Emerging Global Health Crisis of Our Times- Climate Change

The progress of the human race over the last 200 years is unprecedented in recent history. Rapid industrialization, urbanization, and consumerism have made lives easier for humankind. Still, these changes come at a very high price. We never anticipated that we will have to pay the price in the form of climate change and global warming. Our planet, the earth is getting warmer by 0.85 ̊centigrde annually for the last one hundred and seventy years. Hence, glaciers are melting faster than ever, water levels are rising, and cities are sinking, while greenhouse gas emission numbers are at their highest points in human history. Unfortunately we humans are living in anthropogenic epoch and are also speeding up the destruction of the earth's ecosystem by being the dominant cause of the warming observed since the 20th century. Deforestation coupled with increased greenhouse gas emissions has led to a surge of heat-waves globally. These environmental disasters not only affect the environment, plants, and land but also have a profound direct and indirect impact on the health of people. In-fact the health impact has already debuted in the form of worsening key health indicators. In Pakistan alone, the 2015 heat-wave claimed the lives of twelve hundred people in Sindh province. Due to variable rainfall patterns that affect the availability of fresh water, it also affects food production & delivery and brings on the drought. Quality of air, clean drinking water, and availability of food are the top three indicators most influenced by these disasters. Coupled with these, the more than the frequent occurrence of natural calamities; tsunamis, wildfires, snowstorms, and extremes of temperatures has put an extra financial burden on already, stretched to limits budgets of health

Analysis of Efficacy of Depo-Med Role Injection in Post-Operative Pain Relief for Lumbar Discectomy Patients

Objectives:  The main objective of the study was to analyze the efficacy of Depo-medrole injection in post-operative pain relief after lumbar discectomy. Material and Methods: This study was conducted in the Neurosurgery department of Mayo Hospital KEMU, Lahore during March 2018 to September 2018. The data was collected from 50 patients of lumbar discectomy randomly into two groups. One was operated patients and in group 2 patients were injected with local Depo-med role after lumbar discectomy. We studied the efficacy of Depo-med role injection in the second group. Pain intensity was measured using VAS from the whole sample at two weeks, four weeks, three months and last at one year post operatively. Results: Data were collected from 50 patients. These patients were divided into two groups, 25 in group one and 25 in group two. The mean age of group one was 30.14 ± 8.15 and for group two was 29.82 ± 7.16. Both groups neither contrasted by age (p = 0.187) nor as indicated by term of side effects (p = 0.639) at the season of operation. Conclusion: The usage of low dose Depo-med role decreased an abrupt lumbago and pain leg after surgery effectively. But it needs more observations due to small nonrandomized sample.&nbsp

Micro-Endoscopic Discectomy versus Open Discectomy: A Struggle for Better Clinical Outcomes

Objective:  The objective of the current study was to compare the clinical outcomes of a micro-endoscopic discectomy with an open discectomy. Materials & Methods:  This Quasi-experimental study was conducted in the Department of Neurosurgery, Alrazi Healthcare, Lahore, and Ammar Medical Complex, Lahore. The sample consisted of 40 patients with lower back pain with radiation to the lower limbs. A lumbar disc single-segment hernia was diagnosed based on magnetic resonance imaging (MRI) findings. Independent sample t-test was used to explore the difference in outcomes and level of pain between group A and group B. Chi-square test was used to compare the recovery rate of patients in both groups. Results:  A significant difference between the two groups in terms of surgery duration (t = 15.977, P = .000), blood loss during surgery (t = -10.256, P = .000), length of incision (t = -58.355, P = .000), and hospital stay after surgery (t = -4.687, P = .000) was found. The overall recovery rate for the micro-endoscopic Discectomy group was 95% whereas, in the open discectomy group, it was 90%. Conclusion:  Micro-endoscopic discectomy is superior to open discectomy in terms of lesser surgical trauma, lesser blood loss, lesser hospital stay, earlier return to work, and higher pain resolution

Autologous Bone Graft vs PEEK Cage in Patients with Cervical Spondylotic Myelopathy

Background:  Cervical spine stenosis is one of the most common degenerative changes of cervical spondylotic myelopathy (CSM) and results in severe dysfunction of the cervical spinal cord. The conventional treatment of such degenerative cervical spine conditions is anterior cervical discectomy and fusion (ACDF). Strut graft remains the gold standard in ACDF with excellent patient recovery but has many shortcomings. Polyetheretherketone (PEEK) cages have recently become popular as a replacement for strut grafts in patients undergoing ACDF. Objective:  This study was carried out to compare the clinical and radiographic outcomes of autologous bone grafts versus PEEK cages in patients undergoing ACDF surgery. Materials and Methods:  It was a randomized controlled trial conducted at the Neurosurgery Department Punjab Institute of Neurosciences for three years. Patients who consented to be a part of this study and fulfilled our predefined inclusion criteria were recruited and randomized into 2 groups. One group underwent ACDF with auto bone graft whereas the other group underwent ACDF with PEEK cage. Results:  A total of 198 subjects were included in this study. The mean age was calculated as 47.60 ± 9.17 years in the PEEK cage group and 46.74 ± 8.87 years in the Autologous bone graft group. Males accounted for 59.6% of the study population.  The fusion rate was found to be higher in the PEEK cage group with a p-value of 0.002. Conclusion:  PEEK cages are superior to strut grafts as they have lesser morbidity after ACDF surgery in patients with CSM. &nbsp

Interpretation of immunofluorescence slides by deep learning techniques: anti-nuclear antibodies case study

Nowadays, diseases are increasing in numbers and severity by the hour. Immunity diseases, affecting 8\% of the world population in 2017 according to the World Health Organization (WHO), is a field in medicine worth attention due to the high rate of disease occurrence classified under this category. This work presents an up-to-date review of state-of-the-art immune diseases healthcare solutions. We focus on tackling the issue with modern solutions such as Deep Learning to detect anomalies in the early stages hence providing health practitioners with efficient tools. We rely on advanced deep learning techniques such as Convolutional Neural Networks (CNN) to fulfill our objective of providing an efficient tool while providing a proficient analysis of this solution. The proposed solution was tested and evaluated by the immunology department in the Principal Military Hospital of Instruction of Tunis, which considered it a very helpful tool

Comparing Mean Post-Operative Back Pain Score between Hemilaminectomy and Conventional Laminectomy in Patients of Lumbar Stenosis

Objective:  To observe the comparative mean post-operative back-pain score between hemilaminectomy and conventional laminectomy in patients of lumbar stenosis. Material and Methods:  The randomized controlled study was carried out in Neurosurgery Unit, Allied Hospital, Faisalabad, Pakistan. A total of 60 patients were distributed equally in two groups. Group A underwent hemilaminectomy while group B underwent conventional laminectomy. A linear median fascial incision was made on the side with more pain or symptoms. Only in the hemilaminectomy group, ipsilateral decompression was performed. It involves partial resection of adjacent parts of the hemi laminae of the superior and inferior vertebrae using operative loupes or neurosurgical microscope. Mean ±SD was calculated for quantitative data including back pain score. Results:  Mean age was 46.2 ± 6.94 years in hemi group and 46.3 ± 6.74 years in the conventional group. We observed that in hemi group, the back pain score was 2.23 ± 0.73 and it was 2.7 ± 0.65 in the conventional group (p-value was 0.011). Significant differences (p value<0.050) existed in these age ranges with respect to the back pain score in both surgery groups. A significant difference (p value < 0.0001) observed only in male patients between two surgery groups for the back pain scores. Conclusion:  Mean post-operative back pain score is significantly reduced in hemilaminectomy cases when compared with conventional laminectomy in patients of lumbar stenosis

Evaluation of self-reported knowledge and understanding towards a blended research course among pharmacy students: Objective Search Literature Evaluation (OSLE) method validation

Background: The objective of the study was to evaluate the impact of classroom versus online Modular object-oriented dynamic learning environment (MOODLE)-based teaching on objective search literature evaluation (OSLE) score, as well as to validate the OSLE method for the assessment of research skills in pharmacy students. Methods: The four-station OSLE method was used to assess the performance and self-reflection at the end of each delivery mode. The students were asked to voluntarily vote for the preference of delivery mode in research courses. A hierarchical regression analysis was performed for variables predicting the “preference” for class-based teaching and/or MOODLE-based learning. Internal face and content validation were performed with students and faculty members not involved in the course teaching. External validation was performed with three professors working in different colleges in United Arab Emirates (UAE), Saudi Arabia and Qatar. Results: Thirty-five students completed the courses and showed significant improvement in self-reported reflection of pre-post knowledge and understanding. Findings suggested that 87.3% (110/126, 95%CI: 75.9 – 89.4, p < 0.001) achieved performance indicators and reported the OSLE method as an effective tool for the assessment of knowledge and understanding of research skills in pharmacy education. The predictive model suggested a strong positive effect associated with article appraisal, article application, self-reporting of knowledge and self-reporting of understating (R2 0.47, F-1.26, p < 0.001). Conclusion: The findings suggested the OSLE method as an effective tool of assessment in pharmacy education. A negative impact of MOODLE-based learning was found with self-reflection on knowledge

Metastatic Posterior Fossa SOL Secondary to Carcinoma Breast

Aim: To describe our experience with Metastatic Carcinoma (CA) breast in posterior fossa.Materials and Methods: All patients who had history of Carcinoma (CA) breast and had posterior fossa space occupying lesion (SOL) were included in this study. Detailed history, examination and baseline investigations were done and patients were operated on list and are on regular follow up. The duration of study was 2 months and is an ongoing project.Results: Three patients were included in this study. All had previous history of mastectomy for Carcinoma (CA) breast. One had invasive ductal carcinoma, other had ductal carcinoma. Third one didn’t have her previous records with her. All patients presented with SOL in posterior fossa. 1st and 2nd patient had undifferentiated carcinoma and 3rd patient had metastatic differentiated carcinoma on biopsy of SOL brain. It is interesting to note that 1st and 2nd patients completed their chemotherapy and radio therapy while the 3rd patient didn’t consulted her surgeon after mastectomy for further treatment.Conclusion: A multidisciplinary approach is recommended for the long term management of patients with Carcinoma (CA) breast and they should be kept on regular follow-up for the rest of their lives

Gender bias and ‘doctor brides’. A social dilemma of medical students in Pakistan

Objective: To assess gender bias, discrimination and bullying at medical schools, and to explore the phenomenon of ‘doctor brides’. Method: The multicentre survey was conducted at 14 medical education institutions across Pakistan from September 2020 to April 2021, and comprised medical students of either gender at both public-sector and private-sector institutions. The survey questions explored beliefs, experiences and knowledge related to common stereotypes and social issues in medical education, including female role models, work-life balance, gender roles, lack of support from family and faculty, and bullying. Association between gender with survey variables was explored. Data was analysed using SPSS 26. Thematic analysis was used to exploring knowledge around ‘doctor-brides’. Results: Of the 377 subjects, 245(65%) were females. The overall mean age was 21.4+/- 1.8 years. There were 211(53.8%) subjects aged 21-23 years, and 368(97.6%) were Muslims. Significantly more women than men were of the opinion that men are encouraged and are more likely to assume leadership roles (p=0.002). More women than males agreed that household chores and work had an impact on speciality choice (p&lt;0.001). Most sexual assault victims were women (p&lt;0.0001), but men generally faced more bullying and hostile behaviour (p=0.014). With regard to women being forced to quit medicine after marriage/childbirth by their in-laws/husbands or change their careers from clinical medicine to preclinical teaching, 99(26.25%) subjects knew first-hand of such cases, while 238(63.12%) had no such experience to share. Conclusion: Gender bias, discriminatory behaviour and bullying were found to be widely prevalent in medical schools across Pakistan. The general perception of ‘doctor brides’ needs to be revisited