Ustekinumab does not increase risk of new or recurrent cancer in inflammatory bowel disease patients with prior malignancy.

BACKGROUND AND AIM: There is limited data on the rate of new or recurrent cancer in patients with inflammatory bowel disease (IBD) and a history of prior or current malignancy who are initiated on biologic therapies. Furthermore, there is no data on this topic in patients using ustekinumab. METHODS: The retrospective study included 341 patients with IBD and a history of cancer who were subsequently treated with vedolizumab (VDZ; n = 34), ustekinumab (USK; n = 27), tumor necrosis factor α antagonists (anti-TNF; n = 99), or had no immunosuppressive therapy (control; n = 181). Cox proportional hazard models were developed to determine the independent effect of post-cancer immunosuppressive treatment on the occurrence of incident cancer. RESULTS: Over a median of 5.2 person-years of follow up, cancer recurrence occurred in only one patient on anti-TNF, while new cancers developed in one patient on VDZ, three patients on USK, and six patients on anti-TNF, corresponding to cancer rates of 0.4, 1.8, and 0.7 per 100 person-years, respectively. The rate of incident cancer in control patients was 2.4 per 100 person-years and included 18 new and 9 recurrent cancers. Compared with controls, a stepwise Cox proportional hazards model adjusting for significant covariates found no increased risk of incident cancer in patients receiving post-malignancy treatment with USK (hazard ratio [HR] 0.88; 95% confidence interval [CI] 0.25-3.03), VDZ (HR 0.18; 95% CI 0.03-1.35), or anti-TNF (HR 0.47; 95% CI 0.20-1.12). CONCLUSION: Use of biologic therapy in IBD patients with a previous history of malignancy was not associated with an increased risk of new or recurrent cancer.

Prevention of occupational injuries and accidents: A social capital perspective.

Prior research has consistently established the pragmatic nature of literature regarding occupational injuries and accidental happenings faced by nursing professionals. However, current realities require a subjective approach to identify preventative measures that could influence occupational health and safety in healthcare sectors. A qualitative design followed a descriptive approach to assess unbiased opinions towards occupational obstructions that lead to accidental happenings. This study used the social capital framework in particular as a support resource to eliminate its detrimental effects on nurse's capacity to serve their patients. The findings extended the fundamental understanding of social capital from social ties to workplace and personal ties as potential mechanisms of support. Healthcare organizations need to redefine their control policies to provide the ultimate support to their care agents. A social capital model offers nursing practitioners and nursing managers an approach for building evidence-based policies with implications for nurse's safety, education and training.

Metabesity: expert panel recommendation for taking up the challenge by a multidisciplinary approach.

Metabesity refers to metabolic aberrations associated with obesity. These include low- grade inflammation, mitochondrial dysfunction, and changes in gut microbiome. Along with a genetic component, the phenotypes in metabesity are largely the result of sedentary lifestyle and unhealthy eating habits. Metabesity is associated with several co-morbidities including an increased risk for cardiovascular conditions like hypertension, heart failure, myocardial infarction, stroke, and sudden death. Insulin resistance, high blood pressure and glucose levels, visceral adiposity, progressive atherosclerosis, dyslipidaemia and fatty liver are common in obese individuals. Obesity increases the risk for and overall mortality due to cancer. Metabesity adversely impacts endocrine balances in the body and increases the risk of degenerative conditions like dementia. Metabesity is an impending epidemic of huge public health implications with enormous clinical, socioeconomic, and humanistic burden. Interventions to combat sedentary lifestyle and unhealthy eating should be introduced early in life to prevent the onset and progression of metabesity. This review also summarizes the experts' recommendation from Pakistan to manage the rising metabesity concern in their geography based on the literature evidences.

To evaluate the efficacy and safety of CartiNovex plus tablet in osteoarthritis and rheumatoid arthritis.

Interminable arthritis issue, for example, osteoarthritis (OA) and rheumatoid arthritis (RA) have in like manner an upsurge of aggravation, and oxidative anxiety, bringing about dynamic histological modifications and incapacitating indications. As of now utilized allopathic prescription (extending from painkiller executioners to natural operators) is intense, yet regularly connected with genuine, even dangerous symptoms. Utilized for centuries in customary herbalism, restorative plants are a promising option, with bring down rate of unfavorable occasions and productivity every now and again tantamount with that of traditional medications. In any case, their instrument of activity is as a rule smooth and additionally indeterminate. Despite the fact that a large number of them have been demonstrated powerful in ponders done in vitro or on creature models, there is a shortage of human clinical proof. This clinical trial was conducted at Liaquat National Hospital, Karachi, Pakistan. This was a single blind, placebo control phase II clinical trial. Total 200 patients were enrolled in the study, in which 110 received the CartiNovex plus tablet and 90 received the placebo. The age range of patients was 40 years to above 70 years. The sample paired t-test was applied to evaluate the significant level. Different parameters like pain on sitting or lying, morning stiffness, pain on walking, stiffness in sitting, lying or resting later in the day, getting on/off toilet, light domestic duties (such as tidying room, dusting, cooking), WOMAC score % were tested for both group i.e. CartiNovex plus group and placebo group in all parameters CartiNovex plus show significant improvement in all parameters. CartiNovex plus tablet was very effective in the management of OA and RA. The CartiNovex plus tablet was safe and well tolerated in all patients and side effects are non-significant.

LOW BONE MINERAL DENSITY AMONG PATIENTS WITH NEWLY DIAGNOSED RHEUMATOID ARTHRITIS.

BACKGROUND: Osteoporosis is an early and common feature in rheumatoid arthritis. Apart from other manifestations, Osteoporosis is an extra-articular manifestation of rheumatoid arthritis whichmay result in increased risk of fractures, morbidity mortality, and associated healthcare costs. This study evaluates bone mineral density changes in patients withrheumatoid arthritis of recent-onset. METHODS: This cross sectional descriptive study was conducted in the Rheumatology Department of a tertiary care hospital in Karachi. Data was collected from 76 patients presenting with seropositive or seronegative rheumatoid arthritis. Bone mineral density of these patients measured at lumbar spine and hip by using dual energy x-ray absorptiometrys can. Variables like age, gender, BMI, menstrual status, disease duration, erythrocyte sedimentation rate, vitamin D level, clinical disease activity index and seropositivity for rheumatoid arthritis were measured along with outcome variables. RESULTS: A total of 104 patients fulfilling inclusion criteria were registered with 28 excluded from study. A mong the remaining 76 patients, 68 (89.50%) were female, with mean age of patients (with low bone mineral density) as 50.95 ± 7.87 years. Nineteen (25%) patients had low bone mineral density, 68.52% had low BMD at spine while 10.52% at hip and 21.05% at spine and hip both. Low bone mineral density was found higher in patients with seronegative 7 (50%) as compared to seropositive patients 12 (19.4%) (p-value 0.017), whereas low bone mineral d ensity was found higher 12 (70.6%) among post-menopausal women. CONCLUSION: Low BMD was found in 25% of patients at earlier stage of the rheumatoid arthritis with seropositivity, age and menopausal status as significant risk factors.

Frequency of low bone mineral density in spondyloarthropathy presenting at a tertiary care hospital.

OBJECTIVE: To determine the frequency and risk factors of low bone mineral density in patients with spondyloarthropathies. METHODS: The cross-sectional study was conducted at the Rheumatology Department of a tertiary care hospital in Karachi between June and November 2014, and comprised spondyloarthritis patients whose bone mineral density of lumbar spine and hips was measured using dual energy X-ray absorptiometry scan. Variables like disease duration, diagnosis, human leukocyte antigen subtype B27, erythrocyte sedimentation rate, C-reactive protein, Bath ankylosing spondylitis disease activity Index, Bath ankylosing spondylitis functional index, Bath ankylosing spondylitis metrology index were measured along with outcomes, differentiating between osteopenia and/or osteoporosis. SPSS 21 was used for statistical analysis. RESULTS: Of the 25 patients in the study, 16(64%) were males, 19(76%) had predominant axial involvement, and 20(80%) had duration of disease less than 10 years. Low bone mineral density at the spine and hip was found in 18(72%). Osteopenia was present in 9(36%) at hip and 8(32%)in spine, while osteoporosis was seen in 5(20%) at hip and 9(36%) in the spine. No significant association was found between bone mineral density and all the other parameters measured (p>0.05 each). CONCLUSIONS: Majority of spondyloarthritis patients had decreased bone mineral density which could be observed in early stages of the disease.

Rheumatoid arthritis clinical features and management strategies at an urban tertiary facility in Pakistan.

OBJECTIVE: To determine the presentation patterns, biologically vulnerable patient groups and treatment strategies of rheumatoid arthritis. METHODS: The retrospective study was conducted at the Rheumatology Clinic of Liaquat National Hospital and Medical College, Karachi, and comprised data of rheumatology patients who presented between September 2006 and September 2012. After screening all the files, rheumatoid arthritis cases were identified. Data collection was done using a questionnaire that included patient demographics, co-morbidities, clinical manifestations and drug therapy. SPSS 13 was used for statistical analysis. RESULTS: Of the 2300 files screened, 500(21.7%) related to patients of rheumatoid arthritis. The mean age at presentation of these 500 patients was 41±15 years. There were 367(73.4%) women and they presented at an earlier age compared to men (p<0.024). Erosions were present in 198(40%) patients on X-rays and 22(4.4%) had joint deformities. Seropositive rheumatoid arthritis was associated with higher erythrocyte sedimentation rate levels (p<0.014), but did not differ from seronegative rheumatoid arthritis in terms of Disease Activity Score-28 levels (p<0.21). CONCLUSIONS: The skewed gender distribution was likely an effect of rheumatoid arthritis biology rather than due to issues of healthcare accessibility. Seronegative RA is likely to present late though it is as destructive as the seropositive disease.

Lupus, still a mystery: a comparison of clinical features of Pakistani population living in suburbs of Karachi with other Asian countries.

OBJECTIVE: To determine the presenting features of patients with systemic lupus erythematosus at a private hospital in Karachi, and to compare the features with those of other Asian populations. METHODS: The retrospective study comprised records of all lupus cases meeting the revised American Rheumatism Association criteria at the time of presentation at Jinnah Medical College Hospital, Karachi, from May 2008 to June 2011. Demographic and clinical data was analysed using SPSS 11.5. RESULTS: Of the 105 cases in the study, there were 6 (5.7%) males and 99 (94.3%) females, with a male-to-female ratio of 1:16 and a mean age of 31.6+/-10.5 years. Clinical manifestations included: constitutional symptoms in (n=69; 65.7%), arthropathy (n=81; 77%), cutaneous involvement (n=39; 37%), lupus nephritis (n=24; 22.8%), pleurisy (n=9; 8.6%), Raynaud's phenomenon (n=24; 22.8%), and vasculitis (n=18; 17%). One (0.95%) patient presented with mononeuritis multiplex, and 1 (0.95%) with acute pancreatitis. CONCLUSION: The diversity in clinical presentation appeared to be a reflection of the great variability that exists among Asian countries with regards to their genetic, environmental and socio-demographic backgrounds. The differences also existed in our own population, suggesting some unknown etiology.

The association between digitalization and mental health: The mediating role of wellbeing at work.

The study aims to measure the mediating relationship of wellbeing at work between digitalization (IT infrastructure, IT business spanning, and IT proactive stance) and their effect on mental health. The study uses primary data collection techniques to gather data and used purposive sampling to analyze the data. The sample size of the study is 349 respondents. The research uses Smart PLS software to measure the relationship through bootstrapping and algorithms. The study finds a significant positive mediating role of wellbeing between digitalization (IT infrastructure, IT business spanning, and IT proactive stance) and their effect on mental health. The study outcomes are helpful for managers and policymakers.

Medical Students' Online Learning Perceptions, Online Learning Readiness, and Learning Outcomes during COVID-19: The Moderating Role of Teacher's Readiness to Teach Online.

This study determined the direct and indirect effects of medical students' online learning perceptions on learning outcomes via their readiness for online learning. It also determined the moderating effect of teachers' online teaching readiness on medical students' online learning perceptions and learning outcomes. We apply the theoretical lens of self-determination theory and constructivist theory to formulate hypotheses. We used self-administered and postal survey methods to collect data from fourth and fifth-year medical students on online learning perceptions, readiness for online learning, and learning outcomes in two waves. We also collected data from the teachers about their perceptions of online teaching readiness. We received 517 usable students' responses (Level-1) and 88 usable teachers' responses (Level-2). We tested Level-1 hypotheses about direct and indirect effects in Analysis of Moment Structures (AMOS), and a Level-2 hypothesis about moderating effect was tested using Hierarchical Linear Modeling (HLM). The results for the Level-1 hypotheses supported the positive effects of students' online learning perceptions and readiness for online learning on learning outcomes. Student readiness for online learning significantly mediated the relationship between online learning perceptions and learning outcomes. HLM results also supported a moderating effect of teachers' online teaching readiness on medical students' online learning perceptions and learning outcomes in such a way that learning outcomes were high when students' online learning perceptions and teachers' online teaching readiness were high. Based on the study's findings, we offer contributions to theory and practice.

Autoimmune Hepatitis With Concomitant Pernicious Anemia: A Rare Association.

The co-occurrence of autoimmune hepatitis (AIH) and pernicious anemia (PA) is extremely rare. We present a case of a 70-year-old woman with AIH who presented for the evaluation of poor appetite and weight loss. Laboratory studies were significant for microcytic anemia, B12, and iron deficiency. Esophagogastroduodenoscopy showed diffuse gastric mucosal atrophy, and the pathology from the body of the stomach showed chronic gastritis. Additional testing was positive for parietal cell antibody and intrinsic factor blocking antibody, confirming the diagnosis of PA. To the best of our knowledge, there is only one documented case of AIH associated with PA.

Effects of internal service quality on nurses' job satisfaction, commitment and performance: Mediating role of employee well-being.

AIM: The attitudes and behaviours of nursing staff are critical to determine patients' satisfaction and to have a competitive advantage for any healthcare organization. This study is set to investigate the effects of internal service quality (ISQ) on nurses' job satisfaction, employee commitment, well-being and job performance in the healthcare sector of Pakistan. Further, this study also examines the mediating role of nurses' well-being for the relationship of job satisfaction and commitment with their job performance. METHODS: This was a cross-sectional quantitative research. A self-administered survey was used to collect data from 412 nursing employees of 20 private sector healthcare centres operating in Pakistan. Partial least square of structural equation model (PLS-SEM) and structural equation modelling (SEM) were employed through Smart PLS 3.2.8 for data analysis. RESULTS: Study results revealed that ISQ directly effects employees' satisfaction, commitment, well-being of the nursing employees. Moreover, employees' well-being has mediated job satisfaction and job performance relationship; however, well-being did not mediate the relationship between commitment and job performance.

From Machiavellianism to Unethical Behavior: A Cross-Level Examination of Cultural Factors.

This study establishes the relationship between a manager's Machiavellian personality and unethical behavior. It also tests the cross-level interaction effects of collectivism and power distance on the relationship between a Machiavellian personality and unethical behavior. The multi-level and multi-source data are collected from 22 public sector organizations from which 202 responses from managers about their personalities, power distance, and collectivism, and 626 subordinates' ratings of the managers' unethical behavior were received and used. The results show that Machiavellian personality has a positive relationship with unethical behavior. The cross-level interaction effects also show that cultural dimensions such as power distance, and collectivism-significantly and positively moderate the relationship between Machiavellian personality and unethical behavior. Based on the study's findings, implications for theory and practice are offered.

COVID-19: An Emerging Culprit of Inflammatory Arthritis.

Arthralgia is one of the most common symptoms that occur in patients with COVID-19. About 15% of patients present with arthralgia at some point. Although COVID-19 seems to attack the musculoskeletal system (muscles and joints) in its infective and postinfective stage causing inflammatory arthritis, not much is known about the rheumatic manifestations of this infection. In this case series of 5 patients, we discuss the occurrence of bilaterally symmetrical polyarthritis in patients, previously free from any rheumatic disease, after encountering COVID-19 infection. The musculoskeletal manifestations in these patients phenotypically resembled rheumatoid arthritis. These patients were treated successfully with low-dose glucocorticoids and disease-modifying antirheumatic drugs (DMARDs).

A Rare Case of Metastatic Colon Cancer in a Patient With Squamous Cell Carcinoma of the Tongue.

Squamous cell carcinoma (SCC) of the colon, both primary and metastatic, are extremely rare malignancies. We present a case of a 60-year-old man with metastatic SCC of the tongue status after radiation and chemotherapy who presented with fatigue and melena. Colonoscopy revealed a 5 cm mass in the transverse colon. Pathology established the diagnosis of poorly differentiated SCC with p16 immunostaining, similar to biopsies from his initially diagnosed lingual cancer. To the best of our knowledge, there are no previously reported cases of primary SCC of the tongue metastasizing to the colon.

Wettability and capillary effects: Dynamics of pinch-off in unconstricted straight capillary tubes.

We study the interfacial evolution of immiscible two-phase flow within a capillary tube in the partial wetting regime using direct numerical simulation. We investigate the flow patterns resulting from the displacement of a more viscous fluid by a less viscous one under a wide range of wettability conditions. We find that beyond a wettability dependent critical capillary number, a uniform displacement by a less viscous fluid can transition into a growing finger that eventually breaks up into discrete blobs by a series of pinch-off events for both wetting and nonwetting contact angles. This study validates previous experimental observations of pinch-off for wetting contact angles and extends those to nonwetting contact angles. We find that the blob length increases with the capillary number. We observe that the time between consecutive pinch-off events decreases with the capillary number and is greater for more wetting conditions in the displaced phase. We further show that the blob separation distance as a function of the difference between the inlet velocity and the contact line speed collapses into two monotonically decreasing curves for wetting and nonwetting contact angles. For the phase separation in the form of pinch-off, this work provides a quantitative study of the emerging length and timescales and their dependence on the wettability conditions, capillary effects, and viscous forces.

Pore-scale study of water salinity effect on thin-film stability for a moving oil droplet.

HYPOTHESES: The interfacial dynamics in natural porous media are affected not only by the interplay between viscous and capillary forces but also the solid surface wettability. It has been hypothesized that the wettability alteration induced by changes in the water salinity is primarily caused by electric double-layer force expansion, which strongly affects the multiphase flow dynamics. SIMULATIONS: We investigate the effect of water ionic composition and surface roughness on pore-scale wettability alteration. Multiphase hydrodynamics is numerically captured by a lubrication approximation describing the evolution of thin-films coupled with a multiscale level-set approach. An oil blob mobilized by water within a single pore is considered as a case study. The effect of brine ionic composition is accounted for by an electric double-layer through the water ionic strength and zeta-potential parameters. FINDINGS: We demonstrate that high-salinity water thin-films collapse to an adsorbed nanometer layer, leading to a large pressure drop during mobilization of the blob induced by the attractive surface forces. However, low-salinity water thin-films are stable due to the repulsive electric double-layer forces, leading to less pressure drop during mobilization of the blob. The novelty of this work lies in efficiently capturing the nanoscale effects of the electric double-layer in pore-scale multiphase flow displacements. Our quantitative investigations provide fundamental insights into the efficiency of low-salinity waterflooding.

Prevalence and Pattern of Pulmonary Manifestation in Patients with Connective Tissue Disorder.

Background A substantial number of deaths and morbidities are caused by pulmonary involvement in connective tissue disorders (CTDs). The majority of patients suffering from CTDs show diverse clinical presentations arising in the lungs, the diaphragm, vasculature, and the pleura during the course of their disease. The clinical course is highly variable ranging from asymptomatic to symptomatic and from reversible to an irreversible stage. The most common occurring pulmonary appearance is the interstitial disease of the lung. In our study, we aim to determine the prevalence and pattern of pulmonary manifestation in patients with CTD presenting at a tertiary care hospital of Karachi, Pakistan. Methods A descriptive cross-sectional study was conducted in the department of Rheumatology Medical Unit II, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan. All patients having CTD were enrolled. Patients with human immunodeficiency virus (HIV) infection, smokers, chronic obstructive pulmonary disease (COPD), bronchogenic carcinoma and patients with underlying cardiac disease were excluded from the study. Pulmonary manifestations like nonspecific interstitial pneumonia (NSIP), pleural effusion, usual interstitial pneumonia (UIP), interstitial pneumonitis, pulmonary arterial hypertension (PAH), tuberculosis, and pulmonary embolism were observed. In addition to this, treatment history and immunological test findings of these patients were also recorded. Results A total of 290 patients with rheumatologic disorders were included in this study, out of which 90.7% (263) were females and the average age of the entire cohort was 35.13 ± 12.53 years. A majority, 71% (206), of the patients were young (≤ 40 years of age). Rheumatoid arthritis (RA) was the most commonly observed rheumatologic disorder in this cohort which was in 70.3% (204) patients. RA was more prevalent in patients above 40 years of age as compared to young patients (≤ 40 years of age) with a frequency of 81% vs. 66%; p=0.012. Pulmonary involvement was observed in 27.2% of the patients while no pulmonary involvement was noted in 72.8% of patients. Conclusion Pulmonary manifestations in patients with CTD is not that uncommon (27.2%). PAH and NSIP collectively account for three-fourth of the total prevalent cases of pulmonary involvement in CTD patients.

Gastric Inflammatory Fibroid Polyp: A Rare Cause of Occult Upper Gastrointestinal Bleeding.

Inflammatory fibroid polyps (IFPs) are rare mesenchymal lesions that can arise throughout the gastrointestinal tract. These tumors represent less than 0.1% of all gastric polypoid lesions and are frequently found incidentally on endoscopic evaluation. While presenting symptoms depend on the location of the tumor, gastric polyps commonly present with epigastric pain and early satiety. We hereby delineate the case of a middle-aged female who presented with chronic iron deficiency anemia and a positive fecal occult blood test. She underwent an upper endoscopy, which revealed an actively oozing umbilicated lesion in the gastric antrum. Endoscopic ultrasound divulged the submucosal origin of the lesion. It was subsequently excised using endoscopic mucosal resection. Pathologic examination of the resected specimen confirmed the diagnosis of gastric IFP. Furthermore, we conducted a systematic literature search of the MEDLINE database centered on gastric IFPs from January 2000 till March 2020. The data on patient demographics, clinical features, endoscopic findings, lesion site and size, and treatment approaches were collected and analyzed. This article illustrates the overarching need for clinicians to be vigilant of gastric IFPs presenting with initial clinical symptoms suggestive of occult upper gastrointestinal bleeding. Prompt diagnosis and management of gastric IFPs carry paramount importance to combat chronic unexplained iron deficiency anemia following occult bleeding in such patients. A concoction of endoscopy, biopsy, and immunohistochemical examination can be employed toward their prompt detection. Although gastric IFPs have conventionally been treated with surgery, endoscopic resection is now emerging as a safe and efficient therapeutic modality.

Primary antiphospholipid antibody syndrome and autoimmune haemolytic anaemia--a rare combination.

Primary Antiphospholipid Antibody Syndrome (PAPS) and Autoimmune haemolytic anemia (AIHA) is a very rare combination. Antiphospholipid Antibody Syndrome (APS) with underlying SLE, however, has a well documented association with Coomb's positive Auoimmune Haemolytic Anaemia. We describe a young girl with PAPS presenting with deep venous thrombosis, livedo reticularis and features of AIHA. The patient was refractory to treatment for 5 years however, her condition improved dramatically with anticoagulants, corticosteroid therapy and the addition of hydroxychloroquine and azathioprin. We have also discussed hydroxychloroquine therapy in PAPS which is not yet fully established and the probability of this patient developing other autoimmune disorders in future.