From Global Warming to Global “Boiling” – UN Secretary General

Shahid Kamal

The steady increase in average global temperatures, both on land and sea, coupled with an increasing frequency of extreme weather events is not only endangering ecosystems but now even threatening plants and animal species. Shrinking glaciers, dry spells, heat waves and forest fires compounded by ever increasing greenhouse gases synergistically escalate the problem.
A 0.1°, 0.5°, 1.5° or 2°C rise in temperature may have profound effects. A half a degree or even a few tenths of a degree change may have a dramatic impact – causing dire water shortages, flooding and heat waves. Polar ice caps and coral reefs may be severely impacted by even a 0.5° C rise [1].
The Intergovernmental Panel on Climate Change (IPCC) report states that unparalleled climate changes caused by human activity has increased the planet’s temperature by 1.1°C [1].


Dialysis Termination and Dialysis Dose in Severe Intra-Dialytic Hypotension Managed with Inotropic Support in a Low Income Setting

Peter K. Uduagbamen, Folasade O. Soyinka, Titilope A. Bamikefa, Boladale A. Alalade, Marion I. Ogunmola, Chukwuyerem I. Nwogbe, Tolulope E. Falana

Abstract: Background: Intradialytic Hypotension (IDH) still remains a major complication and burden, and is associated with inadequate dose, poor quality of life, increased morbidity and mortality. Inotropic support could minimize dialysis termination and improve the dialysis dose.
Objective: To determine the impact of inotropic support on the incidence of dialysis termination (a common finding in resource limited settings), and the dialysis dose.
Materials and Methods: This retrospective, observational study compared the dialysis outcome in severe IDH with, and without dopamine treatment.
Results: The 36 participants had 518 sessions with IDH, of this, 405 (78.19%) were without dopamine while 113 (21.81%), with severe IDH, were managed with dopamine. The mean ages of participants in the two groups were not significantly different, P=0.05. The risk of severe IDH was negatively related to the predialysis systolic blood pressure (SBP) P=0.03 while the postdialysis. Blood pressure was higher in dopamine treated sessions (DTSs). The blood flow rate (BFR) and dialysis dose were higher in the DTSs (P=0.05) and (P=0.04), but the dialysis dose was lower with anemia (P<0.001), metabolic acidosis (P<0.001), heart failure (0.04) and diabetes (P=0.04). In DTSs, females were more likely to have lower dialysis doses, (P=0.02). Independent associates of inadequate dialysis dose were infrequent dialysis sessions, infrequent erythropoietin doses, metabolic acidosis and anemia. Conclusion: Managing severe intradialytic hypotension with low dose dopamine is associated with reduced frequency of dialysis termination and augmentation of the dialysis dose. Reductions in the intradialytic BP gradients could minimize the complications associated with wide intradialytic BP variations.

Received: May 05, 2023
Revised: July 17, 2023
Accepted: July 19, 2023


The Relationship between the Severity of Lumbar Spinal Stenosis and Levels of Vitamin D and Parathyroid Hormone

Zeliha Cosgun, Yasar Dagistan, Emine Dagistan, Melike Elif Kalfaoglu, Caner Cicek

Abstract: Background: It is known that parathyroid hormone (PTH) and vitamin D have a wide variety of effects on bone metabolism. However, the levels of PTH and vitamin D in patients with lumbar spinal stenosis (LSS) have not been adequately investigated in the literature.
Objective: The objective of this study was to investigate the relationship between PTH and vitamin D levels and the severity of stenosis in patients with LSS.
Materials and Methods: This retrospective observational study included consecutive patients who presented to the Neurosurgery outpatient clinic with chronic leg pain and low back pain and were diagnosed with LSS between January 2019 and July 2022. Patients were categorized into three groups based on their vitamin D and parathyroid hormone status. Group 1: High parathyroid hormone and Low vitamin D levels; Group 2: Normal parathyroid hormone and low vitamin D levels; Group 3: Normal parathyroid hormone and vitamin D levels. There were 17 (37%), 10(22%), and 19(41%) subjects in groups I, II, and III, respectively.
Results: The mean age of the groups with a total of 46 patients I, II and III were 62.2±11, 58.3±6, and 63.2±6.4 years, respectively (p=0.553). Sex of the study groups was not statistically different, either (p=0.079). Spinal canal AP diameter (p=0.002) and ligamentous interfacet distance (p=0.008) were significantly different in study groups. Vitamin D positively correlated with Spinal canal AP diameter (r=0.56, p<0.001) and ligamentous interfacet distance (r=0.51, p=0.003), while PTH was inversely correlated with them (r=-0.33, p=0.020), ( r=-0.47, p=0.007). Conclusion: Vitamin D is significantly correlated with the diameters of spinal canal AP and ligamentous interfacet distance. PTH is negatively correlated with the diameters of spinal canal AP and ligamentous interfacet distance..

Received: June 09, 2023
Revised: August 31, 2023
Accepted: September 01, 2023


Assessment of Average Length of Stay among Stroke Patients in a Tertiary Care Hospital

Muhammad Irfan Hashmat, Muhammad Owais Hashmat, Jay Singh Rana, Imran Rafiq, Mohsina Syed

Abstract: Background: Stroke is defined as a clinical syndrome where sudden onset neurological deficit appears and remains for 24 hours or more due to vascular compromise. Stroke is the leading cause of disability worldwide and the second leading cause of death. Certain risk factors have been discussed in the literature previously which are strongly associated with stroke. However, the literature is scarce in terms of risk factors affecting the hospital stay of patients suffering from stroke.
Objective: The objective of this study is to evaluate the risk factors that may affect the hospital stay in stroke patients.
Materials and Methods: This study was conducted prospectively at Aga Khan University Hospital, Karachi where length of hospital stay among stroke patients were included. The length of hospital stay (LOS) was found and compared by dividing the included participants into subgroups including age (30-50 and 51-80), gender (male and female), diabetes mellitus type II (yes or no), hypertension (yes or no), duration of disease (2 days), smoking (yes or no), BMI, and type of stroke (ischemic or hemorrhagic).
Results: We included 94 stroke patients. The LOS in hospital was significantly associated with age (P=0.01), gender (0.01), diabetes mellitus type II (P=0.04), smoking (P=0.01), BMI (P=0.01) while it was not associated significantly with hypertension (P=0.09), duration of disease (P=0.05) and type of stroke (P=0.08).
Conclusion: LOS after stroke differed according to the sex, age, diabetes mellitus type II, and BMI. Hence, BMI and smoking are modifiable risk factors that could decrease the LOS while more efforts can be made to control blood sugars at optimum levels for further decreasing the LOS.

Received: February 27, 2022
Revised: September 13, 2023
Accepted: September 23, 2023


Perception and Attitude of Dental Students and Graduates towards Business Management as a Subject in the Dental Curriculum

Hammad Hassan, Hiba Mukhtar, Salman Aziz, Haseeb Mukhtar, Taha Tarin, Asma Shakoor

Abstract: Background: In the past two decades, dentistry has transformed into a market-driven, entrepreneurial industry; consequently, the next generation of dentists must demonstrate proficiency in the disciplines of dental economics.
Objective: To identify the attitude, awareness, and willingness of final-year dental students and dental graduates regarding dental business management as a subject in dentistry.
Materials and Methods: This cross-sectional study was conducted from April 22 to September 22, with the approval of the IRB of CMH Lahore Medical College. The survey was conducted using online questionnaires developed by the authors and sent to the final-year dental students and young dental graduates in private and public dental colleges. The first part targeted demographics, and the second part dealt with attitude, awareness, and willingness regarding dental business management as a subject.
Results: A total of 281 people responded, with 48.6% males and 53.4% females. Lack of business knowledge (n=198, 70.5%) and a lack of funds (n=157, 55.9%) were key obstacles. Most respondents were slightly aware (n=141, 50.2%) of the criteria for setting up a dental practice. 95.7% (n=267) were not taught dental business management, nor had any seminars (n=187, 66.5%) or workshops (n=184, 65.5%). Most respondents agreed (n=243, 86.4 %) that business management will help them establish a successful practice. A significant difference was observed between private and public institutions regarding lack of funds, confidence, and communication skills.
Conclusion: Most students had favorable opinions on dental business management as a subject in dentistry. We must teach aspiring dentists both dental education and business management at the same time.

Received: May 18, 2023
Revised: July 26, 2023
Accepted: July 31, 2023


Clinical Profile and Predictors of Outcome of Guillain Barre Syndrome Variants among Children Admitted in the Pediatric Department of a Tertiary Care Hospital, Karachi

Muhammad Rafique, Sharmeen Nasir, Zareen Qasmi,Waseem Jamalvi

Abstract: Background: Guillain Barre Syndrome (GBS) is one of the leading cause of Acute Flaccid Paralysis presenting in pediatric emergency, marking incidents in Asian countries as 3-4 per 100, 000 population. To improve outcome, an accurate and early recognition of predictors of bad prognosis is required.
Objective: To identify requirement of intensive monitoring and aggressive treatment to help the health system in decreasing morbidity and mortality associated with Guillain Barre Syndrome.
Materials and Methods: This is a cross-sectional study, conducted at Dr. RKMP Civil Hospital Karachi. Medical records of patients >3 months to 12 years of age, admitted with diagnosis of Guillian Barre syndrome from Jan 2017 to June 2022 were reviewed. Data was analyzed in SPSS version 23. For independent variables, frequency and percentage was used.
Results: A total of 46 patients were enrolled in the study, mean age of study participants was 80.26 ± 31.7 months. The most common variant of GBS identified was AIDP in 19 (41.3%) followed by ASMAN 14 (30.4%). A positive association between winter season with 2.7 (95% CI 1.4-5.8) and progression within 7 days with 3.2 (95% CI 1.9-6.7) was found with mortality.
Conclusion: Acute inflammatory demyelinating polyneuropathy was the most common variant of Gullian-Barre syndrome with male predominance. Presentation in winter seasons and progression of disease in less than 7 days are risk factors for mortality. Bulbar palsy is an independent risk factor for mechanical ventilation, irrespective of GBS variant.

Received: May 29, 2023
Revised: July 27, 2023
Accepted: July 27, 2023


The Impact of COVID-19 on Orthodontic Practitioners and their Practice in Pakistan

Yusra Shaukat, Um-e-Ayman, Afeef Umar Zia, Hafiz Muhammad Talha Arshad

Abstract: Background: The Coronavirus pandemic is an ongoing coronavirus disease epidemic that had a profound effect on the healthcare system. When the epidemic first spread widely in Pakistan in March 2020, many dental offices went on an emergency-only closure schedule. Changes were evident even after they reopened..
Objective: Primary objectives were to ascertain the consequences of COVID-19 pandemic on Orthodontic practitioners and their practice in Pakistan; how their psychological and financial well-being was affected, and to bring light to the perception of Orthodontists regarding the impact of the COVID-19 pandemic on future of Orthodontists. Secondary objectives were to see if there was any difference in impact between male and female participants and Orthodontic Consultants and Orthodontic Residents.
Materials and Methods: This cross-sectional study was conducted among the Orthodontic community of Pakistan. It included 183 participants which comprised 41 Orthodontists and 142 Orthodontic Residents. A self-administered online questionnaire (Google forms) was circulated. Chi-square test was used to compare qualitative variables. P value less than or equal to 0.05 was considered significant.
Results: This study showed that 80% of the participants stopped their Orthodontic practice during the lockdown period. The majority of the practitioners had a negative impact on their psychological well-being. A significant difference was noted between male and female professionals’ responses(p=0.021). Most of the residents reported having a negative impact on their training as well..
Conclusion: The need for more training programs for infection control cannot be emphasized enough to prevent all the adverse effects caused by such outbreaks.

Received: April 26, 2023
Revised: July 08, 2023
Accepted: July 11, 2023


Multi-Disciplinary Management of Hidradenocarcinoma

Mariam Hina, Asra Hasan, Maria Tariq, Muhammad Muaz Abbasi, Muneeb Uddin Karim

Abstract:Hidradenocarcinoma makes up 6% of eccrine malignancies, and is an uncommon eccrine sweat gland tumour. The etiology is due to genetic alterations and transformation from an existing lesion or hidradenoma. It typically affects the face and scalp, although it can also cause nodal involvement and show up on the trunk, abdomen, or groin. Due to its similarities to other skin tumours, it is challenging to diagnose histopathologically. Therefore, immunohistochemical markers, such as p53, Ki-67, keratin AE1/AE3, and cytokeratin 5/6, are crucial for the diagnoses. There are no prospective randomized trials available to direct treatment of hidradenocarcinoma. A key component of therapy is early diagnoses and case discussion in multidisciplinary tumor board. Wide local excision with clear margins is the mainstay of treatment. Adjuvant treatment like chemo radiation therapy is incorporated if nodal disease or positive margins are present. Recurrences are treated by re-excision followed by adjuvant radiation therapy. Adjuvant hormonal therapy depends on the receptor status of the disease. These tumors have a 50% recurrence rate and up to 60% of the time they metastasize to the brain, bone, lung, liver, mediastinum, or peritoneum in a two-year period. The overall five year survival rate is around 30%. Keeping in view the aggressive course of this disease, research based clinically evident new treatment strategies are the need of time to optimize overall survival and local disease control.

Received: June 01, 2023
Revised: September 14, 2023
Accepted: September 14, 2023


Different Covid-19 Vaccines in Pakistan: Administration and Effectiveness

Anwaar Iftikhar, Muhammad Farooq Sabar, Quart ul Ain Ahmad, Rida Farooq, Mubeen Akhtar

Abstract:Pfizer-BioNTech, Moderna, Sputnik V (typically manufactured in Russia), CoronaVac (China), Sinopharm (China), Vaxzevria, and Cansino (both made in China) are among the vaccines that have been certified for emergency use in several countries. All of the above vaccinations were authorized to Pakistan, bypassing Pfizer and Moderna. The effectiveness, safety, mechanism of action, dosage, and availability of mandatory vaccines in Pakistan up to May 20, 2021. We searched PubMed and Google Scholar for all known material on COVID-19 vaccinations. We also looked at grey literature papers. Instead of Pfizer and Moderna, Pakistan has approved all the preceding vaccines. Moderna and Pfizer were determined to be the most effective among all vaccinations, with 90% effectiveness, followed by Vaxzevria, Sputnik V, Sinopharm, and Cansino. All immunizations have caused lesser bad effects like fever, injection site pain, or headaches. Further clinical studies are being done throughout the world to combat the epidemic. In large populations, public attention plays a critical role in vaccination efforts.

Received: May 09, 2023
Revised: August 22, 2023
Accepted: August 23, 2023


A Case Report of Spinal Cord Edema and Cervical Spondylosis Masquerading as Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

Muhammad Sohail Ajmal Ghoauri, Nauman Ismat Butt, Dur-e-Sabeh, Muhammad Bilal Rasheed, Muhammad Umair Javed, Faizan Ali Khan

Abstract: A 64-year-old previously-healthy male presented with 2-year history of progressive neurological symptoms of numbness and muscle weakness involving all 4 limbs. There was gait disturbance, urinary and fecal incontinence. On examination, the left upper limb had normal tone, diminished deep tendon reflexes and power of 4/5 with wasting both in proximal and distal muscles. There were reduced pinprick pain and temperature sensations below the elbow bilaterally with intact vibration and proprioception. Both lower limbs had increased tone, diminished deep tendon reflexes, power of 3/5 with wasting both in proximal and distal muscles with unequivocal plantar reflex bilaterally. There were reduced pinprick pain and temperature sensations below the knee on right and below the ankle on left with intact vibration and proprioception. Nerve Conduction Studies (NCS) were done which showed axonal type of denervation in all limbs. MRI scan of Cervical Spine showed T2W hyperintense signals and narrowing of spinal canal from C3 to C7 region. The final diagnosis was spinal cord edema in the cervical region and cervical spondylosis causing spinal cord compression.

Received: March 26, 2023
Revised: September 14, 2023
Accepted: September 14, 2023



NJHS Front Page v8.n2
2023 VOL 8 , Issue 3