National Journal of Health Sciences 2022-04-05T05:08:20+00:00 Mr. Muhammad Akif Ali Atif Open Journal Systems <p>National Journal of Health Sciences (NJHS) aims to provide a platform that will construct substantial and reliable involvement of the scientific community; NJHS will publish scholarly articles as Open Access related to broad spectrum of research disciplines. NJHS offers a well-organized handling system that will provide the users speed and convenience in publications. Moreover, we will ensure publication of high quality manuscripts via efficient peer review process.</p> <p>The manuscripts that will be published can be accessed easily and free of cost. This will benefit not only the author(s) but readers as well. We are dedicated in the progression of science through widest probable propagation of trustworthy information, and will facilitate researchers that are one of our priorities. It will provide huge amount of free access of the content to scholars and researchers in the field of health sciences. Manuscripts that are clinically relevant will be made publicly available of each issue.</p> The COVID-19: Yet another Viral Spill-Over of Unexpected Consequences 2022-04-04T07:27:44+00:00 Samina Naz Mukry 2022-04-05T00:00:00+00:00 Copyright (c) 2022 Coronavirus – Do We Know Enough? 2022-04-04T09:12:23+00:00 Shahzad Ali Jiskani <p>Coronavirus 2019 (COVID-19), previously called as 2019-nCoV, was emerged from Wuhan, China in December 2019. It is caused<br>by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). By 22 March 2020, 323,265 people were infected from this virus, including 13,745 deaths globally. It is declared as pandemic by World Health Organization as it involved 185 countries of the world. World Health Organization also declared it as 6th public health emergency of international concern. COVID-19 presents as various outcomes; asymptomatic (carrier), pneumonia and acute respiratory disease. People of all ages can be affected from this virus but adult population is observed to be involved in high ratio. Additionally, there is possibility that infection can be spread as nosocomial infection to patients and healthcare workers. On chest imaging, ground – glass opacity with bilateral involvement is seen as most common abnormality in patients with pneumonia. Older patients are prone to develop more severe disease as compared to young population. Patients with underlying chronic co-morbidities are also more prone to develop poor outcome. Till now, specific treatment of COVID-19 is not available; however clinical trials are under investigation to see the clinical efficacy of various therapeutic agents in China e.g. remdesivir and chloroquine etc. At this time, standard infection control measures are only possible means for prevention of SARS-CoV-2.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022 Disturbances in Serum Electrolytes in Type 2 Diabetes Mellitus 2022-04-04T07:30:11+00:00 Shahzad Ali Jiskani Saba Islamaili Khawaja Rizwan Ali Talpur <p>Introduction: Diabetes mellitus is a multi-factorial disease having widespread effect on various functions of body. Electrolyte<br>imbalance is a major problem presenting in diabetic patients due to direct effect of hyperglycemia on these electrolytes.<br>Objective: The aim of this study is to evaluate the electrolyte imbalance in patients with diabetes mellitus type 2.<br>Methods: It is a prospective study, conducted at Department of Pathology, Indus Medical College. Tando Muhammad Khan between the periods of January 2018 to March 2018. A total of 290 patients were included in this study. Group A contains 140 known diabetic patients and Group B contains 150 normal healthy individuals. Blood samples of all patients were evaluated for HbA1c, serum sodium (Na), potassium (K) and chloride (Cl).<br>Results: A total of 290 patients were included in the study. Male to female ratio was higher in both diabetic and control groups. Hemoglobin A1C (HbA1c) was found to be higher in diabetic patients as compared to normal healthy individuals with statistically significant difference (p&lt; 0.001). Sodium (Na) was found to be low in diabetic group as compared to normal healthy individuals with statistically significant difference (p = 0.02). Potassium (K) and chloride (Cl) did not show any difference in diabetic group and normal healthy individuals.<br>Conclusion: Diabetes mellitus has wide diversity of effects on major functions and cellular events. Electrolyte imbalance is a major problem in diabetic patients as disturbs the distribution of cells across the cellular compartments.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022 Efficacy of Hematological Indices for ? Thalassemia Trait Screening in Pregnant Women 2022-04-04T07:39:45+00:00 Maryam Habib Masooma Shaheen Amina Nazir Wardah Aslam <p>Background: ß thalassemia is one of commonest inherited disorder in Pakistan having a carrier rate of 5%. Pregnant women having ß thalassemia trait can have offspring having ß thalassemia major which is lifelong blood transfusion dependent state. Different screening programmes are being carried out in various parts of the world so that the birth of children having ß thalassemia major can be effectively reduced.<br>Objective: To determine the diagnostic accuracy of hematological parameters in identifying ? thalassemia trait in pregnant women keeping measurement of HgbA2 as gold standard.<br>Methods: 108 pregnant women were enrolled during one year of the study period. Blood sample was taken and blood complete picture was obtained. By using variables of CP card Green &amp; King index, Shine &amp; Lal index and RDWI were calculated keeping hemoglobin electrophoresis as gold standard.<br>Results: The age of patients ranged from 17 to 37 years with mean age of 24.65. Out of 108 pregnant women enrolled in study 40 were found to have ß thalassemia trait based on results of hemoglobin electrophoresis. Shine &amp; Lal index showed 100% sensitivity, 0% specificity, 35% PPV and 0% NPV. Green &amp; Kings index had sensitivity of 32%, specificity 100%, PPV of 100% and NPV of 71% while RDWI showed 50% sensitivity, 100% specificity, PPV of 100% and NPV of 77% in diagnosing ß thalassemia trait in pregnant women.<br>Conclusion: Automated cell counters based formula including Green &amp; King index, Shine &amp;Lal index and RDWI provide rapid, reliable and cost effective method for screening of ß thalassemia trait especially in third world countries like Pakistan. However none of them have 100% sensitivity and specificity. So they should be collectively looked at in screening programmes.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022 Adjunct Use of Low Dose Risperidone Verses Adjunct Use of Clonazepam with an SSRI in Treatment of Moderate to Severe Anxiety States; A Comparative Study 2022-04-04T08:33:35+00:00 Naurose Ali Aysha Rasheed Ismail Tariq Farukh Abdullah Ayesha Sarwar Rizwan Atta Zahra Qammer <p>Background: The unprecedented and unaccounted use of benzodiazepines is running havoc in many countries in terms of substance abuse problems and is exponentially increasing. The prescription of benzodiazepines should be minimized and the search for and use of better alternatives be incorporated into clinical practice of Psychiatry.<br>Aim: The aim of this study is to compare the efficacy of low dose risperidone and relatively higher dosage of clonazepam in moderate to severe anxiety states when used in combination with an SSRI.<br>Method: A group of 60 patients having moderate to severe anxiety level, as measured by Hamilton Anxiety Rating Scale (HARS) were randomly divided into two groups. First group was given 1 mg risperidone with 50 mg Sertraline and the second group was given 3 mg of clonazepam with 50 mg Sertraline. The anxiety levels of patients in both groups were again calculated on the 10th post treatment day and compared to each other. Moreover, the Side Effect profiling of Risperidone was also done in all the Patients by using the Glasgow Anti-psychotic Side-effect Scale (GASS)’.<br>Result: The first group had a decrease in the HARS scores having a value of 19.56 between day 0 and day 10. The second group also showed a decrease in the anxiety levels with a mean HARS score of 31.12 on day 0 to 12.36 on day 10. The mean value of decrease in HARS score was comparable.<br>Conclusion: The efficacy of low dose risperidone is comparable to that of relatively high dose of clonazepam in treating moderate to severe anxiety states. Use of risperidone for symptomatic relief from anxiety is a viable alternative to benzodiazepines.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022 Knowledge of Nurses in ENT Related Complications in Non-Dedicated Sub-Specialty Wards 2022-04-04T08:57:13+00:00 Talha Ahmed Qureshi Rahim Dhanani Anwar Suhail Ahad Ahmed Qureshi Zeeshan Ali Shaikh <p>Introduction: In our tertiary care hospital, we do not have a specialized ENT in-patient ward. All ENT patients are accommodated<br>in any of the surgical wards or medical wards. In the event of any complications, we were not sure as to how adept are the nurses in all the wards to handle different situations in ENT patients.<br>Objective: To assess whether there is difference amongst nurses in terms of knowledge of potential ENT related complications and patient care between different wards and formal ENT training.<br>Methodology: Nursing staff involved in routine care of adult patients in general ward and special care units were included in the study. A ten-point questionnaire was used to assess knowledge of nurses in ENT patient care. Participants were approached during the working day and were asked to fill out the questionnaire ‘on the spot’. Each questionnaire was checked and evaluated by two ENT residents and rated out of 10.<br>Result: The average scores of nurses across the wards were not same and there was significant differences (p &lt; 0.01); it was found that in ward b1 nurses scored higher marks compared to those from other wards. Trained nurses were evenly distributed in all wards and there were no association between the distributions of trained nurses across the wards. Positive correlation was observed between the scores and experience of ENT trained nurses.<br>Conclusion: It is advisable to have dedicated ENT and subspecialty wards and provide formal nursing training with respect to managing ENT complications to ensure ultimate patient care.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022 Frequency of Vitamin D Deficiency in Newly Diagnosed Type 2 Diabetes Mellitus Patients 2022-04-04T09:05:28+00:00 Zara-tul-ain Bashir Huma Amjad Syed Tanveer Abbas Gilani Amjad khan Syeda Urooj Riaz <p>Objective: To determine the frequency of vitamin D deficiency in newly diagnosed patients of type 2 diabetes mellitus.<br>Study Design: Prospective case control study.<br>Place and Duration of Study: Department of medicine, Pakistan Navy Ship (PNS) Shifa Hospital Karachi from January to December 2015.<br>Materials and Methods: A total of 302 study subjects were selected, out of which 151 healthy controls while 151 patients included in the study were newly diagnosed type-2 diabetes mellitus with non-probability, consecutive sampling at medical Out Patient Department (OPD) of PNS Shifa Karachi. All controls and newly diagnosed type-2 diabetics were tested for fasting plasma glucose, HbA1C and 25 hydroxycholecalciferol (25(OH) D3 / vitamin D) levels in pathology laboratory of PNS Shifa Hospital. Patients having serum level of 25(OH) D3 &lt; 25 nmol/L was considered as having vitamin D deficiency.<br>Results: Out of total 302 subjects, vitamin D levels of 36 ± 19nmol/L in newly diagnosed type 2 DM cases and of 65 ± 31nmol/L in controls of similar age groups and gender were found significantly lower in newly diagnosed type 2 DM. Vitamin D deficiency was found in 58 (38.4%) cases and 13 (8.6 %) in controls. In 151 newly diagnosed patients of type 2 Diabetes, 73 (48 %) were males and 78 (52 %) were females with mean age of 53.7 ± 8.7 years in both gender. In cases, mean and SD of fasting plasma glucose was 9.2 ± 1.5 mmol/L, HbA1C 9.4 ± 1.4 % and serum 25(OH) D3 36 ± 19 nmol/L. In cases, low vitamin D levels in different age groups and gender was found significant with advancing age predominantly in females. Significant correlation was found between hyperglycemia (HbA1C) and vitamin D deficiency (p-value &lt; 0.001).<br>Conclusion: Higher frequency of vitamin D deficiency was found among patients newly diagnosed as diabetes mellitus type-2 with advancing age especially in females. Vitamin D levels were inversely related to hyperglycemia. Considering such high frequency, screening of diabetic patients for vitamin D deficiency would be beneficial.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022 Central Pleomorphic Adenoma of Mandible – Report of the First Case in a Pediatric Patient 2022-04-04T09:15:33+00:00 Manas Bajpai <p>Pleomorphic adenomas (PA) are the commonest salivary gland tumors of parotid gland. Central pleomorphic adenomas are<br>extremely rare and so far only 7 cases have been reported in the literature; 2 in maxilla and 5 in mandible. The mean age of occurrence of central PA is 58.8, none of the case of central PA in children has been reported in the literature; hence this is the first report of central PA in a child. An 11 year old Indian boy presented with the jaw swelling from 1 year. Radiographic examination revealed a multilocular osteolytic lesion of mandible. A complete surgical removal of the lesion was performed and the defect was restored with reconsctruction plates. Histopathological features were consistent with central PA. Till now this is the first description of central PA in a child.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022 A Severe Hypokalemia Case Due to Ectopic Acth Syndrome Secondary to Small Cell Lung Cancer 2022-04-05T05:00:04+00:00 Edip Erkus M. Zahid Kocak Gulali Aktas Emine Ozsari Selma E. Duzcu Tuba T. Duman Burcin M. Atak Haluk Savli <p>Ectopic adrenocorticotropic hormone (ACTH) syndrome is responsible about 15% of Cushing syndrome cases. Malignant tumors,<br>such as, small cell lung cancer, gastric or bronchial carcinoids, pheochromacytoma, medullary thyroid cancer, are principle causes of ectopic ACTH secretion. Syndrome manifest with impaired glucose tolerance or overt diabetes, hypertension, hypokalemia and lipid disorders. Here we report a subject presented with severe hypokalemia due to ectopic ACTH syndrome, who was diagnosed with small cell lung cancer consequently.<br>A sixty five year old man presented with severe hypokalemia. He was diagnosed with small cell lung cancer. Serum ACTH and cortisol levels of the subject were extremely high. Although chemotherapy initiated, he died due to respiratory failure. Radiologic studies should be ordered to rule out underlying tumoral developments in patients presenting with delirium and hypokalemia. Moreover, hyperglycemia in elderly without prior history of diabetes mellitus should be evaluated for malignant lesions and ectopic release of ACTH.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022 A Case of Long Standing Unusual Elbow Pain, Diagnosed as Glomus Tumor on Biopsy: A Case Report and Review of Literature 2022-04-05T05:08:20+00:00 Masud Ur Rahman Mehtab Ali Shahani Abdullah Osama Mirdad <p>Extradigital presentation of glomus tumors is not common. We are presenting the case report of glomus tumor around elbow and<br>review of literature with regard to its clinical presentation, work-up and management. We also want to highlight glomus tumor as the essential part of differential diagnosis into patients having atypical pain around elbow joint.</p> 2022-04-05T00:00:00+00:00 Copyright (c) 2022