Anterior Spinal Artery Syndrome After Bronchial Embolization for Hemoptysis: A Case Report and Literature Review.

Background: Bronchial artery embolization (BAE) is the established first-line treatment for patients presenting with massive haemoptysis, a life-threatening condition that can occur because of numerous underlying diseases. BAE is a relatively safe procedure with control of haemorrhage achieved in 77%-90% of cases and rare occurrence of complications. Spinal cord infarction is one such rare complication, which can have severe implications in terms of morbidity. Case presentations: We present a case of a 70-year-old man who developed paraplegia with loss of pain and temperature sensation as well as sphincteric involvement following BAE for hemoptysis. MRI of the spine was suggestive of an ischaemic event involving anterolateral spinal cord segment T4-T6, so a diagnosis of anterior spinal artery syndrome post BAE was made. The patient was given corticosteroids, dual antiplatelet medications, pregabalin, supportive management and regular physiotherapy. Follow-up of the patient at 3 and 6 months failed to show any significant improvement in neurological function, although the patient did not report problem of significant hemoptysis afterward. Conclusion: Spinal cord infarct is a rare and disabling complication of BAE despite it being a safe procedure with good long-term outcomes. Detailed knowledge about the anatomy of bronchial arteries and spinal arteries with detailed preprocedure investigations may lower the risk of this disabling complication.

Perceptions of oncology as a career choice among the early career doctors in Pakistan.

BACKGROUND: Lack of oncologists is a growing global concern. With the rise in cancer burden across the world, the supply-demand mismatch of the oncology workforce is projected to increase. Furthermore, oncology is a low-ranked field of choice among medical students, and without understanding the perceptions and concerns of early-career doctors regarding oncology, any investments made in cancer care will be futile. This study aims to determine the opinions of young doctors and the factors most affecting their preferences in order to devise focused strategies to attract more doctors into oncology. METHODS: A cross-sectional study was conducted on 300 early-career doctors across various public and private hospitals in Pakistan, from March to November 2019. A close-ended, self-administered questionnaire was used to assess their opinions in terms of the workplace environment, scope, and the emotional and financial aspects of oncology. Data was analyzed using SPSS version 23 and the influence (positive or negative) of the perceptions on the choice of oncology as a career was determined by binary logistic regression analysis. RESULTS: Almost three-quarters of the participants did not want a career in oncology. The top positive perceptions about oncology in descending order were: progressive field, gender-neutral, stable working hours, financially healthy, and work-family balance. Top negative perceptions were: lack of oncologic facilities in hospitals, radiation exposure, need for private practice, poor patient prognosis, high patient load, and depressing environment. Participants who attended private medical school (p < 0.10), planned to live abroad (p < 0.10), had an oncologist (p < 0.05), cancer survivor or death due to cancer in the family (p < 0.05), were more likely to adopt oncology as a career. Those who believed that poor patient prognosis can have an impact on career choice were less likely to prefer oncology (p < 0.05). CONCLUSION: Despite the rising cancer burden, early career doctors are reluctant to join oncology. Curricular, infrastructural and policy changes are needed at the level of medical school, oncology training and practice to recruit more young doctors and minimize the existing paucity of the oncologic workforce.

Microbiological and antimicrobial pattern of diabetic foot ulcers (DFUs) at a tertiary care center in North East, Punjab.

OBJECTIVE: To determine the pattern of antimicrobial sensitivity of common microorganisms isolated from diabetic foot infections. METHODS: The cross-sectional study was conducted from January to August 2019 at the Diabetes and Footcare Clinic, Mayo Hospital, Lahore, Pakistan, and comprised deep-seated tissue samples from the ulcer bed that were tested for culture and sensitivity. Antimicrobial susceptibility was determined in accordance with Clinical and Laboratory Standards Institute guidelines. Data was analysed using SPSS 26. RESULTS: There were 389 bacterial isolates collected from 201 patients who had a mean age of 53.05±10.70 years. . Of the isolates, 238(61.11%) were gram-negative and 151(38.89%) were gram-positive organisms. Methicillin-resistant Staphylococcus aureuswas found in 62(64.58%) isolates. CONCLUSIONS: Early identification of diabetic foot infections can help in timely initiation of empirical treatment and prevention of unwanted amputations.

The Association of Subacute Thyroiditis with COVID-19: a Systematic Review.

The multisystem effects of SARS-CoV-2 encompass the thyroid gland as well. Emerging evidence suggests that SARS-CoV-2 can act as a trigger for subacute thyroiditis (SAT). We conducted a systematic literature search using PubMed/Medline and Google Scholar to identify cases of subacute thyroiditis associated with COVID-19 and evaluated patient-level demographics, major clinical features, laboratory findings and outcomes. In the 21 cases that we reviewed, the mean age of patients was 40.0 ± 11.3 years with a greater female preponderance (71.4%). Mean number days between the start of COVID-19 illness and the appearance of SAT symptoms were 25.2 ± 10.1. Five patients were confirmed to have ongoing COVID-19, whereas the infection had resolved in 16 patients before onset of SAT symptoms. Fever and neck pain were the most common presenting complaints (81%). Ninety-four percent of patients reported some type of hyperthyroid symptoms, while the labs in all 21 patients (100%) confirmed this with low TSH and high T3 or T4. Inflammatory markers were elevated in all cases that reported ESR and CRP. All 21 cases (100%) had ultrasound findings suggestive of SAT. Steroids and anti-inflammatory drugs were the mainstay of treatment, and all patients reported resolution of symptoms; however, 5 patients (23.8%) were reported to have a hypothyroid illness on follow-up. Large-scale studies are needed for a better understanding of the underlying pathogenic mechanisms, but current evidence suggests that clinicians need to recognize the possibility of SAT both in ongoing and resolved COVID-19 infection to optimize patient care.

A review of access to cancer facilities in Punjab, Pakistan.

BACKGROUND: Punjab is the most populous province of Pakistan, with only 12 countries in the world succeeding it in terms of population. AIMS: This review article has the objective of providing novel statistics regarding available cancer therapeutics in Punjab across four different sectors-including government, semi-private, trust and private sectors. METHODS AND RESULTS: Keywords such as "cancer treatment," "facilities," "Pakistan," were used to search Pubmed Database. 36 results were generated: after sifting based on a personal reference list as well as for relevance, 16 articles were finally reviewed. Novel statistics regarding current state of access to cancer facilities were drawn from personal references as well as from studies conducted in other LMICs. There is a gross deficit of oncological services in Punjab, with the ratio of medical oncologists to population being 0.027 per 100, 000, and every oncologist checking 1300-1500 patients annually. Only 21.4% of the population has access to radiotherapy facilities. Major problems include lack of healthcare professional awareness; poor infrastructure including drug access, radiotherapy, and cancer pain management facilities; lack of planning; and lack of educational and research programs. CONCLUSIONS: Improving education & training, developing infrastructure based on public-private-partnership models, building cancer registries and organizing national cancer screening programs, as well as encouraging basic health education and research in oncology, are measures that can ensure Punjab's healthcare delivery system becomes capable of handling increasing incident burden of cancer.

Recommendations for Anti-inflammatory Treatments in Alzheimer's Disease: A Comprehensive Review of the Literature.

Alzheimer's disease (AD) is the most common cause of dementia in elderly patients, affecting individuals older than 60 years. It is a complex degenerative brain disease characterized by progressive cognitive impairment. AD constitutes a major global health concern. A central role for inflammation has been implicated in the pathogenesis of AD. Despite the understanding of multiple molecular pathways in the pathophysiology of AD, novel treatment agents with a possible role in modifying the disease activity are still lacking. Our article provides a comprehensive review of various observational studies and randomized trials encompassing the use of anti-inflammatory agents in the management of AD patients and utilizes the conclusions derived therefrom to give recommendations in this regard.