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 Onco-Fertility Tumor Board is Vitally Important for Addressing Fertility Issues in Cancer Patients <p>Some cancers and some cancer treatments can lead to temporary or permanent infertility. Infertility is a special issue which need to be considered and addressed in cancer patients who may face this issue due to their malignancy itself or due to the treatment offered to them. Our team had reviewed contemporary literature and came to the opinion that it is vitally important to establish a specialized board of experts who can have regular board meetings in which all selected cases of cancer patients are discussed who can potentially suffer from some form of temporary or permanent infertility. The relationship between infertility and cancer is being documented in various studies and systemic reviews published lately [1, 2]. Counselling of patients and their next of kin is also an important aspect of this proposed multi-disciplinary team (MDT) Board .Before making any consideration regarding the relevance of the issue of infertility in selected cases of cancer the multidisciplinary team has to develop robust processes in order to make sure that we will not be missing this important problem which our cancer patients may face at the time of diagnosis, treatment or later on as a late sequela of oncological treatment. Practice committee on onco-fertility consortium made clear recommendations highlighting the importance of expert team involvement. The proposals are being published in January 2021 issue of Journal of assisted reproduction [3]. This document provides a valuable insight regarding the establishment healthcare quality processes and their practical implications.</p> Ahmed Nadeem Abbasi Fatima Shaukat Sehrish Abrar Bilal Qureshi Nasir Ali Asim Hafiz Hina Hafiz Copyright (c) 2021 2021-07-12 2021-07-12 5 4 146 147 Pediatric Chronic Myeloid Leukemia with Megakaryocytic Blast Crisis as Initial Presentation: Case Report and Review of Literature <p>Abstract: Background: Pediatric Chronic Myeloid Leukemia (CML) is a rare entity accounting for 2-3% of pediatric malignancies. CML rarely presents as Blast Crisis (BC) at the time of diagnosis, and megakaryocytic blast crisis is even rarer.<br>Case Presentation: We herein, report a case of a young female, 10-year-old who presented with anemia, leukocytosis and massive<br>splenomegaly. Clinical features, peripheral film and bone marrow findings were consistent with CML in megakaryocytic blast crisis. Bone marrow cytogenetic analysis revealed karyotype of 46, XX, t(9:22)(q34;q11.2) in 20 metaphases and BCR-ABL P210 by PCR was detected with transcript level of 83%, which further confirmed our diagnosis.<br>Conclusion: De novo presentation of chronic myeloid leukemia with megakaryocytic blast crisis is rarely observed in pediatric population with very few cases published till now. We are presenting this case because of its rarity, likelihood of misdiagnosis as AML (M7) and poor prognosis, if not treated precisely.</p> Tuba Iqbal Amber Younus Uzma Zaidi Jawad Hassan Tahir Sultan Shamsi Copyright (c) 2021 2021-07-26 2021-07-26 5 4 171 174 Variceal Bleeding in Patients with Initation of Sofosbuvir and Ribavirin – Case Reports <p>Abstract: Sofosbuvir is an oral nucleoside analogue and potent inhibitor of the Hepatitis C virus (HCV) RNA polymerase that is used in combination with other antiviral agents to treat chronic Hepatitis C Nevertheless, and for unknown reasons, successful antiviral therapy of Hepatitis C with Sofosbuvir and other direct acting agents in patients with cirrhosis is occasionally complicated by hepatic decompensation. Here we describe 2 case report of upper gi bleed at initial days of treatment with Sofosbuvir and Ribavirin.</p> Sadiq Memon Madiha Zaki Shahzad Ali Jiskani Copyright (c) 2021 2021-07-26 2021-07-26 5 4 175 176 Median Arcuate Ligament Syndrome: An Exceptional Cause of Abdominal Pain <p>Abstract: Median Arcuate Ligament Syndrome (MALS) is caused by the compression of celiac artery by median arcuate ligament and may cause serious symptoms; such as abdominal pain and weight loss. Here we present a 56 year old man with MALS, whom suffered of postprandial abdominal pain, weight loss, nausea and vomiting. Laparoscopic surgery revealed his symptoms after MALS diagnosis was established. In conclusion, MALS should be considered in the differential diagnosis of patients with complaints of postprandial abdominal pain, nausea and weight loss. Laparoscopic surgery could be as successful as other treatment options in these patients.</p> Satilmis Bilgin Gulali Aktas Ozge Kurtkulagi Tuba Taslamacioglu Duman Burcin Meryem Atak Gizem Kahveci Mehmet Zahid Kocak Haluk Savli Copyright (c) 2021 2021-07-26 2021-07-26 5 4 177 179 A Case Report: An Overweight Patient with High Dose Insulin Usage <p>Abstract: Insulin is vital for patients with type 1 diabetes and useful for certain patients with type 2 diabetes [1]. In this article we aim to explain a case wrongly using high dosage insulin. A 68-year-old female patient with known 10 years of type 2 diabetes mellitus and hypertension came to our outpatient clinic because her blood glucose levels were high at home. She was using perindopril 10 mg, metformin and insulin. Since the patient did not want to make multiple injections her previous doctor has changed her therapy from glargine u300 1x50 units and insulin aspart 3x30 units to a mixed insulin; insulin degludec + insulin aspart, as 2x 40 units per day. However, the patient did not understand the change of treatment and made the combination of insulin glargine u300 1x50 units and insulin degludec + insulin aspart two times a day as 30 units. She was using this therapy more than two months. Diabetes and complications of diabetes is a challenging healthcare problem. Especially patients’ education is as important as the drug therapy [2, 3]. Among serious side-effects of insulin therapy are overdose, resulting in severe hypoglycemia, causing seizures, coma and even death [1]. Patients must be well educated about the risks of using high doses of insulin.</p> Burcin Meryem Atak Mustafa Ramiz Tel Copyright (c) 2021 2021-07-26 2021-07-26 5 4 180 181 Pharmacovigilance – A Medication Safety Perspective <p>The aim of pharmacovigilance (PV) is to evaluate the risk of adverse events of medication being administered to patients keeping in mind that no medication is completely safe [1]. Goal of therapeutics is to improve patient quality of life with minimizing risk and harmful effects associated with it. Medication safety is the process which optimizes the use of medicines and prevents from harm. Medicines are generally safe but as chemical in nature and xenobiotics to living organism are associated with unknown and known risk. Previously, drug safety issues were not discussed galanty due to false adversity consideration [2], but with time and awareness this has changed with highlighting the importance and necessity of pharmacovigilance. WHO classifies pharmacovigilance as the science and process that is associated with detection, assessment, understanding and prevention of adverse effects or any other drug related problem [3]. Moreover, we should consider that the medications to be administered to patient must be assessed by the science of pharmacovigilance. It is the activity that majorly involve monitoring the effect of any medication during its life cycle starting from manufacturing to the patient’s use [4].</p> Syed Saad Hussain Copyright (c) 2021 2021-07-26 2021-07-26 5 4 148 149 Prevalence of Intestinal Parasites and Associated Risk Factors in Chepang Community of Saktikhor Area, Chitwan, Nepal <p>Abstract: Objective: Pathogenic species of protozoa and helminth cause intestinal parasitosis, which continues to be a significant community well-being issue in many regions of the world, especially in pastoral regions of developing countries like Nepal. The study focused on determining the prevalence of intestinal parasitic infections and the associated risk factors among the people of the Chepang community of the Saktikhor area in the Chitwan district.<br>Materials and Methods: A transversal study was conducted between May 2017 and October 2017, with a total of 125 participants. The fecal samples were examined using a wet media (saline media, iodine preparation), concentration and sucrose flotation method. The association between risk factors and parasitic prevalence was evaluated using the Pearson’s chi-square test.<br>Results: The general prevalence of intestinal parasite infection was 52%. Infections with soil-borne helminth were more common than those with cestodes and protozoa. Common intestinal parasites included Ascaris lumbricoides (69.23%), Trichuris trichiura (9.23%), Hookworm (7.69%), Strongyloides stercoralis (4.62%), Hymenolepis nana (6.15%), Taenia sp. (6.15%), and Entamoeba coli (9.23%). High prevalence of infection was observed among male (53.96% ) participants and those aged over 20 years (69.44%). Pearson's chi-square test revealed a substantial relationship between prevalence of parasite and age group (P=0.0452), hand washing material (P&lt;0.001) and preference for defecation site (P&lt;0.001).<br>Conclusion: Hence, a heavy occurrence of intestinal parasites within the Chepang community is particularly evident. There is a need for increased emphasis on intrusion, which can be achieved by improving personal hygiene and sanitation of participants and constructing proper sanitary toilets to prevent the spread of parasitic infections.<br>Keywords:&nbsp; , , , , , , .</p> Srijana Adhikari Janak Raj Subedi Shanti Chaudhary Copyright (c) 2021 2021-07-26 2021-07-26 5 4 150 156 Clinicohematological Characteristics and Survival Analysis of Aplastic Anemia in Pakistan; A Single Centre Experience <p>Objective: Aplastic anemia (AA) is characterized by pancytopenia and hypocellular bone marrow. Several factors like infections, toxins, chemotherapeutics and radiations are known causes for the suppression of hematopoietic cells which results in bone marrow failure but the exact etiology is unknown. The current study was conducted to assess the baseline demographics, laboratory and clinical characteristics of patients presenting with aplastic anemia and evaluate their cytogenetic profile.<br>Materials and Methods: A retrospective cohort study conducted at National Institute of Blood Diseases and Bone Marrow Transplantation after approval by Institutional Ethics Committee. In this study, AA patients were enrolled from January 2010 to December 2018. Data collection included demographic, laboratory and clinical characteristics including age, gender, symptoms, treatment, and blood counts. Cytogenetic analysis was performed on bone marrow samples. Data analysis was done by using SPSS version 23.<br>Results: Based on camitta classification, a total of 362 aplastic anemia patients were enrolled in the study. The frequency of severe aplastic anemia was most common 199(55%). Median and interquartile range (IQR) age of overall patients was 17(11-26) years, for children and adult population it was 12(9-14) years and 28 (21-43) years respectively. Male predominance was observed i.e.251(69%). The most common presenting complaint was fever 202(55.8%). The median and IQR of hemoglobin (Hb) was 7.8(5.8-9.4)g/dl, MCV 90(83-91)fl, total leucocyte count (TLC) 2.6 (1.9-3.6) × 109/l, absolute neutrophil count (ANC) 0.64 (0.27-1.2)×109/l and platelet count 13 (5-27) ×109/l. Bone marrow cytogenetics was done and 76 (67%) patients were found to have normal karyotype. CMV was positive in 24(6.6%). Majority of patients were treated with blood transfusion and supportive care only 230(64%) and the survival rate was 84%.<br>Conclusion: In conclusion, the study represents a large cohort of aplastic anemia in the country. Majority of cases were acquired aplastic anemia predominantly being severe aplastic. Limited numbers of patients opted for standard treatment options probably due to financial reservations to afford standard treatments like immune suppression therapy and hematopoietic stem cell transplant. Further, local studies with larger number of sample size and provision of standard treatment options are needed to explore the treatment response, etiological factors, prognosis and outcomes.</p> Nida Anwar Aisha Arshad Naveena Fatima Sumaira Shaheen Tahir Sultan Shamsi Copyright (c) 2021 2021-07-26 2021-07-26 5 4 157 161 Diagnostic Performance of Three Serological Assays for Anti-SARS-CoV-2 Antibody Detection <p>Abstract: Objective: To evaluate the diagnostic performance of Electrochemiluminescence (ECLIA) enzyme linked immunosorbent (ELISA) and lateral flow Immunofluorescence (LFIA) for anti-SARS-COV-2 antibody detection.</p> <p>Materials and Methods: Sensitivity was calculated with convalescent plasma (CP) donor’s samples. Specificity was checked by using pre-pandemic October 2019 samples. All samples were tested for anti-SARS-COV-2 antibody by using Electrochemiluminescence (ECLIA), Enzyme Linked Immunosorbent Assay (ELISA) and Lateral flow Immunofluorescence (LFIA) assay.<br>Results: Total 55 patients were included, 45 patients were CP donors and 10 were Pre-Pandemic October 2019 samples archived from our blood bank. The ECLIA-total antibody, ELISA-IgG and LLFIA-IgG were positive in 41 (91.1%), 34 (75.5%) and 44 (97.75%) respectively. The highest sensitivity was observed for LFIA with highest specificity among all three assays. There was almost perfect agreement between LFIA and ECLIA (k=0.936, p&lt;0.001) but there was fair agreement between LFIA and ELISA (k=0.412, p=0.001) and ECLIA and ELISA (k=0.357, p=0.001).<br>Conclusion: The LFIA showed a higher sensitivity and specificity in comparison with ECLIA and ELISA. It might be due to fact that LFIA detect antibody against ncleocapsid and spike protein as well of SARS- COV-2 virus, while ECLIA and ELISA detects antibodies only against “N” Protein of SARS- COV-2 virus.</p> Shabnam Dildar Asma Danish Mehjabeen Imam Arshi Naz Tahir Sultan Shamsi Copyright (c) 2021 2021-07-26 2021-07-26 5 4 162 165 Comparison of Open Gastrostomy and Percutaneous Endoscopic Gastrostomy in Head and Neck Cancer Patients, Tertiary Care Hospital Experience <p>Abstract: Objective: The current study was conducted to review and compare PEG and Gastrostomy in terms of early complications in head and neck cancer patients.<br>Materials and Methods: This was prospective comparative study recruited total 60 patients as per the inclusion criteria, 30 in each group. Patients were assigned to the groups based on the surgeon’s choice. Ethical clearance was taken from ethical review board. Informed consent was taken from patients before enrolling them into the study. Non-probability consecutive sampling technique was used to enroll study participants. Data was collected on pre-designed performa and analyzed using SPSS version 16.<br>Setting: Section of Otolaryngology, Department of Surgery, Aga Khan University Hospital Karachi.<br>Results: The two groups did not differ on basis of age, gender and tumor site. The outcomes variables including pain and bleeding from post-operative day1 to day 5 were significantly lower in patients who underwent PEG placement as compared to patients whom we performed OPEN gastrostomy. None the patient had peristomal infection in PEG group throughout the study. However, difference between the groups was statistically significant from post-operative day 3 to day 5.<br>Conclusion: In our study, PEG was associated with lesser complications than open gastrostomy. Recently clinicians are using newer modalities like radiological and laparoscopic gastrostomy at various centres in Pakistan as the first option for placing feeding gastrostomy.<br>Therefore, future studies are warranted to compare their efficacy and post-operative complications PEG.</p> Talha Ahmed Qureshi Shabir Akhtar Sohail Awan Amir Shariff Mohammad Adeel Copyright (c) 2021 2021-07-26 2021-07-26 5 4 166 170