Positron emission tomography - computed tomography as a monitoring response tool in pre-fibrotic myelofibrosis: A case report.

Primary myelofibrosis is a haematopoietic stem cell neoplasm resulting in ineffective haematopoiesis and bone marrow fibrosis. We present a case of a 67-year-old male patient who came to the oncology/haematology department of Dr. Ziauddin Hospital, Karachi, in February 2020 with complaints of weight loss, gastroesophageal reflux and loss of appetite. Examination revealed splenomegaly and initial workup demonstrated bicytopenia on complete blood picture. Bone marrow biopsy was consistent with pre-fibrotic myelofibrosis (Janus kinase 2 (JAK-2) positive). He was categorized as intermediate-2 risk according to Dynamic International Prognostic Scoring System (DIPPS) with score of 3 and was advised to start JAK-1/JAK-2 inhibitors. Prior to therapy, he underwent positron emission tomography-computed tomography (PET/CT) scan which showed increased fluorodeoxyglucose (FDG) uptake in the spleen and bone marrow. Monitoring by the scan after initiating treatment demonstrated decreased FDG uptake in bone marrow and spleen, demonstrating that PET/CT is a non-invasive way to assess and monitor treatment response in pre-fibrotic myelofibrosis.

The invisible victims - Impact of the pandemic on patients without COVID-19.

The coronavirus disease (COVID-19) pandemic has shocked the world to a standstill. Routine healthcare has been severely disrupted. Healthcare service is a finite resource and in the current pandemic situation the risks of providing care to individual patients, whether they be confirmed, probable or suspected cases, should be balanced against the ability to provide safe routine long-term care to others. But how far can the healthcare system protect itself and fear the unknown, before it starts causing harm by omission? Herein we provide a review of cases that were misdiagnosed, left stranded in the system or had to face unnecessary delays due to the lack of an organised pathway.

Non-alcoholic fatty liver disease: A real threat in Pakistan.

The rise in obesity, along with its association with unhealthy lifestyles and poor health awareness, has lead to an increasing prevalence of non-alcoholic fatty liver disease (NAFLD). Only a few studies have addressed the changing trends in obesity and have tried to estimate the frequency of NAFLD in Pakistan. Fatty liver is seen in about 15% of the general population. Insulin resistance, diabetes, dyslipidaemia, high body mass index (BMI) and waist circumference, and increasing age are associated with NAFLD. In patients without insulin resistance, dyslipidaemia is usually present. Lean NAFLD is not common. In facilities where elastography in unavailable, NAFLD fibrosis score may be used to predict NAFLD in such patients. There is a need to conduct population-based studies to understand the risks and to design initiatives to increase public awareness regarding this disease. NAFLD screening is advisable in overweight individuals, diabetic patients, and persons at high cardiovascular disease risk.

Knowledge and Beliefs Regarding Thalassemia in an Urban Population.

BACKGROUND:  Thalassemia is one of the most common genetic blood disorders in Asia. Consanguineous marriages and avoiding pre-marital and antenatal screening are common in Pakistan due to psychosocial, cultural, and religious factors. Few studies have investigated the beliefs regarding thalassemia, especially in a developing country. The aim of this study was to assess the knowledge, beliefs, and practices regarding thalassemia in an urban population. METHOD:  A cross-sectional descriptive study was conducted in the urban areas of Karachi, Pakistan over a period of six months during March 2016 through August 2016. Participants selected by representative sampling were interviewed face-to-face using a pre-designed, pre-tested questionnaire. The questionnaire was divided into four parts. The first part inquired about general demographic variables, while the second part assessed knowledge of the participant regarding thalassemia. The third and fourth parts were concerning the beliefs and practices regarding thalassemia. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) Statistics, v. 24.0 (IBM SPSS Statistics, Armonk, NY). RESULTS:  Only 53% (n = 720) of the respondents had heard about thalassemia. The mean knowledge score was 5.8. The total possible score ranged between 0 - 12 with the higher scores indicating better knowledge. About three-quarters (70%) of the sample did not know that an individual can be a carrier of thalassemia. Less than half (38%) of the participants viewed premarital screening for thalassemia as necessary, with only 10% agreeing that thalassemia carriers should not marry. There was no pre-marriage counseling done in 98% of the families.  Conclusion: Our study highlights the prevalence of numerous myths and a low level of knowledge regarding thalassemia in an urban population of Pakistan.

Influences on medical career choice and future medical practice plans among women: Perspective from final year students and house officers.

There is a growing perception in Pakistan that comparatively more women are gaining admissions and graduating from medical colleges; however these graduates are not practicing medicine. This pilot study provides perspectives on the influences on medical career choice and plans regarding future medical practice among female final-year students and house-officers in Karachi. Using convenience sampling, a study was conducted in August and September 2016, wherein out of 141 women, 95 (67.4%) were final-year medical students and 46 (32.6%) were house-officers. Most of the women (n=101; 71.6%) made their own choice to become doctors, while only 18 (12.8%) were compelled by their parents. An overwhelming majority (n=131; 92.9%) planned to do house job upon graduation or complete their ongoing one. Regarding post-graduation, 124 (87.9%) participants intended to acquire post-graduate qualification. Results indicate the need for representative studies to quantify the determinants and correlates of women's choice to study and practice medicine.

Awareness about human papillomavirus as a cause of cervical cancer and its prevention in the undergraduate female students of Karachi.

OBJECTIVE: To determine the rate of acceptance of human papillomavirus vaccine for prevention of cervical cancer, and to identify causes of its low acceptance and means of encouraging its uptake. METHODS: This cross-sectional study was conducted at five different universities of Karachi, from July to December 2011, and comprised female undergraduate students. The participants, aged between 17-26 years, were in their first four years of undergraduate studies, and were selected from five universities. The distributed questionnaire included queries related to demographic information, knowledge and attitude about sexually transmitted diseases, cervical cancer, human papillomavirus and its vaccine. SPSS 20 was used for data analysis. RESULTS: Of the 1,277 participants, 1,038(81.3%) filled in the questionnaires correctly. Of them, the awareness level regarding sexually transmitted diseases, cervical cancer, human papillomavirus, and human papillomavirus as a cause of cervical cancer was 863(83.1%), 483(51.3%), 244(23.5%), and 138(13.3%), respectively. Moreover, 200(19.3%) participants were aware of the vaccine and 13(1.3%) had had themselves vaccinated. CONCLUSIONS: Few respondents were aware of all the three topics, i.e. sexually transmitted diseases, cervical cancer and human papillomavirus. .