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A Rare Case of Foreign Body Ingestion, Mimicking as Mesenteric Cyst. "Case Report"

Background: Foreign body ingestion by children is a commonly encountered problem and accounts for a significant emergency visits among pediatric population. Although these ingested foreign bodies pass spontaneously and uneventfully, a subset of such bodies may become trapped in the digestive tract, eventually leading to significant injury. Most of these bodies are radio-opaque and detectable radiologically, but some radio-lucent may become a diagnostic dilemma and subtle management issue. Case Report: We report a case of a one-year girl who presented after accidental ingestion of foreign body with signs and symptoms of acute intestinal obstruction. Initially we were unable to diagnose the cause, but later the radiological investigation suspected a mesenteric cyst. After failure to respond to conservative measures she underwent exploratory laparotomy, and a jelly ball was removed from the gut. The patient had uneventful post-operative recovery and was kept on follow-up for three months without any complication. Conclusion: These patients do not respond to conservative measures and need surgery on an emergency basis. It is likely that if left untreated may have caused Intestinal perforation and irreversible shock. Radiolucent foreign bodies are difficult to diagnose and need high level of suspicion. Need of the hour is to educate the parents to be extra vigilant as “prevention is better than cure”.
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Ruptured Unilateral Twin Tubal Ectopic Pregnancy. Case Report of an Oddity & Literature Review

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Analysis of Essential Medicines Used for Emergency Care in Pakistan

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Correlation of Atrial Fibrillation with Left Atrial Volume in Patients with Mitral Stenosis. a Single Centre Study From Pakistan

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Predatory Journals: a Literature Review

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Professional Secrecy and Privileged Communication in Medical Practice

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Acute-on-chronic Liver Failure: MELD Score 30-day Mortality Predictability and Etiology in a Pakistani Population

Background: Cirrhosis is a pathological condition that ultimately leads to liver failure. Acute on chronic liver failure (ACLF) has a high short term mortality rate. Viral hepatitis is the most common cause of liver failure in our local population. We carried out this study to identity the 30-day mortality and etiology of patients presenting with ACLF using Model for End-Stage Liver Disease (MELD) score predictability. Methodology: This was a descriptive case series, conducted at Sheikh Zayed Hospital, Lahore, Pakistan from January 31, 2018 to July 30, 2018. One hundred and eighty five patients who met the inclusion criteria were enrolled using 95% confidence level and 4% margin of error. Data was entered and analyzed with SPSS version 23.0. Numerical variables including age was presented by Mean ± S.D. Categorical variables i.e. gender, etiology of acute-on-chronic liver failure and 30-day mortality were presented by frequency and percentage. Data was stratified for age, gender, duration of chronic liver disease and MELD grade to address the effect modifiers. Post-stratification chi-square test was calculated using 95% significance (p≤0.05). Results: Majority of the enrolled patients were male (74.6%) while only 25.4% of the patients were female. One hundred and thirty patients (70.3%) had underlying viral hepatitis while twelve patients (6.5%) and forty three patients (23.2%) presented with alcoholic liver disease and drug-induced ACLF, respectively. Eighty patients (43.2%) died within 30 days of admission.The 30-day mortality with respect to MELD grade was statistically significant (p<0.001) with the highest mortality noted in grade-IV and thirty five patients (43.8%) dying within 30 days of admission (p<0.001). Grade-II and III MELD scores also contributed to the 30-day mortality with twenty three patients (28.8%) and nineteen patients (23.8%) dying within 30 days of admission (p<0.001). Conclusion: MELD scores are able to accurately predict the short-term mortality in patients with ACLF and viral hepatitis was the most common etiology in our population. Early detection and use of appropriate prognostic models may alleviate mortality and morbidity in paitents with ACLF.
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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.
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Prevalence of Muscle Dysmorphia and Associated Health Activities in Male Medical Students in Karachi, Pakistan

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Prevalence of Muscle Dysmorphia and Associated Health Activities in Male Medical Students in Karachi, Pakistan

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Hyperparathyroidism Presenting as Acute Pancreatitis: Case Report of Mortality

Background: Acute pancreatitis may be caused by a myriad of factors, hypercalcemia secondary to hyperparathyroidism, albeit is a rare cause of acute pancreatitis but not unheard of. If the underlying cause of acute pancreatitis is diagnosed, goal-directed management becomes possible, reducing morbidity and mortality. Though acute pancreatitis on its own presents significant mortality, hypercalcemia, especially detected late, augments this. Case Report: We report a case of acute pancreatitis secondary to hyperparathyroidism. The patient was undiagnosed at the time of admission and presented with non-specific gastrointestinal symptoms. After admission, he developed multi-organ dysfunction and was managed by intensive care. The patient died within hours of admission despite our best efforts. Diagnosis of acute pancreatitis secondary to hyperparathyroidism was suspected on the basis of hypercalcemia, confirmed by a posthumous result of a raised parathyroid hormone assay. Conclusion: When a patient is admitted in the emergency department with a suspicion of acute pancreatitis, serum calcium levels and its reporting should be expedited to as early as possible. Hypercalcemia in the setting of acute pancreatitis merits a multidisciplinary approach and expedited parathyroid hormone levels sent with a high suspicion of long standing untreated hyperparathyroidism. Hyperparathyroidism is a cause of silent hypercalcemia and can be lethal if not diagnosed in time.
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Relative Odds of Neck Pain to Helmet Use Among Motorcyclists: a Case-Control Study

Background: Neck pain is a widespread problem among motorcyclists, which is often neglected. There is limited research on the motorcycle's ergonomics, particularly in the context of the interaction between the riders and motorcycle. Motorcycle helmets have proven to increase the weight on the neck, thus causing more burdens which can lead to neck pain. Methodology: Case-Control study design was opted to measure the relative odds of neck pain in relation to the helmet use as an exposure. A total of 260 (mean age of 22.58 ± S.D. 1.95 years) undergraduate students were selected using purposive sampling. The case to control ratio was 1:4 (54 Cases and 206 Controls) where cases were defined as the motorcyclists having neck pain with a riding experience of more than one year. The neck pain and disability scale were obtained using a self-administered questionnaire. Chi-square and binary logistic regression were used to calculate the significant relationship and odds of neck pain amongst motorcyclists with and without helmet use. Results: The study results showed that out of 260 motorcyclists, 190 (73.1%) were helmet users, and 54 (20.8%) had neck pain, 70 (27.9%) helmet users had a neck pain prevalence of 11 (4.2%). The relative odd to have neck pain was 2.13 times more amongst the motorcyclists using the helmet as compared to that of non-helmet users. The logistic regression results showed significant results (P < 0.05) with regards to the BMI, helmet weight and duration of helmet use but did not show a significant relation with average motorcycle use per day unless it exceeded 70 kilometres. Conclusion: Use of helmet can be a potential cause of neck pain amongst motorcyclist users but the odds to have neck pain enhance with the increase in motorcycle use per day. The protective benefits are multi-fold for helmet use which outreaches the negative impact, including neck pain amongst motorcyclists.
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Awareness of Swine Flu Among the Medical Students of Shaikh Zayed Medical College Rahim Yar Khan

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Empathy and Role Modeling. is IT Missing?

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The Economic Impact of Lower Extremity Amputations in Diabetics. a Retrospective Study From a Tertiary Care Hospital of Faisalabad, Pakistan