COVID-19 Vaccine Uptake in Pakistan: No Time to Err

COVID 19 pandemic has had a significant impact on social, physical, mental and financial aspects of human life. Among the sickness and despair experienced for last more than a year, COVID vaccination is a ray of hope. The uptake of COVID vaccines has remained low. The government, institutions as well healthcare professionals should take this responsibility of promoting vaccination. A strong will and simple nudges are what it takes to fight the menace of the COVID pandemic

Acute presentation of cocoon abdomen as septic peritonitis mimicking with strangulated internal herniation: A case report

Background: Abdominal cocoon syndrome is a rare cause of intestinal obstruction in which loops of small bowel get entrapped inside a fibro-collagenous membrane. Condition is also known in the literature as sclerosing peritonitis and in the majority of cases, it has no known cause. Although the majority of patients exhibit long-standing signs and symptoms of partial bowel obstruction in an out-patient clinic, its acute presentation in the emergency room with features of sepsis is extremely rare. This case report aims to describe the emergency presentation of cocoon abdomen with septic peritonitis.Case presentation: A 35-year-old male with no known co-morbidity and no prior history of prior laparotomy presented in emergency room first time with a 1-day history of generalized abdomen pain, vomiting, and absolute constipation. He was in grade III shock and had metabolic acidosis. The clinical impression was of the perforated appendix, but initial contrast-enhanced computed tomography (CECT) was suggestive of strangulated internal herniation of small bowel. Emergency laparotomy after resuscitation revealed hypoperfused, but viable loops of small bowel entrapped in the sclerosing membrane. Extensive adhesiolysis and removal of the membrane were performed and the entire bowel was straightened. Postoperatively he remained well and discharged as planned. Histopathology report confirms features of sclerosing peritonitis.Discussion: Cocoon abdomen is a very rare cause of acute small bowel obstruction presenting in an emergency with features of septic peritonitis. Condition is mostly chronic and generally mimics abdominal TB in endemic areas like India and Pakistan. A high index of suspicion is required in an emergency setting and exploratory laparotomy is diagnostic and therapeutic as well and the condition mimics internal herniation in acute cases.Conclusion: Cocoon abdomen as a cause of septic peritonitis is extremely rare and might be an unexpected finding at laparotomy. Removal of membrane and estimation of the viability of entrapped bowel loops is the treatment of choice, which may require resection in the extreme case of gangrene

Managing acute pain in HIV+/AIDS patients: Knowledge and practice trends among emergency physicians of major tertiary care centers of a developing country

Objective: To assess knowledge and practice trends in managing acute pain in patients infected with human immunodeficiency virus (HIV+) or having acquired immunodeficiency syndrome (AIDS) among emergency physicians of four tertiary care hospitals. Acute pain management in such patients is complex because of multiple concomitant painful conditions related to their disease. After obtaining ethical approval and written informed consent, emergency physicians were requested to fill out a questionnaire.Results: Out of 84 physicians who participated, 49 had managed HIV+/AIDS patients during the preceding year. Out of the 49, 30 (61.2%) physicians stated that they used a combination of analgesics for acute pain in these patients. Forty-two (50%) out of the 84 participants believed that routine doses of opioids were adequate for pain relief, while 42 (50%) agreed that pain management was more complex in these patients mainly due to presence of multiple coexisting problems and psychological issues. Only 26 (31%) respondents considered that pain was under-reported and under-treated in these patients, mainly because physicians were more focused on patients\u27 other disease related complications and issues. Formulation of guidelines are recommended for effective acute pain management in these patients encompassing associated issues, including concomitant painful conditions, opioid dependence, psychiatric problems, etc

Cardiac Angiogenic Imbalance Leads to Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is an often fatal disease that affects pregnant women who are near delivery, and it occurs more frequently in women with pre-eclampsia and/or multiple gestation. The aetiology of PPCM, and why it is associated with pre-eclampsia, remain unknown. Here we show that PPCM is associated with a systemic angiogenic imbalance, accentuated by pre-eclampsia. Mice that lack cardiac PGC-$1\alpha$, a powerful regulator of angiogenesis, develop profound PPCM. Importantly, the PPCM is entirely rescued by pro-angiogenic therapies. In humans, the placenta in late gestation secretes VEGF inhibitors like soluble FLT1 (sFLT1), and this is accentuated by multiple gestation and pre-eclampsia. This anti-angiogenic environment is accompanied by subclinical cardiac dysfunction, the extent of which correlates with circulating levels of sFLT1. Exogenous sFLT1 alone caused diastolic dysfunction in wild-type mice, and profound systolic dysfunction in mice lacking cardiac PGC-$1\alpha$. Finally, plasma samples from women with PPCM contained abnormally high levels of sFLT1. These data indicate that PPCM is mainly a vascular disease, caused by excess anti-angiogenic signalling in the peripartum period. The data also explain how late pregnancy poses a threat to cardiac homeostasis, and why pre-eclampsia and multiple gestation are important risk factors for the development of PPCM

Stigmatization and Resources Allocation-Ethical Dilemmas for HIV Positive Intravenous Drug Users

The burden of disease due to Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) in Pakistan is on the rise. According to an estimate approximately 0.165 million people in Pakistan are infected with HIV and 17,149 person are currently receiving treatment for HIV/AIDS. The prevalence of HIV is 20% for intravenous Drug Users (IVDUs) while national surveillance data shows rate of infection in most major cities in range of 15-50%. In light of such alarming figures, distribution of resources and stigmatization are two ethical issues that gain attention of not only healthcare providers but also patients. Following is a case with discussion on these ethical issues

THYROID AND THYROIDECTOMY: A REPORT

The thyroid gland is a small butterfly-shaped gland located in front of the neck. It secretes hormones called thyroid hormones that regulate almost every function of the body. Enlargement of the thyroid gland is called goiter, also called “giller” or “ghudood” by the natives. Thyroidectomy is the surgical removal of all or part of the thyroid gland. It is performed for various reasons, such as cosmetic, functional, or oncological. Thyroidectomy is a challenging surgery that poses a major burden to the healthcare system in under-developed areas like Muzaffarabad, Azad Kashmir. Funding for investigations and procedure should be made available in each healthcare setup to investigate and treat the goiter in time. Proper training of surgeons as well as staff is also required to make thyroidectomy less challengin

Medical Students’ Views on Medical Ethics Education-A Mixed Method Study

Background: Medical Ethics (ME) is considered an integral component of medical education around the world. However, limited training is being offered to medical students in Pakistan. Objectives: This study was designed to evaluate medical students' perspectives regarding medical ethics and to explore their experiences about medical ethics as a subject at a private medical college in Lahore, where Medical Ethics was formally introduced as part of the undergraduate curriculum in 2017. Methods: This mixed-method study included medical students from all five years of medical college. Quantitative component included a survey questionnaire, and the sample size was 410.  Convenient sampling technique was used. Qualitative component included focus group discussions. The students who have attended medical ethics lectures were included in the study. Results: The response rate was 82.72%. There were more females in gender distribution; 76.1% were female and 23.9% were male. Most respondents (74.9%) found medical ethics classes interesting and 72% thought that lecture sessions were important in medical ethics. Conclusions: Medical students find medical ethics as an important component of medical education. Although it is hard to correlate ethics education with their clinical experience as medical students, they believe that medical ethics education can be useful. Social and cultural issues inform clinical decision-making in Pakistan and hence these discussions should be incorporated into medical education. Further studies must be conducted on the actions that need to be taken to help students internalize the ethical issues