

Abstract: Objective: Diabetes mellitus (DM) is a serious health burden and its frequency is increasing worldwide. Several complications are related with diabetes mellitus and now periodontal disease (PD) is also considered as DM-related problem. A 2-way association between DM and PDs has been reported. The purpose of this article is to deliver the knowledge relating to the association between DM and PDs. Several researches have been published over the past 50 years in this regard yet more research is obligatory so as to elucidate the two-way relationship trait between DM and PDs.

Received: July 18, 2022
Revised: August 4, 2022
Accepted: August 29, 2022


Sweat Gland Tumors – A Systematic Review on the Histopathology and Immunohistochemistry

Sana Khan, Khalid Mahmood Uddin, Shamail Zia, Cynthia Chizoba Esimoleze, Sarah Khalid, Farozaan Shamail, Fazail Zia, Syed Jawwad Ali and Muhammad Ali Khan

Abstract: Objective: The categorization of sweat gland tumors has been inconsistent over time. These tumors, having varying potential for malignancy, may behave as indolent neoplasms while others can be highly metastatic. The characteristics of most of these tumors are overlapping and the information of distinctive findings about these neoplasms is imperative. Traditionally, sweat gland tumors were classified as eccrine and apocrine only but recently, this has been found that several sweat gland tumors may exhibit eccrine and apocrine types both. Some tumors exhibit further complex features due to the existence of other differential appearances. This can be in the instance of apocrine neoplasms because of the close embryological link between apocrine glands, hair follicles and sebaceous glands and they can be classified as follicular and/or sebaceous tumors. Cutaneous adnexal neoplasms are a diagnostic challenge, especially for tumors with sweat gland differentiation, due to a huge number of uncommon entities, designation of different terms to the identical tumor following to disagreement about the taxonomy and nomenclature of such tumors. This review article provides updated information about various cancerous sweat gland neoplasms with emphasis on recent conclusions for the diagnosis and generalized therapy of such neoplasms.

Received: July 28, 2022
Revised: September 18, 2022
Accepted: September 22, 2022


An Exceptional Case of Cobalamin Deficiency that Presented with Extremely High Indirect Bilirubin Levels

Hamza Kaya, Tuba Taslamacioglu Duman, Gizem Kahveci, Elif Basaran and Gulali Aktas

Abstract: Cobalamin deficiency anemia is a type of anemia that present with weakness, fatigue, icteric sclera and neuropathy. Main causes of cobalamin deficiency are low intake or decreased absorption (gastric and intestinal causes). In present case, we report a 65-year-old male who presented to the emergency department with signs and symptoms of cobalamin deficiency including bilateral peripheral neuropathy, icteric skin and sclera, and abdominal pain in right upper quadrant. He had low cobalamin and extremely high bilirubin levels (8mg/dL) in serum. After the diagnosis of cobalamin deficiency established, 1mg daily cobalamin treatment initiated for five days which would follow weekly and monthly intramuscular injections consequently. Hemolysis and other causes of elevated indirect bilirubin levels were excluded in differential diagnosis. Clinical and laboratory improvements were achieved after the treatment. In conclusion, physicians should kept in mind cobalamin deficiency even in subjects with unusual high levels of indirect bilirubin.

Received: January 25, 2022
Revised: February 16, 2022
Accepted: February 17, 2022


Postpartum Acquired Hemophilia (PAH) – A Rare Entity

Safia Mehmood Khan, Saima Siddiqui and Qurat-Ul-Ain Abedin

Abstract: Objective: Acquired Hemophilia A (AHA) is a rare autoimmune disease that can result in life threatening bleeding. Formation of auto-antibodies (inhibitors) against coagulation factor VIII develops the hemorrhagic syndrome that may appear at any age; however, prevalence of AHA is chiefly observed in post-partum and elderly persons. Idiopathic acquired hemophilia is commonest type of acquired hemophilia whereas it is also associated with autoimmune disease, malignant neoplasm, medication and vaccinations. Post-partum acquired hemophilia (PAH) may develop due to development of antibodies against fetal FVIII. In this case report, 36-year-old Asian woman presented with complain of bruises from 2 months. There was history of cesarean section four months ago. Family history, past medical and drug history were not significant. As there was no active bleeding, patient was started an oral prednisolone along with azathioprine and was counseled regarding disease and precautions. Patient presented after 2 weeks with severe PV bleed, anemia secondary to self-induced medicine abortion.
For this she receives pack cells and cryoprecipitate. Steroids and azathioprine were continued and patient was discharged in stable condition. Her ultrasound pelvis however showed small fibroids. Patient went back to her village where she again develops severe PV bleed and for that she underwent hysterectomy. Patient presented in our hospital with severe operative site bleeding, pain and anemia. She was managed with Packed Red Blood (PRBCs), Fresh Frozen Plasma (FFP), Recombinant Activated Clotting Factor VII (rFVIIa), prednisolone IV and azathioprine PO. Her Activated Partial Thromboplastin, Hemoglobin were continuously monitored. After a week bleeding was stopped but Activated Partial Thromboplastin Time (APTT) was still prolonged so we tapered rFVIIa dose and advice two sessions of plasmapheresis. APTT, hemoglobin levels, inhibitor titer, High-Sensitivity C – reactive protein (hs-CRP) levels were improved. Patient was discharged in a stable condition and was advised to continue medication at home with supportive care and wound dressing.

Received: July 25, 2022
Revised: September 09, 2022
Accepted: September 26, 2022



NJHS Front Page v6.n3
2021 VOL 6 , Issue 3