National Journal of Health Sciences <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> NIBD Publications en-US National Journal of Health Sciences 2519-7053 Covid-19 Vaccination: A Bird’s Eye View <p>Covid-19 pandemic plagued this world since the beginning of 2020 AD. It is caused by a new positive-strand RNA virus of coronaviridae family [1]. It causes Coronavirus disease 2019 (hence the name COVID-19). It is a contagious disease predominantly causes severe acute respiratory syndrome, hence the name SARS-CoV-2. It started from Wuhan, China, in December 2019. Since then, it has spread globally.</p> <p>It is reported to be a new virus therefore it’s properties, pathogenesis, virulence, immunogenicity, variants, and how will host body will react to this virus was unknown. Despite of 22 months since this virus started to spread worldwide, researchers and clinicians continued to learn about it on daily basis. Newer information about it poured in daily in scientific journals as well as in print / electronic media. Mostly, newer information continued to negate earlier information. Social media disinformation continued to confuse the masses.</p> Tahir Sultan Shamsi Mehjabeen Imam Copyright (c) 2021 2021-11-08 2021-11-08 6 1 1 2 Olanzapine in Chemotherapy Induced Nausea and Vomiting <p>Abstract: Objective: Patients diagnosed with cancer and undergoing chemotherapeutic regimen often anticipate many negative effects of the therapy. Chemotherapy induced nausea and vomiting is of their principal concerns which remains one of the most unpleasant, distressing and feared adverse effect. The management of chemotherapy induced nausea and vomiting has always been a challenge for high and moderate emetogenic chemotherapeutic agent. D2 receptor antagonists were the first agents to produce antiemetic effect. Then 5-HT3 receptor antagonist and NK1 receptor antagonist were developed which proved to possess higher selective antiemetic effect compared to D2 receptor antagonist. This review includes the clinical advancements of an atypical antipsychotic agent olanzapine and its role in chemotherapy induced nausea and vomiting. Olanzapine is traditionally used to treat schizophrenia and manic disorder. But recent clinical studies have illustrated its additional therapeutic effect as an antiemetic agent. This advancement may prove to have beneficial effect in managing chemotherapy induced nausea and<br>vomiting and providing a better quality of life to patient being treated with different chemotherapeutic agents.</p> Syed Saad Hussain Fasiha Abdul Rahman Sarmad Iqbal Copyright (c) 2021 2021-11-08 2021-11-08 6 1 26 31 Interim-Guidelines for COVID-19 Vaccination in Hematological Malignancies and Hematopoietic Stem Cell Transplant Recipients <p>Abstract: Objective: Hematologic malignancies such as Acute Leukemias, Myelodysplastic Syndromes (MDS), Myeloproliferative<br>Neoplasms (MPNs), Lymphomas and Multiple Myeloma (MM) can be treated with chemotherapy, Hematopoietic Stem Cell Transplant (HSCT) or Chimeric Antigen Receptor T-cell (CAR-T) therapies with either a curative intent or to prolong survival. The hematologic malignancy itself or the anti-cancer therapies can result in long-term immunodeficiency; COVID-19 infection in this population is associated with a significantly higher risk of hospitalization and death [1].<br>Given lack of available data on COVID-19 vaccination from Pakistan, this guidance is based on the review of safety and efficacy of FDA and CDC approved vaccines for the prevention of COVID-19 disease and recommendations of European Society for Blood and Marrow Transplant (EBMT), American Society for Transplantation and Cellular Therapies (ASTCT) and British Society of Haematology (BSH) for the use of COVID vaccination in HSCT recipients and those with hematological malignancies. The American Society of Hematology (ASH), EBMT, ASTCT and BSH recommends the desired access to vaccines for this highly susceptible<br>group along with care takers, family members, and domestic&amp; everyday contacts when vaccine supply is available.</p> Raheel Iftikhar Uzma Zaidi Copyright (c) 2021 2021-11-08 2021-11-08 6 1 38 43 Non-Institutional Independent Tumor Boards Beneficial Impact on Post-Graduate Medical Training <p>The doctors who are going through our postgraduate residency training programs are tomorrow's specialists who will be<br>playing pivotal roles as healthcare policy decision-makers. To establish site-specific multidisciplinary tumor boards, we<br>have to rely on our present-day resident’s leadership skills. We intend to provide meaningful specific patient-centered<br>goals to our postgraduate students who are our future specialist healthcare providers. We are witnessing a slow positive<br>change towards shared care and the implementation of multidisciplinary culture. This is high time to develop modules<br>with a specific learning objective of providing high-quality leadership skills to all our postgraduate trainees. Effective and<br>efficient team-building skills will enable them to initiate and maintain multidisciplinary professional processes complying<br>with international standards [1].</p> Ahmed Nadeem Abbasi Sohail Rasool Muhammad Tahir Bashir Copyright (c) 2021 2021-11-08 2021-11-08 6 1 3 6 Severe Pancytopenia and Stomatitis Case due to the Treatment with High Dose Methotrexate <p>Abstract: Objective: Methotrexate is used to suppress inflammation in many rheumatologic conditions. Here we present an elderly patient who developed serious side effects due to methotrexate. A 78 year old male admitted to emergency department with oral mucosal bleeding, skin rash, decrease in oral nutrition intake and weakness. He had been using 5 milligrams of methotrexate as 2 tablets twice a day for 10 days, after he was diagnosed with psoriatic arthritis 15 days ago. A diagnosis of methotrexate intoxication established with history, physical examination and laboratory analysis, which revealed pancytopenia. His signs and symptoms, as well as pancytopenia were recovered on 6th day of the hospitalization. He had been treated with folinic acid and filgrastim along with supportive care. Although methotrexate treatment and toxicity is well established it is still a clinical challenge that all clinicians must be aware of. In conclusion, methotrexate intoxication is a clinical entity that can lead to serious clinical consequences, and it is essential to diagnose and initiate appropriate treatment without delay to prevent<br>morbidity and mortality.</p> Burcin Meryem Atak Tel Satilmis Bilgin Ozge Kurtkulagi Gizem Kahveci Recep Aktas Kamile Kurt Tuba Taslamacioglu Duman Gulali Aktas Copyright (c) 2021 2021-11-08 2021-11-08 6 1 32 34 Acute Visual Loss in Young Boy <p>Abstract: Objective: Multiple sclerosis is immune mediated disorder of central nervous system (CNS). Diagnosis of multiple sclerosis is based on clinical findings and investigations, like MRI of CNS. Herein, we presents a 13-year old boy who presented with sudden loss of vision in both eyes for two days duration. The concurrent phenomenon of optic neuritis and multiple sclerosis is less common in children and rarely reported.</p> Muhammad Saeed Memona Mohiuddin Mohammad Hassan Al Sumaili Copyright (c) 2021 2021-11-08 2021-11-08 6 1 35 37 Hypothyroidism is Strongly Correlated with Mean Platelet Volume and Red Cell Distribution Width <p>Abstract: Objective: Hypothyroidism is characterized with insufficient production and release of thyroid hormones, and cause a variety symptoms including cold intolerance, constipation, deceleration in movement, and hair loss. It is associated with increased inflammatory burden. Therefore, we aimed to observe red cell distribution width (RDW) and mean platelet volume (MPV) levels, novel predictors of inflammation, in patients with hypothyroidism and to compare to those in healthy subjects.<br>Materials and Methods: The subjects with hypothyroidism that show up in internal medicine outpatient clinics of Abant Izzet Baysal University Hospital between January 2020 and January 2021 were enrolled to the retrospective study. Healthy volunteers were enrolled as control subjects. MPV and RDW of the study groups were compared.<br>Results: The median RDW level of hypothyroid and control groups were 13.3 (10-20.7) % and 15.3 (11.8-21.3) %, respectively (p&lt;0.001). The median MPV level of hypothyroid and control groups were 10.2 (6.4-12.4) fL and 8.1 (5.4-11.5) fL, respectively (p&lt;0.001). MPV levels greater than 9.47 fL have 80% sensitivity and 72% specificity in predicting hypothyroidism (AUC: 0.66 [95% CI: 0.58-0.74]; p&lt;0.001). RDW levels greater than 13.4% have 80% sensitivity and 50% specificity in predicting hypothyroidism (AUC: 0.67 [0.82 [95% CI: 0.59-0.75]; p&lt;0.001).<br>Conclusion: We suggest that elevated MPV and reduced RDW levels should alert physicians for hypothyroidism in otherwise healthy subjects.</p> Satilmis Bilgin Burcin Meryem Atak Tel Gizem Kahveci Tuba Taslamacioglu Duman Ozge Kurtkulagi Semanur Yurum Asli Erturk Buse Balci Gulali Aktas Copyright (c) 2021 2021-11-08 2021-11-08 6 1 7 10 Knowledge and Attitude towards Infection Prevention at a Newly Established Hospital <p>Abstract: Objective: Health care associated infections are those infections that patients acquire in hospitals during their treatment and health care workers are important source for it. The study was designed to evaluate the knowledge and attitude of Health care workers towards infection control.<br>Materials &amp; Methods: A cross sectional study conducted from December 2019 to February 2020 at NIBD &amp; BMT. Approval was taken from NIBD Research Committee. A pre-designed questionnaire was given to staff that had given informed consent. The questionnaire was composed of two parts. The first part comprised of sociodemographic information and the second part comprising 37 questions of knowledge and 11 question of attitude. Data was analyzed by SPSS version 23. Frequencies and percentages were calculated for categorical variables and mean for quantitative data. Chi-square test was used for association with level of significance as P-value &lt;0.05.</p> <p>Results: A total of 82 health care professionals were interviewed. Out of which 49(60%) were male. The mean age of participants was 28.87 ± 6.4 years. Majority of staff had graduate or above graduate education 40(49%). The overall mean knowledge score was found below average with mean of 18.3±12.3. The mean knowledge scores between age groups (p=0.786), gender (p=0.760) and department (p=0.360) were not found significant. Knowledge score was significantly different among educations level (p= &lt;0.001). 71% were found to have good attitude. Educational status was associated with attitude (p&lt;0.001).<br>Conclusion: Our findings revealed below average knowledge however, attitude was found satisfactory. It is the need of time to organize training and educational sessions in order to minimize the rate of infection for the betterment of health care professionals and patients.</p> Haya Ul Mujtaba Nida Anwar Naveena Fatima Samina Mukry Aisha Jamal Qurat Ul Ain Rizvi Tahir Sultan Shamsi Copyright (c) 2021 2021-11-08 2021-11-08 6 1 11 16 High Fluorescence Lymphocyte Count and Immature Platelet Fraction; “Can these Two Parameters Reliably Distinguish between Dengue and ITP?” <p>Abstract: Objective: Thrombocytopenia is a frequent finding in Dengue fever. Immune Thrombocytopenia (ITP) is a diagnosis of exclusion and is not associated with febrile illness. Ignoring fever, low platelet count and clinical signs may be similar in both conditions. Peripheral film finding in Dengue fever shows many reactive lymphocytes. Enumeration of these reactive lymphocytes as high fluorescence lymphocyte count (HFLC) and computing immature fraction of platelets (IPF) may be useful in differentiating these two disorders as soon as the blood sample is analyzed on XN-1000 hematology analyzer.<br>Materials and Methods: A cross-sectional study was conducted at National Institute of Blood Disease and Bone Marrow transplantation from January to July 2019 during (Dengue season); blood samples from emergency room were analyzed on XN-1000 hematology analyzer for complete blood count and IPF. Samples with thrombocytopenia were checked for IPF count and HFLC from the extended research parameter data of the analyzer. Patients presenting with fever, had Dengue NS-1 tested. Detailed history &amp; examination was recorded from the patients.<br>Results: Out of the 124 patients, 62 (50%) patients of Dengue and ITP respectively. Male to female ratio was 2:1. Mean age in Dengue was 25.52±10.46 years while 34.44 + 20.82 years in ITP group. Mean platelet count was significantly higher in dengue than ITP patients (120.59 ± 80.28 x109/L versus 41.84 ±38.62 x109/L) (p&lt;0.001). HFLC was 11.71± 7.17% in Dengue fever while 0.198±0.25% in ITP patients whereas IPF in ITP group was 21.91 ± 16.09% while 8.79± 4.39%in Dengue patients were found to be significant i.e. (p&lt;0.001).<br>Conclusion: Excluding fever, thrombocytopenia, presence of increased number of HFLC and low or normal IPF can reliably a predictor of a diagnosis in Dengue season.</p> Jawad Hassan Samra Waheed Madiha Abid Tahir Sultan Shamsi Copyright (c) 2021 2021-11-08 2021-11-08 6 1 17 21 Is The Theoretical Knowledge Reflected in Current Practice: Histopathological Helicobacter Pylori Research? <p>Abstract: Objective: Helicobacter pylori (H. pylori) is considered in the category of biological agent directly responsible for cancer.<br>Guidelines recommend discontinuing suppressive conditions prior to histopathological helicobacter pylori testing, but there is little clinical trial data on how outcome is affected if this is not done. Optimal test recommendations in the guidelines are based on in vitro study results. In present study, we aimed to observe whether there was a difference in the prevalence of H. pylori histopathologically in patients who met the necessary prerequisites before Esophago-Gastro-Duodenoscopy (EGD) compared to the subjects group who did not meet the PPI discontinuation condition.<br>Materials &amp; Methods: This retrospective study was conducted between October 2015 and August 2016 in a reference hospital with 1.5 million hinterlands. Patients who underwent EGD by meeting all the prerequisites recommended by the guidelines for the H. pylori test were included in the study group (n=213), and those who discontinued other suppressive drugs except PPI were included in the control group (n=193).</p> <p>Results: While H. pylori was found to be 74.6% positive in the study group that provided all the prerequisites for histopathological H. pylori detection, H. pylori was found to be 64.9% positive in the control group continuing to receive PPI treatment (p=0.02).<br>Conclusion: In conclusion, we suggest that it is necessary to proceed with the guidance of classical knowledge in determining the presence of H. pylori, which is a common public health problem that is up-to-date.</p> Mehmet Ali Kosekli Copyright (c) 2021 2021-11-08 2021-11-08 6 1 22 25