Background Disasters, crises and pandemics are emergencies which impact on businesses severely. The COVID-19 pandemic reached its peak in mid-April 2020 in the UK. During this period, NHS Occupational Health Services (OHS) were stretched to their limit along with other health services. OHS may have had to change their pattern of operation, operating times, services offered, etc. to cope with the pandemic. Data about business model modifications, services offered by the OHS businesses during the pandemic could help in better utilization of OHS resources in the future. Aims To understand the behaviour of OHS in different parts of the country during the COVID-19 pandemic. Methods An online survey link was sent to both accredited and unaccredited UK Occupational Health Physicians (OHPs). Results Sixty-two OHPs responded to the survey. In the current pandemic, 51% of the OHS (95% CI 0.38–0.62) offered weekend or out-of-hours (OOH) services, 21% had to employ extra staff (95% CI 0.13–0.33) and 54% had to change their working hours (95% CI 0.41–0.65). Ninety per cent of the OHS (95% CI 0.78–0.94) continued to offer routine services; however, there was a decline in offering vaccination services. Fifty-six per cent of the OHS (95% CI 0.42–0.67) offered a dedicated telephone line and 46% of the OHS (95% CI 0.32–0.56) started a dedicated COVID-19 queries inbox. Conclusions There was a change in the behaviour of the OHS to cope with the pandemic. Having a dedicated helpline to manage the crisis situation seemed a logical step whilst offering routine services.
Obesity is an increasing burden on health-care globally. Significant obesity is presenting at a younger age, with pathology that has not been previously seen. This case report illustrates the catastrophic consequences which may occur when minor trauma occurs in a young person who suffers from morbid obesity. A 19-year-old woman with BMI 50 tripped over an uneven curb, and suffered complete dislocation of the knee with associated popliteal artery injury. She required femoro-popliteal bypass using vein. This case reports the youngest person to suffer from this injury and the first in the UK.
Objective: To discuss common indications and findings on upper gastrointestinal endoscopy as well as to correlate these findings with alarm symptoms in the rural population of Gadap town, Sindh. Methods: This was a retrospective study on 1288 patients conducted in the medical ward of Fatima Hospital, Baqai Medical University. Patients’ demographics and other data related to the procedure were recovered from patients’ records. SPSS version 20 was used for statistical analysis. Results: Ratio of male and female patients was approximately 1:1. Majority of the patients were young, and most procedures were done as outpatients without the requirement of conscious sedation. Epigastric pain was the primary indication for upper GI endoscopy (62.6%). One third of the procedures performed did not report any pathological finding. Probability of a positive finding was more likely if a patient presented with dysphagia, heart-burn, hematemesis, vomiting, or for screening endoscopy (for varices). Patients who were diagnosed with esophageal candidiasis, esophageal varices or esophageal growth/ ulcer had reported one or more alarm symptoms in their history. Conclusions: Upper gastrointestinal endoscopy is a useful test to diagnose disorders of the esophagus, stomach and duodenum. However, it is an expensive procedure and therefore referring physicians should keep appropriate clinical indication and ethical considerations in mind before recommending such an investigation to their patients. doi: https://doi.org/10.12669/pjms.37.1.3297 How to cite this:Kamran M, Fawwad A, Haider SI, Hussain T, Ahmed J. Upper gastrointestinal endoscopy; A study from a rural population of Sindh, Pakistan. Pak J Med Sci. 2021;37(1):9-14. doi: https://doi.org/10.12669/pjms.37.1.3297 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Jefferson fracture is a C1 fracture, which happens when an axial load is from the occiput downward to the C1 ring. Usually, it causes outward displacement of the C1 arch, which can injure the vertebral artery. We present a Jefferson fracture with vertebral artery injury, resulting in an asymptomatic ischemic stroke of the left cerebellum. Usually, vertebral artery injuries are asymptomatic since the contralateral vertebral artery and the collateral arteries will adequately supply the cerebellum. Vertebral artery injury (VAI) is typically treated with conservative management with anticoagulants and antiplatelet therapy.
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