COVID-19, Neuro-oncology and Safe Clinical Practice

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COVID-19 Pandemic; Anxiety and Depression among Frontline Healthcare Workers: Rising from the Ashes

This chapter gives an insight into the psychological journey of the essential healthcare workers (HCWs) during the COVID-19 pandemic. The catastrophe which started off with uncertainty, provoked fear-related behaviors among the frontline doctors, nurses and paramedical staff. With meager resources and lack of a disaster plan, fire-fighting was a reflex response of healthcare institutions. Though the whole world seemed to be unprepared for the calamity, developing countries with fragile healthcare systems were more vulnerable to collapse. The negative aura was complicated by mistrust among the general population, regarding healthcare workers, institutions and government. Furthermore, with economic downfall; balancing work and protecting the family was a challenge for HCWs, especially during the pandemic peak. The psychological distress translated to rising incidence of depression and anxiety among them. As institutions gained insight into psychosocial issues of HCWs; support and therapies were offered to them. Positive messages labelling HCWs as “Heroes of the Pandemic” were circulated and structured programs developed to address their needs. With the advent of COVID-19 vaccine, a ray of hope emerged, although there are still apprehensions about its efficacy and side-effects. The whole world now eagerly awaits the calamity to perish while normality can rise from ashes

Unveiling the Uncertainty-Revolutionizing Medical Education in COVID-19 Era

The beginning of the year 2020 marked the biggest pandemic of the twenty-first century. COVID-19 not only jeopardized the global health care system but also lead to unprecedented effects on every aspect of life. The tragedy evoked by the virus, resulted in disruption of face-to-face learning across the globe. The aftermath of this pandemic on medical education will be enormous and long-lasting. Therefore, it is of utmost importance to identify the challenges and threats facing medical education, both at undergraduate and postgraduate level. Comparative analysis of the innovative models adapted globally in post-COVID era will help countries learn from success stories. Amidst the uncertainty posed by the pandemic, there is a special prospect for medical education. Medical educationist and health policy makers may convert this crisis into opportunity through innovative strategies maximizing the outcome of e-learning. This is the time to relook medical curricula, redesign assessment, focus on standardization of e-learning and upgrade faculty development programs to produce doctors equipped and prepared to serve in the new era

Preventive gabapentin versus pregabalin to decrease postoperative pain after lumbar microdiscectomy: A randomized controlled trial

Study design: Randomized controlled trial.Purpose: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital.Overview of literature: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery.Methods: This randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing lumbar microdiscectomy were randomized to group A (gabapentin) or group B (pregabalin) and started on trial medicines one week before surgery. The VAS for pain was recorded at 24 hours and one week postoperatively.Results: Both groups had similar baseline variables, with mean ages of 42 and 39 years in groups A and B, respectively, and a majority of male patients in each group. The mean VAS values for pain at 24 hours for gabapentin vs. pregabalin were comparable (1.97±0.84 vs. 1.6±0.87, respectively; p=0.087) as were the results at one week after surgery (0.27±0.45 vs. 0.3±0.46, respectively; p=0.79). None of the patients required additional analgesia postoperatively. After adjusting for age and sex, the VAS value for group B patients was 0.028 points lower than for group A patients, but this difference was not statistically significant (p=0.817, R2=0.018).Conclusions: Pregabalin is equivalent to gabapentin for the relief of postoperative pain at a lower dose in patients undergoing lumbar microdiscectomy. Therefore, other factors, such as dose, frequency, cost, pharmacokinetics, and side effects of these medicines, should be taken into account whenever it is prescribed

Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma

Study DesignProspective observational study.PurposeTo assess the clinical outcome after early versus late decompression for traumatic cervical cord injury.Overview of LiteratureTraumatic spinal cord injury is common globally with the most tragic outcomes in the cervical spine. Although recent studies have shown that early decompression results in more favourable outcome, its authority is yet to be established.MethodsStudy on 98 patients with a traumatic cervical cord injury was conducted over a period of 5 years. The patients who were operated on within 24 hours of the onset of the primary injury (n=34) were classified as the early group, and those who were operated on after 24 hours of the onset of the injury (n=64) were categorized as the late group. The outcome of both the groups was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the 6-month follow-up.ResultsThe patients in the early group were operated on at a mean time of 18.4 hours (range, 13-24 hours) while patients were operated on at a mean time of 52.7 hours (range, 31-124 hours) in the late group. At the 6-month follow-up, 7 (23.3%) in the early group and 5 (8.7%) in the late group showed >2 grade improvement in the AIS.ConclusionsThe results of patients undergoing decompression within 24 hours of the injury are better than those who are operated on later. An attempt should be made to decompress the traumatic cervical spine early in all possible cases

Variation in Outcome in Tethered Cord Syndrome

Study DesignFifty patients surgically treated for tethered cord syndrome (TCS) were retrospectively studied at Liaquat National Hospital, Karachi from 2010 until 2014.PurposeTo assess the common presentations of TCS in our part of the world and the surgical outcome of the different presentations.Overview of LiteratureTCS is a stretch-induced functional disorder of the spinal cord with its caudal part anchored by an inelastic structure, which results in characteristic symptoms and signs. Due to the variety of lesions and clinical presentations and the absence of high-quality clinical outcome data, the decision regarding treatment is difficult.MethodsFifty consecutive patients with TCS were reviewed retrospectively with a follow-up period of 12–48 months. The majority of the patients were 0-15 years of age with the mean age of 4 years. The presenting complaints and the associated pathologies were documented, and the patients were assessed using the new Karachi TCS severity scale for clinical assessment.ResultsEighty five percent of the patients with thickened filum terminale improved. Sixty six percent of the patients with diastematomyelia, 60% with lipoma and only 46% with myelomeningocele showed clinical improvement postoperatively. Sixty two percent of the patients who presented with paraperesis improved following surgery while 37% remained stable and only one patient deteriorated. Back and leg pain improved in 93% of patients and 50% of patients with urinary impairment improved.ConclusionsOutcome of patients with TCS varies according to pathology and severity of symptoms. Diastematomyelia and thickened filum had the best outcome. The Karachi TCS severity scale is a valid tool for future studies

How oil prices, gold prices, uncertainty and risk impact Islamic and conventional stocks? Empirical evidence from QARDL technique

There are shreds of evidence of Islamic securities to behave differently from conventional ones, especially under the influence of certain factors such as oil, gold, economic policy uncertainty, and geopolitical risk. This paper has empirically evaluated such pieces of evidence through Quantile Autoregressive Distributed Lags Error Correction Model. Analysis has been performed on monthly returns from Dow Jones Islamic Market and Dow Jones Conventional Market Indexes for the sample period from January 1997 to July 2019. Results suggest that the Islamic stocks do behave differently from conventional stocks only for the long term in case of oil price influence under bullish market conditions; whereas, under bearish market conditions, economic policy uncertainty causes Islamic securities to behave differently. Hence, investment in Islamic stocks can be used for diversification of conventional securities’ portfolio under specific conditions. For instance, under oil price changes Islamic and conventional securities can diversify risk in bullish market trends; such diversification can also be achieved in case of the bearish market trend under economic policy uncertainty shock. The results of this study are significant for policymakers and investors as this will provide a clear picture to the investors regarding their investment with respect to Islamic or conventional markets. A further new basis will be provided to both speculators and portfolio managers of Islamic and conventional markets

Common Genotypes of Hepatitis B virus prevalent in Injecting drug abusers (addicts) of North West Frontier Province of Pakistan

<p>Abstract</p> <p>Background</p> <p>The epidemiological significance of Hepatitis B virus genotypes has been well established and becoming an essential concern day by day however, much little is known about the mixed infection with more than one Hepatitis B virus genotypes and their clinical relevance.</p> <p>Methods</p> <p>Intravenous drug abusers are considered as a major risk group for the acquisition and transmission of blood borne infections like hepatitis B, however, in Pakistan, no such data has ever been reported about the epidemiology of HBV and its genotypes in Injecting Drug Users. 250 individuals were analyzed for hepatitis B virus genotypes after prior screening with serological assay for the detection of HBsAg.</p> <p>Results</p> <p>56 (22.4%) individuals were found positive on ELSIA for HBsAg. The genotype distribution was found to be as: genotype D, 62.5%; genotype A, 8.92% while 28.57% individuals were found to be infected with a mixture of genotype A and D.</p> <p>Conclusion</p> <p>There is an urgent need of the time to develop public health care policies with special emphasis towards the control of HBV transmission through high risk groups especially Injecting Drug Users.</p

Supine PCNL is the Way Forward, with Reduced Anesthesia and Operative Times As Compared to Prone PCNL, Along with Comparable Blood Loss and Stone Free Rates

Objective:The aim of this study is to compare safety and efficacy of supine versus prone percutaneous nephrolithotomy (PCNL) in terms of stonefree rate, operative time, anesthesia time and blood loss in a retrospective case-control trial.Materials and Methods:Fifty patients underwent supine PCNL during the study period (group A). Equal number of patients, who underwent prone PCNL during same period with similar demographic and clinical attributes, were taken as controls (group B). Demographic details, such as gender and age, and body mass index, stone size, stone location and stone laterality were comparable between the two groups. Pre- and post-operative hemoglobin (Hb) levels in patients in both groups were tabulated. Variables analyzed to compare the groups included operative time, anesthesia time, fall in Hb, blood transfusion, stone clearance and need for auxiliary procedure.Results:The median operative time (minutes) in patients of group A [35; interquartile ratio (IQR): 25], was significantly different from group B (70; IQR: 40) (p=0.000). The median anesthesia time (minutes) in patients in group A (50; IQR: 25) was significantly different from group B (85; 45) (p=0.000). The median fall in Hb (g/dL) in patients in group A (1.700; IQR: 1.2) was significantly different from group B (1.200; IQR: 2.4) (p=0.967). Two patients in group A and 7 in group B needed blood transfusion (p=0.080). Thirty two patient in group A and 34 in group B achieved stonefree status (p=0.833). Eleven patients in group A and 6 in group B needed auxiliary procedure in the form of extracorporeal shockwave lithotripsy (p=0.287).Conclusion:Supine PCNL is as safe and effective as conventionally performed prone PCNL, with an added benefit of decreased operative and anesthesia time

Is Routine Measurement of Post-operative Hemoglobin and Electrolytes Necessary in Every Patient After Transurethral Resection of the Prostate?

Objective: To evaluate the importance of post-operative hemoglobin and electrolyte monitoring after transurethral resection of the prostate (TURP) and establish the parameters to be considered for monitoring.Materials and Methods:Data of patients who underwent TURP between 2007 and 2017 were reviewed. Data regarding prostate size, irrigation fluid volume, resection time, pre- and post-operative electrolytes, hemoglobin levels taken within 48 hours before and after surgery, and blood transfusion information were collected. In order to establish parameters for post-operative laboratory monitoring, we categorized prostate size, resection time, and irrigation fluid into groups i.e. (80 g), (60 min) and (40 L) respectively.Results:A total of 1.000 patients were included. The median age was 66 years with the minimum of 46 years and maximum of 98 years. The median prostate size was 54.26 g. Among all pre- and post-operative laboratory parameters, only hemoglobin and sodium showed a significant change, which were analyzed further. Drop in hemoglobin was significantly associated with increasing prostate size and volume of irrigation fluid. Patients with a prostate size of >80 g had 27.3 times higher chance of significant (>2 g) drop in hemoglobin while 5.1 times higher when irrigation volume exceeded 40 liters. Low levels of sodium were strongly associated with prostate size, irrigation fluid volume, and resection time. However, all these factors become insignificant (p≥0.05) for their effect on low sodium, when these variables were adjusted with each other. Blood transfusion was performed in 27 patients. All these patients belonged to a group of patients with prostate size of more than 80 g with high resection time and irrigation fluid volume. Three patients had TUR syndrome. Post-operative hemoglobin and electrolytes monitoring contributed to a change in the management of only 14% of patients.Conclusion:Routine post-operative hemoglobin and electrolyte measurement is not required in every patient undergoing TURP. Use of risk stratification approach will help us to decide which patient needs post-operative lab testing