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Fulltext Hospitalized Patients' Awareness Of Their Rights-A Cross Sectional Survey In A Public And Private Tertiary Care Hospitals Of Punjab, Pakistan

Tabassum T, Ashraf M, Thaver I

J Ayub Med Coll Abbottabad, 2016 Jul-Sep;28(3):582-586.
PMID: 28712241

BACKGROUND: The awareness of patient's rights is negligible in developing countries where no legal framework is present to protect these rights and Pakistan is no exception. Not only is there an absence of legal structure for protection of patients' rights, but the enforcement and implementation for existing law is also questionable. Pakistan has an Islamic Charter of Medical and Health Ethics which includes the medical behaviour and physician's rights and duties towards the patients. Despite all these charters on patients' rights, there is little to no awareness regarding these rights and their practice remains low in healthcare system of Pakistan. This assessment of awareness among patients about their rights will guide in formulating recommendations to improve the existing system of healthcare delivery in the country.

METHODS: This descriptive cross-sectional comparative study was conducted in two hospitals in Lahore, each belonging to public and private sector. A structured questionnaire was used to collect data from patients. A total of 220 patients were selected to participate in the study, 110 belonging to each private and public hospital.

RESULTS: The findings indicate that most of the patients (64%) were not aware of their rights. The awareness level was better in patients seeking care from private hospital than those from public hospital. Education, monthly income and type of hospital utilized were found to be positively associated with the level of awareness. Most of the patients were not satisfied with the practices of their rights, especially in public hospitals.

CONCLUSIONS: The lack of awareness regarding the rights of a patient was more common in patients of public/government hospitals compared to private hospitals. A nation-wide healthcare education program is needed to increase awareness and practice of patients' rights in the country.
Neck Abscess Caused By Morganella Morganii

Chang CY, Rajappan M, Zaid M, Ong E

J Ayub Med Coll Abbottabad, 2021 3 29;33(1):172.
PMID: 33774979
Idiopathic Fascicular Left Ventricular Tachycardia: A Diagnostic Challenge

Chang CY

J Ayub Med Coll Abbottabad, 2022 2 7;33(4):707.
PMID: 35124938
Fulltext Necrotizing Pneumonia Due To Rhodococcus Hoagii In A Patient With Advanced Retroviral Disease

Gan YL, Chang CY, Yusoff YK, Radhakrishnan AP

J Ayub Med Coll Abbottabad, 2022;34(4):877-879.
PMID: 36566419 DOI: 10.55519/JAMC-04-10234

Rhodococcus hoagii is a well-known zoonotic disease, especially in foals. Its occurrence in humans is uncommon and usually occurs in immunocompromised patients. We present a case of Rhodococcus hoagii infection resulting in necrotizing pneumonia in a patient with advanced retroviral disease who had defaulted treatment. Effective treatment of Rhodococcus hoagii infection requires a combination of antibiotics. We also highlighted the importance of effective communication between clinicians and microbiologists so that prompt treatment can be initiated to improve patient outcomes.
Fulltext Afebrile Plasmodium Knowlesi Severe Malaria With A Fatal Outcome

Chang CY

J Ayub Med Coll Abbottabad, 2023;35(1):186-187.
PMID: 36849407 DOI: 10.55519/JAMC-01-11418
ACQUIRED HAEMOPHILIA A

Koh EJ, Tan JT, Amalina Manan NN, Hor KY, Teh ZY, Chin ML

J Ayub Med Coll Abbottabad, 2023;35(4):690-692.
PMID: 38406963

Acquired haemophilia A (AHA) is a rare disease believed to be caused by spontaneous inhibition of clotting Factor VIII by autoantibodies. This is in contrast to the more common congenital haemophilias which are largely due to an absolute deficiency in coagulation factors. It has a prevalence of approximately one per million per year. However, this figure may be underestimated because there are many undocumented cases due to a lack of recognition. Patients who develop this disease may present with catastrophic bleeding despite having no previous bleeding history. In this study, we report a case of acquired Haemophilia A presenting with spontaneous unprovoked bruising and discuss the approach to diagnosis and how to alert the clinician to suspect this potentially rare but devastating disease.
Fulltext Burkholderia Pseudomallei As The Predominant Cause Of Splenic Abscess In Kapit, Sarawak, Malaysian Borneo

Chang CY

J Ayub Med Coll Abbottabad, 2023;35(2):348-350.
PMID: 37422837 DOI: 10.55519/JAMC-02-11390

BACKGROUND: Splenic abscess is an uncommon condition, with autopsy studies estimating an incidence rate of 0.14-0.70%. Causative organisms can be extremely diverse. Burkholderia pseudomallei is the most common cause of splenic abscess in melioidosis-endemic areas.
METHODS: We reviewed 39 cases of splenic abscesses in a district hospital in Kapit, Sarawak, from January 2017 to December 2018. The demographics, clinical characteristics, underlying diseases, causative organisms, therapeutic methods, and mortality rates were investigated.
RESULTS: There were 21 males and 18 females (mean age, 33.7±2.7 years). Almost all patients (97.4%) had a history of pyrexia. Diabetes mellitus was present in 8 patients (20.5%). Splenic abscesses were diagnosed using ultrasonography and were multiple in all 39 cases. Positive blood cultures were obtained in 20 patients (51.3%), and all yielded B. pseudomallei. Melioidosis serology was positive in 9 of 19 patients (47.4%) with negative blood cultures. All patients were treated for melioidosis with antibiotics without the need for surgical intervention. All splenic abscesses resolved after anti-melioidosis treatment was completed. One patient died (2.6%) as a result of B. pseudomallei septicaemia with multiorgan failure.
CONCLUSIONS: Ultrasonography is a valuable tool for diagnosing splenic abscesses in resource-limited settings. B. pseudomallei was the most common etiological agent of splenic abscesses in our study.
Fulltext A Fatal Case Of Persistent Burkholderia Pseudomallei Bacteraemia With Severe Pneumonia And Splenic Abscess

Chang CY, Lee HL

J Ayub Med Coll Abbottabad, 2023;35(2):331-333.
PMID: 37422833 DOI: 10.55519/JAMC-02-11131

Burkholderia pseudomallei is a Gram-negative bacterium that causes melioidosis. Melioidosis is a potentially fatal disease that is endemic in Southeast Asia and Northern Australia and is being increasingly recognized in other regions worldwide. Melioidosis can affect any organ system and present with a wide range of clinical manifestations including pneumonia, bone, skin/soft tissue, or central nervous system infections. In this report, we describe a diabetic farmer who succumbed to persistent B. pseudomallei bacteraemia with multiorgan involvement despite treatment with meropenem and ceftazidime.
Fulltext A New Association Of Guillain Barre Syndrome In A Patient With Central Nervous System Melioidosis

Koh EJ, Tan KN, Chan ZW, Candice Wong HY, Chin ML, Lee TC

J Ayub Med Coll Abbottabad, 2023;35(2):334-336.
PMID: 37422834 DOI: 10.55519/JAMC-02-11470

Burkholderia pseudomallei affecting the central nervous system has been extensively reported in the literature. However, combined central nervous system and peripheral nervous system involvement in melioidosis has never been reported. We report a 66-year-old man with diabetes mellitus who was diagnosed to have central nervous system melioidosis and developed acute flaccid quadriplegia. Nerve conduction studies and anti-ganglioside antibodies were consistent with Guillain-Barre syndrome. This case report highlights the importance to recognise the possibility of Guillain Barre syndrome complicating central nervous system melioidosis and stresses the urgency of early consideration of this complication, as early immunomodulatory therapy may hasten neurological recovery.
Fulltext OVERLAP AXONAL POLYNEUROPATHY WITH IMMUNE MEDIATED NECROTISING MYOPATHY

Koh EJ, Chin ML, Ab Allah NA

J Ayub Med Coll Abbottabad, 2024;36(3):657-660.
PMID: 39623852 DOI: 10.55519/JAMC-03-12883

Immune mediated necrotising myopathy (IMNM) is a rare autoimmune disease of the muscles belonging to the subset of the idiopathic inflammatory myopathies (IIM). This disease entity has classically been associated with myositis specific antibodies. The hallmark feature in clinching the diagnosis of IMNM would be a muscle biopsy showing muscle necrosis and regeneration in the absence of significant inflammatory infiltrates, interpreted in an appropriate clinical context. The term 'neuromyositis' was previously coined in the year 1893 to describe a concomitant polyneuropathy in patients with polymyositis or dermatomyositis. However, a combined polyneuropathy with IMNM has never been reported in previous literature. We describe a case of a 35-year-old gentleman who presented with a 5-day history of symmetrical bilateral lower limb pain and weakness. Despite a negative autoimmune work-up, his muscle biopsy was suggestive of IMNM. A nerve conduction study done had also revealed a superimposed non-length dependant axonal polyneuropathy. The patient had responded well to steroids and is now under remission. This case serves to highlight a rare entity of seronegative IMNM superimposed with an axonal polyneuropathy.
Fulltext IRISIN AS A NOVEL DIAGNOSTIC BIOMARKER FOR INFLAMMATORY DISEASES: A REVIEW

Rana S, Wahab NA, Shima Shahidan WN, Atif S, Fahim A

J Ayub Med Coll Abbottabad, 2024;36(3):636-641.
PMID: 39623849 DOI: 10.55519/JAMC-03-12344

Inflammatory biomarkers are molecules that can offer vital information on the intricate chain of happenings and molecular processes underpinning the pathophysiology of any inflammatory disease. They can be measured in various biological samples such as blood, urine, or saliva, and are used as indicators of the presence and severity of inflammation. Measuring salivary inflammatory biomarkers is a non-invasive and relatively easy way to monitor inflammation, and it has been shown to be a useful tool in the diagnosis and management of various oral and systemic inflammatory diseases. Irisin is a novel anti-inflammatory protein and its implication and diagnostic role in inflammation have been widely studied; however, not much have been studied in oral inflammation per se. Irisin is predominantly downregulated in several inflammatory conditions, including obesity, type 2 diabetes, periodontitis, and cardiovascular diseases. This suggests that irisin may be involved in the inflammatory process, but more research is needed, especially of salivary irisin to understand its precise role. Overall, the role of irisin as an inflammatory biomarker is still an area of active research, and more studies are needed to determine its diagnostic and therapeutic potential. This review highlights the diagnostic and therapeutic potential of irisin in various systemic and oral inflammatory conditions.
Guidelines For The Process Of Cross-Cultural Adaptation And Translation Of Therapeutic Modules

Qamar T, Ibrahim N

J Ayub Med Coll Abbottabad, 2024;36(4):681-685.
PMID: 40121622 DOI: 10.55519/JAMC-04-13584

BACKGROUND: Language is a very important aspect for the adaptation and translation process. For many people, their native language is not just a means of communication but a vessel of cultural identity and emotional expression. When individuals are experiencing the difficulties of life, they should have the chance to address them using a language that truly connects with their personal experiences. Adapting and translating therapeutic modules to align with cross-cultural settings is important to ensure effectiveness and practicality among different populations. The objective of this article is to provide the guidelines for the process of cross-cultural adaptation and translation-back-translation of the therapeutic modules, and also provide the guidelines to test the reliability and validity of the translated version of therapeutic modules.
METHODS: The Back-to-Back translation model (10) was used in this study for the guidelines of adaptation and translation of therapeutic modules. Following the instructions in this document made the process of adaptation and translation simpler.
RESULTS: Results showed that the (10) is a significant model and provided a systematic and comprehensive way for adaptation and translation of therapeutic module with make little changes in reaction to feedback and cultural awareness.
CONCLUSION: At the end, it emphasised how important it is to conduct an extensive study to determine the effectiveness and cultural compatibility of the updated modules. However, these principles ultimately enhance effective and inclusive health care, providing health professionals with a foundation for adapting and translating therapeutic processes to diverse cultural conditions.