Fish Hook as Foreign Body: Not All Foreign Bodies Can Be Fished Out of the Esophagus With Endoscopy Alone.

A 75-year-old male presented to the hospital with acute onset of neck pain. Although the patient did not report known ingestion of a foreign body, there was evidence of a fish hook in the cervical esophagus on plain neck radiography. Due to the location at the upper esophageal sphincter in the hypopharynx, the foreign body was not retrievable by endoscopy alone and required better visualization and airway protection with direct laryngoscopy and rigid esophagoscopy. A fish hook was promptly retrieved within 24 hours of the patient's presentation and his symptoms resolved without complications. We report this unusual case to emphasize the importance of proper food preparation, thoroughly chewing food before swallowing, and prompt management of foreign body ingestion in adults.

Assessment of knowledge, attitude, and practice of child abuse amongst health care professionals working in tertiary care hospitals of Karachi, Pakistan.

INTRODUCTION: UNICEF report (2004) states that a significant percentage of total child population under the age of 5 years suffered malnutrition. Child sexual abuse remains undiscussed across Pakistan. Health care professionals (HCPs) are usually the first notifiers of child abuse and are ethically obliged to manage and report it. OBJECTIVE: This study was conducted to assess HCPs' response in dealing with patients of child abuse. With a better understanding, we can have a better outcome for the victims. METHODS: A total of 101 participants filled out a structured questionnaire by HCPs working in three tertiary hospitals of Karachi i.e., Aga Khan University, National Institute of Child Health (NICH), and Civil Hospital. Data were entered into SPSS 19.0. RESULTS: HCPs believed that young male relatives were thought to be most likely the offender, and that every child regardless of class is prone to get abused triggered by financial stressors and the absence of parents. Proper physical exams helped identify cases. A proper system of reporting was required in hospitals, but HCPs were reluctant to report the cases to authorities. There was a significant difference noted between public and private hospitals. CONCLUSION: Our findings indicate that HCPs have limited knowledge in defining various types of abuse and most were unaware of any reporting facility in hospitals. Senior HCPs as consultants have a better understanding of child abuse than nurses or interns. Mandatory reporting should be implicated so that prompt action could be taken. There could be a more successful outcome of managing a child abuse victim with proper training.

The Frequency of Neurological Symptoms in COVID-19 Patients at a Tertiary Care Hospital in Pakistan.

Introduction Coronavirus disease 2019 (COVID-19) primarily affects the pulmonary system and presents itself as shortness of breath, fever, and cough. However, it may affect other systems as well, including the nervous system. This study aimed to determine the frequency of neurological symptoms in COVID-19 patients and its association with the severity of the disease. Methods This cross-sectional study was conducted at a public sector tertiary care teaching hospital in Karachi, Pakistan, from April to July 2020. All patients with positive polymerase chain reaction (PCR) tests were included, except those with pre-existing neurological and psychiatric conditions. Results The most common neurological symptom was dizziness (17.5%), followed by headache (15.7%). Three (2.6%) patients had a stroke. Nine (7.8%) participants had a taste impairment, and another nine (7.8%) had a smell impairment. There was no significant difference in the frequency of neurological symptoms when severe and non-severe disease was compared. Conclusion Neurological symptoms are frequent in COVID-19. Care should be taken to identify them early. COVID-19 should be suspected in patients presenting with neurological abnormalities and should be included in the differential diagnosis to prevent further virus transmission.

Comparison of Pregabalin Versus Placebo in Reduction of Pain due to Lumber Disc Herniation.

Introduction  Lower back pain is an extensive problem globally, and quite prevalent in Pakistan as well. In most cases of lower back pain, the cause is lumbar disc herniation. To treat this pain, there are various treatment options available. In this study, we aim to find the efficacy and safety of pregabalin in lower back pain due to lumbar disc herniation. Methods  We conducted an open-label prospective trial in a public tertiary care hospital in Karachi, Pakistan, for a duration of five months, i.e. from July 2019 to December 2019. A total of 105 patients were randomized into two groups: pregabalin group and placebo group, and they were required to respond to visual analog scale (VAS) on day 0 and week 12 of the study. Results The results showed a significant reduction in pain over time in both the groups: pregabalin (p-value < 0.0001) and placebo (p-value < 0.0001). However, the difference in pain reduction between pregabalin and placebo was not significant (p-value = 0.57). The most commonly reported side effects were somnolence and dizziness. Conclusion  Based on the results of this study, we conclude that adding pregabalin to non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy had no significant effect on pain reduction. Further large-scale studies are needed to evaluate the role of gabapentoids in lower back pain due to lumbar disc herniation.

Diabetic Ketoacidosis: Clinical Characteristics and Precipitating Factors.

INTRODUCTION: Diabetic ketoacidosis (DKA) is a complication of hyperglycemia. Through this study we plan to study the clinical features of DKA and precipitating factors responsible for DKA in type 1 and type 2 diabetes. METHODS: This cross-sectional observational study was conducted in the emergency department of a tertiary care hospital in Sukkur, Pakistan from August 2019 to February 2020. Symptoms and precipitating factors were noted in a self-structured questionnaire. RESULTS: Out of 71 patients, 19 (26.7%) patients had type 1 diabetes mellitus and 52 (73.3%) patients had type 2 diabetes mellitus. The most common clinical symptom was nausea and vomiting (57.7%), followed by pain in abdomen (42.2%) and dehydration (42.2%). We found that the most common precipitating factors were infections (69.0%) and non-compliance to treatment (53.5%). Among various infections, people commonly presented with pneumonia (38.7%) and urinary tract infection (30.6%). CONCLUSION: Diabetic ketoacidosis presents with vague symptoms such as nausea, vomiting, and pain in abdomen. Characteristic findings of DKA such as Kussmaul breathing was present in limited patients. Infections in diabetic patients should be carefully monitored as they are the most common precipitating factors for DKA.