Pakistan Journal of Medical & Health Sciences

Determine the Prevalence and Factors Contributing to Increase the Caesarean Section Rate amongst post-partum women at Lyari Town Karachi, Pakistan

Shahla Pardhan Sameer Ali — 2024-09-25

Aim: To determine the prevalence and factors contributing to the increase in the Cesarean Section Rate among Post-Partum Women in Two Private Hospitals in Lyari Town, Karachi, Pakistan.
Methodology: A descriptive cross-sectional study was conducted from August to November 2022 after getting approval from the Institutional Review Board (IRB) of Kharadar General Hospital. The purposive sampling technique and self-structured questionnaires were used to achieve the sample size of 230 post-partum women with age < than 45 were included in the study whereas Women who were delivered vaginally, and those who were not willing were excluded in this research criteria and the data was analyzed by using SPSS V-16 software.
Results: The results showed that CSR was more observed between the ages of (26-35) (56%), and were mainly housewives (71.3%), matriculated (47.8%), and belonged to the Balochis family. As, CSR has drastically increased in Lyari Town Karachi, Pakistan (33%), and the rate of Planned Cesarean Section (CS) (63%) exaggerated more than an Emergency CS (37.4%).Scarred Uterus (32.1%)being an obstetrical factor, while Patient Preferences (30.4%) being a non-obstetrical factor were the most common reasons for Planned C-Section. Fetal Distress (33.9%) and Polyhydramnios (11.3%) were the reasons for an Emergency C-Section. Labor anxiety also influenced cesarean section. Besides, smokeless tobacco (Pan, Ghutka, Chalia, and Supari), (18% to 23%) was also identified as contributing factor among women.
Practical Implication: The study found a strong correlation between Corporate Social Responsibility (CSR) and demographic factors and medical practices, particularly among women aged 26-35. In Karachi, Pakistan, CSR activities increased significantly. Women prefer Planned Cesarean Sections over Emergency Cesarean Sections, with scarred uterus and patient preferences being primary reasons.
Conclusion: Planned CS is increasing unnecessarily in the health care setting, and this could be reduced by offering written guidelines, policy development, monthly medical audits, and advised CS when there is a medical necessity

Cytological and Histological Correlation of Medullary Carcinoma of Thyroid Based on Bethesda System for Reporting Thyroid Cytology: A Single Center Experience

Muhammad Fahad Faiz — 2024-09-25

Background: The cytological evaluation of thyroid carcinoma is a diagnostic tool with additional benefits of accuracy, being
minimally invasive and cost-effective. However, a histological correlation is necessary to affirm its effectiveness in case of
medullary carcinoma thyroid.
Aim: To evaluate the correlation between cytological and histological findings in cases of medullary carcinoma of the thyroid.
Methods: Retrospective study. Shaukat Khanum Memorial Cancer Hospital (SKMCH) from 1st December 2021 to 30th June,
2022. Thirty patients were sought who underwent cytology as well as histopathology after surgery. The data of fine needle
aspiration cytology and the corresponding information were sought from the hospital archives. The Bethesda categorization was
done according to the cytological appearance. Data after the histopathological analysis was also sought.
Results: Most of the patients 53.3% were females. Twenty out of these were diagnosed as medullary carcinoma. 93.3% of the Bethesda category IV were diagnosed as medullary carcinoma (p=0.000). The majority of category IV FNAs were also adequate for performing tumor markers (p=0.00).
Practical Implication: The study highlights the high incidence of medullary carcinoma in Bethesda Category IV thyroid nodules, with 93.3% being diagnosed. The majority of patients are female, highlighting the need for vigilance. The majority of fine needle aspirations (FNAs) for these nodules were adequate for performing tumor markers, indicating their reliability for diagnosis and treatment planning. The findings underscore the importance of thorough diagnostic procedures for this high malignancy rate.
Conclusion: The cytological categories of Bethesda have strong association with diagnosis of medullary carcinoma thyroid especially if category IV is diagnosed, there are high chances carcinoma may turn out to be medullary carcinoma.

The Prevalence, Rainbow of Histological Features and Initial Clinical Presentation of Post-Transplant IgA Nephropathy

Hanzla Maryam — 2024-09-25

Background: IgA nephropathy is the most common primary glomerulopathy which is characterized by the presence of prominent IgA deposits in the mesangial regions.
Aim: To compare the clinical and histological features of pre and post- transplant IgA nephropathy patients.
Methods: A descriptive retrospective study. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, between 1st January 2016 and 30th September 2022. Forty eight cases of pre-transplant and 20 cases of post-transplant IgA nephropathy were enrolled. The biopsies included at least one core submitted in 10% buffered formalin and one core in normal saline. The formalin-fixed tissue was embedded in paraffin and cut at 4mm thickness, followed by staining with hematoxylin, eosin, PAS, JMS, and Trichrome stains. Immunofluorescence was performed on the tissue in normal saline. All biopsy was evaluated for the MEST-C score. Patients were also evaluated for proteinuria and hematuria; we categorized hematuria as mild (3-20 red blood cells per microliter of urine), moderate (20-50 red blood cells per microliter of urine), and severe (above 50 red blood cells per microliter of urine). Proteinuria was divided as sub-nephrotic range proteinuria and nephrotic range proteinuria.
Results: The 90% of patients were male and 10% were female, and the highest proportion of post-transplant patients (45%) were between 35 and 45 years old. 25% of patients experienced significant hematuria, and an equal percentage (25%) experienced mild to moderate hematuria. 40% of patients experienced nephrotic range proteinuria, and 20% had sub-nephrotic range proteinuria. Histological evaluation of renal biopsies of these patients demonstrated M1 lesions in 75% of patients, S1 lesions in 65% of patients, and T1 lesions in 45% of patients. Among the patients with pre-transplant IgA nephropathy, 70% were male, 27% were female, and 45% of patients were below the age of 25. 30% of patients experienced severe hematuria, while 36% experienced mild to moderate hematuria. 42% of the patients had nephrotic range proteinuria and 40% had sub-nephrotic range proteinuria. Histological evaluation of their renal biopsies demonstrated M1 lesions in 94% of the pre-transplant patients, S1 lesions in 90%, and E1 lesions in 27% of cases.
Practical Implication: The high significance in implementing the service care delivery to the kidney transplant patient as by critically assessing the urine testing predictors, biopsy results and patient gender as well as age the IgA nephropathy risk can be reduced.
Conclusion: The combination of proteinuria and hematuria assessment could provide an important insight of disease recurrence in kidney transplant patients. Moreover, the results emphasize the importance of carefully monitoring transplant patients with high M-scores and T-scores, especially those with S1 scores, to ensure early detection and management of disease recurrence.

Urinary Tract Infection among infants and school aged children: A review

Shehab Ahmed Alenazi — 2024-09-25

A considerable number of bacteria of the same species growing in the urine is known as a urinary tract infection (UTI). Currently,
it is thought that the most common cause of a serious bacterial disease in children under the age of two is a febrile urinary tract infection. Boys are more likely than girls to have it in their early years, but after infancy, girls are far more likely to have it. UTIs can be classified into three groups based on their clinical presentations: asymptomatic bacteriuria, lower UTI (cystitis), and upper UTI (acute pyelonephritis). UTI prevalence varies by country, from 6% in industrialized nations to 37% in low-income countries. According to a study conducted in Saudi Arabia, 24% of people had UTIs. In children, gut flora, specifically Escherichia coli and Klebsiella, are the most frequent causal organisms of urinary tract infections. Kidney failure and kidney scarring are among the short- and long-term consequences that need for fast and suitable treatment. There could be a 30 to 50% chance of a return of UTI. This review disucssed UTI prevalence, causes, classifications, complications, and treatment among age groups of infants and school aged children

Workplace Violence: Consequences and Solutions in Healthcare Institutions

Khalil Ahmed Shaikh — 2024-09-25

Violence may appear in a variety of contexts, such as private homes, public places, commercial spaces, colleges and universities, and other facilities1. It has a profound effect on people from all social classes. Because there was no standard term for violence, which made it a complicated and pervasive issue, it was not previously seen as a public health concern2. There is more to understanding violence than just tying it to empirical data. Instead, it entails making decisions about what constitutes proper and acceptable behaviour, which are influenced by societal norms, beliefs, and practices3. The deliberate use of force, real or threatened, towards themselves, another individual, an organisation or society, or oneself is what the World Health Organization, or WHO, defines as violence. This conduct has the risk of causing injury, death, psychological suffering, stunted growth, or impoverishment4. Although professional violence, including punching, kicking, shoving, hitting, shooting, and harming, has been acknowledged, until recently, little has been done to combat intellectual assault5. The intentional use of harm towards a person or group, including the threat or application of blunt force, is referred to as psychological abuse. The victim of this kind of assault may have detrimental effects on their psychological, ethical, moral, physical, and cognitive well-being6.