Patterns of coronary artery vessel disease on diagnostic angiography in a south asian population

Objective: The objective was to establish patterns of diseased vessels amongst the study population.Methodology: This retrospective descriptive study analyzed the data of 396 patients who underwent diagnostic angiographies at a large tertiary care public hospital in Islamabad, from January-2018 till October 2018. All data was coded and recorded in SPSS and was quantitatively run to find percentages and tests of significance were done.Results: We found that single vessel disease was the most common at 31.6%, and that the left anterior descending was the most commonly involved vessel with the most significant coronary artery disease, 86.6% and 71.4% respectively. Conclusion: Hypertension and diabetes has a great burden on our South Asian population and contribution to the development of coronary artery disease. Severe disease present in one vessel should alert physicians to the possibility of multi-vessel involvement and multi vessel progression in the disease progress.  Delineation of the vessel involvement pattern in South Asians forms the basis for formulating local guidelines and strategies for tackling coronary artery disease.Keywords: Angiography, CAD, patterns

Impressions and attitudes of adult residents of Karachi towards a possible public health insurance scheme

Objective: To gauge the general population\u27s knowledge and attitude towards a possible public health insurance scheme.Methods: This descriptive, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from April to May 2015, and comprised permanent residents of the city. Convenience sampling was used. Data was collected via questionnaires. SPSS 22 was used for data analysis.Results: There were 340 participants in the study with an overall mean age of 32.9±12.4 years. Besides, 159(46.8%) participants were aware of the concept of medical insurance while the correct definition was identified by 160(50.5%) respondents. Overall, 256(75.3%) participants were willing to join a theoretical public health insurance scheme. Of all the respondents, 107(31.5%) had faced a catastrophic event in the past and consequently were more willing to join. Of those unsure or not willing to join, 33(37.9%) respondents identified lack of trust in government programmes as the main reason for their choice.CONCLUSIONS: A large majority of adults had a favourable attitude towards the implementation of a possible public health insurance scheme

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Modified Kenalog Protocol for Perianal Fissures- A Quasi Experimental Trial

Objective: To ascertain the role of triamcinolone injection at the base of an anal fissure and its effect on healing and pain relief. Methodology: A quasi-experimental study was conducted from November 2021 to February 2022. Under aseptic measures, a 1ml Triamcinolone 40mg/ml injection was administered at the base of the anal fissure using a 1cc insulin syringe. This was injected in four positions around the base of the fissure. Patients were followed for one week to assess pain relief and improvement in quality of life. Patients were assessed for quality of life improvement and satisfaction with treatment. Patients were offered lateral internal sphincterotomy at the end of one week and again on follow up after two weeks given they were not satisfied with pain relief or symptom recurrence occurred. Results: Twenty five patients were enrolled and analysed. All fissures were seen to have a red inflamed base at enrollment. At one week after treatment, a paler base with less signs of inflammation was observed. Patients reported a mean 70% improvement in their symptoms. A mean change of 16.45 points was seen in Brief Pain Inventory scores at one-week follow up. 25% underwent a lateral internal sphincterotomy. The number needed to treat was 2.5. 5 patients were lost to follow-up after the initial one week follow-up. Conclusion: Injection of Triamcinolone at the base of an anal fissure may have a role as an adjunct to standard management in treatment. It has been shown to decrease pain and enhance healing of the fissure thus decreasing the need for surgical intervention

Breast Cancer And Self Breast Examination Awareness Amongst Pakistani Female Medical Students and Hospital Employees: Assessing Shortcomings in Health Literacy

Objective: To assess the knowledge, attitudes, and practices related to breast cancer and breast cancer screening among female medical students, healthcare workers, and hospital employees. Methodology: This cross-sectional study was conducted from September 1, 2021, to October 30, 2021. A questionnaire on breast cancer awareness and self-breast examination was distributed to female medical students across all five years at Fatimah Jinnah Medical University, Lahore, and to female hospital employees at Sir Ganga Ram Hospital, Lahore. A total of 404 women participated and were included in the study. Results: Out of the respondents, 71.2% were medical students, and 26.7% were doctors. Approximately 24% reported a family history of breast cancer. Media was identified as the primary source of information on breast cancer by 79.2% of women. Only 64.9% of respondents practiced self-breast examination, with merely 23.8% performing it monthly. Furthermore, only 37.1% correctly identified all the essential steps for conducting a breast self-examination. Conclusion: While the knowledge of breast cancer is satisfactory among healthcare workers and hospital employees, there is room for improvement in attitudes and practices related to early detection and screening. Initiatives should be undertaken by medical undergraduate curriculum coordinators to incorporate breast self-examination, clinical breast examination, and screening guidelines in both pre-clinical and clinical years of medical education. Additionally, information dissemination programs should be implemented in hospitals for all employees

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality