Leadership Skills Development & Establishment of Multi-Disciplinary Team (MDT) Tumor Boards

Shahid Kamal

Leadership and managerial skills have long been identified in the developed countries as essential components of their post graduate trainees to enable them to meet the challenges of modern health care systems. However, health care systems in LMIC have their own challenges. Certain models such as public, public-private partnerships, private, welfare and insurance-based systems do exist in this part of the world, but comprehensive and efficient integration is still lacking. Cancer patients depend largely upon public sector facilities already over-burdened by long waiting list.



The Role of Hemogram Parameters in Predicting Sentinel Lymph Node Metastasis in Breast Cancer

Bahri Ozer, Adil Koyuncu, Songul Peltek Ozer, Oguz Catal and Mustafa Sit

Abstract: Background: Breast cancer remains the second most common cancer in the world after lung cancer. Breast cancer rate in Turkey was 40-50 / 100.000 in the west, and was 20 / 100.000 in the east.
Objective: In our study, we aimed to investigate the prediction of hemogram parameters in showing sentinel lymph node metastasis.
Materials and Methods: Patients undergoing sentinel lymph node biopsy (SLNB) with the diagnosis of breast cancer between January 2015 and August 2019 in General Surgery Department of Abant Izzet Baysal University were retrospectively analyzed in present descriptive study. The patients were divided into two groups, SLNB positive and negative. The measured hemogram parameters were compared between these two groups. Analysis of the data was held with a statistical software (SPSS 18.0 for Windows, IBM Inc., Chicago, IL, USA).
Results: A total of 93 patients were included in the study. The average age of SLNB positive and negative patients were 55 (30-81) years 59 (35-88) years respectively. In detecting SLNB positivity, sensitivities and specificities of Tumor diameter> 0.9 cm were 72% sensitivity, 56% specificity, of CRP> 0.65 mg/dL were 76% sensitivity, 51% specificity, of RMR> 1.85 were 72% sensitivity, 46% specificity, of RDW> 15.45% were 75% sensitivity,% 42 specificity, of PLR> 106.5 were 72% sensitivity, 56% specificity.
Conclusion: Since auxiliary metastasis is one of the most important points for the prognosis of breast cancer, we suggest PLR, RDW, RMR could serve as prognostic factors in determining lymph node metastasis along with CRP and tumor size in breast cancer.

Received: November 10, 2022
Revised: February 03, 2023
Accepted: February 07, 2023



Correlation of Blood Groups and Intelligence Quotient Levels among Medical Students

Erum Afaq, Mariam Sajjad, Navaira Shoaib, Naveen Azhar, Arooma Shaukat Siddiqui, Ayesha Hussain and Hira Fatima Waseem

Abstract: Background: Blood group and intelligence are both highly heritable traits unique to each individual. For the past several years, a possible correlation between these two traits has been suggested but existing studies report contrasting results in different geographical populations.
Objective: To investigate a potential relationship between blood group and intelligence among consenting medical and dental students of Dow University of Health Sciences, Karachi.
Materials and Methods: This study is a cross-sectional study involving the MBBS and BDS students of Dow University of Health Sciences within age group of 18-21 years. The study was conducted in the department of Physiology, Dow Medical College (DUHS) from 15th February 2021 to 1st July 2021. After the Institutional Review Board’s approval, we determined the ABO and Rh blood group of the participants through test tube method (forward grouping) during the physiology practical sessions. Intelligence levels were assessed using the Stanford Binet IQ Test. SPSS 21 was used to analyze the data collected.
Results: Out of 353 participants, 67 (18.98%) were male and 286 (81.01%) were female with a mean age of 20 years. We found highest IQ scores in blood group A negative (25.80±8.25) with no statistical significance (p=0.162). Moreover, there was no statistically significant difference between the intelligence of male and female participants (p=0.257).
Conclusion: Blood group and intelligence of an individual are two heritable traits that are not linked with each other. There is no difference in the IQ of males and females. This finding has important implications in the educational field as it shows that male and female students of different blood groups have similar cognitive capabilities and consequently, similar educational needs.

Received: February 09, 2023
Revised: March 04, 2023
Accepted: March 08, 2023



Risk Factors Associated with Conversion of Laparoscopic to Open Cholecystectomy

Hira Moosa, Dileep Kumar, Mohammad Naeem, Syed Baquer Rivzi, Irtiza Ahmed Bhatti,
Shabina Jaffer and Shamim Qureshi

Abstract: Background: Gallstones disease is one of the major problem of gastro intestinal tract and surgical removal is usually advised. Surgery is usually laparoscopic but if the dissection is tedious, laparoscopic procedure can be converted into open procedure.
Objective: This study aims to assess the reasons and risk factors for the conversion of laparoscopic cholecystectomy (LC) into open cholecystectomy (OC).
Materials and Methods: A prospective assessment of medical records of patients who underwent laparoscopic cholecystectomy at ward-2, Jinnah Postgraduate Medical Centre from January 2019 to December 2021 was undertaken to identify indications of all laparoscopic cholecystectomies converted to open cholecystectomy and assess operative time and length of hospital stay of these patients.
Results: A total of 984 elective cholecystectomies were performed in which 85.5% (n=841) were females and 14.5% (n=143) were males. Male to female ratio was 1:5.8 with conversion rate 0.40 % (n=04) and 4.36% (n=43) respectively. Laparoscopic cholecystectomy was done in 95.22% (n=937) cases while 4.78% (n=47) patients required conversion to open cholecystectomy with major pre-operative risk factors being acute cholecystitis (p<0.001), history of acute cholecystitis (p=0.012), history of acute pancreatitis (p=0.007), history of previous open surgery (p<0.001) and major per-operative risk factors being severe bleeding (p<0.001), dense adhesions (p=0.755), distorted anatomy (p<0.001), visceral damage (p<0.001) and biliary injury(p<0.001).
Conclusion: We have identified some important risk factors for the conversion of surgical approach for acute cholecystitis. However, the open approach should be done by experienced surgeons when necessary. The overall impact of the study is to identify the patients who are the risk of conversion into open preoperatively so that proper arrangement and counseling should be done.

Received: February 09, 2023
Revised: February 28, 2023
Accepted: March 02, 2023



Measuring Emotional Intelligence in First Year Medical Students

Kainat Javed, Umair Bin Nasir and Arooj Javed

Abstract: Background: The term emotional intelligence is being used more often in the medical field and different healthcare-related fields. The evaluation of emotional intelligence is crucial in assessing how well students adjust and perform academically. Neglecting this stage of life can result in psychiatric issues or make them worse, as well as failure in social and academic situations.
Objectives: To evaluate first-year medical students’ emotional intelligence (EI) and determine how it relates to their social and personal characteristics.
Materials and Methods: This cross-sectional study included 166 first-year medical students and took place at University College of Medicine and Dentistry between September and December 2022. Ethical approval was obtained from the ERB committee before the study was conducted. A proforma was used to collect social and demographic information, while an emotional quotient self-assessment checklist was used to assess participants’ emotional intelligence, rated on a five-point Likert scale. The collected data was then subjected to statistical analysis.
Results: Out of 166 students approached in the first year class, 149 (79 females and 70 males) participated in the study with an average age of 19.12 ± 0.69 years. Results showed that 33.6% of the first-year medical students scored below the 20 cutoff in all emotional intelligence domains. Those who reported making a conscious career choice, getting adequate sleep, and engaging in more social and physical activity than average had higher emotional intelligence scores (p=0.05). Additionally, females had significantly higher emotional intelligence scores compared to males (p=0.02). A positive correlation was observed among the various emotional intelligence domains.
Conclusion: Good emotional intelligence comprises the capacity to comprehend and regulate emotions, to be empathic, to be emotionally aware, and so on. These traits enhance general communication abilities, which enhance performance in the medical training.

Received: January 09, 2023
Revised: March 02, 2023
Accepted: March 02, 2023



Diagnostic Accuracy of NIHSS Score in Predicting in-Hospital Mortality in Patients of Ischemic Stroke taking Actual in-Hospital Mortality as Gold Standard

Umaima Waris, Nauman Ismat Butt, Tehreem Shafqat, Sehrish Hameed, Mohammad Sohail Ajmal Ghouri and Aniqa Anser

Abstract: Objective: To determine the diagnostic accuracy of NIHSS score for predicting in-hospital mortality among patients of ischemic stroke taking in-hospital mortality as gold standard.
Materials and Methods: The present cross-sectional study was carried out from May 2020 to November 2020 at Medicine Department, Services Institute of Medical Sciences Lahore. A total of 142 patients aged 30-70 years of both sex with ischemic stroke patients as per-operational definition of duration ?24 hours were enrolled. Patients of hemorrhagic stroke, cardiac disease and CRF were excluded. After taking informed consent, NIHSS score was evaluated in each patient and in hospital mortality will be noted. All patients were followed by the researcher herself and in hospital mortality was noted.
Results: Mean age was 53.5+9.2 years with74 (52.11%) females. Mean disease duration was 6.8+1.7 hours and mean NIHSS score was 24.3+7.1. NIHSS score was evaluated in each patient and found 75 True Positive while 06 False Positive. In the 61 NIHSS score negative patients, in-hospital mortality was seen in 06 (False Negative) while 55 (True Negative) did not have in-hospital mortality (p-value <0.001). The Specificity, Sensitivity, Negative Predictive Value (NPV), Positive Predictive Value (PPV) and diagnostic accuracy of NIHSS score to predict in-hospital mortality among patients of ischemic stroke taking in-hospital mortality as gold standard was 92.59%, 90.16%, 92.59%, 90.16% and 91.55% respectively.
Conclusion: Diagnostic accuracy of NIHSS score in predicting in-hospital mortality in ischemic stroke patients is quite high.

Received: January 16, 2023
Revised: February 28, 2023
Accepted: March 02, 2023



Platelet Rich Plasma Effects on Diabetic Foot Ulcers – A Review

Shamail Zia, Abdul Salam, Sanam Nusrat, Muhammad Hamza Khan, Venkata Anirudh Chunchu, Hassan Nawaz, Danial Hassan, Tatheer Zehra, Fazail Zia, Farozaan Shamail

Abstract: Utilizing platelet rich plasma, one of the newest autologous cellular therapies, as an adjuvant therapy in a regenerative medicine management, can be very beneficial. Patients with complications like osteoarthritis, spinal disorders and musculoskeletal problems still facing global lacking in the area of tissue repair strategies. Along with this another major complication associated is with diabetic patients – the development of diabetic foot ulcers that predisposes to limb amputation. To advance the healing process and prevent the patients from progressing towards amputations. Besides many other approaches used. Platelet Rich Plasma (PRP) therapy is attaining momentum, which is composed of platelet growth factors that assist the wound healing cascade – inflammation, proliferation and remodeling. It may occur because of provision of vital growth factors necessary for healing. Currently, variety of PRP formulations have been assessed. The article intends to evaluate the PRP effectiveness for managing diabetic ulcers.

Received: January 11, 2022
Revised: February 06, 2022
Accepted: February 07, 2022



Management of Malignancy Associated Superior Vena Cava Syndrome in the Emergency Department

Muhammad Muaz Abbasi, Mutahir Tunio and Farrukh Irshad

Abstract: Objective: The objective of this article was to do a review of the available literature on Malignancy associated Superior Vena Cava Syndrome (SVCS), and provide a quick effective guide on the latest approaches on management of patients presenting in the Emergency Room with SVCS.
Methods: Multiple documents were identified which were published with regards to SVCS, Emergency Management of SCVS and case reports. All the papers were studied and latest diagnostic methods and management protocols were identified and extrapolated from the literature.
Results: Of approximately 30 papers shortlisted that were written on SVCS, newer ways of identifying and managing SVCS is the ER (specifically) were collected and presented. Newer therapies i.e. External Beam Radiation Therapy via Photons in the Emergency setting, Multidisciplinary approach to Malignancy associated SVCS were discussed along with traditional symptoms relief measures.
Conclusion: Both adults and children who present with the signs and symptoms of SVCS in the emergency room require extra care and multidisciplinary management.

Received: September 02, 2022
Revised: January 01, 2023
Accepted: January 26, 2023



A Case of Celiac Disease Admitted to Our Clinic with Symptoms of

Burcin Atak Tel, Tuba Duman, Gulali Aktas, Satilmis Bilgin and Mustafa Ramiz Tel

Abstract: Celiac disease is an immune-mediated chronic intestinal disease that causes atrophy of the intestinal mucosa by ingestion of gluten and related proteins in genetically susceptible individuals. Presentation of the illness can differ from a severe malabsorption to mild symptomatic and even asymptomatic. The only treatment for celiac disease is to follow a strict gluten-free diet for life and it is not a cure. A 37-year-old female patient was followed up with the diagnoses of irritable bowel syndrome and dyspepsia applied to our outpatient clinic with severe malabsorption symptoms. She was diagnosed as celiac disease. Celiac disease should be questioned in all patients presenting with dyspeptic complaints. With a simple treatment, the quality of life increases significantly.

Received: January 01, 2023
Revised: March 08, 2023
Accepted: March 10, 2023



Cutaneous Epithelioid Angiomatous Nodule with Unusual Localization

Songul Peltek Ozer

Abstract: Brenn and Fletcher described cutaneous epithelioid angiomatous nodule (CEAN) as a benign vascular proliferation that was in 2004. It is very rare condition. It is characterized by endothelial cells that have histiocytoid appearance. It is generally found in the dermis or sub cutis and rarely, in visceral organs. Despite the etiology of CEAN is not clear, it is considered as a reactive entity and no association with either infection, trauma or immunosuppression has been described yet. A 76-year-old woman visited hospital for routine examination. The physician noticed an erythematous nodule on the upper part of her right labium minus which appears like a cystic lesion. Histopathological examination revealed a relatively circumscribed, unencapsulated, unilobular vascular lesion which is in the superficial dermis. There were also moderately lymphoplasmacytic infiltration on the background. There were also scattered extravasated erytrocytes around. Positive stained for CD34, CD31 and negative stained for HHV-8 (performed to rule out a possibility of Kaposi sarcoma), pancytokeratin and s-100 were prominent in epithelioid cells. The overall histopathological appearance was consistent with CEAN and there was not any previous report CEAN occurring at this area.

Received: January 11, 2023
Revised: February 14, 2023
Accepted: February 17, 2023




NJHS Front Page v8.n1
2023 VOL 8 , Issue 1