General practitioners (GPs) are often the first clinicians to encounter patients with trigeminal neuralgia (TN). Given the gravity of the debilitating pain associated with TN, it is important for these clinicians to learn how to accurately diagnose and manage this illness. The objective of this article is to provide an up-to-date literature review regarding the presentation, classification, diagnosis, and the treatment of TN. This article also focuses on the long-term management of these patients under the care of GPs. GPs play an important role in the management of patients with TN by following the evidence-based management guidelines. The most important aspects of the management of TN are discussed in this review article.
BackgroundPunjab is the most populous province of Pakistan, with only 12 countries in the world succeeding it in terms of population.AimsThis 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 ResultsKeywords 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.ConclusionsImproving 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.
The rate of undertreatment of cancer pain in Pakistan is alarming. Inadequate clinicians' training, patients' and caregivers' beliefs, lack of availability of opioid medications, and socioeconomic factors are some of the barriers to effective pain control. A multidisciplinary team approach is necessary to follow the World Health Organization pain ladder guidelines for the treatment of cancer pain.
Methodology: A total of 57 patients, who have been diagnosed with chronic adenotonsillitis and operated for obstruction or infection, were included in the study. Patients were divided into two groups according to their palatine tonsil sizes. Each patient performed voice analysis preoperatively and one month postoperatively, recruiting both objective and subjective methods. F0, jitter % and shimmer % values were assessed with objective methods; while subjective methods evaluated pediatric voice handicap index (pVHI) scores. Pre-and post-operative F0, jitter % and shimmer % values and pVHI scores from each study group were compared. Results: In each study group, pre-and post-operative F0, jitter % and shimmer % values were found to be similar. In Group A, postoperative pVHI scores were found to be significantly reduced (p<0.001). In Group B, however, pre-and postoperatively assessed pVHI scores were similar. Conclusion: Adenotonsillar hypertrophy in children, who underwent adenotonsillectomy, seems to be an important and positively effecting factor on the subjective, but not the objective, parameters of voice.
A total of 91 patients were included with the help of non-probability purposive sampling.All female patients were over 18 years, diagnosed with breast cancer having reports of receptor status confirmed
Objective: This study aims to determine level of stress, resilience and moral distress among health care providers during covid-19 pandemic. Methods: This is a cross-sectional study performed using an online questionnaire. Data was collected from Health Care Providers, working in various tertiary care hospitals of Lahore, using an online questionnaire. Perceived stress scale (PSS), Connor-Davidson Resilience Scale (CD-RISC 10) and Moral Distress Thermometer were used to determine level of stress, resilience and moral stress respectively among the HCPs. Scores on the PSS can range from 0 to 40 with scores of 0-13, 14-26 and 27-40 being considered as low, moderate and high stress respectively. The Moral Distress Thermometer has scores ranging from 0-10 with value of ≥4 considered high. Data was analyzed using SPSS version.23.Descriptive variables were reported as means and frequencies. Intergroup analysis was done using Chi square test with p<0.05 taken as significant. Results: A total of 278 (n=278) HCPs participated in study. According to the PSS (Perceived Stress Scale) scores, 5.03% (14) reported low, 86.69% (241) moderate and 8.27% (23) high stress levels. The mean stress score is 21.56+/-4.32. Providing patient care (mean = 2.28+/-1.15 SD) and transmitting infection to others (mean = 3.02+/-1.10 SD) were deemed major causes of stress. The mean CD-RISC score was 23.14+/-7.81 SD. Only 10.8% (30) had a score of ≥ 32. The mean Moral Distress score was 4.2+/-2.98 SD, with 53.2% (149) participants reporting high Moral distress (score ≥4). Conclusion: The high level of stress among HCPs during COVID-19 pandemic highlights the need of urgent measures to overcome this psychological issue which if left un-addressed can affect performance of HCPs. Key Words: Stress, Resilience, HCPs How to cite: Latif A., Yaqub S., Dar A.Q., Awan S.U., Farhat Hina., Khokhar A.M., Stress, Resilience and Moral Distress among Health care Providers during COVID-19 pandemic. Esculapio 2021;17 (01):79-82
Objective: To study the tissue nuclear matrix protein 22 (NMP22) expression in bladder carcinoma biopsy and correlate it with prognostic factors like stage and grade of bladder cancer.
The study was carried out in ENT Department ofKEMU, Lahore from December 2012 to November 2015 to assess theoutcome of early tracheostomy in grade II (moderate) tetanus patients.A total of fifty-six adults of both genders, diagnosed as grade II tetanus patients, were included. Clinical characteristics,mode of trauma, incubation period, vaccination status and investigations were recorded. All patients were managed in ICU and early tracheostomy was performed in addition to standardized medical treatment. A total of 86% males with age 32±8.3 years presented the study participants. Results demonstrated thatmost common mode of trauma was road traffic accident, and majority (54%) of patients were never vaccinated. Incubation period noted was 7±1 days. Tracheostomy was performed in 16±3 hours of admission and tracheostomy decannulation was performed in 23±3 days. Patients were discharged in 27±3 days.Weconcludethat early control of airway with tracheostomy in grade II tetanus patients helped in better patient management with early recovery and decreased hospital stay with minimal morbidity.
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