Journal of the Dow University of Health Sciences (JDUHS)

Objectivity in a Subjective Field: The Current State and Future Directions of “Objective” Diagnostics in Psychiatry

Adith V. Ram — 2024-08-09

Even in its most evidence-based practice, medicine is often an inherently subjective field, both in terms of self-reported symptoms on the patient side and clinical reasoning on the provider side. There is arguably no area of medicine as subjective as psychiatry, a specialty which often focuses on emotions, experiences, and realities that are difficult to quantify or “objectively” analyze. Historically, this subjectivity limited progress and treatment options in psychiatry in many ways. Until the mid-20th century, psychiatry was rooted in anecdotal cases within institutions, followed by a largely psychoanalytic framework supported by evidence which was tenuous at best.

Transversus Abdominis Plane Block Versus Local Wound Infiltration for Postoperative Pain Management in Patient Undergoing Total Abdominal Hysterectomy

Muhammad Arif — 2024-08-09

Objective: To compare the outcomes of transversus abdominis plane (TAP) block versus local wound infiltration (LAI) for postoperative analgesia in patients undergoing total abdominal hysterectomy (TAH).
Methods: This randomized controlled trial was conducted at Dr. Ziauddin Hospital & Medical College, Karachi, Pakistan from December 2023 to May 2024. Female patients aged 18 to 50 years, and scheduled for TAH under general anesthesia were included. Patients were randomly allocated to the TAP group or the LAI group using sealed opaque envelopes. The primary outcome was pain score at different time intervals postoperatively. Pain score measured using the Visual Analogue Scale. Secondary outcomes included total analgesia consumption within 24 hours.
Results: Of total 100 patients, the median (IQR) age was 50.0 (47.2-55.0) years. At 8 hours postoperatively, the median pain score was significantly lower in the TAP group 0.0 (0.0-1.0) compared to the LAI group 1.0 (0.0-2.0) (p-value <0.001). Similarly, at 12 hours, the TAP group reported a median pain score of 2.0 (1.0-2.0), significantly lower than the LAI group 3.0 (2.0-4.0) (p-value <0.001). At 24 hours, the median pain score remained significantly lower in the TAP group 50.0 (50.0-70.0) compared to the LAI group 130.0 (120.0-140.0) (p-value <0.001). Total analgesia consumption was also significantly lower in TAP group as compared to LAI group i.e., 50.0 (50.0-70.0) vs. 130.0 (120.0-140.0) (p-value <0.001).
Conclusion: The TAP block provided superior postoperative pain control compared to LAI in patients undergoing TAH, evidenced by lower pain scores and reduced analgesia consumption.

Efficacy of Azithromycin and Meropenem in Pediatric XDR Salmonella Typhi: A Retrospective Study from Abbottabad, Pakistan

Khyal Muhammad — 2024-08-09

Objective: To evaluate the efficacy of azithromycin as a first-line therapy and the combination of meropenem and azithromycin as the second-line therapy in treating pediatric patients with extensively drug-resistant (XDR) Salmonella Typhi in Abbottabad, Pakistan.
Methods: This retrospective cross-sectional study was conducted at Department of Pediatrics, Abbottabad International Medical Complex, Pakistan from May 2022 to January 2024. Children aged 1-15 years clinically diagnosed with typhoid fever were enrolled if subsequent blood cultures confirmed XDR Salmonella Typhi infection. Initial treatment comprised azithromycin. If there was no response to azithromycin, patients received a combination therapy of meropenem alongside continued azithromycin. Primary outcomes were clinical recovery, recurrence within 30 days post-treatment, and treatment-related adverse effects.
Results: Of total 67 pediatric patients, the mean age of the patients was 10.02 ±2.76 years. The overall mean duration of defervescence was 6.01 ±2.98 days. Initially, all patients were treated with azithromycin alone. Most patients recovered clinically 57 (85.1%). For the 10 (14.9%) who did not respond, meropenem was added to azithromycin, resulting in recovery for all. The mean duration of defervescence found significantly low in patients who received azithromycin monotherapy as compared to patients who received combination therapy i.e., 4.80 ±0.58 days vs. 12.90 ±1.10 days (p-value <0.001). Mild nausea was the only adverse event observed in 29 patients (43.3%) during treatment.
Conclusion: Azithromycin monotherapy demonstrated a high clinical recovery rate, with a significant reduction in fever duration compared to combination therapy with meropenem. Mild nausea was the only treatment-related adverse effect observed.

Comparison of Fibrosis-4 with FibroScan for Liver Fibrosis Assessment in Non-Alcoholic Fatty Liver Disease Patients: A Cross-sectional Study

Fahad Kakar — 2024-08-09

Objective: To compare the efficacy and accuracy of the Fibrosis-4 (FIB-4) index with FibroScan in assessing liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).Methods: This cross-sectional study was conducted at Patel Hospital, Karachi, Pakistan, from October 2023 to April 2024. All known cases of NAFLD or non-alcoholic steatohepatitis (NASH) aged ≥18 years, regardless of gender, were included. FIB-4 scores were measured using age, platelet level, aspartate transaminase (AST), and alanine transaminase (ALT). FibroScan categorized liver fibrosis into stages F0 to F4 with specific stiffness ranges: F0 (1–6 kPa), F1 (6.1–7 kPa), F2 (7.1–9 kPa), F3 (9.1–10.3 kPa), and F4 (≥10.4 kPa).Results: Of the 146 patients, the median age was 52.00 (IQR: 47.00–54.00) years. Based on FibroScan results, 61 (41.8%) patients were classified as F1, 35 (24.0%) as F2, 30 (20.5%) as F3, and 20 (13.7%) as F4. The diagnostic performance of FIB-4 showed an area under the curve of 0.83 (95% CI: 0.76–0.90). The optimal cut-off for FIB-4 was 1.28 with sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy of 98.0%, 65.6%, 59.7%, 98.4%, and 76.7%, respectively. Spearman's correlation test (ρ) was applied and a significantly moderate correlation was found between FibroScan and FIB-4 (ρ = 0.50, p < 0.001).Conclusion: FIB-4 demonstrated higher accuracy and diagnostic performance in determining liver fibrosis in NAFLD patients compared to FibroScan.

Factors Affecting the Quality of Life among the Aging Population during the Coronavirus Disease-19 Pandemic in Thailand

Plernta Ethisan — 2024-08-09

Objective: To determine the factors affecting the quality of life (QoL) among aging population during the Corona Virus Disease-19 (COVID-19) crisis.

Methods:This cross sectional study was conducted at Central, Northern, Northeastern, and Southern regions of Thailand from June to November 2021. Elderly persons aged 60 and above with Thai nationality included in the study. The QoL was measured with the WHO Quality of Life (WHOQoL-BREF-THAI) instrument which consisted of 26 items. QoL scores ranged from 26 to 130 points, classified as poor (26-60), moderate (61-95), and good (96-130).

Results:Of total 400 participants, the mean age was 68.32 ±6.93 years. Not good QoL was observed in 3 (0.8%) participants, moderate QoL was observed in 213 (53.2%) participants, and good QoL was observed in 184 (46.0%) participants. A significant association of QoL found with education level (p-value 0.002), alcohol drinking (p-value 0.003), exercise (p-value <0.001), comorbidities (p-value <0.001), and hearing/knowing about COVID-19 (p-value 0.015). The chances of good QoL was 2 times significantly higher in participants who did exercise as compared to participants who did not perform exercise (cOR 2.03, 95% CI 1.35 to 3.07, p-value <0.001).

Conclusion: The study concluded that exercise, higher education, avoiding alcohol, and good health significantly improve the QoL among the elderly during the COVID-19 pandemic. Moreover, regular exercise notably doubles the likelihood of better QoL.